Transcript 742-Keohavong-_b

Use of Antibiotics among Mothers
after Normal Delivery in Two
Provinces in Lao PDR
Authors:
Keohavong B1, Sihavong A2, Soukhaseum T3, Oudomsak P1, Souliyavong K4,
Soundavong K5, Voradeth S1, Kounnavong S5, Houamboun K5, Akkhavong
K5, Wahlstrom R6, Eriksson B6, Stalsby Lundborg C6.
1. FDD; 2. VCHD; 3. LPB Hospital; 4. CPS Health Dept; 6. NIOPH, MOH, Lao
PDR; 6. IHCAR, KI, Sweden.
Presenter:
Amphoy Sihavong, MD, PhD
Deputy Director
Vientiane Capital Health Department
Ministry of Health, Lao PDR
BACKGROUND

Self medication with antibiotics is widespread in
low-income countries, including Laos

Such use might be irrational and increase the risk
of antimicrobial resistance

A particular concern in Laos is the use of
antibiotics by the women after normal delivery

A population-based study on the use of
antibiotics among women after normal delivery
had not been carried out in Laos
OBJECTIVES

To describe the use of antibiotics among
mothers after normal delivery

To assess their knowledge about antibiotics
in two provinces in Lao PDR
In order to give evidence to policy makers
for further interventions
Study areas
China
CHINA
Phongsali
Myanmar
MYANMAR
Luangprabang
Luang
Namtha
Bokeo
Luangprabang Province (LPB)
 Located in the north of the
country
 Population: 400,000 (2005)
 12 districts, 855 villages,
70,000 households
Oudomxay
LAOS
Champasack Province (CPS)
 A southern province
 Population: 603,880 (2005)
 10 districts, 924 villages,
105,000 households
Vietnam
VIETNAM
THAILAND
Thailand
LPB and CPS provinces were
purposively selected as study
areas based on practical
reasons
Champasack
Cambodia
CAMBODIA
METHODS

Study Design: Cross-sectional survey with structured
questionnaires including closed and open-ended
questions

Study Population: A total of 300 mothers who had
had a normal delivery in the 12 months preceding the
study were interviewed in their homes

Study Setting: 43 villages of four districts (two urban
and two rural districts) in LPB and CPS provinces:
 151 mothers from 25 villages in LPB
 149 mothers from 18 villages in CPS

Inclusion criteria:
 Women having a normal delivery in the 12
months preceding the study
 Willing to participate

Definition: Normal delivery means delivery
without complications and without cesarean
section or episiotomy

Sampling procedure:
Screening by household interviews

Data collection: March to April 2008

Data analysis: Using Epi Info version 6.04 and
SPSS version 12
RESULTS (1)

Of 300 mothers who participated in the study:
 237 mothers (79%) normally delivered at homes
 63 (21%) normally delivered at health facilities:
 Only one (0.3%) delivered at health center
 35 (11.6%) delivered at district hospitals
 27 (9%) delivered at provincial hospitals

Among 237 mothers delivering at homes, 99 (42%) were
assisted by traditional birth attendants
RESULTS (2)

24.5% (58/237) of mothers delivering normally at
homes used antibiotics, significantly (p<0.05) more
often in CPS (40%) than in LPB (8%)

41% of those mothers had been advised by health
workers to use antibiotics, while the others used it
after their own decision or the advice from relatives
or friends

79% (58/63) of mothers delivering normally in
hospitals received antibiotics. This was significantly
(p<0.05) higher than for those normally delivering at
homes (24.5%)
RESULTS (3)

Ampicillin was the most commonly used antibiotic,
folllowed by Amoxycillin and Tetracyclin

Few women knew about the reasons for treatment with
antibiotics and even fewer about antibiotic resistance

37% of all respondents had ever heard information
about drugs, mostly through television and radio

Of those, 67% replied that they understood the drug
information revealed
CONCLUSIONS




The majority (79%) of respondents had a normal
delivery at home
The proportion of mothers using antibiotics after
normal delivery was high, and about three times higher
in hospitals (79%) than at homes (24.5%)
Few women knew about the reasons for antibiotic
treatment and even fewer about antibiotic resistance
The majority of respondents had never heard about
drug information, particularly among people in rural
areas
RECOMMENDATIONS

The inappropriate use of antibiotics after normal delivery
should be discouraged, and obstetric practitioners should
be more restrictive in prescribing antibiotics

Standard treatment guidelines for post partum women
should be developed

The Food and Drug Department needs to develop more
appropriate health messages and feasible methods to
increase accessibility of the information for the people in
rural areas

Further studies are needed to compare the impact of use
and non-use of antibiotics after normal delivery
THANK YOU
FOR YOUR ATTENTION
Acknowledgements:
We would like to express our gratitude to the Directors of FDD, NIOPH, and
the two Provincial Health Departments for their support, and to all
interviewees for their participation. We would also like to express our sincere
thanks to Sida for financial support.