Thalassemia in Laos: Situation Analysis by Dr. Sourideth Sengchanh, Dr. Alongkone Phengsavanh, Assoc. Prof. Dr. Khampe Phongsavat, University of Health Sciences, Vientiane, Laos. Presented by Assoc. Prof. Dr. Khampe Phongsavat.

1. Thalassemia in Laos:
Thalassemia in Laos:
Situation analysis
y
Dr. Sourideth Sengchanh
id h h h
Dr. Alongkone Phengsavanh
Assoc. Prof. Dr. Khampe Phongsavat
p g
University of Health Sciences, Vientiane , Laos

2. Country profile
Country profile
• P
Population of 5,621,000
l ti f 5 621 000
• Laos is also very ethnically
diverse, and socio‐cultural beliefs
,
and practices among the 49
ethnic groups.
• Laos is having geographic and
Laos is having geographic and
financial barriers and relatively
poor health infrastructure.
• Laos has experienced relatively
high economic growth in the last
decade
• Total budget on health is less
than 10%
• Annual birth rate
Annual birth rate
• Average income

3. Health system in Laos
Health system in Laos
• Health services system in Laos is divided into 3
levels:
– Primary care : Health centers and district hospitals
y p
– Secondary care: Provincial and regional hospitals
– Tertiary care: Central and University hospitals
Tertiary care: Central and University hospitals
• No private hospital, only private clinic are run
by government staffs after working hours.
by government staffs after working hours
• Non‐communicable diseases national strategy
is being developed
i b i d l d
• No special policy on Hb diseases.
p p y

4. Data in 3 central hospitals (2009‐2010)
Data in 3 central hospitals (2009 2010)
• 51 cases of beta‐thalassemia major
• 224 cases of Beta thal/B Hb E disease
224 cases of Beta‐thal/B Hb E disease
• 78 cases of Hb E trait (hospital data base)
• 29 cases of Alpha thalassemia
• 37 cases of splenectomy
37 cases of splenectomy
• 177 cases of iron overload
• 82 cases of iron chelation
• Prevalence of Hydrops Fetalis: 0.3%
Prevalence of Hydrops Fetalis: 0 3%

5. Diagnostic services available
g
• Screening tests
g
– Mean Corpuscular Hemoglobin (MCH)
– Mean Corpuscular Volume (MCV)
Mean Corpuscular Volume (MCV)
– Osmotic Fragility test (OFT)
• Confirmed test
– Hemoglobin typing

6. Unavailability of diagnostic test
Unavailability of diagnostic test
• HPLC
• Polymerase Chain Reaction
Polymerase Chain Reaction
• Prenatal diagnostic
– Amniocentesis
– Cordocentesis

7. Utilization of Blood components
Utilization of Blood components
• Blood donation center is under Lao red cross
• Blood donation is inadequate
Blood donation is inadequate
• Almost blood components can be separated
such as
h
– Whole blood
– Pack red cells
– Cryoprecipitate
– Platelet
– Fresh Frozen Plasma

8. Barriers of thalassemia control in Laos
Barriers of thalassemia control in Laos
– Policy of thalassemia control is not available
– National guideline for thalassemia screening and
treatment is not unified
– Lacking of human resources such as hematologist
Lacking of human resources such as hematologist
, laboratory technicians, etc
– Lacking of medical equipment in the field of
Lacking of medical equipment in the field of
hematology
– Iron chelators are not included in the essential
Iron chelators are not included in the essential
drug list
– Thalassemia treatment unit is not available

9. The way forwards
The way forwards
• Development of national strategic planning for
p
thalassemia treatment and prevention
• Development of update national treatment
guidelines for thalassemia
guidelines for thalassemia
• Initiation of national thalassemia screening
program
• Development of community and hospital
Development of community and hospital
based registration system for thalassemia.

10. The way forwards
y
• Inclusion of iron chelators into national
Inclusion of iron chelators into national
essential drug list
• I
Increasing the public awareness and
i th bli d
community motivation regarding the cost
effectiveness for thalassemia prevention and
treatment
• Organize the thalassemia prevention campaign
• Collaborate internationally in term of research

11. Thank You for Your Attention
Thank You for Your Attention