1. Use of Antibiotics among Mothers after Normal Delivery in Two Provinces in Lao PDR Authors: Keohavong B 1, Sihavong A 2, Soukhaseum T 3, Oudomsak P 1, Souliyavong K 4, Soundavong K 5, Voradeth S 1, Kounnavong S 5, Houamboun K 5, Akkhavong K 5, Wahlstrom R 6, Eriksson B 6, Stalsby Lundborg C 6. 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

2. 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

3. 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

4. Study areas China Vietnam LAOS Myanmar Thailand Cambodia Luangprabang Champasack Luangprabang Province (LPB) Located in the north of the country Population: 400,000 (2005) 12 districts, 855 villages, 70,000 households Champasack Province (CPS) A southern province Population: 603,880 (2005) 10 districts, 924 villages, 105,000 households LPB and CPS provinces were purposively selected as study areas based on practical reasons

5. 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

6. 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

7. 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

8. 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%)

9. 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

10. 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

11. 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

12. 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.