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Featured researches published by Jo Durham.


BMC Public Health | 2013

Adherence to Antiretroviral Therapy (ART) among People Living With HIV (PLHIV): a cross-sectional survey to measure in Lao PDR

Visanou Hansana; Pattara Sanchaisuriya; Jo Durham; Vanphanom Sychareun; Kongmany Chaleunvong; Suwanna Boonyaleepun; Frank Peter Schelp

RationaleSince 2001, antiretroviral therapy (ART) for people living with HIV (PLHIV) has been available in the Lao People’s Democratic Republic (PDR). A key factor in the effectiveness of ART is good adherence to the prescribed regimen for both individual well-being and public health. Poor adherence can contribute to the emergence of drug resistant strains of the virus and transmission during risky behaviors. Increased access to ART in low-income country settings has contributed to an interest in treatment adherence in resource–poor contexts. This study aims to investigate the proportion of adherence to ART and identify possible factors related to non-adherence to ART among people living with HIV (PLHIV) in Lao PDR.MethodsA cross-sectional study was conducted with adults living with HIV receiving free ART at Setthathirath hospital in the capital Vientiane and Savannakhet provincial hospitals from June to November 2011. Three hundred and forty six PLHIV were interviewed using an anonymous questionnaire. The estimation of the adherence rate was based on the information provided by the PLHIV about the intake of medicine during the previous three days. The statistical software Epidata 3.1 and Stata 10.1 were used for data analysis. Frequencies and distribution of each variable were calculated by conventional statistical methods. The chi square test, Mann–Whitney test and logistic regression were used for bivariate analyses. Multiple logistic regression analysis was conducted to determine the predictors of non-adherence to ART. A p-value < 0.05 was considered to indicate statistical significance.ResultsOf a total of 346 patients, 60% reported more than 95% adherence to ART. Reasons for not taking medicine as required were being busy (97.0%), and being forgetful (62.2%). In the multivariate analysis, educational level at secondary school (OR=3.7, 95% CI:1.3-10.1, p=0.012); illicit drug use (OR=16.1, 95% CI:1.9-128.3, p=0.011); dislike exercise (OR=0.6, 95% CI:0.4-0.9, p=0.028), and forgetting to take ARV medicine during the last month (OR=2.3, 95% CI:1.4-3.7, p=0.001) were independently associated with non-adherence.ConclusionsNon-adherence to ART was associated with individual factors and exposure to ART. Priority measures to increase adherence to ART should aim to intensify counseling and comprehensive interventions, such as guidance for PLHIV on medication self-management skills, tailoring the regimen to the PLHIV life style, and improving adherence monitoring and health care services.


Bulletin of The World Health Organization | 2013

The underreporting of landmine and explosive remnants of war injuries in Cambodia, the Lao People's Democratic Republic and Viet Nam

Jo Durham; Peter S. Hill; Damian Hoy

Injuries place an enormous burden on individuals, households, and communities and they exacerbate poverty.1 A substantial but often under-recognized cause of injury in post-conflict environments is the presence of land mines and explosive remnants of war (ERW), such as abandoned ordnance or weapons and cluster munitions, bombs, mortars or other devices that failed to detonate on impact but remain volatile and can explode if touched or moved. This under-recognition, which is partly the result of underestimates, has global implications because it affects to what extent the resources assigned to injury prevention and the rehabilitation of injured people are prioritized. This paper provides detailed case studies of three countries that are heavily contaminated with land mines and ERWs and where mine action pro- grammes – i.e. programmes for humanitarian, non-military purposes – have been in place for a long time: Cambodia, the Lao People’s Democratic Republic (PDR) and Viet Nam. The purpose is to illustrate the degree to which injuries caused by land mines and ERW are underreported. The paper highlights how little has been published in the health literature on the subject of land mines and ERW and the failure to include available national data on the injuries caused by these devices in global burden of disease (GBD) estimates. The GBD is a measure that combines the contribution of both mortality and impaired functionality resulting from a range of diseases and injuries to provide a national ranking for comparing disease burdens across countries and, by implication, for assessing the relative importance of a given health problem at the national and global levels. Hence, underreporting is of global relevance. Language: en


Journal of Mixed Methods Research | 2011

Utilizing Mixed Research Methods to Develop a Quantitative Assessment Tool An Example From Explosive Remnants of a War Clearance Program

Jo Durham; B.-K. Tan; Rob White

This article outlines the process of developing a quantitative instrument and livelihood asset index. The intent of the index was to assess household perspectives of the impact of the removal of explosive remnants of war on livelihoods. Conducted in the Lao People’s Democratic Republic, the study used a sequential mixed methods design. It began with a qualitative component, which informed instrument development. The article discusses the instrument development process and some of the challenges faced. These included developing a reliable livelihood asset index and finding the limitations of quantitative indexes in this setting. Another challenge was reconciling tensions in mixing methods informed by different worldviews.


Bulletin of The World Health Organization | 2016

Disability, noncommunicable disease and health information

Nicola C. Richards; Hebe N. Gouda; Jo Durham; Rasika Rampatige; Anna Rodney; Maxine Whittaker

Noncommunicable diseases (NCDs) are a major cause of preventable disability worldwide.1 While actions to monitor NCDs have gained significant momentum in the global health agenda, similar developments to monitor and manage the growing burden of NCD-related disability have been relatively slow. The global NCD action plan was developed to support country efforts in addressing the devastating social, economic and public health impacts of NCDs.2 The NCD action plan includes nine voluntary targets and a monitoring framework. However, the monitoring framework has been criticized for its focus on mortality while neglecting adequate measures of morbidity and disability.3 This has resulted from focusing on existing data within health information systems, rather than on identifying appropriate data for measuring disease burden. Indeed, the issue of the chronicity of NCDs seems absent in most monitoring and evaluation frameworks, with an implicit assumption that the only outcome of interest for countries is premature mortality.


BMC Pregnancy and Childbirth | 2013

Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People’s democratic republic: a qualitative study

Vanphanom Sychareun; Sysavanh Phommachanh; Soudavanh Soysouvanh; Chaeun Lee; Minah Kang; Juhwan Oh; Jo Durham

BackgroundTo reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national ‘Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services’. This paper reports on implementation constraints identified in three demonstration sites.MethodsThe objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al’s health system constraint framework.ResultsIn each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women’s position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up.ConclusionThe Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the initiative. To achieve effective implementation and scale-up a number of concurrent interventions are needed to address identified constraints. More research is needed to identify the optimal combination of interventions to improve these constraints. The broader contextual characteristics require longer-term, cross-sectoral action.


Medicine | 2015

A Systematic Review and Meta-Analysis of Medical Students’ Perspectives on the Engagement in Research

Cho Naing; Victor Nyunt Wai; Jo Durham; Maxine Whittaker; Ni Ni Win; Kyan Aung; Joon Wah Mak

AbstractEngaging students in active learning lies at the center of effective higher education. In medical schools, students’ engagement in learning and research has come under increasing attention. The objective of this study was to synthesize evidence on medical students’ perspectives on the engagement in research. We performed a systematic review and meta-analysis.Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed. Overall, 14 observational studies (with 17 data sets) were included. In general, many studies did not use the same questionnaires and the outcome measurements were not consistently reported; these presented some difficulties in pooling the results. Whenever data permitted, we performed pooled analysis for the 4 education outcomes. A Bayesian meta-analytical approach was supplemented as a measure of uncertainty.A pooled analysis showed that 74% (95% confidence interval [CI]: 1.57%–11.07%; I2: 95.2%) of those students who engaged in research (while at the medical school) had positive attitudes toward their research experiences, whereas 49.5% (95% CI: 36.4%–62.7%; I2: 93.4%) had positive attitudes toward the study of medical sciences, 62.3% (95% CI: 46.7%–77.9%; I2: 96.3%) had self-reported changes in their practices, and 64% (95% CI: 30.8%–96.6%; I2: 98.5%) could have published their work. There was substantial heterogeneity among studies. We acknowledged the caveats and the merit of the current review.Findings showed that engagement in research resulted in favorable reactions toward research and academic learning. Future well-designed studies using standardized research tools on how to engage students in research are recommended.


Human Resources for Health | 2015

Human resources for health in six healthcare arenas under stress: a qualitative study

Jo Durham; Enrico Pavignani; Mark Beesley; Peter S. Hill

BackgroundResearch on “human resources for health” (HRH) typically focuses on the public health subsector, despite the World Health Organization’s inclusive definition to the contrary. This qualitative research examines the profile of HRH in six conflict-affected contexts where the public health subsector does not dominate healthcare service provision and HRH is a less coherent and cohesive entity: Afghanistan, the Central African Republic (CAR), the Democratic Republic of Congo (DR Congo), Haiti, the Occupied Palestinian Territories and Somalia.MethodsThe study uses a multiple-country qualitative research design including documentary analysis and key informant interviews undertaken between 2010 and 2012. The documentary analysis included peer-reviewed articles, books, unpublished research and evaluations and donor and non-government organisation reviews. A common thematic guide, informed by this analysis, was used to undertake key informant interviews. Informants thought able to provide some insight into the research questions were identified from ministry of health organograms, and from listings of donors and non-government organisations. Local informants outside the familiar structures were also contacted. In CAR, 74 were interviewed; in Somalia 25; . in Haiti, 45; in Afghanistan, 41; in DR Congo, 32; and in the Occupied Palestinian Territories, 30. In addition, peer review was sought on the initial country reports.ResultsThe study discovered, in each healthcare arena investigated, a crowded HRH space with a wide range of public, private, formal and informal providers of varying levels of competence and a diverse richness of initiatives, shaped by the easy commodification of health and an unregulated market. The weak regulatory framework and capacity to regulate, combined with limited information regarding those not on the state payroll, allowed non-state providers to flourish, if not materially then at least numerically.ConclusionWhen examining HRH, a reliance on information provided by the state health sector can only provide a partial and inadequate representation of reality. For policy-makers and planners in disrupted contexts to begin to appreciate fully current and potential HRH, there is a need to study the workforce using conceptual tools that reflect the situation on the ground, rather than idealised patterns generated by incomplete inventories and unrealistic standards.


Asian Pacific Journal of Cancer Prevention | 2013

Retrospective Appraisal of Cancer Patients from Vientiane Capital City, Lao People's Democratic Republic (PDR), Seeking Treatment in Thailand

Kongmany Chaleunvong; Supot Kamsa-ard; Krittika Suwanrungruang; Surapon Wiangnon; Vanphanom Sychareun; Phetsamone Alounlangsy; Jo Durham; Supannee Promthet

BACKGROUND Recent estimates suggest that in the Lao Peoples Democratic Republic (Lao PDR) the burden of cancer in terms of DALYs lost is amongst the highest in South East Asia. As such, increasingly cancer is becoming an important public health concern in the country. Lao PDR however has no population-based cancer registry and only one hospital-based registry. Cancer treatment within the country is extremely limited. Patients who can, may travel to neighboring countries for treatment, but little information about this is available in the country. The aim of this study was to estimate some of the otherwise largely unknown parameters of the cancer burden in Lao PDR. MATERIALS AND METHODS This is a retrospective, descriptive study based on the records of 847 Lao cancer cases treated with surgery, radiation and chemotherapy at Srinagarind Hospital, Khon Kaen University, in Thailand between 1988 and 2010. RESULTS The annual rate of registration of Lao cancer cases fluctuated, but showed an increasing trend. Most cancers were diagnosed by histology (65.2%), and a combination of endoscopy and radiology (15.6%). In most cases (70.2%) the stage of cancer at diagnosis could not be determined. In those whose stage could be identified, 54.0% were at the final stage (Stage IV). Among males, the commonest cancer sites were the liver (16.1%), blood (12.3%) and nasopharynx (10.6%). Those in female patients were the cervix (22.2%), breast (14.6%) and blood (8.1%). CONCLUSIONS This study indicates that despite some fluctuations, the number of Lao cancer patients presenting at Srinagarind Hospital, Khon Kaen, gradually increased between 1988 and 2010. The unfavorable pattern of late-stage cancer diagnosis among male and female patients suggests a need for cancer control interventions and the establishment of cancer registration and treatment facilities within Lao PDR.


American Journal of Public Health | 2014

The Convention on the Rights of Persons With Disabilities: A Foundation for Ethical Disability and Health Research in Developing Countries

Jo Durham; Claire E. Brolan; Bryan Mukandi

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) has foregrounded disability as a human rights and equity issue, elevating it to a priority global research area. Academics from Western universities are likely to play an increasing role in disability health research in developing countries. In such contexts, there is a need to bridge the gap between procedural ethics and the realities of disability research in cross-cultural contexts. We provide guidance on engaging in ethical disability health research that intersects with and upholds the CRPD. We highlight challenges and tensions in doing so, underscoring the need to be sensitive to the sociocultural and political context of disability that determines how ethical research should proceed. We conclude with 5 recommendations.


Global Public Health | 2013

Predictors of premarital sexual activity among unmarried youth in Vientiane, Lao PDR: The role of parent-youth interactions and peer influence

Vanphanom Sychareun; Alongkone Phengsavanh; Visanou Hansana; Kongmany Chaleunvong; Sengchan Kounnavong; Monika Sawhney; Jo Durham

Research indicates that adolescents in low-income countries have an early sexual debut and engage in risky sexual behaviours. Few studies in low-income countries however, have explored the factors that influence young peoples sexual behaviours. This study examined individual, family and peer-level factors associated with premarital sexual behaviours in the Lao Peoples Democratic Republic (PDR). A cross-sectional survey was undertaken with unmarried youth aged 18 to 24 years (N = 1200) in Vientiane Capital City. Logistic regression models, controlling for confounding variables, were employed to test for the contribution of factors influencing premarital sexual activity. Most respondents held positive attitudes towards premarital sex, with males having more liberal attitudes than females (mean score of 2.68 vs. 2.32, p < 0.001). Prevalence of premarital sexual activity was higher among males than females (44.7% and 19.2%, respectively). Predictors of premarital sex for males were age, sexual attitudes, perceived parental expectations regarding sex, dating and peer influence. For females, predictors were fathers level of education, parent-youth sexual communication, peer influence and liberal sexual attitudes. The results highlight the role of parent-youth interaction and peer influence. The results suggest the need for a range of strategies at the individual, peer and family level, as well as a gender-specific focus.

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Peter S. Hill

University of Queensland

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Damian Hoy

Secretariat of the Pacific Community

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Mark Griffin

University of Queensland

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Hebe N. Gouda

University of Queensland

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Amara Bains

University of Queensland

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