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Regional Stakeholders’ Consultation Meeting for the
SIOG Global Policy 2019
LAO PDR Country Presentation
Lao PDR Country Profiles
• 236,800 km², 70 % mountainous
• Population 7 millions • Density 29.5/km² • Diversity of 50 official group ethnics
• Urban 38.6% (2015) and could reach
50% in 2030
Country Profiles • Life expectency at birth 65.8 years in
2015 and would not reach 70 years until
2036 • Ageing of the population is not yet an
issue for Lao PDR (only 4% are 65+)
• The population is relatively young with median age of 22 and 58% under 25
National Development • Lao PDR is classified as a lower-middle-
income economy • one of the fastest growing economies Goals to achieve:
- Graduate from Least Developed Country by 2020
- Attain UHC by 2025 - Achieve SDGs by 2030
NCDs in Lao PDR NCDs are estimated to account for 48% (2012) and 60%(2016) of all dealths, all ages, both sexes
NCDs 2012 2016 Cardiovascular diseases 22% 27% Cancers 11% 12% Chronic respiratory Diseases 5% 5% Diabetes 2% 12% Other NCDs 8% 12%
Lao NCD Risk Factors
* Percentage who ate less than 5 servings of fruit and/or vegetables on average per day
0
25
50
75
100
Tobaccosmoking
Alcoholconsumption
Unhealthydiet*
Low level ofphysicalactivity
Overweight Raised bloodpressure
Raisedfasting blood
glucose
Raised totalcholesterol
Pe
rce
nta
ge
Male Female
Source: Lao PDR 2013, STEPwise approach to surveillance (STEPS)
Surveys on Risks factors of NCDs
Risks Factors M F T Tobacco smoking (2011) 48.4% 3.5% 25.7% Alcohol consumption (litre) (2010) 12.5 2.3 7.3 Raised Blood pressure (2008) 24.1% 20.4% 22.2% Obesity(2014) 1.8% 4.1% 3.0% Physical inactivity (2010) 3.1% 14.6% 9.0% Household solid fuel use (2012) 98.0%
National systems response to NCDs
• To date, Lao PDR has applied a disease-specific approach to NCDs prevention and control
• Disease-specific treatment institutions are being proposed
- Lao-Luxembourg Heart Institute - Mittaphab Hospital Cancer center
- Treatment Unit for diabetes in some hospitals
Lao National NCDs policy
Lao Ministry of Health organized workshops that involved stakeholders from Health and Non-Health sectors in order to plan a project coordination on the control and solve the problem of NCDs in Lao PDR. The draft of Lao National NCDs policy and MSA plan 2014-2020 was developed with WPRO technical assistance
Lao National NCDs policy’s Objectives
1. To establish a national multisectoral mechanism and action plan (MSA) for prevention and control of NCDs in Lao PDR.
2. To build national capacity for prevention and treatment of NCDs.
3. To provide legal support and financial resources for NCDs prevention and control
Lao National MSA Plan 2014-2020
GOALS:
To reduce premature deaths and disability from Laos’ four main non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes), and reduce the prevalence of four of their shared causes (tobacco, alcohol, diets&physical inactivity, infections causing cancer).
Lao National MSA Plan 2014-2020
Objectives: 1.To reduce the population prevalence of common factors for NCDs 2. Strengthen governance & resourcing for NCDs 3. NCDs prevention and control through healthy cities and settings 4. Pursue cost-effective detection, treatment, rehabilitation and palliative care 5. Enhance NCDs surveillance
Raised blood pressure
25%
Salt/ sodium intake
30%
Tobacco 30%
Physical inactivity
10%
Harmful use of alcohol
10%
Medicines and technologies
80%
Drug therapy and counseling
50%
Premature mortality from NCDs
25% reduction
Mo
rtal
ity
and
m
orb
idit
y
Ris
k fa
cto
rs
Nat
ion
al
syst
em
s re
spo
nse
Diabetes/ obesity
0%
WHO’s set of 9 voluntary global targets for NCD prevention and control (by 2025)
Bio
logi
cal
Be
hav
iora
l
Lao national targets from 2014 to 2025
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 WHO
targets
Percentage who
engage in heavy
episodic drinking
(male)
67.0 66.4 65.9 65.3 64.8 64.2 63.7 63.1 62.5 62.0 61.4 60.9 60.3 10%
Physical
inactivity
10.4 10.3 10.2 10.1 10.1 10.0 9.9 9.8 9.7 9.6 9.5 9.4 9.4 10%
Current daily
tobacco smoking
(both sexes)
29.8 29.1 28.3 27.6 26.8 26.1 25.3 24.6 23.8 23.1 22.4 21.6 20.9 30%
Current daily
tobacco smoking
(male)
59.1 57.6 56.1 54.7 53.2 51.7 50.2 48.8 47.3 45.8 44.3 42.8 41.4 30%
Current daily
tobacco smoking
(female)
8.9 8.7 8.5 8.2 8.0 7.8 7.6 7.3 7.1 6.9 6.7 6.5 6.2 30%
Salt intake 6.5 6.3 6.2 6.0 5.9 5.7 5.5 5.4 5.2 5.0 4.9 4.7 4.6 30%
Raised
BP/Hypertension
18.3 17.9 17.5 17.2 16.8 16.4 16.0 15.6 15.3 14.9 14.5 14.1 13.7
25%
Obesity 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 maintain
2013
level
Diabetes 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 maintain
2013
level
Main Challenges
• Previous Lao government contract with TOBACCO Company to keep low tobacco price
• Difficulty to tobacco excise tax
• Powerful alcohol company influence in Lao PDR • Harmful alcohol drinking
• Capacity building issues • Insufficient staff dedicated on NCD activities
• insufficient local funding available for NCD activities • Rely on WHO funding assistance • Proposal of 2% of tobacco tax for NCD activities
• Low human resources allocated in Primary Care • Difficulty for appropriate WHO PEN implementation
Cancer in Lao PDR (Source: GLOBOCAN 2018) Males Females Both sexes
Population 3 473 601 3 487 607 6 961 208 Number of new cancer cases 3 769 3 941 7 710
Age-standardized incidence rate (World) 166.4 145.6 154.3 Risk of developing cancer before the age of 75 years (%) 17.5 15.2 16.2
Number of cancer deaths 3 079 2 471 5 550 Age-standardized mortality rate (World) 140.0 95.8 115.9
Risk of dying from cancer before the age of 75 years (%) 14.9 10.5 12.5 5-year prevalent cases 5 417 7 825 13 242
Top 5 most frequent cancers excluding non-melanoma skin cancer Liver Breast Liver
(ranked by cases) Lung Colorectum Breast
Stomach Liver Lung
Colorectum Cervix uteri Colorectum
Oesophagus Thyroid Stomach
Pathology Based Cancer Registration
Figure 1: Number of Lao cancer patients by year of diagnosis (n=915)
2010 2011 2012 2013 2014 2015
12
54 55
101 86
5 20
103 122
237
213
17
Number of Lao cancer patients by year and gender b of
diagnosis
Male Female
17
Pathology Based Cancer Registration Figure 1: Number of Lao cancer patients by year of diagnosis (n=915)
Cancer patients 2017
6 8 8 10 10
18
26
18
29
5 10 11
0
5
10
15
20
25
30
35
Cancer patients N=207, both sexes
Cancer patients 2018
0
5
10
15
20
25
30
35
Lip
Ton
gue
Ora
l cav
ity
Saliv
ary
glan
d
Nas
op
har
ynx
Eso
ph
agu
s
Sto
mac
h
Smal
l in
test
in
Co
lon
Rec
tum
Live
r
Ch
ola
ngi
oca
rcin
om
a
Pan
crea
s
Lun
g
Oth
er t
ho
raci
c
Bo
ne
Skin
Soft
tis
sue
Bre
ast
Ute
rus
Cer
vica
l
Ova
ry
Bla
dd
er
Pro
stat
e
Test
is
Kid
ney Eye
Bra
in
Thyr
oid
Hea
d a
nd
nec
k
Lym
ph
om
a
Cancer Patients N=249 (Both sexes)
Famale Male
Lao PDR Cancer situation
Limited cancer data: only some Pathology-based cancer registry
Cancer treatment facilities are primitive: only one Cancer Center that provides limited services (chemotherapy, palliative care, radiotherapy). Surgery is done for some cases in hospitals. No community/home care.
Patients used to travel to neigboring countries for treatment (Thailand, Vietnam,...)
Lao PDR Cancer situation
Few cancer plans, monitoring and surveillance - Lao PDR finalizes the national action plan to eliminate asbestos-related diseases among workers. (April 2018)
- Lao Government should integrate national cancer-control programme in existing health systems
Cancer primary prevention policies:
- Tobacco control
- Reducing harmful use of Alcohol
- Immunisation (Hepatitis B, HPV)
Lao PDR Cancer situation Cancer screening and early detection:
available in some facilities (PAP smear, clinical breast exam, tumor marker, radio diagnosis, pathology lab.)
Shortage of human resources (Oncologits/technicians):
- Only 7 pathologists - Needs many kinds of oncology staff (
Hemato, Surgical, Gyneco, Clinical, Radiation therapy staff, onco-pharmacist, oncology nursing staff, palliative care specialist,....) -
Researches on NCDs/Cancer
Only some publications available: for example
Survey-based cancer mortality in the Lao PDR. (Nguyen TL et al. 2007-2008)
Retrospective appraisal of cancer patients from Vientiane capital Lao PDR seeking for treatment in Thailand
(Chareunvong K.et al. 2013)
Non communicable diseases risk factors in Lao PDR
( Siengsounthone L.)
Researches on NCDs/Cancer
Two institutions are main responsible for Health Research in Lao PDR:
1. National Institute of Public Health and Tropical Medicine, Ministry of Health
2. Institute of Research and Educational Development, University of Health Sciences
Registered Researches can be found at LAO PDR Health Research Portal
SUMMARY
Lao PDR has young population and Ageing is not yet an issue. (Median age =22 and 58% under 25. Life expectency = 65.8 and only 4% aged 65+)
NCDs (including Cancer) are increased and surpassed Communicable diseases and caused premature mortality
Necessity to review curricula for Doctors and nurses about NCD/Geriatric and provide more in-service trainings.
Lao PDR had policy and plan for NCDs/cancer prevention and Control but shortage of human resources and financial support are the challenges (Health expenditure only 2.2% of GDP, Out of pocket 40% and USD 76 per capita.)
THANK YOU FOR YOUR ATTENTION
RADIOTHERAPY CENTER