Mayfong Mayxay: Field research in Laos
Little clinical research has been conducted in Laos so far, as reflected in the literature, and this results in limited evidence to guide treatments or patient management. Research done so far by LOMWRU has nevertheless influenced health policies in Laos: clinical trials on antimalarial drugs led to the adoption of ACTs, and studies on the causes of fever resulted in changes in treatment guidelines and vaccination programme.
My name is Mayfong Mayxay and I am a medical doctor. I am Head of Field Research in LOMWRU, Laos, and at the same time, I am the vice-rector of the Lao University of Health Sciences. My area of research is on infectious disease and tropical medicine; this includes malaria, dengue, Japanese encephalitis, comunity-acquired septicaemia, leptospirosis, melioidosis, scrub typhus, murine typhus and also the causes of fever.
It is very important and crucial to conduct field research in Laos, because very little research has been conducted in this country so far, especially clinical research. If you compare Laos to the neighbouring countries in this region, such as Thailand, Cambodia, Vietnam, Myanmar or China, Laos has the least record of the research in this region. For example, if you put the key word ‘Laos’ in PubMed, which is a search engine for health and medicine, you will get only approximately 3,000 papers from PubMed; but if you do the same thing for other countries, you will have approximately 5,000 papers for Cambodia, around 80,000 papers for Thailand or even 1.5 million papers for China. With this small research, it means that we have very little information or evidence to guide treatment or management of the patients in the country. That’s why it is very crucial and important for us to conduct research in our country.
I can give you two examples: the first one is the study of the causes of fever in rural provinces in Laos. Another study is looking for a way to eliminate malaria from the country, called the targeted malaria elimination study. The study on the causes of fever provided us with very comprehensive information that can be applied for the treatment of patients with fever. And the study on targeted malaria elimination provided us with evidence that Mass Drug Administration (MDA) of dihydroartemisinin-piperaquine plus a single low dose of primaquine can probably be useful to eliminate malaria from the country.
The research that we have done so far has influenced the health policy in the country. For example, the clinical trial on antimalarial drugs that we did before has led to a change of the national malaria treatment guideline from the old drugs, chloroquine or sulfadoxine-pyrimethamine or quinine, to the new antimalarial drug, which is called artemisinin-based combination therapy. Secondly, the clinical trial on typhoid fever has also led to a change of the treatment guideline of typhoid fever in the country. Lastly, the study on the causes of fever provided the information that Japanese encephalitis is an important cause of fever. This led to the introduction of Japanese encephalitis vaccine into the Laos EPI programme (Expended Programme on Immunization). So, this is very important and influential.
LOMWRU is part of the MORU Tropical Health Network, and MORU is a key part of NDM here. Approximately 40% of our research in LOMWRU is done jointly with the MORU Tropical Health Network. This is very synergistic and facilitates the conduct of research in Laos; that can be beneficial for Lao people’s health by giving the evidence to inform health policy and implementation.
This interview was recorded in September 2019