L’épilepsie est une des maladies neurologiques la plus fréquentes dans le monde. Cette maladie constitue un problème de santé publique dans les pays en développement où les ressources médicales et économiques sont faibles pour la prise en charge de cette pathologie. Ce travail de doctorat a été raisonné comme une recherche en santé publique qui vise à analyser la mise en place progressive de la prise en charge des personnes vivant avec une épilepsie (PVE) en République Démocratique Populaire Lao (RDP Lao). Nos travaux de recherche ont été conduits dans un premier temps par des recherches observationnelles,sanctionnées par 5 publications scientifiques concernant le personnel de santé, les médicaments antiépileptiques, l’adhérence au traitement antiépileptique et la prise en charge des enfants épileptiques. Dans un deuxième temps, des recherches interventionnelles ont expérimenté le dépistage actif des PVEs et un suivi à fréquence régulière par des visiteurs (personnels de santé) à domicile. Ce travail a identifié les enjeux de la prise en charge de l’épilepsie en RDP Lao : les croyances socioculturelles, la faible qualification des personnels de santé, le faible approvisionnement en médicaments antiépileptiques et leurs prix élevés. Nos interventions ont été efficaces et ont augmenté le nombre de PVEs traitées dans le système de soin. L’extension spatiale de la prise en charge efficace de l’épilepsie à l’échelle nationale nécessite le renforcement de la capacité des soins au niveau communautaire, d’une gouvernance dédiée, de la contribution de l’Association pour les Personnes avec une Epilepsie (APE) et des acteurs de recherches. / Epilepsy is one of the most common neurological diseases worldwide. It is a public health issuein developing countries, where the medical and economic resources are poor for the case management. This doctoral work was set-up as a public health research, assessing the progressive implementation of the management of people living with epilepsy (PWE) in Lao People’s Democratic Republic (Lao PDR). Our research was conducted first through observational research and produces five scientific publications on the health staff,antiepileptic drugs, management of pediatric cases and treatment adherence. Secondly, interventional research focused on a one-year PWE’s follow-up using active screening and domestic health visitors. This work has identified the challenges of the management of epilepsy in Lao PDR: the socio-cultural beliefs, the low qualification of health staff for epilepsy management, the low antiepileptic drug supply and the high price of the drugs. Our interventions were successful, increasing the number of PWEs treated in the healthcare system. The extension of effective management for epilepsy at a national level requires the strengthening of capacity of healthcare at community level, the governance, the contributions of civil society and research actors.

Unexploded Ordnance (UXO) contamination presents a considerable level of danger in almost all post-conflict environments. Globally there are a vast amount of casualties every year. However, accurate numbers of casualties is hard to obtain both globally and locally. The purpose of this thesis is to examine how UXO affects Human Security in Lao PDR. The methodology used is a theory consuming empirical and heuristic method. The thesis is a case study that does not attempt to generalize but to understand and analyze the relation between UXO and Human Security in the context of Lao PDR. The theory used in the thesis is Human Security based on the concept of the 1994 UNDP Human Development Report. The findings of the thesis make clear the connection between UXO contamination and lack of Human Security in Lao PDR. The direct and indirect consequences of UXO contamination are explored. Finally, the thesis works at a broader societal level where the links to poverty and development are illustrated.

The aim of the thesis is to investigate patterns and consequences of internal and international migration in Laos during the period 1985-2005 on both a macro-and a micro-level. The thesis focuses on the influences of socio-economic change and government policies on inter-regional and rural-urban migration as well as on crossborder migration from Laos to Thailand. The study also examines the effects of migration and industrial factory work on gender relations during economic transition and consequences of undocumented migration to Thailand. The background consists of a discussion on socio-economic change within the country and on government policies influencing migration patterns, as well as on how socio-economic change, urbanization and industrialization in the region affect internal and international migration in Laos. The thesis consists of three empirical studies which derive from different sources of data; the first is based on Population Censuses in 1995 and 2005 and the second and the third draw from empirical surveys in 2004-2005 and 2006. Paper I focuses on how socioeconomic factors and government policies influence migration patterns in Laos. The paper found that the interregional migration rate decreased in the later census period. This was due to significantly higher rural-rural migration in the earlier period, which in turn was influenced by various types of government policies. Papers II and III are based on micro surveys; paper II focuses on an urban industrial area in Vientiane Capital and explores the current feminization of rural-urban migrations during economic transition with specific focus on the effects of industrial work on gender roles and status of women as industrial workers. Industrial work was seen by the women as temporary jobs for saving money, for sending remittances, and for either returning home or moving to other jobs in Vientiane or Thailand. Paper III is based on surveys in three provinces, and deals with undocumented migration from Laos to Thailand and its consequences. Different income levels, existing social networks, similar language and socio-cultural backgrounds were determinants of cross-border migrations. The study found that migrants who had contacts with informal brokers were highly exposed to risks of human trafficking and violence.

This thesis looks at the introduction of educational action research as part of the national education reforms in Lao PDR. National policies on education emphasise concepts such as ‘education for all’ and ‘student-centred education’ taken from the globalised education reform agenda. Action research became a tool to implement the new pedagogy of student-centred education that was labelled ‘the five-pointed star’. The thesis contributes to the field of global policy studies. It combines global and contextual aspects in order to analyse how action research travelled from policy to practice. This process was part of a Lao national education reform that developed after the introduction of the new economic mechanism, when the previous socialist planned-economy system was replaced by a globalised market-oriented system. Data were collected from national policy documents, international donor documents, instructional material, and interviews with Lao educators involved with action research in different ways. Furthermore, we carried out action research as part of our own teaching duties in Lao PDR, which were subsequently documented and analysed. In this study of educational reform in Lao PDR we have found that an educational approach like action research that is introduced as part of a taken-for-granted global agenda of change, is reduced to a technical rationality and practices that resemble previous experiences. Our findings are explained from the theoretical perspectives of hidden policy ensembles and policy backlashes. Hidden policy ensembles reduce action research to a technical rationality due to their alien cultural and social connections that are not brought into the open at the reform arena. Policy backlashes become a way for practitioners to create meaning based on previous contextual practices, conceptions, and discourses as a consequence of the technical rationality created by the hidden policy ensembles and the use of the cascade model. The thesis concludes with an outline of a possible future educational development in the form of a critical and educative action research network in Lao PDR that is inspired by cross-cultural dialogue, a critical pedagogy of place, and our own action research experiences.

No description available.

La tuberculose (TB) reste parmi les 10 premières causes de décès dans le monde ; l’émergence/réémergence de la TB résistante aux antituberculeux aggrave la situation et représente un défi majeur pour l’éradication de la TB. Le Laos est entouré par des pays fortement touchés par la TB et la TB multi-résistante (MDR) et cette maladie représente une priorité en termes de santé publique dans ce pays. Il n’existe encore aucune donnée sur la structure génétique et la résistance aux antibiotiques de la population de M. tuberculosis au Laos.Dans ce contexte, ce travail avait pour but d’analyser la diversité génétique et la structure des populations de M. tuberculosis ainsi que les déterminants génétiques associés à la résistance à partir d’échantillons collectés lors de l’enquête de prévalence nationale de la Tuberculose (TBPS) 2010-2011, l’enquête de résistance aux antituberculeux (DRS) 2016-2017 et chez les cas suspects de MDR-TB au Laos (2010-2014). Plusieurs techniques d’analyses ont été utilisées, comprenant les tests de sensibilité aux médicaments (phénotypique et génotypique), le séquençage et le génotypage par spoligotypage et MIRU-VNTR. Les données ont été analysées par des méthodes statistiques et phylogénétiques.Premièrement, ce travail s’est focalisé sur la diversité des familles de M. tuberculosis circulant au Laos. Les familles EAI et Beijing (76.7% et 14.4% respectivement) ont été principalement observées dans les échantillons de TBPS, alors que la famille Beijing était plus fréquente dans les échantillons de DRS et chez les patients suspectés de MDR-TB (35% et 41% respectivement). La transmission récente était non-négligeable avec un taux de « clustering » global de 11.9%, et des taux pour Beijing de 20 % et EAI de 11 %. Deuxièmement, les résultats ont révélé des profils de résistance très diverses allant de la mono-résistance jusqu’à la pré-XDR (ultrarésistance). Les mutations associées aux profils de résistance ont montré une grande diversité, avec cependant certaines mutations majeures dans les gènes rpoB, katG, et rpsL. Le gène pncA a montré un pattern différent avec de la diversité sans mutations prééminentes. En plus des mutations détectées, des délétions et insertions de bases ont été également observées. Le séquençage a montré son utilité pour la détection de la résistance aux antibiotiques dans les trois échantillons à l’étude. Enfin, la famille Beijing, famille la plus problématique au niveau mondial en termes de résistance et de transmissibilité, a été identifiée de manière significative dans le groupe de patients <35 ans, principalement dans les provinces du Nord, dans les cas de transmissions récentes et chez les isolats très résistants. Tous ces points suggèrent un risque d’émergence de la MDR-TB accrue au Laos dû à la famille Beijing.En conclusion, cette étude permet d’avoir pour la première fois un aperçu de la structure des populations de M. tuberculosis au Laos. Les résultats soulignent le risque d’augmentation du nombre de cas infectés par la famille Beijing et donc des cas de résistance. Pour empêcher une dégradation de la situation, il est essentiel d’améliorer les stratégies pour le dépistage des résistances et de développer des tests moléculaires capables de couvrir un large nombre de mutations qui soit simple à implémenter dans les pays à ressources limités. Les résultats de ce travail serviront de base en termes de famille/sous-famille/génotype et de mutations associées à la résistance au Laos. Ces données pourront être comparées avec de futures études/analyses pour étudier l’évolution de la TB et de la TB résistante et ainsi d’évaluer l’efficacité des politiques de contrôle mises en place. La description des mutations associées aux résistances est utilisée pour créer une base de données régionale en collaboration avec le Vietnam et le Cambodge pour développer un outil de diagnostic basé sur la technologie des puces à ADN pour améliorer la détection de la résistance dans la région. / Tuberculosis (TB) is still one of the top 10 leading causes of death worldwide; the emergence/re-emergence of drug resistant TB aggravates the situation globally and challenges the prospect of ending TB by 2035. Lao PDR is surrounded by TB and MDR-TB high burden countries and TB continues to be one of the priority infection diseases in this country. The prevalence of TB in 2010 was almost twice as high than previous estimates and little is known about drug resistance. Up to now, M. tuberculosis population data regarding drug resistance and genetic structure are totally absent. In this context, we aimed to study the diversity and the structure of M. tuberculosis population and the genetic determinants associated to drug resistance using clinical samples collected from the TB prevalence survey (TBPS), 2010-2011; from the Drug resistance survey (DRS), 2016-2017 and from presumptive MDR-TB cases in Lao PDR (2010-2014). Various methods and analyses were used, including drug susceptibility testing (phenotypic and genotypic), DNA sequencing and genotyping of M. tuberculosis using spoligotyping and MIRU-VNTR. The data were analyzed by statistical and phylogenetic analyses.Firstly, this work was focused on the diversity of M. tuberculosis families circulating in Lao PDR. According to the result form TBPS, EAI and Beijing family (76.7% and 14.4% respectively) were mainly observed, while Beijing family was more observed in DRS, and presumptive MDR-TB cases (35% and 41% respectively). The level of recent transmission in Lao PDR was non-negligible with a global clustering rate of 11.9% and in Beijing and EAI of 20% and 11%, respectively. Secondly, the results demonstrated the diversity of drug resistant patterns from mono-resistance to pre-extensively drug resistance (pre-XDR). A high diversity of mutations associated with drug resistance was also observed, however common mutations were mainly found (e.g: mutations in rpoB gene, katG and rpsL). The pattern was different for pncA gene, we observed a diversity of mutations without preeminent ones. Besides the number of known and unknown mutations associated with anti-TB drug resistance, deletion and insertion of bases were also observed. The sequencing showed its usefulness for drug resistance detection. Lastly, Beijing family, which is the more problematic family in the world in terms of resistance and transmissibility, was observed on a significant manner in young age group, mainly in the northern provinces, in recent transmission cases and among highly drug resistant isolates, suggesting an increasing risk of highly drug resistance TB due to highly transmissible Beijing strains in Lao PDR.In conclusion, this study provides the first genetic insights into the M. tuberculosis population in Lao PDR. The results underline the risk of increase of Beijing and drug resistant TB in the country. In order to prevent a more serious situation in the future regarding drug resistance as observed in neighboring countries, there is an urgent need of effective strategy improvement for drug resistance screening and the development of rapid molecular tests that cover a large number of drug resistance simultaneously with a feasible implementation in the limited resource countries. The results of genotyping from our study will be the baseline of families/subfamilies/genotype of M. tuberculosis population and of the mutations associated with drug resistance in Lao PDR. These data will be compared with further study/analysis to evaluate the trend of TB and drug resistant TB in the country and to determine if the drug resistance is under control after the set-up of new policies. The data of drug resistance associated mutations are used to build a regional database in collaboration with Vietnam and Cambodia in order to develop a diagnostic tool based on DNA chip technology to improve the drug resistance detection in the region.

Victors do not always write history. To date our knowledge of how the Pathet Lao seized power in Laos in 1975 has been based on accounts from those who witnessed events but who were not privy to the thinking and planning behind them. After the violent fall of Cambodia and Vietnam, the slow, relatively peaceful and seemingly dilatory takeover of power they observed did not equate with the Lao People’s Revolutionary Party’s assertion that its seizure of power was due to the “creative application of Marxism-Leninism to Lao conditions”. This work attempts to determine the accuracy of the Lao Party’s claim by using LPRP documents and written and verbal accounts, which reveal the strategic thinking and tactics behind the Lao Revolution. The piecing together of information drawn from many and varied sources that were directly involved, at last sheds some light on how a small, weak movement overthrew a government almost without violence. It also reveals that the LPRP carefully and deliberately planned and executed the peaceful formation of the Lao People’s Democratic Republic in December 1975 in a revolution that was unprecedented in the history of Marxist-Leninist revolutions.

The species of Amomum Roxb. (Zingiberaceae) in Cambodia, Laos and Vietnam are revised. Thirty-five species and two varieties are recognised, all names are typified, and detailed descriptions and a key are provided. Nine new species are described and one species is validated. Whilst revising Amomum for the Flore du Cambodge, du Laos et du Viêtnam, we have proposed to conserve the name Amomum villosum Lour. with a recent collection from Laos, which was not included in the protologue, as its type. Our research on the use of Amomum focuses on the use of plants during pregnancy, parturition, postpartum recovery and infant healthcare among three ethnic groups, the Brou, Saek and Kry. The investigations aim to identify culturally important traditions that may facilitate implementation of culturally appropriate healthcare. Data were collected in Khammouane province, Lao PDR, through group and individual interviews with women by female interviewers. More than 55 plant species are used in women's healthcare, of which &gt; 90 % are used in postpartum recovery. This wealth of novel insights into plant use and preparation will help to understand culturally important practices such as confinement, dietary restrictions, mother roasting and herbal steam baths and their incorporation into modern healthcare. Through chemical analyses of Amomum we have recorded compounds with antimicrobial, analgesic and sedative effects that point to an empirical development of the traditional treatments around childbirth. Essential oils of three species used in hotbed and mother roasting, Amomum villosum Lour. Amomum microcarpum C.F.Liang &amp; D.Fang and Blumea balsamifera (L.) DC. were found to contain significant amounts of the following terpenes: b-pinene, camphor, bornylacetate, borneol, linalool, D-limonene, fenchone, terpinen-4-ol and a-terpinene.

Haematophagous parasites and disease vectors such as leeches, ticks, mites, lice, bed bugs, mosquitoes, and myiasis-causing fly larvae are common health problems in Lao Peoples Democratic Republic (Lao PDR). A main aim of my field work in Lao PDR in 2006-2010 was to document traditional knowledge among different ethnic groups about plants that people use to repel or to kill blood-feeding invertebrates. We carried out structured interviews in 66 villages comprising 17 ethnic groups, covering a range of ethnic group, throughout Lao PDR and recorded a total of 92 plant species - in 123 different plant-ectoparasite combinations - that are used as traditional repellents and/or as “pesticides” to kill "pest" invertebrates. Traditional use was confirmed in the scientific literature for 74 of these plant species, and for an additional 13 species based on literature on closely related species. We concluded that repellents and pesticides from many plant species are commonly used in the Lao countryside. We also investigated traditionally used Lao plants for their activity to repel or to kill certain disease vectors and parasites. Target organisms were mosquitoes (Diptera, Culicidae), fly larvae (Diptera, Cyclorrhapha) in fermented fish production, and terrestrial blood-sucking leeches (Hirudinea, Haemadipsidae). The potential mosquito repellent activities of essential oils of Croton roxburghii (Euphorbiaceae), Hyptis suaveolens (Lamiaceae), and Litsea cubeba (Lauraceae) were evaluated in the field near Vientiane. Oils at concentrations of 1.7-6.7 µg/cm2 were significantly repellent to Aedes, Armigeres and Culex attracted to human baits. The activities against fly larvae, infesting fermenting fish, of three plant species, Tadehagi triquetrum (Fabaceae), Uraria crinita (Fabaceae) and Bambusa multiplex (Poaceae) were investigated: When fresh material of the plants was added on top of fermenting fish infested with fly larvae significant proportions of the larvae were repelled or killed. The total protective effect, i.e., repellent and killing effect combined, of T. triquetrum, U. crinita, and B. multiplex was 60-83 %, 77-90 %, and 60-93 %, respectively. Field evaluation of the potential leech repellent activities of water extracts of Sapindus rarak (Sapindaceae), Catunaregam spathulifolia (Rubiaceae) and Vernonia elaeagnifolia, (Asteraceae) impregnated on stockings and worn by persons in two leech-infested biotopes revealed leech repellent activities of 82.6%, 62.6% and 63.0%, respectively. The corresponding repellencies of deltamethrin and diethyl-3-methyl-benzamide (DEET) were 73.1% and 88.4%, respectively. Identification of the active components in certain of the plants with the ultimate aim to develop more optimal, less costly repellents, insecticides, acaricides, and anti-leech compounds as alternatives to synthetic repellents and pesticides against blood-feeding insects, ticks, mites, and leeches is in progress.

This thesis deals with an analysis and comparison of tourism within Thailand and Lao PDR. The paper discusses global tourism trends with a special interest dedicated to southeast Asia. Based on studies of history, geography and government programmes of each individual country, conditions for conducting tourism activities were defined. History of tourism as well as develompent of individual destinations were concerned, too. The conclusion summarising present and future possibilities of travel industry in Thailand and Lao PDR also involves information about knowledge and personal approach of Czech public to both countries. The data were collected through an exploratory questionnaire. The next part offers a list of destinations provided by Czech and German travel agencies. Based on the list, an overview of available destinations provided by major Czech and German official mediators was created. One of the chapters also deals with legal conditions governing the rights for setting up a travel agency by non-residents.