Do they really boil their drinking water? : a descriptive study in a rural district of the Lao People's Democratic Republic

doi:10.21203/rs.3.rs-4346612/v1

Background: For safe drinking water, household water treatments (HWT) are important to reduce the risk of diarrhea in low-and-middle countries including Lao People’s Democratic Republic (Lao PDR). However, the measurement of HWT relies chiefly on self-report in most nationwide surveys. Thus, the validity of self-reported measurement is of concern. The objective of this study was to determine the proportion of households with the presence of boiled water among households that report boiling practices in a rural area of the Lao PDR.

Methods: This study was conducted with randomly selected 108 households in the four villages in the catchment area of the two health centers, in Xepon district of the Savannakhet province, between September and October 2023. The inclusion criterion of the households was the households that report boiling as HWT. Surveyors conducted interviews with an adult household member and observations on boiled water through household visits, using a questionnaire. Descriptive statistics were conducted to summarize the collected information using the frequency with proportion for categorical variables and the median with interquartile range for continuous variables. Bivariate analyses were conducted to assess an association between each of the factors and the presence of boiled water, using Fisher’s exact test.

Results: Among the 108 households that reported boiling practice, 91 households were able to show the surveyor self-reported boiled water. Thus, the proportion of households with the presence of boiled water was 90.1% (95% confidence interval: 82.5% to 95.1%.). The presence of a fixed schedule of boiling (p<0.001) was statistically significant between households with boiled water and households without boiled water. Not all family members do not necessarily drink boiled water: approximately a quarter (25.7%) of the participants reported that some household members drink unboiled water.

Conclusion: This study showed that among households that reported boiling drinking water, 90.1% were able to present a container with self-reported boiled water. It suggests that the self-reported measure of boiling practices can be valid in the study villages. In the future, recommending people to make a schedule for boiling and promoting all family members to drink boiled water will spread the drinking of boiled water.

water treatment

health behavior

self-report

Demographic and Health Survey

Laos

Diarrhea is a leading cause of death among children under five years old in the world and approximately 525,000 children die each year from diarrhea [1, 2]. Diarrhea can be prevented using safe drinking water, sanitation facilities, and hand washing with soap. For safe drinking water in particular, household water treatments (HWT) are important to reduce the risk of diarrhea [3].

Although HWT is critical, the measurement relies chiefly on self-report in most nationwide surveys and research studies. The Demographic and Health Surveys [4] measure HWT practices with the following two questions; 1) Do you treat your water in any way to make it safer to drink, and 2) What do you usually do to the water to make it safer to drink [5].

Self-report of HWT practices can be biased because people tend to over-report their practices [6]. Some studies report that people are over-reporting their HWT practices. A study in Zambia found that among respondents who reported doing HWT, only 23.1% had household-treated water during the survey [7]. A similar study in Peru found that only 21.3% had household-treated water [8]. Additionally, a similar study in Cambodia also found that 73.7% had household-treated water [9]. Thus, the validity of self-reported measurement of HWT practices is of concern.

Lao People’s Democratic Republic (Lao PDR) is a lower-middle-income country located in Southeast Asia. Diarrhea is a common disease and there are challenges related to drinking water in the rural area [10]. Chlorination is not widespread, and the source of drinking water is often contaminated with Escherichia coli (E. coli): 83.3% of the household population were exposed to E. coli in the source of their drinking water [11].

The Lao Social Indicator Survey II (LSIS II) is a household-based nationwide survey conducted by the Lao government in 2017 [11]. According to the LSIS II, in rural areas without roads, 59.8% of households treated their drinking water by boiling, 37.8% did not treat and 4.2% treated it by straining through a cloth. As is done in Demographic and Health Surveys, the HWT practices were measured by self-report in the LSIS II. Therefore, the validity of the measurement is also of concern in the LSIS II.

As far as we know, no study has been conducted to determine the proportion of the presence of boiled water among households that report boiling practices in Lao PDR. The objective of the present study was to determine the proportion of households with the presence of boiled water among households that report boiling practices in a rural area of the Lao PDR.

Study design

This is a descriptive study that described 1) the proportion of households with the presence of boiled water among households that report boiling as HWT and 2) the boiling-related characteristics of households.

Study site and population

This study was conducted in the four villages in the catchment area of the Salan Health Center and Lako Health Center, in Xepon district of the Savannakhet province, between September and October 2023. Xepon district is located on the Vietnamese border, approximately 600 km to the southeast of the Vientiane capital. According to the Xepon District Health Department, the population of the district in 2023 is 65,000. Most of the people are ethnic minorities, including Tri and Makong people. Xepon was chosen from many rural districts of the Lao PDR because we have established relationship with Xepon District Health Department and Savannakhet Provincial Health Department through the long-term research collaboration.

There are 12 health centers in Xepon District. Of these, Salan Health Center and Lako Health Center were chosen because people there do not buy bottled water and thus, they are expected to boil their drinking water. Four villages exist in the catchment area of the Salan Health Center, whereas eleven villages exist in the catchment area of the Lako Health Center. Two villages were selected from the catchment area of each health center, based on the following two criteria; 1) safely accessible during the rainy season and 2) large enough to meet the sample size requirement (27 or more households). In the area of the Salan Health Center, two villages met the criteria, and those two villages were selected. In the area of the Lako Health Center, three villages met the criteria, and the two closest villages were selected.

From each of the selected villages, 27 households were randomly selected using a household list. The inclusion criterion of households was the households that boil their drinking water.

The exclusion criteria were 1) households that had lived in the village for less than three months, 2) households that had not boiled their drinking water in the past seven days, and 3) households without a member aged 18 or over. Seven households did not meet the selection criterion and no households met the exclusion criteria. In total, 108 households that met the criteria were invited to participate in the study. All the invited households participated in the study.

Survey and data collection

Surveyors conducted interviews with an adult household member and observations on boiled water through household visits, using a questionnaire (additional file 1) that was developed based on HWT-related studies [7, 8, 9, 11]. One day before the household visits, villagers were requested that one adult member in charge of boiling water stay at home on the day of the survey. In the interview, surveyors collected boiling-related information including boiling practices and perception on boiling, and socio-economic and demographic information. In the observation, surveyors observed the presence of self-reported boiling water and facilities and goods related to boiling, including kitchen stoves and kettles.

Outcome variable

The outcome variable was the presence of boiled water in the household at the time of the survey. To measure the outcome, we asked the following question to the interview respondent "Could you show us boiled water?" and then, observed the water the respondent showed us. We defined the presence of boiled water as the state where a participant is able to show the surveyor a kettle or other container that contains self-reported boiled water.

Sample size

The sample size was calculated using a confidence interval of ± 10%, a confidence level of 95%, and an estimated proportion of households with boiled water of 50%. The proportion of households that have boiled water was estimated from the results of similar studies [7, 9, 14]. As a result of the calculation, the required number of households was 97. On the assumption that the participation rate of invited households is 90%, we needed to invite 108 households in order to have 97 participating households. The calculation was performed using EZR [15].

Statistical methods

This study used three statistical approaches. First, confidence intervals were calculated for the proportion of households with the presence of boiled water among households that report boiling practices. Second, descriptive statistics were conducted to summarize the collected information using the frequency with proportion for categorical variables and the median with interquartile range for continuous variables. Third, bivariate analyses were conducted to assess an association between each of the factors and the presence of boiled water, using Fisher’s exact test.

Presence of self-reported boiled water

Data were collected from 108 households that reported boiling practice. The data of the seven households were excluded, due to missing values in their questionnaires, leaving the data of 101 households.

Among the 101 households, 91 households were able to show the surveyors self-reported boiled water. Thus, the proportion of households with the presence of boiled water among households that report boiling practices was 90.1% (95% confidence interval: 82.5–95.1%.).

Socio economic and demographic characteristics of study participants

Most of the participants (82.2%) were males (Table 1). The median age was 39 years old. The most common educational attainment was "no formal education"(54.5%), followed by "primary level education" (24.8%). Almost all the participants were a farmer (96.0%). Most of the participants (77.2%) were living with a young child, whereas fewer participants (49.5%) were living with an elderly person.

Table 1

Demographic and socio-economic characteristics of participants
			Total			Households with boiled water		Households without boiled water
Characteristics			n (n = 101)		%	n (n = 91)	%	n (n = 10)	%	p-value^a
Gender
	Male		83	82.2		73	80.2	10	100.0	0.202
	Female		18	17.8		18	19.8	0	0.0
Age
		18–29 years	30		29.7	25	27.5	5	50.0
		30–49 years	45		44.6	40	44.0	5	50.0
		50 years and more	26		25.7	26	28.6	0	0.0
		Median (inter-quartile range): years	39 (27–50)			40 (27–50)		31 (24.5–38.8)
Educational attainment
		No formal education	55		54.5	51	56.0	4	40.0	0.324
		Primary school	25		24.8	20	22.0	5	50.0
		Secondary school or higher	21		20.8	20	22.0	1	10.0
Main source of income
		Farming	97		96.0	87	95.6	10	100.0	1.000
		Company officer	4		4.0	4	4.4	0	0.0
Living with a child under five years of age
		Yes	78		77.2	69	75.8	9	90.0	0.448
		No	23		22.8	22	24.2	1	10.0
Living with a person aged 60 years or over
		Yes	50		49.5	44	48.4	6	60.0	0.525
		No	51		50.5	47	51.6	4	40.0
Wealth Index
		First (least poor)	32		31.7	30	33.0	4	40.0	0.767
		Second	35		34.7	31	34.1	4	40.0
		Third (poorest)	34		33.7	30	33.0	2	40.0
Floor material
		Wood	58		57.4	51	56.0	7	70.0
		Bamboo	33		32.7	30	33.0	3	30.0
		Cement	10		9.9	10	11.0	0	0.0
Wall material
		Wood	52		51.5	48	52.7	4	40.0
		Bamboo	45		44.6	39	42.9	6	60.0
		Brick	4		4.0	4	4.4	0	0.0
^a: Fisher’s exact test

Boiling practices

Except for two participants, all the participants boil their drinking water using an open cooking stove with wood fuel (Table 2). The most common place for boiling water was outside the living room but inside the house (59.4%), followed by inside the living room (24.8%) (additional file 2). A kettle (92.1%) was the most common tool for boiling water. Most of the participants (96.1%) owned only one or two kettles/other boiling tools. The most common type of container for boiled water was kettles (37.6%), followed by pitchers (30.7%) and bottles (29.7%). Most of the participants (96.0%) boiled water on the day of the survey or one day before the survey. The majority of the participants (90.1%) have a fixed schedule for boiling water: most of the participants (94.1%) boil water every day: the most common time for boiling water is in the morning (84.2%). Almost all participants (95.0%) put something (mostly leaf) in water when they boil water. The most common reason for putting something was to improve the taste (72.9%), followed by to boil water fast (13.5%).

Table 2

Water boiling-related information
		Total		Households with boiled water		Households without boiled water
Characteristics		n (n = 101)	%	n (n = 91)	%		n (n = 10)	%		p-value
Presence of boiled water (95%confidence intervals)		(82.5% − 95.1%)
How to boil the water
	Open cooking stove	99	98.0	90	98.9		9	90.0		0.189
	Electric pot	2	2.0	1	1.1		1	10.0
Fuel material		(n = 99)		(n = 90)			(n = 9)
	Wood	99	100.0	90	100.0	9		100.0
Fuel stockpile		(n = 99)		(n = 90)			(n = 9)
	For within a week	36	36.4	32	35.6		4	44.4		0.367
	For one to three weeks	16	15.2	15	16.7		0	0.0
	For four weeks or longer	48	48.5	43	47.8		5	55.6
Place of boiling
	Outside the living room but inside the house	60	59.4	55	60.4		5	50.0		0.714
	Inside the living room	25	24.8	22	24.2		3	30.0
	Outside the house	16	15.8	14	15.4		2	20.0
Tool of the boiling
	Kettle	93	92.1	85	93.4		8	80.0		0.529
	Pot	6	5.9	5	5.5		1	10.0
	Electronic pot	2	2.0	1	1.1		1	10.0
Number of boiling tools
	One	63	62.4	55	60.4		8	80.0		0.664
	Two	34	33.7	32	35.2		2	20.0
	Three	4	4.0	4	4.4		0	0.0
Type of the container for boiled water
	Kettles	38	37.6	29	31.9		2	20.0		0.109
	Picher	31	30.7	25	27.5		5	50.0
	Bottles	30	29.7	36	39.6		2	20.0
	Electric pot	2	2.0	1	1.1		1	10.0
When was the last time you or other member boiled water?
	Today/yesterday	97	96.0	89	97.8	8		80.0	0.048
	2 to 3 days before	2	2.0	1	1.1	1		10.0
	4 ≥ days before	2	2.0	1	1.1	1		10.0
Do you have a fixed schedule for boiling water?
	Yes	91	90.1	86	94.5	5		50.0	< .001
	No	10	9.9	5	5.5	5		50.0
Frequency of boiling water in a week
	Everyday	95	94.1	88	96.7	7		70.0	0.012
	3 or 4 times a week	5	5.0	3	3.3	2		20.0
	1 or 2 times a week	1	1.0	0	0.0	1		10.0
Timing of boiling in a day
	In the morning	85	84.2	78	85.7	7		70.0	0.128
	In the evening	3	3.0	2	2.2	1		10.0
	Whenever necessary	13	12.9	11	12.1	2		20.0
Do you put something in water during/after boiling?
	Yes	96	95.0	87	95.6	9		90.0	0.413
	No	5	5.0	4	4.4	1		10.0
What do you put in water?		(n = 96)		(n = 87)		(n = 9)
	Leaf	86	85.1	77	88.5	9		100.0	1.000
	Branch	3	3.0	3	3.4	0		0.0
	Root	6	5.9	6	6.9	0		0.0
	Vietnam tea leaf	1	1.0	1	1.1	0		0.0
Reason for putting things in water		(n = 96)		(n = 87)		(n = 9)
	To taste good	70	72.9	66	75.9	4		44.4
	To boil water early	13	13.5	11	12.6	2		22.2
	To improve water for health purposes	7	7.3	6	6.9	1		11.1
	To clean water	5	5.2	4	4.6	1		11.1
	I don’t know	1	1.0	0	0.0	1		11.1

Source of drinking water and preferences

The most common source of drinking water was piped spring (43.5%), followed by groundwater (22.2%) and spring (17.6%) (Table 3). Most of the participants (74.3%) reported that they can get to their water sources within five minutes. However, some participants (15.8%) need over 10 minutes to reach the water sources.

Table 3

Water source, perception and belief
		Total		Households with boiled water		Households with no boiled water
Characteristics		n (n = 101)	%	n (n = 91)	%	n (n = 10)	%	p-value
Main source of drinking water (Multiple choices were allowed)		(n = 108)		(n = 97)		(n = 11)
	Piped spring	47	43.5	46	47.4	1	9.1
	Groundwater	24	22.2	20	20.6	4	36.4
	Spring	19	17.6	15	15.5	4	36.4
	Tap water	12	11.1	12	12.4	0	0.0
	Well	6	5.6	4	4.1	2	18.2
Time required to reach the water source
	Within 5 minutes	75	74.3	72	79.1	3	30.0	< .001
	6 to 10 minutes	10	9.9	9	9.9	1	10.0
	Over 10 minutes	16	15.8	10	11.0	6	60.0
Is it hard for you to boil water?
	Yes	33	32.7	28	30.8	5	50.0	0.288
	No	68	67.3	63	69.2	5	50.0
Which water tastes better, boiled/non-boiled water?
	Boiled water	96	95.0	89	97.8	7	70.0	< .001
	Non-boiled water	5	5.0	2	2.2	3	30.0
Frequency of drinking boiled water in a day
	Every time	75	74.3	75	82.4	0	0.0	< .001
	While at home	24	23.8	16	17.6	8	80.0
	While outside	2	2.0	0	0.0	2	20.0
Who drinks boiled water in your family?
	All the family members	75	74.3	68	74.7	7	70.0	0.866
	Only adult member	8	7.9	7	7.7	1	10.0
	Some members: details are unknown	18	17.8	16	17.6	2	20.0
Do you think drinking boiled water will prevent diarrhea?
	Yes	84	83.2	77	84.6	7	70.0	0.256
	No	6	5.9	5	5.5	1	10.0
	I don’t know	11	10.9	9	9.9	2	20.0

Water drinking behavior, perception and belief about boiling

Most of the participants (67.3%) perceived that boiling drinking water is not hard. For most of the participants (95.0%), boiled water taste better than non-boiled water. Although most of the participants (74.3%) drink boiled water every time, approximately a quarter (23.8%) of the participants drink boiled water only when they are at home. Not all family members do not necessarily drink boiled water: approximately a quarter (25.7%) of the participants reported that some household members drink unboiled water. Most of the participants (83.2%) believed that drinking boiled water can prevent diarrhea.

Results of Fisher's exact test

There were statistically significant differences between households with boiled water and households without boiled water regarding water boiling-related information; the last time when water was boiled (p = 0.048), the presence of a fixed schedule of boiling (p < 0.001), and the frequency of boiling water in a week (p = 0.012). There were statistically significant differences in the following variables regarding water source, perceptions, and beliefs; time required to reach the water source (p < 0.001), preference for drinking water (p < 0.001), and frequency of drinking boiled water in a day (p < 0.001).

High presence of boiled water

To be the best of our knowledge, this study is the first study that assessed the gap between self-reported measurement and observational measurement for household boiling water practice in Lao PDR. This study showed that among the households that reported boiling as HWT, 90.1% were able to show water that seems to have been boiled. It suggests that the validity of the self-reported measure of boiling practices can be high in the study site. There are at least two possible reasons for the high proportion. First, most of the participants (95.0%) put something (mostly leaves) in their water. In these areas, most people drink tea for drinking water. These areas are located near Vietnam thus the tea-drinking habit might come from Vietnamese culture [17]. The tea-drinking habit may have led to the high proportion of boiled water. Second, most of the participants (83.2%) believed that drinking boiled water can prevent diarrhea, suggesting that knowledge about the importance of boiling is a contributing factor. In fact, a study conducted in Ethiopia reported that knowledge about drinking water is associated with better HWT practices [18, 19].

Statistical significance of daily scheduled boiling water

Among the factors that were statistically significantly associated with the presence of boiled water, we should emphasize "having a fixed schedule for boiling water": households having a fixed schedule for boiling water were approximately two times more likely to have self-reported boiled water. This is because setting up a fixed schedule can be adopted by households without additional resources.

Higher participants of male

The most of the participants (82.2%) were male. This is because of the traditional division of gender roles in this area. A child nutrition study in Savannakhet reported that the father often enjoyed greater autonomy than the mother [20]. This gender gap may have been a barrier to women's participation. If we could have asked women, their answers could have been different.

Perception of drinking boiled water

This study also showed that, even though boiled water is available at household, some household members including young children do not drink boiled water. A study in Savannakhet find that 37.0% of mother do not boil drinking water to their children [20]. This suggests that the investigation at household-level alone is not enough: water-drinking behavior at individual level should also be investigated for better assessing drinking water-based risk of diarrhea.

Limitations

There are two major limitations of the study. First, the measurement of the presence of boiled water may be inaccurate, because of no direct observation of the actual boiling process. Therefore, some of the participant-identified boiled water might not have been boiled. The present study used a proxy observation which is used when it is difficult to observe the actual object of a study directly. The proxy observation of boiling practice in the present study is considered to be reliable for the following two reasons. First, a study with rural households in Cambodia reported that the participant-identified boiled water showed significantly lower microbial indicators compared to the participant-identified pre-treatment water [14]. Second, during the household survey, when the surveyors asked study participants to show boiled water, most of the study participants showed brown color water (i.e., tea water). These pieces of information could serve as evidence that the participant-identified water was actually boiled. The second limitation is that, the study area was confined to the purposively selected four villages in the two health center zones, the applicability of the present study’s findings to a wider area is therefore of concern. However, the present study’s findings can be applicable to a wider area of the Xepon district, because the study participants’ ethnic group (i.e., Tri group) is widely seen in Xepon district [21].

The present study showed that among households that reported boiling drinking water, 90.1% (95% CI: 82.5–95.1%) were able to show a container with water that seems to have been boiled. It suggests that the self-reported measure of boiling practices is valid in the study villages. A further study in randomly selected villages from a wider area is recommended to confirm the findings of the present study.

Ethical approval and consent to participate.

This study was conducted with the approval of the National Ethics Committee for Health Research, Lao PDR (No.42) and the Ethics Committee of the University of the Ryukyus for Medical and Health Research Involving Human Subjects, Japan (No.23-2163). Before starting the survey, the researchers explained to the participants the following details; 1) the purpose of the study, 2) voluntary nature of the participation , 3) details of information we collect, and 4) method of storing and managing the data. Written informed consent was obtained from each participant.

Consent for publication

Not applicable.

Availability of data and materials

The datasets generated or analyzed in the current study are available from the corresponding author upon a reasonable request.

Competing interests

The authors declare that one of the authors (DN) is serving as an editor for Tropical Medicine and Health.

Funding

This work was supported by JSPS Core-to-Core Program (grant number: JPJSCCB20220002).

Authors contributions

SK was the principal investigator and drafted the manuscript. DN was the expert on the analysis of data and made final comments on the manuscript. NI was contributed to the conceptual framework and reviewed the manuscript. All authors read and agreed to the final manuscript.

Acknowledgments

We sincerely thank the study participants and surveyors for their contribution to this study.

United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), 　Levels & Trends in Child Mortality: Report 2021, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation, United Nations Children’s Fund, New York, 2021
World Health Organization. Diarrhoeal Disease. Available online: https://www.who.int/news-room/fact-sheets/detail/ diarrhoeal-disease accessed 1^st May 2024.
Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, Ensink J, Freeman M, Jenkins M, Odagiri M, Ray S, Sinha A, Suar M, Schmidt WP. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health. 2014 Nov;2(11):e645-53.
DHS program. Who We Are. Available online: https://dhsprogram.com/Who-We-Are/About-Us.cfm accessed 1st May 2024.
WHO/UNICEF, 2006. Core Questions on Drinking Water and Sanitation for Household Surveys. Geneva, Switzerland: World Health Organization
Chidziwisano K, Tilley E, Morse T. Self-Reported Versus Observed Measures: Validation of Child Caregiver Food Hygiene Practices in Rural Malawi. Int J Environ Res Public Health. 2020 Jun 23;17(12):4498.
Rosa G, Kelly P, Clasen T. Consistency of Use and Effectiveness of Household Water Treatment Practices Among Urban and Rural Populations Claiming to Treat Their Drinking Water at Home: A Case Study in Zambia. Am J Trop Med Hyg. 2016 Feb;94(2):445-55.
Rosa G, Huaylinos ML, Gil A, Lanata C, Clasen T. Assessing the consistency and microbiological effectiveness of household water treatment practices by urban and rural populations claiming to treat their water at home: a case study in Peru. PLoS One. 2014 Dec 18;9(12):e114997.
Benwic A, Kim E, Khema C, Phanna C, Sophary P, Cantwell RE. Factors associated with post-treatment E. coli contamination in households practising water treatment: a study of rural Cambodia. Int J Environ Health Res. 2018 Apr;28(2):178-191.
GBD 2016 Diarrhoeal Disease Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017, 17, 909–948.
Lao Statistics Bureau. Lao Social Indicator Survey II (LSIS II). Available online: https://lao.unfpa.org/sites/default/files/pubpdf/Lao%20Social%20Inndicator%20Survey%20II%202017-18%20%28English%29_0.pdf accessed 1^stMay 2023.
Nonaka D, Inthavong N, Takahashi K, Chanthakoumane K, Toyama Y, Luangphaxay C, Pongvongsa T, Kounnavong S. Primary health care situations in remote rural villages of the Savannakhet province, Lao People's Democratic Republic. Trop Med Health. 2022 Nov 28;50(1):90. doi: 10.1186/s41182-022-00482-9.
Rosa G, Clasen T. Consistency of Use and Effectiveness of Household Water Treatment among Indian Households Claiming to Treat Their Water. Am J Trop Med Hyg. 2017 Jul;97(1):259-270. doi: 10.4269/ajtmh.16-0428.
Brown J, Sobsey MD. Boiling as household water treatment in Cambodia: a longitudinal study of boiling practice and microbiological effectiveness. Am J Trop Med Hyg. 2012 Sep;87(3):394-8. doi: 10.4269/ajtmh.2012.11-0715. Epub 2012 Jul 23.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013 Mar;48(3):452-8.
Lao People Democratic Republic Peace Independence Democracy Unity Prosperity Ministry Of Education And Sports Education And Sports Sector Development Plan 2021-2025 Available online: https://planipolis.iiep.unesco.org/sites/default/files/ressources/lao_pdr_education_and_sports_sector_development_plan_2021-2025.pdf accessed 1st May 2024
Wenner, Robert, "The Deep Roots of Vietnamese Tea: Culture, Production and Prospects for Development" (2011). Independent Study Project (ISP) Collection. 1159.
Bitew BD, Gete YK, Biks GA, Adafrie TT. Knowledge, Attitude, and Practice of Mothers/Caregivers on Household Water Treatment Methods in Northwest Ethiopia: A Community-Based Cross-Sectional Study. Am J Trop Med Hyg. 2017 Sep;97(3):914-922. doi: 10.4269/ajtmh.16-0860.
Sisay W/Tsadik D, Debela BG, Ali Ewune H, Hareru HE. Determinants of Household-Level Water Treatment Practices in Southern Ethiopia. Environ Health Insights. 2022 Jun 27;16:11786302221109399. doi: 10.1177/11786302221109399.
Boulom S, Bon DM, Essink D, Kounnavong S, Broerse JEW. Understanding Discrepancies in Nutritional Outcomes Among Under-Fives in Laos: A Mixed-Methods Study Using the Positive Deviance Approach. Food and Nutrition Bulletin. 2022;43(3):303-322.
Inthavong N, Nonaka D, Kounnavong S, Iwagami M, Phommala S, Kobayashi J, Hongvanthong B, Pongvongsa T, Brey PT, Kano S. Individual and household factors associated with incidences of village malaria in Xepon district, Savannakhet province, Lao PDR. Trop Med Health. 2017 Nov 7;45:36. doi: 10.1186/s41182-017-0077-2.

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Do they really boil their drinking water? : a descriptive study in a rural district of the Lao People's Democratic Republic

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Journal Publication

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Abstract

Background

Methods