Health and health care in Laos were poor in the early 1990s. Although diets are not grossly inadequate, chronic moderate vitamin and protein deficiencies are common, particularly among upland ethnic groups. Poor sanitation and the prevalence of several tropical diseases further eroded the health of the populatioÍÍÍÍn. Western medical care is available in few locations, and the quality and experience of practitioners are, for the most part, marginal, a situation that has not improved much since the 1950s.

The life expectancy at birth for men and women in Laos was estimated in 1988 at forty-nine years, the same as in Cambodia but at least ten years lower than in any other Southeast Asian nation. High child and infant mortality rates strongly affected this figure, with the Ministry of Public Health estimating the infant mortality rate at 109 per 1,000 and the under-five mortality rate at 170 per 1,000 in 1988. The United Nations Children's Fund (UNICEF--see Glossary) believed these figures underestimated the true mortality rate but still represented decreases from comparable rates in 1960. Regional differences were great. Whereas the infant mortality rate for Vientiane was about 50 per 1,000, in some remote rural areas it was estimated to be as high as 350 per 1,000 live births that is, 35 percent of all children died before the age of one.

Children's deaths are primarily due to communicable diseases, with malaria, acute respiratory infections, and diarrhea the main causes of mortality as well as morbidity. Vaccination against childhood diseases was expanding, but in 1989 Vientiane's municipal authorities still were unable to vaccinate more than 50 percent of targeted children. Other provinces have much lower rates of immunization. Malaria is widespread among both adults and children, with the parasite Plasmodium falciparum involved in 80 to 90 percent of the cases.

In the first malaria eradication program between 1956-60, DDT was sprayed over much of the country. Since 1975 the government has steadily increased its activities to eradicate malaria. The Ministry of Public Health operates provincial stations to monitor and combat malaria through diagnosis and treatment. Prevention measures involve chemical prophylaxis to high-risk groups, elimination of mosquito breeding sites, and promotion of individual protection. The campaign has had some success: the ministry reported a decline in the infected population from 26 percent to 15 percent between 1975 and 1990.

As of 1993, diarrheal diseases were also common, with regular outbreaks occurring annually at the beginning of the rainy season when drinking water is contaminated by human and animal wastes washing down hillsides. Only a few rural households have pit or water-seal toilets, and people commonly relieve themselves in the brush or forested areas surrounding each village. For children in these villages, many of whom are chronically undernourished, acute or chronic diarrhea is life-threatening because it results in dehydration and can precipitate severe malnutrition.

740Althoughgh nutrition appears to be marginal in the general population, health surveys are of varying quality. Some data indicate that stunting--low height for age--in the under-five population ranged from 2 to 35 percent, while wasting--low weight for height--probably does not exceed 10 percent of the under-five population. These figures reflect village diets based predominantly on rice, with vegetables as a common accompaniment and animal protein--fish, chicken, and wild foods--eaten irregularly. Children aged six months to two years--the weaning period--are particularly susceptible to undernutrition. The nutritional status of adults is related closely to what is being grown on the family farm, as well as to dietary habits. For example, fresh vegetables and fruits are not highly valued and therefore are not consumed in adequate amounts. As a result, it is likely that vitamin A, iron, and calcium deficiencies are common in all parts of the country.

Data as of July 1994