Local ownership of public health research in low- and middle-income countries: The case of nutrition research in the Lao PDR

Abstract Background: In Low- and Middle-Income Countries (LMICs) such as Lao PDR, public health research is frequently donor-driven, which may lead to a misalignment between research outputs and national priorities. Without local ownership, defined as the ability of local actors to lead the design, management, and implementation of research, evidence is less likely to inform effective policies. This thesis explores local ownership within the context of the triple burden of malnutrition (the coexistence of undernutrition, overnutrition, and micronutrient deficiencies) in Lao PDR. The primary objective was to determine how nutrition research can be tailored through specific priorities, metrics, and target populations to effectively inform national health strategies. Methodology: Utilizing an emergent design, the thesis combined six studies employing mixed methods, including participatory workshops, cross-sectional quantitative surveys, and qualitative semi-structured interviews. Indicators were tracked across the life course, from infancy and adolescence through to adulthood. Key Findings 1. Research Priorities: A National Health Research Agenda was established through a participatory process involving stakeholders from central to district levels. Eleven research domains were prioritized, with health-seeking behavior, health systems, and mother and child health (MCH) ranking highest. Over 200 unique, action-oriented research questions were identified to steer future resource allocation. 2. Locally Appropriate Metrics: The thesis evaluated the validity of anthropometric tools and data collection methods for the Lao context. It was found that the waist-to-height ratio (WHtR), with an optimal cutoff of 0.5, outperformed the conventional Body Mass Index (BMI) as a non-invasive screening tool for diabetes and hypertension. A contextualized “Photo Food Book” was developed to improve the accuracy of dietary assessments. Significantly, the research validated novel online data collection tools to assess adolescent food preferences, providing a cost-effective alternative for reaching internet-active youth in resource-limited settings. 3. Neglected Populations: Gaps in current programming were identified, noting that while national policies focus on rural MCH, they often overlook adolescents, adult males, and the elderly. A mixed-methods study in Vientiane revealed that high undernutrition persists in urban areas not due to food scarcity, but because of challenges in the translation of nutritional knowledge into practice by caregivers Conclusion and Recommendations: Sustainable nutrition improvement in Lao PDR depends on transitioning from donor-led directives to robust local ownership. This requires multi-sectoral collaboration to address the evolving epidemiological landscape. Policies must incorporate a life-course approach addressing both persistent undernutrition and the rising burden of non-communicable diseases (NCDs). Key recommendations include institutionalizing the National Health Research Agenda, adopting WHtR for clinical screening, and leveraging validated online tools and technology for practical health education that empowers caregivers. Ultimately, local ownership ensures research is inclusive, culturally acceptable, and capable of generating sustainable public health impact