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1.
BMC Pediatr ; 21(1): 390, 2021 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-34493225

RESUMEN

BACKGROUND: Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies' Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. METHODS: This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies' Lives programme, which is the intervention. The Saving Babies' Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies' Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. DISCUSSION: Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04663620 . Registered on 11th December 2020, retrospectively registered.


Asunto(s)
Mortalidad Infantil , Población Rural , Cambodia , Agentes Comunitarios de Salud , Atención a la Salud , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto
2.
Trop Anim Health Prod ; 53(5): 480, 2021 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-34561731

RESUMEN

In Cambodia, information on common pathogens causing reproductive losses in cattle and buffalo are lacking, despite there being a need to address livestock health to enhance food security. We analysed stored buffalo (n = 29) and cattle (n = 471) serum samples collected in 2016 using commercially available enzyme-linked immunosorbent assay kits. Antibodies to Neospora caninum, bovine viral diarrhoea virus (BVDV), Leptospira interrogans serovar Hardjo and Brucella abortus were detected in buffalo samples at 79.3% (95% CI 64.6-94.0), 3.4% (95% CI 0-10.0), 0% and 0%, respectively, and in cattle at 4.2% (95% CI 2.4-6.0), 6.4% (95% CI 4.2-8.6), 8.1% (95% CI 5.6-10.6) and 0%, respectively. The high N. caninum seroprevalence in buffalo was associated with increasing age, with buffalo having a 13.1% chance of being seropositive at birth, increasing to 99.4% by age 7 (p = 0.045). This suggests a predominance of horizontal transmission, possibly from exposure to faeces from free-roaming village dogs. Cattle L. interrogans serovar Hardjo seroprevalence was highest in Tbong Khmum province (20.4%) compared to other provinces (p < 0.001), and may be compromising bovine fertility and creating a zoonotic risk for smallholders who may contract leptospirosis from farm work. These high infection rates prompt further research to determine: to what extent these pathogens are linked to the low reproductive efficiency observed in large ruminants in Cambodia, the risk factors to pathogen exposure and appropriate strategies to reduce these risks. Low BVDV and B. abortus exposure is an important observation. Increasing large ruminant livestock trade into the country will require improved biosecurity and disease surveillance to prevent their emergence. An enhanced understanding of the status of infectious reproductive livestock pathogens in Cambodia can assist development projects to make evidence-based strategies to enhance cattle and buffalo health and improve food security.


Asunto(s)
Enfermedades de los Bovinos , Enfermedades de los Perros , Neospora , Animales , Búfalos , Cambodia/epidemiología , Bovinos , Enfermedades de los Bovinos/epidemiología , Perros , Seguridad Alimentaria , Estudios Seroepidemiológicos
3.
Emerg Infect Dis ; 27(10): 2742-2745, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34546164

RESUMEN

In February 2021, routine sentinel surveillance for influenza-like illness in Cambodia detected a human avian influenza A(H9N2) virus infection. Investigations identified no recent H9N2 virus infections in 43 close contacts. One chicken sample from the infected child's house was positive for H9N2 virus and genetically similar to the human virus.


Asunto(s)
Subtipo H9N2 del Virus de la Influenza A , Gripe Aviar , Gripe Humana , Animales , Aves , Cambodia/epidemiología , Pollos , Humanos , Subtipo H9N2 del Virus de la Influenza A/genética , Gripe Aviar/epidemiología , Gripe Humana/epidemiología
4.
Parasite ; 28: 60, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34374642

RESUMEN

Between 2016 and 2020, the Medical and Veterinary Entomology unit of the Institut Pasteur du Cambodge collected over 230,000 mosquitoes. Based on this sampling effort, a checklist of 290 mosquito species in Cambodia is presented. This is the first attempt to list the Culicidae fauna of the country. We report 49 species for the first time in Cambodia. The 290 species belong to 20 genera: Aedeomyia (1 sp.), Aedes (55 spp.), Anopheles (53 spp.), Armigeres (26 spp.), Coquillettidia (3 spp.), Culex (57 spp.), Culiseta (1 sp.), Ficalbia (1 sp.), Heizmannia (10 spp.), Hodgesia (3 spp.), Lutzia (3 spp.), Malaya (2 spp.), Mansonia (5 spp.), Mimomyia (7 spp.), Orthopodomyia (3 spp.), Topomyia (4 spp.), Toxorhynchites (4 spp.), Tripteroides (6 spp.), Uranotaenia (27 spp.), and Verrallina (19 spp.). The Cambodian Culicidae fauna is discussed in its Southeast Asian context. Forty-three species are reported to be of medical importance, and are involved in the transmission of pathogens.


Asunto(s)
Aedes , Culex , Culicidae , Animales , Cambodia , Lista de Verificación , Mosquitos Vectores
5.
BMC Infect Dis ; 21(1): 763, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34362310

RESUMEN

BACKGROUND: Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients' and health facilities' burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model's effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. METHODS: We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD-a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers' work burden, the model's cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. DISCUSSION: This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04766710 . Registered 23 February 2021, Version 1.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Fármacos Anti-VIH/uso terapéutico , Cambodia , Infecciones por VIH/tratamiento farmacológico , Humanos , Calidad de Vida , Factores de Tiempo
6.
Matern Child Nutr ; 17(4): e13224, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34414653

RESUMEN

Child undernutrition in Cambodia is a persistent public health problem requiring low-cost and scalable solutions. Rising cellphone use in low-resource settings represents an opportunity to replace in-person counselling visits with phone calls; however, questions remain on relative effectiveness. Our objective was to evaluate the impact of two options for delivering a World Vision infant and young child feeding (IYCF) counselling programme: (1) traditional Positive Deviance/Hearth (PDH) programme with in-person visits or (2) PDH with Interactive Voice Calling (PDH-IVC) which integrates phone calls to replace 62.5% of face-to-face interaction between caregivers and volunteers, compared to the standard of care (SOC). We conducted a longitudinal cluster-randomised controlled trial in 361 children 6-23 months. We used an adjusted difference-in-difference approach using baseline, midline (3 months) and endline (12 months) surveys to evaluate the impact on child growth among the three groups. At baseline, nearly a third of children were underweight, and over half were food insecure. At midline the PDH group and the PDH-IVC groups had improved weight-for-age z-scores (0.13 DID, p = 0.011; 0.13 DID, p = 0.02, respectively) and weight-for-height z-score (0.16 DID, p = 0.038; 0.24 DID, p = 0.002), relative to SOC. There were no differences in child height-for-age z-scores. At endline, the impact was sustained only in the PDH-IVC group for weight-for-age z-score (0.14 DID, p = 0.049), and the prevalence of underweight declined by 12.8 percentage points (p = 0.036), relative to SOC. Integration of phone-based IYCF counselling is a potentially promising solution to reduce the burden of in-person visits; however, the modest improvements suggest the need to combine it with other strategies to improve child nutrition.


Asunto(s)
Teléfono Celular , Trastornos de la Nutrición del Niño , Desnutrición , Cambodia/epidemiología , Niño , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/prevención & control , Trastornos del Crecimiento , Humanos , Lactante , Desnutrición/epidemiología , Desnutrición/prevención & control
7.
Int J Radiat Oncol Biol Phys ; 111(1): 14-22, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34348108

RESUMEN

PURPOSE: Cambodia is a Southeast Asian low-middle-income country with a population of >15 million. In 2020, Cambodia was estimated to have 18,375 new diagnoses of cancer and 12,638 deaths attributable to cancer. Cambodia was estimated to have a deficit of 16 megavoltage machines in 2012. Cambodia's radiation therapy services have suffered through the tumultuous events of the country's history, with intermittent services until the last decade. In recent years, Cambodia has undergone rapid economic growth and, with this, the development of its first comprehensive cancer center, the National Cancer Centre (NCC). METHODS AND MATERIALS: Planning for NCC began in the early 2000s, with the aim to provide comprehensive care, including modern radiation therapy services, to the public. Funding for the center was supplied primarily by the Cambodian government, assisted by donations from partners including the International Atomic Energy Agency. Training collaborations were formed with international partners, including the Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) of the Royal Australian and New Zealand College of Radiologists and the Asia-Pacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists and Engineers in Medicine. RESULTS: The main model of APROSIG/APSIG collaboration has been in-country training, including the posting of an Australian medical physicist and radiation therapist in Phnom Penh for a year's duration to oversee a safe and sustainable start to the radiation therapy program. The first linear accelerator patient was treated at NCC in March 2018 and the first brachytherapy patient in September 2018. Since that time, the department has treated to capacity, with very little machine downtime. NCC provides comprehensive cancer services including medical oncology, pediatric oncology, hematology, palliative care, surgical oncology, and nuclear medicine. Several challenges to expanding radiation therapy services currently exist, including human resources and cultural stigma. CONCLUSION: Despite many decades of tragedy and suffering, Cambodia serves as an example of successful implementation of modern radiation therapy in a low- and middle-income country. The keys to success have included local champions, support of the Ministry of Health, and willingness to embrace collaboration. The pandemic brings yet another challenge to cancer control in Cambodia, and novel training platforms are being explored.


Asunto(s)
Cooperación Internacional , Oncología por Radiación , COVID-19/epidemiología , Cambodia/epidemiología , Atención a la Salud , Humanos , SARS-CoV-2 , Cambio Social , Recursos Humanos
8.
J Obstet Gynaecol Res ; 47(10): 3652-3660, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34342367

RESUMEN

AIM: Management of hydatidiform mole is important to reduce the mortality and morbidity of choriocarcinoma. This study aims to understand the existing health services for hydatidiform mole and to estimate the incidence of gestational trophoblastic disease (GTD) in Cambodia. METHODS: A questionnaire was used to collect information on the existing health services for pregnancy and hydatidiform mole at health facilities from attendants of the 16th Annual Conference of the Cambodian Society of Gynecology and Obstetrics in 2017. The incidence of GTD in 2014-2017 was estimated using Health Information System data. RESULTS: A total of 126 attendants, who were from all provinces except three provinces, answered the questionnaire. The work places were national hospitals (n = 29), provincial hospitals (n = 42), district hospitals (n = 20), health centers (n = 6), and others (n = 29). The answers of participants from the public sector suggested the following: Ultrasonography is available at all hospitals but not health centers; Human chorionic gonadotropin (hCG) measurement is only available at national hospitals; Treatment of hydatidiform mole is performed at national hospitals and provincial hospitals; and Treatment of gestational trophoblastic neoplasia (GTN) is provided at national hospitals. The incidence of hydatidiform mole and GTN at health facilities in the public sector in 2014-2017 was 0.95 per 1000 deliveries and 6.58 per 100 000 deliveries, respectively. CONCLUSIONS: The results suggest that provincial hospitals are important to detect suspected invasive mole and refer to national hospitals for diagnosis and treatment. Further studies on the management of GTD and development of the guidelines of GTD are needed.


Asunto(s)
Enfermedad Trofoblástica Gestacional , Mola Hidatiforme , Neoplasias Uterinas , Cambodia/epidemiología , Gonadotropina Coriónica , Femenino , Servicios de Salud , Humanos , Mola Hidatiforme/diagnóstico , Mola Hidatiforme/epidemiología , Mola Hidatiforme/terapia , Embarazo , Neoplasias Uterinas/epidemiología , Neoplasias Uterinas/terapia
10.
BMJ Open ; 11(7): e045900, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-34233975

RESUMEN

INTRODUCTION: In the Greater Mekong Subregion, adults are at highest risk for malaria. The most relevant disease vectors bite during daytime and outdoors which makes forest work a high-risk activity for malaria. The absence of effective vector control strategies and limited periods of exposure during forest visits suggest that chemoprophylaxis could be an appropriate strategy to protect forest goers against malaria. METHODS AND ANALYSIS: The protocol describes an open-label randomised controlled trial of artemether-lumefantrine (AL) versus multivitamin as prophylaxis against malaria among forest goers aged 16-65 years in rural northeast Cambodia. The primary objective is to compare the efficacy of the artemisinin combination therapy AL versus a multivitamin preparation as defined by the 28-day PCR parasite positivity rate and incidence of confirmed clinical malaria of any species. The sample size is 2200 patient-episodes of duration 1 month in each arm. The duration of follow-up and prophylaxis for each participant is 1, 2 or 3 consecutive 28-day periods, followed by a further 28 days of post-exposure prophylaxis, depending on whether they continue to visit the forest. Analysis will be done both by intention to treat and per protocol. ETHICS AND DISSEMINATION: All participants will provide written, informed consent. Ethical approval was obtained from the Oxford Tropical Research Ethics Committee and the Cambodia National Ethics Committee for Health Research. Results will be disseminated by peer-reviewed open access publication together with open data. TRIAL REGISTRATION NUMBER: NCT04041973; Pre-result.


Asunto(s)
Antimaláricos , Malaria Falciparum , Malaria , Adulto , Antimaláricos/uso terapéutico , Arteméter/uso terapéutico , Combinación Arteméter y Lumefantrina/uso terapéutico , Cambodia , Bosques , Humanos , Malaria/tratamiento farmacológico , Malaria/prevención & control , Malaria Falciparum/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
11.
Matern Child Nutr ; 17 Suppl 1: e13169, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34241960

RESUMEN

This study aims to understand nutrition-related roles, responsibilities and ethical issues of grandparents caring for their grandchildren in skip-generation households in rural Cambodia. Over the past decade, Cambodia has experienced a rise in economic migration of working age populations. This has resulted in increasing numbers of 'skip-generation' households, in which grandparents and grandchildren co-reside without parents, reflecting potential household vulnerability. This qualitative study involved in-depth interviews and focus group discussions with Cambodian grandparents who were primary caregivers to grandchildren for six months or longer. A total of 39 grandparents were recruited at two sites in north-west Cambodia. Interviews and focus group discussions were conducted in Khmer and were recorded, transcribed and translated into English. Data were analysed using thematic analysis. Grandparents in this study looked after an average of three children, aged between two months and 18 years old. Overall, 40% were sole caregivers. Analysis showed that grandparents, particularly grandmothers, played a central role in their grandchildren's health and nutrition. Although grandchildren's health and nutrition were a major priority to grandparents, they reported facing significant challenges to safeguard their grandchildren's and their own nutritional needs. As a result, grandparents frequently faced difficult ethical trade-offs and prioritised their grandchildren's health and nutrition over their own. This study highlights that in order to improve child nutrition, policies and interventions need to be designed in ways that support and enable grandparent caregivers to meet their grandchildren's health and nutritional needs without neglecting their own.


Asunto(s)
Abuelos , Grupo de Ascendencia Continental Asiática , Cambodia , Cuidadores , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Humanos , Lactante
12.
Parasitol Res ; 120(8): 2819-2825, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34324098

RESUMEN

Cattle and buffaloes, popular protein sources worldwide, are intermediate hosts for several Sarcocystis species. These coccidian protozoans cause sarcocystosis resulting in subclinical and chronic infections in striated muscles by forming macrocysts or microcysts. In Thailand, Lao People's Democratic Republic, and Cambodia, Sarcocystis species have been reported, but molecular identification has been lacking. This study investigates the prevalence of infection, histo-morphology, and molecular identification of Sarcocystis species in hearts of cattle and buffalo sold in local markets. A phylogenetic tree inferred from a portion of the 18S ribosomal (r) RNA gene was used to identify the genus and species of Sarcocystis. The mitochondrial cytochrome c oxidase subunit 1 (cox-1 gene) was sequenced to confirm the species of host tissue. In Thailand, Sarcocystis was detected in 66.7% (14/21) of samples. In Lao People's Democratic Republic, 90% (9/10) of samples were infected and in Cambodia 100% (8/8). For the first time from these countries, we report Sarcocystis cruzi, Sarcocystis heydorni, and Sarcocystis levinei found in taurine cattle (Bos taurus) and water buffalo (Bubalus bubalis). Zoonotic protozoan transmission needs to be controlled by inspection activities by local health inspectors, and appropriate action is required at all points in the food chain by competent authorities to protect consumer health and prevent sarcocystosis in cattle and water buffaloes.


Asunto(s)
Sarcocystis , Sarcocistosis , Animales , Búfalos/parasitología , Cambodia/epidemiología , Bovinos/parasitología , Corazón/parasitología , Laos/epidemiología , Filogenia , Sarcocystis/genética , Sarcocystis/aislamiento & purificación , Sarcocistosis/epidemiología , Sarcocistosis/veterinaria , Tailandia/epidemiología
13.
BMC Public Health ; 21(1): 1389, 2021 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-34256730

RESUMEN

BACKGROUND: In China, Guangdong and Yunnan are the two most dengue-affected provinces. This study aimed to compare the epidemiological characteristics of dengue fever in Guangdong and Yunnan during 2004-2018. METHODS: Descriptive analyses were used to explore the temporal, spatial, and demographic distribution of dengue fever. RESULTS: Of the 73,761 dengue cases reported in mainland China during 2004-2018, 93.7% indigenous and 65.9% imported cases occurred in Guangdong and Yunnan, respectively. A total of 55,970 and 5938 indigenous cases occurred in 108 Guangdong and 8 Yunnan counties, respectively during 2004-2018. Whereas 1146 and 3050 imported cases occurred in 84 Guangdong and 72 Yunnan counties, respectively during 2004-2018. Guangdong had a much higher average yearly indigenous incidence rate (3.65 (1/100000) vs 0.86 (1/100000)), but a much lower average yearly imported incidence rate (0.07 (1/100000) vs 0.44(1/100000)) compared with Yunnan in 2004-2018. Furthermore, dengue fever occurred more widely in space and more frequently in time in Guangdong. Guangdong and Yunnan had similar seasonal characteristics for dengue fever, but Guangdong had a longer peak period. Most dengue cases were clustered in the south-western border of Yunnan and the Pearl River Delta region in Guangdong. Most of the imported cases (93.9%) in Guangdong and Yunnan were from 9 Southeast Asian countries. Thailand, Cambodia, and Malaysia imported mainly into Guangdong while Myanmar and Laos imported into Yunnan. There was a strong male predominance among imported cases and an almost equal gender distribution among indigenous cases. Most dengue cases occurred in individuals aged 21-50 years, accounting for 57.3% (Guangdong) vs. 62.8% (Yunnan) of indigenous and 83.2% (Guangdong) vs. 62.6% (Yunnan) of imported cases. The associated major occupations (house worker or unemployed, retiree, and businessman, for indigenous cases; and businessman, for imported cases), were similar. However, farmers accounted for a larger proportion of dengue cases in Yunnan. CONCLUSIONS: Identifying the different epidemiological characteristics of dengue fever in Guangdong and Yunnan can be helpful to formulate targeted, strategic plans, and implement effective public health prevention measures in China.


Asunto(s)
Dengue , Cambodia , China/epidemiología , Dengue/epidemiología , Femenino , Humanos , Laos , Malasia , Masculino , Mianmar , Tailandia
14.
Nutrients ; 13(6)2021 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-34072630

RESUMEN

There is limited evidence regarding the potential risk of untargeted iron supplementation, especially among individuals who are iron-replete or have genetic hemoglobinopathies. Excess iron exposure can increase the production of reactive oxygen species, which can lead to cellular damage. We evaluated the effect of daily oral supplementation on relative leukocyte telomere length (rLTL) and blood mitochondrial DNA (mtDNA) content in non-pregnant Cambodian women (18-45 years) who received 60 mg of elemental iron as ferrous sulfate (n = 190) or a placebo (n = 186) for 12 weeks. Buffy coat rLTL and mtDNA content were quantified by monochrome multiplex quantitative polymerase chain reaction. Generalized linear mixed-effects models were used to predict the absolute and percent change in rLTL and mtDNA content after 12 weeks. Iron supplementation was not associated with an absolute or percent change in rLTL after 12 weeks compared with placebo (ß-coefficient: -0.04 [95% CI: -0.16, 0.08]; p = 0.50 and ß-coefficient: -0.96 [95% CI: -2.69, 0.77]; p = 0.28, respectively). However, iron supplementation was associated with a smaller absolute and percent increase in mtDNA content after 12 weeks compared with placebo (ß-coefficient: -11 [95% CI: -20, -2]; p = 0.02 and ß-coefficient: -11 [95% CI: -20, -1]; p= 0.02, respectively). Thus, daily oral iron supplementation for 12 weeks was associated with altered mitochondrial homeostasis in our study sample. More research is needed to understand the risk of iron exposure and the biological consequences of altered mitochondrial homeostasis in order to inform the safety of the current global supplementation policy.


Asunto(s)
ADN Mitocondrial , Suplementos Dietéticos , Hierro , Leucocitos/efectos de los fármacos , Telómero/efectos de los fármacos , Adulto , Antioxidantes/administración & dosificación , Antioxidantes/farmacología , Cambodia , ADN Mitocondrial/sangre , ADN Mitocondrial/efectos de los fármacos , Femenino , Humanos , Hierro/administración & dosificación , Hierro/farmacología , Estrés Oxidativo/efectos de los fármacos , Adulto Joven
15.
BMC Pregnancy Childbirth ; 21(1): 410, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34078318

RESUMEN

INTRODUCTION: Cambodia has achieved significant progress in maternal health, yet remains in the group of countries with the highest maternal mortality ratio in South-East Asia. Extra efforts are needed to improve maternal health through assessing the coverage of maternal health services as a continuum of care (CoC) and identifying the gaps. Our study aims to explore the coverage level of the Optimal CoC by (1) measuring the continuity of optimal antenatal care (ANC), skilled birth attendance (SBA) and optimal post-natal care (PNC), (2) identifying the determinants of dropping out from one service to another and (3) of not achieving the complete CoC. METHOD: The study employed data from the Cambodia Demographic Health Survey 2014. We restricted our analysis to married women who had a live birth in the five years preceding the survey (n = 5678). Bi-variate and multivariate logistic regression were performed using STATA version 14. RESULTS: Almost 50% of women had achieved the complete optimal CoC, while the remaining have used only one or two of the services. The result shows that the level of women's education was positively associated with the use of optimal ANC, the continuation to using optimal PNC and achieving the complete CoC. More power of women in household decision making was also positively associated with receiving the complete CoC. The birth order was negatively associated with achieving the complete CoC, while exposure to the mass media and having health insurance increased the odds of achieving the complete CoC. Household wealth consequently emerged as an influential predictor of dropping out and not achieving the complete CoC. Receiving all different elements of ANC care improved the continuity of care from optimal ANC to SBA and from SBA to optimal ANC. CONCLUSION: The findings urge policy makers to approach maternal health care as a continuum of care with different determinants at each step. Household wealth was found to be the most influential factor, yet the study discovered also other barriers to optimal maternal health care which need to be addressed: future intervention should thus not only aim to increase wealth or health insurance coverage but also stimulate the education of women and empower women to claim power in household decision-making.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Regionalización , Adolescente , Adulto , Cambodia , Demografía , Femenino , Humanos , Embarazo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
16.
Artículo en Inglés | MEDLINE | ID: mdl-34064939

RESUMEN

People with disabilities and as women and girls face barriers to accessing water, sanitation, and hygiene (WASH) services and facilities that fully meet their needs, especially in low- and middle-income countries. Women and girls with disabilities experience double discrimination. WASH policies should support and uphold the concepts of disability and gender inclusion, and they should also act as a guide to inform WASH programs and service delivery. Using a modified version of the EquiFrame content analysis tool, this study investigated the inclusion of 21 core concepts of human rights of people with disabilities and women and girls in 16 WASH policy documents and seven end-line program reports from Bangladesh and Cambodia. Included documents typically focused on issues of accessibility and neglected wider issues, including empowerment and support for caregivers. The rights of children and women with disabilities were scarcely focused on specifically, despite their individual needs, and there was a disconnect in the translation of certain rights from policy to practice. Qualitative research is needed with stakeholders in Bangladesh and Cambodia to investigate the inclusion and omission of core rights of people with disabilities, and women and girls, as well as the factors contributing to the translation of rights from policy to practice.


Asunto(s)
Personas con Discapacidad , Saneamiento , Bangladesh , Cambodia , Niño , Femenino , Humanos , Higiene , Políticas , Agua , Abastecimiento de Agua
18.
Reprod Health ; 18(1): 115, 2021 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-34108001

RESUMEN

BACKGROUND: Delivery is a critical moment for pregnant women and babies, and careful monitoring is essential throughout the delivery process. The partograph is a useful tool for monitoring and assessing labour progress as well as maternal and foetal conditions; however, it is often used inaccurately or inappropriately. A gap between practices and evidence-based guidelines has been reported in Cambodia, perhaps due to a lack of evidence-based knowledge in maternity care. This study aims to address to what extent skilled birth attendants in the first-line health services in Cambodia have knowledge on the management of normal delivery, and what factors are associated with their level of knowledge. METHODS: Midwives and nurses were recruited working in maternity in first-line public health facilities in Phnom Penh municipality, Kampong Cham and Svay Rieng provinces. Two self-administered questionnaires were applied. The first consisted of three sections with questions on monitoring aspects of the partograph: progress of labour, foetal, and maternal conditions. The second consisted of questions on diagnostic criteria, normal ranges, and standard intervals of monitoring during labour. A multiple linear regression analysis was performed to identify relationships between characteristics of the participants and the questionnaire scores. RESULTS: Of 542 eligible midwives and nurses, 523 (96%) participated. The overall mean score was 58%. Only 3% got scores of more than 90%. Multivariate analysis revealed that 'Kampong Cham province', 'younger age', and 'higher qualification' were significantly associated with higher scores. Previous training experience was not associated with the score. Substantial proportions of misclassification of monitoring items during labour were found; for example, 61% answered uterine contraction as a foetal condition, and 44% answered foetal head descent and 26% answered foetal heart rate as a maternal condition. CONCLUSION: This study found that knowledge was low on delivery management among skilled birth attendants. Previous training experience did not influence the knowledge level. A lack of understanding of physiology and anatomy was implied. Further experimental approaches should be attempted to improve the knowledge and quality of maternity services in Cambodia.


Asunto(s)
Parto Obstétrico/normas , Monitoreo Fetal/instrumentación , Partería/normas , Parto , Atención Posnatal , Monitoreo Uterino/instrumentación , Adulto , Cambodia/epidemiología , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Servicios de Salud Materna , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Embarazo
20.
Glob Health Sci Pract ; 9(2): 344-354, 2021 06 30.
Artículo en Inglés | MEDLINE | ID: mdl-33989171

RESUMEN

Cambodia has made impressive progress in reducing malaria trends and, in 2018, reported no malaria-related deaths for the first time. However, the coronavirus disease (COVID-19) pandemic presents a potential challenge to the country's goal for malaria elimination by 2025. The path toward malaria elimination depends on sustained interventions to prevent rapid resurgence, which can quickly set back any gains achieved.Malaria Consortium supported mobile malaria workers (MMWs) to engage with target communities to build acceptance, trust, and resilience. At the start of the pandemic, Malaria Consortium conducted a COVID-19 risk assessment and quickly developed and implemented a mitigation plan to ensure MMWs were able to continue providing malaria services without putting themselves or their patients at risk. Changes in malaria intervention coverage and community uptake have been monitored to gauge the indirect effects of COVID-19. Comparisons have been made between output indicators reported in 2020 and from the same month-period of the previous year.In general, malaria service intervention coverage and utilization rates did not decline in 2020. Rather, the reported figures show there was a substantial increase in service utilization. Preliminary internal reviews and community meetings show that despite a heightened public risk perception toward COVID-19, malaria testing motivation has been well sustained throughout the pandemic. This may be attributable to proactive program planning and data monitoring and active engagement with the communities and the national authorities to circumvent the indirect effect of COVID-19 on intervention coverage in Cambodia during the pandemic.


Asunto(s)
COVID-19 , Servicios de Salud Comunitaria , Malaria/prevención & control , Pandemias , Cambodia , Erradicación de la Enfermedad , Objetivos , Planificación en Salud , Humanos , Malaria/diagnóstico , Tamizaje Masivo , Características de la Residencia , Medición de Riesgo , SARS-CoV-2
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