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1.
Acta Trop ; 201: 105221, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654901

RESUMO

Opisthorchiasis-associated cholangiocarcinoma (OV-CCA) is a major public health problem in Greater Mekong Subregion (GMS) Countries, the poorest region in Asia. People in this region have similar traditions or respect the same religion. There is no difference in lifestyle and food culture. Excluding Thailand, publications on risk factors for OV-CCA from the GMS Countries are few, especially data on behavioral risk factors for OV-CCA. Therefore, this study aimed to assess the behavior-related risk factors and to compare the risk of OV-CCA among rural people living along the Mekong River in five GMS countries. It was a cross-sectional analytic study during June and October 2017. All participants with informed consent completed the questionnaires. Descriptive statistics were used to describe the prevalence of risk factors. Odds ratio with 95% confidence intervals were used to compare the risk of OV-CCA. It was found that there were more drinkers than non-drinkers in all areas, except in Vietnam. The highest history of liver fluke infection was found in Cambodia. Praziquantel use and consumption of raw freshwater fish dishes were mostly found in Lao PDR. The highest consumption of nitrosamine-contaminated foodstuffs was found in Ubon Ratchathani, Thailand. The spatial comparison of OV-CCA risk showed that Lao PDR and Ubon Ratchathani were two risk areas when compared to Tachileik, Myanmar (a reference area). This study provided the behavior-related risk factors for OV-CCA among people in five GMS Countries which would be a major jigsaw puzzle leading to proactive surveillance for OV-CCA prevention in the future.


Assuntos
Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/epidemiologia , Opistorquíase/epidemiologia , Assunção de Riscos , População Rural/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Neoplasias dos Ductos Biliares/epidemiologia , Camboja/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Tailândia/epidemiologia , Vietnã/epidemiologia
2.
BMC Public Health ; 19(1): 1200, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470824

RESUMO

BACKGROUND: Rates of childhood undernutrition are persistently high in Cambodia. Existing ready-to-use supplementary and therapeutic foods (RUSFs and RUTFs) have had limited acceptance and effectiveness. Therefore, our project developed and trialled a locally-produced, multiple micronutrient fortified lipid-based nutrient supplement (LNS) with therapeutic and supplementary versions. This ready-to-use food (RUF) is innovative in that, unlike many RUFs, it contains fish instead of milk. Development began in 2013 and the RUF was finalised in 2015. From 2015 until the present, both the RUTF and the RUSF versions were trialled for acceptability and effectiveness. METHODS: This paper draws on project implementation records and semi-structured interviews to describe the partnership between the Cambodian Ministries of Health and Agriculture, Forestry and Fisheries, UNICEF, the French National Research Institute for Sustainable Development (IRD), universities, and Vissot factory. It discusses the project implementation and lessons learned from the development and trialling process, and insights into positioning nutrition on the health agenda in low and middle-income countries. RESULTS: The lessons learned relate to the importance of project planning, management, and documentation in order to seize opportunities in the research, policy, advocacy, and programming environment while ensuring adequate day-to-day project administration and resourcing. CONCLUSIONS: We conclude that projects such as ours, that collaborate to develop and test novel, locally-produced RUTFs and RUSFs, offer an exciting opportunity to respond to both local programmatic and broader research needs.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Suplementos Nutricionais , Fast Foods , Camboja/epidemiologia , Criança , Transtornos da Nutrição Infantil/epidemiologia , Humanos
3.
Glob Health Action ; 12(1): 1646024, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31500551

RESUMO

Background: Most studies evaluate active case findings (ACF) for bacteriologically confirmed TB. Adapted diagnostic approaches are needed to identify cases with lower bacillary loads. Objectives: To assess the likelihood of diagnosing all forms of TB, including clinically diagnosed pulmonary and extra-pulmonary TB, using different ACF algorithms in Cambodia. Methods: Clients were stratified into 'high-risk' (presumptive TB plus TB contact, or history of TB, or presumptive HIV infection; n = 12,337) and 'moderate-risk' groups (presumptive TB; n = 28,804). Sputum samples were examined by sputum smear microscopy (SSM) or Xpert MTB/RIF (Xpert). Initially, chest X-ray using a mobile radiography unit was a follow-up test after a negative sputum examination [algorithms A (Xpert/X-ray) and B (SSM/X-ray)]. Subsequently, all clients received an X-ray [algorithms C (X-ray+Xpert) and D (Xray+SSM/Xpert)]. X-rays were interpreted on the spot. Results: Between 25 August 2014 and 31 March 2016, 2217 (5.4%) cases with all forms of TB cases were diagnosed among 41,141 adults. The majority of TB cases (1488; 67.1%) were diagnosed using X-ray. When X-rays were taken and interpreted the same day the sputum was collected, same-day diagnosis more than doubled. Overall, the number needed to test (NNT) to diagnose one case was 18.6 (95%CI:17.9-19.2). In the high-risk group the NNT was lower [algorithm D: NNT = 17.3(15.9-18.9)] compared with the 'moderate-risk group' [algorithm D: NNT = 20.8(19.6-22.2)]. In the high-risk group the NNT was lower when using Xpert as an initial test [algorithm A: NNT = 12.2(10.8-13.9) or algorithm C: NNT = 11.2(9.6-13.0)] compared with Xpert as a follow-up test [algorithm D: NNT = 17.3(15.9-18.9)]. Conclusion: To diagnose all TB forms, X-ray should be part of the diagnostic algorithm. The combination of X-ray and Xpert testing for high-risk clients was the most effective ACF approach in this setting.


Assuntos
Algoritmos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Camboja/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Escarro/microbiologia , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
4.
Nutrients ; 11(7)2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31284369

RESUMO

Even though limited evidence is available, the relationship between morbidity and under-nutrition among children under-five is likely to be a strong two-way association. This study aims to explore this vicious cycle by employing longitudinal data of four periods within a 24 month follow-up, whereby morbidity was captured between two subsequent anthropometric measures. Malnutrition was classified according to z-scores of anthropometric measures and morbidity by number of sick days experienced inbetween. Mixed-effects models were used to assess this relation, where dependency of morbidity and nutritional status were interchanged; models were adjusted for province, age, gender, wealth index score, maternal education level, diet, and Water, Sanitation, and Hygiene indicators. Stunting and wasting prevalences were 29.9% and 8.9%, respectively, where 21.3% of the children hadmultiple anthropometric failures. Children identified as wasted were 35% more likely to experience prolonged illness periods (OR: 1.35, 95% CI: 1.02-1.56). Those experiencing high proportion of sick days were found to be 64% more likely to become stunted (OR: 1.64, 95% CI: 1.18-2.29). This study suggests that the link between wasting and stunting could be partly explained by acute illness, where wasting increases the likelihood of prolonged epiosed of illness, which increases the risk of stunting.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Fatores Etários , Camboja/epidemiologia , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo
5.
J Prev Med Hyg ; 60(2): E93-E102, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31312738

RESUMO

Introduction: Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia. Methods: Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother's handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained. Results and Conclusion: Access to safe drinking water was reportedly higher for communities in Guatemala and Zambia (> 80%), than those in Cambodia and Kenya (< 63%), with significantly higher levels in intervention sites for Guatemala and Kenya. Improved sanitation was low (< 10%), for Kenya and Zambia, compared to Cambodia and Guatemala (> 40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p < 0.001, Guatemala, 3.0 vs 2.5, p < 0.001, Kenya, 2.6 vs 2.3, p < 0.001). Factors significantly associated with lower odds of diarrhea were; mother's marital status, higher educational status, one or more handwashing practices, wealthier quintiles, older (> 24 m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.


Assuntos
Diarreia Infantil/prevenção & controle , Desinfecção das Mãos , Promoção da Saúde , Mães/psicologia , Adolescente , Adulto , Camboja/epidemiologia , Pré-Escolar , Diarreia Infantil/epidemiologia , Feminino , Guatemala/epidemiologia , Promoção da Saúde/métodos , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Paridade , Abastecimento de Água , Adulto Jovem , Zâmbia/epidemiologia
6.
PLoS One ; 14(7): e0210919, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31265458

RESUMO

BACKGROUND: With support of the national tuberculosis (TB) program, KHANA (a local non-governmental organization in Cambodia) has implemented an innovative approach using a seed-and-recruit model to actively find TB cases in the community. The model engaged community members including TB survivors as seed and newly diagnosed people with TB as recruiters to recruit presumptive TB cases in their social network in a snowball approach for screening and linkage to treatment. This study aimed to explore the acceptability of the active case finding with the seed-and-recruit model in detecting new TB cases and determine the characteristics of successful seeds. METHODS: This qualitative study was conducted in four provinces (Banteay Meanchey, Kampong Chhnang, Siem Reap, and Takeo) in Cambodia in 2017. Fifty-six in-depth interviews and ten focus group discussions (with a total of 64 participants) were conducted with selected beneficiaries and key stakeholders at different levels to gain insights into the acceptability, strengths, and challenges in implementing the model and the characteristics of successful seeds. Transcripts were coded and content analyses were performed. RESULTS: The seed-and-recruit active case finding model was generally well-received by the study participants. They saw the benefits of engaging TB survivors and utilizing their social network to find new TB cases in the community. The social embeddedness of the model within the local community was one of the major strengths. The success of the model also hinges on the integration with existing health facilities. Having an extensive social network, being motivated, and having good knowledge about TB were important characteristics of successful seeds. Study participants reported challenges in motivating the presumptive TB cases for screening, logistic capacities, and high workload during the implementation. However, there was a general consensus that the model ought to be expanded. CONCLUSIONS: These findings indicate that the seed-and-recruit model is well-accepted by the beneficiaries and key stakeholders. Further studies are needed to more comprehensively evaluate the impacts and cost-effectiveness of the model for future expansion in Cambodia as well as in other resource-limited settings.


Assuntos
Programas de Rastreamento/economia , Tuberculose Pulmonar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Camboja/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/economia , Tuberculose Pulmonar/epidemiologia
7.
PLoS Negl Trop Dis ; 13(6): e0006943, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31220075

RESUMO

BACKGROUND: Strongyloides stercoralis is a neglected soil-transmitted helminth that occurs worldwide, though it is particularly endemic in tropical and subtropical areas. It can cause long-lasting and potentially fatal infections due to its ability to replicate within its host. S. stercoralis causes gastrointestinal and dermatological morbidity. The objective of this study was to assess the S. stercoralis infection risk and, using geostatistical models, to predict its geographical distribution in Cambodia. METHODOLOGY / PRINCIPAL FINDINGS: A nation-wide, community-based parasitological survey was conducted among the Cambodian population, aged 6 years and older. S. stercoralis was diagnosed using a serological diagnostic test that detects IgG antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. S. stercoralis prevalence among 7,246 participants with a complete data record was 30.5%, ranging from 10.9% to 48.2% across provinces. The parasite was ubiquitous in Cambodia; only five south-eastern provinces had prevalence rates below 20%. Infection risk increased with age for both men and women, although girls under the age of 13 and women aged 50 years and over had lower odds of infection than their male counterparts. Open defecation was associated with higher odds of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields. CONCLUSIONS / SIGNIFICANCE: S. stercoralis infection is rampant in Cambodia. Control programs delivering ivermectin are needed to manage the parasite. However, the high cost of this drug in Cambodia currently precludes the implementation of control initiatives. Donations, subsidies or affordable generics are needed so that S. stercoralis, which infects almost a third of the Cambodian population, can be addressed through an adequate control program.


Assuntos
Anticorpos Anti-Helmínticos/urina , Strongyloides stercoralis/imunologia , Estrongiloidíase/epidemiologia , Topografia Médica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Camboja/epidemiologia , Criança , Feminino , Humanos , Imunoglobulina G/urina , Masculino , Pessoa de Meia-Idade , Medição de Risco , Estudos Soroepidemiológicos , Inquéritos e Questionários , Adulto Jovem
8.
Emerg Infect Dis ; 25(7): 1354-1362, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211672

RESUMO

We investigated dengue virus (DENV) and asymptomatic DENV infections in rural villages of Kampong Cham Province, Cambodia, during 2012 and 2013. We conducted perifocal investigations in and around households for 149 DENV index cases identified through hospital and village surveillance. We tested participants 0.5-30 years of age by using nonstructural 1 rapid tests and confirmed DENV infections using quantitative reverse transcription PCR or nonstructural 1-capture ELISA. We used multivariable Poisson regressions to explore links between participants' DENV infection status and household characteristics. Of 7,960 study participants, 346 (4.4%) were infected with DENV, among whom 302 (87.3%) were <15 years of age and 225 (65.0%) were <9 years of age. We identified 26 (7.5%) participants with strictly asymptomatic DENV infection at diagnosis and during follow-up. We linked symptomatic DENV infection status to familial relationships with index cases. During the 2-year study, we saw fewer asymptomatic DENV infections than expected based on the literature.


Assuntos
Doenças Assintomáticas/epidemiologia , Vírus da Dengue , Dengue/epidemiologia , Dengue/virologia , Adolescente , Adulto , Fatores Etários , Camboja/epidemiologia , Criança , Pré-Escolar , Dengue/diagnóstico , Dengue/história , Surtos de Doenças , Feminino , História do Século XXI , Humanos , Masculino , Programas de Rastreamento , Vigilância em Saúde Pública , Vigilância de Evento Sentinela , Adulto Jovem
9.
Influenza Other Respir Viruses ; 13(5): 465-476, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31251478

RESUMO

BACKGROUND: Influenza virus circulation is monitored through the Cambodian influenza-like illness (ILI) sentinel surveillance system and isolates are characterized by the National Influenza Centre (NIC). Seasonal influenza circulation has previously been characterized by year-round activity and a peak during the rainy season (June-November). OBJECTIVES: We documented the circulation of seasonal influenza in Cambodia for 2012-2015 and investigated genetic, antigenic, and antiviral resistance characteristics of influenza isolates. PATIENTS/METHODS: Respiratory samples were collected from patients presenting with influenza-like illness (ILI) at 11 hospitals throughout Cambodia. First-line screening was conducted by the National Institute of Public Health and the Armed Forces Research Institute of Medical Sciences. Confirmation of testing and genetic, antigenic and antiviral resistance characterization was conducted by Institute Pasteur in Cambodia, the NIC. Additional virus characterization was conducted by the WHO Collaborating Centre for Reference and Research on Influenza (Melbourne, Australia). RESULTS: Between 2012 and 2015, 1,238 influenza-positive samples were submitted to the NIC. Influenza A(H3N2) (55.3%) was the dominant subtype, followed by influenza B (30.9%; predominantly B/Yamagata-lineage) and A(H1N1)pdm09 (13.9%). Circulation of influenza viruses began earlier in 2014 and 2015 than previously described, coincident with the emergence of A(H3N2) clades 3C.2a and 3C.3a, respectively. There was high diversity in the antigenicity of A(H3N2) viruses, and to a smaller extent influenza B viruses, during this period, with some mismatches with the northern and southern hemisphere vaccine formulations. All isolates tested were susceptible to the influenza antiviral drugs oseltamivir and zanamivir. CONCLUSIONS: Seasonal and year-round co-circulation of multiple influenza types/subtypes were detected in Cambodia during 2012-2015.


Assuntos
Farmacorresistência Viral , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Estações do Ano , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Camboja/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A/genética , Vírus da Influenza B/genética , Vacinas contra Influenza/uso terapêutico , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Sequenciamento Completo do Genoma , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 515, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185925

RESUMO

BACKGROUND: Most of studies on the relationship between drug use and HIV have focused largely on people who inject drugs. Non-injecting drug use is much more common than injecting drug use, and although it can also predispose people to HIV infection, it is not widely explored. We therefore conducted this study to explore the prevalence of HIV and identify risk factors for HIV infection among people who use non-injecting drugs (PWUD) in Cambodia. METHODS: This cross-sectional study was conducted in 2017. The Respondent Driven Sampling method was used to recruit the study participants who were interviewed face-to-face using a structured questionnaire. Blood samples were collected for HIV and syphilis testing. A multivariable logistic regression analysis was conducted to identify risk factors associated with HIV infection. RESULTS: In total, 1367 PWUD were included in this study, whose mean age was 28.0 (SD = 7.7) years. The majority (95.1%) of the participants used methamphetamine. The prevalence of HIV was 5.7, and 35.2% of the identified HIV-positive PWUD were not aware of their status prior to the survey. After adjustment for other covariates, HIV infection remained significantly associated with being in the age group of ≥35 (AOR = 2.34, 95% CI = 1.04-6.11), having lower level of formal education of ≤ 6 years (AOR = 2.26, 95% CI = 1.04-5.15), living on the streets (AOR = 2.82, 95% CI = 1.10-7.23), perception that their HIV risk was higher as compared to that of the general population (AOR = 3.18, 95% CI = 1.27-8.62), having used injecting drugs in lifetime (AOR = 3.8, 95% CI = 1.36-4.56), and having cuts or sores around the genital area in the past 12 months (AOR = 3.42, 95% CI = 1.09-6.33). CONCLUSIONS: The prevalence of HIV among PWUD in this study was more than 10 times higher than the prevalence in the general adult population. The findings reveal a higher vulnerability to HIV infection among specific sub-populations of PWUD, such as those who are homeless, who may benefit from tailored interventions that respond to their specific needs. To enhance HIV case finding, stratification of PWUD to facilitate HIV risk profiling based on socio-economic profiles and drug injection history is recommended.


Assuntos
Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Camboja/epidemiologia , Estudos Transversais , Feminino , HIV , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
11.
BMC Oral Health ; 19(1): 107, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196058

RESUMO

BACKGROUND: The Southeast Asian Forum for Early Childhood Caries identified the need for more epidemiological surveys involving preschool children. To date, the only data on Early Childhood Caries in Cambodia come from convenience samples and only using the basic dmft index without measurement of the early signs of disease. METHODS: A cross-sectional survey on an epidemiological sample of Cambodian preschool children was conducted in conjunction with the fourth follow-up of the Cambodian Health and Nutrition Monitoring Study. Children were examined in a field setting using both the South East Asian Index for Early Childhood Caries as well as the 'pulpally involved, ulcerated, fistula, abscess' (pufa) index. Caregivers also participated in a short questionnaire covering dietary habits, oral health knowledge and behaviors, as well as the Family Impact Scale (FIS) for Oral-Health-Related Quality-of-Life. RESULTS: The sample included 3985 participants between birth and 4-years of age, across three provinces. There was an even sex distribution (50.7% male). Overall 56.6% of participants had one or more carious lesions and 5.4% had one or more pulpally-involved teeth. There were some significant differences by age and location. Among those in the 3-year-old age group 84.9% had at least one decayed tooth, and 16.1% had one or more pulpally-involved teeth. There were differences in oral health knowledge and behaviors by province; those in Phnom Penh reported more favorable responses. Consumption of non-nutritious foods also differed between provinces with those in Phnom Penh consuming a higher mean number of sweet beverages per day. Those children with at least one pulpally involved tooth had a ten times greater chance of realizing an impact across the FIS. CONCLUSIONS: Cambodian preschool children have a severe burden of dental caries and a high proportion of families are impacted by this problem. There were differences in oral health knowledge and behaviors according to province and this translated into differences in caries experience. The data from this study support the need for urgent action to address the issue of ECC in Cambodia.


Assuntos
Cárie Dentária/epidemiologia , Camboja/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Qualidade de Vida , Inquéritos e Questionários
12.
Matern Child Nutr ; 15 Suppl 3: e12757, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148398

RESUMO

There is inconsistent evidence on the efficacy of agriculture programmes at improving women and children's anaemia and nutritional status. The primary aim of this study was to evaluate the impact of a nutrition-sensitive enhanced homestead food production (EHFP) programme on anaemia in women (18-45 years) and children (6-59 months) in rural Cambodia. Secondary outcomes were women's micronutrient status and women and children's anthropometry. In this cluster-randomized controlled trial, 900 households from 90 villages (clusters) were randomized to either (a) home gardens and behaviour change communication (BCC) on nutrition, hygiene, women's empowerment, and marketing (EHFP); (b) home gardens plus fishponds and BCC (EHFP + F); or (c) control (no intervention). Haemoglobin concentration and anthropometry were measured in women and children at baseline and at 22 months. Venous blood samples were collected in a subset of women (n = 450) at baseline and at 22 months. Generalized linear mixed effect models with repeated measures were used to evaluate the difference across groups and the change from baseline to end of study. Ninety clusters, 552 women, and 754 children completed the trial. Compared with control, we found a statistically significant impact on anaemia prevalence in children (-14.0 percentage points; P = 0.02) and retinol binding protein concentrations in women (difference in difference: 0.34; P = 0.02) randomized to EHFP and EHFP + F groups, respectively. No other statistically significant effects on anaemia, nutritional biomarker concentrations, or anthropometry were observed. Future research is needed to examine longer term impacts of EHFP on anthropometry in women and children and into the nutritional causes of anaemia among children in Cambodia.


Assuntos
Anemia/dietoterapia , Anemia/prevenção & controle , Dieta/classificação , Micronutrientes/administração & dosagem , Estado Nutricional , Adolescente , Adulto , Antropometria , Aquicultura , Camboja/epidemiologia , Pré-Escolar , Análise por Conglomerados , Produtos Agrícolas , Feminino , Jardinagem , Comportamentos Relacionados com a Saúde , Humanos , Higiene/educação , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Micronutrientes/deficiência , Pessoa de Meia-Idade , População Rural , Adulto Jovem
14.
Nagoya J Med Sci ; 81(2): 269-280, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31241062

RESUMO

On June 4, 2016, the Prey Veng Provincial Health Department reported a total of 107 patients with influenza-like illness (ILI) from Chakhlanh village to the Cambodian Ministry of Health. To confirm the outbreak and evaluate its clinical and epidemiological characteristics, the investigation team visited the village and reviewed the case-based surveillance (CBS) data on severe respiratory infection (SRI) and patients' records in health facilities. The team interviewed all households in the village from May 1 to June 5, 2016 and obtained the following data: age, medical history, date of onset, treatment, symptoms, and history of contact with patients or dead poultry. Nasal swab samples were collected from suspected ILI cases to test for influenza virus by RT-PCR. The investigation detected 498 suspected ILI cases, including 288 females. Although the incidence of suspected ILI cases who visited health centers was 63.0 per 1,000 persons per month, the attack rate was 27.1 per 100 population. The major age group was 5-14 years followed by 0-4 years. Major symptoms were cough, fever, runny nose, and headache. Six of seven nasal swab samples were positive for influenza A/H1N1 pdm09 virus. Most children with flu symptoms had contact with previous cases. This study showed that the ILI outbreak might be caused by seasonal influenza A/H1N1 pdm09 spread from person to person. Poor living conditions and poor hygiene and sanitation practices were environmental factors that caused the outbreak. As the CBS system was unable to identify this epidemic, it needs to be improved.


Assuntos
Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Camboja/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Saúde Pública/estatística & dados numéricos , Adulto Jovem
15.
Int J Public Health ; 64(7): 1015-1024, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31243470

RESUMO

OBJECTIVES: To assess the association of living and working conditions experienced during trafficking with mental health of female and male survivors. METHODS: We analyzed a cross-sectional study of 1015 survivors who received post-trafficking services in Cambodia, Thailand, and Vietnam. Modified Poisson regression models were conducted by gender to estimate prevalence ratios. RESULTS: For females, the elevated prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms was associated with adverse living conditions, while for males the prevalence of anxiety (PR = 2.21; 95% CI 1.24-3.96) and depression (PR = 2.63; 95% CI 1.62-4.26) more than doubled and almost tripled for PTSD (PR = 2.93; 95% CI 1.65-5.19) after adjustment. For males in particular, excessive and extreme working hours per day were associated with more than a four- and threefold greater prevalence of PTSD. Being in a detention center or jail was associated with all three mental health outcomes in males. CONCLUSIONS: Providers and stakeholders need to consider the complex mental health trauma of the differential effects of living and working conditions for female and male survivors during trafficking to support treatment and recovery.


Assuntos
Habitação/normas , Tráfico de Pessoas/psicologia , Saúde Mental , Sobreviventes/psicologia , Local de Trabalho/normas , Ansiedade/epidemiologia , Camboja/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Tailândia/epidemiologia , Vietnã/epidemiologia
16.
Eur J Clin Microbiol Infect Dis ; 38(9): 1585-1590, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31044332

RESUMO

Vietnam, Laos, and Cambodia have reported first cases of Zika virus (ZIKV) infection since 2010 (Cambodia) and 2016 (Vietnam and Laos). One case of ZIKV-related microcephaly was recognized among a hundred infected cases in these areas, raising a great concern about the health risk related to this virus infection. At least 5 cases of ZIKV infection among travelers to Vietnam, Laos, and Cambodia were recorded. It is noticeable that ZIKV in these areas can cause birth defects. This work aims to discuss the current epidemics of ZIKV in Vietnam, Laos, and Cambodia and update the infection risk of ZIKV for travelers to these areas.


Assuntos
Epidemias , Viagem , Infecção por Zika virus/epidemiologia , Camboja/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Humanos , Laos/epidemiologia , Microcefalia/virologia , Fatores de Risco , Vietnã/epidemiologia , Infecção por Zika virus/complicações
17.
PLoS One ; 14(5): e0216774, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141514

RESUMO

BACKGROUND: Donor funding for HIV/AIDS services is declining in Cambodia, and domestic resources need to be mobilized to sustain and expand these services. However, the cost of delivering HIV/AIDS services is not well studied in Cambodia. This study aims to assess the costs of delivering HIV/AIDS services, identify the major components of costs, and sources of funding. METHODS: Four of the six highest HIV burden provinces were selected at random for this study. Within each province, four health centers and two hospitals were selected for detailed data collection. A mix of top-down and bottom-up methods were used to assess the costs for HIV testing and antiretroviral therapy (ART) from the provider perspective. We assessed the differences in the quantity and prices of inputs between health facilities of the same type to identify cost-drivers. RESULTS: The average cost per visit for HIV testing was $8.92 at health centers and $14.03 at referral hospitals. Differences in the number of visits per staff were the primary determinant of differences in the cost per visit. First-line ART costed about $250 per patient per year, and the number of patients per staff was an important cost driver. Second-line ART costed from $500 to $716 per patient per year, on average, across the types of facilities, with the quantity and mix of second-line antiretroviral drugs being an important cost driver. Inpatient care at referral and provincial hospitals in total represented less than 2 percent of costs of outpatient ART. DISCUSSION: Costs are similar to neighboring countries, but over 50% of the costs of ART are financed by donors. Cambodia now is scaling up social health insurance coverage; the data from this study could serve as one input when setting reimbursement rates for HIV/AIDS services to help ensure that providers are adequately reimbursed for their services.


Assuntos
Síndrome de Imunodeficiência Adquirida , Antirretrovirais , Custos de Cuidados de Saúde , Instalações de Saúde/economia , Hospitalização/economia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/economia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Antirretrovirais/administração & dosagem , Antirretrovirais/economia , Camboja/epidemiologia , Feminino , Humanos , Masculino
19.
Am J Trop Med Hyg ; 100(6): 1424-1432, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30994087

RESUMO

Distributing long-lasting insecticidal nets (LLINs) to individuals living in malaria-endemic regions is a cornerstone of global malaria control. National malaria control programs aim to achieve "universal coverage" of at-risk populations to reach LLINs' full potential to reduce malaria, progress of which is then measured by indicators constructed from standardized questionnaires. Through an exploration of variability in LLIN use in Cambodia, we argue that indicators of universal coverage of LLINs are not sufficiently commensurate with the realities they are intended to measure, limiting the suitability of the data to serve program and policy purposes in a malaria elimination era. Reflecting on the various sources of variability in LLIN use, we apply and extend the concept of "appropriateness" as a third prong to the widely used "efficacy" and "effectiveness" criteria for evaluating LLINs as a tool for malaria prevention. Describing first the different dimensions of the intervention and the sociocultural context separately, we will further show how the variability underlying both is affected and induced by inappropriate aspects of the intervention and the measurements of its impact. We consider the gap between "net use" and the numerical representations of such local net use justifies further exploration of potential strategies to improve LLIN use in subgroups where persisting malaria transmission clusters.


Assuntos
Mosquiteiros Tratados com Inseticida , Malária/prevenção & controle , Controle de Mosquitos/métodos , Animais , Camboja/epidemiologia , Humanos , Inseticidas , Malária/epidemiologia , Inquéritos e Questionários , Fatores de Tempo
20.
Am J Trop Med Hyg ; 100(6): 1566-1568, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30994093

RESUMO

Neonatal sepsis is the second most prevalent cause of neonatal deaths in low- and middle-income countries, and many countries lack epidemiologic data on the local causes of neonatal sepsis. During April 2015-November 2016, we prospectively collected 128 blood cultures from neonates admitted with clinical sepsis to the provincial hospital in Takeo, Cambodia, to describe the local epidemiology. Two percent (n = 3) of positive blood cultures identified were Gram-negative bacilli (GNB) and were presumed pathogens, whereas 10% (n = 13) of positive blood cultures identified were likely contaminants, consistent with findings in other published studies. No group B Streptococcus was identified in any positive cultures. The presence of GNB as the primary pathogens could help influence local treatment guidelines.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Sepse Neonatal/epidemiologia , População Rural , Bactérias/classificação , Bactérias/isolamento & purificação , Hemocultura , Camboja/epidemiologia , Humanos , Recém-Nascido
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