F Stuer | PubMed Health

PubMed2002

Prevalence of pulmonary tuberculosis among HIV-infected persons in a home care program in Phnom Penh, Cambodia.

SETTING: Phnom Penh, Cambodia. OBJECTIVE: To determine the burden of active pulmonary tuberculosis among an HIV-infected cohort and the proportion of drug-resistant strains, using active case-finding adapted to a home care setting. DESIGN: Cross-sectional study. Measures include the prevalence of culture-confirmed Mycobacterium tuberculosis, utilizing a single spot sputum specimen; the proportion of pulmonary TB, detected and undetected; proportion of cases resistant to isoniazid, rifampicin, ethambutol, streptomycin; and the diagnostic value of symptoms. RESULTS: Of 441 persons surveyed, 41 (9%) had active pulmonary TB by culture; 29 were smear-positive (71%), and only one case was on treatment. The total burden of pulmonary TB was 12% (54/441), with a ratio of undetected to detected cases of 3:1. Primary isoniazid resistance was detected in six new cases (15%); no MDR-TB was identified. Symptoms were not predictive of active pulmonary disease. Mortality was high among those not surveyed (20%) and those found to have TB (49%). CONCLUSIONS: Tuberculosis is epidemic in this HIV-infected population. Active case-finding yielded three times the number of cases already detected and should be considered where resources allow. However, effective passive case detection and improved coordination of TB and HIV care programs are required to address HIV-associated TB morbidity and mortality.

AIDS-Related Opportunistic Infections↗

PubMed1998

Enhancing health programme efficiency: a Cambodian case study.

In 1995, the Cambodian Urban Health Care Association (CUHCA) was set up as facilitator between private health care providers and patients, guaranteeing good quality health care and fair pricing to patients and providing training and logistic support to providers. Providers were engaged on a fee-for-service basis and competition encouraged. CUHCA's objectives followed the same line of thought as the 1993 World Development Report, aiming at influencing the unregulated private health care market through competition mechanisms. But soon after the start of the project the basic problem was recognized to be not the absence of effective government regulation but rather that consumers lack the requisite knowledge to make good choices in the market for health services. CUHCA had not adequately addressed the demand for health services. The original supply-side strategy of improving health services by increasing competition was a failure. In order to improve CUHCA's health programme efficiency the association's objectives were subsequently redefined and its functioning reorganized. CUHCA now tries to educate consumers and provides good quality services so that consumers will be able to act on the basis of their newly acquired knowledge. CUHCA's health centres serve as model clinics for first-line health care. Community educators organize information, education and communication (IEC) activities. Staff help school teachers to improve formal health education in schools and CUHCA assists local leaders in sanitation development. Only full-time personnel are employed, encouraging team spirit and communication with the target population. Salaries are based on team performance. The CUHCA programme demonstrates that, depending on the market situation, health programme models need to address both the supply and the demand for services in order to be efficient. Where consumers lack essential knowledge to make appropriate choices in the health service market, interventions should focus on health education and social marketing and provide models of quality care catering to informed consumer choice.

Cambodia↗