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OBJECTIVE: This study surveyed the sexual behaviour of commercial sex workers and their clients in an attempt to identify factors of transmission of STDs (including HIV/AIDS) and to control their epidemics in Cambodia and South-East Asia. DESIGN: Cross-sectional study. SETTING: Trained questioners asked items of the questionnaires to each objective subject in December 1996. Data were analysed to show the descriptive status by risk group of each person. PARTICIPANTS: 200 direct commercial sex workers, 220 indirect commercial sex workers, and 211 clients in Phnom Penh. RESULTS: Prostitution was widely accepted by both young males and females, and this was an easy way for young girls to obtain money. Although commercial sex workers and clients were knowledgeable about prevention methods against STDs, they seldom used condoms. Some commercial sex workers had been infected with STDs many times, and many of them incompletely treated the diseases by themselves. Social support from governmental and non-governmental organisation was poor. CONCLUSIONS: It is very important to support both commercial sex workers in practicing preventive methods against STDs and also visiting physicians when they notice symptoms of STDs. It is strongly recommended that not only governmental but also non-governmental organisations should be more active in this area.
39 members of a medical team working in an area near the Cambodia-Thaï border were given an individual antimalaria chemoprophylaxis by Mefloquine (2 tablets--500 mg--every other week), carried on for 2 months after return. Two falciparum accesses were reported after the return, and in one of them, there was also a failure of the Mefloquine treatment (1,5 g in 16 hours). This access was successfully treated by Naphtyridine. The results proved that Mefloquine is now the best individual chemoprophylaxis in this area of South East Asia where, from 1979 to 1981, the other prophylaxis failed (chloroquine, pyrimethamine + sulphonamide or sulfone, quinine); it was also discovered that some strains of P. falciparum were resistant to Mefloquine.
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The present study determined the concentrations of persistent organochlorines (OCs) such as DDT and its metabolites (DDTs), polychlorinated biphenyls (PCBs), hexachlorocyclohexane isomers (HCHs), hexachlorobenzene (HCB), chlordane compounds (CHLs), tris(4-chlorophenyl)methane (TCPMe), and tris(4-chlorophenyl)methanol (TCPMOH) in human breast milk from Cambodia. DDTs, PCBs, HCHs, HCB, CHLs, and TCPMe were detected in almost all the human breast milk samples analyzed, and the concentrations ranged from 310 to 11,000, 6.0 to 87, <0.12 to 21, <0.12 to 8.1, <0.12 to 5.3, and 2.9 to 70 ng/g lipid wt, respectively. TCPMOH was detected in only 10 among 36 samples. Concentrations of DDTs in human breast milk from Cambodia were notably higher than those from developed countries and comparable to those from other developing countries, where usage of DDT for agricultural and public health purposes has been suspected to be continuing still, implying the recent usage of DDT in Cambodia. On the other hand, concentrations of PCBs, HCHs, HCB, and CHLs in human breast milk from Cambodia were 1-2 orders of magnitude less than those from other countries, indicating that Cambodia is one of the less contaminated countries by these OCs. Significant correlation between concentrations of TCPMe and DDTs in human breast milk suggested that exposure to DDT is the source of TCPMe in Cambodian residents. Concentrations of OCs in human breast milk tended to decrease with an increase in the number of children, implying that the first infant would be exposed to higher levels of OCs from breast milk and might be at higher risk by these contaminants, especially DDTs in Cambodia. To our knowledge, this is the first comprehensive study on the residue levels of OCs in human breast milk from Cambodia.
We used a classical isotopic microtest to assess the in vitro sensitivity of 352 Plasmodium falciparum isolates collected in Cambodia in 2001 and 2002 to chloroquine, mefloquine, quinine and artesunate. Our results confirm conclusions drawn from earlier studies conducted by the Cambodian national malaria centre. Chloroquine-resistant phenotypes were highly prevalent in Cambodia. Similarly, a high proportion of isolates displayed elevated IC50 to mefloquine. In contrast, only 0.67 and 1.7% of isolates presented decreased susceptibility to quinine and artesunate, respectively. Distributions of mean IC50 according to drug and geographic origin indicated that the parasites circulating to the west of Cambodia largely account for the global situation of drug resistances in Cambodia. Isolates with decreased susceptibility to chloroquine and mefloquine were common along the border with Thailand. In contrast, most of the isolates from eastern Cambodia were susceptible to these compounds. Isolates collected at the western and eastern borders did not respond differently to artesunate. No major differences in responses to antimalarial drugs were observed between 2001 and 2002, suggesting that the situation of drug resistance is now stabilized and under control in Cambodia. However, the decreased susceptibility of isolates collected in the western provinces of Cambodia to mefloquine and the correlation between susceptibility to artesunate and susceptibility to mefloquine and quinine justify the need for an improved international surveillance program for malaria drug resistance in the Mekong sub region.
BACKGROUND: Dutch (ex-)servicemen were deployed in the 1992-3-peace operation UNTAC in Cambodia. Since their return, they have voiced concerns about the health consequences of their service and they have reported symptoms such as fatigue and cognitive problems. The natural course of symptoms in Dutch Cambodia veterans was evaluated in a prospective study. METHODS: At 18-months follow-up, a questionnaire was sent to 354 veterans who met a set case definition for symptoms in Cambodia veterans or who had sub-threshold scores. Initial measurement of fatigue severity, psychological well-being, depression, post-traumatic stress disorder, trait-anxiety, self-efficacy and causal attributions, was used to evaluate predictors for self-reported improvement and low levels of fatigue at follow-up. RESULTS: At follow-up, 19% of the respondents reported complete recovery, 20% felt much better, 57% had the same complaints and 4% had become worse compared with their initial assessment. Self-reported improvement and less severe fatigue at follow-up were predicted by less severe fatigue at initial assessment and more perceived control over symptoms. CONCLUSIONS: Self-reported improvement was reported in a considerable percentage of Cambodia veterans, whereas another substantial percentage of Cambodia veterans continued to suffer with severe levels of fatigue and related symptoms. Predictors of improvement in Cambodia veterans and patients with chronic fatigue syndrome show similarities and also seem to bear importance for Gulf War veterans.
Dr. Mam Bunheng, Undersecretary of State for Health, Cambodia, provided an overview of the health situation of women and children in Cambodia during a visit to JOICFP on December 8. He also expressed his country's desire to seek collaboration with JOICFP in the future. Providing background on the maternal and child health (MCH) system in Cambodia, Mam explained that the birth-spacing program is an integral part of the MCH activities and is primarily aimed at ensuring the health of women. Cambodia, which has a population of about 10 million people, presently has a high maternal mortality rate of 500/100,000 deliveries. Noting that the country also has a high total fertility rate of about 5.1, Mam emphasized that the government's birth spacing program is not aimed at controlling the population, but rather to ensure balanced development and population growth with the ultimate goal of guaranteeing the health of women. Cambodia also has a high infant mortality rate of 113/1000 live births. Mam explained that lack of access to services, supplies, and trained personnel hamper efforts to promote birth spacing. To overcome these obstacles, Cambodia needs support to develop human resources and to ensure supplies of basic medical equipment and essential drugs. Specifically, Mam stressed the need to train and retrain health staff to ensure adequate staffing at the community level. At present, the total number is insufficient, he said. While in Japan, Mam visited many health facilities as part of JICA's technical cooperation program and was impressed most with the quality services and facilities of the public health center.
Since the takeover of Cambodia by the Khmer Rouge in 1975, the social conditions within the country have been understudied. Only recently has dependable socio-demographic data become available. We use some these data to examine living arrangements and other socio-demographic conditions among Cambodia's older population. We compare results to those recently found in Thailand and Vietnam, two neighboring countries, in order to place Cambodia within a regional context. On balance, living arrangements in Cambodia are similar to those in neighboring countries. Older adults are likely to be living with a child and in a variety of diverse arrangements involving different family members. We attempt to get at gender preference for coresident children indirectly by adjusting living arrangement patterns for Cambodia's unique sex and marital status structure. We find a predominance of elders living with never married children of either sex and a slight daughter preference. Older adults in Cambodia may face particular challenges due to the influences of the past decades of instability and violence. We conclude our paper with a discussion of how future research might assist in developing a national policy for older adults.
Set within the context of recent literature on the private-public divide in the health sector of developing countries generally and Asia specifically, this study considers the major government and the major indigenous non-government clinics offering out-patient reproductive health services in Phnom Penh, Cambodia. Reproductive health is of critical importance in Cambodia, which has one of the highest levels of unmet need for family planning in the developing world and suffers from what is arguably the most severe STD and HIV/AIDS problem in Asia. The study is unusual in that it examines and compares aspects of service delivery and pricing along with the socio-economic profile and health-seeking behaviour of clients self-selecting services in the two settings. The socio-economic status of clients was much higher than the norm in Cambodia but did not differ significantly between the two clinics. A few service indicators suggested that the quality of care was better in the NGO clinic. Underlying variables--such as the broader mandate of the public sector institution and the significant discrepancy between public and private sector salaries--offer an obvious explanation for these differences. The Ministry of Health in Cambodia has been developing policies related to the NGO sector, which has expanded rapidly in Cambodia during the 1990s, and it is struggling to increase staff remuneration within the public sector.
Large alluvial deltas of the Mekong River in southern Vietnam and Cambodia and the Red River in northern Vietnam have groundwaters that are exploited for drinking water by private tube-wells, which are of increasing demand since the mid-1990s. This paper presents an overview of groundwater arsenic pollution in the Mekong delta: arsenic concentrations ranged from 1-1610 microg/L in Cambodia (average 217 microg/L) and 1-845 microg/L in southern Vietnam (average 39 microg/L), respectively. It also evaluates the situation in Red River delta where groundwater arsenic concentrations vary from 1-3050 microg/L (average 159 microg/L). In addition to rural areas, the drinking water supply of the city of Hanoi has elevated arsenic concentrations. The sediments of 12-40 m deep cores from the Red River delta contain arsenic levels of 2-33 microg/g (average 7 microg/g, dry weight) and show a remarkable correlation with sediment-bound iron. In all three areas, the groundwater arsenic pollution seem to be of natural origin and caused by reductive dissolution of arsenic-bearing iron phases buried in aquifers. The population at risk of chronic arsenic poisoning is estimated to be 10 million in the Red River delta and 0.5-1 million in the Mekong delta. A subset of hair samples collected in Vietnam and Cambodia from residents drinking groundwater with arsenic levels >50 microg/L have a significantly higher arsenic content than control groups (<50 microg/L). Few cases of arsenic related health problems are recognized in the study areas compared to Bangladesh and West Bengal. This difference probably relates to arsenic contaminated tube-well water only being used substantially over the past 7 to 10 years in Vietnam and Cambodia. Because symptoms of chronic arsenic poisoning usually take more than 10 years to develop, the number of future arsenic related ailments in Cambodia and Vietnam is likely to increase. Early mitigation measures should be a high priority.
Ocular trauma is a major cause of monocular blindness in both the developed and developing world, but is not seen as a significant cause of bilateral blindness. Trauma is therefore generally thought of as a major cause of blind eyes without being a major cause of blind people. Because of the difficulties of surgical treatment of ocular trauma in many developing countries, long-term management is usually aimed at prevention, e.g. by improving safety standards in the workplace. The situation in countries such as Cambodia, which have high landmine densities, is different. Cambodia has an estimated 4-10 million landmines which cause significant morbidity and mortality. This hospital-based study of blindness in the north-west of Cambodia found that of 453 bilaterally blind individuals, 17 (4%) were blind as a result of trauma, and 14 of these were males 15-35 years old. Fourteen cases were due to bilateral penetrating injuries caused by landmine explosions, and usually occurred in association with other severe injury. The other main causes of blindness were cataract (59%), glaucoma (14%) and corneal scarring (12%). Penetrating ocular trauma is a significant cause of bilateral blindness in Cambodia, and predominantly affects young men. It is estimated that it would take 250 years to clear Cambodia of landmines at current activity levels.
In 1992 and 1993, Dutch military personnel were deployed in the peace operation UNTAC in Cambodia. Since returning, Cambodia veterans have reported health complaints which they perceive to be related to their service. Their symptoms strikingly resemble health problems reported by Gulf War veterans. Four years post-return, a cross-sectional survey on health symptoms in Cambodia veterans was initiated. Questionnaires were sent to all Cambodia veterans and four comparison groups. Forgetfulness, difficulty concentrating and fatigue were the symptoms most commonly endorsed. An operational case definition was constructed using a validated fatigue severity questionnaire. Cases were not uniquely found in Cambodia veterans (17%). In Rwanda and Bosnia veterans, respectively, 28% and 11% also met our case definition. Fatigue severity level was predicted by pre-mission, during-mission and post-mission variables, of which retrospective recollection of side-effects of vaccines and causal attributions also have been shown to be relevant in studies on Gulf-related illness.
In the past decade, Cambodia has been experiencing the most serious HIV/AIDS epidemic in Southeast Asia. With full support from the top policy makers, good leadership in program management, and the commitment of the public health program officers, the HIV/AIDS prevention and care program in Cambodia has been successful, despite its resource constraints. Available data from surveillance and other studies in Cambodia indicate a downward trend in HIV prevalence and incidence among high-risk groups, an increase in condom use among commercial sex workers and their clients, and a declining trend of sexually transmitted infections. Although these findings reflect the success of programs to prevent transmission, the incidence of HIV infections is still high in high-risk populations, and transmission among the general population continues. Cambodia therefore needs to increase its efforts to reduce transmission. More research and prevention programs should focus on the vulnerable populations. HIV/AIDS modeling indicates that Cambodia needs to prepare for increasingly large numbers of AIDS patients who will require expensive medical care.
Following their participation in a United Nations peacekeeping operation in Cambodia (1992-1993), Dutch veterans complained of symptoms similar to those reported by Gulf War veterans. The authors conducted a matched case-control study to evaluate 76 symptomatic and 32 matched asymptomatic Cambodia veterans on the basis of data collected by postal questionnaire. The number of symptomatic veterans who reported having used insect repellants that contained N,N,-diethyl-meta-toluamide (DEET) during the mission in Cambodia was significantly higher, compared with asymptomatic veterans. The percentage of veterans who reported feeling ill following brief exposures to chemicals such as paint or pesticides was equal in both groups, but the percentage was low compared with the results of other studies of Multiple Chemical Sensitivity Syndrome. The current study was limited by self-report and time delay (potential recall bias) between deployment to Cambodia and the time of survey. Nevertheless, the study results did not support the hypothesis that symptoms in the total group of Cambodia veterans could be related to Multiple Chemical Sensitivity Syndrome.
BACKGROUND: The prevalence rates of scabies are compared in Bamako, Mali, Karonga District, Malawi, and Battambang Province, Cambodia. METHODS: In Mali, children attending three different urban schools catering for different socio-economic levels were examined specifically for scabies. In Malawi, data were collected during a total population survey for leprosy. In Cambodia, a sample survey was carried out in a rural area to determine the prevalence of leprosy and other skin diseases. RESULTS: In Mali, the prevalence rate of scabies among all the children examined was 4% (44/1103), but only 1.8% (7/388) in the higher socio-economic group. In Malawi, the overall prevalence rate of scabies was 0.7% (408/61,735). The highest rate (1.1%) was found among children 0-9 years of age. In Cambodia, the overall prevalence in the 13 villages screened was 4.3% (645/14,843). The highest rate (6.5%) was found among children 0-9 years of age. CONCLUSIONS: Scabies was most prevalent among children in Cambodia and Malawi, but there were considerable differences in the overall rates between the two areas studied. The data from all three countries indicate that poor socio-economic conditions, in particular crowding and public water supplies, are risk factors for scabies.