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Mao S, Soputhy C, Lay S, Jacobs J, Ku GM, Chau D, Chhea C, Ir P. The barriers and facilitators of implementing a national laboratory-based AMR surveillance system in Cambodia: key informants' perspectives and assessments of microbiology laboratories. Front Public Health 2023; 11:1332423. [PMID: 38179556 PMCID: PMC10764616 DOI: 10.3389/fpubh.2023.1332423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Background Collecting data on antimicrobial resistance (AMR) is an essential approach for defining the scope of the AMR problem, developing evidence-based interventions and detecting new and emerging resistances. Our study aimed to identify key factors influencing the implementation of a laboratory-based AMR surveillance system in Cambodia. This will add additional insights to the development of a sustainable and effective national AMR surveillance system in Cambodia and other low- and middle-income countries. Methods Key informants with a role in governing or contributing data to the laboratory-based surveillance system were interviewed. Emerging themes were identified using the framework analysis method. Laboratories contributing to the AMR surveillance system were assessed on their capacity to conduct quality testing and report data. The laboratory assessment tool (LAT), developed by the World Health Organisation (WHO), was adapted for assessment of a diagnostic microbiology laboratory covering quality management, financial and human resources, data management, microbiology testing performance and surveillance capacity. Results Key informants identified inadequate access to laboratory supplies, an unsustainable financing system, limited capacity to collect representative data and a weak workforce to be the main barriers to implementing an effective surveillance system. Consistent engagement between microbiology staff and clinicians were reported to be a key factor in generating more representative data for the surveillance system. The laboratory assessments identified issues with quality assurance and data analysis which may reduce the quality of data being sent to the surveillance system and limit the facility-level utilisation of aggregated data. A weak surveillance network and poor guidance for outbreak response were also identified, which can reduce the laboratories' opportunities in detecting critical or emerging resistance occurring in the community or outside of the hospital's geographical coverage. Conclusion This study identified two primary concerns: ensuring a sustainable and quality functioning of microbiology services at public healthcare facilities and overcoming sampling bias at sentinel sites. These issues hinder Cambodia's national AMR surveillance system from generating reliable evidence to incorporate into public health measures or clinical interventions. These findings suggest that more investments need to be made into microbiology diagnostics and to reform current surveillance strategies for enhanced sampling of AMR cases at hospitals.
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Affiliation(s)
- Sovathiro Mao
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Sokreaksa Lay
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Jan Jacobs
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Grace Marie Ku
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Frailty in Ageing Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Darapheak Chau
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
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Bui TC, Hoogland CE, Chhea C, Sopheab H, Ouk V, Samreth S, Hor B, Vidrine JI, Businelle MS, Shih YCT, Sutton SK, Jones SR, Shorey Fennell B, Cottrell-Daniels C, Frank-Pearce SG, Ngor C, Kulkarni S, Vidrine DJ. Ending Tobacco Use Through Interactive Tailored Messaging for Cambodian People With HIV (Project EndIT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48923. [PMID: 37384390 PMCID: PMC10365624 DOI: 10.2196/48923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The prevalence of smoking remains high in many low- and middle-income countries (LMICs), including the Southeast Asian nation of Cambodia. Smoking is especially hazardous for people with HIV. In Cambodia, approximately 43%-65% of men with HIV and 3%-5% of women with HIV smoke cigarettes. Thus, there is a critical need for cost-effective smoking cessation interventions for Cambodian people with HIV. This paper describes the design, methods, and data analysis plans for a randomized controlled trial assessing the efficacy of a theory-based mobile health smoking cessation intervention in Cambodian people with HIV. OBJECTIVE This 2-group randomized controlled trial compares the efficacy of a mobile health-based automated messaging (AM) intervention versus standard care (SC) in facilitating smoking cessation among Cambodian people with HIV. METHODS Cambodian people with HIV who currently smoke and are receiving antiretroviral treatment (target, N=800) will be randomized to (1) SC or (2) the AM intervention. SC participants will receive brief advice to quit smoking, written self-help materials, nicotine patches, and will complete weekly app-delivered dietary assessments for 26 weeks. AM participants will receive all SC components (but will complete smoking-related weekly assessments instead of dietary assessments), in addition to a fully automated tailored messaging program driven by the weekly assessments to facilitate smoking cessation. In the Phase-Based Model of smoking cessation, the cessation process is partitioned into 4 phases: motivation, preparation (precessation), cessation (quit date to 2 weeks post quit), and maintenance (up to 6 months post quit). Our AM program targets processes within these phases, including increasing motivation to quit, enhancing self-efficacy, obtaining social support, skills to cope with nicotine withdrawal symptoms and stress, and skills to maintain abstinence. All participants will complete baseline and 3-, 6-, and 12-month in-person follow-up assessments. The primary outcome is biochemically confirmed abstinence at 12 months, with 3- and 6-month abstinence as secondary outcomes. Potential mediators and moderators underlying treatment effects will be explored, and cost-effectiveness will be assessed. RESULTS This study was approved by all relevant domestic and international institutional and ethical review boards. Participant recruitment commenced in January 2023. Data collection is expected to conclude by the end of 2025. CONCLUSIONS By demonstrating the greater efficacy and cost-effectiveness of AM relative to SC, this study has the potential to transform HIV care in Cambodia and prevent tobacco-related diseases. Furthermore, it may be adapted for use in other Cambodian populations and in other low- and middle-income countries. Ultimately, the AM approach to smoking cessation could greatly improve public health in the developing world and beyond. TRIAL REGISTRATION ClinicalTrials.gov NCT05746442; https://clinicaltrials.gov/ct2/show/NCT05746442. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48923.
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Affiliation(s)
- Thanh Cong Bui
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Charles E Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Chhorvann Chhea
- School of Public Health, National Institute of Public Health of Cambodia, Phnom Penh, Cambodia
| | - Heng Sopheab
- School of Public Health, National Institute of Public Health of Cambodia, Phnom Penh, Cambodia
| | - Vichea Ouk
- National Center for HIV/AIDS, Dermatology and STD of Cambodia, Phnom Penh, Cambodia
| | - Sovannarith Samreth
- National Center for HIV/AIDS, Dermatology and STD of Cambodia, Phnom Penh, Cambodia
| | - Bunleng Hor
- National AIDS Authority of Cambodia, Phnom Penh, Cambodia
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Michael S Businelle
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ya Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Sarah R Jones
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Bethany Shorey Fennell
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | | | - Summer G Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Chamnab Ngor
- School of Public Health, National Institute of Public Health of Cambodia, Phnom Penh, Cambodia
| | - Shweta Kulkarni
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
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Chhim S, Ku G, Mao S, Put WVD, Van Damme W, Ir P, Chhea C, Or V. Descriptive assessment of COVID-19 responses and lessons learnt in Cambodia, January 2020 to June 2022. BMJ Glob Health 2023; 8:bmjgh-2023-011885. [PMID: 37137538 PMCID: PMC10163327 DOI: 10.1136/bmjgh-2023-011885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023] Open
Abstract
As a member state of the International Health Regulations 2005, Cambodia is continuously strengthening its capacity to respond to health emergencies and prevent the international spread of diseases. Despite this, Cambodia's capacity to prevent, detect and rapidly respond to public health threats remained limited at the onset of the pandemic, as was the case in most countries. This paper describes epidemiological phases, response phases, strategy and lessons learnt in Cambodia between 27 January 2020 and 30 June 2022. We classified epidemiological phases in Cambodia into three phases, in which Cambodia responded using eight measures: (1) detect, isolate/quarantine; (2) face coverings, hand hygiene and physical distancing measures; (3) risk communication and community engagement; (4) school closures; (5) border closures; (6) public event and gathering cancellation; (7) vaccination; and (8) lockdown. The measures corresponded to six strategies: (1) setting up and managing a new response system, (2) containing the spread with early response, (3) strengthening the identification of cases and contacts, (4) strengthening care for patients with COVID-19, (5) boosting vaccination coverage and (6) supporting disadvantaged groups. Thirteen lessons were learnt for future health emergency responses. Findings suggest that Cambodia successfully contained the spread of SARS-CoV-2 in the first year and quickly attained high vaccine coverage by the second year of the response. The core of this success was the strong political will and high level of cooperation from the public. However, Cambodia needs to further improve its infrastructure for quarantining and isolating cases and close contacts and laboratory capacity for future health emergencies.
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Affiliation(s)
- Srean Chhim
- Technical Office, National Institute of Public Health, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Grace Ku
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sovathiro Mao
- Technical Office, National Institute of Public Health, Phnom Penh, Cambodia
| | - Willem Van De Put
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Gerontology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Por Ir
- Management team, National Institute of Public Health, Phnom Penh, Cambodia
| | - Chhorvann Chhea
- Management team, National Institute of Public Health, Phnom Penh, Cambodia
| | - Vandine Or
- Management team, Ministry of Health, Phnom Penh, Cambodia
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Carnevale CR, Woldetsadik MA, Shiver A, Gutierrez M, Chhea C, Ilori E, Jani I, MaCauley J, Mukonka V, Nsanzimana S, Ospina ML, Raji T, Spotts Whitney EA, Bratton S. Benefits and challenges of consolidating public health functions into a National Public Health Institute: a policy analysis. Health Policy Plan 2023; 38:342-350. [PMID: 36610743 DOI: 10.1093/heapol/czac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 01/19/2023] [Indexed: 01/09/2023] Open
Abstract
National Public Health Institutes (NPHIs) around the world vary in composition. Consolidated organizational models can bring together critical functions such as disease surveillance, emergency preparedness and response, public health research, workforce development and laboratory diagnosis within a single focal point. This can lead to enhanced coordination and management of resources and enable more efficient and effective public health operations. We explored stakeholders' perceptions about the benefits and challenges of consolidating public health functions in an NPHI in seven countries where the US Centers for Disease Control and Prevention has supported NPHI establishment and strengthening. From August 2019 through January 2020, we interviewed a total of 96 stakeholders, including NPHI staff (N = 43), non-NPHI government staff (N = 29) and non-governmental and international organization staff (N = 24) in Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda and Zambia. We conducted a policy analysis using Tea Collins's health policy analysis framework to assess various possible options for coordinating public health functions and their likely effectiveness. The findings can be used by policymakers as they consider public health infrastructure. We found that consolidating functions in an NPHI, to the extent politically and organizationally feasible, promotes efficiency, flexibility and coordination, as well as supports data-driven health recommendations to government decision makers. Countries pursuing NPHI establishment can weigh the potential challenges and benefits of consolidating functions when determining which public health functions will comprise the NPHI, including clarity of role, access to resources, influence over decisions and political viability.
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Affiliation(s)
- Caroline R Carnevale
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road MS H21-7, Atlanta, GA 30329, USA
| | - Mahlet A Woldetsadik
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road MS H21-7, Atlanta, GA 30329, USA
| | - Arielle Shiver
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road MS H21-7, Atlanta, GA 30329, USA
| | - Margaret Gutierrez
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road MS H21-7, Atlanta, GA 30329, USA
| | - Chhorvann Chhea
- Cambodia National Institute of Public Health, Lot #80, Samdach Penn Nouth Blvd. (St. 289), Phnom Penh 855, Cambodia
| | - Elsie Ilori
- Nigeria Centre for Disease Control, 801 Ebitu Ukiwe St., Jabi 900108, Abuja, Nigeria
| | - Ilesh Jani
- Instituto Nacional de Saúde, Estrada Nacional N1, Bairro da Vila Parcela n3943, Marracuene, Mozambique
| | - Jane MaCauley
- National Public Health Institute of Liberia, Congo Town Back Road, Monrovia, Liberia
| | - Victor Mukonka
- Zambia National Public Health Institute, Stand No. 1186 Corner Addis Ababa Drive and Chaholi Road, Lusaka, Zambia
| | | | | | - Tajudeen Raji
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Roosevelt Street (Old Airport Area), Addis Ababa, Ethiopia
| | - Ellen A Spotts Whitney
- International Association of National Public Health Institutes, 1599 Clifton Road, Atlanta, GA 30322, USA
| | - Shelly Bratton
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road MS H21-7, Atlanta, GA 30329, USA
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Chhim S, Vong WI, Pa K, Chhorn C, Housen T, Parry AE, Van Damme W, Ir P, Chhea C. A descriptive assessment of the National Institute of Public Health's contribution to the COVID-19 response in Cambodia,
2020-2021. Western Pac Surveill Response J 2023; 14:1-7. [PMID: 37064543 PMCID: PMC10090031 DOI: 10.5365/wpsar.2023.14.1.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Objective This paper examines the contributions made by the National Institute of Public Health to Cambodia's response to the coronavirus disease (COVID-19) pandemic during 2020-2021. Methods The activities conducted by the Institute were compared with adaptations of the nine pillars of the World Health Organization's 2020 COVID-19 strategic preparedness and response plan. To gather relevant evidence, we reviewed national COVID-19 testing data, information about COVID-19-related events documented by Institute staff, and financial and technical reports of the Institute's activities. Results The main contributions the Institute made were to the laboratory pillar and the incident management and planning pillar. The Institute tested more than 50% of the 2 575 391 samples for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and provided technical advice about establishing 18 new laboratories for SARS-CoV-2 testing in the capital city of Phnom Penh and 11 provinces. The Institute had representatives on many national committees and coauthored national guidelines for implementing rapid COVID-19 testing, preventing transmission in health-care facilities and providing treatment. The Institute contributed to six other pillars, but had no active role in risk communication and community engagement. Discussion The Institute's support was essential to the COVID-19 response in Cambodia, especially for laboratory services and incident management and planning. Based on the contributions made by the Institute during the COVID-19 pandemic, continued investment in it will be critical to allow it to support responses to future health emergencies in Cambodia.
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Affiliation(s)
- Srean Chhim
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Kimsorn Pa
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Tambri Housen
- University of Newcastle, Newcastle, New South Wales, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Amy Elizabeth Parry
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
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Rachmat A, Kelly GC, Hontz RD, Supaprom C, Heang V, Hip P, Garcia-Rivera JA, Prom S, Chhea C, Sutherland IW, Corson KS, Letizia AG. Clinical and epidemiologic evaluation of a 2020 chikungunya outbreak in Cambodia. BMC Infect Dis 2022; 22:949. [PMID: 36526991 PMCID: PMC9758031 DOI: 10.1186/s12879-022-07936-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2020, the Kingdom of Cambodia experienced a nationwide outbreak of chikungunya virus (CHIKV). Despite an increase in the frequency of outbreaks and expanding geographic range of CHIKV, diagnostic challenges remain, and limited surveillance data of sufficient granularity are available to characterize epidemiological profiles and disease dynamics of the virus. METHODS An ongoing and long-standing cross-sectional study of acute undifferentiated febrile illness (AUFI) in Cambodia was leveraged to describe the disease epidemiology and characterize the clinical presentation of patients diagnosed with CHIKV during the 2020 outbreak. Participants presenting with AUFI symptoms at ten study locations provided acute and convalescent blood samples and were tested for CHIKV using a reverse transcription-polymerase chain reaction (RT-PCR) and serological diagnostic methods including IgM and IgG. Acute and follow-up clinical data were also collected. RESULTS From 1194 participant blood samples tested, 331 (27.7%) positive CHIKV cases were detected. Most CHIKV positive individuals (280, 84.6%) reported having a fever 3 to 4 days prior to visiting a health facility. Symptoms including chills, joint pain, nausea, vomiting, and lesions were all statistically significant among CHIKV positive participants compared to CHIKV negative AUFI participants. Cough was negatively associated with CHIKV positive participants. Positivity proportions were significantly higher among adults compared to children. No significant difference was found in positivity proportion between rainy and dry seasons during the outbreak. Positive CHIKV cases were detected in all study site provinces, with the highest test positivity proportion recorded in the rural northeast province of Kratie. CONCLUSIONS Surveillance data captured in this study provided a clinical and epidemiological characterization of positive CHIKV patients presenting at selected health facilities in Cambodia in 2020, and highlighted the widespread distribution of the outbreak, impacting both urban and rural locations. Findings also illustrated the importance of utilizing both RT-PCR and serological testing for effective CHIKV surveillance.
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Affiliation(s)
- Agus Rachmat
- AC Investment Co, Contractor for NAMRU-2, Phnom Penh, Cambodia
| | | | | | | | - Vireak Heang
- U.S. Naval Medical Research Unit TWO, Phnom Penh, Cambodia
| | - Phireak Hip
- AC Investment Co, Contractor for NAMRU-2, Phnom Penh, Cambodia
| | | | - Satharath Prom
- Department of Health, Ministry of National Defense, Phnom Penh, Cambodia
| | - Chhorvann Chhea
- grid.436334.5National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
| | | | - Karen S. Corson
- U.S. Naval Medical Research Unit TWO, Singapore, Singapore ,U.S. Naval Medical Research Unit TWO, Phnom Penh, Cambodia
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Horváth C, Hong K, Wheeler P, Ir P, Chhea C, Kinzer MH, Ly V, Willacy E. How Management and Leadership Training Can Impact a Health System: Evaluation Findings From a Public Health Management Training Program in Cambodia. Front Public Health 2022; 9:784198. [PMID: 35155346 PMCID: PMC8826233 DOI: 10.3389/fpubh.2021.784198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022] Open
Abstract
In 2017, the National Institute of Public Health in Cambodia collaborated with the U.S. Centers for Disease Control and Prevention to provide management and leadership training for 20 managers and senior staff from 10 health centers. We conducted a mixed methods evaluation of the program's outcomes and impact on the graduates and health centers. From June 2018 (baseline) to January 2019 (endpoint), we collected data from a competency assessment, observational visits, and interviews. From baseline to endpoint, all 20 participants reported increased competence in seven management areas. Comparing baseline and endpoint observational visits, we found improvements in leadership and governance, health workforce, water, sanitation, and hygiene, and health centers' use of medical products and technologies. When evaluating the improvements made by participants against the World Health Organization's key components of a well-functioning health system, the program positively contributed toward building four of the six components—leadership and governance, health information systems, human resources for health, and service delivery. While these findings are specific to the context of Cambodian health centers, we hope this evaluation adds to the growing body of research around the impact of skilled public health management on health systems.
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Affiliation(s)
- Chelsea Horváth
- Consultant to Training Programs in Epidemiology and Public Health Interventions Network, Boldogasszonyfa, Hungary
| | - Kimsear Hong
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Paulah Wheeler
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Michael H Kinzer
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vanthy Ly
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Erika Willacy
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Boston, MA, United States
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Woldetsadik MA, Bratton S, Fitzpatrick K, Ravat F, Del Castillo L, McIntosh KJ, Jarvis D, Carnevale CR, Cassell CH, Chhea C, Prieto Alvarado F, MaCauley J, Jani I, Ilori E, Nsanzimana S, Mukonka VM, Baggett HC. Qualitative evaluation of enabling factors and barriers to the success and sustainability of national public health institutes in Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda and Zambia. BMJ Open 2022; 12:e056767. [PMID: 35365531 PMCID: PMC8977788 DOI: 10.1136/bmjopen-2021-056767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The success of National Public Health Institutes (NPHIs) in low-income and middle-income countries (LMICs) is critical to countries' ability to deliver public health services to their populations and effectively respond to public health emergencies. However, empirical data are limited on factors that promote or are barriers to the sustainability of NPHIs. This evaluation explored stakeholders' perceptions about enabling factors and barriers to the success and sustainability of NPHIs in seven countries where the U.S. Centers for Disease Control and Prevention (CDC) has supported NPHI development and strengthening. DESIGN Qualitative study. SETTING Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda and Zambia. PARTICIPANTS NPHI staff, non-NPHI government staff, and non-governmental and international organisation staff. METHODS We conducted semistructured, in-person interviews at a location chosen by the participants in the seven countries. We analysed data using a directed content analysis approach. RESULTS We interviewed 43 NPHI staff, 29 non-NPHI government staff and 24 staff from non-governmental and international organisations. Participants identified five enabling factors critical to the success and sustainability of NPHIs: (1) strong leadership, (2) financial autonomy, (3) political commitment and country ownership, (4) strengthening capacity of NPHI staff and (5) forming strategic partnerships. Three themes emerged related to major barriers or threats to the sustainability of NPHIs: (1) reliance on partner funding to maintain key activities, (2) changes in NPHI leadership and (3) staff attrition and turnover. CONCLUSIONS Our findings contribute to the scant literature on sustainability of NPHIs in LMICs by identifying essential components of sustainability and types of support needed from various stakeholders. Integrating these components into each step of NPHI development and ensuring sufficient support will be critical to strengthening public health systems and safeguarding their continuity. Our findings offer potential approaches for country leadership to direct efforts to strengthen and sustain NPHIs.
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Affiliation(s)
- Mahlet A Woldetsadik
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelly Bratton
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaitlin Fitzpatrick
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatima Ravat
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisetta Del Castillo
- Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Kelsy J McIntosh
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dennis Jarvis
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline R Carnevale
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia H Cassell
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chhorvann Chhea
- Cambodia National Institute of Public Health, Phnom Penh, Cambodia
| | - Franklyn Prieto Alvarado
- Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogota, Colombia
| | - Jane MaCauley
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Ilesh Jani
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | | | | | - Henry C Baggett
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Morrison AC, Schwarz J, Mckenney JL, Cordova J, Rios JE, Quiroz WL, Vizcarra SA, Sopheab H, Bauer KM, Chhea C, Saphonn V, Hontz RD, Gorbach PM, Paz-Soldan VA. Potential for community based surveillance of febrile diseases: Feasibility of self-administered rapid diagnostic tests in Iquitos, Peru and Phnom Penh, Cambodia. PLoS Negl Trop Dis 2021; 15:e0009307. [PMID: 33901172 PMCID: PMC8101991 DOI: 10.1371/journal.pntd.0009307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 05/06/2021] [Accepted: 03/12/2021] [Indexed: 11/18/2022] Open
Abstract
Rapid diagnostic tests (RDTs) have the potential to identify infectious diseases quickly, minimize disease transmission, and could complement and improve surveillance and control of infectious and vector-borne diseases during outbreaks. The U.S. Defense Threat Reduction Agency's Joint Science and Technology Office (DTRA-JSTO) program set out to develop novel point-of-need RDTs for infectious diseases and deploy them for home use with no training. The aim of this formative study was to address two questions: 1) could community members in Iquitos, Peru and Phnom Penh, Cambodia competently use RDTs of different levels of complexity at home with visually based instructions provided, and 2) if an RDT were provided at no cost, would it be used at home if family members displayed febrile symptoms? Test kits with written and video (Peru only) instructions were provided to community members (Peru [n = 202]; Cambodia [n = 50]) or community health workers (Cambodia [n = 45]), and trained observers evaluated the competency level for each of the several steps required to successfully operate one of two multiplex RDTs on themselves or other consenting participant (i.e., family member). In Iquitos, >80% of residents were able to perform 11/12 steps and 7/15 steps for the two- and five-pathogen test, respectively. Competency in Phnom Penh never reached 80% for any of the 12 or 15 steps for either test; the percentage of participants able to perform a step ranged from 26-76% and 23-72%, for the two- and five-pathogen tests, respectively. Commercially available NS1 dengue rapid tests were distributed, at no cost, to households with confirmed exposure to dengue or Zika virus; of 14 febrile cases reported, six used the provided RDT. Our findings support the need for further implementation research on the appropriate level of instructions or training needed for diverse devices in different settings, as well as how to best integrate RDTs into existing local public health and disease surveillance programs at a large scale.
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Affiliation(s)
- Amy C Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Julia Schwarz
- Icahn School of Medicine at Mt Sinai, New York, New York, United States of America
| | - Jennie L Mckenney
- University of California Fielding School of Public Health, Los Angeles, California, United States of America
| | - Jhonny Cordova
- Department of Entomology and Nematology, University of California, Davis, California, United States of America
| | - Jennifer E Rios
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - W Lorena Quiroz
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - S Alfonso Vizcarra
- Department of Entomology and Nematology, University of California, Davis, California, United States of America
| | - Heng Sopheab
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Karin M Bauer
- Tulane School of Public Health and Tropical Medicine, New Orleans, Lousiana, United States of America
- University of Washington, Seattle, Washington, United States of America
| | - Chhorvann Chhea
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Robert D Hontz
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
- U.S. Naval Medical Research Unit No. 2 (NAMRU-2), Singapore
| | - Pamina M Gorbach
- University of California Fielding School of Public Health, Los Angeles, California, United States of America
| | - Valerie A Paz-Soldan
- Tulane School of Public Health and Tropical Medicine, New Orleans, Lousiana, United States of America
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10
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Bui TC, Sopheab H, Businelle MS, Chhea C, Ly SP, Vidrine JI, Thol D, Frank-Pearce S, Vidrine DJ. Mobile-health intervention for smoking cessation among Cambodian people living with HIV: A mixed-methods pilot study. AIDS Care 2021; 34:430-439. [PMID: 33715537 DOI: 10.1080/09540121.2021.1887443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This mixed methods study aimed to evaluate the feasibility and preliminary efficacy of a fully automated, interactive smartphone-delivered intervention for smoking cessation among people living with HIV in Cambodia. We used the explanatory sequential design, with a pilot two-group single-blind randomized controlled trial (N = 50) followed by in-depth interviews with all trial participants. In the trial, participants were randomized to Standard Care (SC) or Automated Messaging (AM) group. SC comprised brief advice to quit and self-help materials. AM consisted of the SC components plus a fully automated smartphone-based treatment program that involved interactive and tailored proactive messaging for 2 months. Results showed that the AM approach was highly feasible and efficacious. Feasibility was supported by high rates of treatment engagement (e.g., 81% of delivered messages and assessments were read or completed) and high retention (96%) through the 2-month follow-up. Biochemically verified point prevalence abstinence at follow-up was 40% for the AM group and 8% for the SC group (relative risk: 5.0, 95% confidence interval: 1.2, 20.5). Being able to avoid other smokers, having coping skills, and having social/familial support contributed to successful abstinence. The AM program has the potential for wide-scale implementation in Cambodia and other low-income countries.
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Affiliation(s)
- Thanh Cong Bui
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Heng Sopheab
- School of Public Health, National Institute of Public Health of Cambodia, Phnom Penh, Cambodia
| | - Michael S Businelle
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chhorvann Chhea
- School of Public Health, National Institute of Public Health of Cambodia, Phnom Penh, Cambodia
| | - Sun Penh Ly
- National Center for HIV/AIDS, Dermatology and STD of Cambodia, Phnom Penh, Cambodia
| | - Jennifer I Vidrine
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL, USA
| | - Dawin Thol
- Preventive Medicine Department, Ministry of Health of Cambodia, Phnom Penh, Cambodia
| | - Summer Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Damon J Vidrine
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL, USA
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11
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Nov V, Chau D, Chhea C. 1439. High Rates of Drug Resistance in Escherichia coli from a Pilot Antimicrobial Resistance Surveillance System in Cambodia. Open Forum Infect Dis 2020. [PMCID: PMC7776451 DOI: 10.1093/ofid/ofaa439.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a major and growing global public health problem. The Cambodia Ministry of Health established a pilot laboratory-based AMR surveillance system for blood specimens in 2017. The objective of this study is to characterize AMR among pathogenic isolates from blood samples. Methods A retrospective analysis was performed using one year of data from a pilot AMR Surveillance system in Cambodia. Four blood culture isolate pathogens were included: Escherichia coli, Klebsiella pneumoniae, Salmonella Typhi /Salmonella Paratyphi A and Staphylococcus aureus. Blood culture isolates that were referred from eleven sentinel sites were analyzed at the National Public Health Laboratory for identification. Antibiotic susceptibility testing (AST) was done using disk diffusion, minimum inhibitory concentration method following Clinical Laboratory Standard Institute (CLSI) guidelines. Results Among 214 pathogenic isolates from blood samples, E.coli was the most common (56.1%), followed by Salmonella Typhi/Salmonella Paratyphi A (18.7%), Staphylococcus aureus (13.5%), and Klebsiella pneumoniae (11.7%). Methicillin Resistance Staphylococcus aureus (MRSA) was detected in half of the isolates. E.coli was resistant to ampicillin (94.4%), trimethoprim-sulfamethoxazole (84.5%), and ceftriaxone (79.2%). Salmonella Typhi was resistant to ampicillin (73.3%) and trimethoprim-sulfamethoxazole (60.0%) and Salmonella Paratyphi A were resistant to fluoroquinolones (91.7%). For last resort antibiotics, E.coli was resistant to carbapenem groups (3.2% for imipenem, 4.9% for meropenem, and 5.0% for ertapenem). Klebsiella pneumoniae was not resistant to any groups. Conclusion E.coli was found at high rates in blood samples and was resistant to common antibiotics used in Cambodia. These pilot data show the importance of establishing a national AMR surveillance system in Cambodia to monitor AMR trends following GLASS guidelines. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Vandarith Nov
- National Institute of Public Health, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Darapheak Chau
- National Institute of Public Health, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Chhorvann Chhea
- National Institute of Public Health, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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12
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Paz-Soldan VA, Morrison AC, Sopheab H, Schwarz J, Bauer KM, Mckenney JL, Chhea C, Saphonn V, Khuon D, Hontz RD, Gorbach PM. Potential Use of Community-Based Rapid Diagnostic Tests for Febrile Illnesses: Formative Research in Peru and Cambodia. PLoS Negl Trop Dis 2019; 13:e0007773. [PMID: 31658252 PMCID: PMC6837536 DOI: 10.1371/journal.pntd.0007773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/07/2019] [Accepted: 09/11/2019] [Indexed: 12/04/2022] Open
Abstract
In 2012, the U.S. Defense Threat Reduction Agency Joint Science and Technology Office initiated a program to develop novel point-of-need diagnostic devices for surveillance of emerging infectious diseases including dengue, malaria, plague, and melioidosis. Prior to distribution of devices to observe their correct use among community members in Iquitos, Peru, and Phnom Penh, Cambodia, research was conducted to: 1) assess acceptability of use, including the motivation to use a rapid diagnostic test (RDT) before or instead of seeking care at a health facility, 2) explore comprehension of RDT use instructions, and 3) examine possible strategies for large scale RDT distribution and use at each site. In February 2014, 9 focus group discussions (FGD) with community members and 5 FGD with health professionals were conducted in Iquitos, and 9 FGD with community members and 9 in-depth interviews with health professionals in Phnom Penh. In both places, participants agreed to use the device themselves (involving finger prick) or could identify someone who could do so in their home or neighborhood. The main incentive to RDT use in both sites was the ability for device results to be used for care facilitation (post confirmatory tests), specifically reduced wait times to be seen or obtain a diagnosis. Comprehension of RDT use instructions was assessed in Iquitos by asking some participants to apply the device to research team members; after watching a short video, most steps were done correctly. In Phnom Penh, participants were asked to describe each step after reading the instructions; they struggled with comprehension. Health professionals’ main concerns in both sites were their community’s ability to accurately use the test, handle complicated instructions, and safety (i.e., disposal of lancets). Health system structure and ability to use home diagnostic devices varied in the two disease endemic sites, with substantial challenges in each, suggesting the need for different strategies for RDT large scale community use, and illustrating the value of formative research before deployment of novel technologies. Development and use of devices to diagnose infectious diseases outside of health facilities (i.e., at home or in remote areas) continues to increase, providing new options for the follow up and treatment options of individuals, depending on the diseases. In this qualitative study, researchers in Iquitos, Peru, and Phnom Penh, Cambodia explored what local people thought about the possible availability of such a device to diagnose dengue and malaria in their own houses, and what would motivate them to use such a device instead of going directly to a health facility for the diagnosis. Participants reported being willing to use device on themselves and were motivated by the possibility that, by using this diagnostic device and taking the result to their health facility, they might be able to obtain quicker and more optimized attention at the health facility; for example, by obtaining a positive result to dengue or malaria on the rapid diagnostic device, they are aware they might still need confirmatory tests, but they would be able to reduce the wait time for obtaining a definitive diagnosis and starting treatment by a full day. Questions regarding accuracy of tests, complicated instructions and safety of using these devices in the community were brought up by participants—individuals living in the communities and local health professionals. Also, in this study, it was clear that if these devices were to be made available in Peru and Cambodia, different strategies for disseminating and using these in the communities would be needed to accommodate for different health infrastructure in both sites.
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Affiliation(s)
- Valerie A. Paz-Soldan
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
- Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
- U.S. Naval Medical Research Unit—6 (NAMRU-6), Lima, Peru
| | - Heng Sopheab
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Julia Schwarz
- Icahn School of Medicine at Mt Sinai, New York, New York, United States of America
| | - Karin M. Bauer
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
- University of Washington, Seattle, Washington, United States of America
| | - Jennie L. Mckenney
- University of California Fielding School of Public Health, Los Angeles, California, United States of America
| | - Chhorvann Chhea
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Dyna Khuon
- University of Health Sciences, Phnom Penh, Cambodia
| | - Robert D. Hontz
- U.S. Naval Medical Research Unit—6 (NAMRU-6), Lima, Peru
- Naval Medical Research Center, Fort Detrick, Maryland, United States of America
| | - Pamina M. Gorbach
- University of California Fielding School of Public Health, Los Angeles, California, United States of America
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13
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Sopheab H, Suy S, Chhea C, Chhit S, Mun P, Bui TC. Psychological distress among Cambodian people who use drugs. Drug Alcohol Rev 2019; 39:66-70. [PMID: 31646699 DOI: 10.1111/dar.13000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS People who use drugs (PWUD) face several mental health problems. This report aims to examine the prevalence of and factors associated with psychological distress among Cambodian PWUD. DESIGN AND METHODS Data used in our analysis were from the national survey of 1626 PWUD recruited through respondent-driven sampling method in Cambodia in 2012 to 2013. Distress was measured through self-report by using the 10-item Kessler Psychological Distress Scale (K10). All analyses were weighted. RESULTS Approximately half of PWUD had mild to severe psychological distress in the past four weeks (K10 ≥ 20). In the adjusted analysis, being female (odds ratio 1.60; 95% confidence interval 1.22, 2.12) and having experienced living in rehabilitation centres (odds ratio 2.46; 95% confidence interval 1.56, 3.87) were associated with a higher risk of having moderate or severe psychological distress (K10 ≥ 25). DISCUSSION AND CONCLUSIONS Psychological distress was prevalent among Cambodian PWUD. PWUD who were female or experienced living in rehabilitation centres were more likely to report distress. Policy makers should consider shifting further from compulsory institutionalised treatment model to community-based treatment program. Mental health assessment and mental health care services should be included in drug treatment programs and should be gender-sensitive. Further research investigating other mental disorders among PWUD are also needed.
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Affiliation(s)
- Heng Sopheab
- School of Public Health, National Institute of Public Health, Ministry of Health of Cambodia, Phnom Penh, Cambodia
| | - Sovanthida Suy
- Public Health Department, University of Health Sciences, Phnom Penh, Cambodia
| | - Chhorvann Chhea
- School of Public Health, National Institute of Public Health, Ministry of Health of Cambodia, Phnom Penh, Cambodia
| | - Sophal Chhit
- Department of Mental Health and Substance Abuse, Ministry of Health, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STIs, Ministry of Health, Phnom Penh, Cambodia
| | - Thanh C Bui
- Department of Family and Preventive Medicine, Stephenson Cancer Center, Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, USA
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14
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Ngor C, Sopheab H, Mam S, Gorbach P, Chhea C. Factors Associated With Sexual Risk Behaviors Among People Who Use Drugs in Communities in Cambodia. Asia Pac J Public Health 2019; 31:335-347. [PMID: 31113218 DOI: 10.1177/1010539519848280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Cambodia, HIV prevalence at 4% remains high among people who use drugs (PWUD). Complex and overlapping risk behaviors may enhance sexual transmission risk beyond PWUD. This study, therefore, aims to assess the factors associated with sexual risk behaviors among PWUD. Respondent Driven Sampling was used to recruit 1626 PWUD. Univariate and multivariate logistic regression analyses were used to identify factors associated with transmission risk including that high mental disorder scores were a strong predictor of sexual risk behaviors (odds ratio [OR] ranged from 1.9 to 2.8). Factors associated with sexual risk behaviors varied by gender: for men, these included geographical regions, non-married status, and heroin use; and for women, factors were age ≤20 years (OR = 5.4), living with friends (OR = 6.4), living in Central coastal region (OR = 6.1), and heroin use (OR = 4.8).
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Affiliation(s)
- Chamnab Ngor
- 1 National Institute of Public Health, Phnom Penh, Cambodia
| | - Heng Sopheab
- 1 National Institute of Public Health, Phnom Penh, Cambodia
| | - Sovatha Mam
- 2 National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
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15
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Fitzpatrick AL, van Pelt M, Heang H, Steinman L, Ide N, Chhea C, LoGerfo JP. Using Targeted mHealth Messages to Address Hypertension and Diabetes Self-Management in Cambodia: Protocol for a Clustered Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11614. [PMID: 30888330 PMCID: PMC6447150 DOI: 10.2196/11614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension and diabetes represent the first and third highest contributors to global disability. While mobile health (mHealth) messaging programs have rapidly increased in low- and middle-income countries (LMIC), adaptations for specific patient health needs is a new approach to manage chronic conditions. Objective The primary aim of this study is to develop and test an mHealth communication intervention using electronic data capture (by tablet) and voice messaging to improve hypertension and diabetes self-management in Cambodia. The secondary aim is to share results with the Cambodian Ministry of Health and development partners to inform health policy and develop strategies for hypertension and diabetes control. Methods The study design is a cluster randomized controlled clinical trial randomizing each of 75 Community peer educators (PEs), trained and coordinated by MoPoTsyo Patient Information Center in Phnom Penh, into one of 3 groups of 25 (approximately 60 patients each) to receive either tablet+messages, tablet only, or no intervention (control). The total sample within each group includes 25 clusters and approximately 1500 patients located in 7 Operational Districts in rural regions or urban slums in Cambodia. The interventions (groups 1 and 2) were compared with usual PE monitoring without the tablet or mHealth messaging interventions. Focus groups and informant interviews were conducted to develop messages according to specific themes—medications adherence, laboratory testing, physician visits, obesity, smoking, and general lifestyle issues. Using the data received at monthly PE monitoring meetings, patients will receive specific messages based on their individual health challenges. Following the intervention completion, clinical and process outcomes will be compared with baseline metrics between groups. Results PEs were randomized in July 2017, and the intervention was implemented in September 2017 through June 2018. Analyses are underway. Conclusions This project is unique in its combination of electronic data transfer, which can be accessed immediately, with voice messages most relevant to individual patients’ needs. Positive results will indicate the value of using targeted messaging in patient-specific, self-management issues to improve hypertension and diabetes control. International Registered Report Identifier (IRRID) DERR1-10.2196/11614
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Affiliation(s)
- Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Hen Heang
- MoPoTsyo Patient Information Center, Phnom Penh, Cambodia
| | - Lesley Steinman
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Nicole Ide
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | | | - James P LoGerfo
- Department of Global Health, University of Washington, Seattle, WA, United States
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16
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Sopheab H, Chhea C, Tuot S, Muir JA. HIV prevalence, related risk behaviors, and correlates of HIV infection among people who use drugs in Cambodia. BMC Infect Dis 2018; 18:562. [PMID: 30424727 PMCID: PMC6234604 DOI: 10.1186/s12879-018-3472-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 10/31/2018] [Indexed: 11/30/2022] Open
Abstract
Background Although HIV prevalence in Cambodia has declined to 0.6% among the general population, the prevalence remains high among female sex workers (14.0%) and men who have sex with men (2.3%). Over the past 10 years, the number of people who use drugs (PWUDs) has increased considerably. PWUDs, especially people who inject drugs (PWIDs), who have multiple sex partners or unprotected sex contribute to a higher HIV prevalence. This paper aims to estimate the prevalence of HIV across PWUD groups and to identify factors associated with HIV infection. Methods Respondent-driven sampling (RDS) was used to recruit 1626 consenting PWUDs in 9 provinces in 2012. Questionnaires and blood specimens were collected. HIV prevalence estimates were calculated using RDSAT 7.1. Individual weightings for HIV were generated with RDSAT and used for a weighted analysis in STATA 13. Multivariate logistic regression was used to identify the independent factors associated with HIV prevalence. Results Most of the PWUDs were men (82.0%), and 7.3% were PWIDs. Non-PWIDs, especially users of amphetamine-type stimulants (ATS), represented the larger proportion of the participants (81.5%). The median age for of the PWUDs was 24.0 years (IQR: 20–29). The HIV prevalence among the PWUDs was 5.1% (95% CI: 4.1–6.2), 24.8%, among PWIDs and 4.0% among non-PWIDs. The HIV prevalence among female PWIDs was 37.5, and 22.5% among male PWIDs. Four factors were independently associated with HIV infection: female sex, with AOR = 7.8 (95% CI: 3.00–20.35); age groups 21–29 and older (AOR = 10.3, 95% CI: 1.2–20.4); and using drugs for ≥12 months (AOR = 4.0, 95% CI: 1.38–11.35). Finally, injecting drugs remained a strong predictor of HIV infection, with an AOR = 4.1 (95% CI: 1.53–10.96). Conclusion HIV prevalence remains high among PWIDs. Harm reduction efforts, such as needle and syringe provision programs, must improve their coverage. Innovative strategies are needed to reach sub-groups of PWUDs, especially women who inject drugs. Furthermore, the large proportion of non-PWIDs, especially ATS users, should not be ignored. Therefore, combined HIV prevention and harm reduction programs should integrate ATS users.
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Affiliation(s)
- Heng Sopheab
- School of Public Health at the National Institute of Public Health, Lot #80, Samdech Penn Nouth Blvd. Tuol Kork District, Phnom Penh, Cambodia.
| | - Chhorvann Chhea
- School of Public Health at the National Institute of Public Health, Lot #80, Samdech Penn Nouth Blvd. Tuol Kork District, Phnom Penh, Cambodia
| | - Sovannary Tuot
- Center for Population and Health Research, KHANA, Phnom Penh, Cambodia
| | - Jonathan A Muir
- Department of Epidemiology, University of Washington, Seattle, USA
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17
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Chhea C, Ir P, Sopheab H. Low birth weight of institutional births in Cambodia: Analysis of the Demographic and Health Surveys 2010-2014. PLoS One 2018; 13:e0207021. [PMID: 30408102 PMCID: PMC6224106 DOI: 10.1371/journal.pone.0207021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low birth weight (LBW), an important risk factor for early childhood mortality and morbidity, is a major public health concern in developing countries including Cambodia. This study examined the prevalence of LBW across provinces in Cambodia and changes over time, and identified the factors associated with such condition. METHODS We used children datasets from Cambodia Demographic and Health Survey (CDHS) 2010 and 2014. There were 3,522 children and 4,991 children in both surveys. Maps illustrating provincial variation in LBW prevalence were constructed. Then, multivariate analyses were conducted to assess factors independently associated with LBW in CDHS 2014. RESULTS LBW prevalence remained stable between 2010 and 2014, at around 7.0% 95% CI: 5.8-8.1). all institutional births, but within significant variation across provinces. Factors independently associated with LBW included mother's no education compared with those whose mothers had secondary or higher education (AOR = 1.6, 95% CI: 1.0-2.6), babies born to mothers with < 4 antenatal care (ANC) visits during the pregnancy compared with those whose mothers had at least 4 ANC visits (AOR = 2.0, 95% CI: 1.5-2.8). Also, first-born babies were at greater risk of LBW compared with second-born babies (AOR = 1.4, 95% CI: 1.0-2.0). CONCLUSION The study points to key sub-populations at greater risk and regions where LBW is particularly prevalent. Programs should target provinces where LBW prevalence remains high. Illiterate women, especially those pregnant for the first time should be the program priority. The current national program policy, which recommends that pregnant women have ≥ 4 ANC visits during pregnancy should be further reinforced and implemented. Program design should consider ways to communicate the importance of making the recommended number of ANC visits among women with no formal education.
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Affiliation(s)
- Chhorvann Chhea
- School of Public Health at the National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Por Ir
- School of Public Health at the National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Heng Sopheab
- School of Public Health at the National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
- * E-mail:
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18
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Menasria L, Blaney S, Main B, Vong L, Hun V, Raminashvili D, Chhea C, Chiasson L, Leblanc CP. Mitigated Impact of Provision of Local Foods Combined with Nutrition Education and Counseling on Young Child Nutritional Status in Cambodia. Nutrients 2018; 10:nu10101450. [PMID: 30301233 PMCID: PMC6212877 DOI: 10.3390/nu10101450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Cambodia, stunting and wasting affect, respectively, 32% and 10% of children 0⁻59 months while 55% are anemic. Our research aims to assess the efficiency of two local foods combined with nutritional education and counseling (CEN) activities as compared to CEN alone on improving child nutritional status and dietary intake. METHODS A cluster-randomized controlled trial was conducted in Soth Nikum area over a six-month period among children 6⁻23 months (n = 360) assigned to receive either moringa +CEN, cricket +CEN or CEN alone. Anthropometric measurements were performed and hemoglobin and ferritin levels assessed. RESULTS Overall, no significant increase in the mean length/height-for-age z-score was observed, although a small increase of the weight-for-length/height was noted in intervention groups. Hemoglobin and ferritin mean values increased in all groups. The degree of satisfaction of energy, proteins, iron, and zinc requirements improved in all groups, but to a greater extent in the intervention groups and more children were healthy. CONCLUSION Our research shows no significant impact of the provision of two local foods combined with CEN on the improvement of child nutritional status as compared to CEN alone. However, children consuming them better fulfilled their energy, iron, and zinc requirements and were healthier.
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Affiliation(s)
- Lylia Menasria
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, Moncton, NB E1A 3E9, Canada.
| | - Sonia Blaney
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, Moncton, NB E1A 3E9, Canada.
| | - Barbara Main
- International Programs, World Vision Canada, 1 World Drive, Mississauga, ON L5T 2Y4, Canada.
| | - Lenin Vong
- Independent consultant, Phnom Penh 12203, Cambodia.
| | - Vannary Hun
- World Vision Cambodia, Phnom Penh 12203, Cambodia.
| | | | - Chhorvann Chhea
- National Institute of Public Health (NIPH), Ministry of Health, Phnom Penh 12203, Cambodia.
| | - Lucie Chiasson
- Direction du mieux-être, Ministère du développement social, Miramichi, NB E1N 1B6, Canada.
| | - Caroline P Leblanc
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, Moncton, NB E1A 3E9, Canada.
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Neyhouser C, Quinn I, Hillgrove T, Chan R, Chhea C, Peou S, Sambath P. A qualitative study on gender barriers to eye care access in Cambodia. BMC Ophthalmol 2018; 18:217. [PMID: 30157788 PMCID: PMC6116508 DOI: 10.1186/s12886-018-0890-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/17/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Fred Hollows Foundation (FHF) Cambodia recently partnered with the Ministry of Women's Affairs (MoWA) and National Program for Eye Health (NPEH, part of the Ministry of Health) to establish the Gender Equality in Eye Health Project. As part of this project, a qualitative study was carried out to identify barriers affecting women's access to eye health in Cambodia. METHODS A cross-sectional qualitative study was conducted in four provinces in both urban and rural locations between May and June 2015. Purposive sampling was used to identify respondents from a range of age groups, geographical locations, and experiences to explore different perceptions regarding access barriers to eye health care. Thirteen women experiencing eye problems (age range 45-84 years; mean age 63 years) and 25 eye health professionals took part in in-depth interviews. Eleven focus groups discussions were held with 69 participants (50 women, 19 married men) to capture the views and experiences of both younger and older women, as well as household decision makers' perspectives. RESULTS Gender-based differences in decision-making, access and control over resources and women's social status all contributed to impeding women's access to eye health services. Women relied predominantly on informal sources of information about health, and these channels might be utilised to address barriers to information and access. Disparities in perceived costs of eye health treatment were evident between eye healthcare providers and users: costs were not perceived as a barrier by service providers due to health financing support for poor patients, however, many users were not aware of the availability of the scheme. CONCLUSION Demand-side and supply-side elements interact to reduce women's ability to seek eye treatment.
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Affiliation(s)
- Camille Neyhouser
- The Fred Hollows Foundation, Level 2, 61 Dunning Avenue, Rosebery, Sydney, NSW, 2018, Australia. .,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.
| | | | - Tessa Hillgrove
- The Fred Hollows Foundation, Level 2, 61 Dunning Avenue, Rosebery, Sydney, NSW, 2018, Australia
| | - Renee Chan
- The Fred Hollows Foundation, Level 2, 61 Dunning Avenue, Rosebery, Sydney, NSW, 2018, Australia
| | | | - Seang Peou
- The Fred Hollows Foundation Cambodia, Phnom Penh, 12301, Cambodia
| | - Pol Sambath
- The Fred Hollows Foundation Cambodia, Phnom Penh, 12301, Cambodia
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Chhim S, Chhea C, Sopheab H, Mathers BM, Kaldor J, Evans JL, Stein ES, Carrico A, Muth S, Song N, Maher L, Page K. Proportion and predictors of loss to follow-up in a longitudinal cohort study of female entertainment and sex workers in Cambodia. Int J STD AIDS 2018; 29:1295-1304. [PMID: 29979143 DOI: 10.1177/0956462418779471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We examined the proportion and correlates of loss to follow-up (LTFU) among female entertainment and sex workers (FESWs) in a longitudinal HIV prevention intervention trial in Cambodia. The Cambodia Integrated HIV and Drug Prevention Intervention trial tested a comprehensive package of interventions aimed at reducing amphetamine-type stimulant use and HIV risk among FESWs in ten provinces. The present study estimated the proportion of women LTFU and assessed factors associated with LTFU. Logistic regression analyses were used. Of a total 596 women enrolled, the cumulative proportion of LTFU was 29.5% (n = 176) between zero- and 12-month follow-up. In multivariate analyses, women with no living children (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI]: 1.1, 2.3) and those who experienced recent food insecurity (AOR 1.7; 95%CI: 1.1, 2.7) were more likely to be LTFU. Women who were members of the SMARTgirl HIV prevention programme for ≥ 6 months compared to non-members were less likely to be LTFU (AOR 0.3; 95%CI: 0.2, 0.6). LTFU was moderately high in this study and similar to other studies, indicating a need for strategies to retain this population in HIV prevention programmes and research. Interventions aimed at stabilizing women's lives, including reducing food insecurity and creating communities of engagement for FESWs, should be considered.
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Affiliation(s)
- Srean Chhim
- 1 Technical Bureau, National Institute of Public Health, Phnom Penh, Cambodia.,2 (Former) FHI360, Phnom Penh, Cambodia
| | - Chhorvann Chhea
- 3 School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Heng Sopheab
- 3 School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | | | - John Kaldor
- 4 Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jennifer L Evans
- 5 Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Ellen S Stein
- 5 Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Lisa Maher
- 4 Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Kimberly Page
- 8 Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Jacobs B, Bajracharya A, Saha J, Chhea C, Bellows B, Flessa S, Fernandes Antunes A. Making free public healthcare attractive: optimizing health equity funds in Cambodia. Int J Equity Health 2018; 17:88. [PMID: 29940970 PMCID: PMC6019830 DOI: 10.1186/s12939-018-0803-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 06/14/2018] [Indexed: 11/15/2022] Open
Abstract
Background Following the introduction of user fees in Cambodia, Health Equity Funds (HEF) were developed to enable poor people access to public health services by paying public health providers on their behalf, including non-medical costs for hospitalised beneficiaries (HEFB). The national scheme covers 3.1 million pre-identified HEFB. Uptake of benefits, however, has been mixed and a substantial proportion of poor people still initiate care at private facilities where they incur considerable out-of-pocket costs. We examine the benefits of additional interventions compared to existing stand-alone HEF scenarios in stimulating care seeking at public health facilities among eligible poor people. Methods We report on three configurations of HEF and their ability to attract HEFB to initiate care at public health facilities and their degree of financial risk protection: HEF covering only hospital services (HoHEF), HEF covering health centre and hospital services (CHEF), and Integrated Social Health Protection Scheme (iSHPS) that allowed non-HEFB community members to enrol in HEF. The iSHPS also used vouchers for selected health services, pay-for-performance for quantity and quality of care, and interventions aimed at increasing health providers’ degree of accountability. A cross sectional survey collected information from 1636 matched HEFB households in two health districts with iSHPS and two other health districts without iSHPS. Respondents were stratified according to the three HEF configurations for the descriptive analysis. Results The findings indicated that the proportion of HEFB who sought care first from public health providers in iSHPS areas was 55.7%, significantly higher than the 39.5% in the areas having HEF with health centres (CHEF) and 13.4% in the areas having HEF with hospital services only (HoHEF). The overall costs (out-of-pocket and transport) associated with the illness episode were lowest for cases residing within iSHPS sites, US$10.4, and highest in areas where health centres were not included in the package (HoHEF), US$20.7. Such costs were US$19.5 at HEF with health centres (CHEF). Conclusions The findings suggest that HEF encompassing health centre and hospital services and complemented by additional interventions are better than stand-alone HEF in attracting sick HEFB to public health facilities and lowering out-of-pocket expenses associated with healthcare seeking.
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Affiliation(s)
- Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), c/o NIPH, No.2, Street 289, Khan Toul Kork, P.O. Box 1238, Phnom Penh, Cambodia.
| | | | | | | | | | - Steffen Flessa
- Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany
| | - Adelio Fernandes Antunes
- Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany.,SOCIEUX + Expertise on Social Protection, Labour and Employment, Brussels, Belgium
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Dizechi S, Brody C, Tuot S, Chhea C, Saphonn V, Yung K, Kim S, Yi S. Youth paying for sex: what are the associated factors? Findings from a cross-sectional study in Cambodia. BMC Public Health 2018; 18:113. [PMID: 29310630 PMCID: PMC5759259 DOI: 10.1186/s12889-017-4999-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND At-risk male youth in Cambodia who purchase sex are at greater risk for HIV compared to the general population. Factors associated with paying for sex among youth are poorly studied, both globally and in Cambodia. This study aimed to identify specific factors associated with transactional sex with women among most-at-risk male youth in Cambodia. METHODS This cross-sectional questionnaire survey was conducted with 405 sexually active male youth aged 16-24 recruited at 'hotspots' in the capital city of Phnom Penh and seven provinces. We collected data on demographic factors, sexual behaviors, HIV testing and other potential factors. Multivariable logistic regression analysis was used to identify factors associated with transactional sex. RESULTS In total, this study included 405 male youth with a mean age of 21.3 (SD = 2.2). Of the total respondents, 82.5% (n = 334) have ever paid for sex. After controlling for potential confounding, participants who purchased sex in the last 12 months remained significantly more likely to be older than 18 (AOR = 3.60, 95% CI = 1.26-10.62), reside in an urban area (AOR = 2.29, 95% CI = 1.24-4.20), never have been married (AOR = 9.58, 95% CI = 4.34-21.12), spend less than 2.55 USD per day (AOR = 2.22, 95% CI = 1.12-4.40), and have had more than 4.6 sexual partners in the past year (AOR = 16.73, 95% CI = 4.71-59.36). CONCLUSIONS This study highlights the high proportion of Cambodian male youth who paid for sex and the potential challenges to addressing this issue. While the majority of HIV prevention interventions surrounding sex work are aimed at female sex workers themselves, targeting the demand side of sex work, particularly the local demand, may be an important next step towards a sustainable HIV prevention.
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Affiliation(s)
- Soaman Dizechi
- Center for Global Health Research, College of Education and Health Sciences, Touro University California, Vallejo, USA
| | - Carinne Brody
- Center for Global Health Research, College of Education and Health Sciences, Touro University California, Vallejo, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No 33, Street 71, Tonle Bassac, Chamka Mon, Phnom Penh, Cambodia
| | | | | | - Kunthearith Yung
- Department of School Health, Ministry of Education, Youth and Sports, Phnom Penh, Cambodia
| | - Sanh Kim
- Department of School Health, Ministry of Education, Youth and Sports, Phnom Penh, Cambodia
| | - Siyan Yi
- Center for Global Health Research, College of Education and Health Sciences, Touro University California, Vallejo, USA. .,KHANA Center for Population Health Research, No 33, Street 71, Tonle Bassac, Chamka Mon, Phnom Penh, Cambodia.
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Abstract
In Cambodia, despite great achievements in reducing the prevalence of HIV in the general population, reducing new HIV infections among young at-risk women remains a challenge. This study was designed to examine the prevalence of risky behaviors of sexually active female youth in Cambodia and to explore risk factors associated with engagement in transactional sex. We surveyed sexually active female youth aged 10-24 enrolled at risk "hotspots" in eight provinces in Cambodia. We collected data on demographic factors, sexual behavior, and factors hypothesized to be associated with transactional sex. Multivariable logistic regression was used to identify associations between demographic and sexual behavior and transactional sex. Of the 280 respondents, the mean age was 21.2, and 48.1% had been paid for sex in the past year. After adjustment, at-risk females who were never have been married (adjusted odds ratio (AOR) 3.40, 95% confidence interval (CI) = 1.65-6.97), have completed less than 6 years of school (AOR 3.26, 95% CI = 1.60-6.66), have 1 or more parents who had died (AOR 4.34, 95% CI = 2.00-9.38), be a heavy alcohol drinker (AOR 3.58, 95% CI = 1.78-7.18), have used a condom with their boyfriend during last sexual encounter (AOR 3.50, 95% CI = 1.68-7.32), and have ever had an HIV test (AOR 3.51, 95% CI = 1.68-7.32) were more likely to engage in sex work. Our findings suggest that prevention strategies for female youth at risk of engagement in sex work should include upstream structural interventions that aim to encourage girls' education and empowerment. In addition, tailored sex education and behavior change messaging about the risks of heavy drinking, condom use with romantic partners, and the importance of frequent HIV testing for at-risk youth and sex workers should be designed and delivered to youth currently engaging in sex work.
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Affiliation(s)
- Carinne Brody
- a Public Health Program, College of Education and Health Sciences , Touro University California, Vallejo , CA , USA
| | | | - Chhorvann Chhea
- c School of Public Health , National Institute of Public Health , Phnom Penh , Cambodia
| | - Vonthanak Saphonn
- d Faculty of Medicine , University of Health Sciences , Phnom Penh , Cambodia
| | - Siyan Yi
- a Public Health Program, College of Education and Health Sciences , Touro University California, Vallejo , CA , USA.,b Research Center , KHANA , Phnom Penh , Cambodia
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Sopheab H, Tuot S, Chhea C, Gorbach P. Characteristics, risk behaviors and factors associated with abortion among female entertainment workers in Cambodia. Reprod Health 2015; 12:82. [PMID: 26341129 PMCID: PMC4560886 DOI: 10.1186/s12978-015-0075-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 08/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Linkages between HIV and reproductive health (RH) among female entertainment workers (EWs) have not been addressed well in most developing countries. In Cambodia, there has been considerable research on HIV epidemiology among EWs. However, there have been limited studies on RH and specifically factors related to abortion. We examine socio-behavioral characteristics, and RH practices as determinants of abortion among Cambodian EWs. Methods A survey was conducted in Siem Reap and Battambang and Phnom Penh provinces/city among EWs in September 2012. Trained female interviewers administered the survey to 595 EWs. Two-stage cluster sampling was used to select EWs. Bivariate associations were examined using chi-squares; univariate and multivariate logistic regression were used to assess factors independently associated with reporting having at least one abortion while working as an EW. Results Three-quarters (75 %) of EWs were sexually active, of which nearly one third reported at least one abortion while working as an EW. About 40 % of EWs reported recent an abortion in the past six months. Contraceptive use in the past year was low. Factors found to be independently associated with reporting a recent abortion included: ages 25–29 (OR = 2.2, 95 % CI: 1.2–4.0), living with spouse/cohabitated partner (OR = 2.2, 95 % CI: 1.1–4.2), longer duration of entertainment work (OR = 4.8, 95 % CI: 2.5–9.2), higher number of partners (OR = 4.4, 95 % CI: 2.2–8.7) and being a karaoke worker (OR = 2.2, 95 % CI: 1.1–4.4). Conclusion This study highlights a high proportion of EWs reporting abortion. While HIV vulnerability of EWs has been clearly established, broader RH needs have gone largely unrecognized and not prioritized. Though HIV/RH integrated initiatives have been introduced by the HIV program, challenges for EWs with multiple risks from professional and partners are profound. Therefore, there is an urgent need for practical programmatic approaches to help address their RH needs.
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Affiliation(s)
- Heng Sopheab
- School of Public Health at the National Institute of Public Health, Cambodia, # 2, Street 289, Tuol Kork District, Phnom Penh, Cambodia.
| | | | - Chhorvann Chhea
- School of Public Health at the National Institute of Public Health, Cambodia, # 2, Street 289, Tuol Kork District, Phnom Penh, Cambodia.
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA.
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