Cambodia Journal of Public Health (CJPH) of the School of Public Health at NIPH
Cambodia Journal of Public Health (CJPH) since 2020 ISSN: 2788-7081 Purposes Cambodia Journal of Public Health (CJPH) is the first peer-reviewed public health journal in Cambodia published online, with open access and no article processing charge (APC). The objectives of the CJPH are to initiate a culture of academic publication among students, faculty members, and researchers in Cambodia to increase the visibility of their public health research and related works both nationally and internationally. Also, CJPH will be used as a platform to learn and share their health-related work, research, and program implementation challenges, positive and negative experiences, and lessons learned. Aims & Scope Cambodia Journal of Public Health (CJPH) is a peer-reviewed open-access journal published online. The Journal welcomes original articles on all aspects of public health and health-related issues in Cambodia, including socio-behavioral determinants of health outcomes and diseases, infectious diseases and non-infectious diseases, health promotion, health service research, health systems, policy development, epidemiology, occupational health, environmental health, nutrition, food science, and one health. The School of Public Health (SPH), NIPH is responsible for publishing the CJPH. The SPH is dedicated to the training of public health professionals in Cambodia. The CJPH welcomes and encourages researchers and public health professionals to submit their manuscripts. Articles are published in English.
Patient Satisfaction Survey in Sampov Loun Referral Hospital, Battambang Province from 2021 to 2022
Introduction Patient satisfaction is widely recognized as a key measure of healthcare quality and reflects patients’ perceptions of care, health-seeking behavior and future utilization patterns. In Cambodia, national surveys have consistently highlighted concerns about provider attitudes, waiting times, and cleanliness, underscoring the importance of systematically monitoring satisfaction as part of hospital quality improvement. This study aimed to assess the level of patient satisfaction at Sampov Loun Referral Hospital (RH) in Battambang Province, Cambodia, and to identify key service domains and factors associated with patient satisfaction. Methods A secondary analysis was conducted using data from the Sampov Loun RH’s patient satisfaction surveys, which were collected between April 2021 and December 2022. A total of 5,166 patients from different departments were analyzed. Satisfaction was measured across core domains, including treatment and care, waiting time, counseling and cleanliness, and other domains, including staff friendliness, return intention and results, using a five-point Likert scale. Descriptive statistics were used to summarize satisfaction levels, whereas bivariate analyses were used to explore the associations between demographic and service characteristics and overall satisfaction. The data were analyzed using STATA V.15. Results Overall, patient satisfaction was high, with an average score of 84%, and 99% of the respondents indicated their intention to return for future care and treatment. Satisfaction scores improved steadily quarterly over time, rising from 75% in early May 2021 to 87% by November 2022. Across the domains, treatment and care consistently received the highest ratings, whereas counseling, cleanliness and staff friendliness improved significantly. The waiting time was relatively short for most patients, with 83% receiving care within 30 minutes. Patient satisfaction was strongly associated with younger age, type of service received and perceived treatment outcome (p value < 0.001). Patients who reported being fully recovered had significantly higher satisfaction (94%), followed by those who reported being better (79%), and patients without relieving reported lower satisfaction (67%). Conclusion Sampov Loun Referral Hospital achieved high and steadily improving levels of patient satisfaction during 2021–2022, particularly in the domains of counseling, cleanliness and staff friendliness, while maintaining consistently strong performance in treatment and care. These findings demonstrate the value of institutionalizing patient feedback systems to guide hospital-level quality improvement and support Cambodia’s broader goals for hospital accreditation and universal health coverage.
Copyright (c) 2026 Cambodia Journal of Public Health (CJPH) of the School of Public Health at NIPH
Case Report on Super-Refractory Status Epilepticus
Introduction Super-refractory status epilepticus (SRSE) is a critical condition that poses a serious threat to a patient’s neurological outcome, with a high mortality rate, and is defined as a status epilepticus that persists despite 24 hours of treatment with an IV anesthetic, with the possibility of recurrence once the patient is weaned off the anesthetic medication. In Cambodia, there are no documented case reports of SRSE, nor are there established protocols to guide physicians, particularly emergency doctors and intensivists, in managing this condition. This case report aims to raise awareness, highlights diagnostic challenges, and discusses appropriate management strategies in resource-limited settings. Case Presentation A 21-year-old Cambodian male patient was admitted to the Medical Intensive Care Unit (ICU-Med) at Khmer-Soviet Hospital because of prolonged unmanageable seizures for four days following fever and extreme headache, with a visual analog score (VAS) of 9/10. The patient had been known to have had epilepsy since his first year of life. Owing to persistent seizures and unresponsiveness to the treatment, the patient was then transferred to the ICU-Med for the management of refractory status epilepticus. Conclusion SRSE is extremely rare, and its diagnosis and management are challenging. This case report provides the first evidence to spread the message, findings, management approach, and patient outcomes. The message is that even in a resource-limited situation, we are still able to manage the condition effectively.
Characteristics of Illicit Drug Use, Binge Drinking and Its Association with Sexual Risk Behavior among Female Entertainment Workers (FEWs) in Cambodia
Introduction Cambodia has made notable progress in controlling the HIV epidemic, with new infections declining by 50% between 2010 and 2021. Despite this, HIV remains concentrated among key populations (KPs), particularly female entertainment workers (FEWs), who face high risks related to illicit substance abuse and unsafe sexual behaviors. This study aimed to assess the associations between behavioral risk factors, specifically illicit drug use and binge drinking, and sexual risk behaviors among FEWs in Cambodia. Methods Using data from the 2016 Integrated Biological and Behavioral Surveillance (IBBS), a total of 3,151 FEWs were analyzed. The key outcome variables were having paid sex partners in the past 12 months and inconsistent condom use in the past three months. The independent variables included illicit drug use and binge drinking. Descriptive statistics and bivariate analysis using chi-square tests were performed using STATA 14 SE to determine the association between behavioral risk factors and sexual risk behaviors. Results Most of the FEWs were karaoke women (70.6%), with an average age of 26.2 years (SD = 5.7). Over half (54%) reported having paid sex partners in the past 12 months, and close to 20% reported inconsistent condom use in the past three months. Illicit drug use was reported by 7.6% of participants, and most of them used amphetamine-type stimulants (ATSs). Additionally, 57.6% of FEWs reported binge drinking over the past week, especially among karaoke women. About 70% of the FEWs reported having HIV testing in the past 12 months. Factors significantly associated with sexual risk behavior included illicit drug use in the past 12 months (80.4% vs. 50.9%, p < 0.001) and binge drinking in the past week (55.9% vs. 49.9%, p = 0.003). Also, being a freelancer or former brothel-based sex worker and karaoke worker; younger age at first sexual intercourse; a younger FEW; never-married FSW, having a low level of education; and having HIV testing were associated with sexual risk behaviours, with p values < 0.05. Conclusion Our study revealed high-risk sexual behavior among FEWs, especially among binge drinkers and illicit drug users. This study highlights the urgent need for targeted interventions addressing substance use and risky sexual behaviors among FEWs, especially karaoke workers. Interventions should include health promotion, safe work environments, and structural changes to reduce exploitation and improve access to care. Further research is needed to determine the contributing factors related to workplace conditions and environments that contribute to high risk for substance use and sexual risk behaviors.
Prevalence and Risk Factors of Taeniasis Infection among Residents in Mondulkiri and Ratanakiri Provinces at North-Eastern, Cambodia
Introduction Taeniasis, an intestinal infection caused by Taenia solium and Taenia saginata, remains a significant public health concern in developing regions, particularly Southeast Asia. In Cambodia’s North-east provinces, socio-economic, dietary, and environmental factors contribute to infection persistence, yet localized data are limited. Therefore, this study aimed to determine the prevalence of taeniasis and identify associated socio-economic, demographic, dietary, and environmental risk factors among residents in Mondulkiri and Ratanakiri provinces. Methods A cross-sectional study was conducted using stratified random sampling of 508 participants from rural households. Data collection included structured questionnaires assessing demographics, characteristics, hygiene and sanitation practices, dietary habits (particularly pork consumption) and contact with livestock. Furthermore, stool samples were collected and analyzed using the formalin‒ethyl acetate concentration technique for the detection of taenia eggs. Stata was used in the statistical analyses, which included descriptive statistics, chi-square tests for bivariate associations, and multivariate logistic regression to identify independent risk factors presented as adjusted ORs (AORs) and 95% CIs. Results Among the total sample, 59.5% were females, with a median age of 25 years (IQR: 11–40). The most common age group was 6–18 years (40.4%), followed by 19–40 years (34.8%). The overall prevalence of taeniasis was 11.0%. While general awareness of helminth infection was high (84.5%), only 75.6% had specific knowledge of taeniasis. There was no significant association between prevalence of taeniasis and sex, study site, pig ownership, pork consumption, or latrine availability. However, significant associations were found for increased ages (p<0.001), specific knowledge of taeniasis (p=0.008), and a history of observing tapeworm segments in the stool (p<0.001). Compared with those aged 6–18 years, those aged 19–40 years (AOR=6.07; 95% CI: 1.91–19.20) and 41–80 years (AOR=5.05; 95% CI: 1.60–16.00) had significantly greater odds of taeniasis. Reporting the observation of tapeworm segments in feces was also independently associated with infection, with an AOR of 2.47 (95% CI: 1.12–5.42). Sex, latrine availability, and general knowledge of taeniasis were not statistically significant in the adjusted model. Conclusion This study revealed an 11% prevalence of taeniasis among rural residents of Mondulkiri and Ratanakiri provinces. Older age groups and a history of observing tapeworm segments in feces were significantly associated with increased infection risk. These findings highlight the need for age-targeted health education, improved diagnostic access, and community-based deworming strategies.
Understanding Factors Contributing to Young Adults Aged 18--25 in Preah Vihear Province: The Start-up of Smoking
Introduction Tobacco is a major risk factor for non-communicable diseases, although the prevalence of tobacco use among adults in Cambodia has decreased, with approximately 1.6 million adults in Cambodia smoking. The smoking prevalence among adolescents aged 13-15 years was 3.5%, but it quickly reached 21% once they became adults. Overall, the prevalence of smoking was 28.4% among men and 2.4% among women. This study aimed to understand the reasons encouraging young adults aged 18–25 years in Preah Vihear Province to begin smoking by examining personal, social, and institutional factors, including their perceptions, societal norms, and environmental factors, that influence their smoking decision. Methods A qualitative method was used, including 6 FGDs (8-10 per group) and 12 in-depth interviews (IDIs) with current young male smokers aged 18-25 years who lived in the urban and rural areas of Preah Vihear. IDI was used to explore detailed stories of each participant related to behavior and their social norm toward smoking, whereas FGDs were used to provide detailed data about the perceptions, feelings, thoughts, and impressions of participants through group interaction. Thematic analysis was employed. Results Among all current smokers, 33.3% were aged 18-21 years, and the rest were aged between 22-25 years. The percentage of start-up smokers aged 16-18 years was 54.2%. Petty cash sellers, farmers, and construction workers accounted for more than half of the young smokers (56.3%). Three themes emerged: (1) individual factor - beliefs that smoking relieves stress, prevents insect bites, or, for e-cigarettes, has a pleasant aroma alongside low perceived health risks; (2) social influence - peer influence and family acceptance normalizing tobacco use; and (3) environmental factor - easy product access, low prices, single-stick sales, free samples, and pervasive advertising. Conclusion This study revealed that smoking initiation among young adults in Preah Vihear is driven by personal perceptions, social norms, and an enabling environment, reinforcing tobacco acceptability and accessibility. Therefore, prevention strategies should enforce age restrictions, ban single-stick sales and point-of-sale advertising, and deliver targeted education through schools, communities, and social media, with the active involvement of local leaders in anti-smoking campaigns.
Assessing the Financial Burden of Out-of-Pocket Expenditures for Childbirth Delivery Services at Chey Chumneas Referral Hospital in Kandal Province
Introduction Cambodia has been and continues to make significant efforts to develop its healthcare sector, in line with the Rectangular Strategy, aiming for universal health coverage and poverty reduction. Despite remarkable progress in reducing maternal and infant mortality rates, financial barriers remain a major obstacle to accessing healthcare services, particularly due to out-of-pocket (OOP) expenditures, which account for approximately 60% of total health expenditures. This spending poses a financial risk, especially for poor and vulnerable families. Previous studies have shown that most OOP spending is on inpatient and private services. This study aims to understand the burden of direct out-of-pocket spending for pregnant women and their families related to natural childbirth delivery at a provincial referral hospital. Methods This was a cross-sectional study conducted to estimate the burden of out-of-pocket spending for pregnant women and their families related to natural childbirth delivery at Chey Chumneas referral hospital in Kandal province. A total of 100 mothers were conveniently selected after they met the inclusion criteria and consented to participate. Data were collected between April and June 2024 before their leave from the hospital for less than 72 hours. We interviewed them with a predesigned questionnaire focused on demographic characteristics, medical and non-medical expenses, funding sources, and satisfaction with services. Descriptive analysis, including the mean (SD), median (IQR), frequency and percentage, was performed in Microsoft Office Excel 2020. Results The study revealed that the mean age of the participating women was 28 years (SD = 6.5 years), with 96% being Khmer and 58% being factory workers. Approximately 79% of all participants resided in Kandal province. Approximately 66% of the women had National Social Security Fund (NSSF) cards, 16% had Health Equity Fund (HEF) cards, and 18% paid for services themselves. For nonmedical costs, women with insurance cards spent a median of 630,000 Riels (IQR = 430,000), whereas women without cards spent slightly more, at 843,500 Riels (IQR = 401,000). The main sources of expenses were personal savings, with 68.2% for NSSF users, 25% for HEF users, and 44.4% for uninsured women. The issue of debt was raised, with 22% of participants borrowing money without interest and another 4% borrowing it at high interest rates. Despite some financial challenges, more than 70% of women expressed high levels of satisfaction with the quality of services, staff behavior, and hospital hygiene. Conclusion Out-of-pocket spending remains the primary source of payment for childbirth at Chey Chumneas Referral Hospital, even though social health insurance has helped them significantly reduce the financial burden. Nonmedical expenses, especially for supplies and food, continue to be a heavy burden for women in all groups. For poor women, borrowing money at high interest becomes a financial issue at a worrying point that must be addressed. This study highlights the government's efforts and mechanisms to move toward effective universal health coverage and reduce the financial burden on families.
Case Report of Complete Right Main Bronchus Rupture after Blunt Chest Trauma: Diagnostic Challenges and Surgical Repair
Introduction Tracheobronchial injuries (TBI) represent a rare but potentially life-threatening condition requiring prompt recognition and multidisciplinary management. Clinical signs may include subcutaneous or mediastinal emphysema, hemoptysis, and increased airway resistance, especially in intubated patients. Rapid diagnosis using CT and bronchoscopy is essential to guide treatment. Management strategies vary depending on the etiology, ranging from conservative approaches in iatrogenic injuries to surgical repair in cases of blunt or penetrating trauma. Early airway stabilization and treatment of associated life-threatening injuries are critical. The objective of this article is to present a rare case of complete right main bronchus rupture following blunt trauma and highlight diagnostic and surgical challenges. Case Presentation A 35-year-old male presented with dyspnea and chest pain following blunt chest trauma. Initial evaluation revealed a right-sided tension pneumothorax with subcutaneous emphysema, which was managed by chest tube drainage. Persistent air leakage prompted a chest CT on day 8 post chest tube insertion, raising suspicion of right main bronchus rupture. Flexible bronchoscopy performed on day 9 post chest tube insertion demonstrated bronchial stenosis without an obvious defect. Definitive diagnosis was established intraoperatively on day 10 post chest tube insertion, confirming a complete circumferential rupture of the right main bronchus. The patient underwent right posterolateral thoracotomy with end-to-end bronchial reimplantation, followed by an uneventful recovery. Follow-up bronchoscopy showed a well-healed bronchial anastomosis. Conclusion This case underscores the practical challenges clinicians face in recognizing and diagnosing tracheobronchial injuries after blunt trauma. When a pneumothorax persists despite adequate chest tube drainage, frontline providers must consider early advanced imaging and bronchoscopy, even in resource‑limited settings, because definitive diagnosis may sometimes only be confirmed intraoperatively. Early surgical intervention, once diagnosis is suspected or confirmed, can yield excellent outcomes.
Copyright (c) 2025 Cambodia Journal of Public Health (CJPH) of the School of Public Health at NIPH
Knowledge, Attitudes, and Practices (KAPs) toward Zoonotic Transmission from Wildlife in the Context of COVID-19 in Two Provinces, Cambodia
Introduction Zoonotic diseases, which are transmitted between animals and humans, pose significant public health risks, especially in Southeast Asia and Cambodia, due to high biodiversity and human‒animal interactions. This study assessed knowledge, attitudes, and practices (KAPs) regarding zoonotic pathogen transmission from wildlife during the COVID-19 outbreak. Methods A cross-sectional study was conducted in 2021 among 503 participants aged ≥ 18 years in Stung Treng and Mondolkiri provinces, Cambodia. Using cluster sampling, participants were interviewed with a tablet-based, standardized questionnaire on wildlife consumption and zoonotic risk. Descriptive analysis summarized the sociodemographic data, and chi-square tests were used to assess potential associations between independent factors and KAP levels. Multivariate logistic regression analysis with forward and backward stepwise approaches was used. A p-value ≤ 0.05 was considered statistically significant. Results Overall, 62.0% were female, 68.0% were aged 25--54 years, 89.2% were married, and 74.6% were farmers. KAP levels were suboptimal: only 42.7% demonstrated good knowledge, 46.5% had positive attitudes, and 54.9% reported safe behaviors. Several key predictors are independently associated with high KAP. The predictors of better knowledge included primary/secondary education (AOR = 2.19, 95% CI = 1.35-3.56) and higher education (AOR = 9.38, 95% CI = 4.15-21.22), and the Khmer ethnic group (AOR = 1.64, 95% CI = 1.02-2.65). The predictors of positive attitudes included being younger than 24-54 years of age, having a higher income ($100-299 USD) with AOR=1.68 (95% CI=1.12-2.52), being in the Khmer ethnic group (AOR=2.19, 95% CI=1.37-3.49), and having better knowledge (AOR=2.23, 95% CI=1.53-3.25). Safe practices were associated with being female (AOR=1.79, 95% CI=1.21-2.65), having a Khmer ethnicity (AOR=1.92, 95% CI=1.23-2.99) and having positive attitudes (AOR=2.27, 95% CI=1.56-3.32). Conclusion This study revealed a low level of knowledge and attitudes but a moderate level of practices (P) regarding zoonotic diseases in rural Cambodia, which are influenced by education, ethnicity, and income. Public health campaigns should focus on wildlife-transmitted zoonoses, wild meat consumption, and safe animal handling, which are culturally tailored interventions. Enhancing access to health information in rural areas, particularly for the most vulnerable communities, is essential. Future research should assess the long-term impact of public health interventions and explore cultural factors to improve awareness and prevention.
The Magnitude, Characteristics, Surgery Uptake and Factors Associated with Cataracts among Patients at Prey Veng Provincial Referral Hospital
Introduction Cataracts remain one of the leading causes of visual impairment and blindness globally, especially among aging populations in low- and middle-income countries, including Cambodia. In the past, most available data focused on urban healthcare centers, leaving a gap in understanding how cataract cases are diagnosed, treated, and managed in rural areas where access to specialized eye care is often limited. Understanding its prevalence, associated risk factors, and treatment utilization is crucial for informing and designing proper clinical management, planning, and public health strategies. This study aimed to assess the prevalence of cataracts and the rate of treatment uptake as well as to examine associated demographic and clinical factors among patients attending the ophthalmology department at Prey Veng Provincial Referral Hospital. Methods A study was conducted using secondary data from 1,046 patients who visited the ophthalmology department of Prey Veng Provincial Referral Hospital in 2024. Data were extracted from structured patient records, which were stored in a high-security database system. Only authorized personnel can access it. We analyzed the data in Stata 15 via both descriptive and inferential statistical methods. The frequency distributions and percentages of categorical variables, such as sex, age group, and cataract management, are reported. To identify factors associated with cataracts, bivariate analyses were conducted with the chi-square test. Results The overall mean age was 55.0 years (SD = 15.0). High proportions of patients were older, particularly those aged 51–60 years (30.3%) and those aged over 60 years (39.3%). Females accounted for 61.7% of the patients. Among the 1,046 patients, 11.8% (123/1046) were diagnosed with cataracts. A strong association was observed between cataracts and increasing age, with 19.5% of cataract cases occurring in patients over 60 years old and 10.7% occurring in patients aged 51–60 years (p value < 0.001). Male patients accounted for 14.2% of the cataract cases, whereas the prevalence of cataracts was 10.2% in female patients (p value = 0.052). Only 28.5% (35/123) of the diagnosed individuals received cataract surgery. Conclusion Although the prevalence of cataracts in patients seeking services in the ophthalmology department at the provincial RH of Prey Veng is relatively low compared with that reported in similar studies in the region, the burden increases markedly with age, especially among men. The limited use of cataract surgery underscores the need to address barriers to care through enhanced public awareness, community-based screening initiatives, and expanded access to surgical services.
Case Report: A Rare Case of Dengue-Triggered Very Severe Aplastic Anemia in a Pediatric Patient in Cambodia
Introduction Dengue fever is a common viral infection in tropical regions, including Cambodia. While rare, it can lead to severe aplastic anemia (AA), a life-threatening condition marked by bone marrow failure and pancytopenia, posing significant diagnostic and therapeutic challenges. Early recognition and treatment are crucial for improving outcomes. This case report presents a unique instance of dengue-induced very severe AA that was successfully managed with immunosuppressive therapy. Case Presentation An 11-year-old Cambodian boy presented with fever, headache, myalgia, vomiting, and mild abdominal pain. Laboratory tests revealed pancytopenia, with a WBC count of 0.9 × 10⁹/L, an absolute neutrophil count (ANC) of 0.5 × 10⁹/L, an Hb concentration of 7.3 g/dL, and a platelet count of 70 × 10⁹/L. Dengue serology was positive for both IgG and IgM, confirming the presence of dengue fever. After 16 days, the patient was afebrile for more than 9 days, but persistent pancytopenia led to a referral for haematology. Repeated laboratory investigations confirmed severe pancytopenia, with a white blood cell count (WBC) of 0.9 × 10⁹/L, an ANC of 0.08 × 10⁹/L, a hemoglobin (Hb) concentration of 7.7 g/dL, a platelet count of 40 × 10⁹/L, and an absolute reticulocyte count of 2.94 × 10⁹/L, with a bone marrow exam revealing very severe aplastic anemia (AA) secondary to dengue. Biimmunosuppressive therapy with cyclosporin A (8 mg/kg/day) and prednisolone (2 mg/kg/day) was started. The patient improved significantly, with normalization of blood counts and resolution of hemorrhagic symptoms, and was discharged. Cyclosporine treatment was continued for 3 months, resulting in complete remission. Conclusion Aplastic anemia secondary to dengue fever is an uncommon but serious complication. Early recognition, particularly in endemic areas, and timely initiation of immunosuppressive therapy are crucial for favorable outcomes. In resource-limited settings where ATG is not accessible, such as in Cambodia, a combination of cyclosporin A and corticosteroids can be an effective alternative, as demonstrated in this case.
Assessment of Patient Safety Culture among Healthcare Workers in Preah Sihanouk Provincial Hospital
Introduction Patient safety culture provides cultural support and promotes patient safety throughout the organization. It refers to the values, beliefs, and norms shared by healthcare practitioners and staff that influence their actions and behaviors. It can be measured by determining values, beliefs, norms, and behaviors related to patient safety. It is an important aspect of healthcare quality and is a public health concern globally. However, little work has been done on patient safety culture in Cambodia. This study aims to assess the degree of patient safety culture among healthcare workers in a provincial hospital. Methods A cross-sectional survey was conducted among 122 selected healthcare providers at Preah Sihanouk Provincial Hospital in September 2024. Data were collected through self-administered questionnaires via Google Forms. The tool was adapted from the Hospital Survey on Patient Safety Culture of the Agency for Healthcare Research and Quality. The responses were entered into statistical software (SPSS V-26) for analysis. Descriptive statistics were used to calculate the percentage of positive responses for each of the 41 items in the 12 safety culture dimensions. Results The positive culture scores varied greatly across the 12 dimensions, ranging from 86.1%, the highest, to 27.9%, the lowest, with an overall average score of 55.3%. The items with a strong safety culture (score >75%) were teamwork within the hospital units and organizational learning-continuous improvement, whereas the items with a moderate level of safety culture (score between 50%-75%) included feedback and communication about error, teamwork across hospital units, hospital management support for patient safety, supervisor‒manager expectations and actions promoting safety, and hospital handoffs and transitions. The items with a weak safety culture with scores <50% were communication openness, frequency of event reporting about errors, overall perception of safety, staffing, and nonpunitive response to errors. These require well-designed patient safety interventions that are integrated with organizational policies to address all dimensions of patient safety culture, particularly those with the lowest scores. Conclusion The current patient safety culture perceived by healthcare workers at Preah Sihanouk Provincial Hospital must be improved. Broader cultural improvements are needed, with a particular focus on dimensions with the lowest positive culture scores, such as communication openness, event reporting, staffing, and nonpunitive response to error. These require well-designed patient safety interventions to be integrated with organizational policies to address all dimensions of patient safety culture.
Factors Associated with HIV Viral Load Testing among People Living with HIV Initiating ART between January 2022 and June 2024, Cambodia
Introduction HIV viral load testing (VLT) is a critical component of monitoring the effectiveness of antiretroviral therapy (ART) and evaluating progress toward the third “95” target of the UNAIDS 95-95-95 goals. Despite significant progress in scaling up VLT services in Cambodia, limited evidence exists regarding the coverage and determinants of VLT among individuals newly initiated on ART. This study aimed to assess the coverage of HIV viral load testing and identify factors associated with VLT uptake among people living with HIV (PLHIV) who initiated ART between January 2022 and June 2024 in Cambodia. Methods We performed a cross-sectional study using existing data from the National Center for HIV/AIDS, Dermatology, and STDs (NCHADS) between 1st January 2022 and 30th June 2024, with a total of 12,861 PLHIVs recorded. Descriptive statistics were used to summarize the characteristics of the patients and the proportions of PLHIV who underwent VLT and achieved a viral load suppression (VLS). Multivariable logistic regression with manual backward stepwise elimination was used to identify factors independently associated with VLT uptake after adjusting for potential confounders. Results The median age of the PLHIV was 32 years (IQR: 25-39), with 76.8% male patients. Among the 12,861 patients on ART, 10,356 (80.5%) had been on treatment for ≥ 6 months, and 7,615 patients (73.5%) had received at least one VLT. Among those tested, 91.4% achieved VLS, defined as a viral load < 1,000 copies/ml. Pediatric patients (<15 years) had slightly lower VLT coverage (72.4%) and substantially lower viral suppression rates (74.0%) than did adults (91.7%). In the multivariable logistic analysis, factors independently associated with higher VLT uptake included residing in coastal/seaside regions (AOR=1.46), working in informal or formal employment sectors (AOR=2.15 and 1.79, respectively), having higher educational attainment (AOR=1.57), having an ART duration of ≥6 months (AOR=28.69), and having higher CD4 counts. Conversely, residence in mountain and plateau regions was associated with lower VLT uptake (AOR=0.50). Conclusion While Cambodia has achieved commendable viral suppression rates, notable gaps remain in VLT coverage, particularly among pediatric populations and those living in remote regions, particularly mountain and plateau areas. Strengthening pediatric-specific strategies, expanding access in underserved areas, and addressing disparities in education and employment may help improve VLT uptake and overall HIV program outcomes.
Understanding the Out-of-Pocket Financial Burden of Childbirth at the National Maternal and Child Health Center.
Introduction To achieve the 2030 vision of becoming an upper-middle-income country, the government of Cambodia prioritizes improving health and well-being through primary health care services toward universal health coverage (UHC). Additionally, the policy ensures that all citizens receive the services they need without financial risk. High out-of-pocket expenditure costs for health care in Cambodia can pose a financial barrier to accessing necessary health care services, such as maternal services, especially for poor and vulnerable people. This study aims to explore the burden of out-of-pocket costs on women who deliver at the National Center for Maternal and Child Health (NMCH), Phnom Penh. Methods A cross-sectional study was conducted with 100 women who underwent normal vaginal delivery from January to March 2024. The data were entered and analyzed via Microsoft Excel 2020. Descriptive analysis was performed. The mean or median (IQR) was calculated for continuous variables, and the frequency and percentage were calculated for categorical variables. The results are presented in tables and graphs with detailed explanations. Results The women’s mean age was 27 years with ranging from 17 to 40 years. Close to half (48%) of the women were workers, and 57% were from Phnom Penh. Sixty percent of the women had National Social Security Fund (NSSF) cards, 17% had health equity fund (HEF) cards, and 23% did not have any cards. The median total cost of childbirth was 710,000 Riel (IQR = 581,500 Riel). When stratified, it costed 677,500 Riel for women with an NSSF card, 325,000 Riel for women with an HEF card and 1,199,000 Riel for women without a card. Women with NSSF cards and HEF cards did not pay for hospital-funded services, except for a small number, who paid extra fees for beds and gave courtesy fees to the doctors. Women without a card spent approximately 564,000 Riel (IQR = 60,000 riel) out-of-pocket on funded services. The median non-medical expenditure was 619,000 Riel (IQR = 397,000 Riel), of which 659,000 Riel for women with an NSSF card, 325,000 Riel for women with an HEF card, and 576,500 Riel for women without a card. With respect to the resources, 71% were from personal savings, 22% were from relatives’ loans, and 4% were from high-interest loans. Conclusion The out-of-pocket expenditure burden associated with childbirth at the NMCH appears to be at a level that poses a financial risk to women and their families. Although the social security health care system and the HEF have helped reduce the overall cost of financing services for women who are members, many still have to pay out-of-pocket, especially for non-medical services, and some are forced to take out-of-pocket loans to cover these costs. For women without a card, there is a cost for both financial and non-medical services. Some recommendations are provided for reducing this out-of-pocket cost burden.
National Maternal and Child Health Center
Determinants of Complete Basic Childhood Vaccination among Children Aged 12–35 Months in Cambodia
Introduction Vaccination is a critical public health intervention to prevent childhood morbidity and mortality. Despite global progress, vaccination coverage in low- and middle-income countries (LMICs), such as Cambodia, remains suboptimal. Studies on the factors associated with complete basic childhood vaccination in Cambodia are limited. This study aimed to assess the determinants of complete basic childhood vaccination among children in Cambodia. Methods This study utilized data from the 2021–2022 Cambodia Demographic and Health Survey (CDHS). Children aged 12–35 months were included. We performed weighted analysis via descriptive statistics, bivariate analysis, and multivariate logistic regression. Statistical significance with a p-value < 0.05 and an AOR with a 95% CI were calculated to measure the strength of the association between completing basic childhood vaccination and independent predictors. Results A total of 3,065 children were included, 49.6% of whom were girls, with a mean age of 23 months (SD=6.9). Overall, 66.3% of the children received complete basic childhood vaccinations, with Ratanakiri (23.1%) and Koh Kong provinces (38.9%) having the lowest rates. Lower basic childhood vaccinations were associated with higher birth order (≥4th) (AOR=0.55, 95% CI: 0.36–0.84) and fewer ANC visits (<4) (AOR=0.55, 95% CI: 0.39–0.77). Higher basic childhood vaccinations were observed in children with birth weights ≥2.5 kg (AOR=1.72, 95% CI: 1.11–2.54), wealthier households (AOR=1.53, 95% CI: 1.13–2.06), mothers who received PNC (AOR=1.29, 95% CI: 1.03–1.62) and mothers aged ≥40 years (AOR=2.23, 95% CI: 1.04–4.78). Regional disparities were significant, with greater coverage in the plain region, Tonle Sap region, and mountain region than in the coastal/sea region. Conclusion Overall, complete basic childhood vaccination was lower than the national target, particularly in Koh Kong and Ratanak Kiri provinces. Lower vaccination rates were associated with higher birth orders, fewer ANC visits, and no PNC visits, whereas higher coverage was linked to greater birth weight, wealthier families, older maternal age, and geographical region. Targeted interventions in specific low-rate groups and regions are crucial for improving vaccination coverage and ensuring that targets are met.
Characteristics and Treatment Outcomes of Tuberculosis Patients in Siem Reap Province, Cambodia, 2022
Introduction Tuberculosis (TB) remains a major public health challenge globally and is a concern in Cambodia, particularly in Siem Reap Province. The TB Program reported that 2023 Siem Reap an estimated TB incidence rate of 40 per 100,000 people in 2022. Understanding the characteristics and treatment outcomes of TB patients is crucial for evaluating the effectiveness of TB control efforts and informing future interventions aligned with the Cambodia National Strategic Plan to End TB 2021–2030 and the WHO End TB Strategy. This study aimed to describe the sociodemographic characteristics and treatment outcomes of TB patients reported in Siem Reap Province in 2022. Methods A retrospective study was conducted using secondary data from the TB Management Information System (TB-MIS) for TB cases registered in Siem Reap Province from January to December 2022. After the data were cleaned for eligibility, a total of 2244 out of 2249 records were retained. The descriptive analysis was performed using Microsoft Excel, focusing on patient demographics, age, sex, TB type, bacteriological confirmation, and treatment outcomes. Results A mean age of the notified TB patients was 51.2 years. Children aged ≤ 14 years accounted for approximately 1% of the sample, and this proportion gradually increased with age. Most notified TB patients were men (59.3%), and the highest number of notified TB patients were aged 55–64 years (24.2%), followed by those aged ≥ 65 years (22.1%). In terms of site distribution, Siem Reap OD accounted for 45.3%, followed by Sotnikum OD (23.3%), Angkor Chum OD (20.7%), and Krolanh OD (10.7%). Pulmonary TB was the predominant form (83.2%), and 63.5% of the cases were bacteriologically confirmed. Close to 98.8% were new cases, and most (92.1%) were treated with the category 1a regimen (adult) for a total of 6 months, in which 2 months were an attack phase including rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) (2RHZE), followed by 4 months of the continued phase with rifampicin and ethambutol (4RH). The treatment success rate was 92.4%, with a cure rate of 46.0% and a treatment completion rate of 46.6%. However, among new pulmonary bacteriologically confirmed cases, the cure rate was 73.5%. Conclusion The study demonstrated a high treatment success rate, highlighting the effectiveness of the TB control program in Siem Reap Province. However, gender-specific outreach and improved diagnostic capabilities are needed to further optimize TB case detection and management. Integrating childhood TB data from SRP pediatric hospitals, particularly Kantha Bopha Hospital, into TB-MIS would enhance surveillance. The findings provide essential evidence for public health strategies to strengthen TB control efforts in Siem Reap Province, supporting Cambodia’s efforts to achieve the Cambodia National Strategic Plan to end TB 2021--2030 and the WHO’s End TB Strategy goals.
Challenges and Enabling Factors in Providing Vaccines to Target Children at Chroy Changvar Health Center, Phnom Penh, 2023
Introduction Low vaccination coverage rates can lead to disease emergence, outbreaks, and epidemics, potentially resulting in disabilities or fatalities. Globally, in 2023, approximately 14.5 million children had not received any vaccines, whereas 83% of children had received the first dose of the measles vaccine. In Cambodia, vaccines currently in use include BCG, diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophilus influenzae, measles, DTP-Hib-HepB, pneumonia, Japanese encephalitis, and cervical cancer. At the Chroy Changvar health center (HC), the vaccine coverage rate is notably low, standing at 36.6% for key indicators of the National Immunization Program (NIP). Therefore, it is imperative to investigate the factors influencing vaccination coverage at this HC to identify challenges and improve vaccine delivery to target children, achieving higher coverage rates in the Chroy Changvar HC and meeting the NIP indicators. Methods This study used qualitative approaches to collect data in December 2024. They included document review, direct observation, and in-depth interviews (IDIs) with key informants; focus group discussions (FGDs) with parents or child care givers; and semi-structured questionnaires with caregivers. The participants were selected from five villages with the lowest vaccination coverage rates. The interviews were audio recorded, transcribed, and transcribed verbatim. The transcribed data were verified for accuracy. In cases of missing or insufficient data, extra data were gathered. We used thematic analysis methods by coding themes via Microsoft Excel. Results In total, 37 participants were included: 14 IDIs and 23 FGDs. The challenges for the vaccine providers consisted of inaccuracies and reliability in document filling (no recording of the vaccination results, incorrect report filling), no visual charts for vaccine coverage monitoring, and a high vaccine refusal rate (11.5%), especially for DPT-HepB-Hib 3 and MR-18. Moreover, challenges for vaccine recipients included unclear communication between health workers and village heads and non-full involvement from local authorities and stakeholders. Limited knowledge from parents and guardians about the importance of vaccinations was also common. Moreover, enabling factors included HC motivation to further increase vaccination coverage, the availability of proper vaccine storage systems, and regular monitoring and support of the vaccination team at higher levels. Conclusion This study revealed multiple barriers to vaccination coverage from both service providers and recipients while recognizing enablers that could improve immunization rates. To address these challenges, strategic interventions are recommended at both the Operational District and HCs, including strengthening governance and clear operational plans, improving monitoring systems, and ensuring equitable vaccine access. Implementing these measures would increase vaccination effectiveness and ensure that children receive adequate protection against vaccine-preventable diseases.
Key Characteristics of Malaria Case Reporting in Hard-to-Reach Areas of Stung Treng Province, 2021-2023
Introduction Globally, malaria affected 249 million people and caused 608,000 deaths across 85 countries in 2022. In Cambodia, malaria has become more focalized and endemic, requiring a tailored approach to identify and interrupt the remaining sources of transmission. The goal of eliminating all malaria species by 2025 has been set. Stung Treng Province accounted for an alarming 534 malaria cases, constituting 39% of the total cases reported in Cambodia. Therefore, this study analyzes malaria case trends and malaria infection by sociodemographic profiles and other characteristics among hard-to-reach populations in Stung Treng Province from 2021 to 2023. Methods We analyzed malaria data from Stung Treng Province (2021-2023) extracted from the Malaria Consortium's Project, which targeted mobile, migrant, and vulnerable populations who were at high risk of malaria transmission in the province. The data were analyzed via Stata 17 with descriptive statistics to calculate frequencies and percentages for categorical variables. The chi-square test was used to determine associations between socio-demographics (gender, age, occupation, and resident status), case classification, points of care, activity type, and malaria infection. P values < 0.05 were considered statistically significant. Results Among the 552 identified malaria cases, it peaked in 2022 (306 cases) from May to August. Mobile detection (55–74%) surpassed local detection. Most patients were male (1.4%) vs. female (0.5%), with p<0.001. A higher positivity rate was found in children under 5 years of age (1.5%) than in older age groups (p < 0.001), but most of the cases were aged 15–49 years (378 cases). Relapses constituted 62.9% of the cases. Soldiers accounted for half of the cases (50.2%). Mobile Malaria Posts detected 53% of the cases, followed by home detection and outreach/active fever screening/co-traveller activities. Among the 544 Pv/Mix cases, 69 were referred for radical cure; the remaining 475 were not referred because they were ineligible due to low weight. Conclusion The analysis of hard-to-reach populations revealed that malaria cases surged in 2022, with most cases relapsing. Children under 5 years of age had the highest positivity rate, but those aged 15-49 years accounted for most malaria cases. Soldiers reported being most at risk of malaria infection. Active fever screening yielded the highest positivity rate. These findings underscore the need for tailored malaria strategies for these populations, especially military personnel in remote areas, emphasizing ITN use, chemoprophylaxis, early detection, and prompt treatment.
Severe and Prolonged Cutaneous Necrosis Following Jellyfish Envenomation in a Cambodian Child: A Case Report
Introduction Jellyfish envenomation is a significant yet often underrecognized public health issue, particularly in coastal regions with high marine activity. In Southeast Asia, countries such as Thailand, the Philippines, and Malaysia have documented numerous cases of jellyfish envenomation, including severe complications and fatalities. In Cambodia, the coastline stretches along the Gulf of Thailand and includes popular destinations such as Kampot, Kep, and Sihanoukville, jellyfish stings remain underreported. There has been a lack of published data or case reports documenting jellyfish-related injuries among Cambodian children. We report the first documented case of a 6-year-old girl who developed prolonged cutaneous necrosis and secondary infections following jellyfish exposure in the coastal waters of Kampot Province. Case Presentation A 6-year-old girl was initially diagnosed with a jellyfish sting. She presented with non-healing necrotic lesions and significant inflammation in both thighs. Despite receiving treatment at several local clinics, her condition did not improve, prompting her admission to the National Pediatric Hospital for intensive care. During hospitalization, her condition gradually improved with intensive wound care, including repeated debridement. However, secondary infections with methicillin-resistant Staphylococcus aureus (MRSA) and superficial fungal infection (tinea) complicated her recovery. Following appropriate antimicrobial treatment and meticulous wound management, her condition significantly improved. Ultimately, the patient fully recovered, although she had persistent skin lesions for 41 days in total, including 21 days of outpatient care. Conclusion This case highlights the potential severity of jellyfish envenomation in children, including prolonged skin necrosis and secondary infections such as MRSA and tinea corporis. This underscores the need for timely recognition, proper wound care, and appropriate antimicrobial treatment. In Cambodia, where public awareness and clinical guidance on marine envenomation are limited, this report emphasizes the importance of education for both communities and healthcare providers.
Methicillin-Resistant Staphylococcus Aureus
A Pilot Study for Malaria Elimination Certification in Baray Santuk Operational District, Kampong Thom Province, Cambodia 2025
Introduction Cambodia has made significant progress in malaria control, reducing cases by more than 90% since 2010 and resulting in zero malaria-related deaths since 2018. In line with the Cambodia Malaria Elimination Action Framework 2021–2025, the country aims to achieve malaria-free status by 2025. According to World Health Organization (WHO) guidelines, certification of malaria elimination requires three consecutive years of zero indigenous cases, robust surveillance-response systems, and documented programmatic evidence. This study aimed to assess the readiness for malaria elimination certification in the Baray Santuk Operational District (OD) by evaluating epidemiological trends, health system performance, and surveillance capacity from 2021–2024. Methods A mixed-methods approach was used, including a review of malaria data from the National and OD-level Malaria Information Systems (ODMIS), key informant interviews, and health infrastructure assessments. The WHO’s “1-3-7 strategy” was applied as a benchmark for surveillance performance: (1) case notification within 1 day, (2) case classification within 3 days, and (3) foci investigation within 7 days. Descriptive analysis and data visualisations were employed to examine incidence trends, case classification, and system readiness indicators. Results Between 2021 and Quarter 1, 2024, malaria incidence declined to zero. P. falciparum transmission was interrupted by 2022, and the number of P. vivax cases decreased to zero by early 2024. The Baray Santuk OD consistently met 1-3-7 targets from 2023 to 2024, with 100% of confirmed cases reported within one day and classified in a timely manner, and 85% of foci investigated within 7 days. Moreover, community engagement and surveillance-response systems were ready, including the presence of actively trained village malaria workers (VMWs), G6PD testing capacity, radical cure availability, and effective supervision and reporting mechanisms. These components were in line with the required pillars for elimination readiness: strong leadership, a capable health workforce, and integrated vector and case management strategies. Conclusion These findings demonstrate that Baray Santuk OD has made significant strides in controlling and eliminating malaria, achieving the key milestones required for WHO certification. This indicates strong readiness for malaria elimination certification, fulfilling the WHO criteria for zero indigenous cases and providing effective surveillance-response systems. Furthermore, there is an operational capacity and engagement of VMWs, including maintenance of surveillance coverage and timely intervention. This pilot study underscores the feasibility of district-level certification in Cambodia and offers a replicable model for other provinces aiming to meet national and global malaria elimination goals.
Understanding the Characteristics of Patients with Tuberculosis in Stung Treng Province, Cambodia: A Retrospective Study (2018-2023)
Introduction Tuberculosis (TB), caused by Mycobacterium Tuberculosis, is curable and preventable. Globally, 10.8 million people (55% men) fell ill with TB in 2023. The incidence of TB in Cambodia in 2022 was 320/100,000, with a mortality rate of 23/100,000. Understanding TB patient characteristics is crucial for effective interventions. This study describes TB case characteristics in Stung Treng Province from 2018 to 2023. Methods A retrospective study was conducted to analyze TB data extracted from the TB management information system (TB-​​​MIS) in Stung Treng Province from 2018 to 2023. Descriptive analysis was performed to examine case trends, socio-demographics (gender, age, nationality, address, treatment center), patient type, case definition, disease site, TB with HIV status, and treatment outcomes via Microsoft Excel. Results A total of 1052 TB cases reported from 16 out of 20 health facilities were analyzed during this six-year period. The highest and lowest trends of notified TB cases were observed in 2019 (299 cases) and 2022 (86 cases), respectively. Childhood TB represented 22.81% (240 cases). Most of the patients were Khmer, and the largest age group was 55–64 years (209 patients). Males represented 63.50% (668 patients) of all patients. Pulmonary TB (59.03% or 621 cases) was common, with 75.04% (466 cases) being bacteriologically confirmed, while most extrapulmonary TB cases were clinically diagnosed (99.77%, 430). The majority of notified TB patients (83.75%) were tested for HIV, 3 of whom were HIV positive. The treatment success rate was high, ranging from 98.84% to 100%. However, the treatment cure rate (among bacteriologically confirmed TB cases) was low, with an average of only 38.79%. Conclusions The number of TB cases in males reported in Stung Treng Province was significantly greater than that reported in females. However, case detection of TB in all forms remains a challenge. More estimated cases remain undetected. Moreover, the cure rate of bacteriologically confirmed cases is low. To improve TB control in the province, TB diagnosis and proper referral to hospitals should be ensured. Active case finding and contact investigations must be strengthened, especially in hard-to-reach areas and high-risk groups such as older adults and males, with adequate supplies maintained. To address the low cure rate, regular TB-MIS training, data quality audits, and proper follow-up treatment for bacteriologically confirmed cases, mainly a smear examination at month 5 or month 6, are essential. Expanding TB services to all health facilities and ensuring 100% HIV testing coverage among TB patients are also essential.
Factors Associated with Knowledge and Attitudes Toward HIV Prevention among Women Aged 15--24 in Cambodia
Introduction Although improvements in HIV prevention and control have been made worldwide, adolescents and young women remain at increased risk for HIV infection, especially in developing countries. In Cambodia, the prevalence of HIV has decreased substantially from the peak of the HIV epidemic (2%) in the 1990s to 0.6% in 2021. While young women aged 15-24 years are most affected, especially sexually active ones, insight into the factors associated with their knowledge and attitudes toward HIV prevention is critically important for targeted HIV prevention efforts. Therefore, an investigation on this age range is needed to systematically examine the influence of sociodemographic and structural factors on their knowledge and attitudes toward HIV prevention in Cambodia. Methods The study was carried out with secondary data from the 2021-2022 Cambodia Demographic and Health Survey (CDHS). It involved 1,389 women aged 15–24 years. The dependent variables were levels of knowledge and attitudes toward HIV prevention, which were categorized as good or poor. The explanatory variables included educational status, wealth index, age group, marital status, residence, health facility visits, and exposure to media. The data were analyzed using descriptive statistics and bivariate and multivariable logistic regression models. The significance level of alpha (0.05) was used to test the statistical significance. Results Overall, 63.8% of these young women demonstrated a good level of knowledge about HIV/AIDS, whereas 56.7% had moderately positive attitudes. Good knowledge of HIV prevention was independently associated with being aged 20–24 years with an adjusted odds ratio (AOR) of 1.28 (95% CI: 1.02–1.62), being rich (AOR=1.38, 95% CI: 1.03–1.83), having a higher education level with AOR=3.21 (95% CI: 1.57–7.53), and having regular internet access (AOR=1.53, 95% CI: 1.15–2.02). For positive attitudes toward HIV prevention, independent associations were found among women aged 20-24 years with AOR=1.51 (95% CI: 1.17-1.96), married/living with a partner (AOR=2.26, 95% CI: 1.67-3.06), being rich (AOR=1.36, 95% CI: 1.01-1.83), and with higher education (AOR=8.86, 95% CI: 3.83-20.50). Conclusion The finding reveals that young women aged 20-24 years, being in the rich wealth quintile, having higher education, and having regular internet access are important predictors of good knowledge and positive attitudes toward HIV prevention. The study also revealed that positive attitudes toward HIV prevention were associated with marital status. Therefore, intervention efforts should focus on younger women aged 15-19 years and those with a lower socioeconomic status, low education level and nonmarried status.
Management of Choledochal Cyst in Adults: A Four-Year Surgical Experience at a Cambodian Tertiary Center
Introduction A choledochal cyst is a congenital or acquired dilation of the biliary tree, affecting the extrahepatic and/or intrahepatic bile ducts. It is more prevalent in females and Asian populations. Early diagnosis and appropriate surgical management are essential to prevent complications and ensure optimal outcomes. This paper aimed to describe the clinical presentation, diagnostic approaches, surgical management, and postoperative outcomes of adult patients with choledochal cysts at a Cambodian tertiary center. Methods We conducted a retrospective case series of seven adult patients with choledochal cysts who underwent surgical treatment between January 2020 and December 2023 by checking medical records. We collected data on symptoms, imaging, Todani type classification, surgical procedure, and postoperative outcomes. Data were shown as mean, median, frequency and percentage Results Seven patients (five females, two males) were included, with a mean age of 33.7 years. Common symptoms include abdominal pain and jaundice. According to Todani's classification, these included 1 case of type Ia, 3 cases of type Ic, and 3 cases of type IVa. All patients underwent complete cyst excision with Roux-en-Y hepaticojejunostomy and cholecystectomy. No malignancy was found on histology in any case. The median follow-up duration was 24 months. Conclusion Choledochal cysts should be considered in the differential diagnosis of adult patients presenting with epigastric or right upper quadrant pain, jaundice, or signs of cholangitis. Thorough preoperative imaging and classification are essential for planning surgical intervention. Complete cyst excision with Roux-en-Y hepaticojejunostomy remains the standard treatment for extrahepatic types. Long-term follow-up is necessary for monitoring potential complications and early detection of malignant transformation.
Exploring Animal Source Foods Consumption Patterns among Young Children in Cambodia
Introduction Having appropriate childhood nutrition is crucial for growth and development. For this reason, animal source foods (ASFs) are vital foods for providing essential nutrients. However, populations, particularly children in low- and middle-income countries, consume small amounts of ASFs due to poverty, limited access, cultural beliefs, and dietary habits. Child malnutrition in Cambodia remains a problem because of factors that have been linked to diets, such as insufficient nutrient food intake, high consumption of rice-based foods, and feeding practices. This study aims to assess the consumption patterns of ASFs and their determinants among children aged 6–23 months in Cambodia. Methods We used the child dataset from the 2021-22 CDHS. The sample included 1,277 children aged 6–23 months. The 32 food items were asked for within 24 hours before the survey and then classified into 8 main food groups. The ASFs included dairy products, eggs, meat, organ meat, and fish. Stata 14 was used in data analysis with accounting for the sampling weights. Multivariate logistic regression was used to assess the main predictors of ASF consumption among children aged 6–3 months, and the results are presented as AORs and 95% CIs. Results Overall, 87.94% of the children consumed ASFs, with significant variations based on age, health status, parental occupation, women's minimum dietary diversity (MDD-W), and breastfeeding status. Children aged 12–17 months were 5.59 times more likely to consume ASFs than were those aged 6–8 months. Children without recent diarrhea were 2.18 times more likely to consume ASF. Compared with unemployed parents, children from parents who work in blue-collar jobs are 7.08 times more likely to consume ASF. Nonbreastfeeding mothers were 5.20 times more likely to have children consuming ASFs. Children whose mothers met the MDD-W criteria were 2.21 times more likely to consume ASFs. Conclusion The consumption of ASFs is high among children aged 6–23 months. Non-breastfed children may consume more ASFs, but this does not ensure a well-balanced diet. These findings underscore the critical importance of a diversified diet and highlight the significant influence of socioeconomic and parental factors on children's dietary habits. Further research should focus on adequate ASF consumption among children aged 6–23 months to better understand dietary patterns and preferences.
Women's minimum dietary diversity (MDD-W)
Epidemiological Trends and Vaccination Impact: Rubella Surveillance and Control in Cambodia, 2015 - 2022
Introduction Rubella is a highly contagious viral infection with mild symptoms that primarily affects children and young people. It is caused by the rubella virus, which spreads via respiratory droplets when infected people sneeze or cough. The infection during pregnancy, particularly in the first trimester, causes miscarriage, fetal death, stillbirth, or congenital abnormalities in children, known as congenital rubella syndrome (CRS). Every year, more than 100,000 children are born with CRS worldwide. This study aims to analyze the characteristics of rubella cases in Cambodia from 2015 to 2022 and explore control techniques. Methods This study utilized several program data sources to analyze epidemiological trends and provide a comprehensive approach to understanding the impact of vaccination on rubella control from 2015--2022 in Cambodia. These data were collected from national surveillance databases, vaccination data, and data from laboratory surveillance systems. By combining these surveillance data and MR coverage data annually, this study offers insights into the effectiveness of rubella control strategies and identifies areas for future improvement. Results Between 2015 and 2022, the National Immunization Program (NIP) reported 9,755 suspected cases of rubella and 130 laboratory-confirmed rubella cases, with an average annual incidence of 1.01 per million people. Rubella cases increased over time, reaching 1.17 per million people in 2015 and 1.87 per million people in 2019, peaking at 2.45 per million people in 2020, and then decreasing. Additionally, the number of reports of suspected cases increased over time, peaked in 2020 (2,857 cases) and then declined. Among the total 9,755 suspected cases, Phnom Penh reported the most cases (23.9%), followed by Kandal province (8.3%) and other provinces. The 9–59-month-old group accounted for 49.2% (64/130) of the rubella cases. Fewer than half (43.0%) of them were boys. In all years, we observed that girls were more likely than boys to contract rubella. The rainy season accounted for 54.6% of all cases, whereas the dry season accounted for 45.4%. Regarding the vaccination status of eligible rubella cases (N=111), 34.2% of cases had two doses or more, 57.7% had one dose, and 8% had not received any dose. Official MR1 coverage was high, more than 95%, and MR2 coverage was less than 90% from 2015 to 2022. Conclusion This study highlights that rubella circulated throughout the country and peaked from approximately 2019 to 2020, before decreasing trends in rubella incidence were observed. By maintaining high MR coverage and enhancing regular surveillance, Cambodia can continue to control and eventually eliminate rubella, safeguarding the health of its population, particularly women and children.
A Descriptive Study of Hospitalized Cervical Cancer at Khmer-Soviet Friendship Hospital in 2023
Introduction Cervical cancer remains a significant public health concern, particularly in low- and middle-income countries such as Cambodia, where limited access to early screening and treatment exacerbates the burden. Understanding the demographic, clinical, and treatment characteristics of hospitalized cervical cancer patients is essential for informing healthcare policies and improving patient outcomes. This study aims to assess the proportion of cervical cancer patients among all female cancer patients and to describe the sociodemographic characteristics of patients in terms of age, residence, source of payment, health condition of patients at the time of discharge, and length of stay in the hospital. Methods A descriptive study was conducted among cervical cancer patients admitted to the oncology department at Khmer Soviet Friendship Hospital (KSFH) from January to December 2023. Data were collected from the existing electronic health records system of KSFH 2023. We extracted and managed the data in an Excel spreadsheet and analyzed them in Stata V15. Results The present study revealed that among 4,012 female cancer patients, 1,198 (29.85%) were diagnosed with cervical cancer, making it the most common cancer among hospitalized female patients. The mean age was 55.7 years (SD = 9.9). Most of the cervical cancer patients were older women, with 74.9% aged over 49 years. Close to eighty percent (78.96%) were from rural provinces, whereas the rest were from Phnom Penh, indicating limited healthcare access in rural areas. Slightly more than half of the patients (50.3%) paid out-of-pocket for care and treatment. Close to one third (29.8%) were covered by the Health Equity Fund (HEF), and 15.3% were insured under the National Social Security Fund (NSSF). At discharge, 93.2% of patients experienced improvements in their health, whereas 6.7% experienced no significant improvement. Only 0.08% of patients died during hospitalization. The average length of stay was 3.7 days (SD = 2.5), with 54.6% staying 1–3 days, 37.1% staying 4–7 days, and 8.3% staying longer than 7 days. Conclusion This study revealed that cervical cancer was the most common cancer among hospitalized female patients, especially among older women. This suggests disparities in healthcare affordability and highlights the need for improved healthcare access, particularly in rural areas. It also underscores the financial burden of care and treatment and suggests the need for expanded health insurance coverage, such as NSSF and HEF, for rural provinces and increased public health initiatives for the early detection and prevention of cervical cancer.
Vehicle Ownership and Road Crashes in Cambodia: Results from Three Nationwide Surveys
Introduction Cambodia has made remarkable economic progress over the past two decades. A rapid rise in vehicle ownership and road traffic crashes accompanies this advancement. This study investigated the social determinants of road crashes, including increasing vehicle ownership in Cambodia. Methods This is a retrospective analysis of household data from three rounds (2005, 2010, and 2014) of the Cambodia Demographic and Health Survey, a nationally representative survey. We estimated the independent associations between household vehicle ownership (bicycles, motorcycles, and cars or trucks) and the reporting of injury or death from road crashes by any household member. Multivariable logistic regression analysis evaluated the adjusted associations between reporting road crashes and vehicle ownership while controlling for other household and environmental factors. Results A combined total of 45,513 households were surveyed within the study period (2005 to 2014). The proportion of households reporting road crash-related injury or death increased from 3.9% in 2005 to 5.5% in 2014 [p<0.0001]. Among different types of vehicles, households that own motorcycles were 72% [AOR: 1.72 95% CI (1.55 - 1.92)] more likely to report having a victim of a road crash after adjusting for the location of the household, wealth index, education level, and gender of the head of the household. Conclusion An increasing motorized vehicle ownership appears to drive Cambodia's worsening road safety. The threat of deteriorating road safety is worse in countries experiencing rapid economic development, while improvement to physical infrastructure and regulatory frameworks is lagging. As Cambodia continues its journey towards economic prosperity, road safety should receive additional attention. Efforts should especially focus on motorcycles.
Awareness, Knowledge, Attitudes, and Practices Toward Chikungunya Prevention among Publics in Svay Rieng Province, Cambodia
Introduction Chikungunya, a vector-borne disease transmitted by the female Aedes aegypti mosquito, has become a global health concern, particularly in Asia, Africa, and the Americas. The disease, which causes fever, rash, and debilitating joint pain, reemerged in Cambodia in 2020, leading to more than 6,000 cases, indicating the risk of local transmission. This study aims to assess the awareness, knowledge, attitudes, and practices (KAPs) regarding chikungunya among the general population in Svay Rieng Province, Cambodia. Methods A cross-sectional study was conducted in 2022 using data from post-temephos larvicide (Abate application) supervision reports in Svay Rieng Province. A total of 274 participants aged 18 years and above were included. Descriptive statistics were used to summarize sociodemographic characteristics, whereas bivariate and multivariate logistic regression analyses were employed to assess factors associated with KAP toward mosquito bites and mosquito breeding prevention. The adjusted OR was calculated, and a p value ≤ 0.05 was considered statistically significant. Results The mean age was 45 years (SD = 15), with women accounting for 63% of the sample. Of all participants, 33.3% were aware of Chikungunya, primarily through social media and mass communication channels (TV, radio). Of these, 41.7% had good knowledge, 43.9% demonstrated a good attitude, and 42.8% practiced effective mosquito prevention methods; only 28.6% reported sleeping under a bed net in the daytime. Wearing long sleeves and using mosquito repellents are common practices. Factors associated with good knowledge included higher monthly income > $147 (AOR = 5.3, 95% CI: 1.0-24.8), self-employment (AOR = 17, 95% CI: 3.0-94.5) and residing in urban areas (AOR = 3.9, 95% CI: 1.1-3.6). Similarly, positive attitudes were independently associated with self-employment (AOR = 9.2, 95% CI: 1.8-46.2) and higher monthly income (AOR = 6.2, 95% CI: 1.2-31.2), while positive practices were associated with self-employment (AOR = 18.2, 95% CI: 3.4-96) and living in urban areas (AOR = 3.6, 95% CI: 1.1-11.9). Conclusion This study highlights the low level of awareness and knowledge of Chikungunya in Svay Rieng Province, with significant gaps in attitudes and practices. Public health interventions focusing on education and targeted awareness campaigns are necessary to improve KAP related to Chikungunya, especially in rural areas and among lower-income populations.
The Patient Satisfaction with Nursing Care and Its Associated Factors among Adult Patients in Khmer-Soviet Friendship Hospital
Introduction Patient satisfaction (PS) is the patient's perception of their care, compared with their expected level of care during hospitalization. The Ministry of Health in Cambodia aims to increase the quality of nursing care in all health facilities, particularly hospitals, but studies on patient satisfaction with nursing care are limited. Therefore, this study aimed to determine the level of satisfaction and identify factors associated with nursing care from the perspective of admitted adult patients in government hospitals in Cambodia. Methods This descriptive, cross‐sectional study was conducted at Khmer Soviet Friendship Hospital (KSFH). Convenience sampling with a total of 133 samples was conducted from five departments or medical wards. We collected data using the Patient Satisfaction with Nursing Care​ Scale (PSNCS), which consists of four domains (health information, affective support, decisional control, and professional technical competencies). Five data collectors were trained before the actual data collection. Descriptive statistics were conducted, such as means (SDs), frequencies, and percentages. T-tests and one-way ANOVA were used to determine the associations between PS mean scores and patients’ demographic characteristics. A p-value of <0.05 was considered to indicate statistical significance. Results The average age of the participants was 49.7 years (SD = 14.7). More than 53% of the participants were females. Approximately 45% of the hospitalized patients were free of charge for hospital admission. The overall mean score of PS with nursing care was 4.32 (SD = 0.47), which was close to 86%. Specifically, the PS with affective support care was 4.41 (SD = 0.45), and the PS with professional-technical competencies was 4.37 (SD = 0.49) and 4.29 (SD = 0.59) for patients’ decision control. The mean PSNC score was significantly different for adult patients with different levels of education (p = 0.034), those who needed nursing care (p = 0.042), those with wards across the hospital (p < 0.001), those with different numbers of patients in each room (p < 0.001), those with different incomes (p = 0.013), and those with different illness severity indices (p = 0.003). Conclusion Overall, KSFH had a high level of PS (85.7%) toward nursing care, with factors such as affective support and technical competencies affecting nursing practices. Further nursing care should pay attention to poor (lower income), less educated, and severely ill patients. Continuous investigations are needed to improve efficiency, considering demographic variations. In cases where patients lack holistic judgement, nurses should involve family members and use visual aids.
Knowledge Components Associated with Antenatal Care Practical Skills among Three-Year Associate Degree in Midwifery Students at the Technical School for Medical Care, University of Health Sciences
Introduction Medical care training has played a significant role in advancing the global health sector by enhancing the quality of healthcare services, contributing to the reduction of morbidity, disability, and mortality rates, particularly antenatal care (ANC) services, which are crucial for supporting women during pregnancy. A fully qualified midwife is at the forefront of health care and is closely involved with the mother. Therefore, the Technical School of Medical Care (TSMC) is responsible for providing training that focuses on developing the skills of students, particularly training to become midwives. This ensures that they are well prepared to provide comprehensive ANC services and that graduated midwives are fully equipped with the necessary expertise and skills. This study aimed to explore the theoretical knowledge and practical abilities of third-year associate degree students at TSMC, the University of Health Sciences, regarding the ANC components included in the course curriculum. Methods This was a descriptive cross-sectional study conducted in July 2023 with all 43 third-year students from 2022-2023 at TSMC. Questionnaires and checklists were used to assess knowledge and students’ practices of prenatal care skills. The data were entered into Excel and imported into Stata V15 for analysis. The data were used to describe the frequencies, percentages, mean values, and analytical methods used to assess the relationships between knowledge of ANC components and the ANC prenatal skills of midwifery students. Results The third-year associate degree midwifery students demonstrated an 81% level of theoretical knowledge and an 88% level of practical ability regarding ANC components. However, the results revealed that students had a limited understanding of certain ANC aspects, such as the importance of recognizing the baby’s presentation (79.1%) and knowing when to conduct an ultrasound to detect fetal abnormalities (51.2%). Additionally, the study revealed that students gained more theoretical knowledge from national hospitals, referral hospitals, and health centers than from simulation laboratories (82.4% vs. 42.8%, P=0.004). The finding also revealed a correlation between theoretical knowledge and practical ability, meaning that students who had higher levels of theoretical knowledge demonstrated stronger practical skills (P=0.015). Conclusion The study highlighted that midwifery students possess adequate theoretical knowledge and practical skills that align with the core competencies of ANC outlined in the curriculum. However, to enhance the quality of preemployment training, it is recommended that students further develop themselves by strengthening both their theoretical understanding and practical application of the ANC components identified as limited in the study.
The Bacterial Profiles and Antimicrobial Susceptibility Patterns of Isolates from National Antimicrobial Resistance Surveillance, Cambodia 2018–2021
Introduction Antimicrobial resistance (AMR) is an emerging global health threat, particularly in low- and middle-income countries where healthcare resources are limited and where antibiotic misuse is widespread. In Cambodia, AMR poses a severe challenge, with increasing resistance among pathogens responsible for bloodstream infections (BSIs) and bacterial meningitis. Key bacterial pathogens, including Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter spp., and Streptococcus pneumoniae, exhibit high levels of resistance, presenting substantial treatment challenges. The emergence of extended-spectrum beta-lactamases (ESBLs), carbapenemases, and methicillin-resistant S. aureus (MRSA) exacerbates the AMR crisis. This study aimed to examine the bacterial profiles and AMR patterns of different bacterial pathogens. Methods A retrospective analysis was conducted using data collected from the National AMR Surveillance System between 2018 and 2021 (CamLIS). It included bacterial isolates from mostly blood and cerebrospinal fluid samples processed at eight sentinel hospitals, including Siem Reap, Battambang, Takeo, and Kampong Cham Provincial Referral Hospitals, and National Pediatric Hospital, Calmette Hospital, Angkor Hospital for Children, and Hope Center of Sihanouk Hospital. Laboratory testing was conducted to identify bacterial isolates and AMR patterns across pathogens. Antimicrobial susceptibility testing (AST) was performed. After cleaning and checking, 38978 records remained. Descriptive analysis was performed via STATA version 14.2 to calculate the means (SDs) for continuous variables such as age and frequency and percentages for categorical variables such as age group and sex, pathogen identification, susceptibility results, and AMR patterns. Results Escherichia coli was the most frequently isolated pathogen (40.5%), followed by Klebsiella pneumoniae, Acinetobacter spp., Staphylococcus aureus, and Streptococcus pneumoniae. The highest prevalence of infections occurred in patients aged 45–64 years (29.5%), with 21.4% in those over 64 years. The findings revealed 94.4% resistance to ampicillin in E. coli and 39.7% resistance to amoxicillin-clavulanate in K. pneumoniae. Carbapenem resistance was detected in 21.6% of the K. pneumoniae isolates, whereas carbapenem resistance increased in A. baumannii. The MRSA prevalence was 61.3%, with high resistance to erythromycin (69.7%) and clindamycin (69.2%), and S. pneumoniae exhibited significant resistance to penicillin and macrolides. Conclusion This study highlights the growing threat of AMR in Cambodia, particularly among E. coli, Klebsiella pneumoniae, and MRSA isolates. Resistance mechanisms such as ESBL production, carbapenemase resistance, and methicillin resistance are widespread, reflecting regional and global trends of AM. Cambodia’s response, including the establishment of the National AMR Surveillance System and the National Action Plan to Combat AMR, represents significant progress. However, geographic disparities in healthcare access, limited laboratory infrastructure, and persistent antibiotic misuse remain major challenges. Strengthening surveillance, enhancing infection control, and promoting responsible antibiotic use are essential to combat AMR effectively.