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.
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
Copyright (c) 2025 Cambodia Journal of Public Health (CJPH) of the School of Public Health at NIPH
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.
Epidemiology and Clinical Characteristics of Women Accessing Cervical Cancer Screening at the Mercy Medical Center Cambodia in 2023.
Introduction In Cambodia, cervical cancer remains one of the leading causes of cancer-related deaths among women, largely due to low rates of screening and limited access to healthcare services. Persistent infection with high-risk types of human papillomavirus (HPV) is the primary cause of cervical cancer in the country. While cervical cancer screening methods such as Pap smears and HPV testing are available, they are underutilized. This study aimed to describe the epidemiology, including the prevalence of HPV infections and the clinical characteristics of women who underwent cervical cancer screening at Mercy Medical Center, Cambodia (MMCC), in 2023. Methods A cross-sectional study was conducted at the MMCC in Phnom Penh, Cambodia, from January until December 2023. We included 648 records from the MMCC database system of women patients who accessed healthcare services. The data were analyzed with STATA (version 15.1 SE). Descriptive statistics were used. For continuous variables, we calculated the mean (SD) number of follow-up visits and age. We generated the frequency and percentage for categorical variables, including educational level, occupation, and marital status. Bivariate analysis was used to assess the associations between demographic and clinical characteristics and HPV infection. Results The mean age of the screened women was 38.7 years (SD = 8.9), with 77.3% reporting that they were married. Among the total samples, 600 women were screened for cervical cancer, 4.2% of whom tested positive for HPV. The highest prevalence of HPV was observed in women aged younger than 30 years. Women had many comorbidities, including anemia (6.5%), hypertension (6.2%), and diabetes (2.3%). Visual inspection of acetic acid (VIA) was the primary screening method in which 10.2% of the samples were VIA positive. Thermotherapy was the most utilized treatment (81.8%). No statistically significant associations were found between HPV status and factors such as age group, occupation, comorbidities, marital status, or education level. Conclusion This study underscores the need for the MMCC management team, local health authorities, relevant ministries, NGOs, and policymakers to be alerted of HPV infection and cervical cancer prevention. To address high-risk populations effectively, we should particularly target women aged younger than 30 years. It is essential to implement targeted preventative and intervention strategies such as enhancing public education and access to cervical cancer screening and vaccination while encouraging healthcare providers to educate patients and implement follow-up initiatives to increase participation.
Factors Associated with Needlestick and Sharp Injuries among Healthcare Workers in Khmer-Soviet Friendship Hospital
Introduction Needlestick and sharps injuries (NSIs) pose significant occupational hazards for healthcare workers (HCWs), particularly in low-resource settings. These injuries risk transmitting bloodborne pathogens such as hepatitis B, hepatitis C, and HIV. Despite global efforts, HCWs face persistent challenges related to unsafe practices, inadequate protective equipment, and insufficient training. Therefore, we aimed to assess the prevalence of NSIs among HCWs at Khmer Soviet Friendship Hospital (KSFH), identify factors contributing to these injuries and provide evidence-based recommendations for prevention. Methods A cross-sectional study was conducted with 145 HCWs across eight departments in KSFH. Data was collected via self-administered questionnaires among healthcare workers to explore their demographic characteristics, work practices, and NSI occurrence. We used statistical analyses, which included both descriptive and inferential methods, to describe and to evaluate associations between variables. Data was managed and analyzed via SPSS 26 software. Results The overall mean age was 30.3 years (SD ± 6.12), with slightly less than half (46.9%) of them being females. The prevalence of NSIs was 78.6%, with the ICU identified as a high-risk area (29.8% of injuries). Unsafe practices such as needle recapping were prevalent (93.8%), of which 46.5% of healthcare workers reported injuries during recapping. Commonly, left-hand injuries (57.0%) were reported. Inconsistent use of personal protective equipment was noted. Post-injury testing for hepatitis and HIV was conducted in 86.8% of the HCWs. The provision of hospital education on NSI prevention was reported (71.0%). Male HCWs had a greater NSI than female HCWs did (59.6% vs. 40.0%, p value = 0.002). Additionally, associated nurses and midwives and those working in the ICU reported higher injury rates. Conclusion This study highlights urgent needs for targeted interventions to reduce NSIs. Gender, occupation risk exposure, and department-specific risks should be addressed. This occupational hazard requires a multi-faceted approach that combines education and regular training, infrastructure improvement, policy reform, and a cultural shift toward NSI safety. The following recommendations should be addressed: regular and mandatory training on NSI safety, discouraging needle recapping, enhancing personal protective equipment availability, and enforcing safety protocols in high-risk areas.
Seroprevalence, Genotypes and Risk Factors Associated with Hepatitis B Infection among Pregnant Women and People Living with HIV/AIDS in Cambodia
Introduction In 2022, 254 million people were living with chronic hepatitis B, and 1.1 million deaths were estimated globally, mostly due to cirrhosis and hepatocellular carcinoma. High-risk populations, mainly pregnant women (PWs) and people living with HIV/AIDS (PLWHA), are more vulnerable, leading to further transmission and developing the complications. In Cambodia, as available epidemiological data are scarce, we aimed to describe the burdens, genotypes and factors associated with HBV infection among PW and PLWHA. Methods This was a cross-sectional study involving secondary data analysis of 935 (PW: 425, PLWHA: 510) participants from an integrated bio-behavioral survey collected in four provinces between March and April 2016. Socio-demographic data, history of previous exposure, and HBV serological and genotyping results were described using descriptive statistics as appropriate. The prevalence of HBV was reported with 95% CI across independent variables. Univariate and multivariate logistic regression were then computed to identify risk factors for HBV infection. Results The prevalence of HBV among PW and PLWHA were 6.1% [95% CI: 4.2–8.5] and 10.4% [95% CI: 7.6–13.7], respectively. Genotype C was predominantly reported, followed by genotype B, in both populations. According to multivariate logistic analysis, PW aged ≥30 years were significantly more likely to have HBV infection (AOR=2.4, 95% CI: 1.1–5.6) than those aged <30 years were. Compared with those who had never migrated, PLWHA who reported residential mobility had almost double the odds of HBsAg positivity (AOR=1.95, 95% CI: 1.0-3.7). Conclusion This study reports high seroprevalence in PW and PLWHA and a prevalent circulating genotype C and B. HBV screening during ANC visits is recommended, mainly for older age groups, to provide antiviral prophylaxis to prevent further transmission. PLWHA who reported previous residential mobility could be targeted for HBV investigation to provide early management to ensure the effectiveness of HIV treatment and prevent liver-related complications.
The Prevalence and Distribution of Burkholderia Pseudomallei Infection at Takeo Provincial Referral Hospital, Cambodia, 2014–2018
Introduction Burkholderia pseudomallei (BP) is a gram-negative bacterium that is found primarily in soil and surface water. It causes melioidosis, a life-threatening infection that accounts for 165,000 global cases and 89,000 deaths annually, with a high prevalence in tropical regions, including Cambodia. Although the true burden of BP remains uncertain, it is clearly a significant cause of sepsis and community-acquired pneumonia in Cambodia. This study aimed to determine the prevalence and distribution of BP infections in patients at Takeo Provincial Referral Hospital in Cambodia from 2014 to 2018. Methods We used existing data from ACESO in collaboration with the NAMRU-2 and Takeo Provincial Referral Hospital (TPRH). They collected 521 eligible samples of patients seeking health care services at TPRH aged ≥18 years between 2014 and 2018. Blood samples were collected and tested for the pathogen Burkholderia at the Takeo provincial referral laboratory. STATA V 16 was used to analyze the data. We described the sociodemographic characteristics of patients in terms of frequency, percentage, mean (SD) and median (IQR). We also calculated the proportion of positive cases. The chi-square test was used to assess the associations between sociodemographic characteristics and BP positivity. Results Overall, there was a high proportion of patients from Takeo Province (75.8%), male patients (63.5%) and farmers (48.9%). The mean age of the patients was 50 years (SD = 16.7). The prevalence of BP among patients at TPRH was 8.5%. Males (9.7%), individuals aged 36–53 (11.9%), farmers (11.7%) and those with a high school education (15.9%). ICU admission (10.8%, p value = 0.017) and mortality (23.6%, p value < 0.001) were significantly associated with BP positivity. Effective antibiotics, including ceftazidime, imipenem and tetracycline, resulted in 100% sensitivity, while ciprofloxacin and gentamicin were resistant. Conclusion BP infections were identified in Takeo Provincial Referral Hospital, with a prevalence of 8.5%. Higher rates were found among males, patients reported as farmers, and older patients (aged 36–53 years). It commonly peaks during the wet season, which could be linked to the increase in exposure to contaminated soil and water in farming fields. These findings provide valuable insights into the patterns and burdens of melioidosis in Cambodia. The findings suggested the need for an increase in awareness, early detection, and proper clinical management to reduce morbidity and mortality.
Since its first establishment in 2019, our main objective of the Cambodia Journal of Public Health (CJPH) has been to initiate a culture of academic writing and publication among students, faculty members, and health researchers in Cambodia to increase the visibility of their public health and health-related works, both nationally and internationally. Therefore, since the beginning, we have operated the journal through a single peer review with open access without charging any fee to the authors. We encourage all researchers, especially the junior ones, to use the CJPH as an academic platform to share their findings, perspectives, experiences, and critical thinking in all health aspects in Cambodia. We also publish students’ abstracts from their graduated theses with the editor’s review and edit to initiate the idea of what academic publication is like for those students who have been exposed to the system for the first time. At the end of 2024, the CJPH Editor and team would like to thank the following reviewers, who have spent their valuable time and commitment reviewing, evaluating, and providing critical and productive comments to the manuscripts submitted to CJPH. Their dedication and contribution are greatly appreciated. Khieu Kimlee, MD, MPH School of Public Health, NIPH Seang Kennarey, MD, PhD University of Health Science Assoc. Prof. An Yom, MD, MPH, School of Public Health, NIPH Ngor Chamnab, BS, MPH, MEpi National Institute of Public Health Khuon Dyna, BS, MSc, PhD University of Health Science Long Sereyraksmey, RN, MPH National Institute of Public Health Ma Sokvy, BSNM, MSc National Institute of Public Health Chhim Srean, MSc, MPhil National Institute of Public Health Um Samnang, MSc, MA, PhD National Institute of Public Health
Copyright (c) 2024 Cambodia Journal of Public Health (CJPH) of the School of Public Health at NIPH
Medicine Consumption Patterns at Batheay Referral Hospital, Kampong Cham Province, 2020 to 2022
Introduction Drug shortages are predominantly reported to have adverse economic, clinical, and humanistic outcomes for patients and cause possible medication errors from attempts to replace missing medications. Optimal medicine management helps ensure that essential medicines are available at an affordable price. This study aimed to describe drug consumption patterns and assess the supply sources of health commodities at Batheay Referral Hospital (BTRH) from 2020 to 2022. Methods A descriptive study was used. The data from the 2020–2022 annual consumption and expenditure of medicine and health commodities (laboratory reagents and chemicals, consumable medical supplies) were extracted from the drug management system (HosDID) and pharmacy records and analyzed via a Microsoft Excel spreadsheet. VEN analysis (vital, essential, nonessential) of medicine consumption on the basis of the Cambodia Essential Medicine List was also presented. Results On average, 231 items were consumed annually, of which medicines made up 62.3% (144 items), consumables 29.9% (69 items), and reagents 7.8% (18 items). The three most consumed medicines in terms of quantity during the study period were paracetamol 500 mg, multivitamins, and omeprazole 20 mg. The consumption of NCD-related medicines (amlodipine 5 mg, metformin 500 mg) increased from 2021 to 2022. The VEN analysis revealed that vital drugs (V) accounted for an average of 71.3% (103 items) of the total drug consumption at the BTRH, essential drugs (E) accounted for 13.4% (19 items), nonessential drugs (N) accounted for 7.6%, and nonformulary medicines accounted for an average of 7.6%. The CMS provided to BTRH includes mostly oral medicines (69.1%), consumables (27.3%), and reagents (3.6%). The hospital had to purchase additional injectable medicines and most medical supplies. Approximately 90% of the reagents were supplied by hospital budgets, whereas the CMS solely provided national program reagents. Conclusion The V and E drugs accounted for 84.7% of the total drug expenditure, and 7.6% of the drugs in this study were nonformulary. CMS is the hospital's primary source of health commodities, but its supply is still insufficient to meet hospital needs, particularly for injection medicines, medical supplies, and laboratory reagents. Therefore, the government should allocate adequate funds to healthcare services to ensure the availability of essential medicines and medical supplies.
Hand Hygiene Compliance among Healthcare Workers at Baty Referral Hospital: Direct Observation
Introduction Hand hygiene is a way of cleaning one's hands and substantially reduces potential microorganisms on both hands. Good hand hygiene, the simple task of cleaning hands at the right time and in the right way, can prevent healthcare-associated infections and their negative consequences, improve the quality of care, and save lives. However, ensuring good hand hygiene practices in hospital settings remains a challenge. A better understanding of hand hygiene practices among healthcare workers can help determine the most appropriate interventions to improve hand hygiene. Therefore, a study is proposed to assess hand hygiene compliance (HHC) at Baty Referral Hospital, Takeo Province, Cambodia, and make recommendations for improvements. Methods A total of 52 healthcare workers with a total of 260 opportunities (five opportunities each) were included, including 5 medical doctors, 29 nurses, and 10 midwives from the medicine, pediatric, emergency, and maternity departments. They were directly observed by trained data collectors for their HHC with respect to the five moments: (1) before touching a patient, (2) before cleaning or an aseptic procedure, (3) after body fluid exposure risk, (4) after touching a patient, and (5) after touching patient surroundings. The data collected were analyzed via SPSS. Results The overall HHC rate at Baty Referral Hospital was 87.3%, whereas it was 56.8% in 2018. The HHC rate was comparable among medical doctors, nurses and midwives, but it was significantly different among the four departments, with the highest rate (96%) for the emergency department. The HHC rate was 79.7%, the lowest at the moment “before touching a patient”, followed by 82.9% and 83.7% “after touching a patient or patient surroundings”, respectively. The HHC rate was highest at the moments “before the clean/aseptic procedure” and “after body fluid exposure risk,” at 94.4% and 94.8%, respectively. Conclusion Our findings show that HHC at Baty Referral Hospital has been reasonably good, with considerable improvement since 2018. However, further improvement is needed. Such improvement requires continuing efforts in awareness campaigns and training healthcare workers on hand hygiene, coupled with effective monitoring, supervision, and enforcement of rules, with particular attention to hand hygiene action at the moments “before and after touching a patient or patient surroundings”. We also recommend that hospitals regularly continue the five moments of hand hygiene assessment.
Factors Associated with Micronutrient (Iron and Zinc) Deficiency among School Adolescents Aged 10-17 Years in Cambodia
Introduction Adolescence is a critical period of rapid growth, second only to infancy, when nutritional needs are heightened. Malnutrition and micronutrient deficiencies are the result of complex interactions among poor diet, hygiene, and illness and affect physical and mental growth and development. Iron and zinc deficiencies are pressing public health concerns that significantly affect both the physical and cognitive development of adolescents, particularly in developing countries, including Cambodia. They are often overlooked among adolescents since many programs have focused on women and children. Therefore, this study aims to identify the factors associated with iron and zinc deficiency among school-aged adolescents aged 10-17 years in Cambodia. Methods This cross-sectional study used 2015 data from the FIDR, which surveyed children and adolescents from 136 schools in 23 provinces via two-stage cluster sampling. A total sample of 1526 adolescents aged 10–17 years was extracted from the original data of the 2020 samples. Iron and zinc deficiencies were the dependent variables. The independent variables included demographic characteristics, sociodemographic characteristics, household characteristics, school adolescent characteristics, and WASH. We used the chi-square test and logistic regression to assess the associations between iron and zinc deficiencies and sociodemographic characteristics and WASH questions among school-aged adolescents. The data analysis was performed with Stata V15. Results Most adolescents were from rural areas (80.5%), and 60.8% reported being sick in the past month. Overall, iron deficiency was 22.0% and higher in provinces such as Preah Vihear (39.1%) and Stung Treng (39.3%). The associated factors included younger age (10-12 years), female sex, lower education, recent illness, and non-water treatment practices. These factors are linked to higher iron deficiency rates. After adjustment, only those aged 13–15 and 16–17 years had significantly lower odds than those aged 10–12 years did, with AOR = 0.65 (95% CI: 0.46–0.92) and AOR = 0.47 (95% CI: 0.29–0.74). However, nearly all adolescent students had zinc deficiency (99.9%). Conclusion Iron and zinc deficiencies are prevalent among Cambodian adolescents, with iron deficiency rates varying significantly by province, age, sex, education level and health status, particularly among younger adolescent students. However, zinc deficiency is consistently high across all demographics, highlighting a widespread nutritional gap in zinc intake. Therefore, interventions should focus on early dietary education, emphasizing iron-rich foods (meat, beans, leafy greens) and zinc-rich foods (nuts, whole grains).
The Influence of Alcohol Advertising, Promotion, and Sponsorship Appeals to Young Adults (Aged 18 to 25) in Kratie Province, Cambodia.
Introduction The harmful use of alcohol contributes to 5.1% of the global disease burden and causes 3 million deaths annually. From 2003 to 2016, alcohol consumption among Cambodians aged 15 years and older increased from 4.6 liters to 6.7 liters per person. Cambodia has recently introduced rules and procedures for regulating alcohol advertising products; however, these laws have not been fully implemented, and only a partial ban has been enforced. This study aims to explore how alcohol advertising, promotion, and sponsorship influence the attractiveness and perceptions of alcohol use and social norms among youth. Methods This study employed a qualitative research design in which youth who were current drinkers aged 18–25 years were purposively recruited from two universities in Kratie Province. We included twelve focus group discussions (FGDs) in which there were 6 male and 6 female groups. Each FGD consisted of 10 youths. Moreover, 6 in-depth interviews (3 males and 3 females) were included to gain insight into individuals’ understanding, perspective toward alcohol advertisements, social norms, and personal experience using alcohol. In total, we reached 126 students. Thematic analysis was used to analyze verbatim transcripts and notes. Results Alcohol advertising that appealed to young adults featured by celebrities or idols who acted as role models or individuals sharing stories of life struggles, dreams, and fame. Moreover, prizes such as cars, motorcycles, or money and attractive alcohol packaging (e.g., colorful designs and bottle shapes) could influence youth’s attention. The types of alcohol advertising included broadcasts of concerts, music bands, and sporting events. Young adults perceived alcohol advertising and alcohol products as safe and legal. Some even believed that alcohol has medicinal properties and can help individuals with mental illness. However, the study revealed that changing social norms are crucial. Young adults view alcohol consumption as a social necessity to fit into society, avoid social stigma, and strengthen friendships, leading them to drink alcohol. Conclusion In Cambodia, alcohol advertising is diverse, utilizing various forms and strategies to attract young adults to drink alcohol, often without their awareness. Additionally, the new laws still have significant gaps that need to be addressed. Stricter regulations and enforcement are required to restrict alcohol advertising, promotion, and sponsorship, with a particular emphasis on the specific forms and types of advertising that target young adults. These measures are essential to protect young adults from the harmful effects of alcohol consumption.
Prevalence and Factors Associated with Ever Tobacco Use among Secondary and High School Students in Cambodia
Introduction Tobacco use remains a persistent global health concern. In the Western Pacific Region (WPR), tobacco alone has claimed 3 million lives annually, including over 490,000 nonsmokers who are exposed to secondhand smoke. Tobacco use annually costs $663 million in healthcare expenses and invisible productivity losses caused by early deaths, disabilities, and breaks for smoking. Despite the prohibition of the sale of tobacco products to minors, the prevalence of current tobacco usage among school students remained a concern, at 2.4%. It is crucial to deter young people from using tobacco products to reduce disease and death rates. Nearly 90% of adult smokers picked up the habit during their teenage years or early adulthood. We aimed to investigate the factors associated with ever tobacco use among secondary and high school students in Cambodia. Methods We analyzed data from the Cambodia Global Youth Tobacco Survey (GYTS) 2016, a nationally representative sample of secondary (grades 7-9) and high school students (grades 10-12) with a total of 3,716 participants. The overall response rate was 81.0%. GYTS used a two-stage cluster sampling design. A weighting factor was taken into account to adjust for nonresponse and for unequal probability selection. Multiple logistic regression models with stepwise backward regression were performed to identify the main predictors of ever tobacco use via adjusted odds ratio (AOR) with 95% CIs. The significance level of alpha (0.05) was used to test the statistical significance. Results Most of the students (65.8%) were aged 15-17 years, and 34.2% were aged 11-14 years. Boys accounted for 43.6% of the sample. More than half (63.2%) of the participants were in secondary school. Overall, 15.1% of them had ever used any type of tobacco. Ever tobacco use was found to be associated with both parents' smoking, with AOR = 2.06 (95% CI: 1.06-4.00); close friends smoked, with AOR = 5.63 (95% CI: 2.83-11.21); and their teachers smoked (AOR = 2.43, 95% CI: 1.51-3.93), making them feel comfortable at a social gathering (AOR = 1.68, 95% CI: 1.20-2.34) and believing that smoking made them more attractive (AOR = 1.51, 95% CI: 1.08-2.10). Conclusion Factors such as having friends who smoke, the perception of attractiveness, comfort and fit in their social circle, smoking parents, and the visibility of teacher smoking were significantly associated with ever tobacco use among secondary and high school students. It is crucial to consider targeted intervention strategies to educate smoking parents, address peer dynamics through educational interventions, and have law enforcement prohibit tobacco sales to those aged under 18. In the school setting, enhancing school-based tobacco control policies and imposing strict penalties on teacher smoking should be prioritized to reduce tobacco use, not only among students but also among teachers.
Factors Influencing Induced Abortion in Cambodia: Evidence from Cambodian Demographic Health Survey 2021-2022
Introduction Despite legal abortion services, unsafe practices persist in Cambodia, with few national studies examining the factors of women who choose abortion. Therefore, this study was carried out to find out the factor influencing induced abortion among the women of reproductive age group of Cambodia. Methods We used data from the 2021-2022 Cambodia Demographic and Health Survey. The primary outcome was a report of induced abortion as recorded in pregnancy history in the last three years. Bivariate and multivariate logistic regressions were performed using SPSS 21. Results Out of 6156 women, 8.8% reported an induced abortion within three years. Women aged 35-49 had higher odds (Adjusted Odds Ratio (AOR), 2.70; 95% CI, 1.47-4.98) of having had an induced abortion compared to women aged <20 years. Women from the poorest wealth quintiles were less likely to have an induced abortion (AOR, 0.53; 95% CI, 0.37-0.76). Women who had 3 or more children of under 5 years were 90% less likely to have abortion (AOR, 0.10; CI (0.04-0.23) as compared to those who didn’t have under five children. Women who had used contraception currently had higher odds of induced abortion (AOR 1.96; 95% CI, 1.56-2.45) as compared to non-user. Exposure to media was also a significant factor of the abortion (AOR, 1.30; 95% CI, 1.01-1.69). Conclusion In Cambodia, age, wealth quintile of respondents, number of children of under 5 years, media exposure and current use of contraceptive methods influenced induced abortion among women. Interventions targeted at young, poor, women with more than three children of under 5 years and from rural area and remote individuals can address unequal access to abortion services.
The Epidemiological Characteristics of Conjunctivitis among Patients in Prey Veng Provincial Hospital in 2023
Introduction Conjunctivitis (pink eye) is a highly contagious eye condition that presents major public health challenges, particularly in communal environments such as schools, workplaces, and healthcare settings, where it can lead to widespread outbreaks. These outbreaks strain healthcare systems and reduce productivity. In Cambodia, where access to healthcare is limited, especially in rural areas, outbreaks are worsened by poor hygiene, overcrowded living conditions, and low public awareness. Understanding the characteristics and risk factors associated with conjunctivitis is crucial for managing and preventing future outbreaks. This study aimed to examine the epidemiological characteristics and risk factors for conjunctivitis among patients at the Eyecare Unit of Prey Veng Provincial Hospital in 2023. Methods A cross-sectional study was conducted using routine data collected by the Eyecare Unit at Prey Veng Provincial Hospital from January to September 2023. A total of 281 patients seeking eye care services at the OPD consultation were included. Stata V15.1 SE was used in this data analysis. Descriptive statistics and bivariate analysis were performed via the chi-square test to identify factors associated with conjunctivitis. Results The mean age of the patients was 45.5 years (SD = 18.8). Half of them were men, of whom 178 (63.4%) were diagnosed with conjunctivitis. More than one-fifth of the eye patients (22.5%) had moderate impairment, whereas 14.0% had severe impairment. The most common symptoms included redness, itching, and swelling (43.3%), followed by redness, watery eyes, and pain (30.9%); and blurred vision, eye burning, and dry eyes (20.2%). Only 5.6% reported foreign body sensation and severe itching. Most comorbidities included hypertension (13.2%), anemia (8.2%), and diabetes (4.6%). The study revealed significant associations with age, gender, education, and occupation. Conjunctivitis was most prevalent in children (77.8%), adolescents (86.4%) and elderly patients (31.8%). Females were more affected than males were (69.9% vs. 56.5%, p = 0.02). The highest prevalence was observed in individuals with no formal education (90.0%) and factory workers (93.1%), followed by students (83.9%). Conclusion Conjunctivitis was common (63.4%) among eye patients seeking eye care services at Prey Veng Provincial Hospital, with common symptoms of redness, itching, swelling and watery eyes. Hypertension, anemia, and diabetes were notable comorbidities. Younger ages, female sex, and a low education level were linked to increased susceptibility to conjunctivitis. Public health efforts should focus on hygiene education related to health among women, children and those with low education levels. Comprehensive evaluations of coexisting conditions are also recommended to improve ocular health.