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Student's abstract
Roy Thearith1*, Sodara Chan1, Heng Sopheab1
1-School of Public Health of the National Institute of Public Health
*Corresponding author: Roy Thearith, Email: roythearith@gmail.com
Original abstract was written in Khmer
Student's Abstract
Veasna Pen, Yom An, Darapheak Chau
School of Public Health, NIPH Cambodia
Samnang Um1, Heng Sopheab1
1 School of Public Health, National Institute of Public Health
Heng Sunleng; Koeut Pichenda; Tol Bunkea
STUDENT'S ABSTRACT
Supheap Leang1*, Heng Sopheab2
1 Technical Bureau of the National Institute of Public Health,
2 School of Public Health, National Institute of Public Health
Romaing Tep1,2, Sodara Chan1, Heng Sopheab1
*Corresponding author: Romaing Tep, Email: tromaing@gmail.com
THESIS'S ABSTRACT
Introduction
Globally, by the end of 2018, there were 37.9 million of people living with HIV (PLHIV) included 36.2 million adults and 1.7 million children (<15 years). Of these numbers, about 10% (3.8 million) were living South-East Asia. Also, 23.3 million PLHIV were accessing to antiretroviral therapy (ART) that was about 62% of all PLHIV. However, PLHIV who were not retained in treatment are still a big threat to the global long-term success of ART. In Cambodia, despite the HIV response including care and treatment has been highly successful, there was limited knowledge of retention rate and its associated factors.
Methods
A retrospective analysis was conducted by using existing data from ART database. PLHIV enrolled in ART service from 2010 to 2018 through National Center for HIV/AIDS, Dermatology and STDs (NCHADS) database were included and followed up until the end of 2019 when the censoring of the analysis occurred. Kaplan–Meier method was used to estimate the probability of 12-month retention rate in care after the ART initiation. All demographic and clinical variables were included in the univariate and multivariate Cox proportional hazard regression to identify factors associated with poor retention.
Results
Of the 32,684 PLHIVs, 51.7% were men, with 6.8% were under 15 years old. The 12-month retention rate was 87.5% in 2011 and declined respectively from 86.6% to 84.0% in 2015. However, it slightly increased from 84.0% (2017) to 86.5% (2019). The retention in care gradually declined from 78.3%, 74.7%, 70.6% to 67.9% at 24, 36, 48 and 60-month follow-up, respectively. With reference to 0-14 years old patients, the patients who were 15-25 years old had adjusted Hazard Ratio (aHR) of 1.73 (95% CI: 1.54 to 1.94) and 26-50 age group (AHR=1.31, 95% CI: 1.15 to 1.49) as well as greater than 50 years old (aHR=1.33, 95% CI: 1.21 to 1.46). In comparison to the earlier stage patients (WHO stage I): stage III with aHR=1.14 (95% CI: 1.06 to 1.22); stage IV with aHR=1.24 (95% CI: 1.11 to 1.38). Patients with higher education level were retained in care better than those with no education with aHR=0.74 (95% CI: 0.69 to 0.79) for primary, aHR=0.65 (95% CI: 0.60 to 0.70) for secondary and aHR=0.36 (95% CI: 0.29 to 0.46) for the university level. Similarly, patients whose baseline CD4 count ≥ 200 had a better retention hazard (CD4 count >200-350, aHR=0.91 and CD4 count >350, aHR=0.73) than CD4 count <200.
Conclusions
The ART 12-month retention rate from 2011 to 2019 was stable between 84.0% to 86.5%. However, long-term retentions more than 12 months in care declined over time. Lower education, patients, advanced clinical stages and older patients were strongly associated with poor retention. We recommend further study on reasons for higher attrition particularly in the long-term care.
Phearak Rin1, Heng Sopheab1, Sodara Chan1
1. School of Public Health, the National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
*Corresponding author: Phearak Rin, Email: phearakrin@gmail.com
THESIS ABSTRACT:
Introduction
Risky sexual behaviours play a significant role in devastating HIV epidemic. Young people’s lack HIV related knowledges are vulnerable to sexual risk behaviours and potentially lead to HIV infection among themselves and their sexual partners. Commonly, young men have greater intention of unsafe sexual practices and are more likely to have more sexual partners, use paid sex services and use condom inconsistently compared with young women. This study aimed to assess the trend of multiple sexual risk behaviours (HIV-SRB) and its determinants among young men aged 15‒24 in Cambodia.
Methods
This serial cross-sectional study used data from Cambodia Demographic and Health Survey (CDHS) 2005, 2010 and 2014 to analyse the trend of HIV SRB and its determinants. We used Stata V12 to manage and analyse the data. Sampling weight was used to compensate for the two-stage stratified cluster sampling. Chi-square test for trend was used to assess HIV SRB linear trend. Multivariable logistic regression was used to determine independent effects between HIV SRB and its predictors. Statistically significant level was set at p-value < 0.05.
Results
In total, there were 2884, 3265 and 1760 young men aged 15-24 from CDHS 2005, 2010 and 2014 respectively. At least 22.0% of young men reported sexually active across CHDS years. Young men reported decline of HIV SRB about half from 2005 (17.5%) to 2010 (9.5%), then levelling off at 9.3% in 2014 without further decline. Main determinants of HIV SRB were more likely to be non-married (AOR=4.8, 95% CI: 2.8–8.4), be in high wealth index scores (AOR=2.0, 95% CI: 1.3–3.3), and have a history of mobility in the past 12 months (AOR=2.4, 95% CI: 1.5–3.8). Youth who reported more discriminatory attitude toward HIV patients was likely to reduce significantly their HIV SRB about 30.0% (AOR=0.7, 95% CI: 0.5–0.9).
Conclusions
An integrated HIV and sex education program should be conducted specifically among non-married male youth, youth with history of mobility with the focus on knowledge, attitude and practice toward multiple sexual risk behaviours linked to HIV transmission. Program intervention on male youth should be prioritized based on these key determinants where feasible, given the limited national budget and other main priorities. Future study should explore to confirm the future trend of HIV SRB and youth discriminatory behaviours when future CDHS data available.
Vanny You1*, Chhorvann Chhea2
1. Laboratory Quality Management System (LQMS, NIPH; 2. National Institute of Public Health
ABSTRACT
Introduction
Laboratory Quality Management System (LQMS) training program was implemented in Cambodia in 2011 under the coordination of National Institute of Public Health (NIPH) and the Bureau of Medical Laboratory Services (BMLS), Hospital Department, Ministry of Health. LQMS training program has been contextualized from a program called “Strengthening Laboratory Management Towards Accreditation” (SLMTA) which intended to improve the quality management in clinical laboratories. This study aims to evaluate the effectiveness of the LQMS training program in 24 laboratories in public hospitals in Cambodia between 2011 and 2020.
Methods
Quality of the laboratory was assessed in percentage point using assessment tool which consists of twelve quality principles based on ISO 15189 requirements. The effectiveness of LQMS program was evaluated by comparing the assessment score (percentage point) before and after participating in LQMS program (using paired t-test) and between laboratories with and without LQMS training (using t-test). Linear regression was used to identify factors associated with the quality improvement of the LQMS group.
Results
Considerable quality improvement was observed at the laboratories after completing LQMS program (before LQMS=18.5% vs after LQMS=64.1%, p-value < 0.001). The laboratories with LQMS had significantly higher score than those absence of LQMS implementation, (11.4% vs 63.7%, p-value <0.001). Results showed that the most recent batches of LQMS training program have positive correlation with the laboratory quality improvement while smaller number of onsite mentoring in laboratory can make more improvement in lab quality management. However, being a laboratory of higher level (provincial level), and applying Laboratory Information System (LIS) did not affect quality of lab management system. There were 4 sections of the LQMS components which remained big gaps in the QMS implementation: management reviews, internal audits, non-conformity managements, and incidence managements.
Conclusions
After nearly a decade of LQMS implementation in Cambodia at 24 laboratories, their quality has been improved significantly. Further scale-up is needed to expand the LQMS program to other laboratories in response to the need for quality improvement of health services in Cambodia.
Pichsovannary Srey1*, Sodara Chan2, Kimcheng Choun1, Heng Sopheab2
1. Sihanouk Hospital Center of HOPE (SHCH), Cambodia
2. School of Public Health at National Institute of Public Health, Cambodia
* Corresponding author: Pichsovannary Srey, Email pichsovannarysrey@sihosp.org
Sereyraksmey Long1*, Panharat Duk1, Chhorvann Chhea1
1. National Institute of Public Health, Cambodia
ABSTRACT
Introduction
In Cambodia, proper management of the health workforce is one of the major challenges faced by the current health system, particularly the uneven distribution of nurses and midwives at the health center level. This study aimed to explore the current workload of health staff and the skill mix needed at the health center.
Methods
We used the data from the study of the Workload Indicators of Staffing Needs (WISN) for health centers in Cambodia, 2019 and 2020. There were 24 public health centers in six provinces with a total of 214 staff, both health staff and non-health staff. The WISN tool was employed to calculate the workload and the staff requirement for health centers.
Results
Across health centers, midwives and nurses spent 43% and 20% of their working hours, respectively, performing core health service activities, while other 57% and 80% of their working time were used for support activities. These included meetings, reporting, training, supervisions, data management, outreach/community activities, finance & administrative tasks, and so on.
Conclusions
Nurses and midwives are mostly occupied with support activities rather than actual core health service activities. Therefore, there is a need for diverse public health skills at the health center level to support this such as management, planning, administrative, finance and community outreach, etc. Therefore, the public health workforces should be employed to improve work efficiency and consequently giving time to nurses and midwives using their technical skills to improve the performance of the primary health at the grassroots level.
STUDENT'S ABSTRACT
Socheata Phou1*, Chhordaphea Chhea2, Heng Sopheab1
1. School of Public Health, the National Institute of Public Health, Phnom Penh, Cambodia
2. National Center for Health Promotion, MoH, Phnom Penh
*Corresponding author: Socheata Phou, Email: socheata.mph8@gmail.com
A STUDENT'S ABSTRACT
Sokmenea Sreymogn1*, Chivorn Var1, Sodara Chan1
1. School of Public Health, the National Institute of Public Health, Phnom Penh, Cambodia
*Corresponding author: Sokmenea Sreymogn, Email: sreymognsokmenea@yahoo.com
Savina Chham1*, Ngovlily Sok1, Vannith Hay1, Por Ir1
1- National Institute of Public Health, Phnom Penh, Cambodia
STUDENT'S ABSTRACT
Seila Den1*, Bunkea Tol1,2, Darapheak Chau1
*Corresponding author: Seila Den, Email: denseila@hotmail.com
STUDENT'S ABSTRACT
Lalin Sin1*, Samnang Um1, Sodara Chan1, Supheap Leang1
1. School of Public Health, the National Institute of Public Health, Phnom Penh, Cambodia
*Corresponding author: Lalin Sin, Email: sinlalin81@gmail.com
STUDENTS ABSTRACT
Samnang Um1, Bunkea Tol1,2, Heng Sopheab1
*Corresponding author: Um Samnang, Email: umsamnang56@gmail.com
Keywords: Under-five mortality, maternal age, contraceptive use, low birth weight, rural
Introduction
Under-five mortality (U5M) is reflected the socio-economic development, and health. Globally, there are about 5.3 million of U5M in 2018, in which more than half of deaths are due to diseases that are preventable and treatable through simple, affordable interventions. In Cambodia, U5M is a major public health problem with a rate of 35 deaths per 1,000 live births in 2014. Identification of drivers of mortality among children aged below five years is crucially important. Consequently, it could help inform health policy makers and program intervention strategists aimed at achieving SDGs target of further reducing U5M to less than 25 per 1,000 live births by 2030. The aim of this study is to examine the prevalence of U5M across provinces and to identify the factors associated with U5M.
Methods
The existing CDHS 2014 data were used to analyze the last births age 0-59 months on 5,880 children. The outcome variable was child survival status (alive or dead). Chi-square test, simple binary logistic and multivariate logistic regression were performed to identify significant factors associated with U5M. Analyses were weighted to adjust for the complex study design due to the two-stage stratified cluster sampling design used in CDHS. Adjusted Odds Ratios (AOR) with 95% confidence intervals, and p-value < 0.05 were used as a statistically significant level.
Results
U5M among all last child births varied greatly from province to province in which Kratie, Preah Vihear/Stung Treng, and Prey Veng were among the provinces with the highest U5M. Our study found that factors associated with increased odds of U5M including children born from older mothers aged 35-49 years-old (AOR=9.63, 95% CI: 1.48–32.61), low birth weight (<2.5 kg) babies (AOR=4.43, 95% CI: 2.32-7.35), and children born to mothers in rural areas (AOR=2.76, 95% CI: 1.25–6.10). However, children born from mother’s use contraceptive remained a protecting factor of U5M (AOR= 0.30, 95% CI: 0.18–0.52). There were no association between U5M and mothers reported attending ANC4 during their last pregnancy, mothers who smoked cigarettes, children’s sex, birth order, household wealth index and children living in the households used improved sanitation.
Conclusions
The U5M was high in most remote provinces. Older mother’s age, low birth weight babies and children born to mothers in rural areas had higher risks of U5M, while mothers reported using contraceptive had a positive impact on child survival in Cambodia. Therefore, Cambodia should target more specifically in remote provinces and taking all the main associated factors into account when designing the maternal and child health program intervention aim at reducing further the U5M.