Archives - Page 6
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.
Chhorvann Chhea1*, Kimsear Hong1
Sokvy Ma1*, Heng Sopheab1, Chhorvann Chhea1
1. School of Public Health at the National Institute of Public Health, Phom Penh
ABSTRACT
Introduction
Minimum meal frequency (MMF), a proxy indicator to examine child’s energy requirements, focuses on the number of times children receive foods apart from breast milk and breastfeeding by child’s age. This study describes the MMF among children aged 6-23 months and its distribution across additional key characteristics of the children and their mothers.
Methods
A secondary data analysis of Cambodia Demographic Health Survey (CDHS) 2014 among 2,201 children aged 6- 23 months was performed. Descriptive analysis and MMF distribution across child and mother’s characteristics were conducted using STATA V 14.
Results
Overall, higher proportion of boys (71.4%) than girls (68.0%) met required MMF. Children who met required MMF were living in urban rather than rural areas (82.6% vs. 69.0%). Higher proportion of children (76.0%) whose mothers working in non-agriculture met required MMF than children (70.1%) with mothers working in agricultural sector. Finally, the higher the number of children the HH had (≥ 4 children), the lower the children met the MMF requirement.
Conclusions
Meeting recommended MMF for children aged 6-23 months remains a concern in Cambodia though found better than many other countries. Therefore, this requires further actions including nutrition specific interventions particularly focused on rural areas and families with more children.
Heng Sotheara1, Heng Sopheab1, Chhea Chhorvann1
1). National Institute of Public Health, Phnom Penh, Cambodia
ABSTRACT
Introduction
In Cambodia, health workers at health centers play an important role in providing essential primary health services to the population in their coverage community. The recent epidemic of coronavirus disease 2019 (COVID-19) could cause additional workload burden for them and undermine their role in maintaining the provision of the essential health services or even cause burnout. This study aims to assess the burden of COVID-19 on the workload of health center staff during this epidemic in Cambodia.
Methods
We used the data from the assessment of Workload Indicator of Staffing Need (WISN) for Health Centers (HCs) in Cambodia 2020. A total of 16 HCs in four provinces with 174 health staff, both health care and non-health staff at HCs from January 2019 to June 2020, was included in this study. WISN tool was used to collect and calculate the workload and staff need for each HC.
Results
The findings indicate that beside the current work as providing MPA services, health center staff also involved in the responding in communicable disease outbreak. About one third (31%) of HCs have overworked staff exceeding 1688 hours per year even before the COVID-19 epidemic in Cambodia. Battambang, the province with high activities on COVID-19, and Svay Rieng spent 4% extra time than the remaining province with low activities on COVID-19.
Conclusions
This study confirms that about 70% of HCs do not have the over workload for staff yet even the tasks related to COVID-19 were factored in. Therefore, it is highly recommended that frequency of COVID-19 prevention and community education should be implemented as part of the routine work at HCs of the coverage community on top of the basic health services.
Kamsan Suon*, Vannary Hun , Heng Sopheab, Chhorvann Chhea
J Reid*, H Sopheab, DD Saulnier, J v Schreeb
Abstract
Introduction
Floods are the most common type of natural disaster worldwide and are projected to become more frequent and more extreme. Cambodia is prone to annual, seasonal flooding. Floods impact health in many ways and can disrupt the health system through destruction of infrastructure and loss or diversion of human, economic and physical resources. Through knowledge acquisition and skills development, training of healthcare professionals can lead to a more effective flood response. Globally, there is a need for more and improved disaster management training for healthcare professionals. Little is known about the current challenges faced by healthcare professionals when working during floods or the gaps and barriers that exist in providing flood management training in Cambodia. This pilot study sought to describe the challenges faced by healthcare professionals and increase understanding of flood management from the perspectives of key training stakeholders in Cambodia.
Methods
Two qualitative methods were used; rapid assessment methodologies during a national workshop attended by 44 health professionals and semi-structured interviews with six key training stakeholders. Data from the workshop was analysed descriptively and thematic content analysis was used for the interviews.
Results
The challenges when working during a flood include a lack of physical and human resources. Challenges are mainly operational, relating to planning, preparation and resource use, and communication between healthcare professionals. Gaps in current flood management training include teaching non-technical skills and providing sustainable training. Barriers include a lack of resources and competing interests from external funders and stakeholders.
Conclusions
The findings of this study offer better understanding into flood management and may help to inform future disaster management curriculums inside and outside of Cambodia. Recommendations for future flood management training in Cambodia include increasing the number and capacity of trainers, harmonizing the involvement of all those involved in training provision and recognising the potential implications of external funders. Recommendations for further research include understanding how informal knowledge sharing processes can contribute to flood management training, particularly in a resource stretched setting, and how best to incorporate essential non-technical skills into training.
Lykheang Sao1*, Heng Sopheab1, Supheap Leang1, Frank Tammo Wieringa2
Sin Sovann1, Chhea Chhordaphea1, Mina Kashiwabara2, Yel Darvuth3, Krishna Mohan Palipudi4,
1. National Center for Health Promotion Ministry of Health, Phnom Penh, Cambodia
2. Technical Officer, Tobacco-free Initiative, Division of NCD and Health through the Life-Course, World Health Organization Regional Office for the Western Pacific
3.. Technical Officer, Tobacco Free Initiative, Mental Health and Substance Abuse
NCDs and Health throughout the Life Course (NHL), Office of the WHO Representative in Cambodia
4. Global Tobacco Control Branch, Office on Smoking and Health, CDC, Atlanta, Georgia, USA
*Corresponding author: Sin Sovann, Email: sovann_sin@yahoo.com
Daraden Vang1*, Heng Sopheab2, Bunkea Tol3
1. Health System Research Center, National Institute of Public Health, Cambodia
2. School of Public Health, National Institute of Public Health, Cambodia
3. Epidemiology Unit, National Center for Entomology and Parasitology
*Corresponding author: Daraden Vang, Email: daradenvang@yahoo.com
Abstract
Introduction
Influenza infection is one of the most common infectious diseases caused by the influenza viruses. It is an important public health problem in the world and also in Cambodia. This study aims to compare the prevalence of influenza virus detected by Immuno-chromatography technique (Rapid test) with Real-time Polymerase Chain Reaction (PCR) and specifically to determine and compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the two techniques among patients with acute undifferentiated febrile illness (AUFI).
Methods
We used the existing data from the cross-sectional study in six provinces: Kampong Speu, Kandal, Svay Rieng, Kratie, Ratanakiri, Stung Treng, and in which it covered 13 health centers. This surveillance was collected 2469 samples from January until December 2013 and we compared the influenza virus detection prevalence by RealTime Polymerase Chain Reaction (RT- PCR) and Immuno-chromatography technique (Rapid test).
Results
Of the total 2469 samples collected, male accounted for 49.3%, and female 50.7%. The mean age was 19.6 years old (SD = 16.3) and ranged from 2 to 96 years old. The positive cases detected by Rapid test and PCR was 11% (248/2469) and 21% (520/2469) respectively. We found that most positive cases were from Kampong Speu province for both techniques, Rapid Test 41.5% n=103 and RT-PCR 32.1 % n=167. In Kratie, we found no positive case by Rapid test, but Real Time PCR could detect up to 6.9% positive cases. We also found more positive cases from June - August (7.7% - 16.9%) and October- November (29.4% – 17.3%). We detected a relatively low sensitivity of Rapid test if compared to RT-PCR 48% (95% CI: 38% - 58%) and Positive Predictive Value of 23% (95% CI: 15% - 32%) for Influenza A virus. However, specificity and Negative Predictive Value of Rapid Test is high at 82% (95%: CI 73% - 89%) and 93 % (95% CI: 86% - 97%) respectively.
Conclusion
RT-PCR is one of the best methods for diagnosing Influenza Virus because of their high sensitivity and the ability to subtype the virus species. However, a positive result by Rapid test could provide a rapid confirmation of influenza case which help facilitate patient’s treatment and quick initiation of antiviral therapy. But a negative test would require further confirmatory techniques using more standard tests for confirmation of influenza. This study shows that RT-PCR is the test of choice for detecting Influenza Virus. We also observed that high prevalence of Influenza Virus was found between July to November from both rapid test and RT- PCR, with significant different from the rest of the year. This might be due to the rainy season and early dry-windy season that take place from July through November.
Kanha Sar, Darapheak Chau, Pichenda Koeut
Naro Kong, Heng Sopheab, Chhorvann Chhea
THESIS'S ABSTRACT
Chansamrach Tous, Darapheak Chau, Vanthy Ly
School of Public Health, NIPH
THESIS ABSTRACT
Sovanthida Suy1*, Heng Sopheab1, Chhorvann Chhea1
1. School of Public Health at the National Institute of Public Health