Chab Dai

Malaria is a life-threatening but preventable disease caused by Plasmodium parasites transmitted through bites of infected female Anopheles mosquitoes. According to the World Health Organization, the Western Pacific Region reported 1.7 million malaria cases in 2023, of which Plasmodium vivax accounted for 28.9% of cases and approximately 3500 malaria-related deaths. This reflects a decrease in the incidence of malaria cases and associated mortality compared to 2022, highlighting progress but underscoring persistent challenges. Cambodia, with its goal to eliminate malaria by 2025, continues to face public health challenges, particularly from P. vivax and mixed-species infections. This report provides an in-depth epidemiological analysis of malaria cases and radical cure treatment outcomes for P. vivax and mixed-species infections in Kampong Speu Province from 2019 to 2023. Data were drawn from Cambodia’s national Malaria Information System and radical cure treatment records. The analysis demonstrated a substantial increase in malaria screening, primarily conducted by village malaria workers, while the number of confirmed malaria cases continued to decline. The annual parasite incidence dropped from 23.8 per 1000 at-risk individuals in 2019 to 0.7 per 1000 in 2023. Radical cure treatment completion rates among eligible cases improved from 78% in 2019 to 98% in 2023. Significant progress has been made towards malaria elimination. However, males aged 15–49 years, particularly forest-goers in the Kampong Speu operational district, remain the most at-risk group. In support of malaria elimination, it is recommended to enhance prevention measures, increase screening and ensure 100% radical cure treatment for all eligible cases in high-risk populations.

In Southeast Asia, services for survivors of human trafficking have historically been centralized within shelter programs. Minimal research has, however, been conducted regarding trafficking-specific shelters, particularly research that highlights the perspectives of survivors themselves. This manuscript presents the perspectives of survivors of human trafficking and sexual exploitation on their own experiences pertaining to trafficking-specific shelter services. We analyzed data from the Butterfly longitudinal research (BLR) study, a 10-year longitudinal study exploring the lives, trajectories, and viewpoints of survivors of human trafficking and sexual exploitation in Cambodia. We analyzed 236 in-depth interviews and narrative summaries of interviews conducted between 2011 and 2016 using an interpretive phenomenological approach ( n = 79). Four themes were identified: feeling privileged to live in a shelter; lacking freedom and feeling imprisoned by rules; limited engagement with family; and mixed experiences with counseling. Findings inform critical recommendations for implementing trauma-informed care and strengthening mental health services for survivors, including services provided within shelter programs and within the anti-human trafficking movement more broadly.

Introduction: The burden of influenza in Cambodia is not well known, but it would be useful for understanding the impact of seasonal epidemics and pandemics and to design appropriate policies for influenza prevention and control. The severe acute respiratory infection (SARI) surveillance system in Cambodia was used to estimate the national burden of SARI hospitalizations in Cambodia. Methods: We estimated age-specific influenza-associated SARI hospitalization rates in three sentinel sites in Svay Rieng, Siem Reap and Kampong Cham provinces. We used influenza-associated SARI surveillance data for one year to estimate the numerator and hospital admission surveys to estimate the population denominator for each site. A national influenza-associated SARI hospitalization rate was calculated using the pooled influenza-associated SARI hospitalizations for all sites as a numerator and the pooled catchment population of all sites as denominator. National influenza-associated SARI case counts were estimated by applying hospitalization rates to the national population. Results: The national annual rates of influenza-associated hospitalizations per 100 000 population was highest for the two youngest age groups at 323 for <1 year and 196 for 1–4 years. We estimated 7547 influenza-associated hospitalizations for Cambodia with almost half of these represented by children younger than 5 years. Discussion: We present national estimates of influenza-associated SARI hospitalization rates for Cambodia based on sentinel surveillance data from three sites. The results of this study indicate that the highest burden of severe influenza infection is borne by the younger age groups. These findings can be used to guide future strategies to reduce influenza morbidity.

To design and examine the feasibility of a sustainable training program to build local capacity and improve obstetric outcomes in Kampong Chhnang, Cambodia. A "train-the-trainers" model was used to conduct an obstetrics course between 2012 and 2015, its aim to reduce maternal mortality and morbidity. All Cambodian healthcare providers trained by the program were included in the study. The obstetric outcomes of all patients under the care of the trained healthcare providers were analyzed retrospectively to assess the feasibility of the program. Data from all three hospitals and 42 health centers in the province that the trainees worked at were collected from case logs. There was a significant increased trend in recognition of cases of postpartum hemorrhage and pre-eclampsia, and occurrence of difficult deliveries and cesarean deliveries (P<0.001). The maternal mortality ratio decreased from 64.7 per 100000 deliveries in 2012 to 40.8 per 100000 deliveries in 2016. This sustainable model has the potential to positively impact obstetric education and maternal outcomes and could be adopted in other resource-poor countries, particularly in Southeast Asia.

This study explores amino acid changes of the reverse transcriptase (rt) of CRF01_AE isolates from pregnant women naive to antiretroviral drugs before and 2, 6, and 52 weeks after exposure to single dose nevirapine (sdNVP). Results based on 51 observations showed that the proportion of isolates with nonnucleoside reverse transcriptase inhibitor (NNRTI) RMs in the group treated with sdNVP (n = 35) increased from 0% pre-NVP to 22.9% at week 2 postpartum (pp) and 22.9% at week 6 pp. In the group treated with zidovudine + sdNVP (n = 16), the proportion with RM was 31.3% and 18.8% at weeks 2 and 6 pp, respectively. Only a few RMs were still detected at week 52 pp. No apparent subtype-specific treatment-related mutations were detected. NNRTI RM occurrence in CRF01_AE strains is similar to subtype A, D, and CRF02_AG strains after exposure to antiretroviral drugs for PMTCT.

A baseline study has been conducted to determine the polymorphism of reverse transcriptase, protease, and envelope genes of HIV-1 isolates from 146 antiretroviral drug-naive Cambodian patients including 22 seroconverters and 124 pregnant women having been diagnosed HIV positive for less than 1 year. Amplification of at least one gene was successful for 144 isolates. All three genes were obtained for 136 isolates. Subtyping showed that CRF01_AE was predominant (130 cases). According to the ANRS September 2004 list, polymorphism substitutions (>50% versus the subtype B consensus) of CRF01_AE at drug resistance positions were observed only in protease: I13V (81%), E35D (87%), M36I (100%), R41K (96%), and H69K (100%). Two strains bore one major resistance mutation to PIs: M46I and N88D. Five other strains carried drug resistance mutations to RTIs: K70R (one strain), V75M (three strains), and K101E (one strain). Of the isolates 4.9% had drug resistance mutations to antiretroviral drugs.