Prey Veng Research Articles

Median Urinary Iodine Concentrations Are Indicative of Adequate Iodine Status among Women of Reproductive Age in Prey Veng, Cambodia.

Iodine deficiency disorders are estimated to affect over 1.9 million people worldwide. Iodine deficiency is especially serious for women during pregnancy and lactation because of the negative consequences for both mother and infant. The aim of this cross-sectional study was to determine the median urinary iodine concentration (UIC) as a population-level indicator of iodine status among rural women farmers of reproductive age (18–45 years) in the province of Prey Veng, Cambodia. A total of 450 women provided a spot morning urine sample in 2012. Of those women, 93% (n = 420) were non-pregnant and 7% (n = 30) were pregnant at the time of collection. UIC was quantified using the Sandell-Kolthoff reaction with modifications. The median UIC of non-pregnant (139 μg/L) and pregnant women (157 μg/L) were indicative of adequate iodine status using the WHO/UNICEF/ICCIDD epidemiological criteria for both groups (median UIC between 100–199 and 150–249 μg/L, respectively). We conclude that non-pregnant and pregnant women in rural Prey Veng, Cambodia had adequate iodine status based on single spot morning urine samples collected in 2012. More research is warranted to investigate iodine status among larger and more representative populations of women in Cambodia, especially in light of recent policy changes to the national program for universal salt iodization.

Farmers’ Perspectives on Risk and Adaptation Strategies in the Mekong, Cambodia

Aims: In Cambodia the frequency and impacts of natural disasters has been increasing. The impacts of droughts and floods are most severe within the agricultural sector which accounts for around 29% of Cambodia’s GDP and 59% of the work force. In this paper we assess the farmers’ perspectives on risk and adaptation strategies in the Mekong, Cambodia. Methodology: Interviews were conducted with 280 farmers in four Mekong provinces in Cambodia as well as at least 10 representatives of local authority and civil society staff from each of the four provinces. Place and Duration of Study: Prey Veng, Kampong Cham, Stung Treng, and Ratanakiri provinces, Cambodia, 2013. Results: Having experienced the adverse effects of flood many times, the farmers ranked flood highest among other risks. Drought was ranked second in particular in areas with lack of access to irrigation. Other risks considered by farmers were fluctuations in agriculture input and output prices, change in weather and shortage of irrigation water. The perception of farmers about the level of risk was closely linked with their adaptation strategy. If risks are perceived as low, no action is taken to cope with the risk. The government pays more attention to floods compared to other disasters. The research shows that most farmers (88%) got support from government and NGOs when there was a flood. The government and NGOs distributed food and hygiene packages during floods and crop seeds after floods. Because this support only lasts a short time, it does not compensate all impacts of the flood. Beside this emergency relief, the government and NGOs support the farmers to improve their livelihood through agriculture extension. However, the farmers did not think the program fit with them. They applied their own adaptation strategies such as selling labor and borrowing money to recover from the flood damage. Conclusion: This study provides evidence that the ongoing climate change programs initiated by NGOs and government alone cannot help farmers recover from the impact of floods. Consequently in this paper we argue that the government should improve their programs to help farmers cope with floods, droughts and other risks.

Patient Perspectives on Acquiring Spectacles: A Cambodian Experience.

To assess the perspectives of patients who acquired spectacles from an eye unit/vision center in Cambodia. A sample (n = 62) of patients was selected across 4 provinces: Prey Veng, Siem Reap, Battambang, and Takeo. The Patient Spectacle Satisfaction Survey covering demographic and semistructured questions regarding patient satisfaction, style, and costs incurred was used to collect data. Information was transcribed and translated into English and analyzed by thematic coding using NVivo. Although there were more women seeking eye health care treatment, there was no significant age difference. Patient satisfaction levels were high although the patients had to pay for transportation, registration, and the glasses themselves. A total of 60 patients (96.7%) stated they would recommend the refractive service center to others. Despite a high level of awareness of eye disease such as cataract, only 2 in 10 people could accurately identify cataract as a major cause of poor vision or blindness. Most of the people (52%) blamed bad vision or blindness on dust or other foreign objects getting into the eye, old age (31%), or poor hygiene (16%). Most people will pay eye care costs once barriers to seeking treatment have been broken via education and encouragement. Satisfaction of wearing spectacles was associated with improved vision; style, color, and fit of the spectacles; and protection from sunlight and dust. The proximity of and easy access to health facilities influenced patient desire to seek treatment.

Elevated levels of iron in groundwater in Prey Veng province in Cambodia: a possible factor contributing to high iron stores in women

Iron is a natural element found in food, water and soil and is essential for human health. Our aim was to determine the levels of iron and 25 other metals and trace elements in groundwater from 22 households in Prey Veng, Cambodia. Water analyses were conducted using inductively coupled plasma-mass spectrometry and optical emission spectrometry. Compared to the 2011 World Health Organization guidelines for drinking water quality, aluminum, iron and manganese exceeded maximum levels (in 4.5, 72.7 and 40.9% of samples, respectively). Compared to the 2004 Cambodian drinking water quality standards, iron and manganese exceeded maximum levels (in 59.1 and 36.4% of samples, respectively). We found no evidence of arsenic contamination. Guidelines for iron were established primarily for esthetic reasons (e.g. taste), whereas other metals and elements have adverse effects associated with toxicity. Iron in groundwater ranged from 134 to 5,200 μg/L (mean ∼1,422 μg/L). Based on a daily consumption of 3 L groundwater, this equates to ∼0.4-15.6 mg iron (mean ∼4.3 mg/day), which may be contributing to high iron stores and the low prevalence of iron deficiency anemia in Prey Veng women. Elevated levels of manganese in groundwater are a concern and warrant further investigation.

Arsenic hazard in Cambodian rice from a market-based survey with a case study of Preak Russey village, Kandal Province.

This study comprises a market-based survey to assess the arsenic (As) hazard of Cambodian rice, encompassing rice from seven Cambodian provinces, comparisons with rice imported from China, Vietnam and Thailand, and assessments of 15 rice varieties. Rice samples (n = 157) were collected from four large markets in Kandal Province and analysed for As using inductively coupled mass spectrometry. The mean As concentration for Cambodian rice (0.185 µg g(-1), range 0.047-0.771 µg g(-1)) was higher than that for imported rice from Vietnam and Thailand (0.162 and 0.157 µg g(-1), respectively) with mean As concentrations highest in rice from Prey Veng Province resulting in a daily dose of 1.77 µg kg(-1) b.w. (body weight) d(-1). Between unmilled rice varieties, Cambodian-grown White Sticky Rice had the highest mean As concentration (0.234 µg g(-1)), whilst White Sticky Rice produced in Thailand had the lowest (0.125 µg g(-1)), suggesting that localised conditions have greater bearing over rice As concentrations than differences in As uptake between individual varieties themselves. A rice and water consumption survey for 15 respondents in the village of Preak Russey revealed mean consumption rates of 522 g d(-1) of rice and 1.9 L d(-1) of water. At water As concentrations >1000 µg L(-1), the relative contribution to the daily dose from rice is low. When water As concentrations are lowered to 50 µg L(-1), daily doses from rice and water are both generally below the 3.0 µg kg(-1) b.w. d(-1) benchmark daily limit for a 0.5% increase in lung cancer, yet when combined they exceeded this value in all but three respondents.

Poor Thiamin and Riboflavin Status Is Common among Women of Childbearing Age in Rural and Urban Cambodia ,

Background: Thiamin deficiency in infancy is the underlying cause of beriberi, which can be fatal without rapid treatment. Reports of thiamin deficiency are common in Cambodia; however, population representative data are unavailable. Because B-complex vitamin deficiencies commonly occur in combination, riboflavin was also investigated.Objective: We determined the biomarker status of thiamin and riboflavin in women of childbearing age in rural and urban Cambodia.Methods: We measured thiamin (erythrocyte thiamin diphosphate; TDP) and riboflavin (erythrocyte glutathione reductase activity coefficient; EGRac) status in a representative sample of Cambodian women (aged 20–45 y) in urban Phnom Penh (n = 146) and rural Prey Veng (n = 156), Cambodia, and, for comparison purposes, in a convenience sample of women in urban Vancouver, British Columbia, Canada (n = 49).Results: Thiamin insufficiency (TDP ≤ 90 nmol/L) was common among both urban (39%) and rural (59%) Cambodian women (P < 0.001), whereas <20% of Vancouver women were thiamin insufficient (P < 0.001). The prevalence of suboptimal and deficient riboflavin status (EGRac ≥ 1.3) was 89%, 92%, and 70% among women in Phnom Penh, Prey Veng, and Vancouver, respectively (P < 0.001).Conclusions: Suboptimal status of both thiamin and riboflavin were common in Cambodian women, with substantially higher rates among women living in rural Prey Veng than in urban Phnom Penh. Strategies may be needed to improve the thiamin and riboflavin status of women in Cambodia. The unexpected finding of high riboflavin inadequacy status in Vancouver women warrants further investigation.

Genetic Hemoglobin Disorders Rather Than Iron Deficiency Are a Major Predictor of Hemoglobin Concentration in Women of Reproductive Age in Rural Prey Veng, Cambodia ,

Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease. We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers. Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and α1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders. Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α(3.7)-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 μg/L), 19% had tissue iron deficiency (sTfR >8.3 mg/L), <3% had folate deficiency (<3 μg/L), and 1% had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12. Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.

Correlates of household food insecurity and low dietary diversity in rural Cambodia.

The objective of this study was to identify correlates of household food insecurity and poor dietary diversity in rural Cambodia. Trained interviewers administered a survey to 900 households in four rural districts of Prey Veng Province, Cambodia. The Household Food Insecurity Access Scale (HFIAS) and Household Dietary Diversity Score (HDDS) were used to assess household food insecurity and dietary diversity. Multivariate logistic regression models were constructed to identify independent correlates of household food insecurity and poor dietary diversity (HDDS<or=3). The mean±SD HFIAS and HDDS scores were 5.3±3.9 and 4.7±1.6, respectively. The respective prevalence of mild, moderate, and severe food insecurity were 33%, 37%, and 12%; and 23% of households had an HDDS<or=3. In multivariate analyses, several indicators of socioeconomic status, and ownership of agricultural land were associated with household food security status, although the latter association lost its significance in models that adjusted for household income. Similarly, although ownership of agricultural and homestead land was initially associated with poorer dietary diversity, income mitigated these associations. The presence of electricity and vegetable production were the only other variables that were significantly associated with both outcomes. In this rural area of Cambodia, the prevalence of any degree of household food insecurity was very high and dietary diversity was generally low. Interventions to improve food security and dietary diversity should encompass income-generating activities and be targeted toward the poorest households.

Perceived Needs Related to Social Participation of People with Leprosy-related Disabilities and other People with Disabilities in Cambodia: A Qualitative Study

Purpose: The objective of this study was to describe the similarities and differences in perceived needs related to social participation of persons with leprosy-related disabilities and other persons with disabilities in Cambodia, and to suggest key interventions to promote participation in the community. Methods: A cross-sectional study was conducted. People with leprosy-related disabilities were selected at home during field visits or at the rehabilitation centre for people with leprosy in Phnom Penh. People with locomotor disabilities were selected at the rehabilitation centre for persons with disabilities in Phnom Penh and Prey Veng. A pilot-tested, face-to-face semi-structured interview, with open and closed questions, and focus group discussions were used to investigate the perceived needs related to social and economic participation in the community. The interview was based on the International Classification of Functioning, Disability and Health (ICF) model of the WHO. Results: Both groups of people with disabilities struggle with social exclusion in society. People with leprosy-related disabilities, in particular, live below the poverty line of US$ 0.5 per day. Most of the participants lived in rural areas. Participants raised the need for enhanced self-esteem and help in finding jobs. To overcome the difficulty in finding employment, they felt vocational training and microcredit to start businesses, were required. Conclusions: The study found that both groups of people with disabilities have similar needs to improve participation in social and economic life. Rehabilitation centres provide vocational training and microcredit. Self-help groups have also proven effective in reaching poor people with disabilities in rural areas and improving social participation. The authors suggest that it is best to form multi-disability self-help groups to empower all the affected people and help fight poverty.

Household food insecurity and dietary diversity as correlates of maternal and child undernutrition in rural Cambodia.

To assess household food insecurity and dietary diversity as correlates of maternal and child anthropometric status and anemia in rural Cambodia. Trained interviewers administered a survey to 900 households in four rural districts of Prey Veng, Cambodia. The Household Food Insecurity Access Scale (HFIAS) and Household Dietary Diversity Score (HDDS) were used to assess household food insecurity and dietary diversity. The height, weight and hemoglobin concentration of the mother and youngest child under 5 years in each household were measured. Multivariate logistic regression models were constructed to assess the association between household food insecurity and dietary diversity, and child stunting and wasting, maternal thinness, maternal and child anemia. The mean (s.d.) HFIAS and HDDS scores were 5.3 (3.9) and 4.7 (1.6), respectively. The respective prevalences of mild, moderate and severe food insecurity were 33, 37 and 12%. Maternal thinness, child stunting and child wasting were present in 14.6, 25.4 and 8.1% of respondents, respectively. The risk of maternal thinness, but not child stunting or wasting, increased as the severity of household food insecurity increased. Household food insecurity was also positively associated with maternal, but not child, anemia. Household dietary diversity status was not significantly associated with any of the outcomes we assessed. Efforts to improve household food security are important as a means of promoting maternal nutritional status; however, additional research is needed to better understand the role of other factors that are driving the burden of child undernutrition in Cambodia.

Removing arsenic from groundwater in Cambodia using high performance iron adsorbent.

In Cambodia, groundwater has been contaminated with arsenic, and purification of the water is an urgent issue. From 2010 to 2012, an international collaborative project between Japan and Cambodia for developing arsenic-removing technology from well water was conducted and supported by the foundation of New Energy and Industrial Technology Development Organization, Japan. Quality of well water was surveyed in Kandal, Prey Veng, and Kampong Cham Provinces, and a monitoring trial of the arsenic removal equipment using our patented amorphous iron (hydr)oxide adsorbent was performed. Of the 37 wells surveyed, arsenic concentration of 24 exceeded the Cambodian guideline value (50 μg L(-1)), and those of 27 exceeded the WHO guideline for drinking water (10 μg L(-1)). Levels of arsenic were extremely high in some wells (>1,000-6,000 μg L(-1)), suggesting that arsenic pollution of groundwater is serious in these areas. Based on the survey results, 16 arsenic removal equipments were installed in six schools, three temples, two health centers, four private houses, and one commune office. Over 10 months of monitoring, the average arsenic concentrations of the treated water were between 0 and 10 μg L(-1) at four locations, 10-50 μg L(-1) at eight locations, and >50 μg L(-1) at four locations. The arsenic removal rate ranged in 83.1-99.7%, with an average of 93.8%, indicating that the arsenic removal equipment greatly lower the risk of arsenic exposure to the residents. Results of the field trial showed that As concentration of the treated water could be reduced to <10 µg L(-1) by managing the As removal equipment properly, suggesting that the amorphous iron (hydr)oxide adsorbent has high adsorbing capacity for As not only in the laboratory environment but also in the field condition. This is one of the succeeding As removal techniques that could reduce As concentration of water below the WHO guideline value for As in situ.

Arsenic Concentrations in Paddy Soil and Rice and Health Implications for Major Rice-Growing Regions of Cambodia

Despite the global importance of As in rice, research has primarily focused on Bangladesh, India, China, and the United States with limited attention given to other countries. Owing to both indigenous As within the soil and the possible increases arising from the onset of irrigation with groundwater, an assessment of As in rice within Cambodia is needed, which offers a "base-case" comparison against sediments of similar origin that comprise rice paddy soils where As-contaminated water is used for irrigation (e.g., Bangladesh). Here, we evaluated the As content of rice from five provinces (Kandal, Prey Veng, Battambang, Banteay Meanchey, and Kampong Thom) in the rice-growing regions of Cambodia and coupled that data to soil-chemical factors based on extractions of paddy soil collected and processed under anoxic conditions. At total soil As concentrations ranging 0.8 to 18 μg g(-1), total grain As concentrations averaged 0.2 μg g(-1) and ranged from 0.1 to 0.37 with Banteay Meanchey rice having significantly higher values than Prey Veng rice. Overall, soil-extractable concentrations of As, Fe, P, and Si and total As were poor predictors of grain As concentrations. While biogeochemical factors leading to reduction of As(V)-bearing Fe(III) oxides are likely most important for predicting plant-available As, husk and straw As concentrations were the most significant predictors of grain-As levels among our measured parameters.

High rates of riboflavin deficiency in women of childbearing age in Cambodia and Canada (1041.12)

High rates of riboflavin deficiency in women of childbearing age in Cambodia and Canada Whitfield, KC1, McCann, A2, Karakochuk, C1, Talukder, A3, Ward, M2, McNulty, H2, McLean, J1, Green TJ1 (1) Department of Food, Nutrition, and Health, University of British Columbia, Canada (2) Northern Ireland Centre for Food and Health, University of Ulster, Northern Ireland (3) Helen Keller International, Phnom Penh, Cambodia As an integral component of the coenzymes flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN), riboflavin is essential for metabolic homeostasis. Limited evidence is available comparing riboflavin status among individuals from developed and developing countries.We conducted two cross‐sectional studies with apparently healthy non‐pregnant, non‐lactating women of childbearing age (20‐45y), on a representative sample from urban Phnom Penh (n=146) and rural Prey Veng (n=156), Cambodia, and a convenience sample of urban women in Vancouver, Canada (n=51). As a functional biomarker of riboflavin status, erythrocyte glutathione reductase activity coefficient (EGRac) was measured.Among Cambodian women, riboflavin deficiency (EGRac 蠅1.4) was prevalent (Prey Veng, 82%; Phnom Penh, 78%). Although a significantly higher proportion of Canadian women were riboflavin sufficient (EGRac 蠄1.3; p&lt;0.001), 67% of Canadians had a suboptimal riboflavin status (EGRac &gt;1.3).The data suggests suboptimal riboflavin status and deficiency may be widespread in both developed and developing countries and merits further investigation.Grant Funding Source: Supported by the University of British Columbia Vitamin Research Fund

Genetic hemoglobin disorders and anemia in Cambodian women of reproductive age (389.7)

Anemia is common in Cambodian women of reproductive age. Anemia can lead to adverse pregnancy outcomes and other serious health consequences. Potential causes of anemia include micronutrient deficiencies, infection and disease. In Cambodia, genetic hemoglobin (Hb) disorders are common, leading to anemia and other complications.Objective: To examine associations between anemia (Hb &lt;120g/L) and genetic Hb disorders in Cambodian women (18‐45 y).Methods: 450 women from Prey Veng province provided blood. A complete blood count was performed and the presence and typing of hemoglobin disorders was carried out by PCR and electrophoresis.Results: Overall, the prevalence of anemia in women was 33.1%, of which 61% was microcytic (Hb &lt;120g/L and MCV &lt;80fl). The prevalence of genetic hemoglobin disorders was over 55% (most commonly alpha‐thalassemia, Hb E and Hb CS) and were significantly correlated with anemia. Of women with anemia, over two‐thirds had an abnormal genetic hemoglobin type. Less than 5% of women had a low serum ferritin (&lt; 15 µg/L).Conclusion: The majority of anemia in Cambodian women is microcytic anemia. A major predictor of anemia was genetic Hb disorders. Low serum ferritin was uncommon suggesting that iron deficiency is not a major problem. However, genetic Hb disorders may be confounding the interpretation of ferritin and leading to an underestimation of iron‐deficiency anemia. Other indicators of iron status and other micronutrients involved in anemia are being examined.Grant Funding Source: Supported by The International Development Research Centre and The Department of Foreign Affairs, Tr

Assessing arsenic intake from groundwater and rice by residents in Prey Veng province, Cambodia

We investigated total daily intake of As by residents in Prey Veng province in the Mekong River basin of Cambodia. Groundwater (n = 11), rice (n = 11) and fingernail (n = 23) samples were randomly collected from the households and analyzed for total As by inductively coupled plasma mass spectrometry. Calculation indicated that daily dose of inorganic As was greater than the lower limits on the benchmark dose for a 0.5% increased incidence of lung cancer (BMDL0.5 equals to 3.0 μg d−1 kg−1body wt.). Moreover, positive correlation between As in fingernail and daily dose of As from groundwater and rice and total daily dose of As were found. These results suggest that the Prey Veng residents are exposed to As in groundwater. As in rice is an additional source which is attributable to high As accumulation in human bodies in the Mekong River basin of Cambodia.

Comprehensive evaluation of the psychosocial parameters of epilepsy: A representative population‐based study in Prey Veng (Cambodia)

We conducted a population-based study of epilepsy in Prey Veng (Cambodia) to explore self-esteem, fear, discrimination, knowledge-attitude-practice (KAP), social-support, stigma, coping strategies, seizure-provoking factors, and patient-derived factors associated with quality of life (QOL). The results are based on a cohort of 96 cases and matched controls (n = 192), randomly selected from the same source population. Various questionnaires were developed and validated for internal consistency (by split-half, Spearman-Brown prophecy, Kuder-Richardson 20), content clarity and soundness. Summary, descriptive statistics, classical tests of hypothesis were conducted. Uncorrected chi-square was used. Group comparison was done to determine statistically significant factors, for each domain, by conducting logistic regression; 95% confidence interval (CI) with 5% (two-sided) statistical significance was used. All questionnaires had high internal consistency. Stress was relevant in 14.0% cases, concealment in 6.2%, denial in 8.3%, negative feelings in public in 3.0%. Mean self-esteem was 7.5, range 0-8, related to seizure frequency. Mean discrimination was least during social interactions. Coping strategies were positive (e.g. look for treatment). Postictal headache, anger, no nearby health facility, etc. were associated with QOL. The reliability of our questionnaires was high. A positive social environment was noted with many infrequent social and personal prejudices. Not all populations should (by default) be considered as stigmatized or equipped with poor KAP. We addressed themes that have been incompletely evaluated, and our approach could therefore become a model for other projects.

Population-Based Study of Epilepsy in Cambodia Associated Factors, Measures of Impact, Stigma, Quality of Life, Knowledge-Attitude-Practice, and Treatment Gap

PurposeIdentify epilepsy-associated factors and calculate measures of impact, stigma, quality of life (QOL), knowledge-attitude-practice (KAP) and treatment gap in Prey Veng, Cambodia.MethodsThis first Cambodian population-based case-control study had 96 epileptologist-confirmed epilepsy cases and 192 randomly selected matched healthy controls. Standard questionnaires, which have been used in similar settings, were used for collecting data on various parameters. Univariate and multivariate regression was done to determine odds ratios. Jacoby stigma, 31-item QOL, KAP etc were determined and so were the factors associated with them using STATA software. Treatment gap was measured using direct method.Key findingsMultivariate analyses yielded family history of epilepsy, difficult or long delivery, other problems beside seizures (mainly mental retardation, hyperthermia), and eventful pregnancy of the subject's mother as factors associated with epilepsy. There was high frequency of seizure precipitants esp. those related to sleep. Population attributable risk (%) was: family history (15.0), eventful pregnancy of subject's mother (14.5), long/difficult birth (6.5), and other problem beside seizures (20.0). Mean stigma (1.9±1.1, on a scale of 3) was mainly related to treatment efficacy. Mean QOL (5.0±1.4 on a scale of 10) was mainly related to treatment regularity. Cause or risk factor could be determined in 56% of cases. Treatment gap was 65.8%.SignificanceFactors in pre- and perinatal period were found to be most crucial for epilepsy risk in Cambodia which inturn provides major prevention opportunities. A global action plan for treatment, stigma reduction and improvement of QOL should be set-up in this country.

The Effectiveness of Farmer Organization Management in Kamchaymear and Baphnom Districts, Prey Veng Province

The Effectiveness of Farmer Organization Management in Kamchaymear and Baphnom Districts, Prey Veng Province

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia

BackgroundCost of delivering reproductive health services to low income populations will always require total or partial subsidization by government and/or development partners. Broadly termed "demand-side financing" or "output-based aid", these strategies include a range of interventions that channel government or donor subsidies to the user rather than the service provider. Initial pilot assessments of reproductive health voucher programs suggest that they can increase access, reduce inequities, and enhance program efficiency and service quality. However, there is a paucity of evidence describing how these programs function in different settings for various reproductive health services.Methods/DesignPopulation Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the "voucher and accreditation" approaches to improving the reproductive health of low-income women in Cambodia. The study comprises of four populations: facilities, providers, women of reproductive age using facilities, and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in a sample of 20 health facilities that are accredited to provide maternal and newborn health and family planning services to women holding vouchers from operational districts in three provinces: Kampong Thom, Kampot and Prey Veng and a matched sample of non-accredited facilities in three other provinces. Health facility assessments will be conducted at baseline and endline to track temporal changes in quality-of-care, client out-of-pocket costs, and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3000 respondents will also be conducted in areas where vouchers are distributed and similar non-voucher locations.DiscussionA quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status and reducing inequities at the population level and assess effects on access, equity and quality of care at the facility level. If the voucher scheme in Cambodia is found effective, it may help other countries adopt this approach for improving utilization and access to reproductive health and family planning services.

First‐ever, door‐to‐door cross‐sectional representative study in Prey Veng province (Cambodia)

To estimate the lifetime prevalence of epilepsy in Prey Veng province (Cambodia). Door-to-door screening was performed using a random cluster survey whereby all people >1 year of age were screened for epilepsy by using a validated and standardized questionnaire for epilepsy in tropical countries. Suspected epilepsy patients identified by the questionnaire were revisited and examined by epileptologists. The confirmation of epilepsy was based on an in-depth clinical examination. Electroencephalograms were recorded at the community dispensary. Five hundred three potential epilepsy cases were identified from 16,510 screened subjects, and 96 were diagnosed to have epilepsy. An overall prevalence of 5.8 per 1,000 [95% confidence interval (CI) 4.6-7.0 per 1,000] was obtained. Generalized epilepsy (76%) was more common than partial epilepsy (12.5%). Three cases were of generalized myoclonic epilepsy (3.1%) and one case each (1.0%) were of absence and olfactory partial epilepsy. Six cases (5.2%) had more than one seizure type [one case with absence + generalized tonic-clonic (GTC), one case each with GTC + partial seizures with secondary generalization and absence + generalized myoclonic seizures and absence + simple partial seizures, and two cases with GTC + complex partial seizures]. Electroencephalography (EEG) studies revealed spike and wave discharges in 43.8%, focal spikes in 21.0%, generalized slow waves in 19.2%, and generalized slowing of background in 15.7%. This is the first population-based study in Cambodia that had epilepsy as a primary objective, and compared to Western and neighboring countries it shows a lower prevalence.