Cambodian Provinces Research Articles

Development and Validation of the TSTSIS Instrument to Measure Teachers’ Self-Efficacy to Teach Science Through Integrated STEM Approach

This study aimed to develop an instrument with acceptable validity and reliability for assessing two key aspects among science teachers: their self-efficacy in teaching science through an integrated STEM approach (STSIS) and their outcome expectancy when employing this approach (OETSIS), which we refer to as TSTSIS. We administered this tool to 109 science teachers in Phnom Penh city and various provinces in Cambodia. The results revealed that STSIS can be broken down into six essential latent factors. Among these factors, five are grouped under the theme of “Integrated STEM Instructional Self-Efficacy,” covering problem-based, robots-based, inquiry-based, engineering-based, and technology-based instructional self-efficacy. The sixth factor relates to teachers’ self-efficacy in terms of accessing materials. Author formulated the subscale “Expectations of High Students’ Achievement in Science” as the factor representing the OETSIS. Scores on the TSTSIS subscales offered evidence of its criterion validity, with significant differences observed across various teacher-related variables. These variables include teachers’ teaching qualifications, school types, teachers from schools where STEM education and an integrated STEM approach are part of the school’s objectives, and correlation with instructors’ teaching experience. The TSTSIS subscale lays the groundwork for designing STEM training programs tailored to the needs of science instructors.

Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study.

Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks. The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns. Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population. COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment. Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics.

Violence and traumatic stress among Cambodian survivors and perpetrators of the Khmer Rouge genocide

This article presents the findings of a groundbreaking focus group cohort method of studying the residual impacts of traumatic stress and violence as reported by survivors and perpetrators of the Khmer Rouge genocide in Cambodia (1975–79). Both cohorts, separately participated in fifteen intensive focus groups lasting between one and five days across nine Cambodian provinces during 2012–13. This research focuses on the experiences of stress and violence by survivors and perpetrators during the genocide and since. The results of this study show that all 61 survivors and 58 perpetrators experienced multiple traumatic violent events during the genocide, and all lived in daily fear of being killed by the leaders of the Khmer Rouge. The results also show similar evidence of continued stress in both cohorts today, and parallel preoccupations with thoughts or memories of trauma and violence under the Khmer Rouge.

Association of Socioeconomic Characteristics with Health and Well-Being of Rural Older Cambodians.

This study examined the demographic, socioeconomic, health, and well-being of rural-dwelling older Cambodians and identified differentials based on age and gender. The goal is to understand disparities in wealth, health, well-being, and support systems among older adults within the context of Cambodia's history of civil unrest and socio-cultural norms. A regionally representative sample from three northwestern Cambodian provinces was used to evaluate household wealth, economic satisfaction, health, psychological well-being, social support, and a government welfare program. Analysis was conducted to document how these factors differed by age and gender. Significant gender differentials in demographics, well-being, and support systems were observed. Older women outnumbered men and reported lower levels of social support and psychological well-being, potentially influenced by high widowhood rates and gender-linked cultural norms. Education levels were generally low, possibly due to disruption from wars and conflicts. Relative to neighboring countries, the health status of older Cambodians was poor, though no significant gender-based health disparities were identified. There were differences in debt and wealth accumulation among age groups but no variation in welfare support by age or gender. These findings underline the significance of addressing gender disparities and socio-cultural factors affecting older Cambodians. They underscore the need for policy attention toward older women's psychological well-being and support systems, as well as health and social support interventions for the oldest age groups. Future research should investigate these observed patterns, accounting for regional variations and survivor selection bias.

Perception on Student Dropout in Secondary Education: An Insight from University Students and Staff in Battambang Province, Cambodia

This study primarily aims to gather initial data on the quantity of four universities, Battambang province in Cambodia, with a secondary goal of characterizing student dropout patterns. The collected data was intended to inform the Cambodian government’s recent initiatives to decrease dropout rates and increase numbers of enrollment. Data was gathered from three universities and an upper secondary school, using a sample size of 120 participants who completed a questionnaire. The data was then analyzed using Microsoft Excel and the R program. The results were utilized to investigate the reasons behind student dropouts in grades 10, 11, and 12, and to devise strategies to prevent such occurrences. The study’s findings highlighted that: The correlation circle, which represents the impact of all factors contributing to student dropout, showed significant contributions from factors accounting for 10% (0.1) to 40% (0.4) of the total variances. There are varying perceptions regarding student dropout. This study helps us comprehend the key factors influencing dropout rates, which include domestic violence (DoVio), student health issues (Unhe), school violence (SchVio), parental attitudes (PaAtt), and immigration (Imm), which are still prevalent issues.

Adherence and acceptability of multiple micronutrient supplementation during pregnancy: Study protocol for a cluster-randomized non-inferiority trial in Cambodia

BackgroundIron and folic acid (IFA) supplements are currently provided to Cambodian women during pregnancy. However, recent research has found benefits of a multiple micronutrient supplement (MMS) over just IFA alone on several outcomes of perinatal and infant health. The Ministry of Health in Cambodia has proposed a transition from IFA to MMS but to effectively guide this transition requires implementation research on the acceptability and adherence to MMS (over IFA).MethodsThis non-inferiority trial aims to assess the adherence and acceptability of IFA (60 mg elemental iron and 400 μg folic acid) compared to MMS (standard UNIMMAP formulation including 15 micronutrients) during antenatal care in Cambodia. A prospective cohort of 1545 pregnant women will be assigned to one of three trial arms: (1) IFA for 90 days [IFA-90]; (2) MMS for 180 days with two distributions of 90-count tablet bottles [MMS-90]; or (3) MMS for 180 days with one 180-count tablet bottle [MMS-180]. Each arm will enroll 515 women across 48 health centers (clusters) in Kampong Thom Province in Cambodia. The primary outcome is the non-inferiority of adherence rates of MMS-180 compared to IFA-90, as assessed by tablet counts. Mixed-effects logistic and linear regression models will be used to estimate the difference in the adherence rate between the two groups, with an ‘a priori’ determined non-inferiority margin of 15%. Acceptability of MMS and IFA will be measured using a quantitative survey conducted with enrolled pregnant women at 30-day, 90-day, and 180-day time-points. DiscussionFindings from this study will guide an effective and feasible MMS scale-up strategy for Cambodia. Additionally, the findings will be shared globally with other stakeholders planning to scale up MMS in other countries.Trial registrationNCT05867836 (ClinicalTrials.gov, registered May 18, 2023).

A remarkable new species from the pygmaea species group of the genus Carebara Westwood, 1840 (Hymenoptera: Formicidae: Myrmicinae) from Cambodia

A new species Carebara bokorensis Matsuura et Hosoishi, sp. n. is described from Kampot Province in Cambodia based on the major and minor worker caste. This new species belong to the pygmaea species group. This species is distinguished from congeners by the transverse striation on the vertex in major workers and presence of well-developed subpetiolar process in minor workers.

Radical cure for Plasmodium vivax malaria after G6PD qualitative testing in four provinces in Cambodia, results from Phase I implementation

BackgroundCambodia aims to eliminate all forms of malaria by 2025. In 2020, 90% of all malaria cases were Plasmodium vivax. Thus, preventing P. vivax and relapse malaria is a top priority for elimination. 14-day primaquine, a World Health Organization-recommended radical cure treatment regimen, specifically targets dormant hypnozoites in the liver to prevent relapse. Cambodia introduced P. vivax radical cure with primaquine after glucose-6-phosphate dehydrogenase (G6PD) qualitative testing in 2019. This paper presents Cambodia’s radical cure Phase I implementation results and assesses the safety, effectiveness, and feasibility of the programme prior to nationwide scale up.MethodsPhase I implementation was carried out in 88 select health facilities (HFs) across four provinces. Males over 20kgs with confirmed P. vivax or mixed (P. vivax and Plasmodium falciparum) infections were enrolled. A descriptive analysis evaluated the following: successful referral to health facilities, G6PD testing results, and self-reported 14-day treatment adherence. P. vivax incidence was compared before and after radical cure rollout and a controlled interrupted time series analysis compared the estimated relapse rate between implementation and non-implementation provinces before and after radical cure.ResultsIn the 4 provinces from November 2019 to December 2020, 3,239 P. vivax/mixed infections were reported, 1,282 patients underwent G6PD deficiency testing, and 959 patients received radical cure, achieving 29.6% radical cure coverage among all P. vivax/mixed cases and 98.8% coverage among G6PD normal patients. Among those who initiated radical cure, 747 patients (78%) completed treatment. Six patients reported side effects. In implementation provinces, an average 31.8 relapse cases per month were estimated signaling a 90% (286 cases) reduction in relapse compared to what would be expected if radical cure was not implemented.ConclusionsPlasmodium vivax radical cure is a crucial tool for malaria elimination in Cambodia. The high coverage of radical cure initiation and adherence among G6PD normal patients demonstrated the high feasibility of providing radical cure at point of care in Cambodia. Incomplete referral from community to HFs and limited capacity of HF staff to conduct G6PD testing in high burden areas led to lower coverage of G6PD testing. Phase I implementation informed approaches to improve referral completion and patient adherence during the nationwide expansion of radical cure in 2021.

A novel hybrid sustainable healthcare supply chain model for patient safety: A case study of Cambodia

This research focuses on elucidating the attributes of a Sustainable Healthcare Supply Chain (SHSC) that play a pivotal role in enhancing patient safety, particularly in developing nations. Patient safety in healthcare supply chains is paramount, particularly in the face of inherent risks and vulnerabilities associated with disruptions and uncertainties. A hybrid selection model, integrating factor analysis, structural equation modeling (SEM), and the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), is introduced to rank these attributes. Twenty-two SHSC attributes are categorized into four facets: social, environmental, economic, and technological. A survey conducted across five Cambodian provinces gathered 361 valid responses from healthcare professionals, forming the basis for a structural SHSC model. This model is subsequently implemented in a Phnom Penh tertiary hospital. The findings underscore the imperative of incorporating patient safety considerations into healthcare supply chains. The hybrid selection model helps healthcare leaders figure out what factors are most important for patient safety and rank them. This gives them information they need to come up with effective strategies and long-lasting projects. The study's outcomes provide actionable insights for healthcare stakeholders. The multi-analytical approach of the model offers a comprehensive perspective to address supply chain challenges, reduce extraneous costs, and minimize environmental footprints. In essence, the effective implementation of sustainable healthcare supply chain strategies not only enhances care quality and fortifies patient safety but also aligns with the broader objectives of healthcare entities.

Water Governance in the Cambodian Mekong Delta: The Nexus of Farmer Water User Communities (FWUCs), Community Fisheries (CFis), and Community Fish Refuges (CFRs) in the Context of Climate Change

Cambodia faces the challenge of managing excess water during the wet season and insufficient water during the dry season. This harms human life and endangers aquatic and natural resources, agricultural practices, and food security. Water governance is crucial to ensure the well-being of both people and their food security. However, Cambodia’s water governance is hindered by various obstacles, including sectoral and centralized influences, top-down and large-scale strategies, weak coordination among relevant agencies, and limited involvement of local communities. This study examines water governance across different sectors, from centralized to community-based natural resources management, and explores the opportunities that can be done to improve water governance. This study undertakes the literature and case studies of farmer water user communities (FWUCs), community fisheries (CFis), and community fish refuges (CFRs) in three Mekong Delta provinces in Cambodia. This study concludes that water governance has been challenged by FWUCs competing for water resources to intensify rice production at the expense of increased pesticides and fertilizer uses, which undermine the fishery productivity, degrade the natural resources in rivers and water bodies, and increase water conflicts among farmers and sectors in the face of climate change. To enhance water governance in Cambodia, it is critical to integrate it at the district level. This will promote sustainable water use and management across the country and pave the way for a brighter future.

Implementation of Glucose-6-Phosphate Dehydrogenase (G6PD) testing for Plasmodium vivax case management, a mixed method study from Cambodia.

Plasmodium vivax remains a challenge for malaria elimination since it forms dormant liver stages (hypnozoites) that can reactivate after initial infection. 8-aminoquinolone drugs kill hypnozoites but can cause severe hemolysis in individuals with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. The STANDARD G6PD test (Biosensor) is a novel point-of-care diagnostic capable of identifying G6PD deficiency prior to treatment. In 2021, Cambodia implemented the Biosensor to facilitate radical cure treatment for vivax malaria. To assess the Biosensor's implementation after its national rollout, a mixed-methods study was conducted in eight districts across three provinces in Cambodia. Interviews, focus group discussions, and observations explored stakeholders' experiences with G6PD testing and factors influencing its implementation. Quantitative data illustrative of test implementation were gathered from routine surveillance forms and key proportions derived. Qualitative data were analyzed thematically. The main challenge to implementing G6PD testing was that only 49.2% (437/888) of eligible patients reached health centers for G6PD testing following malaria diagnosis by community health workers. Factors influencing this included road conditions and long distances to the health center, compounded by the cost of seeking further care and patients' perceptions of vivax malaria and its treatment. 93.9% (790/841) of eligible vivax malaria patients who successfully completed referral (429/434) and directly presented to the health center (360/407) were G6PD tested. Key enabling factors included the test's acceptability among health workers and their understanding of the rationale for testing. Only 36.5% (443/1213) of eligible vivax episodes appropriately received primaquine. 70.5% (165/234) of female patients and all children under 20 kilograms never received primaquine. Our findings suggest that access to radical cure requires robust infrastructure and income security, which would likely improve referral rates to health centers enabling access. Bringing treatment closer to patients, through community health workers and nuanced community engagement, would improve access to curative treatment of vivax malaria.

Improving the technical efficiency of public health centers in Cambodia: a two-stage data envelopment analysis

BackgroundCambodia is undergoing a series of reforms with the objective of reaching universal health coverage. Information on the causes of inefficiencies in health facilities could pave the way for a better utilization of limited resources available to ensure the best possible health care for the population.ObjectivesThe purpose of this study is to evaluate the technical efficiency of health centers and the determinants for inefficiencies.MethodsThis cross-sectional study used secondary data from a costing study on 43 health centers in six Cambodian provinces (2016–2017). Firstly, the Data Envelopment Analysis method with output-orientation was applied to calculate efficiency scores by selecting multiple input and output variables. Secondly, a tobit regression was performed to analyze potential explanatory variables that could influence the inefficiency of health centers.ResultsStudy findings showed that 18 (43%) health centers were operating inefficiently with reference to the variable returns to scale efficiency frontier and had a mean pure technical efficiency score of 0.87. Overall, 22 (51%) revealed deficits in producing outputs at an optimal scale size. Distance to the next referral hospital, size and quality performance of the health centers were significantly correlated with health center inefficiencies.ConclusionDifferences in efficiency exist among health centers in Cambodia. Inefficient health centers can improve their technical efficiency by increasing the utilization and quality of health services, even if it involves higher costs. Technical efficiency should be continuously monitored to observe changes in health center performance over time.

Validation of the person-centered maternity care scale at governmental health facilities in Cambodia.

Women's childbirth experience of interpersonal care is a significant aspect of quality of care. Due to the lack of a reliable Cambodian version of a measurement tool to assess person-centered maternity care, the present study aimed to adapt the "Person-Centered Maternity Care (PCMC) scale" to the Cambodian context and further determine its psychometric properties. The PCMC scale was translated into Khmer using the team translation approach. The Khmer version of PCMC (Kh-PCMC) scale was pretested among 20 Cambodian postpartum women using cognitive interviewing. Subsequently, the Kh-PCMC scale was administered in a survey with 300 Cambodian postpartum women at two governmental health facilities. According to the COnsensus-based Standards for the Selection of health status Measurement Instruments (COSMIN) standard, we performed psychometric analysis, including content validity, construct validity, criterion validity, cross-cultural validity, and internal consistency. The preliminary processes of Kh-PCMC scale development including cognitive interviewing and expert review ensured appropriate levels of content validity and acceptable levels of cross-cultural validity of the Kh-PCMC scale with four-point frequency responses. The Scale-level Content Validity Index, Average (S-CVI/Avg) of 30-item Kh-PCMC scale was 0.96. Twenty items, however, performed optimally in the psychometric analysis from the data in Cambodia. The 20-item Kh-PCMC scale produced Cronbach's alpha of 0.86 for the full scale and 0.76-0.91 for the subscales, indicating adequately high internal consistency. Hypothesis testing found positive correlations between the 20-item Kh-PCMC scale and reference measures, which implies acceptable criterion validity. The present study produced the Kh-PCMC scale that enables women's childbirth experiences to be quantitatively measured. The Kh-PCMC scale can identify intrapartum needs from women's perspectives for quality improvement in Cambodia. However, dynamic changes in and diverse differences of cultural context over time across provinces in Cambodia require the Kh-PCMC scale to be regularly reexamined and, when needed, to be further adjusted.

The ‘Ironclad friendship’ of China-Cambodia, lays the first step in the foundation of early diagnosis and treatment of asymptomatic congenital heart Defects- A multi-national screening and intervention project, 2017–2020

BackgroundCongenital heart disease (CHD) is the leading cause of mortality in childhood worldwide. However, a large number of children with CHD are not diagnosed promptly in low- and middle-income regions, due to limited healthcare resources and lack the ability of prenatal and postnatal ultrasound examinations. The research on asymptomatic CHD in the community is still blank, resulting in a large number of children with asymptomatic CHD can not be found and treated in time. Through the China-Cambodia collaborative health care initiative, the project team conducted research, screened children’s CHD through a sampling survey in China and Cambodia, collected relevant data, and retrospectively analyzed the data of all eligible patients.ObjectivesThe project aimed to evaluate the prevalence of asymptomatic CHD in a sample population of 3-18years old and effects on their growth status and treatment outcomes.MethodsWe examined the prevalence of ‘asymptomatic CHD’ among 3-18years old children and adolescents at the township/county levels in the two participating. A total of eight provinces in China and five provinces in Cambodia were analyzed from 2017 to 2020. During 1 year follow-up after treatment, the differences in heights and weights of the treated and control groups were evaluated.ResultsAmong the 3,068,075 participants screened from 2017 to 2020, 3967 patients with asymptomatic CHD requiring treatment were identified [0.130%, 95% confidence interval (CI) 0.126 -0.134%]. The prevalence rate of CHD ranged from 0.02 to 0.88%, and was negatively related to local per capita GDP (p = 0.028). The average height of 3310 treated CHD patients were 2.23% (95% CI: -2.51%~-1.9%) lower than that of the standard group and the average weight was − 6.41% (95% CI: -7.17%~-5.65%) lower, the developmental gap widening with advancing age. One year after treatment, the relative height difference remained comparable while that, in weight was reduced by 5.68% (95% CI: 4.27% ~7.09%).ConclusionsAsymptomatic CHD now is often overlooked and is an emerging public health challenge. Early detection and treatment are essential to lower the potential burden of heart diseases in children and adolescents.

A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion

BackgroundTo determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy.MethodsWe conducted a multicentre,...

TRELAGLIPTIN'S REAL WORLD EFFICACY AMONG TYPE 2 DIABETES PATIENTS IN CAMBODIA (TRELA -REAL STUDY)

Background: Trelagliptin is the rst once-weekly oral therapy for type 2 diabetes in Cambodia. The afrmation of its efcacy and safety in Cambodian Type 2 Diabetes patients is to be established for extending the clinical benet of this unique oral anti-diabetic agent in this population Objective: To conrm the effect of Trelagliptin (TRELA), a selective once weekly dipeptidyl peptidase-4 (DPP-4) inhibitor, on glycemic control in the management of Type 2 Diabetes Mellitus (T2DM) in real-world practice settings in Cambodia Methods: An open-label, multicentric prospective, observational single-arm study was conducted across Phnom Penh and three other provinces in Cambodia which will include Siem Reap, Kampong Cham, and Battambang in outpatient settings. One hundred and fty patients with Type 2 Diabetes were enrolled after seeking informed consent. Trelagliptin 100 mg one tablet per week was administered to patients with type 2 diabetes who showed poor glycemic control (HbA1c ≥6.5% ) on diet/exercise therapy alone or diet/exercise therapy plus other oral antidiabetic agents or insulin. The study primary endpoint(s) included changes in glycated hemoglobin (HbA1c) from baseline at the end of three months, and at the end of six months of the study. The secondary endpoints included patient satisfaction and investigator assessment at the end of treatment (6 months) to once weekly treatment to Trelagliptin. Result: Treatment with Trelagliptin 100 mg/week led to a mean change in HbA1c 0.86% (from 8.76 ± 2.02 to 7.9 ± 1.60, p &lt; 0.05, CI 95) at the end of 3 months. At the end of 6 months, the mean change in HbA1c was 1.26% (from 8.76 ± 2.02 to 7.5 ± 1.34), p&lt;0.05, CI 95) (p-value signicant) Patient satisfaction and preference with once-weekly trelagliptin treatment was reported in 97.04 % (n=131) patients. As per the investigator's assessment, 77.04 % (n=104) of the patients reported a “good” response to Trelagliptin treatment at the end of the study over a period of 6 months. In 14.07 % (n=19) patients investigators reported that “excellent” response was achieved. Whereas 5.19% (n=7) and 3.7% (n=5) patients reported average and poor responses, respectively. Trelagliptin treatment once a week was demonstrated to be clinically efcacious as monotherapy and in combination with other anti-hyperglycemic agents. Trelagliptin treatment was found to be efcacious in treatment naïve and treatment-experienced patients. The clinical benets of Trelagliptin were consistent across age groups, body mass index (BMIs), and associated co-morbidities like hypertension. Trelagliptin was well tolerated and was safely used in addition to Metformin, Sulfonylureas, Thiazolidinediones, SGLT2-inhibitors &amp; Insulin treatment. The glucose-lowering effect of Trelagliptin was comparable to other DPP4 inhibitors (gliptins), and other classes of oral anti-diabetic medications with the additional advantage of once-a-week dosing treatment regime. Conclusion: Treatment with once-a-week trelagliptin as initial monotherapy and in combination therapy with other anti-hyperglycemic agents for glucose control in Type 2 Diabetes was efcacious and well-tolerated. Trelagliptin 100 mg once a week treatment achieved treatment satisfaction in most patients and reported “good” investigator response in majority of type 2 diabetes patients. Trelagliptin 100 mg once-a-week treatment is a useful consideration in the management of type 2 diabetes patients

Quantitative risk assessment of salmonellosis in Cambodian consumers through chicken and pork salad consumption

Salmonella is a globally important foodborne bacterial pathogen that poses a high risk to human health. This study aimed to estimate the risk to Cambodian consumers from acquiring salmonellosis after consuming chicken and pork salad, using a quantitative microbial risk assessment (QMRA). Chicken and pork salads are typical Cambodian dishes containing raw vegetables and boiled chicken meat or pork. As previously described, chicken meat and pork samples (n = 204 of each) were collected from traditional markets in 25 Cambodian provinces to generate data on Salmonella contamination. Salad preparation and consumption practices were surveyed in 93 Cambodian households and this information was used to design an experiment to assess Salmonella cross-contamination from raw meat to ready-to-eat salad. In the part of the study reported here, data on consumption, Salmonella in salad, dose-response, and predicted salmonellosis were modeled using Monte Carlo simulations at 10,000 iterations. The prevalence of Salmonella in chicken meat and pork were set to 42.6 and 45.1%, respectively, with average most probable number (MPN) per gram of Salmonella in chicken meat was 10.6 and in pork 11.1 MPN/g, based on an earlier study. Half of the interviewed households cooked meat for the salad directly after purchase. The QMRA model showed that the modeled annual risk of salmonellosis from consuming chicken salad, pork salad and both chicken and pork salad were 11.1% probability of illness per person per year (90% CI 0.0–35.1), 4.0% (90% CI 0.0–21.3), and 14.5% (90% CI 0.0–33.5), respectively. The factors most influencing the estimate were cross-contamination while preparing the salad, followed by the prevalence of Salmonella in chicken meat and pork at the market. The wide confidence interval for the incidence was mainly due to the variability in reducing bacteria concentration by cooking and salad consumption. The predicted risk of salmonellosis due to chicken and pork salad consumption is high, and the study provides evidence supporting control measures of improving the safety of retailed chicken and pork obtained from markets to households and improving food preparation methods in the household.

Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia

BackgroundCambodia has made significant progress towards achieving malaria elimination by 2025. Cases continue to decrease and are primarily concentrated in forested areas. Forest-goers are most at risk of malaria due to their proximity to the forest, poor sleeping conditions, frequent mobility, and distance from health services. Consistent use of long-lasting insecticidal nets or hammock nets (LLINs/LLIHNs), early diagnosis and treatment of cases are central to reducing disease burden. The aim of this study was to understand forest-goers’ knowledge, attitudes, and practices related to malaria prevention and care-seeking, and to identify key behavioural determinants of LLIN/LLIHN use and prompt care-seeking within 24 h of developing a fever.MethodsA mixed-methods study design consisting of a cross-sectional survey and qualitative in-depth interviews was implemented in two Cambodian provinces. Survey participants (N = 654) were recruited using respondent driven sampling. Interview participants (N = 28) were selected using purposive sampling. Findings from the survey were analysed using univariate and bivariate analysis and multivariate weighted logistic regression. Interviews were coded and analysed using thematic content analysis.ResultsAll study participants had heard of malaria and 98% knew that malaria was transmitted by mosquitoes. LLIN/LLIHN ownership was high (94%). Although 99% of participants perceived LLIN/LLIHN use as an important malaria prevention measure, only 76% reported using one during their last visit to the forest. Only 39% of survey participants who reported seeking care did so within the recommended 24 h from fever onset during their last febrile illness. Among all study participants, 43% did not seek any healthcare during their last febrile episode. In controlled regression models, perceived community social norms were significantly associated with LLIN/LLIHN use (OR: 2.7, 96% CI 1.99–2.64) and care-seeking within 24 h of fever onset (OR: 1.7, 95% CI 1.00–2.88). Social support from other forest-goers was also significantly associated with LLIN/LLIHN use (OR: 4.9, 95% CI 1.32–18.12).ConclusionsStudy findings are consistent with other studies on LLIN/LLIHN use and care-seeking behaviours. While rates of LLIN/LLIHN ownership were high among the study population, rates of use were not as high. More concerning were the delayed care-seeking behaviours. Social behaviour change activities should incorporate social norms and social support as mechanisms for behaviour change given the identified positive correlations with LLIN/LLIHN use and prompt care-seeking.

Population genomics reveal distinct and diverging populations of An. minimus in Cambodia

Anopheles minimus is an important malaria vector throughout its wide geographic range across Southeast Asia. Genome sequencing could provide important insights into the unique malaria transmission dynamics in this region, where many vector species feed and rest outdoors. We describe results from a study using Illumina deep whole-genome sequencing of 302 wild-caught An. minimus collected from three Cambodian provinces over several years (2010, 2014, 2016) and seasons to examine the level of population structure and genetic diversity within this species. These specimens cluster into four distinct populations of An. minimus s.s., with two populations overlapping geographically. We describe the underlying genetic diversity and divergence of these populations and investigated the genetic variation in genes known to be involved in insecticide resistance. We found strong signals of selection within these An. minimus populations, most of which were present in the two Northeastern Cambodian populations and differ from those previously described in African malaria vectors. Cambodia is the focus of the emergence and spread of drug-resistant malaria parasites, so understanding the underlying genetic diversity and resilience of the vectors of these parasites is key to implementing effective malaria control and elimination strategies. These data are publicly available as part of the MalariaGEN Vector Observatory, an open access resource of genome sequence data.

The associations between stunting and wasting at 12 months of age and developmental milestones delays in a cohort of Cambodian children

Worldwide, over 250 million children under 5 years do not reach their developmental potential due to several causes, including malnutrition. In Cambodia, the prevalence of stunting and wasting among children remains high. This prospective cohort study aimed to assess acquisition of motor and cognitive developmental milestones in early childhood and their associations with stunting and wasting. Children aged from 0 to 24 months were recruited from three provinces in Cambodia and followed up to seven times from March 2016 to June 2019, until their 5 years. Data collection included anthropometry and developmental milestones. Seven motor and seven cognitive milestones were evaluated using the Cambodian Development Milestone Assessment Tool. Associations were assessed with parametric survival models. Hazard ratios (HR) below 1 stood for lower probabilities for achieving developmental milestones. Data were available for 7394 children. At 12 months, the prevalence of stunting and wasting were 23.7% and 9.6% respectively. Both were consistently associated with delays in most motor and cognitive milestones. Stunting was strongly associated with delays in gross motor milestones (HR < 0.85; p < 0.001). Wasting was more strongly associated with delays in fine motor development and most cognitive milestones (HR < 0.75; p < 0.001). Promoting nutritional programs in the first 1000 days to prevent malnutrition is essential to further the optimal growth and motor and cognitive development of Cambodian children.