148 research outputs found
Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia.
No full textBACKGROUND: There is growing interest in the expansion of community health workers programmes in low- and middle-income countries as a cost-effective approach to address shortages of health professionals. However, our understanding of the reception of large-scale programmes and how to improve them remains limited, with knowledge gaps about factors that may promote or discourage equitable access to services. This paper examines the case of the Village Malaria Workers (VMW) programme in Cambodia, an extensive community-based intervention for the management of malaria cases in remote rural areas. METHOD: Fieldwork was conducted in Kampot province, in six case villages characterised by different programme configuration, population size, and distance to the nearest public health facility. In these locations, in-depth interviews (n = 71) with VMWs, village authorities, and residents were conducted to identify facilitators and challenges to service utilisation. Data analysis was informed by a conceptual framework based on five domains of access to services: awareness, accessibility, accommodation, availability, and acceptability. RESULTS: Factors that influenced the utilisation of VMW services in our research sites include: the nature of dissemination activities and their ability to reach different population groups; the village topography and the changing road infrastructure; the involvement of VMWs in other community roles and activities; perceptions about the type of disease after the onset of symptoms; the need for comprehensive diagnosis and care; perceptions about the status of VMWs as medical providers; length of VMW appointment. CONCLUSIONS: This study highlights the complexity and diversity of contextual factors that may influence the uptake of a community health programme. As in other countries, continued use of lay health workers in Cambodia to deliver diagnostic and curative services has the potential for great health and economic impact. However, further consideration should be given to the problem of access in different categories of residents and different contexts of implementation. In addition, a comprehensive mapping of changes in disease epidemiology, road infrastructure and the geography of access to services is crucial to inform policy development in this area
Focused Screening and Treatment (FSAT): a PCR-based strategy to detect malaria parasite carriers and contain drug resistant P. falciparum, Pailin, Cambodia.
No full textRecent studies have shown that Plasmodium falciparum malaria parasites in Pailin province, along the border between Thailand and Cambodia, have become resistant to artemisinin derivatives. To better define the epidemiology of P. falciparum populations and to assess the risk of the possible spread of these parasites outside Pailin, a new epidemiological tool named "Focused Screening and Treatment" (FSAT), based on active molecular detection of asymptomatic parasite carriers was introduced in 2010. Cross-sectional malariometric surveys using PCR were carried out in 20 out of 109 villages in Pailin province. Individuals detected as P. falciparum carriers were treated with atovaquone-proguanil combination plus a single dose of primaquine if the patient was non-G6PD deficient. Interviews were conducted to elicit history of cross-border travel that might contribute to the spread of artemisinin-resistant parasites. After directly observed treatment, patients were followed up and re-examined on day 7 and day 28. Among 6931 individuals screened, prevalence of P. falciparum carriers was less than 1%, of whom 96% were asymptomatic. Only 1.6% of the individuals had a travel history or plans to go outside Cambodia, with none of those tested being positive for P. falciparum. Retrospective analysis, using 2010 routine surveillance data, showed significant differences in the prevalence of asymptomatic carriers discovered by FSAT between villages classified as "high risk" and "low risk" based on malaria incidence data. All positive individuals treated and followed-up until day 28 were cured. No mutant-type allele related to atovaquone resistance was found. FSAT is a potentially useful tool to detect, treat and track clusters of asymptomatic carriers of P. falciparum along with providing valuable epidemiological information regarding cross-border movements of potential malaria parasite carriers and parasite gene flow
Optimising Strategies for Malaria Elimination: Primaquine, Mass Drug Administration and Artemisinin Resistance
No full textResilience and Vulnerability Assessment as the Basis for Adaptation Dialogue in Information-Poor Environments: A Cambodian Example
No full textIntegrating child health services into malaria control services of village malaria workers in remote Cambodia: service utilization and knowledge of malaria management of caregivers
No full textA Review of Slow Noodles: A Cambodian Memoir of Love, Loss, and Family Recipes
No full textSlow Noodles: A Cambodian Memoir of Love, Loss, and Family Recipes by Chantha Nguon, with assistance from Kim Green, is a poignant exploration of the author\u27s journey from a Cambodian refugee to a beacon of empowerment in her homeland. This review delves into the book\u27s narrative structure, which intertwines personal anecdotes with culinary reflections, offering a unique lens into the complexities of Chantha’s personal life. Through a detailed analysis of select chapters, including Chicken-Lime Soup for the Village Soul and Instant Noodles, the review examines themes of resilience, identity, and especially societal expectations for what and how Cambodian women should be. Furthermore, it highlights the memoir\u27s portrayal of Cambodian cultural norms, the impact of historical events such as Pol Pot regime, and the transformative power of compassion and community support. Concluding with reflections on the memoir\u27s universal life lessons, the review underscores its contribution to literature and the importance of cherishing the present amidst life\u27s uncertainties
GUARD study report: Good Use of Antimalarials and Rapid Diagnostic Tests in Cambodia study report
No full textUsing a mixed methods approach that included quality assessments, a mystery client study and qualitative research, we conducted a comprehensive evaluation of malaria Rapid Diagnostic Tests and in the private sector in 12 health centre catchment areas across Cambodia. In summary, we found that the RDTs collected from drug shops had maintained good quality and that storage and transport conditions were on the whole satisfactory. Uptake of RDTs appeared to highest in the most highly trained providers i.e. “cabinets”, and lowest in grocery shops, with pharmacies and drugs shops having some ambiguity around their role. Findings from the focus group discussions and the mystery client study suggest that some of the problems in uptake and interpretation relate to RDTs being on the margins of practice for these providers who see themselves as either providing a diagnosis and cure (pinit pchier bal) or simply selling drugs for symptomatic relief (lout tnam). Several problems with RDTs were identified in terms of their actual use, in particular relating to interpretation of results, blood safety, and problems related to the buffer and the blood collecting device. In summary this study provides a comprehensive assessment of malaria RDTs in one of the first countries to implement them in the private sector
Am J Trop Med Hyg
No full textWidespread availability of monotherapies and falsified antimalarials is thought to have contributed to the historical development of multidrug-resistant malaria in Cambodia. This study aimed to document the quality of artemisinin-containing antimalarials (ACAs) and to compare two methods of collecting antimalarials from drug outlets: through open surveyors and mystery clients (MCs). Few oral artemisinin-based monotherapies and no suspected falsified medicines were found. All 291 samples contained the stated active pharmaceutical ingredient (API) of which 69% were considered good quality by chemical analysis. Overall, medicine quality did not differ by collection method, although open surveyors were less likely to obtain oral artemisinin-based monotherapies than MCs. The results are an encouraging indication of the positive impact of the country's efforts to tackle falsified antimalarials and artemisinin-based monotherapies. However, poor-quality medicines remain an ongoing challenge that demands sustained political will and investment of human and financial resources.2015-06-03T00:00:00
How to implement prevention, test, treat and track (P+T3) amongst populations at higher risk of malaria: lessons from western Cambodia
No full textPromoting community knowledge and action for malaria control in rural Cambodia: potential contributions of Village Malaria Workers
No full textAbstract Background Cambodia has been investing in Village Malaria Workers (VMWs) to improve malaria case management in rural areas. This study assessed the quality of the VMWs’ services compared to those by a government-run health center from the perspective of community members. We focused on VMWs’ contribution to promote their action to control malaria. A community-based cross-sectional study was conducted in Kampot province in 2009. Interviews were conducted at every accessible household in a village with VMWs (n = 153) and a village with a health center (n = 159), using interviewer administered questionnaire. Preference of the interview was given to female household head. Multiple regression analyses were run to compare knowledge about malaria, preventive measures taken, and time before first malaria treatment between the two villages. Findings The villagers perceived the VMWs’ services equally as good as those provided by the health center. After controlling for confounding factors, the following indicators did not show any statistical significance between two villages: community members’ knowledge about malaria transmission (AOR = 0.60, 95% CI = 0.30-1.22) and government-recommended antimalarial (AOR = 0.55, 95% CI = 0.25-1.23), preventive measures taken (Beta = −0.191, p = 0.315), and time before the first treatment (Beta = 0.053, p = 0.721). However, knowledge about malaria symptoms was significantly lower in the village with VMWs than the village with a health center (AOR = 0.40, 95% CI = 0.19-0.83). Conclusions VMWs played an equivalent role as the health center in promoting malaria knowledge, action, and effective case management. Although VMWs need to enhance community knowledge about malaria symptoms, the current government policy on VMWs is reasonable and should be expanded to other malaria endemic villages.</p
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