GLOBAL HEALTH PERSPECTIVES
Communicable &
Non-communicable Diseases
Cambodia
Common Communicable and Non-communicable Diseases
Communicable Diseases
Communicable diseases are “illnesses that are caused by a particular infectious agent and that spread directly or indirectly from people to people, from animals to animals, from animals to people, or from people to animals” (Skolnik, 2016, p. 25). The risk of infectious disease in Cambodia is rated as ‘very high’ by United States heath officials, listing common communicable diseases in the area as: human immunodeficiency virus (HIV), malaria, tuberculosis (TB), influenza, dengue fever, Japanese encephalitis, and rabies (Hays, 2014). One in three Cambodian is estimated to have had TB at one time; furthermore, it is estimated that 2,500 deaths were attributed to HIV/AIDS in 2011 (Hays, 2014). In the 1990s, Cambodia had the highest rate of HIV/AIDS in Asia at 3%, but this number has slowly declined to 0.8% as of 2010 (Hays, 2014).
Non-communicable Diseases
Non-communicable diseases are “illnesses that are not spread by any infectious agent,” (Skolnik, 2016, p. 25). Common non-communicable diseases in Cambodia include: cancer, diabetes, cardiovascular disease, and chronic respiratory disease (Yunguo & Beresford, 2017). As of 2014, these diseases were attributed to 52% of all deaths in Cambodia, which is an increase from 46% in 2011 (Yunguo & Beresford, 2017). Amongst these non-communicable diseases, cardiovascular disease is the cause of the highest number of totals deaths at 24%, followed by cancer at 13%, chronic respiratory disease at 4%, and diabetes at 2% (Yunguo & Beresford, 2017). Cervical cancer is the most common type of cancer in Cambodia, followed by liver, lung, breast, and stomach cancers (Cambodian Ministry of Health, 2013).
(Source: WHO, 2014)
Challenges to the Prevention and Control of Disease
There are a number of challenges to the prevention and control of both communicable and non-communicable diseases in Cambodia. In regard to communicable diseases, poor sanitary conditions, general lack of adequate medical treatment, poor hygiene practices, humid environment, and inadequate nutrition contribute to the infectious process (Hays, 2014). In rural areas, residents often drink the same water that they bathe in and that animals also use; furthermore, these stagnant bodies of water are usually located in swampy areas wherein mosquitoes make their home, increasing the risk for vector-borne diseases. Sadly, many of the antimalarial medications sold in Southeast Asia have been proven to be fake, containing no active ingredient (Hays, 2014). Dengue fever is similarly difficult to prevent and control, as this disease has no vaccine or cure (Hays, 2014). Rabies has also become an increased problem for tourists and Cambodians who venture to the countryside where wild animals roam (Sylvester, 2015).
Challenges to the prevention and control of non-communicable diseases in Cambodia include: unhealthy diet, tobacco use, alcohol use, air pollution, and physical inactivity (Yunguo & Beresford, 2017). Inadequate general medical treatment is a challenge to the prevention of cancer, as three of the most common types are caused by preventable infections: hepatitis B and C, human papilloma virus (HPV), and helicobacter pylori (Cambodian Ministry of Health, 2013). Chronic respiratory disease, lung cancer, and respiratory infections are all caused by air pollution from solid fuel use; furthermore, it is estimated that 2 million Cambodians use tobacco with over half of the population exposed to environmental tobacco smoke (Cambodian Ministry of Health, 2013). It is estimated that 8 out of 10 Cambodians do not consume an adequate amount of fruit and vegetables, which contributes to an unhealthy diet (Cambodian Ministry of Health, 2013). A diet high in salt and saturated fat is common, which results in high cholesterol for 1 out of 5 Cambodians, and high blood pressure in 1 out of 10 Cambodians (Cambodian Ministry of Health, 2013).
(Source: Cambodian Ministry of Health, 2013)
Current and Potential Prevention, Control, and Improvement Measures
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The United Nations Interagency Task Force on the Prevention and Control of Non-communicable Disease (UNIATF) was established in 2013 to promote a government approach in mobilizing health sectors to address the burden of disease. In 2017, UNIATF collaborated with UN agencies to support the Cambodian government’s adoption of the Tobacco Control Law, which restricts point-of-sale promotion of tobacco products, includes pictorial health warning labels on tobacco products, and protects individuals from second-hand tobacco smoke. Furthermore, efforts are being made to increase taxation on tobacco products (Yunguo & Beresford, 2017).
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The World Health Organization’s (WHO) Test-and-Treat Policy was implemented in 2016 wherein all individuals with HIV/AIDS are immediately provided treatment after testing positive. In order to support this policy, Cambodia’s Ministry of Health has also increased viral load testing by acquiring a second machine to test viral loads of HIV patients, which accounts for 20,000 tests per year (U.S. Embassy in Cambodia, 2018).
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In collaboration with the CDC and WHO, Cambodia’s Ministry of Health also implemented an influenza program in 2006. This program emphasizes preparedness, surveillance, communication, and response to seasonal and pandemic influenza. The Cambodian Ministry of Health is supported by the CDC in order to enact early identification and characterization of circulating influenza viruses (U.S. Embassy in Cambodia, 2018).
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A free public hotline, supported by the InSTEDD iLab Southeast Asia, was launched in 2016 in order to allow Cambodians to report possible outbreaks of disease. The hotline can be accessed on any phone in Cambodia by dialing 115. These reports allow community health workers to improve efficiency and effectiveness in their response and prevention measures (InSTEDD, 2018). One such example of the benefits of this hotline is presented in the video to the right.
(Source: InSTEDD Global. (2017, December 15). Cambodia’s national disease hotline in action [Video file]. Retrieved from https://www.youtube.com/watch?v=q0WTY-jnnRQ)