GLOBAL HEALTH PERSPECTIVES
HEALTH FACTORS &
DISEASE
Cambodia
Factors Affecting Health
Nutritional Health
In order to understand the state of health of a country, one must examine the influence of key elements, such as occupational, environmental, and nutritional factors. In regard to Cambodia, each of these components present numerous risk factors to individuals of both rural and urban settings. Fortunately, a number of health promotion activities exist in order to help ease the detrimental effects of risk factors that Cambodians encounter on a daily basis.
Occupational Health
Child labor continues to be a prevalent problem in Cambodia with 48.9% of children working in areas including: agriculture, brickmaking, mining, fishing, salt production, and domestic labor. The children may work long hours in hot weather, using dangerous equipment without the appropriate training; they also work with various chemicals and are often required to complete strenuous tasks without proper food or shelter. An increasing number of children are illegally confined in order to work on the street as beggars and scavengers. Alarmingly, children continue to be trafficked to Thailand and Vietnam for forced labor in factories, domestic work, and prostitution (U.S. Department of Labor's Bureau of International Affairs, 2012).
Stunting is defined as “failure to reach linear growth potential because of inadequate nutrition or poor health. Stunting is measured as height-for-age two z-scores below the international reference” (Skolnik, 2016, p. 196). The Cambodian population continues to experience significant levels of stunting as a result of a lack of nutrition education with a focus on complementary infant feeding practices (USAID, 2015). One-fourth of the population is undernourished and experiences food deprivation; this is a cause of the deaths of approximately one-third of children (USAID, 2015; UNICEF, 2011). Poverty is the leading cause of undernutrition that results in child mortality in Cambodia. Twenty percent of Cambodians cannot afford adequate portions of food, and one in three individuals is living below the poverty line (UNICEF, 2011).
Health Promotion Activities
Recent Research
(Source: Cambodia Ministry of Labour and Vocational Training, 2011)
(Source: U.S. Department of Labor's Bureau of International Affairs, 2012)
(Source: https://sites.google.com/a/tapa.tp.edu.tw/modern-day-slavery/child-labor/children-labor-in-cambodia)
In Cambodia, hazardous working conditions often result in occupational accidents; in 2009, these accidents were the cause of 1,500 fatalities (International Labour Organization, 2017). A large number of factories and construction sites operate under systems that lack the necessary policies to protect workers from injury. The causes of injury, illness, and fatality include: falls from heights, falling objects, collapsing buildings or structures, suffocation, electrocution, exposure to chemicals, asbestos, inhalation of dust, and poor housekeeping. Furthermore, many Cambodian workers are unskilled and hired by the day, which puts them at increased risk for occupational accidents (International Labour Organization, 2017). The chart to the right illustrates that most of the occupational accidents that were investigated in 2005 occurred in garment factories due to a lack of ventilation systems combined with fumes and hot weather; majority of occupational accidents today continue to occur in garment factories, brick factories, and construction sites (Cambodia Ministry of Labour and Vocational Training, 2011).
Environmental Health
In Cambodia, the monsoon season occurs from May through October and is characterized by heavy rainfall that accounts for 75-80% of the yearly total. This often results in flooding, and the communities that are situated along the Tonie Sap and Mekong Rivers are especially vulnerable to its effects. During extreme flooding, the high levels of water wash away dams, dikes, and distribution structures; in turn, this destroys crops and livestock while damaging homes, temples, clinics, schools, and other structures. Flooding also affects Cambodians by contributing to food shortage, illness due to contamination, and loss of economic output. To illustrate the vast damages caused by this natural disaster, data from one of the worst monsoon seasons show that 3.5 million Cambodians were affected, 347 died, and around $157 million USD in damages occurred (Asian Disaster Reduction Center, 2003).
Access to potable water sources is limited in Cambodia due to a combination of problems, including water pollution, drought, flooding, and poorly planned water infrastructures (University of Gothenburg, 2009). Most Cambodians lack access to safe drinking water within their homes and do not use proper sanitation when utilizing water from natural sources. Water pollution is a huge problem in Cambodia due to downstream emptying; Cambodians in rural areas will also wash clothes and bathe in an outdoor water source, then drink the same water, which them at risk for disease (United States Agency for International Development [USAID], 2015). Further increasing vulnerability to illness are the use of agrochemicals that contaminate water, as well as naturally occurring arsenic in groundwater sources (University of Gothenburg, 2009).
(Source: USAID, 2015)
Anemia, as well as other micronutrient deficiencies is also a huge nutritional problem in Cambodia. Anemia is defined as a “low level of hemoglobin in the blood, as evidenced by a reduced quality or quantity of red blood cells,” (Skolnik, 2016, p. 196). It is experienced by more than half of Cambodian children under 5 years old, with a prevalence of more than 80% in children under 2 years old (UNICEF, 2011). Within the context of this issue, there is a notable disparity between the 42% of anemic rural children and 28% of anemic urban children. The difference in percentages is attributed to a greater lack of access to water and sanitation in rural areas, which results in illness that contributes to nutritional deficiencies (USAID, 2015). Anemia also affects a significant percentage of pregnant women and women of childbearing age; for example, around 44% of Cambodian women of childbearing age are anemic (USAID, 2015).
(Source: Lucky Iron Fish. (2014, July 20). Lucky iron fish: Shape of health [Video file]. Retrieved from https://www.youtube.com/watch?v=KJM7Nj1DCwk)
In order to reduce preventable causes of child mortality, such as undernutrition, UNICEF has supported the Cambodian Ministry of Health’s National Campaign on Communication for Behavior Impact on Complementary Feeding for Children. This initiative focuses on children from ages 6 to 24 months and includes specialized training and education for health care providers in infant feeding, counseling, and communication skills. Over 9,000 caregivers in 1,641 villages in 10 provinces have been trained, as well as 6,000 village health volunteers (UNICEF, 2015).
(Source: https://http://4.bp.blogspot.com/-jHy2idrMSfU/UWUW8_Z3U-I/AAAAAAAAAWY/JPMuujqzSIo/s1600/Comp-Feeding_01.jpg)
In order to combat agricultural decline and food insecurity that often result after natural disasters, USAID is leading a project called Helping Address Rural Vulnerabilities and Ecosystem Stability (HARVEST). Agricultural interventions are implemented, such as commercial horticulture, establishing fisheries, and rice harvesting. Rural households are also provided the tools and education to grow nutrient-dense vegetables, fruit, and herbs that will also allow them to bring in increased income. HARVEST introduces various fish species, eels, and prawns to household and commercial ponds, and also manages ponds in which wild fish are bred. Nutrition education is incorporated in all aspects of the program so that the rural Cambodian population is able to cultivate and/or utilize nutritious foods (USAID, 2015).
Reference:
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Reinbott, A., Schelling, A., Kuchenbecker, J., Jeremias, T., Russell, J., Kevanna, O., . . . Jordan, I. (2016).
Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia. British Journal of Nutrition, 116, 1457-1468. doi:10.1017/S0007114516003433
From 2012 to 2014, the Food and Agriculture Organization of the United Nations performed a cluster randomized trial in Cambodia to examine the effects of a nutrition education program and agricultural intervention on poor infant and young child feeding. The researchers posited that both interventions could improve a child’s nutritional status and combat malnutrition by utilizing complementary feeding in order to consume a diverse diet. A total of 743 Cambodian households with children over 6 months of age were monitored throughout 16 different villages. A cross-section baseline study was performed in 2012, followed by implementation of the interventions; some villages only received agricultural intervention while others received nutrition education and agricultural intervention. In 2014, an impact survey was implemented in order to determine the effects of the interventions. The survey consisted of questions regarding dietary diversity in the form of a 24-hour meal recall, and socio-economic status; measurements, such as weight, were also taken. The results demonstrated that nutrition education in combination with agricultural intervention led to improvements in child dietary diversity (3.9 estimated mean) when compared with child dietary diversity in the agricultural intervention group (3.6 estimated mean) (Reinbott et al., 2016). This study supports the efforts of UNICEF and the Cambodian Ministry of Health’s National Campaign on Communication for Behavior Impact on Complementary Feeding for Children. As the study illustrates, nutrition education is valuable in promoting complementary feeding for children by helping to create awareness of the necessity of a diverse diet (UNICEF, 2015).
"Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia"
