Infectious Diseases

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Background
Tuberculosis (TB), malaria and avian influenza are serious concerns in Cambodia. Approximately two-thirds of all Cambodians carry the TB bacterium, one of the highest rates in the world, and some 13,000 Cambodians die annually from the disease. While malaria mortality rates have been halved since 1999, it is still a major killer, especially among children. Of global concern is evidence of malaria parasite resistance to artemisinin combination therapy along the Thai-Cambodia border, a region that has been ground zero in the development of resistance to anti-malaria drugs since the 1950s. In addition, avian influenza is a growing threat with potentially global ramifications.

Objectives
The top priorities of Cambodia’s National TB Program, which USAID collaborates with, are to maintain the detection rate for smear-positive pulmonary TB at 70% or higher; maintain the current cure rate of over 85%; and expand directly observed treatment-short course (DOTS), a community-based service that detects and treats TB. To tackle malaria, USAID works closely with regional and national partners to prevent further spread and eliminate resistant parasites. To respond to the growing threat of avian influenza, USAID supports the Cambodian government’s efforts to improve animal and human disease health surveillance, early warning at the community level, development of a national-level preparedness plan, and behavior-change communication.

Results
• In 3,441 villages of 271 health centers located in eight provinces, successfully treated 93% of the over 10,000 TB cases detected by USAID-supported community-level DOTS.

• Improved the accuracy of chest X-rays, an important tool for detecting TB, from 63% to 91% in USAID-supported hospitals, and increased the quality of sputum smear preparation from 53% to 74%.

• Strengthened the National Center for Malaria Control’s ability to prevent, diagnose and treat groups at high risk of malaria, including the mobile and migrant population, pregnant women, and children in the target provinces of Battambang, Banteay Meanchy, Oddar Meanchey and Pailin.

• Supported the Ministry of Health and Ministry of Agriculture, Forestry, and Fisheries, and other partners in developing national strategies to confront the ongoing challenge of prevention and control of zoonotic diseases.