Investing in the Next Generation: Growing Tall and Smart With Toilets

This brief shows that the level of open defecation in a community is associated with children of shorter stature in Cambodia. By looking at the change in defecation levels and average child height between 2005 and 2010 in Cambodian provinces, the study is able to show that improvements in sanitation access played a substantial role in increasing average child height over the same five years

Geographic Decomposition of Inequality in Health and Wealth : Evidence from Cambodia

The small-area estimation developed by Elbers, Lanjouw and Lanjouw (2002, 2003), in which a census and a survey are combined to produce the estimates of welfare measures for small geographic areas, has become a standard tool for poverty analysis in developing countries. The small-area estimates are typically plotted on a map, which are commonly called a poverty map. Poverty maps proved useful for policy analysis and formulation, and have become increasingly popular among policy-makers and researchers. In Cambodia, poverty maps have been used by various international organizations, ministries and non-governmental organizations for analyzing the poverty situations for their operation areas, selecting the potential locations for their projects and programs, and educating students in classrooms (Fujii, 2007). Besides creating poverty maps, the small-area estimation has been used for a wide array of purposes. For example, it has been used to analyze geographic targeting (Elbers et al., 2007 and Fujii, 2008), consumption inequality (Elbers et al., 2004), local inequality and crime (Demombynes and zler, 2005), and impacts of trade liberalization (Fujii and Roland-Holst, 2008). In this paper, we offer another new application of the small-area estimation; We use the small-area estimation to look at whether poverty is more spatially unequally distributed than child undernutrition. More precisely, we decompose inequality of consumption and child nutrition status into the within-group and between-group inequalities at various levels of spatial aggregation, and compare the decomposition results. While it is widely known that the health and wealth are positively correlated, it is not clear whether the spatial inequality in health and wealth necessarily exhibits a similar pattern. The significance of this point can be easily understood in a simple example. Suppose that the wealthy people in a country only live in the north and poor people only in the south, and suppose further that mosquitoes carrying malaria parasites exist uniformly across the country. Since wealthy people have better knowledge to cope with malaria, and resources to prevent the infection (such as mosquito repellants and mosquito nets), they are less likely to get infection than poor people. However, since there is no perfect preventive measure, the incidence of malaria would be less unequally distributed than poverty across the country. This example is extreme, of course. But it is of interest to see how different the spatial patterns of inequality in poverty and undernutrition are. The knowledge of spatial inequality in consumption and health is valuable for geographic targeting, because the spatial inequality prescribes the potential gains from geographic targeting. In the example given above, the resources for anti-poverty programs can be fully efficiently used if they are delivered to the south because everyone is poor and thus the resources all go to poor people. However, if we deliver all the resources (say, malaria tablets) to the south, the outcome may not be fully efficient. We would be giving the tablets to some in the south who are less vulnerable to malaria while not giving to others in the north who are more vulnerable to malaria. If geographic information is the only information available to the policy-maker, geographic targeting is still useful (and efficient given the available information), but the extent to which one may gain from geographic targeting is determined by the pre-existing spatial inequality. This paper is organized as follows. In the next section, we review the related literature. In Section 3, we shall discuss the small-area estimation methods for consumption and child nutrition status. We shall develop a unified framework for the standard small-area estimation developed by Elbers, Lanjouw and Lanjouw (2002, 2003) and its extension for the estimation of the prevalence of alnutrition by Fujii (2005). In Section 4, we shall discuss the method of inequality decomposition. In Section 5, we shall discuss the data we use. We then present the decomposition results in Section 6. Section 7 provides concludes.estimates of welfare, Cambodia, poverty map, Wealth, consumptionstatus, child nutrition status, inequality decomposition

Can mothers judge the size of their newborn? Assessing the determinants of a mother's perception of a baby's size at birth

Birth weight is known to be closely related to child health, although as many infants in developing countries are not weighed at birth and thus will not have a recorded birth weight it is difficult to use birth weight when analysing child illness. It is common to use a proxy for birth weight instead, namely the mother’s perception of the baby’s size at birth. Using DHS surveys in Cambodia, Kazakhstan and Malawi the responses to this question were assessed to indicate the relationship between birth weight and mother’s perception. The determinants of perception were investigated using multilevel ordinal regression to gauge if they are different for infants with and without a recorded birth weight, and to consider if there are societal or community influences on perception of size. The results indicate that mother’s perception is closely linked to birth weight, although there are other influences on the classification of infants into size groups. On average, a girl of the same birth weight as a boy will be classified into a smaller size category. Likewise, infants who died by the time of the survey will be classified as smaller than similarly heavy infants who are still alive. There are significant variations in size perception between sampling districts and clusters, indicating that mothers mainly judge their child for size against a national norm. However, there is also evidence that the size of infants in the community around the newborn also has an effect on the final size perception classification. Overall the results indicate that mother’s perception of size is a good proxy for birth weight in large nationally representative surveys, although care should be taken to control for societal influences on perception

Utilizing Three Years of Epidemiological Data from Medical Missions in Cambodia to Shape the Mobile Medical Clinic Formulary

Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission teams to Cambodia to shape the mobile medical clinic formulary. Methods: Data for patients seen during week-long, mobile, medical clinics was collected in Cambodia during Septembers 2012 to 2014. Patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most dispensed medications. This project received institutional review board approval. Results: A total of 1,015 patients were seen over three years. Women made up 61.4% and the mean age was 41.8 years. The most common diagnosis was gastrointestinal disorders (22.9%), which included gastroesophageal reflux disease and intestinal parasites. Next, 20.1% of patients had hypertension (BP\u3e140/90), 18.0% had presbyopia, 15.4% had back and joint pain, followed by 8.8% with headache, including migraines. Approximately 8.4% of patients had hyperglycemia (RPG \u3e140 mg/dl). Top five medications dispensed were acetaminophen, omeprazole, multivitamin, ibuprofen and metformin. For hypertension, amlodipine and lisinopril were dispensed. Conclusion: Cambodia lacks systematic public health collection of epidemiological data for prevalence of diseases. Hence, investigators collected and analyzed information from week-long mobile medical clinics over three years. Proton-pump inhibitors and H. pylori lab tests are recommended for gastrointestinal disorders. Acetaminophen and ibuprofen are recommended for pain. Angiotensin-converting-enzyme inhibitors and dihydropyridine calcium channel blockers are recommended over diuretics since patients are already dehydrated. Metformin is recommended for diabetes. Vitamins and supplements are recommended for malnourished patients. Hemoglobin machine and urine test strips are suggested. This information should help future teams decide what medications and laboratory tests are most beneficial on medical teams in Cambodia

Socio-economic disparity in food consumption among young children in eight South Asian and Southeast Asian countries

BACKGROUND/OBJECTIVES This study examined socio-economic differences in diverse food consumption among children 6–23 months of age in South Asia and Southeast Asian countries. SUBJECTS/METHODS Data from Demographic and Health Surveys in four countries in South Asia (n = 15,749) and four countries in Southeast Asia (n = 10,789) were used. Survey-design adjusted proportions were estimated for the following 10 food items: grains, legumes, dark green leafy vegetables (DGLV), vitamin A-rich fruits, vitamin A-rich vegetables, other fruits and vegetables (OFV), fish, meat, dairy, and eggs. An equity gap was defined as an arithmetic difference in the proportion of each food item consumed in the past 24-hours between the wealthiest and lowest quintiles and between rural and urban areas, denoted by percentage points (pp). RESULTS The consumption of most of the 10 food items was higher in the wealthiest quintiles and urban areas across eight countries. The size of equity gaps was greater in Southeast Asia than in South Asia, particularly for vitamin A-rich fruits (3.3–30.0 pp vs. 0.3–19.6 pp), vitamin A-rich vegetables (12.1–26.7 pp vs. 2.4–5.9 pp), meat (17.7–33.4 pp vs. 3.4–13.4 pp), and dairy (14.7–32.5 pp vs. 3.3–11.4 pp). However, the size of equity gap in egg consumption was greater in Southeast Asia than South Asia (11.2–19.8 pp vs. 11.0–26.7 pp). Relatively narrower gaps were seen in the consumption of grains (0.3–12.9 pp), DGLV (0.6–12.4 pp), and fish (0.1–16.8 pp) across all countries. CONCLUSIONS Equity gaps in food consumption differed by socio-economic status and region. Reducing equity gaps in nutrient-rich foods and utilizing regionally available food resources may increase child dietary quality

Institutional and policy issues in the management of fisheries and coastal resources in Cambodia

Fishery management, Governments, Fishery policies, Resource conservation, Resource management, Cambodia,

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

Youth Paying for Sex: What Are the Associated Factors? Findings from a Cross-Sectional Study in Cambodia

BACKGROUND: At-risk male youth in Cambodia who purchase sex are at greater risk for HIV compared to the general population. Factors associated with paying for sex among youth are poorly studied, both globally and in Cambodia. This study aimed to identify specific factors associated with transactional sex with women among most-at-risk male youth in Cambodia. METHODS: This cross-sectional questionnaire survey was conducted with 405 sexually active male youth aged 16-24 recruited at \u27hotspots\u27 in the capital city of Phnom Penh and seven provinces. We collected data on demographic factors, sexual behaviors, HIV testing and other potential factors. Multivariable logistic regression analysis was used to identify factors associated with transactional sex. RESULTS: In total, this study included 405 male youth with a mean age of 21.3 (SD = 2.2). Of the total respondents, 82.5% (n = 334) have ever paid for sex. After controlling for potential confounding, participants who purchased sex in the last 12 months remained significantly more likely to be older than 18 (AOR = 3.60, 95% CI = 1.26-10.62), reside in an urban area (AOR = 2.29, 95% CI = 1.24-4.20), never have been married (AOR = 9.58, 95% CI = 4.34-21.12), spend less than 2.55 USD per day (AOR = 2.22, 95% CI = 1.12-4.40), and have had more than 4.6 sexual partners in the past year (AOR = 16.73, 95% CI = 4.71-59.36). CONCLUSIONS: This study highlights the high proportion of Cambodian male youth who paid for sex and the potential challenges to addressing this issue. While the majority of HIV prevention interventions surrounding sex work are aimed at female sex workers themselves, targeting the demand side of sex work, particularly the local demand, may be an important next step towards a sustainable HIV prevention

Disability and active life expectancy among older Cambodians

Journal ArticleOlder adults in Cambodia are survivors of harsh living conditions, including poverty and periods of extreme violence. Although these experiences may affect health outcomes, little data has existed to monitor Cambodia's older population. The current paper uses data from the 2004 Study of the Elderly in Cambodia (SEC) and focuses on disability status. The data is the first of its kind for Cambodia*a comprehensive survey employing a representative sample of adults 60 and older living across the country. Disability prevalence by age and sex, Active Life Expectancy (ALE) and common correlates of disability, using Activity of Daily Living (ADL) items, are examined. In addition, disability prevalence rates are compared to those for older adults living in other countries in South-east Asia. The results indicate that older Cambodians are more disabled than their counterparts living elsewhere. Possible reasons include long-term influence of social disruption and poverty. Women live longer than men, but spend a greater proportion of their remaining life in states of disability and severe disability. Correlates of disability show that younger age, being male, having higher income satisfaction, being married and living in urban areas associate with lower probabilities of reporting disability. A contribution of the analysis is the examination of a basic measure of health among a population of which little is known