Cambodia 2011

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By integrating education and clinical care in a new national policy on the control of diarrhea and pneumonia, PATH and the Government of Cambodia are placing a broad spectrum of tools in the hands of health workers, volunteers, and families to make a major impact. (All photos: PATH/Heng Chivoan)

In partnership with the Government of Cambodia, PATH launched a pilot project to overcome diarrheal disease and pneumonia—the two leading causes of child illness and death among Cambodia’s children.Villagers near Daun Tom village search for small fish, crabs, and prawns in a rice field’s pond. During the wet season in Cambodia, pre-dug ponds are good sources of seafood but potential hazards for gastrointestinal health. Environmental factors are some of the most important elements to address in overcoming diarrheal disease among rural communities.After attending a mother’s class on diarrhea and pneumonia conducted by her village health volunteer, Sunsreay Mom immediately came to the health center to seek treatment for her six-month-old daughter. During her baby’s clinic visit, Mom learned about at-home care, prevention, and the immunizations her daughter Limsoklang will receive. Combining clinical care with education, the Taing Kok Health Center is ensuring a bigger impact through improved access to and awareness of proven, affordable, and simple interventions.Taing Kok Health Center is one of six participating in PATH’s pilot project to curb diarrhea and pneumonia among children in Baray-Santuk Operational Health District, Kampong Thom Province.Nurse Oun Samspong shows a mother how to mix oral rehydration solution (ORS) and demonstrates the simple steps to rehydrate her baby at home in order to keep a common case of diarrhea from turning severe or even life-threatening.Feeding ORS to a little one sip by sip is the best way to ensure rehydration during a diarrheal episode. Cambodia is expanding the use of low-osmolarity ORS, recommended by the WHO, an improved formulation that enhances re-hydration.
A newborn immunization visit presents a prime opportunity for education on preventing and treating diarrhea and pneumonia in the home to curb infections before they become severe. These grandparents proudly cradle infants born just that day, and nurse Samspong gives them a head start at keeping them healthy.A new national policy recently equipped health workers with comprehensive insight and simple yet powerful tools for treating diarrhea and pneumonia. These tools include low-osmolarity ORS and zinc for diarrhea, a course of antibiotics for pneumonia, and education on how good nutrition, sanitation, and proper home care can prevent severe illness.The new policy also empowers village health volunteers (VHVs) to distribute ORS and zinc. Each quarter, VHVs receive training at the nearest health center from staff trained by the provincial health department. In our pilot areas, two quarterly meetings were dedicated to training VHVs to treat diarrhea using ORS and zinc, and to recognize signs of pneumonia using detailed training manuals and teaching guides written in Khmer.At monthly “mothers’ classes,” VHVs pass down their knowledge to build awareness among mothers in their villages. The groups discuss diarrhea and pneumonia, including when and how mothers can treat children at home and when to visit the VHGs for zinc and ORS when their child has diarrhea. Here, a VHV presents warning signs and contributing factors to pneumonia and diarrhea infections among children, such as unsanitary environments around the household.The new national policy puts ORS and zinc in the hands of VHVs, a revolutionary development that is greatly improving access and availability in rural areas. In most countries, zinc is regulated as a drug that can only be distributed by licensed pharmacists, doctors, and nurses. However, thanks to Cambodia’s  innovative and empowering approach, mothers can rely on their community’s health volunteers—as well as local clinics– to access zinc and ORS.In Daun Tom village, cows walk through roads defecating where they stand, and chickens roam in and out of families’ homes, releasing their dung in yards where children play.
Many children in the villages of Cambodia do not wear shoes, exposing them to bacteria and viruses that may make them very sick.Heavy, seasonal rains are common in Cambodia and often flood villages, compounding difficulties in accessing health centers in rural areas and increasing environmental risks posed by unsafe water.But with new strategies aimed at empowering community volunteers and educating families, policymakers in Cambodia are looking toward a bright future in which diarrhea and pneumonia no longer threaten young lives but instead are manageable inconveniences.To learn more about Cambodia’s integrated approach to diarrhea and pneumonia and for much more information about the burden of diarrheal disease and the promise of simple, yet proven strategies, visit www.defeatDD.org.