National Polytechnic Institute of Cambodia

Piperaquine (PPQ) is widely used in combination with dihydroartemisinin as a first-line treatment against malaria. Multiple genetic drivers of PPQ resistance have been reported, including mutations in the Plasmodium falciparum chloroquine resistance transporter ( pfcrt ) and increased copies of plasmepsin II/III ( pm2/3 ). We generated a cross between a Cambodia-derived multidrug-resistant KEL1/PLA1 lineage isolate (KH004) and a drug-susceptible Malawian parasite (Mal31). Mal31 harbors a wild-type (3D7-like) pfcrt allele and a single copy of pm2/3 , while KH004 has a chloroquine-resistant (Dd2-like) pfcrt allele with an additional G367C substitution and multiple copies of pm2/3 . We recovered 104 unique recombinant parasites and examined a targeted set of progeny representing all possible combinations of variants at pfcrt and pm2/3 . We performed a detailed analysis of competitive fitness and a range of PPQ susceptibility phenotypes with these progenies, including PPQ survival assay, area under the dose response curve, and a limited point IC 50 . We find that inheritance of the KH004 pfcrt allele is required for reduced PPQ sensitivity, whereas copy number variation in pm2/3 further decreases susceptibility but does not confer resistance in the absence of additional mutations in pfcrt . A deep investigation of genotype-phenotype relationships demonstrates that progeny clones from experimental crosses can be used to understand the relative contributions of pfcrt , pm2/3 , and parasite genetic background to a range of PPQ-related traits. Additionally, we find that the resistance phenotype associated with parasites inheriting the G367C substitution in pfcrt is consistent with previously validated PPQ resistance mutations in this transporter. IMPORTANCE Resistance to piperaquine, used in combination with dihydroartemisinin, has emerged in Cambodia and threatens to spread to other malaria-endemic regions. Understanding the causal mutations of drug resistance and their impact on parasite fitness is critical for surveillance and intervention and can also reveal new avenues to limiting the evolution and spread of drug resistance. An experimental genetic cross is a powerful tool for pinpointing the genetic determinants of key drug resistance and fitness phenotypes and has the distinct advantage of quantifying the effects of naturally evolved genetic variation. Our study was strengthened since the full range of copies of KH004 pm2/3 was inherited among the progeny clones, allowing us to directly test the role of the pm2/3 copy number on resistance-related phenotypes in the context of a unique pfcrt allele. Our multigene model suggests an important role for both loci in the evolution of this multidrug-resistant parasite lineage.

Objectives Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022–June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated N. gonorrhoeae AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia. Methods Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire. Results From 437 male patients, 306 had positive N. gonorrhoeae cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR N. gonorrhoeae. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment. Conclusions A high prevalence of ceftriaxone-resistant, MDR and XDR N. gonorrhoeae in several cities of Cambodia were found during 2022–23 in WHO EGASP. This necessitates expanded N. gonorrhoeae AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.

Background The use of chemical pesticides without proper health literacy (HL) and necessary pesticide protection behaviors (PPB) can result in adverse effects on human health. Methods This study aimed to determine whether there was a correlation between HL and PPB among farmers in Nakhon Ratchasima Province using a random sample of 464 farmers. The structured interviews consisted of three parts: 1. General information, 2. Health literacy (including knowledge, understanding, and other subaspects); and 3. Protective behaviors against chemical exposure. Each part of the questionnaire had a reliability index of 0.60 or greater. The reliability of the second and third parts of the questionnaire was as follows: subsections of part 2 had a Kuder-Richardson (KR-20) coefficient of 0.79 and a Cronbach's alpha (α) coefficient of 0.85–0.86, while part 3 had an α of 0.88. The risk of chemical exposure was assessed using a Cholinesterase Reactive Paper test administered via a fingerprick blood test. The data were analyzed using Spearman correlation and binary logistic regression. The study was reviewed by the Human Research Ethics Committee with the following approval dates: August 9, 2021 and August 9, 2022. Results Most participants had moderate overall HL (48.8%) or PPB (44.6%). There was a statistically significant positive correlation between HL and PPB (rs(478) = 0.70, p < .005). Logistic regression analysis demonstrated that HL was significantly positively associated with PPB (p < .001, OR = 6.57, 95% CI 3.95, 10.94) and was associated with blood cholinesterase levels. Conclusion These findings highlight the need for increased health literacy among farmers in Thailand to ensure correct protection against chemical exposure and reduce the adverse effects of pesticide exposure on human health.

Background The use of chemical pesticides without proper health literacy (HL) and necessary pesticide protective behaviors (PPB) can result in adverse effects on human health. Methods This study aims to determine if there is a correlation between HL and PPB among farmers in the Nakhon Ratchasima province, using a random sample of 464 farmers. Structured interviews consisted of three parts: 1. General information, 2. Health literacy (including knowledge, understanding, and other sub-aspects), and 3. Protective behaviors against chemical exposure. Each part of the questionnaire had a reliability index of 0.60 or higher. The reliability of the 2nd and 3rd parts of the questionnaire were as follows: sub-sections of part 2 had a Kuder-Richardson (KR-20) coefficient of 0.79 and Cronbach's alpha (α) coefficient of 0.85–0.86, while part 3 had an α of 0.88. Risk of chemical exposure was assessed using a Cholinesterase Reactive Paper test administered by a finger-prick blood test. Data was analyzed using the Spearman correlation and binary logistic regression. The study was reviewed by the Human Research Ethics Committee with the approval date: August 9, 2021 and expiry date: August 9, 2022. Results Most participants had moderate levels of overall HL (48.8%) and PPB (44.6%). There was a statistically significant positive correlation between HL and PPB (rs(478) = 0.70, p < .005). Logistic regression analysis demonstrated that HL had a statistically significant positive association with PPB (p < .001, OR = 6.57, 95% CI 3.95, 10.94) and was associated with blood cholinesterase levels. Conclusion These findings highlight the need for increased health literacy among farmers in Thailand to ensure correct protective behaviors against chemical exposure and reduce the adverse effects of pesticide exposure on human health.

Overweight and obesity are associated with increased chronic disease and death rates globally. In Cambodia, the prevalence of overweight and obesity among women is high and increasing. This study aimed to determine the prevalence and factors associated with overweight and obesity among women of reproductive age (WRA) in Cambodia. We analyzed data from the 2021–22 Cambodia Demographic and Health Survey (CDHS). Data analysis was restricted to non-pregnant women, resulting in an analytic sample of 9,417 WRA. Multiple logistic regressions were performed using STATA V17 to examine factors associated with overweight and obesity. The prevalence of overweight and obesity among WRA was 22.56% and 5.61%, respectively. Factors independently associated with increased odds of overweight and obesity included women aged 20–29 years [AOR = 1.85; 95% CI: 1.22–2.80], 30–39 years [AOR = 3.34; 95% CI: 2.21–5.04], and 40–49 years [AOR = 5.57; 95% CI: 3.76–8.25], women from rich wealth quintile [AOR = 1.44; 95% C: 1.19–1.73], having three children or more [AOR = 1.40; 95% CI: 1.00–1.95], ever drink alcohol [AOR = 1.24; 95% CI: 1.04–1.47], and current drink alcohol [AOR = 1.2; 95% CI: 1.01–1.45]. Women completed at least secondary education were less likely being overweight and obese [AOR = 0.73; 95% CI: 0.58–0.91]. Overweight and obesity remains highly prevalent among WRA in Cambodia. Therefore, there is an urgent need to take interventions that target women from higher socio-demographic status to reduce the risk of life-threatening caused by being overweight and obese through raising awareness of important changing lifestyles.

This paper presents a stability analysis based on the Zero Moment Point (ZMP) concept during the reconfiguration of a Cable-Driven Parallel Robot (CDPR) using three mobile bases. Each mobile base can be driven forward and backward, and it has a crane that can be moved up and down, to which a cable connected to the end effector is attached. The ZMP should stay within the designated support boundaries to prevent the robot from tumbling. Therefore, the next positions of the cable exit point are changed by applying two reconfiguration schemes to the robot: (I) changing the mobile base position and (II) altering the crane length. Kinetostatic models of both reconfiguration schemes are formulated such that the wrench matrix is expressed to compute the cable tensions. A fifth-degree polynomial test trajectory is defined to be followed by the end-effector. When executing a prescribed trajectory, the sequence of the mobile base position and the crane length are optimized by continuously considering the robot stability based on ZMP. Without reconfiguration, the mobile cranes cannot handle high cable tensions without tipping over. By performing two reconfiguration schemes, the whole system can be constantly maintained in equilibrium, and the robot’s workspace can be enlarged; therefore, the tipping over can eventually be avoided. An experimental setup is built to demonstrate and validate the mathematical models of both reconfiguration scenarios.

Background Collecting data on antimicrobial resistance (AMR) is an essential approach for defining the scope of the AMR problem, developing evidence-based interventions and detecting new and emerging resistances. Our study aimed to identify key factors influencing the implementation of a laboratory-based AMR surveillance system in Cambodia. This will add additional insights to the development of a sustainable and effective national AMR surveillance system in Cambodia and other low- and middle-income countries. Methods Key informants with a role in governing or contributing data to the laboratory-based surveillance system were interviewed. Emerging themes were identified using the framework analysis method. Laboratories contributing to the AMR surveillance system were assessed on their capacity to conduct quality testing and report data. The laboratory assessment tool (LAT), developed by the World Health Organisation (WHO), was adapted for assessment of a diagnostic microbiology laboratory covering quality management, financial and human resources, data management, microbiology testing performance and surveillance capacity. Results Key informants identified inadequate access to laboratory supplies, an unsustainable financing system, limited capacity to collect representative data and a weak workforce to be the main barriers to implementing an effective surveillance system. Consistent engagement between microbiology staff and clinicians were reported to be a key factor in generating more representative data for the surveillance system. The laboratory assessments identified issues with quality assurance and data analysis which may reduce the quality of data being sent to the surveillance system and limit the facility-level utilisation of aggregated data. A weak surveillance network and poor guidance for outbreak response were also identified, which can reduce the laboratories’ opportunities in detecting critical or emerging resistance occurring in the community or outside of the hospital’s geographical coverage. Conclusion This study identified two primary concerns: ensuring a sustainable and quality functioning of microbiology services at public healthcare facilities and overcoming sampling bias at sentinel sites. These issues hinder Cambodia’s national AMR surveillance system from generating reliable evidence to incorporate into public health measures or clinical interventions. These findings suggest that more investments need to be made into microbiology diagnostics and to reform current surveillance strategies for enhanced sampling of AMR cases at hospitals.

The earthquake on Friday, February 25, 2022, centered 18 km northeast of Simpang Empat city with a magnitude of 5.2 M, occurred at 08.35 WIT. After 4 minutes, there was a larger aftershock with a magnitude of 6.2 M. The earthquake that hit Nagari Malampah, Pasaman District and Nagari Kajai, Pasaman Barat District, which caused a number of people to die and minor, moderate to severe damage to people’s houses. Based on the large number of houses damaged, it is necessary to assess the vulnerability of buildings in Nagari Kajai. The vulnerability assessment was obtained from the results of building evaluations where the results of building vulnerability were in the moderate vulnerability category 47 houses and 53 houses with high vulnerability. Most of the vulnerability occurred due to community buildings that were not built according to building standards therefore it was necessary to educate the public on how to repair houses that meet house standards. This paper provides one solution to the community whose houses were damaged through community service activities which the Team carried out with training activities for retrofitting community houses that were moderately or lightly damaged and provided examples. Retrofitting houses is highly expected by the community.

The reduction of deaths from malaria in sub-Saharan Africa (SSA) is stalling, whereas many countries in Southeast Asia are approaching malaria elimination. We reviewed the role of community health worker (CHW) programmes in malaria control and elimination between regions, with a more detailed description of the programmes in Tanzania and Cambodia. Compared with Tanzania, Cambodia has a much more developed CHW network, which has been pivotal in the near elimination of malaria. In Tanzania, the malaria burden has remained similar over the last decade and treatment continues to rely on healthcare facilities, which provide more limited access to early diagnosis and treatment. Overall, the proportion of malaria cases treated by CHWs is substantially lower in SSA than in Southeast Asia. Even though networks of CHWs are resource intensive and malaria epidemiology differs substantially between countries, there is a strong case for expanding CHW networks in rural SSA to improve early access to effective malaria treatment and reduce the malaria burden.

Background Existing research on health equity falls short of identifying a comprehensive set of indicators for measurement across health systems. Health systems in the ASEAN region, in particular, lack a standardised framework to assess health equity. This paper proposes a comprehensive framework to measure health equity in the ASEAN region and highlights current gaps in data availability according to its indicator components. Methods A comprehensive literature review was undertaken to map out a core set of indicators to evaluate health equity at the health system level. Secondary data collection was subsequently conducted to assess current data availability for ASEAN states in key global health databases, national health accounts, and policy documents. Results A robust framework to measure health equity was developed comprising 195 indicators across Health System Inputs and Processes, Outputs, Outcomes, and Contextual Factors. Total indicator data availability equated to 72.9% (1423/1950). Across the ASEAN region, the Inputs and Processes sub-component of Health Financing had complete data availability for all indicators (160/160, 100%), while Access to Essential Medicine had the least data available (6/30, 20%). Under Outputs and Outcomes, Coverage of Selected Interventions (161/270, 59.63%) and Population Health (350/350, 100%) respectively had the most data available, while other indicator sub-components had little to none (≤ 38%). 72.145% (384/530) of data is available for all Contextual Factors. Out of the 10 ASEAN countries, the Philippines had the highest data availability overall at 77.44% (151/195), while Brunei Darussalam and Vietnam had the lowest data availability at 67.18% (131/195). Conclusions The data availability gaps highlighted in this study underscore the need for a standardised framework to guide data collection and benchmarking of health equity in ASEAN. There is a need to prioritise regular data collection for overlooked indicator areas and in countries with low levels of data availability. The application of this indicator framework and resulting data availability analysis could be conducted beyond ASEAN to enable cross-regional benchmarking of health equity.

Objectives Association of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO for health system transformation towards better care for chronic conditions including diabetes. We conducted an umbrella review of systematic reviews on diabetes care components effectively implemented in the ASEAN health systems and map those effective care components into the ICCC framework. Design An umbrella review of systematic reviews and/or meta-analyses following JBI (Joanna Briggs Institute) guidelines. Data sources Health System Evidence, Health Evidence, PubMed and Ovid MEDLINE. Eligibility criteria We included systematic reviews and/or meta-analyses which focused on management of type 2 diabetes, reported improvements in measured outcomes and had at least one ASEAN member state in the study setting. Data extraction and synthesis Two reviewers independently extracted the data and mapped the included studies into the ICCC framework. A narrative synthesis method was used to summarise the findings. The included studies were assessed for methodological quality based on the JBI critical appraisal checklist for systematic reviews and research syntheses. Results 479 records were found of which 36 studies were included for the analysis. A multidisciplinary healthcare team including pharmacists and nurses has been reported to effectively support patients in self-management of their conditions. This can be supported by effective use of digital health interventions. Community health workers either peers or lay people with necessary software (knowledge and skills) and hardware (medical equipment and supplies) can provide complementary care to that of the healthcare staff. Conclusion To meet challenges of the increased burden of chronic conditions including diabetes, health policy-makers in the ASEAN member states can consider a paradigm shift in human resources for health towards the multidisciplinary, inclusive, collaborative and complementary team.

Background: Early access to correct diagnosis and appropriate treatment is essential for malaria elimination, and in Cambodia this relies on village malaria workers (VMWs). Decreasing malaria transmission leave VMWs with diminished roles. Activities related to the control of other health conditions could keep these community health workers relevant. Methods: During 2022, 120 VMWs attended training at local health centres on four health education packages: 1. hygiene and sanitation; 2. disease surveillance; 3. management of mild illness; 4. vaccination and antenatal care. All training and evaluation sessions were documented through meeting minutes, and 19 focus group discussions (FGDs) were conducted among VMWs and health centre personnel. Audio-records of FGDs were transcribed and translated in English and underwent thematic analysis. Results: VMWs reported strong interest in the training and welcomed the expansion of their roles thus assuring their continued relevance. VMWs prioritized disease surveillance and management of mild illness among the available training packages because these topics were seen as most relevant. While training was considered comprehensible and important, the low literacy among VMWs was an impediment suggesting training materials need to be delivered visually. Since VMWs have limited resources, incentives could ensure that VMWs are motivated to undertake additional roles and responsibilities. Conclusions: The transformation of VMWs into community health workers with roles beyond malaria is a promising approach for sustaining health care provision in remote areas. Training needs to consider the low scientific literacy, time constraints and limited resources of VMWs.