Cambodia - WHO eyes new TB test regime for Kingdom

A quicker diagnosis and a shorter and cheaper course of treatment for multidrug-resistant TB patients in Cambodia could soon be on the horizon.

The World Health Organization recommends countries with high incidences of TB, including Cambodia, begin implementing the new treatment regimen based on studies in 10 countries.

“Cambodia, as a WHO member state, is of course expected to take note of this recommendation and adapt it, according to its local epidemical context,” said Ernesto Jaramillo, a TB expert with the WHO.

Health officials in Cambodia will develop a plan to implement the new regimen by late 2017 or early 2018, said Dr Mao Tan Eang, director of the National Centre for Tuberculosis and Leprosy Control.

The new treatment, which costs less than $1,000 per patient, could be completed in nine to 12 months, compared to the current period of 18 to 24 months, said Tan Eang. Officials would phase out the existing regimen.

“We hope to be more efficient and cost-effective,” he said.

Although TB is a leading cause of death in Cambodia, a 2015 Yale Global Heath Review study found that multi-drug resistant TB hasn’t been a significant problem, but rates are rising.

In 2015, 70 multidrug-resistant TB cases were identified in the Kingdom, and officials expect to identify 145 this year, Tan Eang said. It’s too early to estimate funding levels needed, he said.

US Embassy spokesman Courtney Woods said that once the WHO releases the guidelines in June, USAID will discuss with the national centre how it can “support the roll-out of the new recommendations at the country level”.

Yesenia Amaro

phnompenhpost

Cambodia - Doctor slams WHO for causing virus panic

“The WHO in Cambodia should be closed” is the emphatic sign-off to a lengthy and vivid analysis by Kantha Bopha Children’s Hospitals of the recent “mystery disease” scare.

While the World Health Organization and Ministry of Health have declared that a series of recent child deaths are linked to EV-71, causing severe hand, foot and mouth disease, Kantha Bopha founder Dr Beat Richner has slammed the conclusion as a “catastrophic declaration”.

Richner said 72 cases of the unexplained illness have appeared in his hospitals, and of those, 68 have died.

The WHO yesterday said the totals from the Ministry of Health stood at 61 cases and 56 deaths, including one new death over the weekend that fit the case definition of severe HFMD.

The “case definition” is the critical impasse between the MoH and WHO, and Kantha Bopha, which treat 85 per cent of all Cambodian children.

Kantha Bopha’s “case definition” is encephalitis and complete lung destruction leading to a rapid death.

Not one of these cases showed lesions associated with HFMD, Richner’s statement says.

However, WHO communications officer Sonny Inbaraj Krishnan told the Post yesterday that of the cases recorded by the UN agency and the MoH, rashes and blisters were present.

“Sometimes, with EV-71, either blister or rash appears and it could be one or the other,” he said. “The case definition [for WHO and MoH] is that the child has fever with neurological systems such as vomiting and prolonged stretches of sleepiness or convulsions and respiratory symptoms such as difficulty breathing.”

This conclusion is wrong and is still confusing the media and public, Richner rebuts in his statement.

The question that has still not been answered, Richner said, is “what is destroying the lungs in these 72 cases of encephalitis in the last 6 hours of their life, all treated in private clinics?”

Richner believes that the administration of incorrect drugs to these 72 children could be a factor in the astonishing destruction of the lungs present in the cases that have been recorded by his hospitals.

The most “catastrophic” press release by the MoH and WHO, according to the Swiss doctor, was the most recent, in which the joint investigation conclusion is that a mix of pathogens and a root affliction with EV-71 has been aggravated and worsened by the use of steroids.

The Post previously reported Richner decrying WHO’s criticism of the use of steroids as “absolute nonsense”.

The doctor emphasised that all patients arriving with the unknown illness at Kantha Bopha hospitals showed signs of encephalitis, which requires steroids to stem fatal swelling of the brain.

A high number of platelets during the final moments before death could be a sign that underlying tuberculosis is complicating treatment, Richner said in the statement.

Kantha Bopha Children’s Hospitals operate in parallel to the public health system in Cambodia and provide outpatient and emergency care free of charge at their five hospitals in Phnom Penh and Siem Reap.

However, a bitter relationship between Kantha Bopha and the WHO appears to be complicating investigations into and solutions to the child deaths.

MoH Secretary of State Heng Tay Kry said only the minister or WHO could respond about Richner’s allegations.

Minister Mam Bunheng, Communicable Disease Control Department director Sok Touch and his deputy, Ly Sovann, could not be contacted yesterday.

WHO country representative Pieter Van Maaren, told the Post he considered Richner’s statement “irrelevant”.

“We don’t communicate with Kantha Bopha through the media,” Van Maaren said. “And we don’t give comment [on press releases]. The Ministry of Health and WHO joint press releases state what is our position [on the child deaths]."

Bridget Di Certo

With assistance from Chhay Channyda

http://www.phnompenhpost.com/

Cambodia - Hospital hygiene highlighted

Officials from the World Health Organization and the Cambodian Ministry of Health will meet today to set a date for a national hand-washing day to raise awareness of proper hand hygiene and curb infections resulting from hospital visits.

These complications – known as healthcare-associated infections, or HCAIs – are “deemed the most frequent adverse event threatening patients’ safety worldwide” and are three times more prevalent in developing countries such as Cambodia than in the United States and Europe, the authors of a study published in the medical journal The Lancet last year say.

“Healthcare workers play a big role in HCAIs,” Dr Chea Nora, a WHO technical officer for infection prevention and control, said. “By just making them comply with good hand-hygiene practice, the chance of HCAIs is decreased.”

Ministry of Health deputy director of the Department of Hospital Services Dr Sok Srun agrees, saying the ministry has a “strategic plan” in place to address the problem, but has yet to form a ground-level “operational plan”.

“We propose new activities for healthcare-associated infections, but we cannot implement them properly,” he said. “If we have no operational plan, we can’t get funding from the government.”

One of the main hurdles to formulating such a plan, Sok Srun said, was a lack of statistical analysis.

At the moment, the ministry is looking to NGOs to provide skilled researchers to conduct a one- or two-year study of healthcare-associated infections in Cambodia.

“We need epidemiologists,” Sok Srun said. “We need more technical data.”

Some of the issues contributing to HCAIs, such as insufficient supplies of alcohol-based hand sanitiser in some hospitals, could be attributed directly to the lack of an operational plan, Sok Srun said, but others were purely behavioural.

The WHO has a rolling training program in place to teach hospital staff proper hygiene techniques, but the human element continues to confound.

Officials are still trying to figure out which methods, if any, will change healthcare workers’ habits.

“For example, if they had their own small supply of alcohol hand gel, would they use it more often?” Chea Nora said. “Putting all these elements together is a challenge, but should be achievable with a step-wise approach.”

Stuart White

The Phnom Penh Post