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Observations on the Disease Burden in Cambodia: The Top Three Non-Communicable Diseases (NCDs) at the Sihanouk Hospital Centre of HOPE (SHCH)

Author(s): K. Lim*1, A. Finckh2, D. Liu3, C. Haener4
Affiliation(s): 1Medical Department, Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia, 2Rheumatology, University Hospitals of Geneva, Switzerland, 3Hospital Director, 4Surgical Department, Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
Keywords: Burden disease, non communicable disease, Cambodia
Background:

The Cambodian civil war of 1975-1979 affected all aspects of society. The purpose of the Khmer Rouge movement was to reorganize Cambodia into a rural agrarian society based entirely on subsistence farming. With a lack of physicians and institutions in which to train them, over the next 15 years Cambodia struggled to rebuild its public health infrastructure. Efforts to combat the HIV epidemic brought prevalence down from 4% in 1997 to 0.9% in 2005. It seems that NCDs are increasing due to the fast growth in economic development. The prevalence of diabetes in Cambodia is surprisingly high with total of 255,000 (2% of total population), according to WHO and World Diabetes Foundation information made public locally in November 2007. To date, there has been no systematic analysis of available data of NCDs in Cambodia.

Summary/Objectives:

The purpose of this cohort is to identify the proportion of NCDs at the SHCH, a charity NGO hospital in Phnom Penh, Cambodia. From January 2000 until December 2007, a retrospective cohort of 32,082 patients (excluding TB and HIV) were seen and treated at SHCH. During their visits the patients received full physical examinations and complete diagnostic workups, including personal histories.

Results:

Demographics of the patients: mean age 45 (15-70), women 61% (19,663). The top ten NCDs were as follows: 20% (6325) with hypertension, almost 18% (5723) with diabetes without complication and another 5% with peripheral neuropathy; 5% (1663) with cardiovascular diseases, including rheumatic heart diseases; 3.5% with toxic goiter, 3.5% with any arrhythmia, 3.5% with ischemic heart disease; around 3% with dyspepsia; 2% with chronic renal failure from any time of diseases; and 2% with asthmas/COPD. Additionally data report on the advance state of Rheumatology related less then 1% (total of 240).

Lessons learned:

There is a high proportion of NCDs due to the accumulation of patients as we are the only adult hospital in–country offering care free of charge. Further studies nationwide should be conducted to show prevalence of these diseases. Additionally the health system should increase its efforts to provide services for chronic disease at facility level and put more emphasis on primary healthcare in the community. As a training institution, we have and need to incorporate teaching in assessment and treatment of NCDs. On the national level efforts need to be made to develop training curriculum in medical school and training institutions with a focus not only on communicable diseases but also on NCDs.

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