“What do kids know”: A survey of 420 Grade 5 students in Cambodia on their knowledge of burn prevention and first-aid treatment

INTRODUCTION

Cambodia is a developing country of 13 million people where there are an estimated 20,000 burns and 2000 burn deaths annually. Two thirds of the burns occur to children under the age of 10 years. The purpose of this study was to determine the knowledge of burn prevention and first aid for burns in Grade 5 Cambodian school children, as baseline information to design a burn prevention campaign.

METHODS

A 34-question survey regarding burn prevention and first-aid treatment for burn injuries was developed. Additional questions on TV watching habits were included to determine the feasibility of a targeted TV burn educational campaign. The survey was translated into Khmer language and tested on a trial class for accuracy and ease of administration. After obtaining the school director's permission and children's consent the survey was administered by Canadian medical students helped by trained translators and teachers to Grade 5 students from eight different elementary schools in the Kampot province.

RESULTS

A total of 420 students were surveyed. Average age was 12.5 years (range 9-17 years) and 55% were females. Seventy-four percent routinely cared for other children. Only 52% had TV at home but still 78% managed to watch TV for an average 2h per day. Even though 36% of students indicated they had received information about burn prevention and first aid, only 13% mentioned application of cool water as initial treatment, only 7% knew to roll on the ground if their clothes caught fire, and nearly 50% would pour water on a burning pot of oil. Half of students indicated that they would not believe a TV message promoting application of cold water on acute burns. Top reasons given were parental influence, belief in other treatments, and not trusting TV messages. Interestingly, 62% of these skeptics would change their mind if the TV message was endorsed by an authority figure such as a physician, teacher, parent, or the Ministry of Health. A set of five Public Service Announcements for Cambodian TV were developed and produced based on the results of this survey.

CONCLUSIONS

This survey identified significant inadequacies in Cambodian children's knowledge about burn prevention and first aid and suggested that a televised burn prevention campaign could be an effective method to improve their knowledge, especially if it was endorsed by an authority figure.

Toxicity assessment for the horseshoe crab Carcinoscorpius rotundicauda collected from Cambodia

In this study, we assessed the toxicity of the horseshoe crab Carcinoscorpius rotundicauda collected from Cambodia within two successive months during rainy (April-May) and dry (December-January) seasons, respectively. Toxicity assessments of the collected specimens by standard mouse bioassay showed marked individual variation, and their toxin profiles by liquid chromatography/mass spectrometry (LC/MS) revealed tetrodotoxin (TTX) was the main toxin while no paralytic shellfish toxins (PSTs) were detected. All specimens were toxic and the highest toxicity values were 315, 113, 60, 47, 44 and 38 mouse units (MU)/g in the tissues of hepatic caecum, egg, viscera, muscle, intestine and testis, respectively. Although the current findings showed that the Cambodian C. rotundicauda was a moderately toxic species, they are not suitable for human consumption due to their toxicity. To the best of our knowledge, this is the first scientific study on toxic marine seafood ever investigated in Cambodian territorial waters.

Prevalence of oral Candida species in leprosy patients from Cambodia and Thailand

BACKGROUND

Leprosy is a chronic bacterial infection which may lead to significant orofacial morbidity. However, reports on the oral mycotic flora of leprosy patients are rare. The aim of the current study was to explore the oral yeast carriage in two groups of leprosy patients.

METHODS

40 Cambodian (seven men, 33 women) and 48 Thai (14 men, 34 women) leprosy patients from Leprosy Rehabilitation Centre Khien Kleang, Phnom Penh, Cambodia and McKean Rehabilitation Center, Chiangmai, Thailand were randomly selected and their demographic data and clinical history were recorded. Tongue and palatal swabs of each patient were collected using sterile Fungi-Quick swabs (Hain Diagnostika, Nehren, Germany) and they were cultured aerobically on Sabouraud's dextrose agar and CHROMAgar (CHROMagar, Paris, France). Yeast were identified by germ tube, chlamydospore production, and assimilation tests (API 20C AUX, Bio-Merieux, Marcy l'Etoile, France) and reconfirmed using APILAB Plus system (Bio-Merieux).

RESULTS

Two groups (Cambodian and Thai) had median age of 35 and 64 years. They had been with leprosy for median durations of 17.7 and 38.9 years (P<0.05), respectively. Overall yeast carriage in two cohorts were 80% and 93.75%. Candida albicans had highest carriage rate in either group (65.6%, 44.4%). Candida krusei and C. glabrata existed as second-line colonizers after C. albicans. Candida glabrata carriage was significantly higher in Thai patients (P<0.05). Multispecies carriage was seen in three Cambodian (9.4%) and five Thai (11.5%) patients.

CONCLUSIONS

This study indicates high oral yeast carriage in leprosy patients. Candida albicans remains predominant while C. krusei and C. glabrata are second-line oral colonizers. Co-inhabitation of multiple yeast species is also noted in these patients' oral mycotic flora.

Genetic ancestries in northwest Cambodia

A survey of the genetic ancestry of 125 Cambodian children resident in Siem Reap province was undertaken, based on eight Y-chromosome binary polymorphisms and sequencing of the mtDNA HV1 region. The data indicated a largely East Asian paternal ancestry and a local Southeast Asian maternal ancestry. The presence of Y-chromosomes P* and R1al* was suggestive of a small but significant Indo-European male ancestral component, which probably reflects the history of Indian, and later European, influences on Cambodia.

Influence of the involvement of partners in the mother class with voluntary confidential counselling and testing acceptance for Prevention of Mother to Child Transmission of HIV Programme (PMTCT Programme) in Cambodia

The National Maternal and Child Health Center in Phnom Penh, Cambodia commenced PMTCT services as the first site of the National PMTCT programme of Cambodia in November 2001. However, the acceptance of voluntary confidential counselling and testing (VCCT) in the PMTCT services was not as high as expected. The aim of this study was to evaluate influence of partner participation in the mother class to the PMTCT services. During the first visit to antenatal care, all women were invited to the class, where information on PMTCT was provided. From July 2002, when partner participation started, to May 2005, the acceptance rate to the pre-test counselling of those who attended the class alone was 18.7% (3,234/17,340), while that of the attendees with their partner was 85.1% (2,908/3,417) (p <0.001). All of the couples accepted couple counselling and disclosure of their results to their partners. In conclusion, a strong association was observed between acceptance and partner involvement. However, we should consider also other strategies for future programme improvement.

Developments in immunization planning in Cambodia--rethinking the culture and organization of national program planning

INTRODUCTION

As part of its health system reconstruction following decades of civil war, Cambodia undertook a program of health sector reform in 1996 to expand coverage of essential health services to the population of 14 million, 80% of whom are resident in over 13 000 rural villages. During this reform period, one of the major national health programs, the National Immunization Program (NIP), adapted its planning system to accommodate changes in social and health sector structure.

AIMS

The aims of this article are to review changes made in the approach to national immunization planning and to illustrate how these adaptations can help identify future challenges and opportunities for further improving immunization coverage in Cambodia. Sources of information for the study include immunization plans and data from international and national sources, as well as data from the national health information system. Findings of review: Management and service delivery reforms undertaken by the NIP include (1) strengthening links between immunization, health sector and international health planning; (2) development of immunization program multiyear and financial sustainability plans; (3) strengthening of national program decision making structures and processes; (4) widening of decentralized stakeholder participation in health planning; and (5) implementation of service level micro-planning.

OUTCOMES

These management reforms have been associated with significant improvement in public health program performance and outcomes during this period (2003-2006). There has been an increase in vaccination coverage for children under the age of one year, over a five-year period (increase of 29% for fully immunized child at one year of age), with no significant differences in vaccination rates between urban and rural areas, and a sharp decrease in the incidence of vaccine preventable diseases.

CONCLUSION

The NIP is now well positioned to take on additional challenges in coming years associated with expanding international partnerships, the continued development of civil society, further health system decentralization, and the requirement to further improve coverage in support of global and regional disease elimination goals. However, as costs continue to rise, planners in the future will need to emphasize the economic and public health benefits of immunization programs in order to sustain increasing levels of national and international investment.

The role of fish in food-based strategies to combat vitamin A and mineral deficiencies in developing countries

Fish is important in the diets and livelihoods of many poor people suffering from vitamin and mineral deficiencies. In this article, fish intake in rural Bangladesh and Cambodia and the vitamin A, calcium, iron, and zinc contents and nutrient bioavailability of commonly consumed species are presented. The contribution of these species to nutrient intakes as well as their potential to meet dietary recommendations are presented and discussed. Data from consumption surveys were analyzed to obtain fish intake by species. Commonly consumed species were analyzed for nutrient contents, and studies on nutrient bioavailability were conducted. In poor, rural, Bangladeshi households, mean fish intake was 13-83 g raw, whole fish per person/d. Frequency of intake of small fish was high, and small fish made up 50-80% of all fish eaten during the fish production season in rural Bangladesh and Cambodia. Many small fish are eaten whole and therefore are a rich calcium source; some are also rich in vitamin A, iron, and zinc. Even small production of the vitamin A-rich fish mola in ponds in Bangladesh can meet the annual vitamin A recommendation of 2 million children, and a traditional daily meal with the iron-rich fish trey changwa plieng can meet 45% of the daily median iron requirement of Cambodian women. Fish consumption data on the species level, nutrient analyses, awareness of the nutritional value of fish, as well as promotion of the production and accessibility of nutrient-dense species can lead to the use of fish in food-based strategies to combat nutrient deficiencies in poor people in Asia and Africa.

Arsenic and manganese contamination of drinking water resources in Cambodia: coincidence of risk areas with low relief topography

Arsenic contamination of groundwater has been identified in Cambodia, where some 100,000 family-based wells are used for drinking water needs. We conducted a comprehensive groundwater survey in the Mekong River floodplain, comprising an area of 3700 km(2) (131 samples, 30 parameters). Seasonal fluctuations were also studied. Arsenic ranged from 1 to 1340 microg L(-1) (average 163 microg L(-1)), with 48% exceeding 10 microg L(-1). Elevated manganese levels (57% >0.4 mg L(-1)) are posing an additional health threat to the 1.2 million people living in this area. With 350 people km(-2) potentially exposed to chronic arsenic poisoning, the magnitude is similar to that of Bangladesh (200 km(-2)). Elevated arsenic levels are sharply restricted to the Bassac and Mekong River banks and the alluvium braided by these rivers (Kandal Province). Arsenic in this province averaged 233 microg L(-1) (median 100 microg L(-1)), while concentrations to the west and east of the rivers were <10 microg L(-1). Arsenic release from Holocene sediments between the rivers is most likely caused by reductive dissolution of metal oxides. Regions exhibiting low and elevated arsenic levels are co-incident with the present low relief topography featuring gently increasing elevation to the west and east of a shallow valley-understood as a relict of pre-Holocene topography. The full georeferenced database of groundwater analysis is provided as Supporting Information.

Buddhist nuns on the move: an innovative approach to improving breastfeeding practices in Cambodia

The benefits of initiating breastfeeding in the first hour of life and exclusively breastfeeding thereafter are well documented. However, little is known about how best to promote these practices. In this study, we assess the impact of Buddhist nuns and wat (pagoda) grannies on optimal breastfeeding behaviours in rural Cambodia. We did so by interviewing randomly selected mothers of infants less than 6 months of age. A total of 440 mothers in programme and control communities completed the baseline survey (before programme start-up), and 467 mothers responded 1 year later. Mothers' exposure to breastfeeding promotion activities was high. At follow-up, 76% of mothers in programme communities indicated that nuns had advised them about breastfeeding, 73% received a home visit and 72% reported attending an educational session. At baseline, mothers in programme communities were 11% more likely (RR = 1.11, CI: 0.74-1.68) than mothers in control communities to initiate breastfeeding in the first hour of life. At follow-up, they were 62% more likely (RR = 1.62, CI: 1.30-2.01) to do so. Similarly, at baseline, mothers in programme communities were 54% more likely (RR = 1.54, CI: 1.21-1.96) than mothers in control communities to breastfeed exclusively in the previous 24 h. At follow-up, they were 81% more likely (RR = 1.81, CI: 1.49-2.21) to do so. Programme planners may consider using community-based volunteers as one strategy to improve breastfeeding practices and child survival.

Efficacy of Bacillus thuringiensis israelensis, VectoBac WG and DT, formulations against dengue mosquito vectors in cement potable water jars in Cambodia

This study reports the evaluation of Bacillus thuringiensis israelensis (Bti), a biological larvicide, in cement jars holding river, well and rain water. Two Bti formulations, VectoBac WG and VectoBac DT, were evaluated in a village in Phnom Penh. Thirty-one households with cement jars supporting the colonization of Ae.aegypti immatures were chosen. In each house 3 jars were aligned next to each another and filled with the same type of water. One of the 3 jars was treated with VectoBac WG at 0.4 g per 50 liters, a second jar was treated with VectoBac DT at 1 tablet per 50 liters, and a third jar was an untreated control (UTC). The jars were not covered, kept outdoors and not subjected to water exchange activity. The efficacy of VectoBac to control natural Ae.aegypti infestation was measured by Ae.aegypti pupae surveillance, conducted 3 days per week for 3 months post-treatment (June-September 2004). All pupae were removed, allowed to emerge in the Cambodia National Malaria Center insectarium and the emerged adults were identified and counted. The VectoBac treatments were more effective in river water, followed by well and rain water. The VectoBac treatments significantly reduced the pupae numbers for a minimum of 3 months in the river water and 2.5 months in the well water (p < 0.05). In the rain water, the pupae densities in the VectoBac WG and DT treated jars were not significantly different from the untreated jars, although the treated jars yielded 2.0 to 5.2 fold less pupae, respectively, than in the untreated jars during the 3 months post-treatment. The efficacy of VectoBac WG to control Ae.aegypti was similar to the efficacy of VectoBac DT in the 3 water types (p > 0.05). It was also observed that VectoBac WG and DT were target specific, without any adverse effects on aquatic predatory insects common in well and rain water. VectoBac WG and DT were found to be easy-to-use formulations, with no need to repackage them prior to use in the containers. The amounts of VectoBac WG and DT used were 12.5 fold less by weight than temephos (Abate 1.0% SG).

Assessment of the chemical quality of drinking water in Cambodia

Most water supply programmes in Cambodia have focused on providing access to bacteriologically safe water, an approach which has led to an increasing reliance on ground water, especially in rural areas. However, there have been very few data collected on the chemical quality of the nation's drinking water sources, and few water supply programmes have the capacity to assess chemical quality. The study was designed to address this data gap by conducting a low-cost, rapid assessment of drinking water sources nationwide to determine whether there were any chemicals of concern in Cambodian water supply sources. Results of the assessment confirm that there are several parameters of health and aesthetic concern; dissolved arsenic is the most significant. Elevated arsenic levels (some exceeding 500 microgl(-1)) were detected in aquifers of moderate depth in several highly populated areas, confirming that further investigation of the occurrence of arsenic contamination in Cambodia is warranted. Other chemicals of health concern include nitrate, nitrite, fluoride and manganese. Additionally, many ground water sources are negatively impacted by parameters of aesthetic concern, such as iron, manganese, hardness and total dissolved solids. Elevated levels of these parameters have caused consumers to reject newly installed water supplies, often in favour of surface water sources that are bacteriologically unsafe.

Population structure of wild musk shrews (Suncus murinus) in Asia based on mitochondrial DNA variation, with research in Cambodia and Bhutan

The musk shrew (Suncus murinus) is a small mammalian species belonging to Insectivora. It is widely distributed in Asia. To identify the genetic relationship among wild musk shrew populations and examine its migration route, we investigated the populations of Cambodia and Bhutan by using mitochondrial DNA restriction fragment length polymorphism analysis and compared them with other Asian populations previously described. Four haplotypes were detected in Cambodia and eight in Bhutan. A total of 53 haplotypes were detected in Asia and were classified largely into two groups, the Continental and Island types, based on a minimum spanning network. From the distribution of mtDNA types in wild musk shrews, three major population groups are identified in Asia: South Asia, Southeast Asia, and Malay. It is suggested that the Malay population group was a mix of South and Southeast Asian population groups and that this was a contact area of the two groups. In addition, other contact areas between the South and Southeast Asian groups exist in Myanmar, but unlike the Malay, the Myanmar area was the border of these groups.

Abate distribution and dengue control in rural Cambodia

Sustainable public health and community collaboration and partnerships are essential for the effective elimination of vector breeding sites to prevent dengue fever. A prerequisite is that community members appreciate the importance of the infection, understand its transmission and preventive activities, and are able to translate such knowledge to action. In this paper, we draw on an ethnographic study of two villages in the eastern province of Kampong Cham, using data collected from qualitative research methods and entomological surveys to describe community knowledge of the vector, practices related to the reduction of breeding sources, and the effectiveness of temephos to control larvae. During the study period, temephos (distributed as Abate) was applied in water containers only in the rainy season, although these containers were also positive with larvae in the dry season. Discarded containers, ignored in terms of control activities, had twice the number of larvae as water storage containers. The continued reliance on Abate creates financial and technical problems, while its inappropriate distribution raises the possibility of larvicide resistance. Based on research findings, we argue that control strategies emphasizing the use of Abate should be reconsidered.

Response to highly active antiretroviral therapy among severely immuno-compromised HIV-infected patients in Cambodia

BACKGROUND

HAART efficacy was evaluated in a real-life setting in Phnom Penh (Médecins Sans Frontières programme) among severely immuno-compromised patients.

METHODS

Factors associated with mortality and immune reconstitution were identified using Cox proportional hazards and logistic regression models, respectively.

RESULTS

From July 2001 to April 2005, 1735 patients initiated HAART, with median CD4 cell count of 20 (inter-quartile range, 6-78) cells/microl. Mortality at 2 years increased as the CD4 cell count at HAART initiation decreased, (4.4, 4.5, 7.5 and 24.7% in patients with CD4 cell count > 100, 51-100, 21-50 and < or = 20 cells/microl, respectively; P < 10). Cotrimoxazole and fluconazole prophylaxis were protective against mortality as long as CD4 cell counts remained < or = 200 and < or = 100 cells/microl, respectively. The proportion of patients with successful immune reconstitution (CD4 cell gain > 100 cells/microl at 6 months) was 46.3%; it was lower in patients with previous ART exposure [odds ratio (OR), 0.16; 95% confidence interval (CI), 0.05-0.45] and patients developing a new opportunistic infection/immune reconstitution infection syndromes (OR, 0.71; 95% CI, 0.52-0.98). Similar efficacy was found between the stavudine-lamivudine-nevirapine fixed dose combination and the combination stavudine-lamivudine-efavirenz in terms of mortality and successful immune reconstitution. No surrogate markers for CD4 cell change could be identified among total lymphocyte count, haemoglobin, weight and body mass index.

CONCLUSION

Although CD4 cell count-stratified mortality rates were similar to those observed in industrialized countries for patients with CD4 cell count > 50 cells/microl, patients with CD4 cell count < or = 20 cells/microl posed a real challenge to clinicians. Widespread voluntary HIV testing and counselling should be encouraged to allow HAART initiation before the development of severe immuno-suppression.

Hylomysobia gen. n. (Acari: Myobiidae), a new genus of mites parasitic on gymnures of the genus Hylomys (Eulipotyphla: Erinaceidae)

A new genus of Myobiidae, Hylomysobia gen. n. with two new species, H. mikhailzaitzevi sp. n. (type species) and H. chinensis sp. n., is described from gymnures of the genus Hylomys Müller (Eulipotyphla: Erinaceidae). The two species parasitize Hylomys suillus Müller from Cambodia and Vietnam, and Hylomys sinensis (Trouessart) from China, respectively. These species represent the first records of myobiid mites from species in the family Erinaceidae. The new genus differs from the closely related Eutalpacarus Jameson, 1949 by the following features: in both sexes, coxae I have a triangular process, setae ve are about three times wider than sce and c2, and coxae II bear two pairs of setae; in females, setae sci are lanceolate, setae ag1 and ag3 are absent, and the vulvar lobes are weakly developed; in males, setae e2 are absent, and setae c1, d1, d2 and e1 are situated on the genital shield. The life cycle of Hylomysobia spp. includes egg, larva, protonymph, deutonymph, and adults, male and female. In contrast to the most other myobiid genera possessing the tritonymphal stage, the deutonymphs of Hylomysobia moult directly to adults, and the tritonymphs are absent. Based on the restricted distribution of Hylomysobia species on hosts of this family (only on species of the genus Hylomys) and close morphological similarities to myobiids from Soricidae and Talpidae, it is suggested that the ancestor of this genus secondarily colonized the ancestor of Hylomys from moles or shrews.

Cancer diagnosis and telemedicine: a case study from Cambodia

Cambodia is one of the least developed countries in the world, and presents major challenges to the provision of effective healthcare. Partners Telemedicine, a non-profit organization based in Boston, MA, is leading a pilot project to assess whether accurate diagnosis and treatment can be provided by email to patients in remote locales in the developing world. This project, in rural Cambodia, has had a beneficial impact on the public health of the communities served. There has been a reduced demand for acute care services, with patients seeking treatment earlier and adhering better to their prescribed treatment regimens for chronic diseases, and the project illustrates the potential for simple communications technology to improve care, even to some of the most impoverished communities. However, infrastructure must be improved in Cambodia to enable patients, in particular cancer patients, to receive acute care that can only be provided in distant Phnom Penh.

Current problems in national hospitals of Phnom Penh: finance and health care

The current problems in Cambodia's national hospitals subsist in a geographic imbalance in the location of staff and health facilities, and low staff motivation largely due to inadequate payment. This paper aims to investigate the associations among hospital performance, hospital finances, and other related issues in five national hospitals in Phnom Penh, using annual reports of the five hospitals and annual statistics of the Ministry of Health, from 2000 to 2004. The bed occupancy rates (BOR), average lengths of stay (ALS), hospital mortality rates (HMR), maternal and neonatal mortality rates, numbers of patients, main health problems of inpatients, numbers of health personnel, staff incentives, and annual hospital income were used in this study as indicators of five hospitals in Phnom Penh city. The ALS varied from 3.8 to 9 days. The numbers of health personnel (physician, medical assistant, secondary nurses, primary nurses, secondary midwives, and primary midwives) per 100 beds were from 114 to 282. Supplemental salary per staff also differed greatly among these hospitals; the salaries were the highest at Calmette hospital (US$ 212.8) and the lowest at Preah Kossamak (US$ 12.4). In the five hospitals, the average BOR was 58.8%, and the mean of total annual income was US$ 1,427,852 per year. Although not significant, there was a tendency for higher supplemental salaries to be associated with higher BOR (Spearman rank correlation coefficient 0.70, p = 0.188). This study showed the differences in the hospital indicators among five national hospitals in Phnom Penh city, and the tendency of higher BOR in the hospitals paying higher supplemental salaries to the staff. Higher supplemental salary to the staff seemed to contribute the better hospital performance.

Evaluation of NucliSens EasyQ™ HIV-1 assay for quantification of HIV-1 subtypes prevalent in South-east Asia

BACKGROUND

Monitoring anti-retroviral therapy requires that viral load assays for human immunodeficiency virus type 1 (HIV-1) be applicable to diverse HIV-1 subtypes.

OBJECTIVES

To evaluate NucliSens EasyQ HIV-1 assay for quantitation of common HIV-1 subtypes prevalent in South-east Asia.

STUDY DESIGN

One hundred and nineteen plasma samples collected in Hong Kong and Cambodia were used to compare the performance of NucliSens EasyQ HIV-1 and COBAS Amplicor HIV-1 Monitor version 1.5 assays. Viral RNA extracted from the NucliSens MiniMAG was also used for HIV-1 subtyping.

RESULTS

Performance of NucliSens EasyQ correlated well with COBAS Amplicor (r=0.777, p<0.001) and the small mean difference (0.0462log(10)IU/mL) obtained in the Bland and Altman model indicated good agreement between two assays. The NucliSens EasyQ assay demonstrated a 95% sensitivity at 500IU/mL and 100% specificity. Reproducibility of this assay was within log(10)2-4IU/mL and had a coefficient of variation between 2.3% and 10.4%. Among the 109 specimens included in the analysis, HIV-1 subtyping identified 64 CRF01_AE, 38 subtype B, 3 subtype C, 3 CRF07_BC and 1 subtype G viruses.

CONCLUSIONS

Performance of NucliSens EasyQ was comparable to COBAS Amplicor for HIV-1 viral load monitoring. RNA extracts from NucliSens MiniMAG could be used for HIV-1 viral load monitoring, subtyping and drug resistance mutations detection. Our findings highlight the versatility of both NucliSens EasyQ and COBAS Amplicor in monitoring prevalent subtypes and rare circulating recombinant forms (CRFs) in the South-east Asia region.

Double-blind, placebo-controlled trial comparing effects of supplementation of two micronutrient sprinkles on fatty acid status in Cambodian infants

BACKGROUND

Infants in developing countries require early dietary interventions to prevent nutritional deficiencies, above all protein, energy, iron and zinc. To what extent these interventions may affect the fatty acid (FA) status is still unknown.

OBJECTIVES

To examine and compare the effects of 2 micronutrient "sprinkles" supplementations (iron 12.5 mg + folic acid 150 microg, iron/folate and iron 12.5 mg + folic acid 150 microg + zinc 5 mg + vitamins A, C and D3, mineral/micronutrient [MMN]) versus placebo on the FA status of Cambodian infants.

METHODS

A total of 204 infants age 6 mo and living in Kompong Chhnang Province, Cambodia, were randomly assigned to receive daily supplementation of MMN (n = 68) and iron/folate (n = 68) or placebo (n = 68) for a 12-mo period in powder form as sprinkles. At the end of the intervention period, FAs in the range of 16 to 24 C were determined in blood drops absorbed on a strip collected from 182 subjects, and values among the 3 intervention subgroups and those of 21 Italian 18-mo-old, normal-growing infants as the reference group were compared.

RESULTS

At the end of the supplementation trial, higher levels of the 2 essential FAs (EFAs) (linoleic acid, 18:2n-6, and alpha-linolenic acid, 18:3n-3) were found in the MMN group. No differences occurred for the major longer chain derivatives of both EFAs arachidonic acid (20:4n-6) and docosahexaenoic acid (22:6n-3). In MMN supplemented Cambodians, blood levels of linoleic acid approached those of Italian infants, and in addition their alpha-linolenic acid levels were improved. Cambodian infants, mostly still breast-fed through the second year of life, showed significantly higher levels of long-chain derivatives of both the n-6 and the n-3 series compared with Italians.

CONCLUSIONS

Supplementation with iron, folic acid, zinc and vitamins was associated with an increase of linoleic acid and alpha-linolenic acid levels in Cambodian infants versus placebo, without significant changes in the concentrations of their longer chain derivatives, resulting in a FA status closer to Italian counterparts for the essential polyunsaturated FA levels. The iron/folate-treated infants showed no differences compared with the other 2 groups. Studies are needed to differentiate the potential effects of the supplemented micronutrients on the FA status.

[Action of Pharmaciens Sans Frontieres International Committee: an example from Cambodia]

Pharmaciens Sans Frontières Comité International (PSFCI) has been active in Cambodia since 1990. Cambodia is one of the poorest countries in the world and has the highest rate of HIV infection in Asia. Early on the PSFCI was faced with problems related to sexually transmitted diseases (STD) and AIDS. Based on this field experience PSFCI has been able to better understand the pandemic and to define control strategies. Since 1996 PSFCI has been contributing to the implementation and development of multi-component strategy against AIDS and other STD. One component of this strategy involves upstream intervention with prevention and awareness campaigns and deployment of methods best suited to the cultural and socio-economic environment of vulnerable populations. Another component consists in implementation of a screening and treatment network of competent healthcare professionals able of providing patients not only personalized confidential care but also the psychological support necessary to ensure long-term compliance with treatment. The last component involves training of healthcare personnel and social workers so that these programs can be extended throughout the country.