CURRENT SITUATION IN CONTROL STRATEGIES & HEALTH SYSTEMS IN ASIA - CAMBODIA by PRAK PISETH RAINGSEY, MD, DND, MPH Director Preventive Medicine Department MINISTRY OF HEALTH

1. CURRENT SITUATION IN CONTROL
STRATEGIES & HEALTH SYSTEMS IN
ASIA- CAMBODIA
1st Pan-Asian on Haemoglobinopathies
Bangkok, 8-10 February 2012
Royal Orchid Sheraton Hotel & Towers
PRAK PISETH RAINGSEY
MD, DND, MPH
Director
Preventive Medicine Department
i di i
MINISTRY OF HEALTH

2. DEMOGRAPHIC
-Area 181,040 sq. km
-Population 13,395,682
-Ethnic groups: Khmer 90%
h
Vietnam 5%
Chinese 1%
Ethnic 2.8%
Eth i 2 8%
Other 1.2%
-Annual Birth Rate 1.54%
-Capita G
C GDP USD 783 (2010)
S 83
-Total National Budget on
Health $106.49Million
$106 49Million
-RGC spends 6% of GDP on
health (2009)
( )

3. HEALTH SYSTEM
Public sector -3 level of care
 National Hospital 8
 Referral Hospital 79
 Health Center 984 and Health Post 111
Private sector
 H Hospital/ Polyclinic/Cabinet 3 755
it l/ P l li i /C bi t 3,755
 No Health insurance from the government
 NCDs and other public health problem were the 3rd
p p
priority of Health strategic plan
 NCDs policy and strategy focused only on CVDs,
Cancer, diabetes and NCDs risk factors ( PA, diet,
Tobacco and alcohol)
T b d l h l)
 No special policy on Hb disorders / but only policy for
Safe Blood Transfusion

4. PREVALENCE RATE OF
HEMOGLOBINOPATIES SURVEY
 Anemia is a chronic problem in Cambodia, 60% of
children are anemic with Hb < 105 g/L and 40%
related to iron deficiency.
 Retrospective study used to gather all information
on hemoglobinopathy among children under aged
of 19 years.
 Nine provinces were randomized for performed
studies to identify the Prevalence Rates of
Hemoglobinopathies in Cambodia during the past
10 years ( 2000-2010)
Robyn Devenish January, 2010

5. PREVALENCE RATE OF
HEMOGLOBINOPATIES SURVEY
Based on studies performed during the past
10 years (2000-2010)
Robyn Devenish January, 2010

6. PREVALENCE RATE OF
HEMOGLOBINOPATIES SURVEY
Based on studies performed during the past 10 years
(2000-2010)
Robyn Devenish January, 2010

7. PREVALENCE RATE OF
HEMOGLOBINOPATIES SURVEY
RESULT
 Several different methods were used by the various
studies for Hb typing and Hb
Genotyping
 Two of the studies were specifically aimed at the
prevalence of hemoglobinopathies
 FFour of the nine studies, tested for both α and β
f th i t di t t d f b th d
thalassaemia.
 Among 4 111 children only 53.34% have been tested
4,111 53 34%
on β-α thalassaemia and the other did not tested α
thalassaemia
Robyn Devenish January, 2010

8. PREVALENCE RATE OF
HEMOGLOBINOPATIES SURVEY
RESULT
 41% of children had hemoglobinopathie
 Hb H diseases 0.04%
 Hb E homogeneous 17%
 Hb E heterogeneous 29%
 Hb E trait 20 %
 Hb E/ β thalassaemia 13%
 β thalassaemia 0.01%
 α thalassaemia 20.95%.
Robyn Devenish January, 2010

9. PREVALENCE RATE OF
HEMOGLOBINOPATIES SURVEY
 No national policy or program on the prevention and
control of thalassaemia
 Limited laboratory capacity to deal with thediagnosis
of Hemoglobinopathies
 Few pediatric hospital were able to do for Brilliant
cresyl blue stain for Hb H bodies, Hb electrophoresis
bodies
and DCIP (Dicholophenolindol) screening test for Hb E.
 many cases go undiagnosed and untreated or
misdiagnosed
 The red blood cell transfusion is the only treatment
available
 The urgent need to reduce the overall number of
affected births and to improve the survival and quality
of life of the patients with Hb disorders in Cambodia
Cambodia.
Robyn Devenish January, 2010

10. THALASSEAMIA TREATMENT
 Packed Red cells (PRC) is the only
treatment available but low availability
 Leukocyte Poor-Red cells (LPRC) is
currently not available
 Splenectomy available in some hospitals
 Iron Chelatoris not available
Dr Chean Sophâl.Mékong Santé , 2010

11. THALASSEAMIA TREATMENT
Dr Chean Sophâl.Mékong Santé , 2010

12. NATIONAL PREVENTION PROGRAM
R R R
 Thalassaemia prevention is one of action in NCDs policy &
strategic plan of the MoH
 Guidelines for the clinical Management of Patients with
Thalassaemia ( 2011)
Th l i
 Training health professional at all level on the Thalassaemia
Management
 Only CBC result and morphology at :
- The National Institute of Public Health
Brilliant cresyl blue stain for Hb H bodies done from the
beginning of 20062006.
- The Pasteur Institute in Phnom Penh
Hb electrophoresis
- Th A k
The Angkor H Hospital for Children in Si
it l f Child i Siem RReap
DCIP (Dicholophenolindol) screening test for Hb E
Brilliant cresyl blue stain for Hb H bodies

13. NEXT STEP
 Policy development on Thalasseamia
 Establish Molecular diagnostic center
 National Survey to find out a
prevalence of Thalasseamia
 Awareness raising on Thalasseamia
g
screening and prevention
 Develop IEC material