Background: Anemia is highly prevalent in Cambodian women and children, but data on causes of anemia are scarce. We performed a national micronutrient survey in children and women that was linked to the Cambodian Demographic Health Survey 2014 (CDHS-2014) to assess the prevalence of micronutrient deficiency, hemoglobin disorders and intestinal parasite infection. Methods: One-sixth of households from the CDHS-2014 were selected for a follow-up visit for the micronutrient survey. Households were visited from two weeks to two months after the CDHS-2014 visit. Data on micronutrient status were available for 1512 subjects (792 children and 720 women). Results: Anemia was found in 43% of the women and 53% of the children. Hemoglobin disorders affected >50% of the population, with Hemoglobin-E the most prevalent disorder. Deficiencies of iron (ferritin < 15 g/L), vitamin A (retinol-binding-protein (RBP) < 0.70 mol/L) or vitamin B12 (<150 pmol/L) were not prevalent in the women (<5% for all), whereas 17.8% of the women had low concentrations of folic acid (<10 nmol/L). In the children, the prevalence of iron, vitamin A, vitamin B12 or folic acid deficiency was <10%. Zinc deficiency, hookworm infection and hemoglobinopathy were significantly associated with anemia in children, whereas in the women none of the factors was significantly associated with anemia. Iron deficiency anemia (IDA) was more prevalent in children <2 years, but in older children and women, the prevalence of IDA was <5%. The most prevalent, preventable causes of anemia were hookworm infection and zinc and folic acid deficiency. Over 40% of the anemia was not caused by nutritional factors. Conclusion: The very high prevalence of anemia in Cambodian women and children cannot be explained solely by micronutrient deficiencies and hemoglobin disorders. Micronutrient interventions to improve anemia prevalence are likely to have limited impact in the Cambodian setting. The focus of current interventions to reduce the high prevalence of anemia in children and women should be broadened to include zinc and folic acid as well as effective anti-hookworm measures.
A cross-sectional analysis of the Cambodia Demographic Health Surveys from 2000, 2005 and 2010 was conducted to observe the national trends in infant and young child feeding practices. The results showed that rates of exclusive breastfeeding among infants aged 0–5.9 months have increased substantially since 2000, concurrent with an increase in the rates of early initiation of breastfeeding and a reduction in the giving of pre-lacteal feeds. However, the proportion of infants being fed with breast-milk substitutes (BMS) during 0–5.9 months doubled in 5 years (3.4% to 7.0%) from 2000 to 2005, but then did not increase from 2005, likely due to extensive public health campaigns on exclusive breastfeeding. BMS use increased among children aged 6–23.9 months from 2000 to 2010 (4.8% to 9.3%). 26.1% of women delivering in a private clinic provided their child with breast-milk substitute at 0–5.9 months, which is five times more than women delivering in the public sector (5.1%), and the greatest increase in bottle use happened among the urban poor (5.8% to 21.7%). These findings are discussed with reference to the increased supply and marketing of BMS that is occurring in Cambodia.
Background: From 2005 to 2010, the percentage of children dangerously thin (also called wasted) crossed the International Phase Classification Emergency Threshold, increasing from 8.4 to 10.9 %. As a result, Cambodia is now among the 20 worst countries globally for child wasting-with malnutrition implicated in more than 6400 child deaths annually. This study, therefore, sought to provide information on the actual treatment of severely acute malnourished children with complication in Cambodian hospitals. Methods: Data was collected from March to June 2014, from hospital records of 1450 children admitted for treatment of severe acute malnutrition with complications as in-patient in 19 hospitals from 2011 to 2013. Recovery rates were determined using weight-for-height z-scores and the percentage of weight gain for children without oedema. Additional data on duration of stay in hospital, prevalence of follow-up visits, and rates of weight gain were also analyzed. Results: According to weight for height z-score (WHZ), 58.6 % of the children without oedema (n = 1100) were defined as cured of severe acute malnutrition at discharge. On average, during their stay in hospital, children were gaining approximately 7 % of their bodyweight. In regards to follow-up visits, 86.7 % of children without oedema were defined as cured after three follow-up visits, with an improved WHZ of +2.28 z-score since admission. When looking at the progress and achievements in regards to follow-up visits, the rate of children participating in three follow-up visits increased from 25.7 to 42.8 % between 2011 and 2013. Conclusions: A major finding from this research was that the children who completed three follow-up visits were not only cured (>−3 standard deviation (SD)) but were no longer moderately malnourished, as most of them ended up with a z-score >−2SD.
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