Worldwide elimination of HIV transmission from mother-to-child is theoretically achievable. In Cambodia, antenatal care (ANC) prevalence has dropped from 1.6% (2003) to 0.71% (2009). However, success in minimizing vertical transmission has been limited by low testing uptake at ANC and delivery. We trained midwives in counselling and performance of an HIV rapid test, incorporated point-of-care testing into routine antenatal and maternity services and determined acceptability, feasibility, accuracy, cost and yield after one year. In all, 97.3% of ANC clients and 73.0% of maternity admissions had unknown HIV status. Testing was offered to 97.6% and 95.0% of untested ANC and maternity clients, respectively. Acceptance rates were 95.5% and 99.4%. Partner testing rate was 38.6%. HIV was diagnosed in 0.1% of ANC clients, 0.4% of partners and 0.9% of women at delivery. For an operational district with an average population of 158,000, point-of-care testing was estimated in one year to identify 19 HIV-infected pregnant women, nine men, 14 discordant couples and 16 exposed infants who otherwise would have not received prophylaxis. Cost was less than $3.75 per person tested. Point-of-care testing during ANC and at delivery is feasible, acceptable and contributes to reducing mother-to-child transmission.

BackgroundIn Cambodia, while anti-retroviral therapy (ART) services are increasingly available, the unmet needs of family planning among general population are high. These facts raise concern on possible exposure of many HIV-positive women on ART to the potential risk of unintended pregnancy. This study aimed to clarify family planning practices in Cambodia and determine predictors of risk of inconsistent condom use among women on ART.MethodsA cross-sectional survey with a structured questionnaire was conducted at five government-run health centers in Phnom Penh, Cambodia, from June to September, 2012. Multiple logistic regression analysis was used to identify predictors of risk of inconsistent condom use among regular users of contraceptive methods.ResultsOf 408 respondents, 40, 17 and 10 used the pill, IUD, and injection, respectively, while 193 used condoms. 374 were not planning to have a child. Among 238 sexually active women who were not planning to have a baby, 59 were exposed to the risk of unintended pregnancy. Multivariate logistic regression analysis that did not include variables related to partners identified "seeking family planning information" (adjusted odds ratio (AOR): 2.6, 95% confidence intervals (95% CI): 1.1-6.2), awareness of mother-to-child transmission (MTCT) (AOR: 4.7, 95% CI: 1.9-11.6) and "having a son" (AOR: 2.0, 95% CI: 1.1-3.9) were significant predictors of inconsistent condom use. Another model that included all variables identified “able to ask a partner to use condom at every sexual intercourse” was the only predictor (AOR: 23.7, 95% CI: 5.8-97.6).ConclusionsAbout one-quarter of women on ART are at risk to unintended pregnancy although most do not plan to get pregnant. Furthermore, women on ART could be more empowered through improvement of communication and negotiation skills with partners to demand the use of condom during sexual intercourse. The use of other contraceptive methods that do not need partner involvement should be promoted.

Background Background Many factors align to reduce access to quality emergency services in Cambodia, resulting in unnecessary morbidity and mortality among the country's most vulnerable populations. The lack of a well-coordinated emergency referral system acts as a critical barrier for many seeking emergency care, limiting overall referral frequency and quality. To increase the effectiveness of the Cambodian healthcare system, the Quality Health Services (QHS) project implemented a spectrum of targeted, low-cost, locally-tailored interventions, including: triage systems, provincial clinical guidelines and referral hotlines, standardized referral-communication slips, and referral-feedback forms. To inform future health-system-strengthening efforts, the primary aim of this study is to describe the challenges facing the Cambodian referral system and the interventions applied to address these challenges. Secondarily, this study aims to characterize the frequency of emergency referrals in the post-intervention period and the utilization patterns of the implemented referral-system-strengthening tools. Methods Methods Data was collected prospectively on a quarterly basis at 35 government referral hospitals in six Cambodian provinces between March 2016 and June 2017, data from 25 of these facilities was analyzed. Data on overall numbers of referrals was collected from each facility's referral logbook. The frequency and thoroughness of standardized referral-communication slip and standardized referral-feedback form use was ascertained by reviewing copies of these tools collected at each facility during the preceding quarter. Results Results The average number of emergency referrals to target facilities increased from 114.4 to 190.4 per quarter, a 66% increase. Target facilities also received 86% more standardized referral-communication slips and sent 200% more standardized referral-feedback forms per quarter during the monitoring period. Conclusions Conclusions After receiving a package of referral-system-strengthening interventions the 25 hospitals analyzed in this study noted a significant increase in the frequency of emergency referral receipt. The frequency and quality of referral related communication improved consistently during the observation period as well. This data suggests that the interventions implemented addressed ongoing gaps in the Cambodian health system, and improved access to emergency referrals. These developments create a foundation upon which to build future health system strengthening interventions can be built and may provide guidance to implementors in other similarly resourced settings. During the late 1970's, under the rule of the Khmer Rouge, the Cambodian medical system was dismantled, and the country's health workforce decimated. Although the Khmer Rouge were ousted from Phnom Penh in 1979, violence and political unrest continued for many years, draining aid resources and hindering reconstruction efforts. As a result, during the 1980's and early 1990's, the country suffered some of the worst...

clinical characteristics and outcomes were retrospectively collected for all patients that presented to MRRH with a neurosurgical condition between