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In countries with a lack of primary care systems, health workers are of crucial importance to improving the delivery of health and animal health services at community level. But somehow they are rarely evaluated and usually with a top-down approach. This is the case in Cambodia, where thousands of Village Animal Health Workers (VAHWs) have been trained by the government, and where no standardized evaluation tool is available to accurately assess the situation. Based on methodology developed by the French NGO Agronomes et Vétérinaires Sans Frontières (AVSF) in Madagascar for farmers' association evaluation, we developed our own participatory methods to collect information about the VAHW context and build a criteria grid for their evaluation. In this framework, several participatory approaches were used such as problem trees, semi-structured interviews, pair-wise ranking and focus groups. The grid was built with the help of relevant stakeholders involved in the animal health system in Cambodia in order to (i) identify VAHW functions; (ii) set up criteria and associated questionnaires, and (iii) score the grid with all the stakeholders. The tool was divided into five categories of evaluation criteria: sustainability, treatment, production, vaccination and disease reporting. Our approach looked at local indicators of success developed and used by VAHWs themselves, which should lead to better acceptability of evaluation. This method gave priority to dialog aiming to engage decision makers and other stakeholders in a mutual learning process and could be applied in other countries to develop trust between health workers and official service representatives as well as to foster corrective action after evaluation.

Rabies circulates intensely in Cambodia, mainly affecting rural populations. We conducted a prospective study to estimate the baseline incidence of potentially infective dog bites in rural villages of Siem Reap province, Cambodia. The study was conducted in a convenience sample of 844 families totaling 1779 persons in four villages. The study collected data in a total of 802.3 person-years. Trained village health workers (VHW) exhaustively documented consecutive dog bites at the end of each month. Between May 15th and November 15th, 2011, a total of 40 attacks (43 bites; 1.07 bites per attack) were notified by 39 persons (50% female; one suffered two distinct incidents) to VHW. The all-age attack rate for bites over this 6-month period was 2.3% (CI95%: 1.7-3.1%), with a global incidence rate estimated at 4.84 bites/100 person-years (CI95%: 3.5-6.6). The mean age in bite victims was 20.8±18.9years (median 12.5; interquartile range 6-36; range 1-63). The dog was identified in 39 (97.5%) of cases, being the household dog in 9 (22.5%) of cases. Bites were classified as severe (WHO Category III-broken skin with bleeding) in 33 (82.5%) of cases with a severe dog bites incidence estimated at 4/100 person-years (CI95%: 2.8-5.6). The bites involved the hand or face in 1 (2.5%) case each (both Category III). In 20 incidents (50%), only rice was applied to the wounds. There were no suspected or confirmed human rabies deaths during the study period but one dog died after biting (2 others were lost to follow-up and 14 were put down by their owner). Our study documented an extremely high incidence of dog bites in of rural Cambodian adults and children. Adapted control policies for canine vaccination are urgently needed.

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Background:The rabies burden in Cambodia is high, notably affecting children of poor rural communities. Applied strategies are needed to decrease the risk. This study documents baseline epidemiology of dog bites in rural Siem Reap province, Cambodia, to plan a cluster-randomized intervention trial on canine vaccination against rabies.Methods: The study bore on a convenience sample of 80 families totaling 1,725 persons in 4 villages (total population 936 households) monitored for a total of 826.8 person-years. The mean study cohort age was 24.9 ± 17.5 years (median 22; interquartile range 11-36; range 0 -87). Trained village health care workers (VHCW) documented dog bites weekly.Results: Between 01/06 and 31/10/2011, forty incidents (43 bites; 1.07 bites/incident) were notified by 39 persons (one suffered two distinct incidents) to VHCW. The all-age attack rate for bite incidents during this 6-month period was 2.3% (CI95%: 1.7% -3.1%), with a global incidence rate estimated at 4.84 incidents/100 person-years (CI95%: 3.5 -6.6). The mean age in bite victims was 20.8 ± 18.9 years (median 12.5; interquartile range 6-36; range 1 -63). The dog was known in 39 (97.5%) of cases, their own in 9 (22.5%) of cases. They were classified as Grade III (broken skin with bleeding) in 33 (82.5%) of cases with a severe dog bites incidence estimated at 4/100 person-years (CI95%: 2.8 -5.6). The bites involved the hand or face in 1 (2.5%) case each (both Grade III). In 20 incidents (50%), only rice was applied to the wounds. There were no human deaths during the study period but one dog died after biting (2 others were lost to follow-up and 14 were killed by their owner). Conclusion:This assessment conducted by AVSF and Pasteur Institute documented the extremely high incidence of dog attacks, highlighting the need to develop adapted control policies on rabies vaccination and providing pre-intervention baselines. Cambodia is a high canine-rabies endemic country and dog bites are frequent in humans, making rabies a real and present risk for Cambodians.