BackgroundMulti-drug-resistant Plasmodium falciparum threatens malaria elimination efforts in Cambodia and the Greater Mekong Subregion (GMS). Malaria burden in the GMS is higher among certain high-risk demographic groups in Cambodia, especially among migrant and mobile populations (MMPs). This respondent driven sampling (RDS) study was conducted in order to determine malaria knowledge, treatment-seeking behaviours and preventive practices among two MMP groups in Western Cambodia.MethodsAn RDS survey of MMPs was implemented in four purposively-selected communes along the Thai–Cambodia border; two in Veal Veang District and two in Pailin Province, chosen due to their sizeable MMP groups, their convenience of access, and their proximity to Thailand, which allowed for comparison with RDS studies in Thailand.ResultsThere were 764 participants in Pailin Province and 737 in Veal Veang District. Health messages received in Veal Veang were most likely to come from billboards (76.5%) and family and friends (57.7%), while in Pailin they were most likely to come from sources like radio (57.1%) and television (31.3%). Knowledge of malaria transmission by mosquito and prevention by bed net was above 94% in both locations, but some misinformation regarding means of transmission and prevention methods existed, predominantly in Veal Veang. Ownership of treated bed nets was lower in Pailin than in Veal Veang (25.3% vs 53.2%), while reported use the night before the survey was higher in Pailin than in Veal Veang (57.1% vs 31.6%). Use of private sector health and pharmaceutical services was common, but 81.1% of patients treated for malaria in Pailin and 86.6% in Veal Veang had received a diagnostic test. Only 29.6% of patients treated in Pailin and 19.6% of those treated in Veal Veng reported receiving the indicated first-line treatment.DiscussionBarriers in access to malaria prevention and case management were common among MMPs, with marked variation by site. Resolving both nation-wide and MMP-specific challenges will require targeted interventions that take into account this heterogeneity.
Development agencies which address climate change adaptation (CCA) are increasingly adopting human rights-based approaches (HRBAs) as central to their policies and principles. What, however, does that entail in practice? This qualitative case study examines whether and how development NGOs in Cambodia understand and apply HRBAs to CCA programming. We explore the themes of participation, transparency, accountability, and non-discrimination, and examine the experiences and implications of these efforts. An HRBA is a political agenda that is often assumed to challenge a dominant discourse which emphasises technical solutions and sidesteps structural factors of power, vulnerability, inequality, and responsibility. Despite agency commitments to HRBAs, however, this perspective is only cautiously being applied to climate change due to hesitance to critically engage in politics and governance. Linking CCA and human rights would require anchoring efforts within broader efforts related to the participation of vulnerable populations in national development, pressure for greater transparency, accountability of duty bearers, and spotlighting discriminatory governance practices. An HRBA, as currently perceived and applied, has yet to contribute to breaking down the 'silos' and other incentives to treat CCA as a technical concern rather than as an impetus for transformational change. Changes in Cambodia's political landscape may intersect with the global HRBA discourse to challenge dominant development approaches.
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