Barriers in access to services and information gaps by genders and key populations in the national Tuberculosis programme in Cambodia

Yi, Siyan; Teo, Alvin Kuo Jing; Sok, Say; Tuot, Sovannary; Tieng, Sivanna; Khun, Kim Eam; Choub, Sok Chamreun; Pheng, Sok Heng; Mao, Tan Eang

doi:10.1080/17441692.2021.1954226

Cited by 13 publications

(12 citation statements)

References 16 publications

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“…We found that from 2015 to 2019, the number of all-form TB deaths decreased by 11.8%. While ACF interventions have improved access to TB services, other barriers remain high such as fear of high treatment costs [ 45 ], high rates of stigma toward those with TB [ 46 ], lack of awareness of TB-suggestive symptoms among people with TB [ 47 ], and indirect costs associated with long distances to health facilities [ 48 ], all contributing to significant delays in TB care. Widespread communication of TB awareness, of consciousness regarding TB stigma, and of the existing publicly available services for TB screening and treatment in Cambodia will be critical for meeting the End TB milestones.…”

Section: Discussionmentioning

confidence: 99%

Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019

Vongpradith

Ledesma

et al. 2022

BMC Infect Dis

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Background Cambodia was recently removed from the World Health Organization’s (WHO’s) top 30 high tuberculosis (TB) burden countries. However, Cambodia’s TB burden remains substantial, and the country is on the WHO’s new global TB watchlist. We aimed to examine the levels and trends in the fatal and non-fatal TB burden in Cambodia from 1990 to 2019, assessing progress towards the WHO End TB interim milestones, which aim to reduce TB incidence rate by 20% and TB deaths by 35% from 2015 to 2020. Methods We leveraged the Global Burden of Disease 2019 (GBD 2019) analytical framework to compute age- and sex-specific TB mortality and incidence by HIV status in Cambodia. We enumerated TB mortality utilizing a Bayesian hierarchical Cause of Death Ensemble modeling platform. We analyzed all available data sources, including prevalence surveys, population-based tuberculin surveys, and TB cause-specific mortality, to produce internally consistent estimates of incidence and mortality using a compartmental meta-regression tool (DisMod-MR 2.1). We further estimated the fraction of tuberculosis mortality among individuals without HIV coinfection attributable to the independent effects of alcohol use, smoking, and diabetes. Results In 2019, there were 6500 (95% uncertainty interval 4830–8680) deaths due to all-form TB and 50.0 (43.8–57.8) thousand all-form TB incident cases in Cambodia. The corresponding age-standardized rates were 53.3 (39.9–69.4) per 100,000 population for mortality and 330.5 (289.0–378.6) per 100,000 population for incidence. From 2015 to 2019, the number of all-form TB deaths decreased by 11.8% (2.3–21.1), while the age-standardized all-form TB incidence rate decreased by 11.1% (6.3–15.6). Among individuals without HIV coinfection in 2019, alcohol use accounted for 28.1% (18.2–37.9) of TB deaths, smoking accounted for 27.0% (20.2–33.3), and diabetes accounted for 12.5% (7.1–19.0). Removing the combined effects of these risk factors would reduce all-form TB deaths by 54.2% (44.2–62.2). Discussion Despite significant progress in reducing TB morbidity and mortality since 1990, Cambodia is not on track to achieve the 2020 WHO End TB interim milestones. Existing programs in Cambodia can benefit from liaising with risk factor control initiatives to accelerate progress toward eliminating TB in Cambodia.

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Section: Discussionmentioning

confidence: 99%

Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019

Vongpradith

Ledesma

et al. 2022

BMC Infect Dis

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“…Evidence also indicates that many leaders of global health organizations represent groups with societal, historical, and educational privilege that typically lack insight into the realities of gender and other forms of discrimination in low-and middle-income countries 27,51,52 . Another factor is the insufficient tracking of data about gender inequity, which contributes to gender being overlooked in health programs 24,[53][54][55] . Rigid funding requirements and structures, including short budget cycles and timeframes, funding thresholds that are too high or too low, and stringent audit or reporting requirements, also limit efforts to tackle gender and health inequities 56,57 .…”

Section: Discussionmentioning

confidence: 99%

Exploring system drivers of gender inequity in development assistance for health and opportunities for action

Bartel

Coile²,

Zou

et al. 2022

Gates Open Res

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Background: Deep-rooted and widespread gender-based bias and discrimination threaten achievement of the Sustainable Development Goals. Despite evidence that addressing gender inequities contributes to better health and development outcomes, the resources for, and effectiveness of, such efforts in development assistance for health (DAH) have been insufficient. This paper explores systemic challenges in DAH that perpetuate or contribute to gender inequities, with a particular focus on the role of external donors and funders. Methods: We applied a co-creation system design process to map and analyze interactions between donors and recipient countries, and articulate drivers of gender inequities within the landscape of DAH. We conducted qualitative primary data collection and analysis in 2021 via virtual facilitated discussions and visual mapping exercises among a diverse set of 41 stakeholders, including representatives from donor institutions, country governments, academia, and civil society. Results: Six systemic challenges emerged as perpetuating or contributing to gender inequities in DAH: 1) insufficient input and leadership from groups affected by gender bias and discrimination; 2) decision-maker blind spots inhibit capacity to address gender inequities; 3) imbalanced power dynamics contribute to insufficient resources and attention to gender priorities; 4) donor funding structures limit efforts to effectively address gender inequities; 5) fragmented programming impedes coordinated attention to the root causes of gender inequities; and 6) data bias contributes to insufficient understanding of and attention to gender inequities. Conclusions: Many of the drivers impeding progress on gender equity in DAH are embedded in power dynamics that distance and disempower people affected by gender inequities. Overcoming these dynamics will require more than technical solutions. Groups affected by gender inequities must be centered in leadership and decision-making at micro and macro levels, with practices and structures that enable co-creation and mutual accountability in the design, implementation, and evaluation of health programs.

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“…Less than one-third of students believed that tuberculosis diagnosis and treatment were free of charge. The National Tuberculosis Program in Cambodia provides free TB diagnosis and treatment (Lorent et al, 2015;Yi et al, 2021). International donors and partners include the World Health Organization, Japan International Cooperation Agency, the World Bank, the United Nations World Food Program, the United States Agency for International Development, the Centre for Disease Control and Prevention, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Brown et al, 2006;Ruger, 2005).…”

Section: Attitude On Tuberculosismentioning

confidence: 99%

Knowledge and attitude on tuberculosis among college students in Cambodia

Yich

Thon

et al. 2023

J Pal Nurs Stud

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Background: Tuberculosis (TB) is one of the most common infectious diseases in the world, and it remains a significant public health concern. Cambodia is one of the 30 countries with the highest tuberculosis burden. Objective: to explore the knowledge and attitudes about TB and obtain sources of TB information among college students in Cambodia. Methods: The study design was descriptive and cross-sectional. The participants were 240 students from the Royal University of Phnom Penh who were chosen at random. The questionnaire was self-administered. The information was gathered in May 2019 and analyzed using descriptive and t-test statistics and the Chi-square test. To determine statistical significance, a p-value of 0.05 was used. Results: This study revealed that students moderately understood tuberculosis (M = 27.76, range = 21 - 35). Male students had higher levels of TB knowledge than female students (X2 = 5.909, p = 0.052). Many students lacked knowledge regarding tuberculosis transmission and had a negative attitude toward tuberculosis, particularly “if they found out that they had TB” and “if they thought they had symptoms of TB.” TB data was gathered from various sources. TB knowledge was significantly related to TB information obtained by health workers (r = 0.234, p = 0.01). Conclusions: The findings emphasize increasing knowledge about tuberculosis prevention and treatment. They will be able to practice appropriate health behavior through health education effectively, and education will lead to the formation of proper attitudes about tuberculosis.

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Barriers in access to services and information gaps by genders and key populations in the national Tuberculosis programme in Cambodia

Cited by 13 publications

References 16 publications

Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019

Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019

Exploring system drivers of gender inequity in development assistance for health and opportunities for action

Knowledge and attitude on tuberculosis among college students in Cambodia

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