Health
HIV / AIDS
Cambodia is one of the countries worst affected by HIV in south-east Asia. Despite a decline in prevalence from 3.3% in 1998 to 1.6% in 2006, over 250,000 people have been infected with HIV since the beginning of the epidemic in 1991, and over 16,000 people have died of AIDS.
Partly as a consequence of high levels of HIV prevalence, it is estimated that 7.8% of children below 15 in Cambodia have lost one or both parents – approximately 335,000 children. Care of orphans is a major concern in a country still recovering from decades of civil unrest and facing extreme poverty.
Adult HIV prevalence (%) |
0.9 |
People living with HIV/AIDS |
75,000 |
Estimated number of children (ages 0-15) living with HIV/AIDS |
4,400 |
Estimated number of deaths due to AIDS during 2007 |
6,900 |
Estimated number of people needing ARV therapy |
40,000 |
Estimated number of people receiving ARV therapy |
27,000 |
Estimated number of AIDS orphans under age 15 |
6,000 |
Tuberculosis
Despite a decrease in tuberculosis incidence by 1% per year, Cambodia has the highest incidence in the Western Pacific Region, at 500 cases/100 000 population/year. In 2006, the number of notifications of new cases fell for the first time since 1995 to 35 466. The treatment success rate has been maintained consistently at above 90% for the last decade. TB-HIV co-infection is declining, as indicated by the last TB-HIV prevalence survey (2007), which shows an HIV prevalence rate of 7.8% among TB patients. The identification and treatment of multidrug-resistant (MDR) TB has begun on a small scale, and it is expected that MDR TB services will be scaled up in the coming years. Approximately 10 percent of TB patients are co-infected with HIV, and HIV-TB co-infections pose a challenge to providing treatment and care for both diseases.
TB prevalence, all forms (number) |
94,433 |
TB incidence, all forms (number) |
70,949 |
TB mortality, all forms (number) |
13,054 |
TB incidence, smear-positive (number) |
31,243 |
Malaria
Malaria continues to affect mostly the poorer communities living in forested areas, where approximately 2 million people are at risk. The total number of treated malaria cases in public health facilitiesdeclinedsteadily from 133 000 in 2003 to 60 000 in 2007, although there was an increase to 101 000 in 2006. Similarly, the number of reported malaria deaths in public health facilities fell from 492 in 2003 to 241 in 2007, but went up to 396 in 2006. The factors that contributed to the increases in 2006 include: the early start of the rainy season, prolonging the transmission period; delayed and inadequate bed-net distribution/re-impregnation; and increasing population movement to malaria-risk areas. The management of severe malaria has improved and the case fatality rate among severe malaria patients at referral hospitals decreased from 10.4% in 2005 to 8.3% in 2007. The proportion of confirmed malaria among all cases treated in public health facilities increased steadily from 54% in 2003 to 78% in 2006, but fell to 71% in 2007. With improvements in diagnosis, treatment and personal protection at the community level, morbidity and mortality due to malaria are expected to reduce in the coming years. However, the country is also right at the centre of a global multidrug-resistant malaria problem, because of the presence of artemisinin-tolerant malaria parasites, especially in the Cambodia-Thailand border area. At the moment, an intensified containment effort, with the aim of eliminating the tolerant parasites, is a priority for Cambodia.
Reported cases |
59,848 |
Reported deaths |
241 |
Estimated deaths
(in 1000s) |
N/A |
Vulnerabilities and hazards
Like many developing countries, Cambodia faces a range of vulnerabilities and risks, including traditional, modern and emerging health and environmental risks. These risks emanate from unsafe water and inadequate sanitation; unsafe food supplies, especially from street vendors; indoor air pollution and solid fuel use; as well as disease-vector transmission. However, the country is also subject to emerging issues, including health risks related to changes in the global environment (e.g. climate change and biodiversity loss); development, consumption and production of new products and technologies; consumption and production of more energy sources; and the increasing number and use of chemicals. There are also increasing health risks related to changes in lifestyle, urbanization and working conditions.
According to the latest WHO/UNICEF Joint Monitoring Programme (JMP) Report on Drinking Water and Sanitation, 65% of the total population has sustainable access to an improved water source (80% in urban and 61% in rural areas) and only 28% to improved sanitation (62% in urban and 19% in rural areas) in 2006. Other environmental health hazards include bacteriological contamination of drinking water, the most important health-related concern; arsenic in groundwater, which poses a health threat in seven provinces, exposing around 2.24 million people; indoor and urban air pollution, which is a serious health threat due to almost 98 % of the population using biomass fuels for cooking or heating; use of banned pesticides and fertilizers, which has the potential to contaminate food and water; and finally, the serious environmental health impacts from solid and hazardous wastes, including health care waste.
Cambodia has a significant and growing burden of noncommunicable disease. Two recent epidemiological surveys indicated that, in urban areas, 10% of adults had diabetes and 25% high blood pressure, while in a poor rural community, 5% of adults had diabetes and 12% were found to be hypertensive. In total, 300 000 Cambodians are estimated to have diabetes and, if no action is taken, it is estimated that the number will rise to 1.2 million by 2021. In 2005, a nationwide survey of adult tobacco use found that 48% of men and 3.6% of women smoked cigarettes, while 17% of women and 1% of men chewed tobacco. Alcohol consumption is on the increase, and the number of violent incidents, traffic accidents and domestic violence incidents linked to alcohol is alarming.
Due to rapid economic growth and changes in lifestyle, the burden of environment-related disease is an increasing concern, accounting for 26% of the total burden of disease in Cambodia, according to recent WHO estimates. When compared with other countries in the Region, Cambodia has the second highest environmental disease burden. While environmental risk factors are generally associated with noncommunicable diseases and injuries, in Cambodia they are also strongly associated with communicable diseases.
Leading causes of mortality and morbidity
Infectious diseases still constitute the main causes of mortality and morbidity, but Cambodia is facing an epidemiological transition. Currently, acute respiratory infections are the leading cause of both mortality and morbidity, with gastroenteric infections contributing substantially to the morbidity burden of the population and dengue outbreaks exacerbating the situation. In addition, the country is still classified as one of the 22 worldwide with a high burden of tuberculosis. Notably, HIV prevalence has decreased substantially and a high proportion of people living with HIV/AIDS are receiving antiretroviral therapy.
Preventing and treating noncommunicable diseases and injuries will be the challenge in the near future. The number of road accidents is rising very rapidly as a leading cause for mortality due to improved infrastructure and rapid socioeconomic development. Some surveys have indicated high levels of diabetes (5%-10%) and hypertension (12%-25%) in rural and urban areas, both major risk factors for ischemic heart disease and stroke. As half of the male population smokes and alcohol consumption is rising, the composition of the table for leading causes of morbidity and mortality is expected to change in the near future.
