National Prevalence Survey, Cambodia 4/8/2019 National TB Prevalence Survey Cambodia, 2002 8 years after introduction of DOTS Ikushi Onozaki　MD, MPH Chiba Anti-TB　Association/JATA Chiba Foundation for Health Promotion and Disease Prevention Dr Ikushi Onozaki (CENAT/JICA National TB Control Project)

How much TB in Cambodia? Estimates for 2001 estimate number rate/100,000 incidence (all) 75,000 573 incidence HIV+ 9,200 70 incidence (ss+) 34,000 256 prevalence (all) 178,000 1356 prevalence (ss+) 72,000 548 deaths 16,000 121 From Chris Dye

National TB Prevalence Survey 1st Systematic, National Representative and Comprehensive TB Survey in Cambodia First population based survey under a typical DOTS program 42 clusters of 31,000 people across the country 30,000, 97%, participated 22,164, 96%, Age 10 or more Age <15 y : Tuberculin Age 10 or more: X-ray Preparation Meeting with Local People

Lao Thailand Viet Nam Survey Cluster:★

Basic Operation Schedule: Cluster/Week Sunday: Arrival & Basic Preparation Monday: Census/ Informed Consent Arrival of Technical Team Tuesday/Wednesday: Interview, X-ray, Tu-test, Sputum collection Thursday: Interview, X-ray, Sputum collection, Sputum transfer to CENAT Friday: Sputum collection, Tu-reading Saturday: Tu-reading (morning only) , Departure

Census: Confirming eligible population and asking for participation People who basically stay in a defined area more than a month are eligible population regardless the possession of their house and their availability on the survey day Proper informed consent to avoid creating fears

Survey Days Collaboration with local community is essential

Family by family interview by a physician from CENAT TB related symptoms Duration of sickness TB history Possible treatment Consultation Places 1,699 (7.7%) participants who met the TB suspect criteria such as cough more than 3 weeks were asked to submit sputum regardless X-ray findings

Age 10ys or more: Taking X-ray 22,012 X-ray exams 2,432 who showed any kind of abnormality were asked to submit sputum JICA team is monitoring and ensuring the safety of the survey

Developing Film on the Spot Quality Direct X-ray is Available in Villages that contributed to high participation rates and 100% sputum collection from suspects

84 showed smear positive slide(s) 81 Smear Positive TB 1 MOTT 2 contamination susp. 81 S(+) TB :(71 New) New: 66 on Treatment: 5 New, 2 Ret Previously treated: 8 202 S(-)C(+) 190 S(-)C(+) TB Cases 12 contamination susp 190 Cases New: 174 on Treatment: 3 New, 1 Ret Previously treated: 13

Number of S(+) cases actually detected and Prevalence Rate

Prevalence of Bac(+) Pulmonary TB National TB Survey 2002

Relations between prevalence and notification smear positive TB Ａｇｅ

Limitation of Symptom Screening by Interviews to Detect Cases

DOTS in all MPA Health Centers, primary care level per 10,000 population, by 2005

Prevalence of TB and Distance to DOTS Service ( /100,000 age 10 or more)

Point Estimates of ARI, 2002 National Survey Children with No BCG Scar (RT23:2TU) 16 mm mirror 10 mm Age 1-4 (N=993) 0.46% 0.99% Age 5-9 (N=2,245) 1.00% 2.10% Age 10-14 (N=2,532) 1.62% 3.21%

Estimation of Incidence of New S(+) DOTS CDR=52%, Private Tx=10%, TB/HIV: 15%

Conclusions and Research Questions Yes, Cambodia has very high TB burden, however, S(+) Prevalence, 270, a half of WHO estimate No more among 22 HBC???, dropping from 18th to 24th? A large pool of latent infection may be a major source of new cases: Continuous efforts are essential 30/81 S(+) were judged as no-TB suspects by interviews: Limitation of a survey without X-ray and/or CF strategy S(+) occupied only 30% of Bac (+) Less in groups with better access to DOTS: A transitional phenomenon of short history of DOTS? Or Need of new model? Bac (+) prevalence of 902: Total TB burden is probably more than the WHO estimate that may make Cambodia still within 22 HBC, even 16th or 17th ?

Efforts on DOTS Expansion, establishing better access to DOTS, are paying off in case detection

Incidence: 80-85% level of those Yes, DOTS is working to reduce S(+) prevalence in Cambodia even with TB/HIV impact. However: S(+) Prevalence: 50-60% of the WHO estimate and/ or the era before DOTS Incidence: 80-85% level of those Detecting S(+) only: Is it enough in community with such a high prevalence, where one out of 11 “grandfathers” is C(+)? : Need to assess unknown impact of chronic S(-)C(+) with a large number of close contacts in a large family in Asia Incidence of S(-)C(+) may be much higher than the WHO estimate with current model. However, majority of them might not come to health facility to seek treatment because many of them are not so sick.

Now, we’ve got a clear view

Thanks for your collaboration in advance! Challenge: The next round in 2008? Thanks for your collaboration in advance! CENAT/JICA National TB Control Project Cambodia