1. WS on Surveillance & Epidemiology

2. Country Presentation (Tuberculosis Situation)
Mao Tan Eang, MD, MPH
Director of National Center for Tuberculosis
& Leprosy Control
Ministry of Health, Cambodia
Workshop on TB Surveillance and Epidemiology, May 4-7, 2004, Manila.

3. Latest TB Indicators (2003)
No. of new cases (all types) and rate
(28,295) 213/100,000 pop.
No. of new smear positive and rate
(18,923) 142/100,000 pop.
% smear positive out of total new cases
67 %
% retreatment cases out of total new plus retreatment
3 %
% population with access to DOTS
83 %
DOTS cure rate
89.9 %
DOTS success rate
92.8 %
DOTS case detection rate
59 %

5. Provincial data, (new case notification rates)
Province name
Rate per 100,000 population
All
New smear +
Kandal
218
147
Svay Rieng
367
229
Phnom Penh
298
115
Pursat
223
155
Battambang
161
101
Pailin
220
160
Bantey Meanchey
123 90
Siem Reap
334
227

6. Provincial data, (new case notification rates) Cont’
Province name
Rate per 100,000 population
All
New smear +
Odar Meanchey
225
155
Kg. Thom
216
165
Takeo
255
Kg. Speu
214
166
Kampot
196
136
Kep
307 82
Sihanuk ville
211
116
Koh Kong
119

7. Provincial data, (new case notification rates) Cont’
Province name
Rate per 100,000 population
All
New smear +
Prey Veng
291
243
Kg. Chhnang
218
169
Kratie
171 97
Kg. Cham
170
117
Stung Steng
132
100
Preah Vihea
190
111
Mondulkiri 73 32
Rattanakiri 75 52
Country-wide (24 Pro)
142
213

8. Treatment outcomes (%)
1998
1999
2000
2001
2002
Cured
91.6
90.7
87.8
89.3
89.9
Completed
3.0
2.8
3.5
2.5
2.9
Defaulted
2.2 3
3.9
1.9
Failed
0.4
0.3
Died
2.3
2.6
3.6
4.0
3.8
Transferred out
0.5
0.6
0.8
0.9
1.1
Non evaluated 4 1

9. TB/HIV HIV prevalence in 15-49 yrs old group : 2.6 %
HIV prevalence in antenatal women (2002): 2.8 %
HIV prevalence in high risk group (2002):
DFSW : 28.8 %
IDFSW : 14.8 %
Police : 3.1 %
HIV prevalence in TB cases (2003) : 12 %

10. Crude prevalence of HIV among sentinel groups in Cambodia, 2002

11. Trend of HIV Seroprevalence among TB Patients
National Phnom Penh % %
% % %
% % %
% %
% %
% %

12. Mortality Information system on mortality:
No organized registration system for vital statistics
Data on the levels, patterns & trends based on:
1998 General Population Census of Cambodia
2000 Cambodian Demographic & Health Survey
TB deaths per 100,000 population=107/100,000
(as estimated by WHO, 2003)
Other relevant data on mortality:
1996 Demographic Survey of Cambodia (no. of deaths by age & sex) was used to estimate indirectly adult mortality
Model-based life table constructed, combining data from above surveys (using COMBIN from MortPak software)
Life expectancy at birth for males=53.2 yrs; females=59.2 yrs

13. Overall assessment of national information system
Country coverage: 100 % coverage
Quality of data, timeliness of reporting:
Reports from most provinces are sent in a timely manner with reliable data, using the standardized recording and reporting system
Variability of indicators between provinces:
No variation in terms of indicators between provinces
(use the same indicators)
Problems identified:
Some remote provinces are late in reporting

14. Prevalence surveys (1) Sample size Screening procedures
Study size determined=30,000 pop. (WHO est. of prevalence)
Cluster size determined=720 (80% of an av. village)
Urban districts=7; rural=35 (strat. pop. proportionate method)
Screening procedures
All children: given Tuberculin test
All others 10 yrs or over: brief interview (medical history) & CXR
TB suspects asked to submit sputum samples (spot & next morning)
Those with CXR abnormality also to submit sputum samples as above
Absentees traced through home visits for screening purpose
Results of Prevalence and tuberculin survey are not yet finalized

15. Prevalence surveys (2) Difficulties encountered Lessons learned
Mostly related to logistics (road condition,…) and weather conditions
Only a small proportion (3.1%) did not participate
Lessons learned
Efforts to minimize missing bacteriologically +ve cases:
Home visits to trace absent participants
Sputum samples taken from those sick at home
Correction to the estimated case detection rate (when the final results are officially released)