One sunny day in October in the coastal province of Kep in Cambodia, a temporary blue and white medical tent stands out starkly against the surrounding vibrant green rice paddy fields. It is here that Dr Sokkea Hun, Director of the O’Krasa Health Center, oversees operations as villagers from her local community undergo a screening process to detect tuberculosis (TB). As she looks on, a warm smile spreads across her face.
“I’m just really happy to be doing this – engaging with people in the community, helping them learn to care for their health,” said Dr Hun, who has been working at the O’Krasa Health Center for 11 years. “I love working closely with the community like this. It brings me joy,” she added, still smiling. This type of direct community outreach is crucial in villages like O’Krasa, where Dr Hun said TB symptoms were not widely known. “People are not aware they have TB, and that makes it difficult for us to detect all TB cases,” she said.
Despite being a preventable and curable disease, 1.5 million people die from TB globally each year – making it the world’s top infectious killer. Cambodia has made solid progress towards meeting the End TB Strategy targets, and while multiple sources of evidence indicate that the burden of TB is falling in Cambodia – with 500 000 TB patients cured and an estimated 400,000 deaths averted since 2000 – there is uncertainty about the true burden of the disease. The second national TB Prevalence Survey in 2011 revealed a 38% reduction from the first survey in 2002, but TB detection and care has been negatively affected by the COVID-19 pandemic.
With funding from the Australian Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in kind support from USAID, and technical support from WHO and the Research Institute of Tuberculosis and the Japan Anti-Tuberculosis Association and other health partners, the National Centre for Tuberculosis and Leprosy Control (CENAT) hopes to finalize the data collection phase of its third National TB Prevalence Survey in 2024. The results will also be published this year and will allow Cambodia to better understand the country’s TB epidemiology and improve TB control.
“We’re proud that Cambodians are contributing to better understanding the burden of TB and seeking timely treatment. Under our policies, TB treatment is free of charge,” said Dr Huot Chan Yuda, Director of CENAT. “We work diligently to engage partner organizations to continue supporting Cambodia. TB is a disease that comes with high risks. Together, we must achieve our targets to end TB by 2030,” he said.
A TB survey participant has her blood pressure monitored for patient information. © WHO / Tytaart
TB is caused by bacteria (Mycobacterium tuberculosis), and it most often affects the lungs. It is spread through the air when people with pulmonary TB cough, sneeze or spit. Common symptoms include a prolonged cough, chest pain, weakness or fatigue, weight loss, fever, and night sweats. Often, these symptoms will be mild for many months, leading people to delay seeking care and increasing the risk of spreading the infection to others.
The third TB Prevalence Survey is helping to identify TB cases early so people can be directed to appropriate treatment options. The survey focuses on supporting those at high-risk. People such as the elderly, or those in close contact with others who have had bacteriologically confirmed TB, low-income urban residents, and people in marginalized communities.
Chantha Bon, one of the survey participants, shared her newfound awareness of TB. “I had never paid much attention to TB before as no one in my family has had it. But then I heard of this survey from the village chief and thought I should have my health checked too, so if it turned out I was sick I could protect others,” she said, while waiting for her husband to finish the TB screening process.
A health worker sets up the chest X-ray machine during the cluster operation in Kep Province. © WHO / Tytaart
In September 2023, world leaders committed to ambitious new targets for the next five years to advance global efforts towards ending the TB epidemic.
Australian Ambassador Justin Whyatt said, “the endorsement of the ambitious new targets to advance the global efforts to end TB, made at the United Nations General Assembly’s High-Level Meeting on Tuberculosis, marks a profound commitment to transform TB prevention and care.”
“The results from this survey will help the Ministry of Health to better understand where the country sits against its targets and how health partners can best support Cambodia to build a future where TB is eliminated,” added Ambassador Whyatt.
The Australian Government and WHO are working together to support the Cambodia’s goal to improve Tuberculosis (TB) control and care in line with the End TB Strategy 2030 and the Sustainable Development Goals (SDGs). Cambodia’s National Centre for Tuberculosis and Leprosy Control (CENAT), with funding support from the Australian Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and technical support from WHO, the Research Institute of Tuberculosis and the Japan Anti-Tuberculosis Association (RIT/JATA), the Institut Pasteur du Cambodge (IPC), and the United States Agency for International Development (USAID), is conducting the third national TB Prevalence Survey in 2023, with results expected in late-2024.