Phnom Penh's Kantha Bopha children's hospital recently received a one-year-old
patient with a shocking health condition: a section of his spinal cord had
disintegrated, paralyzing him from the waist down.
A mother watches over her son at a Kantha Bopha Hospital. He has a severe form of tuberculosis.
A CT scan revealed
tuberculosis (TB) of the bone, probably transmitted to him by his mother before
he was born. Though doctors saved the boy's life by controlling the infection,
treatment came too late to prevent paralysis.
Although spinal damage
represents a severe form of TB disease among children, doctors at the Kingdom's
three leading children's hospitals say it is not unusual. During the past month
alone, Phnom Penh's two Kantha Bopha hospitals and the affiliated Jayavarman
Hospital in Siem Reap have received at least six similar cases in children
between the ages of one and 12.
"In most of them, it was a typical case
of missed diagnosis. Due to this, the infection spread to their bones over a
long period," says Dr Beat Richner, the Swiss doctor who established the first
of the specialist children's hospitals in 1992. In the majority of cases, he
says, primary infection begins in the lungs and, in the absence of diagnosis,
spreads to other organs causing serious complications.
Of the 35,000
children hospitalized at the Richner-run hospitals last year, almost half
suffered from one form of TB disease. These included pulmonary TB, meningitis,
the intestines, bones (mainly the spine) and tissue surrounding the
Among adults too, TB infection is widespread: the country has the
second highest infection rate in the world, just ahead of Zimbabwe, according to
World Health Organization figures.
More than half of the country's 11.2
million people are believed to have been exposed to TB, but the current
detection rate of 54 percent means many are still spreading the disease. Poor
sanitary conditions, high density dwellings and limited access to healthcare are
the major reasons for the spread of the disease.
"What makes the
situation here more alarming is that Zimbabwe's infection rate of 562 per
100,000 is attributed largely to a huge burden of HIV infection. Cambodia's rate
of 560 per 100,000 is not," says Dr Ikushi Onozaki, chief advisor of the
Japanese-funded National Tuberculosis Control Project (NTCP).
Dr Mao Tan
Eang, director of the National Center for Tuberculosis and Leprosy Control
(CENAT), a part of the Ministry of Health, says a major reason for the spread is
that detection rates in children and adults are low.
efforts have been intensified in our [revised] national TB program," he says.
"The target is to halve TB deaths by 2010 while maintaining a high cure rate,
and increase the detection rate to 70 percent by 2005." The government has
earmarked $25 million to raise the detection rate under the new five-year
Although Cambodia's infection rate is high, the actual number of
people who have TB disease is much less. Differentiating between the two is
"TB is a complicated disease," says Dr Wim van Damme of
Medecins Sans Frontieres-Holland, Belgium and Switzerland (MSF). "You have to
make a clear distinction between TB infection and TB disease. The chance of [an
infected person] getting the disease is only about 10 percent."
Damme says the likelihood of contracting the disease increases if a person
already has HIV/AIDS, diabetes, or suffers from malnutrition. This gives rise to
what health specialists refer to as 'co-infection'.
An HIV/AIDS patient
can have a co-infection, which means they contract both TB and HIV/AIDS. This is
because AIDS weakens their immune system and makes them more susceptible,
explains Dr Hor Bunleng, deputy director of the Ministry of Health's National
Center for HIV/AIDS, Dermatology and STD (NCHDS).
The need to tackle the
problem of co-infection has prompted the two major health programs to work
together on a program that will provide homecare treatment for both TB and
HIV/AIDS. The program, which is in the early stages of development, involves
both CENAT and the NCHDS, says Dr Bunleng.
"We would like to work
together with [CENAT] to come up with a joint strategy," he says.
and MSF-France run the Directly Observed Treatment with Shortcourse (DOTS)
program, which provides medicine at home on a regular basis to ensure that TB
patients complete their treatment.
NCHDS also provides homecare treatment
in its home-based and community-based care program for HIV/AIDS
"We would like to integrate the DOTS and the home-based and
community-based care into one program," says Dr Bunleng. "We could mobilize
Both programs have seen some success. Cambodia's cure rate
for TB is 89 percent and the prevalence of HIV/AIDS among the 15-49 age group
has decreased from 3.1 to 2.8 percent.
"If you look at the target
HIV/AIDS groups, such as commercial sex workers, it is declining," says Dr
Bunleng. "It is a hope for Cambodia in terms of preventing HIV/AIDS."