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About 35% of TB cases ‘missed’

A patient and a family member sit on a bed at the National Center for Tuberculosis and Leprosy Control in Chamkarmon district, Phnom Penh
A patient and a family member sit on a bed at the National Center for Tuberculosis and Leprosy Control in Chamkarmon district, Phnom Penh, in December. Heng Chivoan

About 35% of TB cases ‘missed’

Cambodia continues to shoulder a disproportionate percentage of the world’s tuberculosis victims, with a higher prevalence rate of the extremely contagious respiratory disease than anywhere outside of South Africa, according to the World Health Organization.

With the assistance of free screenings and free treatment, the Kingdom has seen rates of infection falling year by year, though with 764 cases per 100,000 people last year compared to 1,670 cases per 100,000 in 1995, the number still looms twice as high as the 2015 Millennium Development Goal.

While the battle against TB infections in Cambodia has largely hit positive notes, the WHO warned on the eve of World Tuberculosis Day yesterday that about 35 per cent of active infections are “missed” – either not found or not treated.

“One reason that so many cases are being missed is that people have not received enough information and are not aware their cough might be something more serious. Another reason is that some populations remain very hard to reach,” said Mao Tan Eang director of the National Center for Tuberculosis and Leprosy Control.

Tan Eang added that the majority of missed cases occur among the poorest communities, elderly populations and marginalised groups including migrant workers, prisoners and HIV-positive people.

The WHO has previously estimated that up to 64 per cent of the Cambodian population, or more than 9.5 million people in the Kingdom, carry latent Mycobacterium Tuberculosis, the bacteria that causes the potentially lethal infection. One in every 10 latent cases is expected to become an active infection.

The key to finding many of the “missed” cases lies with early detection, according to health experts.

“Until a few months ago, traditionally, health centres (and even the entire world) have been using single-symptom screening for cough of more than two weeks,” said the WHO’s Dr Rajendra-Prassad Yadav. “However, [surveys] have shown that if health centres screen only for this single symptom, they will continue to either miss or delay treatment of about 70 per cent of TB cases.”

In addition to the problem of missed cases, Cambodia is also experiencing a major gap in funding for the public health problem. In 2011, $12 million was available to tackle the disease, but this year, that number dwindled to just $7 million.

And without more money, researching the increasingly problematic multi-drug resistant strains, innovating new preventive vaccines and implementing new rapid screening technology remains elusive.

“We will continue to miss the three million [cases undetected globally] if we continue to do the same thing,” Yadav said. “Progress made by Cambodia’s TB program has been significant [but] the threat to these gains is real.”

ADDITIONAL REPORTING BY LAIGNEE BARRON, AMELIA WOODSIDE AND MOM KUNTHEAR

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