Priority health concerns

Two daughters look at their mother who is dying from HIV/AIDS, Cambodia. Photo by World Bank, taken in 2002. Licensed under CC BY-NC-ND 2.0.

Two common features mark Cambodia’s major health concerns:

• Some health figures are among the worst in the world – the 26 cases of avian flu in Cambodia in 2013 were the highest for any country, for example.¹
• There has been significant progress made in many areas such as malaria, tuberculosis, maternal health and HIV/AIDS. In 2015 Cambodia was declared free of measles.

Among priority health concerns are:

• Maternal and child health
• Tuberculosis
• Malaria
• HIV/AIDS
• Avian flu.

Other widespread health problems include malnutrition, diarrhea diseases, acute respiratory infection and dengue fever.

Maternal and child health

Cambodia’s maternal mortality ratio (women who die from complications in pregnancy or childbirth) is high – it was estimated at 161 for each 100,000 births in 2015 –² but that is a significant reduction from 1,020 in 1990 and 484 in 2000.³ Deaths among children have also also dropped, although they remain comparatively high, and the prevalence of underweight newborns is high compared to many countries.

Significant improvements include:

• 89% of pregnant women had health professionals deliver their babies in 2014, up from 71% in 2010⁴
• 83% of babies were delivered at a health facility in 2014, up from 54% in 2010⁵
• 81.2% of pregnant women attended antenatal care⁶
• 84% received iron and folic acid tablets⁷
• 85% of HIV+ pregnant women received anti-retroviral treatment for protection from mother-to-child virus transmission.⁸

Cambodia had the highest prevalence of underweight newborns among nearly 30 countries studied in a 2014 report.⁹ Around 19% of recorded hospital births were infants small for their gestational age (the number of weeks they were carried). Premature and underweight births correlate with maternal illnesses like eclampsia.¹⁰

The infant mortality rate (children dying before 1 year of age) fell from 79.6 per 1,000 live births in 2000 to an estimated 25.1 in 2017.¹¹ The Cambodian figure fell below the world figure in 2011.

Tuberculosis

The World Health Organisation (WHO) estimated there were 52,000 people with tuberculosis (TB) in Cambodia in 2017.¹² There were a total of 34,467 TB cases notified in 2017, giving a treatment coverage of approximately 66 percent of all those with TB. ¹³

The death rate has fallen by more than 50 percent since 2000.¹⁴ Treatment in 2016 was estimated to have a 94 percent success rate, one of the highest in the world.

WHO data shows that notifications of tuberculosis (TB) quadrupled between 1991 and 2010, before falling to 2.8 percent per year. The treatment success rate has been maintained at over 90 percent.¹⁵

Around 13,000 Cambodians die from tuberculosis (TB) each year.¹⁶ The country has seen a steady decrease in new TB infection rates, however: there were 764 cases per 100,000 people in 2013 compared to 1,670 cases per 100,000 in 1995.¹⁷

WHO estimates that up to 64 % of the population, more than 9.5 million people, carry latent TB bacteria. These people are not (yet) ill and cannot transmit the disease. One in 10 latent cases is expected to become an active infection, but this figure is higher for people with HIV, malnutrition or diabetes, or smokers. Without treatment, up to two thirds of people ill with TB will die.¹⁸

Considering the estimated number of TB cases attributable to different risk factors, WHO estimated undernourishment and smoking were the two biggest risk factors in Cambodia.

The budget for TB work in 2018 was US$37 million. Between 2017 and 2018 there was a notable increase in funding from domestic sources.¹⁹ The estimated cost per patient treated was over $1000.

Malaria

Cambodia had approximately 23,000 cases of malaria and one death in 2017.²⁰ Five years earlier in 2013 there were 21,309 reported cases but 12 deaths.²¹ 

A majority of at-risk households have been provided with insecticide-treated bed nets. Unfortunately, a new strain of malaria that is resistant to the most commonly used drug combinations is a growing threat.

HIV/AIDS

There were an estimated 73,000 people living with HIV in Cambodia in 2018 and 880 people newly infected.²²  The number of new infections peaked at 21,000 in 1995. While there was a dramatic fall in the years since then, the 880 new infections in 2018 were a significantly above 2017 (590), 2016 (680) and 2015 (750). HIV incidence per 1,000 population has been falling, from 0.16 in 2010 to 0.09 in 2015 and 0.05 in 2018.²³ Among people aged 15–49 the prevalence in 2018 was 0.5, down from 0.6 in 2015 and 0.8 in 2010.

An estimated 59,000 people with HIV (81 percent of the total) are receiving antiretroviral therapy and an estimated 47,100 have a suppressed viral load.²⁴ HIV testing among key at-risk populations ranges from 67–75 percent. There have been huge advances made in reducing mother-to-child transmission of the virus: UNAIDS estimates that only 33 percent of pregnant women with HIV in 2010 were receiving antiretroviral medicine, but by 2018 this has jumped to 85 percent.²⁵

America’s health protection agency, the Centers for Disease Control, has said “The Government of Cambodia is a global leader in the fight against HIV.”²⁶

Cambodia has committed itself to achieving the global “90-90-90” targets by 2020 – 90 per cent of people with HIV know they have the virus, 90 per cent of those diagnosed are getting anti-retroviral medicine, and 90 per cent of those on treatment are virally suppressed.

Total spending on HIV/AIDS has generally been declining, from a high of US$58 million in 2010 to $44 million in 2015. Domestic funding has increased in both dollar terms and as a proportion of total funding.

There were an estimated 1300 AIDS-related deaths in 2018, down from 1500 in 2015 and 2500 in 2010.²⁷

Some 240 people in Rokar commune, Sangke district, Battambang, became infected with HIV in 2014 after the re-use of needles by an unlicensed doctor.²⁸

Avian flu

Avian flu virus was first detected in poultry in Cambodia in January 2004 and found in a person in January 2005.²⁹ Since then, the country has reported 56 human cases of the virus, 44 of them in people under 14, and 37 people have died.³⁰,³¹

In 2013, 26 people were confirmed to have contracted the virus, the highest for any country. Twelve died.³² The last reported outbreak in Cambodia was in March 2014.³³

There are 16 different types of avian flu, such as H5N1. This strain can infect humans. The U.N.’s Food and Agriculture Organization believes H5N1 is endemic in Cambodia’s poultry.³⁴

Other health concerns

Other issues facing Cambodia include:

• Malnutrition – a third of Cambodian children under 5 suffer from stunted growth due to malnutrition, although this has dropped from 40% in 2010. A 2014 report from the Asia Pacific Journal of Clinical Nutrition states that malnutrition costs Cambodia more than $400 million annually and contributes to the deaths of 6,000 children each year.³⁵
• Diarrhea diseases – UNICEF says 2,000 Cambodian children die from preventable diarrhea diseases annually.³⁶
• Acute respiratory infection – pneumonia is the third-highest cause of death in children under 5.³⁷
• Dengue fever – in 2016, there were 12,843 cases, with 18 deaths.³⁸ This fell dramatically in 2017, when there were 6,372 cases. The Ministry of Health issued a warning that cases could spike in 2018.³⁹

Last updated: 18 August 2019

Related to priority health concerns

• Social development
• Health services and centers
• Development assistance for health sector
• Health care and policy