Epidemiology insights from the field in Cambodia

Abstract

In this thesis I demonstrate how my completed projects meet the required competencies for the Master of Philosophy in Applied Epidemiology (MAE) at the Australian National University. I undertook these projects while based at Institute Pasteur du Cambodge (IPC) in Phnom Penh, Cambodia.

My data analysis was a retrospective analysis of rabies post-exposure prophylaxis (PEP) use following a social media post (the death of a child from rabies due to a cat bite in February 2019) leading to an increase in the demand for rabies vaccination in Cambodia. To inform my study I conducted a literature review on rabies post exposure prophylaxis intervention and control. For this analysis, I used data collected by Phnom Penh IPC's Rabies center from February 2017 to December 2020 to compare vaccination rates for 132,391 patients, two years before the reported death (the social media post) an uptake in the two years after the death. I found that after the social media post was shared there was a significant increase in rabies vaccinations, especially in the 1 to 15 age group. This finding indicates that the use of social media to communicate evidence based public health measures may be beneficial in Cambodia and be considered in future programs and interventions to address rabies (Chapter 2).

For my epidemiology study, I investigated the knowledge, attitudes and practices of poultry workers in live bird markets in Cambodia in relation to avian influenza viruses (AIVs) to determine the impact of the COVID-19 pandemic in this field. My analysis showed that a significant correlation was found between the awareness of avian influenza among poultry workers and their failure to wear personal protective equipment while engaging in poultry-related tasks. These findings, directed public health activities will be able to concentrate on enhancing control and risk mitigation efforts. Details of this study, including my analysis and findings, are presented in chapter 3.

Chapter 4 details an evaluation of the Severe Acute Respiratory Illness (SARI) system at two paediatric hospitals in Cambodia. This system has been in operation since 2014 and is used to facilitate information management, inform the hospital staff of the current epidemiological system, provides data for appropriate evidence-based health planning and prevention activities. I evaluated eight attributes of the SARI surveillance system using data collected from 2014 to 2022. I used the CDC evaluation attributes to assess the system. There were inconsistencies and missing information in data collection. These results will contribute to the improvement of this system by providing information to streamline and increase consistency in data collection and reporting for both hospitals.

For my disease outbreak investigation, I joined the Communicable Disease Control Department at the Cambodian Ministry of Health to investigate an outbreak in Pursat province where methanol poisoning was suspected at a funeral. I collected data from a field site and hospitals for analysis and interpretation. This outbreak resulted in the death of a 36 year old male and the admission of 27 cases to hospital for treatment. While we found no evidence of methanol. Excessive consumption of rice wine was suspected to have led to the death and hospitalisations. We presented our findings to the Ministry and community. Our findings support continuous alcohol product monitoring and show that health promotion of such dangers are essential to prevent future deaths from similar products. Details of this investigation are presented in Chapter 5.

In Chapter 6 of this thesis, I have outlined my teaching experiences. I presented lessons from the field to my MAE cohort on conducting a Knowledge, Attitudes and Practices survey and also taught on study protocol to the Intermediate level Field Epidemiology Training Program students in Cambodia. Show more