Strategies to Prevent Dangerous Diarrhea

A sick young Cambodian girl in Pailin is located in western Cambodia. (Photo: AP)

Nuch Sarita, VOA Khmer
Washington, D.C Friday, 21 May 2010

"The persons who have cholera have a loss of body fluids leading to dehydration and a life-threatening medical condition."

A prolonged hot season in Cambodia has brought about an increasing number of cases of severe diarrhea, including more than 30 that were fatal.

Diarrhea can be dangerous because it causes dehydration, Taing Tek Hong, a Florida-based physician, said on Thursday.

“You need to drink a lot of water or use oral rehydration solutions,” he said, as a guest on “Hello VOA.”

Rehydration solutions are “a mixture of clean water, salt and sugar, which can be prepared safely at home,” he said. “The glucose in the solution is important because it forces the small intestine to quickly absorb the fluid and minerals.”

“Death can follow severe dehydration if body fluids are not replenished,” he said.

Diarrhea can come from infections caused by bacteria, viruses or parasites in water. Water can be contaminated with human waste from sewage, septic tanks, wells and ponds. Diarrhea can be spread from person to person if they don’t take care of personal hygiene. Food can also cause diarrhea if it is prepared or stored in unclean conditions.

“Fish and seafood from polluted water may also contribute to the disease,” Taing Tek Hong said. “Infection is more common when there is a shortage of clean water for drinking, cooking and cleaning.”

The most common cause of diarrhea is an infection from a virus known as the norovirus,” he said. “It is transmitted by food that is contaminated by sick food-handlers or by infected person. Norovirus spreads very rapidly in communities such as overnight camps, prisons, dormitories and cruise ships. Rotavirus and E. Coli are the two most common causes of diarrhea in developing countries.”

Cholera, meanwhile, is an acute diarrhea caused by an infection of the intestine, he said.

“The persons who have cholera have a loss of body fluids leading to dehydration and a life-threatening medical condition,” he said. “Without treatment, death can occur within hours. A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. The source of the contamination is usually the waste of an infected person. The disease can spread rapidly in areas with inadequate drinking water.”

To prevent diarrhea, Taing Tek Hong recommends drinking only water that has been boiled.

“Other safe beverages include tea, soda, Coca Cola or Sprite with no ice,” he said. “Eat only foods that have been fully cooked and are still hot. Avoid undercooked seafood or shellfish. Make sure all vegetables are cooked.”

And to prevent dehydration, continued feeding and rehydration are important. Zinc tablets can help reduce the severity and duration of diarrhea. And children should be immunized against the rotavirus that can cause the disease.

“Washing your hands with soap could potentially reduce the number of diarrhea cases,” Taing Tek Hong said. “The foundations of good health are safe water, adequate sanitation and proper hygiene.”

Many Succumb to Diarrhea in Prolonged Heat

Chun Sakada, VOA Khmer
Phnom Penh Thursday, 13 May 2010

Health officials are now meeting with villagers to explain to them proper hygiene and food preparation.

Serious diarrhea pushed by a prolonged hot season has killed at least 35 villagers since March, including two who died in Kampong Cham province on Wednesday, officials said.

The most serious cases occurred in Ratanakkiri province, where 15 people died in just over two weeks in April. And since March, seven total have died in Kampong Cham province, five in Kratie, four in Battambang, and two each in Prey Veng and Kampong Chhnang, according to provincial health officials.

The officials say the villagers drank water or ate food infected with microbes exacerbated by high temperatures. Cambodia is undergoing a prolonged hot season, which began in late March and has continued into May, when little rain has fallen.

Typically, Cambodians expect rainfall sometime shortly after Khmer New Year, in mid-April.

Minister of Health Mam Bunheng is now urging provincial offices to monitor the development of diarrhea outbreaks, following Wednesday’s deaths in Kampong Cham.

In that case, two people died in a rural village called Trapeang Chua in Chamkar Leur district, near the border of central Kampong Thom province. In that village, 185 villagers alone have severe diarrhea, according to Yim Navy, deputy chief of the district health center.

Sok Touch, chief of the Ministry of Health’s infectious disease department, said he and other health officials took a delivery of serum and medicine to the area Thursday morning.

Health officials are now meeting with villagers to explain to them proper hygiene and food preparation. Health officials say people should urinate and defecate in proper toilets, keep their houses clean and be careful with cooking and cleaning water.

In our ricefields we have the Viet crocs, in our forest we have the deadly snakes: Plight of Khmer villagers in Svay Rieng

Away from the insdicrete gaze with butt stark naked

11 March 2010
By Kang Kallyann
Cambodge Soir Hebdo
Translated from French By Tout Louse Laut Rek
Click here to read the article in French

In rural areas, hygiene and the availability of toilets remain an elusive luxury. The tough living conditions led to human dramas that are both tragic and ridiculous.

The tragedy is taking place in Svay Rieng province, near the Cambodian-Viet border. During a recent coverage on the border dispute [near Koh Kban Kandal village where the Viet encroachment took place], a villager told me this story: four villagers died there in the last few month because they were bitten by snakes while they were relieving themselves in the forest. At first, I had a hard time holding my laughter when I heard about this story.

Nevertheless, the villager insisted: this snake problem caused a lot of trouble in the village and it is far from being resolved. With the lack of decent toilets, the villagers had no choice but to relieve themselves out in the open air, away from the village and away from any indiscrete gaze. To the chagrin of the villagers, their open air toilet is infested with snakes … but the villagers have no other choice, and they are exposing themselves to this danger on a daily basis. What could be viewed as a joke is in fact a tragedy for these villagers. When I discussed this topic with a local official, he prefers not to talk too much about it: of course, “some villagers” died recently “because of the snakes.” For their safety, the youths were asked to learn how to shoo away the reptilian pests. And, that was the end of the story.

So you think this is funny, eh? Now, think about the families of the victims when they learn that a simple toilet could have saved the life of their loved ones. Think also about this young woman who was raped in the forest, or better yet, think about this young man who was killed by strangers when he was relieving himself. Now you can see that these cases are not laughable at all, but that they are in fact ridiculous! Now, let’s see: how can we explain the contrast between these dirt poor provinces and the luxurious roads that filled the capital city of Phnom Penh? Do you think that, in the 21st century Cambodia, it is acceptable for forests surrounding villages to be strewn with human feces?

Some city dwellers have the habit of showing off their disdain to people who live in isolated villages. But, would these city dwellers be at ease if they had to risk exposing their intimacy, their health, or even worst, their life just to be able to relieve themselves? Hygiene is not always within the reach of everybody in Cambodia just yet. Right now, in Phnom Penh, there is countless number of cosmetic stores where costly plastic surgery is being offered to the public, where young women who are so preoccupied by their look can have their skin whitened up, and yet, there are still a large number of Cambodians who live without using any soap at all. Based on these observations, it is clear that what is supposedly ridiculous is not always what we believe it would be at all.

Quite often, the entrance to villages would bear large signs clamoring: “drink and live healthily to protect your health.” Furthermore, several NGOs insist that they are promoting hygiene and that they are building infrastructures to allow access to drinking water, or building toilets. Keep in mind also that the cost of the most basic toilet is about 140,000 riels, i.e. about $35, with all the numbers in mind, I feel less inclined to smile nowadays when I read stories in the newspapers about villagers having to face snakes.

Hand Washing a Low Priority in Rural Cambodia, Study Says; ADRA Improves Hygiene Practices

31 Dec 2008
By Satha Sin, ADRA Cambodia / Nadia McGill and Hearly Mayr, ADRA International
Source: Adventist Development and Relief Agency (ADRA) International
Website: http://www.adra.org

Silver Spring, Maryland - Only one in four rural Cambodians practice appropriate hand washing regardless of access to clean water and hygiene knowledge, according to a recent study presented by ADRA at the World Federation of Public Health Associations/American Public Health Association (WFPHA/APHA) Annual International Health Breakfast held in San Diego, California.

Dr. Leonard Uisetiawan, provincial projects advisor for the ADRA office in Phnom Penh, Cambodia, who presented the study, discussed the perception and hand washing practices among rural Cambodians. According to Dr. Uisetiawan, the project concluded that less than 26 percent of rural Cambodians use good hand washing techniques regardless of access to clean water and hygiene knowledge. In addition, less than 6 percent of child caretakers properly washed their hands after changing a child's soiled diaper or after defecation.

This research, funded by Colgate-Palmolive through the American Public Health Association, also highlighted that the practice of hand washing in Cambodian homes is not dependent on the availability of soap, water, buckets, accessibility to hand washing areas, household size, amount of children, mother's vocation, or educational level.

"There is a belief that hand washing with soap is a waste of money, water, and time," said Satha Sin, public relations officer for ADRA Cambodia.

Through the findings of this project, ADRA will provide information to parents that will help them improve the health of their children, by promoting good habits as role models. ADRA hopes that parents' approach to teaching personal hygiene, specifically hand washing, will be modified.

"By utilizing traditional values, perspectives, and community beliefs, we expect to be able to increase the number of villages that practice proper hand washing," said Dr. Uisetiawan.

The Hand Washing Research Project has been conducted over the past year as part of "Phum Mittapheap Koma", a three-year initiative aimed at improving rural health and reducing morbidity and mortality among more than 22,500 women and 17,400 children in the Kampong Thom province.

According to the Cambodia Demographic Health Survey, nearly nine percent of Cambodian children die before the age of five as a result of diarrhea, which is associated closely with the ingestion of contaminated food or water. The study identified this as one of the leading causes of death among young children.

ADRA has been active in Cambodia since 1988 in the three main sectors of Health, Water and Sanitation, and Food Security.

ADRA is a non-governmental organization present in 125 countries providing sustainable community development and disaster relief without regard to political or religious association, age, gender, race, or ethnicity.

Additional information about ADRA can be found at www.adra.org.

Author: Satha Sin, ADRA Cambodia / Nadia McGill and Hearly Mayr, ADRA International.

Media Contact: John Torres, Senior Public Relations Manager, ADRA International 12501 Old Columbia Pike Silver Spring, MD 20904 Phone: 301.680.6357 E-mail: Media.Inquiries@adra.org

Cambodian Gov't Calls for Cooperation to Fulfill Sanitation Goals

2008-12-19
Xinhua

Alarming statistics on the state of rural sanitation have led the Cambodian government to call for cooperation at all levels, national media reported Friday.

Only 16 percent of people in Cambodia's rural areas have access to toilets, Chea Sophara, Minister of Rural Development, was quoted by the Phnom Penh Post as saying.

"Cambodian people's understanding of living in a hygienic environment is still low compared to neighboring countries," Chea Sophara said.

He said that the ministry's goal was to ensure that at least 20 percent of the population in the countryside have access to toilets by the year 2010, and 30 percent by 2015, to reach the millennium development goal.

But this would be tough without full cooperation at all levels of government, he added.

"If officials from all departments do not cooperate well with villagers when they are on duty, it will be useless and the development situation will stay the same," he said.

Cambodia lacks toilets

A foreign tourist visiting Cambodia provided this description about this toilet in Cambodia: And here's where I had to go to the bathroom at the ferry crossing. It was a squatter toilet, raised about 6 feet above the river-you just go straight into the river! (Photo: www.camereye.com)

13-11-2207
By Ky Soklim
Cambodge Soir
Translated from French by Luc Sâr

The conclusions from a National Forum on rural hygiene underscore deficiencies which threaten public health, and which constitute also obstacles to the country’s development.

Only 16% of Cambodians living in the countryside own a toilet, in comparison to 99% in Thailand, 61% in Vietnam, and 30% in Laos. “This number shows that rural people do not understand well family hygiene. Therefore, they are more prone to catching diseases. This pushes them into poverty,” launched Yim Chhay Ly, the secretary of state on the ministry of rural development, on Tuesday 13 November, during the National Forum on rural hygiene.

In less than one decade, thanks to the economic growth, the rate of drinking water went from 24% in 1998 to 45% in 2006. The number of individual toilets has also increased: it was 9% in 1998 versus 16% in 2006. According to Yim Chhay Ly, this improvement is not satisfactory yet. The objective of the ministry of rural development is to meet a goal of 50% of rural people who will benefit from purified water and 30% of housings will have toilets in 2015. Up to now, 60 villages in 9 out of 24 provinces have encouraged their people to stop relieving themselves outside of a toilet.

According to Yim Chhay Ly, because of the lack of toilets and hygiene, 20% of children less than 5-year-old suffer from diarrhea. The result of a World Health Organization investigation shows that for each $1 invested in hygiene, $23 is saved in health care cost. During the Forum, Hun Sen called on the ministries involved to find solutions for flooded areas. “This is not a small problem when people have to relieve themselves in water, there are strong risks of infections,” Hun Sen said.