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Abstract Background Limited opportunities to generate income in community‐protected areas (CPAs) often lead to the illegal harvesting of wildlife and natural resources, undermining the aim of protected areas. Sustained livestock production can be an alternative income source. Objectives To understand the effectiveness and feasibility of livestock production in CPAs. Methods We conducted a livestock asset transfer intervention in 25 CPAs across three agroecological zones in Cambodia. We monitored livestock mortality, consumption and sales of livestock over 2 years. Participant observations and structured questionnaires were conducted to elicit information about constraints for livestock production perceived by the participants. A total of 756 households were recruited and 320, 184 and 252 households received chicken, pigs and cattle, respectively. All participants received technical training in livestock production and biosecurity management practices. Results After the intervention, the number of chickens, pigs and cattle increased on average by 5.9 (range: 0.3–26.3), 0.5 (−1 to 2.7) and 0.12 (0–0.35) per 1 input animal, respectively. The extent of increase was significantly different between zones only for chickens (Kruskal–Wallis test p = 0.004). The number of chickens and pigs sold per household was significantly different among zones. We observed that training was ineffective to alter livestock management practices in some CPAs, which partially explains their suboptimal performance of livestock production. Conclusions Understanding contextual factors required for successful livestock production in CPAs is crucial for improving livelihoods and preventing biodiversity loss in Cambodia.

Abstract Social mixing patterns are key determinants of infectious disease transmission. Mathematical models parameterised with empirical data from contact pattern surveys have played an important role in understanding epidemic dynamics and informing control strategies, including for SARS-CoV-2. However, there is a paucity of data on social mixing patterns in many settings. We conducted a community-based survey in Cambodia in 2012 to characterise mixing patterns and generate setting-specific contact matrices according to age and urban/rural populations. Data were collected using a diary-based approach from 2016 participants, selected by stratified random sampling. Contact patterns were highly age-assortative, with clear intergenerational mixing between household members. Both home and school were high-intensity contact settings, with 27.7% of contacts occurring at home with non-household members. Social mixing patterns differed between rural and urban residents; rural participants tended to have more intergenerational mixing, and a higher number of contacts outside of home, work or school. Participants had low spatial mobility, with 88% of contacts occurring within 1 km of the participants’ homes. These data broaden the evidence-base on social mixing patterns in low and middle-income countries and Southeast Asia, and highlight within-country heterogeneities which may be important to consider when modelling the dynamics of pathogens transmitted via close contact.

BackgroundMost of human diarrheal pathogens are zoonotic, and transmission of the pathogens can occur by contaminated food, water, environment and direct contact with animals especially for livestock keepers. Yet little is known of the relative importance of different risk factors especially in under-studied countries. The objectives of this study were to identify risk factors for diarrhea in livestock keepers in Cambodia and detect diarrhea-causing pathogenic bacteria in both humans and livestock within a One Health approach. Of special interest were the links between diarrhea and food consumption and livestock-keeping.Materials and methodsWe used an existing dataset from a questionnaire survey conducted in 400 livestock farms in Prey Veng and Kampot Prefectures between February and March 2013 as well as laboratory results on bacterial isolation from fecal and swab samples from livestock and poultry, and human stool samples. Laboratory results were available for up to three animals of each species kept by a household, and for up to three human samples from households reporting at least one case of human diarrhea in the previous 2 weeks. Presence of Escherichia coli, Shigella spp. and Salmonella spp. was investigated in both animal and human samples, in addition to Aeromonas spp., Vibrio spp. and Plesiomonas spp. in animal samples and Campylobacter spp. in human samples. Univariable and multivariable risk factor analyses were performed by generalized linear mixed model.ResultsHousehold-level diarrhea incidence rate was 9.0% (36/400). The most statistically significant factor associated with diarrhea in multivariable analysis was water treatment for drinking and cooking (OR = 0.33, 95%CI: 0.16–0.69, p = 0.003), followed by number of days consuming egg within 2 weeks (OR = 1.16, 95%CI: 1.04–1.29, p = 0.008), number of children under 5 years old (OR = 1.99, 95%CI: 1.14–3.49, p = 0.016) and keeping poultry (OR = 0.36, 95%CI: 0.14–0.92, p = 0.033). Animal samples for bacterial culture test were collected at 279 cattle, 165 pig and 327 poultry farms, and bacteria were detected from 6 farms with the isolation of Escherichia coli O157 (non H7) from 1 cattle and 1 pig sample, Aeromonas caviae from 1 pig sample and Salmonella spp. from 3 chicken samples. In human samples, 17 out of 67 individual samples were positive for the culture test, detecting Escherichia coli O157 (non H7) from 7 samples and Shigella spp. from 10 samples. None of the households where target bacteria were detected from animal samples had human samples collected due to lack of diarrhea episodes in the household.ConclusionsIt has often been hypothesized that keeping livestock may increase the incidence of diarrhea through multiple pathways. Contrary to this, we found livestock-keeping was not associated with increased risk, but food-related behavior and children under 5 years of age were strongly associated with increased risk. We discuss mediating and confounding factors and make recommendations for reducing the burden of diarrheal disease in Cambodia and more widely in low- and middle-income countries.

Biosecurity and preventive animal health services in Cambodian smallholder backyard farming systems are often limited, leading to an over-reliance on antibiotics. However, data on factors influencing antibiotic use in these settings are lacking. We conducted a study in two rural Cambodian farming communities to investigate how social and contextual influences affect both human and animal antibiotic use behaviours. Data were collected in three phases: a baseline household census to enumerate village residents, a social network survey to understand village-level social ties, and in-depth interviews to elicit information about the influence of social ties on their decision-making processes. Primary outcome measures included knowledge, attitudes and practices surrounding antibiotic use, and awareness of issues relating to antibiotic resistance. Participants commonly accessed antibiotics or learned animal antibiotic use practices through village-level informal sources such as pharmacies or animal health workers. While most participants reported not using antibiotics for animal growth promotion or illness prevention, misconceptions surrounding both antibiotic effectiveness and resistance were common. Social networks capturing informal, work-related and health-related social ties showed that familial connections and geographic proximity were of primary importance for information sharing. Using exponential random graph models, we demonstrated that familial ties, and closer geographic and geodesic distance, were associated with similarity in overall antibiotic knowledge and attitudes. The informal private sector plays a major role in provision of antibiotics and antibiotic-related information in backyard farming communities, but such information is maintained within close social groups. This demonstrates the importance of engaging village-level informal sources in the provision of antibiotic-related information for both human and animal health, as well as in potential interventions to encourage appropriate antibiotic behaviours in lower-resourced settings.

Background: Taeniasis/cysticercosis, caused by the pork tapeworm Taenia solium , represents an important public health and economic burden in endemic countries. However, there is a paucity of data on infection among pigs in many parts of Southeast Asia, particularly Cambodia. We aimed to estimate seroprevalence of porcine cysticercosis, and investigate husbandary practices and knowledge of the disease among livestock workers, across different pig sector units in south-central Cambodia., Methods: A cross sectional survey was conducted among pig smallholders, commercial farms, slaughterhouses and traders/middlemen from south-central Cambodia, selected through multistage sampling in proportion to local pig populations sizes. Questionnaires were administered to 163 pig workers to obtain data pig production, trading and slaughtering practices. Sera from 620 pigs were tested for Taenia antigens using a commercial ELISA-based test. Associations between seroprevalence and pig husbandry practices were assessed using generalised linear mixed models, adjusting for random-effects at herd-level., Results: Of 620 pigs sampled, 29 (4.7%) tested positive for Taenia antigens. Seropositivity was associated with type of pig sector unit ( P  = 0.008), with the highest seroprevalence among pigs sampled from traders/middlemen (16.7%; 95% CI: 4.4%-37.8%), smallholders (7.6%; 95% CI: 3.8%-14.1%) and slaughterhouses (4.1%; 95% CI: 2.0%-7.5%), while none of the pigs sampled from small/medium or large commercial farms tested positive. Although the vast majority of pigs were penned, practices that might facilitate human-to-pig transmission, such as use of household waste and surface water sources to feed pigs, were prevalent among smallholders. However these were not found to be significantly associated with infection. Of 163 interviewed pig workers, 115 (70.5%) were aware of porcine cysticercosis, and 78 (47.8%) also knew it could affect humans. Twenty-six (16.0%) reported having noticed lesions typical of cysticercosis in their pigs., Conclusions: Despite most pigs being kept confined in pens rather than raised in free-roaming systems, porcine cysticercosis appears to be endemic in south-central Cambodia and is associated with smallholder production. Further investigation is needed to identify which Taenia species are causing infections among pigs, and how seroprevalence and zoonotic risk may vary across the country, to understand the risks to public health and assess where interventions might be needed.

Introduction: Human influenza infection poses a serious public health threat in Cambodia, a country at risk for the emergence and spread of novel influenza viruses with pandemic potential. Prior pandemics demonstrated the adverse impact of influenza on poor communities in developing countries. Investigation of healthcare resource distribution can inform decisions regarding resource mobilization and investment for pandemic mitigation., Methods: A health facility survey performed across Cambodia obtained data on availability of healthcare resources important for pandemic influenza response. Focusing on five key resources considered most necessary for treating severe influenza (inpatient beds, doctors, nurses, oseltamivir, and ventilators), resource distributions were analyzed at the Operational District (OD) and Province levels, refining data analysis from earlier studies. Resources were stratified by respondent type (hospital vs. District Health Office [DHO]). A summary index of distribution inequality was calculated using the Gini coefficient. Indices for local spatial autocorrelation were measured at the OD level using geographical information system (GIS) analysis. Finally, a potential link between socioeconomic status and resource distribution was explored by mapping resource densities against poverty rates., Results: Gini coefficient calculation revealed variable inequality in distribution of the five key resources at the Province and OD levels. A greater percentage of the population resides in areas of relative under-supply (28.5%) than over-supply (21.3%). Areas with more resources per capita showed significant clustering in central Cambodia while areas with fewer resources clustered in the northern and western provinces. Hospital-based inpatient beds, doctors, and nurses were most heavily concentrated in areas of the country with the lowest poverty rates; however, beds and nurses in Non-Hospital Medical Facilities (NHMF) showed increasing concentrations at higher levels of poverty., Conclusions: There is considerable heterogeneity in healthcare resource distribution across Cambodia. Distribution mapping at the local level can inform policy decisions on where to stockpile resources in advance of and for reallocation in the event of a pandemic. These findings will be useful in determining future health resource investment, both for pandemic preparedness and for general health system strengthening, and provide a foundation for future analyses of equity in health services provision for pandemic mitigation planning in Cambodia.

Background: Southeast Asia has been identified as a potential epicentre of emerging diseases with pandemic capacity, including highly pathogenic influenza. Cambodia in particular has the potential for high rates of avoidable deaths from pandemic influenza due to large gaps in health system resources. This study seeks to better understand the course and cost-of-illness for cases of highly pathogenic avian influenza in Cambodia., Methods: We studied the 18 laboratory-confirmed cases of avian influenza subtype H5N1 identified in Cambodia between January 2005 and August 2011. Medical records for all patients were reviewed to extract information on patient characteristics, travel to hospital, time to admission, diagnostic testing, treatment and disease outcomes. Further data related to costs was collected through interviews with key informants at district and provincial hospitals, the Ministry of Health and non-governmental organisations. An ingredient-based approach was used to estimate the total economic cost for each study patient. Costing was conducted from a societal perspective and included both financial and opportunity costs to the patient or carer. Sensitivity analysis was undertaken to evaluate potential change or variation in the cost-of-illness., Results: Of the 18 patients studied, 11 (61%) were under the age of 18 years. The majority of patients (16, 89%) died, eight (44%) within 24 hours of hospital admission. There was an average delay of seven days between symptom onset and hospitalisation with patients travelling an average of 148 kilometres (8-476 km) to the admitting hospital. Five patients were treated with oseltamivir of whom two received the recommended dose. For the 16 patients who received all their treatment in Cambodia the average per patient cost of H5N1 influenza illness was US$300 of which 85.0% comprised direct medical provider costs, including diagnostic testing (41.2%), pharmaceuticals (28.4%), hospitalisation (10.4%), oxygen (4.4%) and outpatient consultations (0.6%). Patient or family costs were US$45 per patient (15.0%) of total economic cost., Conclusion: Cases of avian influenza in Cambodia were characterised by delays in hospitalisation, deficiencies in some aspects of treatment and a high fatality rate. The costs associated with medical care, particularly diagnostic testing and pharmaceutical therapy, were major contributors to the relatively high cost-of-illness.

The synthesis of cyclic alkenyl boronic half acids from vinyl and propenyl boronic esters and homoallylic alcohols by ring-closing metathesis is reported. The method is compatible with both conventional and microwave heating and comparable yields are obtained under both conditions. The cyclic alkenyl boronic acids participate in Suzuki-Miyaura coupling reactions in good yields.

SAA and SIA were assayed in the sera of 172 infertile couples and in the CM of the women and 18 control subjects. Complete infertility evaluation was performed in all subjects except the controls. Results of these studies were correlated with PCT's. Sperm antibodies were detected in the CM of 25.6% of infertile women and in the sera of 12.7% of female and 6.4% of male subjects. No sperm antibodies were found in the CM of controls. Sperm antibodies were present exclusively in sera of 8.1% of women and in the CM of 20.9%. In only 4.7% both serum and CM contained antibodies. A significantly higher incidence of sperm antibodies was found in the sera of women and in CM and sera of all couples with unexplained infertility compared to those with explained infertility. The presence and the number of liver spermatozoa in CM collected for PCT's were found to be significantly related to the existence of SAA and SIA in CM and serum. Stepwise multiple regression analysis indicated that SAA or SIA antibodies in CM and SAA in female serum have a significant negative correlation with endocervical PCT, whereas sperm motility has a positive correlation. These factors, together, accounted for 24.5% of variance. These data indicate that the appearance of SAA and SIA in CM is not related to their presence or titer in blood serum and that the PCT is a reliable screening method when sperm antibodies are suspected to exist in CM and to a lesser extent in serum.

The antifertility effect of norgestimate (Ng) 0.125 mg in combination with ethinyl estradiol (EE) 0.035 mg on cervical mucus of 5 apparently normal and ovulatory volunteer women was studied for 2 cycles: a control cycle followed by a study cycle in which the medication was given. Throughout both cycles, basal body temperature, cervical mucus properties, sperm penetration in cervical mucus and karyopyknotic index of vaginal cells were evaluated. Disappearance of cyclicity of these parameters in the study cycle as well as monophasic basal body temperature were suggestive of inhibition of ovulation caused by the combination pill. Deterioration of cervical mucus properties throughout the study cycle and inhibition of sperm penetration may be a reflection of anovulation. However, a direct antifertility effect of Ng on cervical mucus cannot be excluded.

The antifertility mechanism of a new progestin preparation, ethylnorgestrienone (13 beta-ethyl-17 alpha-ethynyl-17-hydroxy-gona-4,9,11-triene-3-one) (R2323), was evaluated. The compound was administered orally in doses of 5 mg weekly to seven subjects for a total of nine treatment cycles. Each woman served as her own control and was studied during a normal menstrual cycle followed by a cycle in which she received R2323. Serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone, as well as cervical mucus properties, were studied serially during the control and treatment cycles. Results indicated that all control cycles were ovulatory. Ovulatory gonadotropin patterns were observed in four treated cycles, but preovulatory FSH and LH peaks and progesterone production during the luteal phase were suppressed significantly. Estradiol levels showed an early increase during the follicular phase and a significantly decreased preovulatory peak. Cervical mucus properties were altered and sperm penetration in cervical mucus was inhibited in all treatment cycles. These findings suggest that at least two different factors might be involved in the contraceptive mechanism of R2323: (1) alteration of the ovulatory process and progesterone production, and (2) cervical mucus changes leading to inhibition of sperm migration.