Human H5N1 influenza infections in Cambodia 2005-2011: case series and cost-of-illness.

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$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 functional, social and economic impact of acute encephalitis syndrome in Nepal--a longitudinal follow-up study.

notes: PMCID: PMC3772013Open Access JournalOver 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families.Wellcome TrustUniversity of Liverpool Clinical Fellowshi

Asia-Pacific mussel watch: monitoring contamination of persistent organochlorine compounds in coastal waters of Asian countries

Contamination of persistent organochlorines (OCs) such as PCBs (polychlorinated biphenyls), DDT and its metabolites (DDTs), HCH (hexachlorocyclohexane) isomers (HCHs), chlordane compounds (CHLs), and HCB (hexachlorobenzene) were examined in mussels collected from coastal waters of Asian countries such as Cambodia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Philippines, Far East Russia, Singapore, and Vietnam in 1994, 1997, 1998, 1999, and 2001 to elucidate the contamination status, distribution and possible pollution sources and to assess the risks on aquatic organisms and human. OCs were detected in all mussels collected from all the sampling sites investigated. Considerable residue levels of p,p′-DDT and α-HCH were found in mussels and the concentrations of DDTs and HCHs found in mussels from Asian developing countries were higher than those in developed nations suggesting present usage of DDTs and HCHs along the coastal waters of Asian developing countries. On the other hand, lower concentrations of PCBs detected in mussels from Asian developing countries than those in developed countries indicate that PCBs contamination in mussels is strongly related to industrial and activities. To our knowledge, this is a first comprehensive report on monitoring OCs pollution in the Asia-Pacific region

Health System Resource Gaps and Associated Mortality from Pandemic Influenza across Six Asian Territories

BACKGROUND: Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia. METHODS AND FINDINGS: We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a "mild-to-moderate" pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as "avoidable" mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored. CONCLUSIONS: The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths

Proceedings of the Sixth International Workshop on Web Caching and Content Distribution

OVERVIEW The International Web Content Caching and Distribution Workshop (WCW) is a premiere technical meeting for researchers and practitioners interested in all aspects of content caching, distribution and delivery on the Internet. The 2001 WCW meeting was held on the Boston University Campus. Building on the successes of the five previous WCW meetings, WCW01 featured a strong technical program and record participation from leading researchers and practitioners in the field. This report includes all the technical papers presented at WCW'01. Note: Proceedings of WCW'01 are published by Elsevier. Hardcopies of these proceedings can be purchased through the workshop organizers. As a service to the community, electronic copies of all WCW'01 papers are accessible through Technical Report BUCS‐TR‐2001‐017, available from the Boston University Computer Science Technical Report Archives at http://www.cs.bu.edu/techreps. [Ed.note: URL outdated. Use http://www.bu.edu/cs/research/technical-reports/ or http://hdl.handle.net/2144/1455 in this repository to access the reports.]Cisco Systems; InfoLibria; Measurement Factory Inc; Voler

Field crop productivity in relation to soil properties in basaltic soils of eastern Cambodia

The basaltic landscapes of eastern Cambodia offer opportunities for increased production of non-rice crops but there is limited experimental data on the performance of these crops in relation to sowing sea son and soil types. The objective of the present study was to determine the emergence, growth and yield of maize. mungbean, peanut, sesame and soybean in farmers’ fields in relation to time of sowing (early wet season, EWS or main wet season, MWS), soil types and soil properties in the basaltic landscapes of eastern Cambodia. Experiments were conducted in Ou Reang 0v district during two years with contrasting rainfall. Peanut was the most reliable crop with successful establishment in both EWS and MWS, and harvestable yield at 80% of sites. Consistently high peanut yields were obtained on Koinpong Siem soils (2.1-3.4 t/ha), but MWS yields were depressed on average by 0.5 t/ha, possibly due to greater waterlogging. On Ou Reang 0v and Labansiek soils, peanut yields varied with site and season, but were generally higher in 2005 than 2004, again possibly due to lower waterlogging prevalence. By contrast, soybean failed on all occasions in the EWS either due to lack of crop establishment or yields that were too low to justify growing this crop. In the MWS, soybean yields of up to 3.3 t/ha were attained on Kompong Siem soils. Like peanut, soybean yields in the MWS were inconsistent on the Ou Reang 0v and Labansiek soils. Mungbean failed to produce harvestable yield on 63% of EWS sites, but on Kompong Sieni and Ou Reang 0v soil, if establishment was successful, mungbean produced grain yield of 0.9-1.3 t/ha. On the same soils in the MWS, mungbean yields were 0.2-1.5 t/ha. Mungbean failure on Labansick soils, in both EWS and MWS in 2004 and 2005 was attributed to soil acidity. Maize was inconsistent in its performance. Over 50% of sowings in 2005 failed due to drought which caused poor crop emergence and establishment. Yields up to 4.5 t/ha were obtained on Labansiek soils in 2004, but no yield was obtained in the same soil type in 2005. Drought, soil acidity and inadequate N fertilizer are suggested to be the main factors accounting for the unreliable performance of maize. High yields of all crops except sesame were achievable but actual yields were variable among soils, sites and season. Overcoming the unreliable performance of crops is the key to decreasing the risk associated with non-rice crop production on the basaltic soils

Mechanized rice establishment in Cambodia: Status quo ante summary report

5 page

How agricultural extension responds to amplified agrarian transitions in mainland Southeast Asia: experts’ reflections

Abstract Recent decades have witnessed widespread agrarian transitions in mainland Southeast Asia. This paper examines how agrarian transitions are shaped by multiple drivers of change, and how these interwoven processes have triggered shifts in agricultural extension practices in three countries in the Lower Mekong Basin: Laos, Cambodia, and Vietnam. Drawing on interviews with experts working on the fields of agrarian studies and rural development, this paper argues that agrarian transitions not only put a strain on agricultural extension systems in responding to evolving needs, but they also stimulate the co-production of innovative agricultural extension models to address gaps left by the limited presence of extensionists. The study gains insight into challenges faced by extensionists, including a lack of resources, skills, and capacities to meet growing needs, which simultaneously urged them to excel in their work performance. The paper highlights the proactive role of ‘champions’ in orchestrating collective efforts towards the co-production of innovative agricultural extension models (e.g. Metkasekor), and the formulation of pluralistic extension platforms in enabling such ‘co-learning-to-act’ practices. By translating these insights into the broader contexts of agricultural and rural development in the Mekong region and beyond, this paper aims to make a two-fold contribution. First, it will assert how the ‘business-as-usual’ extension model has failed to adequately address emerging needs as a result of agrarian transitions. Second, it will provide pathways for the recognition and legitimisation of the pluralistic extension approach that fosters stakeholders’ co-learning and productive engagement in extension practices