Wednesday, November 7, 2012

Community action prevents childhood pneumonia and diarrhoea in Cambodia

Health care worker, Kong Sokhai, examines baby Sakada.
© UNICEF Cambodia/2012/Julie Masis
It is Wednesday morning in Battambang province, just over almost 300 kilometres north of the Cambodian capital, Phnom Penh, and baby Ron Sakada, who has a cough and a runny nose, waits in his mother’s lap at the Russey Kraing Health Centre.

His mother bought him to the centre thanks to the keen observation of village chief and village health support volunteer, Mr. Mea Thy. “Yesterday I was going about my daily activities, and I saw the child breathing fast and coughing,” Thy said. “I had to come here anyway, so I brought the child and the mother here.”
Health volunteers a bridge between community and health system

Thy is one of two trained health support volunteers who work in the village in Battambang province. UNICEF, with consolidated funding from the Lithuanian, Norwegian and Danish Committees for UNICEF, provides technical and financial support for the training of Village Health Support Group Volunteers who are elected by their communities to provide basic health education to prevent childhood illnesses, identify danger signs in children and support timely referrals to health facilities.

The volunteers are trained to recognise the symptoms and danger signs of pneumonia and diarrhoea and provide an important bridge between the community and the health system.

Diarrhoea and pneumonia are among the leading causes of deaths among children under-five in Cambodia.  The world’s leading medical journal, ‘The Lancet’ [2010] attributes 7 per cent of child deaths in Cambodia to diarrhoea, and 28 per cent to pneumonia.

Thy has not recently encountered any severe cases of diarrhoea but says his training has made him confident that he knows what to do. “When a child has diarrhoea, the mother should give him [fluids],” he said. “And if the child is not better, she should bring him or her to the health centre.” As a village health support volunteer he also delivers the first line of treatment for diarrhoea: providing packets of oral rehydration solution (to rehydrate the child) and zinc tablets (to support the immune system).

Health centre provides quality services
Meanwhile, at the Russey Kraing health centre, baby Sakada is being seen by a health care worker, Kong Sokhai, who takes his temperature and counts the number of breaths Sakada takes per minute.

The health workers have been trained to recognize difficulty in breathing as one of the signs of pneumonia. They check if the child’s chest is indrawn and the respiratory rate. There’s cause for concern if there is rapid breathing of 40 breaths per minute for children aged 1 and older; or 50 breaths per minute for children under 1 year of age.
Fortunately, Sakada, does not have pneumonia but his mother is urged to be vigilant, “Watch the child closely, especially his breathing,” Sokhai advises her before she leaves. “And bring the child back to the health centre quickly if you see significant changes.”

Kong Sokhai’s next patient is Mrs. Lam Theun’s baby who has diarrhoea and a temperature. The previous week she had tried to treat the problem herself, buying pills from the local pharmacy. However, because she only went to school for three years and can barely read, she says she wasn’t sure what the names of those pills were.

“I bought the medicine from someone I trust, from someone who lives in my village,” Theun said. “But since my child didn’t get better, I brought him here.”

Kong Sokhai examines Theun’s baby and provides her with packets of oral rehydration solution, advising why and how to use them. With pictures to illustrate severe diarrhoea, he also shows mothers at the health centre what to look out for. “If you observe any of these symptoms– diarrhoea with blood, diarrhoea with vomiting, diarrhoea with fever, diarrhoea without drinking or eating, or diarrhoea that does not get better after three days – you have to quickly bring the child back to the health centre.”

The health workers at Russey Kraing Health Centre and health centres in 17 operational districts receive UNICEF-supported on-the-job training and supportive supervision thanks to consolidated funding from the Danish, Lithuanian and Norwegian Committees for UNICEF. 

According to Sokhai, the diseases he sees most often at the health centre, vary according to the seasons. Diarrhoea is more common during the dry season, when water is scarce. Now, in the middle of the rainy season, he says he sees more colds and pneumonia.

Together, the community outreach of the volunteer health support group and quality services at the health centre are helping to prevent and treat cases of childhood pneumonia and diarrhoea and accelerate Cambodia’s progress on child survival.

By Julie Masis and Denise Shepherd-Johnson

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