A CUTE R ESPIRATORY I NFECTION

Acute respiratory infection (ARI) is one of the leading causes of childhood morbidity and mortality throughout the world. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths caused by ARI. In the 2014 CDHS, the prevalence of ARI was estimated by asking mothers whether their children under age 5 had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. These symptoms are compatible with ARI. It should be noted that the morbidity data collected are subjective—that is, they are based on the mother’s perception of illness with no validation from medical personnel—and that the prevalence of ARI is subject to seasonality.

Table 14.4 shows the percentage of children under age 5 with symptoms of ARI during the two weeks preceding the survey according to selected background characteristics. Six percent of children under age 5 showed ARI symptoms at some point in the two weeks preceding the survey. Only about 3 percent of children under age 6 months experienced ARI symptoms. The prevalence of ARI increased to 6 percent among children age 6-11 months and 7 percent among those age 12-23 months. After age 23 months, ARI prevalence decreased with increasing age. The prevalence of ARI was significantly higher among children whose mothers smoke (10 percent) than among children whose mothers do not smoke (5 percent). There was only minor variation in the prevalence of ARI symptoms between urban and rural children.

65

"All vaccines" includes BCG, measles and three doses each of DPT or tetravalent or pentavalent and polio vaccine.

156 • Child Health

Table 14.4 Prevalence and treatment of symptoms of ARI

Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey, and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Cambodia 2014

Among children under age 5: Among children under age 5 with symptoms of ARI:

Background

characteristic Percentage with

symptoms of ARI¹ Number of children

received antibiotics Number of children

Coal/lignite 5.0 554 (78.7) (86.1) 28

Charcoal 5.5 5,269 69.0 81.6 290

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.

na = Not applicable LPG = Liquid petroleum gas

1 Symptoms of ARI (cough accompanied by short, rapid breathing that was chest-related) are considered a proxy for pneumonia.

2 Excludes pharmacy, shop, and traditional practitioner

3 Includes grass, shrubs, and crop residues

The proportion of children with ARI symptoms was negatively associated with wealth quintile.

Seven percent of children living in households in the lowest wealth quintile experienced ARI symptoms, as compared with 4 percent of children living in households in the highest wealth quintile. There were significant provincial variations in the prevalence of ARI, ranging from a low of 1 percent in Mondul Kiri/Ratanak Kiri to a high of 12 percent in Kampong Chhnang and Preah Sihanouk/Koh Kong.

About 7 of 10 children under age 5 (69 percent) with a cough and rapid breathing were taken to a health facility or provider to seek treatment or advice. Children of mothers with no schooling or with a primary education were less likely to receive treatment for ARI symptoms (66-67 percent) than were children of mothers with a secondary education or higher (75 percent). About 8 in 10 children with ARI symptoms were given antibiotics.

14.4 F

Fever is a primary manifestation of several acute infections in children. Fever and other infections can contribute to high levels of malnutrition and mortality. The 2014 CDHS asked mothers whether their children experienced fever during the two weeks preceding the survey.

Table 14.5 shows the percentage of children under age 5 who had a fever during the two weeks preceding the survey according to selected background characteristics. Overall, 28 percent of children under age 5 had a fever at some time in the two weeks preceding the survey. The prevalence of fever varied by the age of the child, and children age 6-11 months and 12-23 months were more commonly sick with fever (35 percent and 36 percent, respectively) than other children. The prevalence of fever among boys was slightly higher than that among girls. There were no significant differences by residence in the prevalence of fever.

Provincial variations, however, were significant; fever prevalence ranged from a low of 11 percent in Kampot/Kep to a high of 40 percent in Battambang/Pailin. Mother’s education and wealth quintile had little association with the prevalence of fever among children less than age 5.

Sixty-one percent of all children under age 5 with a fever were taken to a health facility or provider to seek treatment or advice. Children of mothers with a primary education and a secondary education or higher were more likely to receive treatment for fever (61 percent and 62 percent, respectively) than children of mothers with no schooling (56 percent). The proportion of children for whom treatment was sought from a health facility or provider was highest in Kampong Chhnang (95 percent) and lowest in Mondul Kiri/Ratanak Kiri (44 percent).

Less than 1 percent of children with a fever received antimalarial drugs, whereas 73 percent received antibiotic drugs. Use of antibiotic drugs was more common in urban areas (75 percent) than in rural areas (64 percent). Mothers in Kampong Chhnang, Takeo, Svay Rieng, and Kampong Thom were most likely to use antibiotic drugs to treat fever (90 percent or more).

158 • Child Health

Table 14.5 Prevalence and treatment of fever

Among children under age 5, the percentage who had a fever in the two weeks preceding the survey, and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs, and the percentage who received antibiotics as treatment, by background characteristics, Cambodia 2014

Among children under age 5: Among children under age 5 with fever:

Background Battambang/Pailin 40.0 545 57.3 0.0 87.4 218 Kampot/Kep 11.2 272 (68.1) (0.0) (57.3) 30

Note: Figures in parentheses are based on 25-49 unweighted cases.

1 Excludes pharmacy, shop, and traditional practitioner

14.5 D

Dehydration caused by severe diarrhea is a major cause of morbidity and mortality among young children, although the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta.

Table 14.6 shows the percentage of children under age 5 with diarrhea in the two weeks preceding the survey according to selected background characteristics. Overall, 13 percent of all children under age 5 had diarrhea, and 2 percent had diarrhea with blood.

Table 14.6 Prevalence of diarrhea

Percentage of children under age 5 who had diarrhea in the two weeks preceding the survey, by background characteristics, Cambodia 2014

Background characteristic

Diarrhea in the two weeks preceding

the survey Number of children All diarrhea Diarrhea with blood

Age in months

Battambang/Pailin 20.9 0.5 545

Kampot/Kep 5.1 0.9 272

1 See Table 2.6 for definition of categories.

2 Not including 4 missing cases

3 See Table 2.7 for definition of categories.

160 • Child Health

The occurrence of diarrhea varies by age of the child. Similar to fever, young children age 6-11 and 12-23 months are more prone to diarrhea (20 percent and 19 percent, respectively) than children in the other age groups. The prevalence of diarrhea is about the same among rural children and urban children, and there is no variation by sex of the child. However, there are significant variations in the prevalence of diarrhea by province. Children living in Battambang/Pailin (21 percent), Preah Vihear/Stung Treng (19 percent), and Takeo (19 percent) are more susceptible to episodes of diarrhea than children living in other provinces. Children living in Kampot/Kep and Prey Veng have the lowest prevalence of diarrhea (5 percent each). The prevalence of diarrhea is higher among children who live in the poorest households, in households without an improved source of drinking water (in both the dry and rainy seasons), and in households with a non-improved or shared toilet facility.

The 2014 CDHS asked mothers of children under age 5 who had diarrhea what was done to treat the illness. Table 14.7 shows the percentage of children with diarrhea who received specific treatments according to background characteristics. Fifty-six percent of children with diarrhea were taken to a health provider. A larger percentage of children in rural areas and children living in the poorest households were taken to a health provider than other children. Children with bloody diarrhea are much more likely to be taken to a health provider. There is little variation by sex of the child in whether or not treatment for diarrhea was sought.

Comparable data from the 2010 CDHS show that the percentage of children with diarrhea taken to a health provider has not changed significantly (59 percent in 2010 versus 56 percent in 2014).

Fifty-seven percent of children with diarrhea were treated with a solution prepared from an oral rehydration salt (ORS) packet or tablet or were given increased fluids. Very few children with diarrhea were treated with antibiotics, antimotility drugs, or other medicines. Almost one in five children (18 percent) with diarrhea did not receive any treatment at all.

Diarrhea treatment varied by age: 39 percent of children less than age 6 months received ORT or increased fluids, as compared with 58-62 percent of children age 6 months and older. Children who had diarrhea with blood were more likely than children with non-bloody diarrhea to receive ORT or increased fluids (68 percent versus 56 percent).

Table 14.7 Diarrhea treatment

Among children under age 5 who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage who were given other treatments, by background characteristics, Cambodia 2014

Percentage of Battambang/Pailin 48.3 22.3 46.5 62.2 7.5 13.1 1.4 0.0 46.9 17.9 114

Kampot/Kep * * * * * * * * * * 14 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. ORT includes fluid prepared from oral rehydration salt (ORS) packets and ORS tablets.

1 Excludes pharmacy, shop, and traditional practitioner

2 Excludes 7 cases for which information on type of diarrhea is missing