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Practical solutions for soil conservation are needed to ensure sustainable food production. Conservation agriculture and the use of cover crops are promising strategies for soil improvement in agricultural systems. These strategies are being promoted in Cambodia to address rapidly declining soil fertility; however, there is a lack of insight into the perceptions of Cambodian smallholders towards cover cropping within a conservation agriculture approach. A greater understanding of the utilization and perceptions of cover crops is needed to increase adoption and prevent further soil degradation. This study utilized a mixed methods approach with quantitative data from a farmer survey and qualitative data gathered from follow-up interviews with farmers. Analysis shows that farmers understand what conservation agriculture is and reported benefits, including increased yields, after practicing conservation agriculture. Conservation agriculture was viewed as a way to protect the environment and increase soil fertility, particularly by using cover crops. However, farmers reported that the use of cover crops as part of a conservation agriculture approach faces challenges, preventing further adoption. Understanding the benefits and challenges for farmers can help improve adoption, leading to improved soil and more resilient agricultural systems. Further research on how to address the challenges presented by farmers is needed.

BackgroundCambodia has seen an increase in the prevalence of type 2 diabetes (T2D) over the last 10 years. Three main care initiatives for T2D are being scaled up in the public health care system across the country: hospital-based care, health center–based care, and community-based care. To date, no empirical study has systematically assessed the performance of these care initiatives across the T2D care continuum in Cambodia. ObjectiveThis study aimed to assess the performance of the 3 care initiatives—individually or in coexistence—and determine the factors associated with the failure to diagnose T2D in Cambodia. MethodsWe used a cascade-of-care framework to assess the T2D care continuum. The cascades were generated using primary data from a cross-sectional population-based survey conducted in 2020 with 5072 individuals aged ≥40 years. The survey was conducted in 5 operational districts (ODs) selected based on the availability of the care initiatives. Multiple logistic regression analysis was used to identify the factors associated with the failure to diagnose T2D. The significance level of P

BackgroundNon-communicable diseases (NCDs) such as type-2 diabetes (T2D) and hypertension (HTN) pose a massive burden on health systems, especially in low- and middle-income countries. In Cambodia, to tackle this issue, the government and partners have introduced several limited interventions to ensure service availability. However, scaling-up these health system interventions is needed to ensure universal supply and access to NCDs care for Cambodians. This study aims to explore the macro-level barriers of the health system that have impeded the scaling-up of integrated T2D and HTN care in Cambodia.MethodsUsing qualitative research design comprised an articulation between (i) semi-structured interviews (33 key informant interviews and 14 focus group discussions), (ii) a review of the National Strategic Plan and policy documents related to NCD/T2D/HTN care using qualitative document analysis, and (iii) direct field observation to gain an overview into health system factors. We used a health system dynamic framework to map macro-level barriers to the health system elements in thematic content analysis.ResultsScaling-up the T2D and HTN care was impeded by the major macro-level barriers of the health system including weak leadership and governance, resource constraints (dominantly financial resources), and poor arrangement of the current health service delivery. These were the result of the complex interaction of the health system elements including the absence of a roadmap as a strategic plan for the NCD approach in health service delivery, limited government investment in NCDs, lack of collaboration between key actors, limited competency of healthcare workers due to insufficient training and lack of supporting resources, mis-match the demand and supply of medicine, and absence of local data to generate evidence-based for the decision-making.ConclusionThe health system plays a vital role in responding to the disease burden through the implementation and scale-up of health system interventions. To respond to barriers across the entire health system and the inter-relatedness of each element, and to gear toward the outcome and goals of the health system for a (cost-)effective scale-up of integrated T2D and HTN care, key strategic priorities are: (1) Cultivating leadership and governance, (2) Revitalizing the health service delivery, (3) Addressing resource constraints, and (4) Renovating the social protection schemes.

As a member state of the International Health Regulations 2005, Cambodia is continuously strengthening its capacity to respond to health emergencies and prevent the international spread of diseases. Despite this, Cambodia’s capacity to prevent, detect and rapidly respond to public health threats remained limited at the onset of the pandemic, as was the case in most countries. This paper describes epidemiological phases, response phases, strategy and lessons learnt in Cambodia between 27 January 2020 and 30 June 2022. We classified epidemiological phases in Cambodia into three phases, in which Cambodia responded using eight measures: (1) detect, isolate/quarantine; (2) face coverings, hand hygiene and physical distancing measures; (3) risk communication and community engagement; (4) school closures; (5) border closures; (6) public event and gathering cancellation; (7) vaccination; and (8) lockdown. The measures corresponded to six strategies: (1) setting up and managing a new response system, (2) containing the spread with early response, (3) strengthening the identification of cases and contacts, (4) strengthening care for patients with COVID-19, (5) boosting vaccination coverage and (6) supporting disadvantaged groups. Thirteen lessons were learnt for future health emergency responses. Findings suggest that Cambodia successfully contained the spread of SARS-CoV-2 in the first year and quickly attained high vaccine coverage by the second year of the response. The core of this success was the strong political will and high level of cooperation from the public. However, Cambodia needs to further improve its infrastructure for quarantining and isolating cases and close contacts and laboratory capacity for future health emergencies.

Abstract Background Hypertension (HTN) is a leading cause of cardiovascular diseases and deaths globally. To respond to the high HTN prevalence (23.5% among adults aged 40–69 years in 2016) in Cambodia, the government (and donors) established innovative interventions to improve access to screening, care, and treatment at different public health system and community levels. We assessed the effectiveness of these interventions and resulting health outcomes through a cascade of HTN care and explored key determinants. Methods We performed a population-based survey among 5070 individuals aged ≥ 40 years to generate a cascade of HTN care in Cambodia. The cascade, built with conditional approach, shows the patients’ flow in the health system and where they are lost (dropped out) along the steps: (i) prevalence, (ii) screening, (iii) diagnosis, (iv) treatment in the last twelve months, (v) treatment in the last three months, and (vi) HTN being under control. The profile of people dropping out from each bar of the cascade was determined by multivariate logistic regression. Results The prevalence of HTN (i) among study participants was 35.2%, of which 81.91% had their blood pressure (BP) measured in the last three years (ii). Over 63.72% of those screened were diagnosed by healthcare professionals as hypertensive patients (iii). Among these, 56.19% received treatment in the last twelve months (iv) and 54.26% received follow-up treatment in the last three months (v). Only 35.8% of treated people had their BP under control (vi). Males, those aged ≥ 40 years, and from poorer households had lower odds to receive screening, diagnosis, and treatment. Lower odds to have their BP under-control were found in males, those from poor and rich quintiles, having HTN

We examined the proportion and correlates of loss to follow-up (LTFU) among female entertainment and sex workers (FESWs) in a longitudinal HIV prevention intervention trial in Cambodia. The Cambodia Integrated HIV and Drug Prevention Intervention trial tested a comprehensive package of interventions aimed at reducing amphetamine-type stimulant use and HIV risk among FESWs in ten provinces. The present study estimated the proportion of women LTFU and assessed factors associated with LTFU. Logistic regression analyses were used. Of a total 596 women enrolled, the cumulative proportion of LTFU was 29.5% (n = 176) between zero- and 12-month follow-up. In multivariate analyses, women with no living children (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI]: 1.1, 2.3) and those who experienced recent food insecurity (AOR 1.7; 95%CI: 1.1, 2.7) were more likely to be LTFU. Women who were members of the SMARTgirl HIV prevention programme for ≥ 6 months compared to non-members were less likely to be LTFU (AOR 0.3; 95%CI: 0.2, 0.6). LTFU was moderately high in this study and similar to other studies, indicating a need for strategies to retain this population in HIV prevention programmes and research. Interventions aimed at stabilizing women's lives, including reducing food insecurity and creating communities of engagement for FESWs, should be considered.

The present review article is intended to provide comprehensive insights into the techniques of sunflower cultivation, methods of processing, and opportunities for value addition through a variety of applications. Sunflower (Helianthus annuus L.) is an economically valuable crop, admired for its vibrant yellow flowers and seeds rich in high-quality oil. The oil derived from sunflower seeds is nutritionally valued for its high content of unsaturated fatty acids, such as linolenic and linoleic acids, which help to reduce cholesterol levels and prevent arterial fat clots. Moreover, it contains essential vitamins A, D, E, and K. Sunflower cultivation primarily occurs in warm regions, aligning with the plant’s climatic preferences. As a short-lived plant, sunflowers demonstrate drought resilience due to their deep root system. In recent years, the use of sunflowers has significantly expanded, driving economic growth. The demand for products derived from sunflowers, including sprouts, roasted seeds, seed oil, and even sunflower-based agricultural tourism, has increased exponentially. Notably, sunflower seeds and their oil hold particular importance as they form the basis for integrated production systems, contributing to the creation of various food and non-food products. By presenting this information, we aim to provide a comprehensive guide for those interested in enhancing the utilization of sunflowers across various sectors.

Introduction Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up.Methods and analysis A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools—including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping—were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed.Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities.

The calamondin (Citrofortunella microcarpa) is a hybrid citrus fruit resulting from the crossing of a mandarin orange with a kumquat. It is a small, round-shaped fruit with thin, smooth skin ranging from orange to dark red. The aroma of the fruit is distinctive and unique. Calamondin is an excellent source of Vitamin C, D-Limonene, and essential oils, providing benefits to the immune system, as well as anti-inflammatory, anti-cancer, anti-diabetic, anti-angiogenic, and anti-cancer properties, and it exhibits various therapeutic effects. It also contains a good amount of dietary fiber from pectin. Its distinctive flavor and high juice content make calamondin juice a popular ingredient in many international cuisines. The juice also contains bioactive compounds, such as phenolics and flavonoids, which are a potential source of antioxidant properties. All parts of the calamondin fruit, including the juice, pulp, seeds, and peel, can be used in various applications, from food products like juices, powders, and candies to non-food uses in herbal medicine and cosmetics, showcasing their versatility and unique properties. This review will examine various bioactive components of calamondin and their related medicinal effects, and provide guidelines for their utilization, processing, and value addition on a commercial scale.

Abstract Background Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown. Methods In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest. Results Malaria prevalence by PCR was high in the forest, with 2.3–5.0% positive for P. falciparum and 14.6–25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging. Conclusions Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.

HIV risk remains high among Cambodian female entertainment and sex workers, driven by amphetamine-type substance use and sexual risk. Conditional cash transfer is an evidence-based approach to reduce stimulant use and optimize HIV/AIDS prevention, but questions remain regarding implementation in resource-limited settings. We conducted formative qualitative research to enhance acceptability of a conditional cash transfer intervention aimed at reducing amphetamine-type substance use and HIV risk among female entertainment/sex workers and inform implementation as part of a large cluster randomized trial. We conducted in-depth interviews with 30 female entertainment/sex workers. Interviews were digitally recorded and conducted and transcribed in Khmer. English transcripts were read for emerging themes and an initial coding scheme was developed. Data were coded using open and axial coding to clarify and consolidate initial themes. While most participants expressed enthusiasm for the intervention, financial and transportation issues emerged as key barriers to participation. The proposed incentive of USD$1 per screen was regarded as unacceptable and participants identified a need for transportation assistance. Participants also expressed concerns about directly observed urine specimen collection. Finally, while most participants found the 4-week aftercare program acceptable, the need for enjoyable as well as educational content was emphasized. Revisions to the protocol taking these data into account were made to optimize the acceptability of the intervention and the implementation of the trial. Findings identified key concerns and preferences that were taken into account in the final trial protocol. In particular, financial and transportation issues were identified as critical barriers to participation, with the potential to impact both intervention uptake and trial feasibility. Results demonstrate the value of formative qualitative research for clinical trial planning and implementation, particularly in settings where little is known about acceptability of interventions or willingness to participate.

Xanthones are significant bioactive compounds and secondary metabolites in mangosteen pericarps. A xanthone is a phenolic compound and versatile scaffold that consists of a tricyclic xanthene-9-one structure. A xanthone may exist in glycosides, aglycones, monomers or polymers. It is well known that xanthones possess a multitude of beneficial properties, including antioxidant activity, anti-inflammatory activity, and antimicrobial properties. Additionally, xanthones can be used as raw material and/or an ingredient in many food, pharmaceutical, and cosmetic applications. Although xanthones can be used in various therapeutic and functional applications, their properties and stability are determined by their extraction procedures. Extracting high-quality xanthones from mangosteen with effective therapeutic effects could be challenging if the extraction method is insufficient. Although several extraction processes are in use today, their efficiency has not yet been rigorously evaluated. Therefore, selecting an appropriate extraction procedure is imperative to recover substantial yields of xanthones with enhanced functionality from mangosteens. Hence, the present review will assist in establishing a precise scenario for finding the most appropriate extraction method for xanthones from mangosteen pericarp by critically analyzing various conventional and unconventional extraction methods and their ability to preserve the stability and biological effects of xanthones.

Rice is a staple crop best known for its crucial role in feeding humans. In Cambodia, the human population depends on rice as its staple food. Increased rice production results in an increase in straw residue. The extensive residue caused by straw burning significantly contributes to high concentrations of air pollution, which are associated with critical health issues. As such, our objective in this study was to assess the human health impact of rice straw production in Cambodia. In this assessment, we focused on primary and secondary fine particulate matter formation (PM2.5, NH3, NOx, and SO2) from fertilizer, combustion of fuel in rice production processing, and burning of straw. We assessed endpoint impact by the following methods: (1) We estimated the proportion of rice straw from the annual rice production of the Ministry of Agriculture, Forestry, and Fisheries (MAFF) of Cambodia subjected to open burning in all 25 Cambodian provinces. (2) We calculated air pollutants emissions in terms of kilograms of pollutants per ton of rice produced by following the air pollutant emission inventory (EI) in the EMEP/EEA Guidebook for 2019, using data for fertilizer and fuel combustion that was applied in the field, based on a face-to-face survey of farmers. (3) We analyzed health impact in terms of DALYs using the characterization factor (CF) adapted from the ReCiPe 2016 v1.1 method. The results showed that the total health impact of rice straw production was 13,093.50 DALYs. Our analysis showed that open burning alone contributed 98.55% of the total health impact considered in this study, while fertilizers and combustion contributed only 0.12% and 1.33%, respectively. As the major of the total health impact arose from open burning, a policy of zero open burnings should be an effective way to reduce health impacts. These findings provide information for policymakers on how to alleviate air quality issues caused by the practice of open straw burning by adopting alternative techniques of rice straw management.

Abstract Background Globally, the prevalence of HIV among transgender women is more than 40 times higher than the prevalence in the general reproductive-age adults. They also face intersecting barriers to health, social, and legal services due to their hidden and stigmatized nature. Despite the particular needs, data regarding the access to services among transgender populations is scant globally. This study aims to identify characteristics of transgender women in Cambodia that may determine their accessibility to community-based HIV services. Methods In the National Biological and Behavioral Survey 2016, a structured questionnaire was used for face-to-face interviews with 1375 sexually active transgender women recruited from the capital city and 12 other provinces using the Respondent-Driven Sampling method. Weighted multivariate regression analysis was conducted to explore factors associated with access to community-based HIV services. Results The mean age of the participants was 25.8 years (SD = 7.1), and 45.0% reported having received at least one community-based HIV service in the past three months. Compared to participants who reported not having been reached by any community-based HIV programs, participants who reported having been reached by the programs were significantly more likely to reside in an urban setting (AOR = 1.41, 95% CI = 1.01–1.96), to have used gender-affirming hormones (AOR = 1.50, 95% CI = 1.17–1.92), to have been tested for HIV in the past six months (AOR = 7.42, 95% CI = 5.78–9.53), and to have been arrested by police or other authorities because of their transgender identity (AOR = 1.55, 95% CI = 1.03–2.33). Participants who reported having been reached by community-based HIV programs were significantly less likely to report being in a receptive role (AOR = 0.34, 95% CI = 0.15–0.82), to use condoms consistently with non-commercial male partners (AOR = 0.72, 95% CI = 0.55–0.94), and to perceive that their co-workers were not supportive regarding their transgender identity (AOR = 0.57, 95% CI = 0.44–0.98). Conclusions Despite the extensive expansion of community-based HIV programs, less than half of transgender women in this national survey had access to the services. Innovative strategies and culturally sensitive interventions should be put in place to reach and respond to the needs of sub-groups of transgender women who are less likely to be reached by the existing traditional approaches.

Abstract Background Globally, the prevalence of HIV among transgender women is much higher than that of the general adult population. This can be explained by the persistently low rate of consistent condom use among this population. This study was therefore conducted to explore factors associated with consistent condom use among sexually-active transgender women in Cambodia, specifically with their non-commercial partners. Methods Data used for this study were collected as part of the National Integrated Biological and Behavioral Survey 2016. Participants were recruited from the capital city of Phnom Penh and 12 other provinces with high burden of HIV using the Respondent-Driven Sampling (RDS) method. Face-to-face interviews were conducted using a structured questionnaire. Weighted multivariate logistic regression analysis was conducted to explore independent factors associated with consistent condom use. Results This study included 1202 transgender women who reported having anal sex with at least one male partner not in exchange for money or gifts in the past three months. The mean age of the participants was 26.0 (SD = 7.0) years. Of the total, 41.5% reported always using condoms with male non-commercial partners in the past three months. After adjustment, the likelihood of consistent condom use was significantly higher among participants who resided in an urban community (AOR = 1.7, 95% CI = 1.1–2.6), had attained at least 10 years of formal education (AOR = 1.8, 95% CI = 1.2–2.7), perceived that they were likely or very likely to be HIV infected (AOR = 2.9, 95% CI = 2.0–4.1), reported drinking alcohol two to three times per week (AOR = 3.1, 95% CI = 1.1–8.3), reported using amphetamine-type stimulants (AOR = 1.9, 95% = 1.1–3.8) or other drugs (AOR = 7.6, 95% CI = 1.5–39.5), and reported inconsistent condom use with male commercial partners in the past three months (AOR = 4.3, 95% CI = 1.8–10.4) compared to that of their respective reference group. Conclusions This study confirms the low rates of condom use, particularly in non-commercial relationship, among transgender women in Cambodia. To address these concerns, efforts towards education about effects of multiple, concurrent relationships, and inconsistent condom use should be reinforced among transgender women.

Cassava is one of the most important cash crops in Cambodia. Agricultural mechanization promotes productivity, but overinvestment may disrupt the balance between inputs and outputs. Depending on the production scale, sometimes hiring equipment is considered better than purchasing it. While we can hypothesize that mechanization and investments might be crucial factors of productivity, technical efficiency analysis for estimating their effects has not yet been conducted. Therefore, this study investigates the impact of mechanization and investments on cassava yield and producers’ technical efficiency in Cambodia using the Cobb-Douglas stochastic frontier production model. For the study, 205 respondents were randomly selected and interviewed in the Battambang and Pailin provinces in northwestern Cambodia in 2017. Our results show that tractor or truck-hire cost was positively significant, and the cassava uprooting machine-hire cost was negatively significant. The average technical efficiency score of 0.62 indicates that cassava producers can increase their level of technical efficiency. Although cassava production in Cambodia is mechanized and investors are investing, it would be more beneficial to producers if they were provided with financial assistance when uprooting the cassava at the harvest time. Appropriate control of input costs can effectively improve cassava yield, following the implementation of the National Policy on Cassava 2020–2025 by the Royal Government of Cambodia.

Abstract Background Transgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia. Methods This cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was conducted to explore factors independently associated with depressive symptoms. Results Of total, 45.0% of the participants had depressive symptoms, and 21.8% had severe depressive symptoms. After controlling for potential confounders, transgender women with depressive symptoms remained significantly more likely to report several negative experiences of gender-based violence such as a feeling that co-workers or classmates were not supportive regarding their transgender identity (AOR = 2.00, 95% CI = 1.22–3.28), having difficulties in getting a job (AOR = 1.67, 95% CI = 1.29–2.16), having been denied or thrown out of housing (AOR = 1.53, 95% CI = 1.02–2.26), having difficulties in getting health services (AOR = 2.40, 95% CI = 1.50–3.82), having been physically abused (AOR = 1.54, 95% CI = 1.15–2.08), and having been fearful of being arrested by police or authorities (AOR = 2.18, 95% CI = 1.64–2.91) because of their transgender identity. Regarding their childhood experiences, transgender women with depressive symptoms remained significantly more likely to report that someone had tried to touch them or make them touch in a sexual way when they were growing up (AOR = 2.08, 95% CI = 1.61–2.68). Conclusions Transgender women in Cambodia experience high levels of gender-based violence and depressive symptoms. To address these concerns, a combination of service and policy interventions are required. These may include training and sensitization of trained and lay health providers in screening for depressive symptoms and integration of mental health services into facility- and community-based HIV services with enforcement of policies and laws that protect the rights of transgender women against gender-based violence.

Abstract Background Early HIV diagnosis and initiation onto antiretroviral therapy may prevent ongoing spread of HIV. Risk Tracing Snowball Approach (RTSA) has been shown to be effective in detecting new HIV cases in other settings. The main objective of this study is to evaluate the effectiveness of RTSA in increasing the rate of newly identified HIV cases among high-risk populations. Our second objective was to evaluate the effectiveness of RTSA, as compared to the walk-in group, in increasing the number of HIV tests and early case detection. Methods This study was conducted from April 1 to September 30, 2016 at two NGO clinics in Phnom Penh, Cambodia. Respondent driven sampling method was adapted to develop RTSA to reach high-risk populations, including key populations and the general population who have social connections with key populations. Bivariate and multivariate logistic regression analyses were conducted. Results During the implementation period, 721 clients walked in for HIV testing (walk-in group), and all were invited to be seeds. Of the invited clients, 36.6% agreed to serve as seeds. Throughout the implementation, 6195 coupons were distributed to seeds or recruiters, and resulted in 1572 clients visiting the two clinics with coupons (RTSA group), for a coupon return rate of 25.3%. The rate of newly identified HIV cases among the RTSA group was significantly lower compared to that in walk-in group. However, the highest number of newly identified HIV cases was found during the implementation period, compared to both pre- and post-implementation period. Although statistically not significant, the mean CD4 count of newly identified HIV cases detected through RTSA was almost 200 cells/mm3 higher than that in the walk-in group. Conclusions Although the rate of newly identified HIV cases among the RTSA group was lower than that in the walk-in group, the inclusion of RTSA in addition to the traditional walk-in method boosted new HIV case detection in the two participating clinics. A higher mean CD4 count for the RTSA group may reveal that RTSA may be able to detect HIV cases earlier than the traditional walk-in approach. Further research is needed to understand whether RTSA is a cost-effective intervention to prevent ongoing spread of the HIV among high-risk populations in Cambodia.

Abstract Background Transgender people are disproportionately affected by HIV. Despite their high vulnerability to HIV, lack of adequate epidemiological and surveillance data related to this population in many countries prevents provision of appropriate services. This paper summarizes descriptive findings from a national integrated biological and behavioral survey and discusses policy implications of the findings on HIV prevention among transgender women in Cambodia. Methods This cross-sectional study was conducted between December 2015 and February 2016. Participants were recruited from 20 sites in the capital city and 12 provinces of Cambodia using Respondent Driven Sampling (RDS) method. Behavioral data were collected through structured questionnaire interviews, and rapid finger-prick HIV testing was performed. Descriptive data analyses were conducted using STATA. Results This study included 1,375 transgender women with a mean age of 25.9 years (SD = 7.1). The overall prevalence of HIV was 5.9%. The prevalence of HIV was significantly higher among urban participants compared to their rural counterparts (6.5 vs. 2.6%, p = 0.02). Almost one in five (19.6%) had never been tested for HIV prior to the study. Overall, 45.0% reported ever using gender affirming hormones. More than one-third (39.1%) reported not using condoms in their last sex, 29.8% had engaged in sex in exchange for money/gifts, and 14.0% reported that they had experienced at least one symptom of sexually transmitted infections (STI) in the past year. About one in ten (10.1%) reported having used some form of amphetamine-type stimulant drugs, while 6.5% reported having sex during or after using illicit drugs. A significant number of participants experienced sexual abuse (39.2%), losing a job (24.3%), or physical abuse (23.6%) because of their transgender identity. In addition, 82.9 and 88.9% would be willing to use the HIV self-test and pre-exposure prophylaxis (PrEP), respectively, if they become available. Conclusions The high prevalence of HIV, STI, and related risk behaviors among transgender women in Cambodia is of great concern, suggesting an urgent need to further expand tailored prevention interventions for this key population focusing on individual, social, and structural drivers of HIV. HIV self-test and PrEP should be explored as a priority.

Cassava is one of the most important annual crops in Southeast Asia, and faces increasing seed borne pest and disease pressures. Despite this, cassava seed systems have received scant research attention. In a first analysis of Vietnamese and Cambodian cassava seed systems, we characterized existing cassava seed systems in 2016–2017 through a farmer survey based approach at both national and community scales, with particular focus on identifying seed system actors, planting material management, exchange mechanisms, geographies, and variety use, and performed a network analysis of detected seed movement at the provincial level. Despite their status as self-organized “informal” networks, the cassava seed systems used by farmers in Vietnam and Cambodia are complex, connected over multiple scales, and include links between geographically distant sites. Cassava planting material was exchanged through farmer seed systems, in which re-use of farm-saved supply and community-level exchanges dominated. At the national level, use of self-saved seed occurred in 47 and 64% of seed use cases in Cambodia and Vietnam, respectively. Movement within communes was prevalent, with 82 and 78% of seed provided to others being exchanged between family and acquaintances within the commune in Cambodia and Vietnam, respectively. Yet, meaningful proportions of seed flows, mediated mostly by traders, also formed inter-provincial and international exchange networks, with 20% of Cambodia's seed acquisitions imported from abroad, especially neighboring Vietnam and Thailand. Dedicated seed traders and local cassava collection points played important roles in the planting material distribution network at particular sites. Sales of planting material were important means of both acquiring and providing seed in both countries, and commercial sale was more prevalent in high-intensity than in low-intensity production sites. Considerable variability existed in local seed networks, depending on the intensity of production and integration with trader networks. Adapted innovations are needed to upgrade cassava seed systems in the face of emerging pests and diseases, taking into account and building on the strengths of the existing systems; including their social nature and ability to quickly and efficiently distribute planting materials at the regional level.

Two-hundred rice farming households from eight lowland rice villages in North-West Cambodia were surveyed in 2020 to determine changes in farmers’ knowledge, weed management practices and weed seed contamination in seed kept for sowing. The major yield constraints cited by farmers were lack of water, inability to manage water and competition by weeds. Water shortages result in reduced crop establishment, non-optimal herbicide application timing and poor weed control. Reduced tillage, drill planting and use of pre-emergence herbicides can improve weed management. The adoption of drill planting improves crop establishment and enables the use of pre-emergence herbicides. Possible reasons for changes in weed problems include the change to a two-crop rice system in the wet season and spread of seeds by harvesting machines. The main weed seed contaminants of rice seed kept for sowing were Echinochloa crus-galli, E. colona, Fimbristylis miliacea, Ischaemum rugosum and Melochia corchorifolia. F. miliacea was the only species effectively removed by village cleaning methods. Although prevalent in rice fields, Cyperus. iria with Leptochloa chinensis with nil contamination were insignificant contaminants of seed samples. The majority of farmers in the study area are relying on repeated use of a narrow range of post-emergence herbicides, thus leading to increased severity of weed problems in dry direct-seeded rice. Integrated weed management is required to reduce over-reliance on post-emergence herbicides. This will require engagement with the local input supply network to introduce advice on improved weed management and sustainable herbicide use.

Objective: This paper examines the contributions made by the National Institute of Public Health to Cambodia's response to the coronavirus disease (COVID-19) pandemic during 2020-2021. Methods: The activities conducted by the Institute were compared with adaptations of the nine pillars of the World Health Organization's 2020 COVID-19 strategic preparedness and response plan. To gather relevant evidence, we reviewed national COVID-19 testing data, information about COVID-19-related events documented by Institute staff, and financial and technical reports of the Institute's activities. Results: The main contributions the Institute made were to the laboratory pillar and the incident management and planning pillar. The Institute tested more than 50% of the 2 575 391 samples for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and provided technical advice about establishing 18 new laboratories for SARS-CoV-2 testing in the capital city of Phnom Penh and 11 provinces. The Institute had representatives on many national committees and coauthored national guidelines for implementing rapid COVID-19 testing, preventing transmission in health-care facilities and providing treatment. The Institute contributed to six other pillars, but had no active role in risk communication and community engagement. Discussion: The Institute's support was essential to the COVID-19 response in Cambodia, especially for laboratory services and incident management and planning. Based on the contributions made by the Institute during the COVID-19 pandemic, continued investment in it will be critical to allow it to support responses to future health emergencies in Cambodia. [ABSTRACT FROM AUTHOR]

HIV risk remains high among Cambodian female entertainment and sex workers, driven by amphetamine-type substance use and sexual risk. Conditional cash transfer is an evidence-based approach to reduce stimulant use and optimize HIV/AIDS prevention, but questions remain regarding implementation in resource-limited settings. We conducted formative qualitative research to enhance acceptability of a conditional cash transfer intervention aimed at reducing amphetamine-type substance use and HIV risk among female entertainment/sex workers and inform implementation as part of a large cluster randomized trial. We conducted in-depth interviews with 30 female entertainment/sex workers. Interviews were digitally recorded and conducted and transcribed in Khmer. English transcripts were read for emerging themes and an initial coding scheme was developed. Data were coded using open and axial coding to clarify and consolidate initial themes. While most participants expressed enthusiasm for the intervention, financial and transportation issues emerged as key barriers to participation. The proposed incentive of USD$1 per screen was regarded as unacceptable and participants identified a need for transportation assistance. Participants also expressed concerns about directly observed urine specimen collection. Finally, while most participants found the 4-week aftercare program acceptable, the need for enjoyable as well as educational content was emphasized. Revisions to the protocol taking these data into account were made to optimize the acceptability of the intervention and the implementation of the trial. Findings identified key concerns and preferences that were taken into account in the final trial protocol. In particular, financial and transportation issues were identified as critical barriers to participation, with the potential to impact both intervention uptake and trial feasibility. Results demonstrate the value of formative qualitative research for clinical trial planning and implementation, particularly in settings where little is known about acceptability of interventions or willingness to participate.

INTRODUCTION:Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia. METHODS:Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited. RESULTS:The majority of the 891 participants self-identified as third gender or female (94.5%), were young (median age 23, IQR [20-27]), had secondary education or higher (80.5%), not married (89.7%), and employed (90.2%). The majority had first sex before 18 years (66.8%), with a male (79.9%), 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%). The majority of participants reported having experienced discrimination in their lifetime (54.8%) and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35-44 and adjusted OR = 7.63 [2.55, 22.81] for age 30-34), only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37, 23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09, 7.73]), inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33]), and reporting low self-esteem (adjusted OR = 3.25 [1.35, 7.85]) were independently associated with HIV infection. CONCLUSIONS:This study confirms transgender individuals as one of the highest-risk groups for HIV infection in Cambodia. It suggests the need for programmatic strategies that mitigate identified associated risks and facilitate access to HIV care for this population.

In Cambodia, HIV prevalence is high while HIV testing rates remain low among transgender women (TG women), men who have sex with men (MSM), and female entertainment workers (FEW). Introducing self-testing for HIV to these key populations (KPs) could potentially overcome the under-diagnosis of HIV and significantly increase testing rates and receipt of the results, and thus could decrease transmission. Therefore, this study aimed to determine the acceptability of HIV self-testing (HIVST) among these three categories of KPs.This study was conducted through focus group discussions (FGDs) with TG women, MSM, and FEW in Phnom Penh city, Kampong Cham, Battambang, and Siem Reap provinces of Cambodia. Convenience sampling was used to recruit the participants. Two FGDs (six participants in each FGD) were conducted in each target group in each study site, totaling 24 FGDs (144 participants). Thematic analysis was performed to identify common or divergent patterns across the target groups.Almost all participants among the three groups (TG women, MSM, and FEW) had not heard about HIVST, but all of them expressed willingness to try it. They perceived HIVST as confidential, convenient, time-saving, and high-tech. Barriers to obtaining HIVST included cost, access, administration technique, embarrassment, and fear of pain. The majority preferred counseling before and after testing.Participants showed high willingness to use and acceptability of HIVST due to its confidentiality/privacy and convenience even if it is not linked to a confirmatory test or care and treatment. Notwithstanding, to increase HIVST, the target groups would need affordable self-test kits, education about how to perform HIVST and read results, assurance about accuracy and reliability of HIVST, and provision of post-test counseling and facilitation of linkage to care and treatment.

One-hundred farmers from lowland rice systems of Battambang province in Cambodia were surveyed in 2017 using a structured questionnaire with the objectives to (1) determine farmers' current knowledge and weed management practices and document the effect of adopted agronomic practices on management of weeds in rice, and (2) quantify the extent of weed seed contamination in farmers' own saved paddy seed lots. To estimate the level of contamination by weed seeds, a one kg paddy seed sample was collected from each surveyed farmer. All farmers practiced broadcast direct-seeded rice (DSR), with an average seeding rate of 181 kg ha−1. For sowing the rice crop, 82% of farmers used their own saved seeds or bought seed from their neighbour. All the paddy seed samples were contaminated with seeds of 34 weed species with an average of 1,070 weed seeds kg−1 of paddy seed. The most common weed contaminants in the seed samples were Oryza sativa f. spontanea (weedy rice), Fimbristylis miliacea , Echinochloa colona , Echinochloa crus-galli , and Ischaemum rugosum. Weeds, in their rice field, were considered a major problem by 93% of farmers with 70% of farmers indicating a yield loss of >20% due to weed competition. All farmers followed a post-emergence based herbicide program for weed control with no use of pre-emergence herbicides. Farmers (75%) relied on the advice of input dealers on the selection and use of herbicides. Knowledge gaps were found among farmers on herbicide application techniques including selection of the right sprayer, nozzle tips, and sprayer calibration. Although 94% of farmers responded that they were aware of pesticide exposure risk, use of boots and gloves, as personal protective equipment, during spraying was low (10 and 54%, respectively). The fertilizer use was lower than recommended rates (50% of recommended N and around 40% of recommended P and K). An exploitable rice yield gap of 1.3 t ha−1 (40%) and 1.1 t ha−1 (30%) was found in the wet and dry season, respectively. These results suggest that integrated weed management (IWM) and optimum fertilizer use can play an important role in closing the rice yield gap in Battambang. IWM options using clean/certified seeds free from weed seeds, optimum fertilizer, selection and application of appropriate pre- and post-emergence herbicides at the right time, amount, and accurate application techniques can improve weed control and hence enhance the rice yield in Cambodia. Farmer training is needed to close their knowledge gaps and to educate them on IWM, especially, to manage difficult-to-control weeds such as weedy rice. • Study was conducted in lowland rice environment of Battambang province in northwest Cambodia. • Knowledge gaps in farmers' current weed and crop management practices identified. • Level of weed seed contamination in farmers saved paddy seed quantified. • 100% seed samples were contaminated with weed seeds with an average of 1070 seeds kg−1 of paddy seeds. • Current practices such as high seed rate + contaminated paddy seed have a major impact on weed management in Cambodia. [ABSTRACT FROM AUTHOR]

The calamondin ( Citrofortunella microcarpa) is a hybrid citrus fruit resulting from the crossing of a mandarin orange with a kumquat. It is a small, round-shaped fruit with thin, smooth skin ranging from orange to dark red. The aroma of the fruit is distinctive and unique. Calamondin is an excellent source of Vitamin C, D-Limonene, and essential oils, providing benefits to the immune system, as well as anti-inflammatory, anti-cancer, anti-diabetic, anti-angiogenic, and anti-cancer properties, and it exhibits various therapeutic effects. It also contains a good amount of dietary fiber from pectin. Its distinctive flavor and high juice content make calamondin juice a popular ingredient in many international cuisines. The juice also contains bioactive compounds, such as phenolics and flavonoids, which are a potential source of antioxidant properties. All parts of the calamondin fruit, including the juice, pulp, seeds, and peel, can be used in various applications, from food products like juices, powders, and candies to non-food uses in herbal medicine and cosmetics, showcasing their versatility and unique properties. This review will examine various bioactive components of calamondin and their related medicinal effects, and provide guidelines for their utilization, processing, and value addition on a commercial scale.

Xanthones are significant bioactive compounds and secondary metabolites in mangosteen pericarps. A xanthone is a phenolic compound and versatile scaffold that consists of a tricyclic xanthene-9-one structure. A xanthone may exist in glycosides, aglycones, monomers or polymers. It is well known that xanthones possess a multitude of beneficial properties, including antioxidant activity, anti-inflammatory activity, and antimicrobial properties. Additionally, xanthones can be used as raw material and/or an ingredient in many food, pharmaceutical, and cosmetic applications. Although xanthones can be used in various therapeutic and functional applications, their properties and stability are determined by their extraction procedures. Extracting high-quality xanthones from mangosteen with effective therapeutic effects could be challenging if the extraction method is insufficient. Although several extraction processes are in use today, their efficiency has not yet been rigorously evaluated. Therefore, selecting an appropriate extraction procedure is imperative to recover substantial yields of xanthones with enhanced functionality from mangosteens. Hence, the present review will assist in establishing a precise scenario for finding the most appropriate extraction method for xanthones from mangosteen pericarp by critically analyzing various conventional and unconventional extraction methods and their ability to preserve the stability and biological effects of xanthones.

A growing concern on the deleterious effects of chemical inputs to the environment has been on the rise from the excessive use of chemical inputs leading to soil and water pollution, destruction to fauna and microbial communities, reduced soil fertility and increased crop disease susceptibility. In the Great Mekong Region (GMR), a large majority of the population relies on agriculture and faces severe challenges including decline in soil fertility, increased pests and diseases, leading to lower ecosystem productivity. In this region, over-dependence on chemical fertilizers also continues to impact negatively on soil health and the wider ecosystem. Agroecological practices, and beneficial microorganisms in particular, offer an affordable and sustainable alternative to mineral inputs for improved plant nutrition and soil health for optimal crop performance and sustainable production. Biofertilizers are a key component in integrated nutrient management as well as for increased economic benefits from reduced expenditure on chemical fertilizers, holistically leading to sustainable agriculture. To cope with the need for biofertilizer adoption for sustainable agricultural production, the countries in the GMR are putting efforts in promoting development and use of biofertilizers and making them available to farmers at affordable costs. Despite these efforts, farmers continue to use chemical fertilizers at high rates with the hope of increased yields instead of taking advantage of microbial products capable of providing plant nutrients while restoring or improving soil health. This study explored the current agricultural practices in the six countries in the GMR (China, Vietnam, Myanmar, Thailand, Cambodia and Lao PDR), the critical need for sustainable agroecological practices with a special emphasis on biofertilizers. We highlighted the current status, distribution, adoption and gaps of biofertilizer production in the GMR, in order to obtain an insight on the nature of biofertilizers, efficacy and production standards, adoption or lack of biofertilizers in the GMR., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

In Asia, cassava ( Manihot esculenta ) is cultivated by more than 8 million farmers, driving the rural economy of many countries. The International Center for Tropical Agriculture (CIAT), in partnership with national agricultural research institutes (NARIs), instigated breeding and agronomic research in Asia, 1983. The breeding program has successfully released high-yielding cultivars resulting in an average yield increase from 13.0 t ha -1 in 1996 to 21.3 t ha -1 in 2016, with significant economic benefits. Following the success in increasing yields, cassava breeding has turned its focus to higher-value traits, such as waxy cassava, to reach new market niches. More recently, building resistance to invasive pests and diseases has become a top priority due to the emergent threat of cassava mosaic disease (CMD). The agronomic research involves driving profitability with advanced technologies focusing on better agronomic management practices thereby maintaining sustainable production systems. Remote sensing technologies are being tested for trait discovery and large-scale field evaluation of cassava. In summary, cassava breeding in Asia is driven by a combination of food and market demand with technological innovations to increase the productivity. Further, exploration in the potential of data-driven agriculture is needed to empower researchers and producers for sustainable advancement., (Copyright © 2020 by JAPANESE SOCIETY OF BREEDING.)

Ecologists have recently devoted their attention to the study of species traits and their role in the establishment and spread of nonindigenous species (NIS). However, research efforts have mostly focused on studies of terrestrial taxa, with lesser attention being dedicated to aquatic species. Aquatic habitats comprise of interconnected waterways, as well as exclusive introduction vectors that allow unparalleled artificial transport of species and their propagules. Consequently, species traits that commonly facilitate biological invasions in terrestrial systems may not be as represented in aquatic environments. We provide a global meta-analysis of studies conducted in both marine and freshwater habitats. We selected studies that conducted experiments with native and NIS under common environmental conditions to allow detailed comparisons among species traits. In addition, we explored whether different factors such as species relatedness, functional feeding groups, latitude, climate, and experimental conditions could be linked to predictive traits. Our results show that species with traits that enhance consumption and growth have a substantially increased probability of establishing and spreading when entering novel ecosystems. Moreover, traits associated with predatory avoidance were more prevalent in NIS and therefore favour invasive species in aquatic habitats. When we analysed NIS interacting with taxonomically distinctive native taxa, we found that consumption and growth were particularly important traits. This suggests that particular attention should be paid to newly introduced species for which there are no close relatives in the local biota. Finally, we found a bias towards studies conducted in temperate regions, and thus, more studies in other climatic regions are needed. We conclude that studies aiming at predicting future range shifts should consider trophic traits of aquatic NIS as these traits are indicative of multiple interacting mechanisms involved in promoting species invasions., (© 2016 John Wiley & Sons Ltd.)

Arsenic contamination has global impacts and freshwaters are major arsenic repositories. Arsenic toxicity depends on numerous interacting factors which makes effects difficult to estimate. The use of aquatic algae is often advocated for bioremediation of arsenic contaminated waters as they absorb arsenate and transform it into arsenite and methylated chemical species. Fish are another key constituent of aquatic ecosystems. Contamination in natural systems is often too low to cause mortality but sufficient to interfere with normal functioning. Alteration of complex, naturally occurring fish behaviours such as foraging and aggression are ecologically relevant indicators of toxicity and ideal for assessing sublethal impacts. We examined the effects of arsenic exposure in the invasive mosquitofish, Gambusia holbrooki, in a laboratory experiment incorporating some of the complexity of natural systems by including the interacting effects of aquatic algae. Our aims were to quantify the effects of arsenic on some complex behaviours and physical parameters in mosquitofish, and to assess whether the detoxifying mechanisms of algae would ameliorate any effects of arsenic exposure. Aggression increased significantly with arsenic whereas operculum movement decreased non-significantly and neither food capture efficiency nor consumption were notably affected. Bioaccumulation increased with arsenic and unexpectedly so did fish biomass. Possibly increased aggression facilitated food resource defence allowing fish to gain weight. The presence of algae aggravated the effects of arsenic exposure. For increase in fish biomass, algae acted antagonistically with arsenic, resulting in a disadvantageous reduction in weight gained. For bioaccumulation the effects were even more severe, as algae operated additively with arsenic to increase arsenic uptake and/or assimilation. Aggression was also highest in the presence of both algae and arsenic. Bioremediation of arsenic contaminated waters using aquatic algae should therefore be carried out with consideration of entire ecosystem effects. We highlight that multidisciplinary, cross-taxon research, particularly integrating behavioural and other effects, is crucial for understanding the impacts of arsenic toxicity and thus restoration of aquatic ecosystems., (Copyright © 2014 Elsevier B.V. All rights reserved.)