“There are two problems in the dengue situation in Cambodia,” says Prof. Ngan Chantha, director of the National Dengue Control Program (NDCP) in Phnom Penh. “First, we only know of dengue cases reported by the main hospitals for children, so there is no data on cases in adults. Besides, there are many cases of dengue that are not treated in hospitals but by informal health practitioners in villages, most of them without proper medical accreditation.” In 2013, 17 533 cases of dengue were registered by the NDCP and 59 of those patients died as a consequence of complications with the disease. This number is lower than 2012, which was an epidemic year for dengue, with more than 42 300 reported cases and 189 fatalities. Besides these challenges in the collection of data, there is an additional problem: financial capacity for awareness campaigns. “We have a small budget to operate basic information campaigns, and every year this budget is reduced considerably,” says Prof. Ngan.   Official awareness efforts in Cambodia Government efforts to increase public awareness are concentrated on education in the cities and rural villages. Because of financial restrictions, the campaigns use basic technology such as motorbikes and tuk-tuk (the main transportation in Cambodia). The government pays $25US per vehicle per day, to go around the villages with information to help prevent the spread of the disease.

The campaigns also include advertising in magazines and newspapers, as well as TV and radio spots to inform people about the most common places in houses and workplaces for mosquitoes to breed.

Informal health practitioners

Another big concern for public officials is the large number of informal health practitioners in Cambodia, who compromise the quality of medical treatment for people with severe dengue. “We have found dengue cases treated as normal flu. Only when the patients get complications do they finally go to the hospital,” says Prof. Ngan. Although there are charity hospitals where they can get free access to doctors, people prefer to go to a village pharmacy and consult people without proper medical accreditation. I talked to one woman in a rural area outside Phnom Penh who told me that the hospitals are too far from the villages, and that they cannot afford the price of transportation. The hospitals are very crowded, she said, and you have to wait for almost an entire day before you can see a doctor. This could explain why people prefer to go to informal practitioners.   “Dengue is a behavioral problem”

I asked Prof. Ngan if he thought dengue could be eradicated from Cambodia some day. “Absolutely not,” he replied without hesitation. I was surprised by his response. “We can run campaigns all year,” he explained, “distribute flyers, make more TV spots. But until people change their bad habits, dengue will keep spreading. And changing a human habit is one of the most complicated things to do.” His words made me consider possible ways to address the problem. Some structural measures are needed to make people change their behavior, but also I think that some creativity in the awareness campaigns could make a difference to how people receive a message.