Iodine

Cambodia

Vitamin A

Iron




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Country Profile		Policy & Legislation
		Program Data
		Monitoring
		Program Resources

	EPIDEMIOLOGICAL DATA


Clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey: 2000 National Micronutrient Survey of Cambodia (rural sample)
	Other Surveys:	1. Cambodia National Micronutrient survey (CMS) 2000 by MOH and Helen Keller International 2. Cambodia Demographic and Health Survey 2000. Data collection between February – July 2000. Women 15-49 years of age and children <5
	Date:	May – July 2000
	Groups Surveyed:	Nationally representative sample which included 10 provinces. Children under five and their mothers. Blood sub-sample also included fathers.
	Sample Size:	15,120 households
	Sampling Method:	Stratified multi-stage cluster sampling.
	Sampling Strategy:	First, the 20 provinces of Cambodia (excluded all urban communes and four provinces because of their urban nature from the sampling framework) were divided into six (6) groups according to the characteristics that are related to the research interest of the survey and homogeneity of population. Each of these six groups serves as sampling stratum. Within each stratum, 50% of the provinces were selected using simple random sampling. An equal number of clusters (communes) was then drawn from each group (84 clusters). Communes are treated as clusters and are the primary sampling units (PSUs) of the survey. Probability proportionate to size (PPS) was used to draw the 84 clusters. Within each cluster, 30 target households will be selected applying systematic sampling. Total sample = 15,120 households.
	Estimated Prevalence of VAD:	( in children 18-59 months of age)

Indicator: XN
Region/Group*	Sample size	Population in region/group (if available)	Prevalence in sample %
#1 Svay Rieng		478252	0.73
#2 Preah Vihear		119261	1.03
#3 Rattankiri		94243	2.11
#4 Otar Meanchey		68279	1.82
#5 Kampong Cham		1608914	0.58
#6 Kandal		1075125	0.23
#7 Koh Kong		132106	1.27
#8 Kampot		528405	0.60
#9 Battambang		793129	0.27
#10 Kampong Thom		569060	1.07
National Total	12,820

Estimated Prevalence of VAD:

(during last pregnancy <3 yrs ago)

Indicator: XN
Region/Group*	Sample size	Population in region/group (if available)	Prevalence in sample %
#1 Svay Rieng		478252	4.4
#2 Preah Vihear		119261	4.8
#3 Rattankiri		94243	9.3
#4 Otar Meanchey		68279	8.5
#5 Kampong Cham		1608914	4.0
#6 Kandal		1075125	2.9
#7 Koh Kong		132106	2.0
#8 Kampot		528405	4.5
#9 Battambang		793129	2.8
#10 Kampong Thom		569060	5.3
National Total	14,933


Sub-clinical Vitamin A Deficiency
Most Recent Clinical VAD Survey
	Same as above, except a sub-national was taken. 1800 households for blood sub-sample. Blood collected on oldest child 0-59 months, mothers, and fathers (when available). Blood samples are in the process of being analyzed.


	POLICY AND LEGISLATION

Legislation on VAD
	There is no VAD legislation in Cambodia. It is neither being developed or about to be enacted. There are government documents published by the government to state the national policy towards VAD; National Vitamin A Policy Guidelines..


Government Agency to Address VAD
	Ministry of Health: National Maternal and Child Health / Nutrition programme. This agency's function is both coordination and monitoring.


	PROGRAM DATA


Supplementation
Program Description
	National programme integrated with EPI in 1997
	There is a policy to address vitamin A supplementation for mothers within 8 wks of delivery, since 1997.
	Supplementations were distributed via National Immunization Day, from 1997 to 2000.


Targeting
	Children 6-59 months:	(estimated 1,810, 403 children for 2001)


Implementation
	Coverage:

Region/Group	Estimated # of people supplemented, number of times/year
National ( children 6-11 months) *	103,847 (53%) around the month of March 2001
National ( children 12-59 months) *	769,253 (48%) around the month of March 2001
National ( children 6-11 months) *	Similar coverage in November2001
National ( children 12-59 months) *	Similar coverage in November 2001
National ( Lactating women < 8 wk of delivery) **	69,334 (16%) all year round

* Source: National Nutrition Program (NMCHC/MoH) for children 6 - 59 mos. old

** Source: Health Information System (HIS)

VA Supply:

Vitamin A Supply (for target year): 2001
Source	Supplementation: Capsules No. & Value of Capsules (000)
	200,000 IU		100,000 IU		50,000 IU		10,000 IU
	No.	$	No.	$	No.	$	No.	$
Imported into country	4,621,959	153,013	449,366	6,188	0	0	0	0
Locally produced	0	0	0	0	0	0	0	0
Totals	4,621,959	153,013	449,366	6,188	0	0	0	0

Source: Central Medical Store (MoH). The $ is converted from local currency


Fortification
	There are no VitA fortification programs


Other Programs
Dietary Change
	There are community-based programs (UNICEF, CARE, HKI) to promote improved vitamin A status through dietary change. It is run by clinics, health centers and health professionals.



	MONITORING

Clinical and Sub-clinical VAD
	Monitoring through Cambodia Demographic and Health Survey (2000).
	The indicators used for monitoring clinical VAD are night blindness (XN), proportion of children who received vitamin A supplements and the proportion of post-partum women who received vitamin A supplements.

Supplementation
	Capsules are procured via the national budget from overseas, and some capsules are provided through UNICEF and MI.
	Vitamin A capsule distribution is usually monitored by the activities that it was integrated with. For example, the EPI supervisors monitored vitamin A capsule distribution. The supervisors from the National Nutrition Program also conducted some supplementary supervision activities, especially during the vitamin A supplementation periods.

Fortification
	There are no fortification programs to monitor.



	PROGRAM RESOURCES

Donor Agencies

Implementing Agency	Description of Activities	Expenditure and source of funds in current year
Implementing Agency	Description of Activities	Supplementation	Fortification	Other (specify)
National/State Governments	· Procurement of vitamin A capsules · Outreach services	Est. Staff time plus USD99,421.00 (2001)	No
External Agencies* UNICEF HKI WHO	· Procurement of vit. A capsules (free donation) · Outreach services · Public Education through mass media & interpersonal communication · Health staff training in vitamin A policy/ guideline	Integrated cost with EPI plus and SNIDs

VAD Program Funding History and Projections

The cost for vitamin A deficiency control activity in Cambodia has been integrated with the other program’s activities, mainly Supplementary National Immunization days( SNIDs), routine EPI. So it will not be accurate to provide the cost for vitamin A program. For example the health staff are not provided any extra cost for delivering vitamin A capsules during the routine outreach activities as well as during the SNIDs. Training of health staff is usually integrated with other training activities such as training for outreach services or EPI training courses.

Year	VAD Activity				Total $(000)
	Supplementation $(000)	Fortification $(000)	Other (specify)
	Supplementation $(000)	Fortification $(000)	Activity	$(000)
1998
1999
2000
2001
2002
2003	250 Vitamin A capsules and training activities Upgrading of laboratory activities	80 Vitamin A fortification of food items( trials)			330
2004	250 Vitamin A capsules and Serum vitamin A assays.	150 Support to Vitamin A industry and promotion of fortified food items and public education on Vitamin A.			400
2005

Note: Budget required includes building capacity of National Nutrition Program to assess sub-clinical and conduct vitamin A survey in the country.

EPIDEMIOLOGICAL DATA

POLICY AND LEGISLATION

PROGRAM DATA

Source: Central Medical Store (MoH). The $ is converted from local currency

MONITORING

PROGRAM RESOURCES

VAD Activity