KEYWORD1:
Cambodia, Measles, Surveillance

BACKGROUND:
Cambodia has endured decades of civil war with significant damage to its public health infrastructure. In 1999, a measles control program was established with enhanced surveillance as a major priority. In October 2002, CDC collaborated with WHO and the Cambodian Ministry of Health to evaluate the measles surveillance system.

OBJECTIVE:
To describe and evaluate the measles surveillance system in Cambodia.

METHOD:
We reviewed the structure and function of the measles surveillance system through visits to outbreak-affected villages and data review at all levels.

RESULT:
Villages are visited monthly by outreach teams who deliver vaccination and preventive services and perform active case finding for measles. Measles is suspected in cases with rash and fever, plus cough, coryza, or conjunctivitis. Children with measles are kept at home during the period of rash due to cultural beliefs, so few cases present to health facilities. When five cases are reported from a village in a four week period, provincial health department staff conduct an outbreak investigation. Financial incentives are provided to health workers for detecting and investigating outbreaks. Diagnosis is made using a clinical case definition with laboratory confirmation available in eight of the twenty four provinces. From January to October 2002, 122 outbreaks were detected and investigated, comprising 1256 cases. 47% of cases were reported within 7 days of rash onset and 36% were investigated within 2 days of report. Few cases were reported from health facilities during this period.

CONCLUSION:
The community-based measles surveillance system provides timely data on measles outbreaks which is more sensitive than health facility reporting. This system could be adopted in other situations with weak public health infrastructure.
LEARNINGOBJECTIVES:
At the end of the session, participants should be able to describe the features and advantages of community-based measles surveillance in Cambodia.