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Limited understanding, limited services, limited resources: patients’ experiences with managing hypertension and diabetes in Cambodia
  1. Bart Jacobs1,
  2. Cheanrithy Men2,
  3. Maryam Bigdeli3,
  4. Peter S Hill4
  1. 1 Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia
  2. 2 Chean and Jaco Consulting, Phnom Penh, Cambodia
  3. 3 Department for Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
  4. 4 Department of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Bart Jacobs, Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), c/o NIPH, No.2, Street 289, Khan Toul Kork, P.O. Box 1238,Phnom Penh, Cambodia ; bart.jacobs{at}giz.de

Abstract

Introduction Health system responses to the emergence of non-communicable diseases (NCDs) in many Southeast Asian nations, Cambodia included, have been insufficient. Little is known about how people suffering from such conditions behave in constrained contexts. We examined the experience of patients with NCDs as they seek care for their conditions and manage them.

Methods In-depth interviews with 28 purposively selected patients with hypertension and/or diabetes using an interview guide to capture the trajectory followed by interviewees from the development and recognition of symptoms to adherence to treatment. A general outline of major topics to be discussed was used instead of a predetermined list of specific questions.

Results All interviewees had experienced symptoms for a substantial period of time, sometimes many years, before being diagnosed. Initial treatment focused on symptoms instead of underlying conditions, often at considerable financial cost. Following diagnosis, many struggled to take medicines daily for their condition and adhering to the required behaviour changes. Many resorted to complementary medicine. Lack of financial resources was a common reason to discontinue treatment. Many reported loss of income and assets such as livestock and productive land and increasingly relied on others.

Conclusion In order to assist people with NCDs in Cambodia, there is a need for a multipronged approach focusing on communities and healthcare providers. Information campaigns could focus on the timely recognition by communities of symptoms indicative of the conditions, together with instigating demand for routine screening at qualified health providers. Peer support is considerable, and locally adjusted approaches based on this principle should be considered.

  • cambodia
  • diabetes
  • hypertension
  • qualitative study
  • health service research

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Footnotes

  • Contributors BJ and CM conceptualised and designed the study. CM conducted the fieldwork and did the initial analyses of the data and wrote the draft report. BJ wrote the first draft of the manuscript and led on its further development. PSH provided further inputs and revisions throughout the manuscript development process. MB reviewed the manuscript and provided additional input. All authors read and approved the final manuscript.

  • Disclaimer The author(s) is(are) staff member(s) of the World Health Organization. The author(s) alone is(are) responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was obtained from the Cambodian National Ethics Committee for Health Research (0008 NECHR) and the Research Ethics Review Committee of the WHO (RPC 551).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data from the study have been published.

  • Correction notice This article has been corrected since it first published. The open access statement has been amended.

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