AB017. Assessing burden of surgical diseases in Cambodia

AB017. Assessing burden of surgical diseases in Cambodia

Ma Wai Wai Zaw1,2, Hui Xiang Chia3, Kim Savuon4, Pheak Chhoun5, Hang Leang Taing5, Siyan Yi5, Hiang Khoon Tan2,6,7, Chee Hsiang Liow3

1Department of Anaesthesiology and Intensive Care, Singapore General Hospital, Singapore, Singapore; 2SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; 4Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia; 5KHANA Center for Population Health Research, Phnom Penh, Cambodia; 6International Collaborations Office, SingHealth, Singapore, Singapore; 7Future Health Systems, Singapore General Hospital, Singapore, Singapore

Correspondence to: Ma Wai Wai Zaw, MMBS, MMed (Anes), MPH. Department of Anaesthesiology and Intensive Care, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Email: ma.wai.wai.zaw@singhealth.com.sg.

Background: Despite growing recognition on the importance of global surgery and theoretical models suggesting highest unmet needs in Southeast Asia (SEA), there is paucity of literature characterising the burden of surgical diseases within each SEA country. We sought to evaluate burden of surgical diseases in Cambodia to inform health planning and priority-setting.

Methods: An anonymised survey was electronically administered with the support of health ministry and district representatives to healthcare providers to determine the proportion of patients who should or would require a surgeon in their management for a given disease category, regardless of the need for surgery. Survey was available in Khmer and English, and was endorsed by health ministry and district representatives. The proportions were then multiplied by estimates of burden of disease in Cambodia taken from the Global Burden of Diseases 2019 study to derive surgical disease burden.

Results: A total of 214 respondents participated in the survey. Thirty-seven were surgeons or anaesthesia providers. 53.5% of participants worked in national hospitals, and 43.2% interacted with surgical patients daily. Cancers, digestive and liver diseases were disease categories with the highest ratings in terms of surgical input required. Overall, respondents estimated that surgical conditions constituted 30.1–34.5% of total disease burden in Cambodia, depending on whether burden is defined in terms of deaths or disability-adjusted life years (DALYs) lost. Providers from CPA-3 and national level hospitals predicted 35.7% and 31.2% of Cambodia’s burden of deaths and DALYs lost to be surgical, respectively. Burden estimates were interestingly lower for surgeons than non-surgeons. However, no statistically significant differences were observed between surgeons versus non-surgeons, or between higher and lower levels of care.

Conclusions: Surgical disease burden estimates in Cambodia are above prior global estimates, underscoring the value of upscaling surgical health services to meet a significant portion of the country’s health needs.

Keywords: Cambodia; disease burden; global surgery


The authors are grateful to the Cambodian Ministry of Health, district health and hospital representatives from participating institutions, without whose help and support this would not have been made possible.

Funding: This project was supported by the SDGHI and SSHPSH Joint Funding Initiative on Global Health Research in Asia, which was administered by Saw Swee Hock School of Public Health, Singapore (grant No. A-0006403-00-00).


Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-2023-apru-ab017/coif). Dr. M.W.W.Z. reported that the SDGHI and SSHPSH Joint Funding Initiative on Global Health Research in Asia, which is administered by Saw Swee Hock School of Public Health, Singapore supported the above-mentioned manuscript and Dr. M.W.W.Z.’s attendance of APRU Global Health Conference 2023. Dr. M.W.W.Z. reported medical stocks (Abbott Labs, Astrazeneca, Becton Dickinson, Edwards Lifesciences, Intuitive Surg, Johnson & Johnson, Medtronic) procured personally and independent of manuscript work. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the National University of Singapore Institutional Review Board (NUS-IRB) (No. NUS-IRB-2021-767). Participant consent is not needed; the waiver of consent does not adversely affect the rights and welfare of the participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/jphe-2023-apru-ab017
Cite this abstract as: Zaw MWW, Chia HX, Savuon K, Chhoun P, Taing HL, Yi S, Tan HK, Liow CH. AB017. Assessing burden of surgical diseases in Cambodia. J Public Health Emerg 2024;8:AB017.

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