Cambodia’s men and women, especially in rural areas, may have as many as three ages—their actual age, their school age and their legal age. The confusion starts with, for example, a six-year-old child who is so small because of malnutrition that parents, as well as teachers, can’t envision him going to school.
A few years later, when the child has physically grown enough to look as if he or she is ready for the first grade, parents then register him as being a six-year-old to make sure that he is admitted without any difficulties.
And when government representatives come to register their children in the family book—which serves as a family’s official birth records—the child’s parents register his school age. Or, if they feel the need to protect the child from possible future military service, they will give an entirely new age.
This means school children often are years older than their declared age, said Philippe Longfils, health adviser to the Rural Development Program for Kampot and Kompong Thom provinces, which is supported by the GTZ-German Development Cooperation.
The usual gap between actual age and school age is two years, although four-year differences are frequent, Longfils said.
Seventeen-year-olds often end up in grade four, registered as being 12, Longfils said. Later on, a 20-year-old man may not be able to get a job because his legal age is 15; or he may be seen as dating a minor if his girlfriend, who in reality is 19-years-old, is registered as 14 in the family book, he said.
One practice commonly used in rural areas is for teachers to put a child to a physical test to determine whether he or she is old enough for school. If he can put one arm over this head and reach the opposite ear, he qualifies.
The government policy is that a child should start school at the age of six, and that age should be the only determining factor for admission, said Pok Than, secretary of state for the Ministry of Education. However, he said, “In some remote areas, where people have no birth certificates of identification cards, maybe they use this method.”
By the age of five, a normal child should have no difficulty with this test, said Longfils. “But the very high prevalence of chronic malnutrition in Cambodia makes that most children stay small, their limbs stay short as they don’t grow up normally, and many cannot perform this test even at eight-years-old,” he said.
A first survey conducted in 1999—as part of the health program that includes about 13,000 children in Kampot province—showed that 64 percent of the students in primary schools were anemic, said Longfils.
“Anemia causes unrecoverable damage to the intellect,” and may reduce a child’s IQ by as much as 10 percent, said Severin von Xylander, medical officer for child and adolescent health and development programs at the World Health Organization.
In the study, nearly 80 percent of the 11-year-old students were stunted or too short for their age, Longfils said. “The prevalence of stunting increases, with the age an indication that the chronic malnutrition persists over the years,” he said.
The problem starts at birth, said von Xylander. By the age of three, half of the children in Cambodia are malnourished, their growth stunted, he said. Solutions often are simple and inexpensive but, he said, “children’s health does not get the attention it deserves.” Of the 61,000 children under five who die each year, 10,000 of them could easily be saved, he said. Oral therapy alone could reduce deaths due to diarrhea by 80 percent, von Xylander said.
Giving iron to students once a week can reduce moderate cases of anemia by about half and eliminate all severe cases within a year, said Longfils. Iron-folic acid tablets cost about 137 riel per child per school year, or $1 per 29 children, he said. With $100,000, the country could run a countrywide iron therapy for all primary-school students, Longfils said.
A study should soon be launched to determine the best vitamin combination against anemia, said Longfils. The study will help the Ministry of Health meet its goal of reducing anemia by 42 percent among children under five by 2007. If tablets distributed twice a week prove as effective as daily doses, this may lower costs by more than three times, Longfils wrote in the study proposal.
In some cases, malnutrition is a matter of education, such as fighting food taboos that make mothers believe meat and vegetables can cause parasite infections or that fresh fruit causes diarrhea in young children, said Longfils.
A study of 418 households conducted in 1999 by village health volunteers in Kampot province had shown that 84 percent of them had no latrine, and that children went barefoot to relieve themselves, which leads to illnesses like hookworm and others, said Longfils.
During their work in Kampot province, the health program team was puzzled by the fact that the worst period for malnutrition and diarrhea was April, May and June when people still have rice left from the previous crop. “We discovered that people in the countryside drink water from ponds or rivers as they have done for centuries; at the end of the dry season, levels are low and the water they drink contaminated,” said Longfils. Agencies may equip villagers with dozens of wells but, since they usually don’t like the taste of well water, they will keep on drinking in ponds unless they are told several times why they should switch to well water, he said.
A great deal could be done nationwide with a small amount of additional funding from the international community, von Xylander said.
“Children are not born malnourished,” he said. “A child who is stunted will carry this burden for the rest of his life.”
