H5N1 Deaths Could Have Been Avoided, Study Says

The lives of Cambodian avian influenza patients could have been saved if the local health system was better equipped, and if staff had better medical training, according to new research re­leased this week.

The report, Human H5N1 influenza infections in Cambodia 2005-2011, also criticizes Cambo­dian health officials’ slow re­sponse to H5N1 outbreaks in humans, as well as the particularly low number of patients who re­ceived antiviral treatment to fight the disease.

Based on the study of all confirmed H5N1 cases in Cambodia between 2005 and 2011, the researchers found that of the total of 18 cases up to 2011, only one patient survived the virus, and almost half of the patients had died within 24 hours of admission to hospitals.

Globally, the mortality rate for avian influenza in humans is about 60 percent. In Vietnam, where outbreaks are also common, the rate is 50 percent. In Cambodia, the mortality rate is 90 percent.

“Based on data collected re­gar­ding key health system re­sour­ces, Cambodia has been identified as having some of the largest resource gaps and potentially the highest rate of avoidable deaths when compared to other countries in Southeast Asia, in­cluding Indonesia, Lao PDR, Taiwan, Thailand and Vietnam,” according to the report, authored by the London School of Hygiene & Tropical Medicine, with support from the Ministry of Health.

Reasons for the large number of H5N1 fatalities is the low density of health professionals in Cambodia, the long distances that must be traveled to reach hospitals, equipment shortages and insufficient health care facilities, as well as the inability to deploy experienced medical experts, according to the research.

“The substantial distances traveled to the admitting hospital and the costs associated with hospitalization may have delayed patients and their caregivers from seeking appropriate treatment,” the researchers say.

In addition, local doctors were either unaware of how to treat and diagnose H5N1 or lacked simple equipment such as mechanical ventilation, necessary to treat Hypoxaemia.

“Hypoxaemia is a common and major cause of mortality in those patients suffering pneumonia [a symptom of H5N1] and a lack of mechanic ventilators is likely to contribute significantly to avoidable deaths,” the paper states.

In all the cases studied, only five patients were administered Tamiflu, the World Health Or­ganization’s recommended an­tiviral treatment for avian influenza, and none of them received the first dose within the recommended 48 hours of the onset of symptoms.

According to the report, in Cambodia, just 28 percent of patients received appropriate treatment for H5N1, a much lower number than in other Southeast Asian countries, such as Thailand and Vietnam, where up to 71 percent and 82 percent of patients received the correct antiviral medicines, respectively.

The release of the unflattering report comes in a year that has already seen a total of ten H5N1 cases and eight deaths from the disease, the highest since avian influenza was first discovered in Cambodia in 2005.

Dr. Sok Touch, director of communicable disease control with the Ministry of Health, said that a lack of professional experience and awareness was the cause of the high mortality rate in Cambodia, but that the situation has improved.

“We have a higher awareness…there has been an im­provement in administering Tami­flu,” Dr. Touch said, despite 8 out of 10 patients passing away this year, in the largest outbreak to date.

Dr. Sin Somuny, executive di­rector of MediCam, an umbrella organization of health NGOs, said that the study failed to point out that people in Cambodia do not take the disease seriously.

“People need to understand that they have to go to the hospital immediately. But instead, they go to a pharmacy or a health center first…that delays the treatment,” Mr. Somuny said.

High costs of hospitalization and traveling, however, keep many from seeking care immediately, the researchers said.

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