Sasakawa Memorial Health Foundation (SMHF) has been the major support for the Schistosomiasis and Helminthiases Control Programme in Cambodia since July 1999. The programme has been extremely successful in Cambodia, thanks to generous support from SMHF and other partners, and has become a model for other countries, which suffer from Schistosomiasis and Helminthiasis.

　

 Our continuous effort with tremendous support from SMHF is expected to achieve elimination of Schistosomiasis mekongi in Cambodia in the near future. In fact, Schistosomiasis has dramatically decreased over the last several years: stool survey based on Kato-katz's method demonstrated that the prevalence of Schistosomiasis, which used to be more than 50% in 1996, finally came down to 0% in the highest endemic villages in January 2006. This rapid decrease was achieved owing to SMHF's support, a part of which is utilized to carry out "The Cambodia-Japan Medical Cooperation Project for the Control of Schistosomiasis in Northeast Cambodia" leaded by Professor Hajime Matsuda, Dokkyo University, Japan. Through this project, Prof. Matsuda and his team have been giving us technical support through regular field visits and discussions with staffs at our centre and at the Ministry of Health. In order to achieve the elimination and meet the international definition of the elimination of S. mekongi, we consider it is crucial to continue working on control activities with adequate monitoring system as well as to make the best use of financial and technical support from SMHF and other partners.

　

 Helminthiases Control Programme has also been making a great progress. It has been incorporated into other health programmes, including outreach services such as measles immunization, nutrition programs and IMCI (Integrated Management of Childhood Illness). The Ministry of Education has given high priority to education of helminthiases control in school health curriculum and strengthened their support for school teachers to carry out educational activities. We have encouraged local NGOs to participate in our programme, and they are now fully involved in the implementation of control activities in their target areas. The United Nations WHO and UNICEF also continue their technical and financial support to our deworming activities for school-age children.

　

　

　

　

　

　

　

　

 Every year after the MDA period, the schistosomiasis team goes to transmission villages in both Kratie and Stung Treng provinces to trace advance schistosomiasis patient on their health condition and also to find new cases. A total of 120 patients were registered, of whom, 11 patients were treated by surgery. We noticed that severe cases got better after the treatment. A man, who got ascitis after 8 times of treatment, his ascites disappeared, he gained weight, and recovered from anemia. Only a few patients still remain severe with hepatomegaly and splenomegaly, but nobody showed ascites any more. Ten patients, who were treated by surgery, are in good health condition, and they can go to work in the field. All of the people with health problems consulted with VHWs. No new severe cases are detected in Schistosomiasis endemic areas, but people still put themselves under the risk of infection by spend long time in Mekong River.

　

　

 A workshop on Schistosomiasis management for clinical staffs was organized by the National team in affected provinces of Kratie and Stung Treng. One clinical health staff per health centre and referral hospital, who works on consultation of out patient, was invited to attend the training course (a total of 32 health staffs). We explained disease transmission and also simple and severe symptoms, including portal hypertension that results from irreversible damage to the liver tissue (fibrosis and cirrhosis) due to the presence of Schistosoma eggs. We demonstrated how to measure important organomegaly (liver and spleen enlargement) and risk factors of variceal bleeding. Our major focus of the training was placed on correct diagnosis and treatment of Schistosomiasis, prevention and early treatment of complications, and follow-up of patients.

　

 An explanatory text in Khmer, including guideline for clinical management of Schistosomiasis, was distributed to all the participants at the training session.

　

　

 The schistosomiasis team at the national level, in collaboration with provincial staffs, went to interview selected population, who live in Shistosomiasis endemic area in Kratie and Stung Treng provinces. We examined their knowledge of transmission, vectors, cause and symptom of the disease, complication as well as their preventive measures and information source. Most of them knew the disease well and the effectiveness of the drug of MDA. They mentioned that they could not avoid their contact with water because of the need for fishing, and the fishing season overlaps with high transmission period. They also claimed that they needed latrine in their villages and requested us to provide MDA every year till the disease is eliminated from the area. Their information source was the MDA campaign, their children, VHWs and monks. We also discussed IEC material for health education with focal persons in target communities, especially about contents of the materials and possible channels which we can use to reach more people.

　

　

　

　

 Before starting the MDA, stool surveys were conducted in sentinel sites and other villages, in order to assess the impact of repeated annual universal treatment campaigns with praziquantel (40mg/kg) and mebendazole (500mg single dose) and also to know the prevalence of schistosomiasis infection or re-infection in endemic areas. The impact of MDA on the prevalence in 4 sentinel villages in Kratie from 1995 till 2006 is shown in Figure 1.

　

　

 Stools surveys were conducted in 13 villages in Stung Treng province and 19 villages in Kratie province. Stool samples were examined with Kato-Katz technique. We examined clinical signs in 4 sentinel sites in Kratie and one sentinel site in Sdau, Stung Treng province. No new case of hepato-splenomegaly was found in sentinel sites after 8 years of MDA (see Figure 1). All the villages are located along the Mekong River and their tributaries. In total, 2330 stool samples (1220 males (52.4%) and 1110 females (47.6%)) in Kratie and 1372 stool samples (697 male (50.8%) and 675 female (49.2%)) in Stung Treng were examined. No Schistosomiasis egg was found in all villages in Stung Treng and Kratie province. But the prevalence of hookworms was still high in most villages (11.3%-47.3%). A. lumbricoides was below 5%. The detail results of stool examination in Kratie and Stung Treng provinces are shown in Table 1 and Table 2, respectively. The prevalence of S. mekongi by ELISA test, which we have been following up every year in collaboration with Dokyo University in Japan, has reduced from 96.7% (1997) to < 58.3% (2006) in both provinces.