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Journal Cover Journal of Global Radiology
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  This is an Open Access Journal Open Access journal
   ISSN (Online) 2372-8418
   Published by U of Massachusetts Homepage  [17 journals]
  • Training Course in Focused Assessment with Sonography for HIV/TB in HIV
           Prevalent Medical Centers in Malawi

    • Authors: Timothy Canan et al.
      Abstract: Purpose: This article describes the process of training medical providers of different backgrounds about the “focused assessment with sonography for HIV-associated TB” (FASH) exam to expand the availability of ultrasound for TB diagnosis in resource poor settings in the central region of Malawi.Methods and Materials: A survey was completed by the 19 eligible participants before and after a 4-day training course regarding the utility of the FASH exam. A six-question quiz was used to assess knowledge of the use of ultrasound in the FASH exam before and after the course.Results: Participants’ knowledge of the FASH technique significantly improved after the four-day course with a 32% increase in total quiz questions answered correctly (p
      PubDate: Wed, 28 Mar 2018 05:51:24 PDT
  • A Rare Case of Enhancing Anterior Interhemispheric Racemose
           Neurocysticercosis with Foci of Calcification and Direct Parenchymal

    • Authors: Anupama Chandrappa et al.
      Abstract: Neurocysticercosis (NCC) refers to the central nervous system (CNS) infestation of the larvae of pork tapeworm Taenia solium. It is endemic in Central and South America, Asia and Africa. It most commonly presents as intraparenchymal subcentimetric ring enhancing lesions of variable ages (or size and duration) with surrounding vasogenic edema. The lesions calcify with time. Rarely, NCC can occur in extraparenchymal locations, within the subarachnoid space and ventricles. At these locations it is usually seen as a proliferative lobulated cystic mass without a scolex which is termed racemose neurocysticercosis. Racemose cysticerci do not show calcification, scolex, or enhancement.We report a case of a 23-year-old man with a two-year history of headache. CT and MRI showed multilocular bubbly cystic mass with epicenter in the anterior interhemispheric fissure showing intraparenchymal extension into adjacent bilateral parasagittal frontal lobes. There was a central nodular calcification and mild peri-lesional vasogenic edema. Rim enhancement was observed in the cysts on post contrast study. The diagnosis of racemose cysticercosis was made on biopsy. Despite being racemose, our case showed coarse central calcification and rim enhancement of the cystic portions, which are rare entities and hence reported here. Direct intraparenchymal extension of racemose form of NCC has not been reported in the literature to date, and our case is the first of this kind to be reported.
      PubDate: Tue, 27 Feb 2018 05:51:00 PST
  • Impact of Trust on Global Health and Global Radiology Initiatives

    • Authors: Nathalie Duchesne et al.
      Abstract: This editorial discusses how the best way to improve implementation and sustainability of humanitarian missions, including those of global imaging, is to employ the currency of the new economy: trust.
      PubDate: Fri, 01 Dec 2017 09:31:15 PST
  • A Survey of Structural Design of Diagnostic X-ray Imaging Facilities and
           Compliance to Shielding Design Goals in a Limited Resource Setting

    • Authors: Flavious B. Nkubli et al.
      Abstract: Purpose: To survey structural designs of x-ray rooms and compliance to shielding design goals of three x-ray imaging facilities.Methods and Materials: The survey was conducted in three radiodiagnostic centers in South East Nigeria, labeled X, Y and Z for anonymity. A stretchable non-elastic meter rule was used to measure x-ray room dimensions. A Vernier caliper was used to measure lead thickness while a calibrated digital survey meter Radalert 100x was used for radiation survey of controlled and uncontrolled areas. Simple statistical tools such as mean and standard deviation were used for analysis with the aid of Microsoft Excel version 2007.Results: Center X had a room dimension of 2.4 m × 2.1 m, Center Y had an x-ray room dimension of 3.6 m × 3.3 m, and Center Z had two x-ray rooms with identical dimensions of 6.3 m × 3.6 m. Measured exit radiation doses for controlled areas in all the centers were: 0.00152 mSv/wk; 0.00496 mSv/wk; 0.00168 mSv/wk; 0.00224 mSv/wk respectively. Lead was the common shielding material used.Conclusion: Based on the parameters studied, Center Z had the ideal room size and layout. Relative distances from the x-ray tubes to the nearest walls were not optimized in all the centers except in Center Z. Measured exit doses were within recommended limits except in Center Y. The location of the control consoles and measured doses were appropriate and within recommended design goals.
      PubDate: Tue, 14 Nov 2017 06:50:55 PST
  • Temporal Bone Hyperpneumatization and Tinnitus: Clinico-Radiological
           Evaluation Using CT Scan

    • Authors: Sattar Razzaq Al-Esawi et al.
      Abstract: Purpose: We propose that there is increased incidence of subjective tinnitus (ST) in patients with temporal bone hyperpneumatization (TBHP). The secondary goal of this project is to assess the degrees of association of TBHP with paranasal sinus hyperpneumatization (PNSHP), chronic sinusitis (CS), otomastoiditis (OM) and concha bullosa (CB).Methods and Materials: A total of 196 patients, who had computed tomography (CT) of the head for various clinical indications, were included in this study. CT head scans of patients with TBHP (n=96) were correlated with control patients (n=100). These patients had no apparent TBHP, history of ST, PNSHP, CS, OM or CB. The TBHP was graded based upon the extent of pneumatization. Size of the maxillary and sphenoid sinuses were also measured, providing pneumatization grade.Results: Subjective tinnitus (ST) was present in 31 cases of TBHP and in 8 patients in the control group, which was statistically significant. Mean volume of maxillary sinus and the largest axial sphenoid sinus diameter were significantly larger in the cases of TBHP than in that of controls. Otomastoiditis was found in only 4 cases of TBHP (4%) and none of the controls; however, the difference was not statistically significant. Chronic sinusitis was present in 8 cases of TBHP and 5 of controls, and was also not statistically significant. Concha bullosa was significantly more frequent among cases of TBHP than controls.Conclusion: There is a significant (p < 0.001) association between subjective tinnitus and increasing grade of temporal bone hyperpneumatization. There is a positive correlation between paranasal sinus hyperpneumatization and occurrence of concha bullosa, mimicking symptoms of sinusitis, with TBHP.
      PubDate: Tue, 05 Sep 2017 12:36:17 PDT
  • Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An
           Initial Experience in Rural Uganda

    • Authors: Christopher R. Stark et al.
      Abstract: Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda.Methods and Materials: Imaging the World Africa (ITWA) is the registered non-governmental organization division of Imaging the World (ITW), a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits.Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD.Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.
      PubDate: Fri, 30 Jun 2017 09:00:48 PDT
  • An Open Conversation with Traditional Birth Attendants in Rural Uganda:
           The Potential for Collaborative Care

    • Authors: Elizabeth D. Yuan et al.
      Abstract: Background: Imaging the World-Africa (ITWA) is a registered non-governmental organization aimed at distributing low-cost ultrasound services at health centres in rural Uganda. Yet, studies demonstrate that the majority of mothers continue to deliver with unregulated traditional birth attendants (TBAs) in their local villages. It has been suggested that the unregulated practices of TBAs has contributed to the high rate of maternal and fetal mortality. A greater understanding of the roles of TBAs in the management of pregnancy and delivery is needed.Purpose: The purpose of this report is to provide the international community with a greater understanding of TBA practices as well as an assessment of their willingness for future collaboration.Methods: Three TBAs from different nearby villages attended a meeting with ITWA in Kamuli District, Uganda. The meeting included an interview and an educational session. A test on the management principles of common obstetric complications was administered at the beginning and end of the meeting to assess baseline knowledge and the effect of the interaction.Results: The meeting with the TBAs provided valuable qualitative information about TBA clinical experience, the value of TBAs to the community and TBA understanding of ultrasound. On the pre-educational test, the TBAs had a limited understanding of pregnancy complications and conditions in which it would be safer for a mother to deliver at a hospital. After the educational session, the TBAs performed statistically significantly better on the post-test (p=0.03).Conclusion: The open conversation with the TBAs provided valuable information on the current role of TBAs in rural Uganda. Our experience with the TBAs demonstrates that TBAs are willing to engage with trained healthcare providers. Collaboration between TBAs and health centers in Uganda has the potential to bring to light previously unknown barriers and create solutions to better maternal and fetal care.
      PubDate: Wed, 07 Jun 2017 19:05:45 PDT
  • Interventional Radiology Readiness Assessment Tool for Global Health

    • Authors: Aaron D. Kline et al.
      Abstract: The Interventional Radiology Readiness Assessment Tool for Global Health is a new tool to methodically evaluate the environment of a medical institution for interventional radiology services given the existing infrastructure. Global health provides an exciting opportunity for interventional radiology to impact health outcomes in developing countries. A systematic and thoughtful approach to integrating interventional radiology services in the health care institutions of resource poor countries is needed in order to maximize global health efforts and outcomes.The IR Readiness Assessment Tool is available as on online form and in PDF format under "Additional Files" below.
      PubDate: Mon, 01 May 2017 13:40:46 PDT
  • Evaluating Factors Affecting Clinicians’ Knowledge on Contrast
           Media: Kenyan Experience

    • Authors: Timothy Musila Mutala et al.
      Abstract: Purpose: Our study aimed to establish exposure to and level of knowledge about contrast media among non-radiological clinicians and evaluate the contributory factors to the status.Methods and Materials: A cross-sectional study was conducted between April and December 2015 through interviews using structured questionnaires. We recruited 197 non-radiological clinicians with experience in use of contrast media in their routine practice. They were of different cadres and years of experience, all working in a large referral hospital in Kenya. Levels of basic knowledge on contrast media were evaluated through a scoring system after each clinician responded to the questions provided. We also sought for training on contrast media among these clinicians and where applicable the source of the same recorded. Descriptive and inferential statistical methods were applied across the different clinicians’ subsets.Results: Thirty-seven respondents representing 18.8% of the study sample had received formal training on contrast media. Mean knowledge score for all clinicians in this study was 14.6 translating to 14.1% of a set maximal theoretical score of 103 points. The standard deviation was 5.5. Analysis of variance (ANOVA) test for knowledge mean score among different cadres gave a P value 0.079. Unpaired t-test gave a two- tailed P value 0.2410 for mean score when trained and untrained clinicians were compared. The level of knowledge (mean score) when analysed against years of experience for the clinicians produced statistically significant results with P value 0.001084.Conclusion: Training and knowledge on contrast media can be profoundly low for clinicians. However, there is a possibility of knowledge improving from experience in practice due to multidisciplinary interaction and the implied advantage of encapsulated knowledge.
      PubDate: Fri, 17 Feb 2017 05:35:42 PST
  • Imaging in the Lion City: Singapore Radiology Country Report

    • Authors: Lionel Tim-Ee Cheng et al.
      Abstract: Singapore is a small tropical island city-state with limited natural resources that has achieved remarkable healthcare outcomes through effective long-term planning and judicious investment in human resources and technology. A full-range of medical imaging services is available in the country, with integrated care delivered to patients through a network of both government and private hospitals. Training in diagnostic radiology, interventional radiology, nuclear medicine and diagnostic radiography continue to evolve in Singapore, with an aim to further increase the range of subspecialty medical imaging services available and address projected challenges for the healthcare system in the future, such as an aging population. Continued government investment in technology and biomedical imaging is expected to further expand the scope and depth of medical imaging services in the future.
      PubDate: Fri, 09 Dec 2016 10:50:40 PST
  • Radiology and Global Health: The Case for a New Subspecialty

    • Authors: Matthew P. Lungren et al.
      Abstract: In high- and medium-income countries, the use of radiology has grown substantially in the last several decades. But in the developing world, access to medical imaging remains a critical problem. Unlike more structured efforts in the field of global health, interventions in global radiology have been largely unplanned, fragmented and sometimes irrelevant to the needs of the recipient society, and have not resulted in any significant progress. Access to medical imaging around the world remains dismal. There is a therefore a clear and urgent need for the radiology community to develop a vision for global radiology, beginning with defining the scope of the subject and establishing measurable goals. Agreement must be reached to declare global radiology as a bona fide subspecialty of radiology. This should soon be followed by the establishment of divisions of Global Radiology in academic radiology departments. Resident and medical students should be taught how physicians in low -income countries practice medicine without access to adequate radiology. As part of training and electives, residents and medical students should accompany global health teams to countries where the need for radiology services is great. Global scholar exchange and sabbatical opportunities should be offered to staff radiologists. Successful implementation of a unified vision of global radiology has the potential to improve access to medical imaging on a large scale. Radiology journals dedicated to the promotion of global radiology can play an important role in providing forums of discussion, analyses and sharing of field experiences. In this discussion we have attempted to make a case for assigning global radiology a subspecialty status.
      PubDate: Mon, 03 Oct 2016 05:20:33 PDT
  • Gestational Age Estimation Based on Fetal Pelvimetry on Fetal Ultrasound
           in Iraqi Women

    • Authors: Sattar Razzaq Al-Esawi et al.
      Abstract: Ultrasound is an integral part of obstetric practice, and assessment of gestational age (GA) is a central element of obstetric ultrasonography. Sonographic estimation of GA is derived from calculations based on fetal measurements. Numerous equations for GA calculation from fetal biometry have been adopted in routine practice. This study reports a new method of estimating GA in the second and third trimester using interischial distance (IID), the distance between the two ischial primary ossification centers, on fetal ultrasound. Four hundred women with uncomplicated normal singleton pregnancies from 16 weeks to term were examined. Standard fetal obstetric ultrasound was done measuring biparietal diameter (BPD) and femur length (FL) for each fetus. The IID, in millimeters, was correlated with the GA in weeks based upon the BPD and FL individually, and the BPD and FL together. Statistical analysis showed strong correlation between the IID and GA calculated from the FL with correlation coefficient (r =0.989, P < 0.001). Strong linear correlation was also found between the IID and GA based upon BPD and BPD+FL. Further statistical analysis using regression equations also showed that the IID was slightly wider in female fetuses, but this difference was not statistically significant. Resulting from this analysis, we have arrived at an easy-to-use equation: GA Weeks = (IID mm + 8) ±1 week. We feel this method can be especially applicable in the developing world, where midwives may not have access to software for fetal biometry in their basic handheld ultrasound machines. Even more sophisticated machines may not come with loaded software for obstetrics analysis. There are several limitations to this study, discussed below. We recommend further studies correlating the IID with other biometric parameters.
      PubDate: Fri, 12 Aug 2016 06:50:30 PDT
  • Ultrasound-guided Intralesional Bleomycin Injection (IBI) for Treatment of
           Cutaneous Hemangiomas and Vascular Malformations

    • Authors: Yousuf Memon et al.
      Abstract: Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations.Material & Methods: The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre- and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [ < 10% reduction].Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were peripheral.. In 24 of the 30 patients (76%), treatment had been completed. In six patients (21%) treatment was ongoing at the time of this report. Seventeen of the 23 hemangiomas (74%) were completely resolved clinically and on ultrasound, five (22%) showed substantial improvement and one (4%) showed mild improvement. In five of the seven vascular malformations (71%) lymphatic malformations resolved completely, and two (29%) venous malformations showed substantial improvement. Of the 13 patients presenting with discoloration, there was complete resolution in one (7.7%), marked reduction in 11 (84.6%) and mild reduction in one (7.7%). Of seven patients presenting with pain, there was complete resolution in two (28.6%), marked reduction in two (28.6%), mild reduction in two (28.6%), and no improvement in one (14.3%). There were no pulmonary complications.Conclusion: Ultrasound-guided intralesional injection of bleomycin is an option to consider for the treatment of certain types of cutaneous hemangiomas and vascular malformations. Prospective studies should be undertaken to understand the various factors contributing to therapeutic success.
      PubDate: Thu, 07 Jul 2016 06:05:31 PDT
  • Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast
           Cancer in Rural Uganda

    • Authors: Alphonsus Matovu et al.
      Abstract: Breast cancer incidence and mortality are rapidly increasing in low- and middle-income countries like Uganda. Shifting the proportion of women presenting with late-stage breast cancer to early-stage breast cancer (downstaging) at the time of diagnosis would substantially improve survival and efficient use of available resources. Imaging The World (ITW) conducted a pilot study in Uganda where trained village health teams (VHTs) promoted breast cancer awareness in the Kamuli District (Uganda). As a result, 212 women with self-detected lumps presented to the community health center level III (Nawanyago HCIII) for a clinical breast examination (CBE). Patients with masses on CBE were examined with breast ultrasound by a certified sonographer trained in breast imaging. Women with ultrasound-detected masses were referred to a regional health center for further evaluation. Of the 212 women, 44 (21%) had a palpable mass by CBE, 11 (28%) examined by ultrasound were recommended for biopsy, and four breast cancers were diagnosed. Providing ultrasound scanning at Nawanyago HCIII reduced the number of women travelling to the referral hospital by 75%. As a result of breast cancer awareness and ultrasound studies, we were able to diagnose breast cancer at an earlier stage than would be otherwise possible. This pilot project supports locally available breast ultrasound as a resource-appropriate strategy to downstage breast cancer in a low-income country.
      PubDate: Thu, 12 May 2016 09:04:11 PDT
  • The Logistics of Bringing Imaging to the World

    • Authors: Sarwat Hussain
      Abstract: The current issue of the Journal of Global Radiology (JGR) covers a range of topics that fall within the sub-specialty of global radiology. Original articles, country reports, and a conference report have attempted to paint an informative picture of the practice, research, and educational opportunities for voluntary contributions and profitable business. These papers contribute, in one way or another, to the vision of the Journal of Global Radiology: Ensuring medical imaging access for all.
      PubDate: Mon, 30 Nov 2015 17:40:21 PST
  • Diagnostic Radiology in Liberia: A Country Report

    • Authors: Farah S. Ali et al.
      Abstract: Liberia is a tropical country located south of the Sahara Desert in coastal West Africa. It lies at 6 °30’ North Latitude and 9° 30’ West Longitude and is bordered by Guinea, Cote d’Ivoire, Sierra Leone and the Atlantic Ocean. Liberia has three distinct topographical areas: 1) coastal plain, creeks, lagoons and mangrove swamps; 2) rolling, forested hills with elevations up to 500 feet that cover most of the country; and 3) low mountains and plateaus in the Northern highlands with elevations reaching 4,748 feet (Nimba Mountains). Liberia is home to approximately four million people and is roughly the size of the US state of Tennessee. Named after former US President James Monroe, Liberia’s capital Monrovia is a coastal city with a population of one million (1).There are two major seasons in Liberia: dry and rainy. The dry season occurs between December and March, and is is characterized by warm days and cool nights, with risk of sand storms from the Sahara Desert (2). The rainy season occurs between mid-April and mid-November. The average annual rainfall is 200 inches on the coast and decreases to 80 inches in areas farthest inland, and the average temperature is 27 degrees Celsius (81 degrees Fahrenheit) (1). Liberia is a low-income country that relies heavily on foreign aid (3). Liberia is the seventh poorest nation in the world, ranking 31st among 46 sub-Sarahan African countries in national income. In 2013, Liberia’s per capita GDP was $900 US (3). Liberia’s economy depends heavily on natural resources, with mining and agriculture being the dominant industries. Iron exportation has grown and in 2013 overcame rubber as Liberia’s top export. According to the 2013 Central Bank of Liberia (CBL) Annual Report, iron ore and rubber represent 82% of Liberia’s total exports (4). Civil war destroyed much of Liberia’s economy, including critical infrastructure in and around Monrovia. Although conditions are favorable for agriculture, Liberia does not produce nearly enough food to meet the demands of its population. The country imports large quantities of food, with rice alone accounting for 10% of its overall imports (5).
      PubDate: Mon, 30 Nov 2015 17:40:19 PST
  • PACS for the Developing World

    • Authors: Jeffrey B. Mendel et al.
      Abstract: Digital imaging is now firmly ensconced in the developed world. Its widespread adoption has enabled instant access to images, remote viewing, remote consultation, and the end of lost or misplaced film. Unfortunately, the current paradigm of Picture Archiving and Communication System (PACS), with advanced technology inseparable from high complexity, high purchase costs, and high maintenance costs, is not suited for the low-income developing world. Like the simple, easy to repair, 1950’s American cars still running on the streets of Havana, the developing world requires a PACS (DW-PACS) that can perform basic functions and survive in a limited-resource environment. The purpose of this article is to more fully describe this concept and to present a blueprint for PACS tailored to the needs and resources of the developing world. This framework should assist both users looking for a vendor-supplied or open-source solutions and developers seeking to address the needs of this emerging market.
      PubDate: Wed, 25 Nov 2015 11:00:32 PST
  • Using Village Health Teams for Effective Ultrasound Education in Rural

    • Authors: Naiim S. Ali et al.
      Abstract: Maternal and child health conditions, many of which can be detected by ultrasound, represent the highest burden of disease in Uganda. Imaging the World (ITW) is a not-for-profit organization which integrates high quality, affordable ultrasound services into rural health facilities. Of all the challenges faced with implementation of ITW programs in Uganda, lack of sensitization to ultrasound represented the greatest barrier. The Village Health Team (VHT) is an existing public health “train the trainer” model sponsored by the Uganda Ministry of Health which provides public health training to community volunteers. Trained VHT members were recruited to help with ultrasound community outreach and education. These VHT members were successful in achieving dramatic community acceptance and increased utilization of ultrasound services in rural communities. This has led to significant contributions in improving population health in low-resource settings.
      PubDate: Wed, 25 Nov 2015 11:00:26 PST
  • Meeting Report: 2015 Scientific Meeting of the Pan Arab Interventional
           Radiology Society

    • Authors: Tauqir A. Rana
      Abstract: The second Annual Scientific Meeting of the Pan Arab Interventional Radiology Society (PAIRS), held March 12-14, 2015, was a step above the inaugural edition, and opened new concepts for development.
      PubDate: Thu, 19 Nov 2015 07:15:17 PST
  • Imaging in the Khmer’s Land: Cambodia Country Report

    • Authors: Samantha G. Harrington et al.
      Abstract: Cambodia is located in Southeast Asia on the Indochina Peninsula and borders Vietnam, Laos, Thailand and the Gulf of Thailand (Figure 1). With a total area of 69,898 square miles and population of 15,458,332, Cambodia’s population density has steadily increased since 1980. The country’s annual rate of urbanization is 2.65 %. As of 2014, 20.5% of the population lives in an urban setting. The estimated population growth rate is 1.63% (1).The capital of Cambodia is Phnom Penh, which is located in the southern part of the country. Other major cities include Battambang and Siem Reap, both of which have populations over 150,000. There are officially 24 provinces and one municipality (Phnom Penh). However, many consider Phnom Penh to be its own province. As a result, some research puts the number of Cambodian provinces at 25.The climate is tropical with two seasons: monsoon season (May to November) and dry season (December to April). Temperatures range from approximately 70 to 95°F. Cambodia’s economy largely depends on the garment industry, tourism, construction, real estate and agriculture.Cambodia gained independence from France in 1953 and was first ruled by a constitutional monarchy under King Norodom Sihanouk. After a five-year struggle starting in 1970, the Khmer Rouge captured Phnom Penh in 1975. Pol Pot, the leader of the Khmer Rouge, oversaw a brutal regime that, through executions and forced labor, was responsible for the deaths of at least 1.5 million Cambodians. The Vietnamese drove out the Khmer Rouge in 1979. After years of Vietnamese occupation, the 1991 Paris Peace Accords established a ceasefire and a democratic framework for the country. By 1993 elections established a new coalition government; yet, political instability and violence persisted throughout the 1990s. Cambodia most recently held elections in 2013, as a multiparty democracy under a constitutional monarchy.The devastation caused by the Khmer Rouge has had long-lasting negative effects on Cambodia’s political and economic systems, as well as to its infrastructure, and public health. Despite this, Cambodia has made measurable improvements. At the end of Khmer Rouge rule in 1980, life expectancy was 30 years (1). Political stabilization, economic improvement and a growing healthcare system improved the life expectancy to 63.78 years by 2015 (2). The physician density remains low, at 0.17 physicians per 1,000 people (2). As of 2012, there were eight national hospitals and three levels of referral hospitals in the public sector. Referral hospitals are categorized by three levels of Complementary Package of Activity (CPA): 1) CPA-1 hospitals do not perform surgery; 2) CPA-2 hospitals perform surgeries but with more limited specialized services; and 3) CPA-3 hospitals perform surgery with more specialized services. There are 26 CPA-3 hospitals in Cambodia (3). As of 2011 there were 2,391 doctors, 8,433 nurses and 3,748 midwives (3). There are also NGOs that run hospitals throughout Cambodia, as well as private sector health care facilities.
      PubDate: Thu, 19 Nov 2015 07:15:15 PST
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