{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T19:19:22Z","timestamp":1778095162431,"version":"3.51.4"},"reference-count":56,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,5]]},"abstract":"<jats:p>Enteric fever is a systemic bacterial infection in humans that is endemic in Cambodia and for which antibiotic resistance is increasingly reported. To guide public health programs, this qualitative study sought to explore community perceptions on transmission and treatment. Participant observation was carried out in hospital settings, pharmacies, and at a community level in Phnom Penh. In-depth interviews 39 and one focus group discussion were carried out with blood culture\u2013confirmed enteric fever patients and purposively selected key informants. Informants were theoretically sampled based on initial themes identified using abductive analysis. Nvivo 11 was used for thematic coding. An urgent need to address health literacy concerning the transmission of enteric fever was identified, as lay informants did not link the disease and its symptoms to bacterial contamination of foods and drinks but rather to foods considered \u201cbad\u201d following humoral illness interpretations. As a result, lay informants considered recurrence of enteric fever preventable with appropriate dietary restrictions and Khmer traditional medicines. This study also reveals pluralistic health-care\u2013seeking behavior. For initial and mild symptoms, patients preferred home treatment or traditional healing practices; limited household finances delayed treatment seeking. When symptoms persisted, patients first visited drug outlets or private practitioners, where they received a mix of nonessential medicines and one or more antibiotics often without prescription or confirmation of diagnosis. Inappropriate use of antibiotics was common and was related to diagnostic uncertainty and limited finances, factors which should be addressed during future efforts to improve the uptake of appropriate diagnostics and treatment of enteric fever.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0432","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T07:09:53Z","timestamp":1539068993000},"page":"1369-1377","source":"Crossref","is-referenced-by-count":6,"title":["Enteric Fever in Cambodia: Community Perceptions and Practices Concerning Disease Transmission and Treatment"],"prefix":"10.4269","volume":"99","author":[{"given":"Laura Maria Francisca","family":"Kuijpers","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Gryseels","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sambunny","family":"Uk","sequence":"additional","affiliation":[{"name":"Independent Researcher, Phnom Penh, Cambodia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panha","family":"Chung","sequence":"additional","affiliation":[{"name":"Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sotharith","family":"Bory","sequence":"additional","affiliation":[{"name":"Calmette Hospital, Phnom Penh, Cambodia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bun","family":"Sreng","sequence":"additional","affiliation":[{"name":"Department of Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Parry","sequence":"additional","affiliation":[{"name":"Independent Researcher, Phnom Penh, Cambodia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koen","family":"Peeters Grietens","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","author":"Epstein","year":"2006"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e0005964","article-title":"The clinical and microbiological characteristics of enteric fever in Cambodia, 2008\u20132015","volume":"11","author":"Kuijpers","year":"2017"},{"key":"b3","series-title":"Lancet","first-page":"1211","article-title":"Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever","volume":"1","author":"Gilman","year":"1975"},{"key":"b4","series-title":"J Clin Microbiol","first-page":"1683","article-title":"Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance","volume":"36","author":"Wain","year":"1998"},{"key":"b5","series-title":"N Engl J Med","first-page":"1770","article-title":"Typhoid fever","volume":"347","author":"Parry","year":"2002"},{"key":"b6","series-title":"Clin Microbiol Rev","first-page":"901","article-title":"Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections","volume":"28","author":"Crump","year":"2015"},{"key":"b7","series-title":"Trans R Soc Trop Med Hyg","first-page":"718","article-title":"Enteric fever in Cambodian children is dominated by multidrug-resistant H58 Salmonella enterica serovar typhi with intermediate susceptibility to ciprofloxacin","volume":"106","author":"Emary","year":"2012"},{"key":"b8","series-title":"PLoS Negl Trop Dis","first-page":"e0004785","article-title":"The molecular and spatial epidemiology of typhoid fever in rural Cambodia","volume":"10","author":"Pham Thanh","year":"2016"},{"key":"b9","series-title":"Euro Surveill","first-page":"20592","article-title":"Increase in Salmonella enterica serovar Paratyphi A infections in Phnom Penh, Cambodia, January 2011 to August 2013","volume":"18","author":"Vlieghe","year":"2013"},{"key":"b10","series-title":"Euro Surveill","first-page":"20594","article-title":"Unusual increase in reported cases of paratyphoid A fever among travellers returning from Cambodia, January to September 2013","volume":"18","author":"Tourdjman","year":"2013"},{"key":"b11","series-title":"Epidemiol Infect","first-page":"602","article-title":"Increase in paratyphoid fever cases in Japanese travellers returning from Cambodia in 2013","volume":"144","author":"Saitoh","year":"2016"},{"key":"b12","series-title":"Emerg Infect Dis","first-page":"1089","article-title":"Salmonella enterica Paratyphi A infections in travelers returning from Cambodia, United States","volume":"21","author":"Judd","year":"2015"},{"key":"b13","series-title":"Antimicrob Resist Infect Control","first-page":"30","article-title":"Pervasive antibiotic misuse in the Cambodian community: antibiotic-seeking behaviour with unrestricted access","volume":"6","author":"Om","year":"2017"},{"key":"b14","series-title":"Antimicrob Resist Infect Control","first-page":"58","article-title":"\u201cIf it\u2019s a broad spectrum, it can shoot better\u201d: inappropriate antibiotic prescribing in Cambodia","volume":"5","author":"Om","year":"2016"},{"key":"b15","series-title":"PLoS One","first-page":"e80343","article-title":"Injections, cocktails and diviners: therapeutic flexibility in the context of malaria elimination and drug resistance in northeast Cambodia","volume":"8","author":"Gryseels","year":"2013"},{"key":"b16","series-title":"Emerg Infect Dis","first-page":"794","article-title":"Antimicrobial resistance determinants and future control","volume":"11","author":"Harbarth","year":"2005"},{"key":"b17","series-title":"Lancet Infect Dis","first-page":"692","article-title":"Non-prescription antimicrobial use worldwide: a systematic review","volume":"11","author":"Morgan","year":"2011"},{"key":"b18","series-title":"Lancet Infect Dis","first-page":"568","article-title":"Antimicrobial resistance in developing countries. Part II: strategies for containment","volume":"5","author":"Okeke","year":"2005"},{"key":"b19","series-title":"Lancet","first-page":"1884","article-title":"Emerging infectious diseases: the role of social sciences","volume":"380","author":"Janes","year":"2012"},{"key":"b20","series-title":"Lancet Infect Dis","first-page":"1057","article-title":"Antibiotic resistance-the need for global solutions","volume":"13","author":"Laxminarayan","year":"2013"},{"key":"b21","series-title":"Emerg Infect Dis","first-page":"18","article-title":"Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries","volume":"5","author":"Okeke","year":"1999"},{"key":"b22","series-title":"Malar J","first-page":"81","article-title":"Local constraints to access appropriate malaria treatment in the context of parasite resistance in Cambodia: a qualitative study","volume":"16","author":"Verschuere","year":"2017"},{"key":"b23","series-title":"Public Health","first-page":"21","article-title":"Comparison of health-seeking behaviour between poor and better-off people after health sector reform in Cambodia","volume":"118","author":"Yanagisawa","year":"2004"},{"key":"b24","author":"Ramage","year":"2011"},{"key":"b25","series-title":"Hum Resour Health","first-page":"9","article-title":"Strengthening health professions regulation in Cambodia: a rapid assessment","volume":"14","author":"Clarke","year":"2016"},{"key":"b26","author":"World Health Organization","year":"2012"},{"key":"b27","series-title":"Int J Environ Res Public Health","first-page":"191","article-title":"Water-borne diseases and extreme weather events in Cambodia: review of impacts and implications of climate change","volume":"12","author":"Davies","year":"2014"},{"key":"b28","series-title":"JAMA","first-page":"2607","article-title":"Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia","volume":"291","author":"Vollaard","year":"2004"},{"key":"b29","series-title":"Malaria Rep","first-page":"17","article-title":"The PASS-model: a model for guiding health-seeking behaviour and access to care research","volume":"2","author":"Hausmann Muela","year":"2012"},{"key":"b30","series-title":"Southeast Asian J Trop Med Public Health","first-page":"343","article-title":"Causes of childhood diarrhea as perceived by mothers in the Punjab, Pakistan","volume":"34","author":"Nielsen","year":"2003"},{"key":"b31","series-title":"BMC Public Health","first-page":"690","article-title":"Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam","volume":"11","author":"Rheinlander","year":"2011"},{"key":"b32","series-title":"J Community Health","first-page":"27","article-title":"Chumnguh thleum: understanding liver illness and hepatitis B among Cambodian immigrants","volume":"36","author":"Burke","year":"2011"},{"key":"b33","author":"Foster","year":"1993"},{"key":"b34","series-title":"J Community Health Nurs","first-page":"41","article-title":"Cambodian refugee health care beliefs and practices","volume":"2","author":"Kemp","year":"1985"},{"key":"b35","series-title":"J Infect Dis:","doi-asserted-by":"publisher","first-page":"jix122","DOI":"10.1093\/infdis\/jix122","article-title":"Social and economic burden associated with typhoid fever in Kathmandu and surrounding areas: a qualitative study","author":"Kaljee","year":"2017"},{"key":"b36","series-title":"Int J Environ Rural Dev","first-page":"113","article-title":"Seasonal direct-use value of Cheung ek peri-urban lake, Phnom Penh, Cambodia","volume":"1","author":"Sar","year":"2010"},{"key":"b37","series-title":"Trop Med Int Health","first-page":"73","article-title":"Faecal and protozoan parasite contamination of water spinach (Ipomoea aquatica) cultivated in urban wastewater in Phnom Penh, Cambodia","volume":"12","author":"Vuong","year":"2007"},{"key":"b38","series-title":"Trop Med Int Health","first-page":"696","article-title":"Risk factors for typhoid in Darjeeling, West Bengal, India: evidence for practical action","volume":"14","author":"Sharma","year":"2009"},{"key":"b39","series-title":"Epidemiol Infect","first-page":"612","article-title":"Risk factors for typhoid fever among adult patients in Diyarbakir, Turkey","volume":"134","author":"Hosoglu","year":"2006"},{"key":"b40","series-title":"PLoS Negl Trop Dis","first-page":"e0003859","article-title":"A large-scale community-based outbreak of paratyphoid fever caused by hospital-derived transmission in southern China","volume":"9","author":"Yan","year":"2015"},{"key":"b41","series-title":"Indian J Microbiol","first-page":"100","article-title":"Street vended food in developing world: hazard analyses","volume":"51","author":"Rane","year":"2011"},{"key":"b42","author":"Food and Agriculture Organization of the United Nations (FAO)","year":"1989"},{"key":"b43","series-title":"Southeast Asian J Trop Med Public Health","first-page":"55","article-title":"An outbreak of paratyphoid A in Singapore: clinical and epidemiological studies","volume":"12","author":"Goh","year":"1981"},{"key":"b44","series-title":"Clin Infect Dis","first-page":"S69","article-title":"A qualitative study investigating experiences, perceptions, and healthcare system performance in relation to the surveillance of typhoid fever in Madagascar","volume":"62","author":"Pach","year":"2016"},{"key":"b45","series-title":"J Epidemiol Glob Health","first-page":"73","article-title":"Putting surveillance data into context: the role of health care utilization surveys in understanding population burden of pneumonia in developing countries","volume":"2","author":"Deutscher","year":"2012"},{"key":"b46","series-title":"J Health Popul Nutr","first-page":"61","article-title":"Healthcare-seeking behaviour for common infectious disease-related illnesses in rural Kenya: a community-based house-to-house survey","volume":"29","author":"Burton","year":"2011"},{"key":"b47","series-title":"Am J Trop Med Hyg","first-page":"106","article-title":"Responding to an outbreak of typhoid fever: assessment of water, sanitation and hygiene interventions in Neno District, Malawi","volume":"85","author":"Bennett","year":"2011"},{"key":"b48","author":"Hudelson","year":"1996"},{"key":"b49","series-title":"BMJ","first-page":"694","article-title":"Framework for design and evaluation of complex interventions to improve health","volume":"321","author":"Campbell","year":"2000"},{"key":"b50","series-title":"BMJ","first-page":"711","article-title":"Development and evaluation of complex interventions in health services research: case study of the Southampton heart integrated care project (SHIP). The SHIP Collaborative Group","volume":"318","author":"Bradley","year":"1999"},{"key":"b51","author":"Muong","year":"2004"},{"key":"b52","series-title":"Soc Sci Med","first-page":"118","article-title":"Impact of health financing policies in Cambodia: a 20 year experience","volume":"177","author":"Ensor","year":"2017"},{"key":"b53","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1223","article-title":"Prevalence and distribution of beta-lactamase coding genes in third-generation cephalosporin-resistant Enterobacteriaceae from bloodstream infections in Cambodia","volume":"34","author":"Vlieghe","year":"2015"},{"key":"b54","series-title":"PLoS Negl Trop Dis","first-page":"e1933","article-title":"Azithromycin and ciprofloxacin resistance in Salmonella bloodstream infections in Cambodian adults","volume":"6","author":"Vlieghe","year":"2012"},{"key":"b55","author":"Sengkong","year":"2016"},{"key":"b56","series-title":"Health Serv Res","first-page":"1189","article-title":"Enhancing the quality and credibility of qualitative analysis","volume":"34","author":"Patton","year":"1999"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/6\/article-p1369.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/6\/article-p1369.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/6\/article-p1369.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T20:37:03Z","timestamp":1722458223000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/6\/article-p1369.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,5]]},"references-count":56,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.18-0432","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,5]]}}}