fit for travel cambodia malaria map

• Travel planning

Malaria: Cambodia, Laos, Thailand, Vietnam

One of the most commonly asked questions by first-time travellers to Southeast Asia is "Should I take malarials?". It's a simple question, with a complicated answer, best summed up as "it depends". Here's ten pointers that we hope will help you make a more informed decision regarding malarials and travel to Southeast Asia.

Planning categories

Get an idea, get some money, get insurance, get your documents, get your gear, get packing, get the most out of your trip, get talking, get booking, get out alive, get working, 1) talk to a travel doctor..

Malaria is a serious disease which kills over one million people every year , and the best place to start is with a doctor who is a travel specialist. Your local medical practitioner or family doctor may not have the expertise nor experience to give you an accurate opinion on what you should be doing. " Traveller's Medical Centres " are a growing niche which you should avail yourself of.

If you talk to your doctor, mention Asia and they lunge for the prescription book, without even asking where in Asia you are considering going, then you need to get a more informed opinion .

Dengue fever in Southeast Asia

As a casual visitor to Southeast Asia you're fare more likely to contract Dengue fever than malaria. Click here to learn more about the disease including first hand reports from those who have suffered the virus .

Talking of a more informed opinion, we talked to a tropical medicine specialist we've known for years and here's what he had to say:

"Generally travel medical doctors try to individualise it with the patient and their trip, rather than adopt a "cookbook" approach and a risk assessment model works well here. Basically the factors to be considered and discussed with a client enquiring about malaria tabs are: - the country itself and overall level of risk which includes "official" recommendations from organisations e.g.. WHO - areas travelled to within the country (esp urban or rural) as risks will vary here. This includes level of remoteness and access to medical care - duration of travel - season of travel i.e. wet / dry - style of travel - on a spectrum of rock bottom to 5-star. - the client's own compliance with mosquito avoidance measures - the client's own wishes regarding what level of risk is acceptable -- some want to be "covered for everything" whilst some others don't want tablets even if they're going to a high risk area. It's a moveable feast and not cast in stone. For example: - Previous blanket recommendations for needing prophylaxis for anywhere in India were recently relaxed about one to two years ago. However a recent increase in cases amongst tourists in Goa forced a rethink. - there is good evidence that due to climate change, malaria in Kenya is now occurring at higher altitudes (incl. Nairobi!) at areas and elevations previously considered malaria free. I think the main message is that the decision to take or not take malaria prevention needs to be made by the client after consultation with a travel medicine provider. "

Now here's some other points about the disease you should consider.

2) Malarials do not immunise you from malaria

This is a common misconception. To quote the WHO: " No antimalarial prophylactic regimen gives complete protection ". Malarials do not protect you 100% from malaria, rather they give you more time to get to a medical centre where you will still need to seek further medical treatment. This is certainly the case with doxycycline -- one of the more commonly prescribed medications.

3) An ounce of prevention is worth a pound of cure

Listen to your Grandma -- An ounce of prevention is worth a pound of cure . The best way to avoid being afflicted by malaria is to avoid being bitten by mosquitos and there are a number of simple steps one can take to dramatically reduce the chances of being bitten. These include:

a) Use a permethrin impregnated mosquito net b) Use mosquito repellent containing DEET c) Dress sensibly -- wear long pants and sleeves at dawn and dusk. d) Use mosquito coils or other anti-mosquito devices (e.g.., citronella) as a secondary control. e) If you are prone to being bitten, lean towards accommodation that can be sealed up -- air-con with no slatted windows nor open eaves. f) Watch out for rooms with bucket showers/toilets. These tend to have buckets of stagnant water -- a mozzie's beach resort -- in the bathroom. g) Don't sleep naked in a swamp .

4) Prevention protects you from other nasties

Another potentially fatal disease spread by mosquitos is dengue fever . It should be a far bigger concern to travellers than malaria, but as there's no pills to sell to "protect" you from it, you hear far less about it from the medical industry. In following the steps outlined in point 3 above, you'll also protect yourself from dengue fever.

5) The need for malarials is dependent on where you are going

The US Centre for Disease Control (CDC), an organisation which tends to err on the cautious side, suggests the following areas have malaria risks: Cambodia: Risk throughout the country, including risk in the temple complex at Angkor Wat. No risk in Phnom Penh and around Lake Tonle Sap. Laos: Risk throughout the country, except no risk in the city of Vientiane. Thailand: Risk in rural areas that border Cambodia, Laos, and Burma. Risk in Ko Pha Ngan. No risk in cities and no risk in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket and Ko Samui. Vietnam: Rural only, except no risk in the Red River delta and the coastal plain north of the Nha Trang. No risk in Hanoi, Ho Chi Minh City, Da Nang, Nha Trang, Qui Nhon, and Haiphong.

The WHO makes the following recommendations: Cambodia: Throughout the year in the whole country except in Phnom Penh and close around Tonle Sap. Risk within the tourist area of Angkor Wat is limited. Laos: Throughout the year in the whole country except in Vientiane. Thailand: Throughout the year in rural, especially forested and hilly, areas of the whole country, mainly towards the international borders. There is no risk in cities (e.g. Bangkok, Chiang Mai, Pattaya), Samui island and the main tourist resorts of Phuket island. However, there is a risk in some other areas and islands. Vietnam: Malaria risk exists in the whole country, excluding urban centres, the Red River delta, and the coastal plain areas of central Vietnam. High-risk areas are the highland areas below 1 500 m. south of 18?N, notably in the 4 central highlands provinces Dak Lak, Dak Nong, Gia Lai and Kon Tum, Binh Phuoc province, and the western parts of the coastal provinces, Quang Tri, Quang Nam, Ninh Thuan and Khanh Hoa.

6) Malarials can have nasty side effects

There are four main types of malarials which are prescribed for travel to Asia. They are atovaquone/proguanil (brand name Malarone), doxycycline, mefloquine (brand name Larium) and primaquine. While the majority of travellers take these without problem, each of these can have serious side-effects, including:

Atovaquone/proguanil Stomach pain, nausea, vomiting, and headache.

Doxycycline Sun sensitivity, nausea, stomach pain and vaginal yeast infection. More inconvenient than a touch of sunburn is that doxycycline can render the birth-control pill ineffective. If you are using doxycycline and don't have plans for baby travellers on your immediate horizon, then you will need to use alternative birth control measures.

Mefloquine The most common side effects include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Rarer, more serious side effects include seizures, depression, and psychosis. We've personally seen individuals bearing the brunt of these side effects and would never suggest anyone take this profilactic for travel in Asia.

Primaquine Stomach cramps, nausea, and vomiting. Primaquine can also cause an hemolysis (bursting of the red blood cells) in G6PD deficient persons, which can be fatal.

That all sounds pretty terrible, but then there's the effects of catching malaria which you need to weight these against: Shaking chills, headaches, muscle aches, tiredness, nausea, vomiting, and diarrhoea. May also cause anaemia and jaundice. Infection with one type of malaria, Plasmodium falciparum , if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death .

7) Many mosquitos are malarial resistant

Malaria is an adapting disease and certain areas are resistant to some malarials. To again quote from the CDC:

Cambodia The provinces of Preah Vihear, Siemreap, Oddar Meanchey, Banteay Meanchey, Battambang, Pailin, Koh Kong, and Pursat bordering Thailand are mefloquine resistant -- use only atovaquone/proguanil or doxycycline. All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine. No risk in Phnom Penh and Tonle Sap.

Laos The provinces of Bokeo, Luang Nam Tha, Salavan and Champassak, along with the areas along the Thai and Burmese borders are all mefloquine resistant -- use only atovaquone/proguanil or doxycycline. All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine. No risk in Vientiane.

Thailand All of Thailand is mefloquine resistant, use only atovaquone/proguanil or doxycycline. No risk in cities and no risk in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket and Ko Samui.

Vietnam The southern and central part of Vietnam, including rural areas of the provinces of Tay Ninh, Song Be, Lam Dong, Ninh Thuan, Khanh Hoa, Dak Lak, Gia Lai, and Kon Tum are all mefloquine resistant -- use only atovaquone/proguanil or doxycycline. All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine. No risk in Hanoi, Ho Chi Minh City, Da Nang, Nha Trang, Qui Nhon, and Haiphong.

To boil all that down, if you are going to take malarials, don't take mefloquine as it doesn't cover the entirety of any one of the above countries.

8) Malarials are expensive

Purchased in the west, malarials can be very expensive . While we're not suggesting there's any profiteering going on (perish the thought), there is a definate financial incentive for the pharmaceutical industry to convince you to purchase the pills before you leave home. If you're comfortable using generic medication, malarials are far more affordable in Asia than in the west,so consider spending your money in Asia.

9) Chances are you'll be fine

You're far more likely to have a motorbike accident , have your bag stolen or contract dengue fever than you are to come into contact with malaria. While the local population has some degree of inherited resistance to the disease, there are thousands of foreigners living in Asia who have no such resistance. Very very few of these foreigners, who live in Asia for years, take malarials on a regular basis.

10) Our personal experience

For what it's worth, in our over ten years of living and travelling absolutely all over the region, we've: Been involved in three motorcycle accidents Had some piece of luggage stolen at least three times Know of at least half a dozen people who have had dengue fever Have known not a single person who has contracted malaria Have seen two people (including a Travelfish staffer) totally freak out as a result of taking mefloquine.

In conclusion , if you're planning on stopping by just the main tourist hotspots, using repellent and a mosquito net, dressing sensibly and never sleeping naked in a swamp, then chances are you probably don't need to take malarials. On the other hand, if you're planning on spending a lot of time trekking in remote areas and hanging out in border zones, don't plan to use a mosquito net or repellent and almost certainly plan to sleep in a swamp in your birthday suit once or twice, then availing yourself of a course of malarials would be a prudent decision.

One last point -- if you do decide to take malarials, make sure you take the full course of pills. If you cut it short you're contributing to drug resistant strains of malaria and also endangering yourself.

Further reading

Start by contacting a travel doctor and getting their opinion, then try the following websites for more information: CDC Malaria website WHO malaria website

Planning well is an integral part of getting the most out of your trip. Be it picking the right backpack, the right vaccinations or the right country, the simple decisions are often the most important.

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COVID-19: travel health notice for all travellers

Cambodia travel advice

Latest updates: Health – editorial update

Last updated: September 24, 2024 11:21 ET

On this page

Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, cambodia - exercise a high degree of caution.

Exercise a high degree of caution in Cambodia due to an increase in petty crime.

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Petty crime

Petty crime, such as phone and bag snatching, occurs frequently. Thieves, sometimes on motorcycles, grab bags and other valuables, including passports. Theft targeting foreigners is frequent on sidewalks, on motorcycles and tuktuks (rickshaws) in:

• Phnom Penh, particularly the riverfronts and the Boeung Keng Kang areas
• Sihanoukville

Personal belongings have been stolen from locked rooms, particularly in low-cost accommodations. Items have been removed from luggage stored in the luggage compartments of buses, especially on the journey between Phnom Penh and Siem Reap.

These crimes occur any time of day or night.

During your stay in Cambodia:

• ensure that your personal belongings, including your passport and your other travel documents are secure at all times
• do not leave your belongings unattended
• if you are robbed, hand over cash, electronic devices and valuables without resistance

Violent crime

Violent crimes, such as stabbings, sometimes occur. Foreigners have encountered difficulties when reporting crimes to police and military personnel lacking discipline.

Organized crime

There are reports of criminal operations in the seaside resort of Sihanoukville and the Special Economic Zone. The criminal activity includes employment scams, drug and human trafficking.

During your trip:

• exercise a high degree of caution at all times
• avoid walking alone after dark
• report any criminal incidents to the local police of the jurisdiction, before leaving Cambodia

Cambodia is one of the most heavily mined countries in the world. Landmines pose a threat to the safety of travellers.

There are still reports of landmines in the following areas:

• the Preah Vihear Phnom Kulen temple areas
• the border areas, including with Thailand
• the River of a Thousand Lingas

There are also landmines in rural areas, especially in the following provinces:

• Banteay Meanchey
• Kampong Thom
• Siem Reap except in the town of Siem Reap and the Angkor temples, which are considered clear by the Cambodian government

If you are travelling through the affected areas:

• be especially vigilant in remote areas, near small bridges and secondary roads
• do not walk in forested areas, fields or in dry rice paddies without a local guide
• don't handle suspicious items and report them to local authorities
• pay attention to signs indicating the possible presence of landmines
• stay on paved and main roads and avoid roadside ditches, shoulders and unmarked trails
• cross only at official border crossings

Although there have been no recent reports of terrorist activity, the global risk of terrorism should not be ruled out.

Always be aware of your surroundings when in public places.

Demonstrations

Demonstrations take place and even peaceful demonstrations can turn violent at any time. They can also lead to disruptions to traffic and public transportation.

• Avoid areas where demonstrations and large gatherings are taking place
• Follow the instructions of local authorities
• Monitor local media for information on ongoing demonstrations

Mass gatherings (large-scale events)

Credit card and ATM fraud

There is bank and ATM fraud. When using debit or credit cards:

• pay careful attention if other people are handling your cards
• use ATMs located in public areas or inside a bank or business
• count and examine your cash at the ATM or with your teller
• avoid using card readers with an irregular or unusual feature
• cover the keypad with one hand when entering your PIN
• check for any unauthorized transactions on your account statements

Scams targeting tourists occur, including card games. The criminals sometimes take travellers to ATMs and force them to withdraw money.

Travellers have been the victim of scams and extortion at border crossings. Some have reported that border officials demanded they pay extra charges before they can enter Cambodia.

Carefully consider accepting assistance from individuals offering to help with documentation or transportation.

Reports of scam operations have increased, especially in the city of Sihanoukville and Poipet.

• Be wary of fake job offers on social media, through agencies, or from unknown employers.
• Verify the business's legitimacy before making the decision.

Telephone scams

Foreigners have received calls from scammers claiming to be local authorities or financial institutions. The caller may try to collect personal information or request a fund transfer to resolve administrative or customs issues.

Do not send any money or personal information in this type of situation.

Romance scams

Romance scams through dating sites or social media have occurred. Be alert to attempts at fraud by persons who profess friendship or romantic interest over the internet. It may be an attempt to get you to send money to pay off fake debts.

• Beware of people who show a keen interest online
• Keep in mind that you may be the victim of a scam if you go to Cambodia to meet someone that you met online
• Always meet new acquaintances in a secure and familiar location
• Be mindful of the risk of inviting new acquaintances in your hotel room or apartment

Useful links

• Overseas fraud
• Cyber security while travelling

Women's safety

Sexual assault has been committed, including against foreign women, in Cambodia. Some of the reported incidents happened in hostels.

• Be cautious of strangers who are helpful and friendly
• Do not accept offers of transportation from strangers
• Avoid dark alleys and isolated areas
• Avoid unattended beaches
• Keep your hotel or hostel doors and windows locked

If you are victim of a sexual assault, you should seek medical attention and report the situation immediately to local authorities and the nearest Canadian embassy or consulate.

Advice for women travellers

Road safety

Driving habits.

Road safety can vary considerably across the country. Drivers do not drive safely or respect traffic laws.

Drinking and driving is common, and frequently the cause of accidents, especially around major holidays. Some vehicles, especially motorcycles, may drive against the flow of traffic and on the sidewalks.

• Exercise caution when driving or walking
• Be particularly vigilant when driving during the holiday periods

In the event of a car accident:

• remain at the scene
• report the accident to the police and your insurance company as soon as possible
• if you are found to be at fault, you may be detained until all fines are paid

Road conditions

The road system outside of major cities is in poor condition. Main roads are paved but secondary roads may not be. Narrow and unpaved roads affect rural driving. Conditions may be more hazardous during the rainy season.

Travel by road during daylight hours.

Travel by motorcycle

Motorcycles are a common in urban areas. Motorcycle accidents kill or maim several Canadians in Cambodia each year.

Riding motorcycles in Cambodia as it is dangerous, even for experienced motorcyclists.

Rental agencies often request passports as a guarantee when renting motorcycles.

You should not use your Canadian passport as collateral or assurance for debts or rental of motorcycles. If your passport is inaccessible or stolen because of such misuse, you may be subject to investigation by Passport Canada and may receive limited passport services.

Checkpoints

Expect checkpoints and have your up-to-date documents ready for traffic police to inspect.

Public transportation

Exercise caution when taking buses in Cambodia.

• Only use reputable transportation companies
• Contact your travel agency for a list of recommended intercity bus companies

Taxis and ridesharing services

Taxis are available in major cities and are easy to obtain at hotels or taxi stands. Self-drive (rental), chauffeur-driven cars and ridesharing services are also available in major cities.

Confirm fares before entering a taxi, and/or request that the taxi driver use the meter.

Travel can be affected by the poor track maintenance and drivers trying to beat the train at crossings.

Boats are often overcrowded and lack adequate safety equipment. Boat owners do not accept liability for accidents.

Each year, illicit drug use leads to the death of several Canadians in Cambodia. Seek medical assistance if you begin to feel sick after using drugs.

More information on how to avoid difficult and dangerous situations related to illegal drugs

Pirate attacks and armed robbery against ships occur in coastal waters. Mariners should take appropriate precautions.

Live piracy report – International Maritime Bureau's Piracy Reporting Centre

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from the Cambodian authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for at least 6 months beyond the date of entry into Cambodia. If you wish to extend your stay in Cambodia, make sure that your passport is valid for at least 6 months beyond the extension period.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: required Business visa: required Student visa: required

Tourist and business visas allow entry to Cambodia for 30 days only, counting from the date of entry.

Travellers must pay a fee in cash of US$30 for tourist visas or US$35 for business visas and provide two passport-sized photos. The photos can be purchased at the airport for US$3 each.

Make sure Cambodian officials stamp your passport when you arrive. Keep your immigration card intact in your passport or put it in a safe place. You will have to contact Cambodian immigration officials if you lose your immigration card before you can leave the country.

You can request a single-entry tourist visa online through Cambodia's e-Visa service.

Apply for an e-visa – Cambodian Ministry of Foreign Affairs and International Cooperation

Visa expiry date

When issued outside Cambodia, visas have an expiry date, which refers to the date by which the visa must be used, not the length of time allowed in the country. Visas must be renewed for stays over 30 days and may only be extended once.

Where to get a visa

Tourist and business visas can be obtained at:

• a Cambodian embassy abroad
• upon arrival at the airports in Phnom Penh and Siem Reap
• certain land borders as e-visas

For more information, contact the nearest Cambodian embassy or consulate.

Other entry requirements

The trial period for the Cambodia e-Arrival application (CeA) will end on August 31, 2024. As of September 1, 2024, the electronic form in the app will replace the standard immigration, customs and health forms.

You will have to complete your e-Arrival forms (immigration, customs and health) within 7 days of your scheduled arrival.

Cambodia e-Arrival (CeA) application – Government of Cambodia

An onward or return ticket and proof of sufficient funds are required to visit Cambodia.

Foreigners Presence in Cambodia System (FPCS)

Cambodian immigration has required that foreign nationals in Cambodia be registered on the FPCS – an online registration system aiming to protect foreigners' safety and security in case of an emergency while living or staying in Cambodia. If you don't register, you may be denied a visa extension. Verify with your accommodation staff or owners if they have registered your information on the system. If you own your accommodation, you can self-register by downloading the mobile app.

• Children and travel

Learn more about travelling with children .

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• Zika virus: Advice for travellers - 31 August, 2023
• COVID-19 and International Travel - 13 March, 2024
• Avian influenza: Advice for travellers - 16 September, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

Yellow fever   is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is no risk of yellow fever in this country.

Country Entry Requirement*

• Proof of vaccination is required if you are coming from or have transited through an airport of a country   where yellow fever occurs.

Recommendation

• Vaccination is not recommended.
• Discuss travel plans, activities, and destinations with a health care professional.
• Contact a designated  Yellow Fever Vaccination Centre  well in advance of your trip to arrange for vaccination.

About Yellow Fever

Yellow Fever Vaccination Centres in Canada * It is important to note that  country entry requirements  may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest  diplomatic or consular office  of the destination(s) you will be visiting to verify any additional entry requirements.

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

Japanese encephalitis is a viral infection that can cause swelling of the brain.  It is spread to humans through the bite of an infected mosquito. Risk is very low for most travellers. Travellers at relatively higher risk may want to consider vaccination for JE prior to travelling.

Travellers are at higher risk if they will be:

• travelling long term (e.g. more than 30 days)
• making multiple trips to endemic areas
• staying for extended periods in rural areas
• visiting an area suffering a JE outbreak
• engaging in activities involving high contact with mosquitos (e.g., entomologists)

Malaria  is a serious and sometimes fatal disease that is caused by parasites spread through the bites of mosquitoes.   There is a risk of malaria in certain areas and/or during a certain time of year in this destination. 

Antimalarial medication may be recommended depending on your itinerary and the time of year you are travelling. Consult a health care professional or visit a travel health clinic before travelling to discuss your options. It is recommended to do this 6 weeks before travel, however, it is still a good idea any time before leaving.    Protect yourself from mosquito bites at all times:  • Cover your skin and use an approved insect repellent on uncovered skin.  • Exclude mosquitoes from your living area with screening and/or closed, well-sealed doors and windows. • Use insecticide-treated bed nets if mosquitoes cannot be excluded from your living area.  • Wear permethrin-treated clothing.    If you develop symptoms similar to malaria when you are travelling or up to a year after you return home, see a health care professional immediately. Tell them where you have been travelling or living. 

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

In this destination, rabies is commonly carried by dogs and some wildlife, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. While travelling, take precautions , including keeping your distance from animals (including free-roaming dogs), and closely supervising children.

If you are bitten or scratched by a dog or other animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. In this destination, rabies treatment may be limited or may not be available, therefore you may need to return to Canada for treatment.  

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who are at high risk of exposure (e.g., occupational risk such as veterinarians and wildlife workers, children, adventure travellers and spelunkers, and others in close contact with animals). 

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Travellers' diarrhea is the most common illness affecting travellers. It is spread from eating or drinking contaminated food or water.

Risk of developing travellers' diarrhea increases when travelling in regions with poor standards of hygiene and sanitation. Practise safe food and water precautions.

The most important treatment for travellers' diarrhea is rehydration (drinking lots of fluids). Carry oral rehydration salts when travelling.

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

There is a risk of schistosomiasis in this destination. Schistosomiasis is a parasitic disease caused by tiny worms (blood flukes) which can be found in freshwater (lakes, rivers, ponds, and wetlands). The worms can break the skin, and their eggs can cause stomach pain, diarrhea, flu-like symptoms, or urinary problems. Schistosomiasis mostly affects underdeveloped and r ural communities, particularly agricultural and fishing communities.

Most travellers are at low risk. Travellers should avoid contact with untreated freshwater such as lakes, rivers, and ponds (e.g., swimming, bathing, wading, ingesting). There is no vaccine or medication available to prevent infection.

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

There is a risk of chikungunya in this country. The level of risk may vary by:

The virus that causes chikungunya is spread through the bite of an infected mosquito. It can cause fever and pain in the joints. In some cases, the joint pain can be severe and last for months or years.

Protect yourself from mosquito bites at all times.

Learn more:

Insect bite and pest prevention Chikungunya

• In this country,   dengue is a risk to travellers. It is a viral disease spread to humans by mosquito bites.
• Dengue can cause flu-like symptoms. In some cases, it can lead to severe dengue, which can be fatal.
• The level of risk of dengue changes seasonally, and varies from year to year. The level of risk also varies between regions in a country and can depend on the elevation in the region.
• Mosquitoes carrying dengue typically bite during the daytime, particularly around sunrise and sunset.
• Protect yourself from mosquito bites. There is no vaccine or medication available in Canada to prevent dengue. 

Learn more: Dengue Insect bite and pest prevention

Zika virus is a risk in this country. 

Zika virus is primarily spread through the bite of an infected mosquito. It can also be sexually transmitted. Zika virus can cause serious birth defects.

• Prevent mosquito bites at all times.
• Use condoms correctly or avoid sexual contact, particularly if you are pregnant.

If you are pregnant or planning a pregnancy, you should discuss the potential risks of travelling to this destination with your health care provider. You may choose to avoid or postpone travel. 

For more information, see Zika virus: Pregnant or planning a pregnancy.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Human cases of avian influenza have been reported in this destination. Avian influenza   is a viral infection that can spread quickly and easily among birds and in rare cases it can infect mammals, including people. The risk is low for most travellers.

Avoid contact with birds, including wild, farm, and backyard birds (alive or dead) and surfaces that may have bird droppings on them. Ensure all poultry dishes, including eggs and wild game, are properly cooked.

Travellers with a higher risk of exposure include those: 

• visiting live bird/animal markets or poultry farms
• working with poultry (such as chickens, turkeys, domestic ducks)
• hunting, de-feathering, field dressing and butchering wild birds and wild mammals
• working with wild birds for activities such as research, conservation, or rehabilitation
• working with wild mammals, especially those that eat wild birds (e.g., foxes)

All eligible people are encouraged to get the seasonal influenza shot, which will protect them against human influenza viruses. While the seasonal influenza shot does not prevent infection with avian influenza, it can reduce the chance of getting sick with human and avian influenza viruses at the same time.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

Tuberculosis is an infection caused by bacteria and usually affects the lungs.

For most travellers the risk of tuberculosis is low.

Travellers who may be at high risk while travelling in regions with risk of tuberculosis should discuss pre- and post-travel options with a health care professional.

High-risk travellers include those visiting or working in prisons, refugee camps, homeless shelters, or hospitals, or travellers visiting friends and relatives.

HIV (Human Immunodeficiency Virus)   is a virus that attacks and impairs the immune system, resulting in a chronic, progressive illness known as AIDS (Acquired Immunodeficiency Syndrome). 

High risk activities include anything which puts you in contact with blood or body fluids, such as unprotected sex and exposure to unsterilized needles for medications or other substances (for example, steroids and drugs), tattooing, body-piercing or acupuncture.

There has been an increase in the number of multidrug-resistant gonorrhea cases reported in this country. Gonorrhea is a sexually transmitted bacterial infection. It is spread through sexual contact (oral, genital or anal) with someone who has the infection. Multidrug-resistant gonorrhea is very difficult to treat as it may not respond to currently recommended antibiotics.

Reduce your risk of getting multidrug-resistant gonorrhea by:

• avoiding sexual activity with a new partner
• packing your own supply of condoms and dental dams
• using condoms consistently and correctly every time you have sex
• using dental dams (rectangular pieces of thin latex) over the vagina or anus for a protective barrier during oral sex 

If you think you may have been exposed to gonorrhea, discuss this with your health care provider. If you are diagnosed with gonorrhea, it is important to follow your health care provider's prescribed treatment and any follow-up recommendations. 

• Safer condom use
• Getting tested for STIs
• Sexual health and travel 

Medical services and facilities

Medical facilities are poor and very limited throughout Cambodia, except some foreign hospitals in Phnom Penh and Siem Reap.

Doctors and hospitals may require cash payment or written guarantees from insurance providers in advance for health services.

Medical evacuation to Thailand or Singapore is often required to obtain adequate treatment. You should seek immediate assistance in Phnom Penh or Siem Reap and consider leaving the country if you experience medical problems.

Psychiatric or psychological facilities and services in Cambodia are almost non-existent.

Some prescription medication may not be available in Cambodia. Pharmacies only carry a limited selection compared to Canada. There have been reports of expired and fake medicines being sold in some pharmacies.

If you take prescription medications, you're responsible for determining their legality in Cambodia.

• Bring sufficient quantities of your medication with you
• Always keep your medication in the original container
• Pack them in your carry-on luggage
• Carry a copy of your prescriptions

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Health and safety outside Canada

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

There are severe penalties for the possession, use or trafficking of illegal drugs. If you are convicted, you can expect lengthy jail sentences and steep fines.

Drugs, alcohol and travel

Expulsion, deportation and limitation of visit

Cambodian authorities can expel, deport or limit a traveller's visit if you are accused, or suspected of:

• violating local laws, which include possession of invalid entry documents and requirements
• having a criminal record
• being involved in criminal activities
• suffering from mental illness or serious transmitted diseases

Legal process

Detention during the investigative period is commo and can exceed 6 months before charges are laid.

Illegal or restricted activities

Overstaying a visa.

Immigration regulations are strict. You could face fines, detention and deportation if you overstay your visa. There is a daily fine for overstaying the validity of your visa. There is no limit to this fine. If you overstay more than 30 days, you will need to leave Cambodia in addition to paying the fine.

Exploitation of minors

There are harsh penalties for sexual exploitation of minors. It is a serious offence in Cambodia.

Canadians may also be subject to criminal proceedings in Canada for acts of this nature committed while abroad.

Child Sex Tourism: It’s a Crime

All forms of commercial surrogacy are illegal in Cambodia. Penalties for surrogates, as well as operators of clinics and hospitals providing surrogacy services, may include imprisonment and/or fines. If you have already entered into a surrogacy agreement, you should seek advice from a local lawyer on how these guidelines, including its exit requirements, apply to your situation.

Cultural heritage and antiquities

A permit is required to purchase, export or possess cultural or archaeological artefacts.

To avoid any difficulties, make sure you obtain and carry the required legal paperwork to purchase or export antiquities.

2SLGBTQI+ persons

Cambodian law doesn't prohibit sexual acts between individuals of the same sex.

Travel and your sexual orientation, gender identity, gender expression and sex characteristics

Dual citizenship

Dual citizenship is legally recognized in Cambodia.

If you are a Canadian citizen, but also a citizen of Cambodia, our ability to offer you consular services may be limited while you're there. You may also be subject to different entry/exit requirements .

Dual citizens

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. It does not apply between Canada and Cambodia.

If your child was wrongfully taken to, or is being held in Cambodia by an abducting parent:

• act as quickly as you can
• consult a lawyer in Canada and in Cambodia to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children's Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country's judicial affairs.

• International Child Abductions: A guide for affected parents
• Canadian embassies and consulates by destination
• Request emergency assistance

You must have and carry a Cambodian driver's licence.

Helmets are mandatory for motorcycle riders, but many helmets do not meet international safety standards. Ensure your medical insurance will cover you when riding as a driver or passenger.

Dress and behaviour

There are reports of local authorities cracking down on events such as pub crawls, raves, booze cruises and pool parties, as well as other events where recreational drugs may be present. Avoid these types of events.

Behaviour that is deemed scandalous, drunken or disorderly is considered highly disrespectful to the local culture and population, especially near the Angkor temples.

To avoid offending local sensitivities:

• dress conservatively
• behave discreetly
• respect religious and social traditions
• do not photograph airports or military installations
• ask permission before photographing individuals, including Buddhist monks

The currency is the riel (KHR).

U.S. dollars are also widely used. Only newer, undamaged notes are accepted. Notes with the slightest tear will not be accepted.

Credit cards are not widely accepted outside major cities. Some banks in Phnom Penh accept certain credit cards for cash advances. There are many ATMs in Phnom Penh, Siem Reap and Sihanoukville but fewer in smaller cities.

The rainy (or monsoon) season extends from May to November. Severe rainstorms can cause flooding and landslides, resulting in loss of life and extensive damage to infrastructure. They can also hamper the provision of essential services. Roads may become impassable and bridges damaged. Flooding can affect wide areas in numerous provinces, including certain parts of Phnom Penh.

• Keep informed of regional weather forecasts
• Avoid disaster areas
• Follow the advice of local authorities
• Tornadoes, cyclones, hurricanes, typhoons and monsoons
• Mekong River conditions  –  Mekong River Commission

Forest fires

The dry season lasts from November to April. Forest fires can start and spread very quickly during this period.

• Stay clear of active fires
• Always verify local conditions with relevant authorities before travelling near forested areas, particularly during the dry seasons

National Committee for Disaster Management – Government of Cambodia

Local services

In case of emergency, dial:

• police: 117
• medical assistance: 119
• firefighters: 118 or 666

Consular assistance

Siem Reap, Battambang, Banteay Meanchey, Oddar Meanchey, and Preah Vihear

Thailand, Cambodia, Laos

For emergency consular assistance, call the Office of the Embassy of Canada in Phnom Penh and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

Cambodia malaria indicator survey 2020: Implications for malaria elimination

Affiliations.

• 1 Health and Social Development (HSD), Cambodia.
• 2 National Institute of Public Health (NIPH), Cambodia.
• 3 National Malaria Control Program (CNM), Cambodia.
• 4 University Research Co., LLC, (URC) USA.
• 5 AQUITY Global Inc., (AGI) USA.
• PMID: 34532228
• PMCID: PMC8415051

Background: Cambodia has made significant progress in controlling malaria in the past decade. It now aims to eliminate malaria from the country by 2025. It launched the Malaria Elimination Action Framework (MEAF 2016-2020) in 2015 with strong political commitment targeting appropriate interventions on high-risk populations, particularly mobile and migrant groups.

Methods: In 2020, the household-level Cambodia Malaria Survey 2020 (CMS 2020) was conducted with the objective to assess the performance of malaria control activities using the indicators outlined in MEAF 2016-2020. The survey used a cross-sectional probability proportional to size approach drawing 4,000 households from 100 villages across the malaria-endemic districts of the country.

Results: A total of 3,996 households with 17,415 inhabitants were interviewed. Of the surveyed households, 98.4% owned a long-lasting insecticide-treated bednet or hammock (LLIN/LLIHN). However, only 79.5% of these reported sleeping under a net the previous night, with only 45.7% sleeping under an insecticide treated net (ITN). Given that forest visitors are at the highest risk of getting malaria, the survey also targeted this group. Of the forest visitor respondents, 89.3% brought an ITN along and 88.9% reported to have used a net during their forest stay. About 10.8% of forest goers had received a forest kit for malaria prevention from mobile malaria workers the last time they went to the forest. Knowledge about mosquito repellents was high among forest goers (62.5%) but the actual use thereof during the last visit to the forest was low (22%). While awareness about malaria prevention with LLINs remained high among most respondents, knowledge about malaria diagnosis and treatment was not universal. Source of malaria knowledge and its treatment was usually from a household member, followed by a village malaria worker or a primary health care center staff. Of those who had fever during the previous two weeks, 93.6% sought advice or treatment outside the home, and the most commonly reported source for advice or treatment was private providers (39.4%) followed by health center/district hospital (31.3%).

Conclusions: ITN distribution and other malaria prevention interventions have largely benefited the high-risk groups including the forest visitors. Comparing the CMS 2020 results with the 2017 CMS results, it is clear that forest visitors' use of LLIN/LLIHN has improved considerably. However, more needs to be done to ensure forest visitors be protected either through using LLINs or repellents while working and staying in the forest areas. Also, given that sleeping under LLINs has decreased over the past several years among the at-risk populations, the programme will have to develop strategies to ensure that the communities do not lower their guard against malaria as cases further dwindle in malaria prone areas. Heightened awareness amongst the general population will be critical for eliminating malaria in Cambodia without any possibility of malaria re-emergence or re-establishment.

Copyright © 2021 Kheang et al.

Yellow Fever

• Requirements: Required if traveling from a country with risk of YF virus transmission and ≥1 year of age, including transit >12 hours in an airport located in a country with risk of YF virus transmission. 1
• Recommendations: None

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Accelerating malaria elimination in Cambodia: an intensified approach for targeting at-risk populations

Siv sovannaroth.

1 National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia

Pengby Ngor

2 Clinton Health Access Initiative, Phnom Penh, Cambodia

Julia C. Dunn

Michelle k. burbach, sovann peng.

3 Catholic Relief Services, Phnom Penh, Cambodia

4 PSI, Phnom Penh, Cambodia

5 USAID/PMI/URC, Phnom Penh, Cambodia

Giulia Manzoni

6 World Health Organization, Phnom Penh, Cambodia

Jean Olivier Guintran

Luciano tuseo, associated data.

National malaria surveillance data available at https://mis.cnm.gov.kh/ . Intensification Plan data available upon reasonable request to the National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia.

Malaria in Cambodia has decreased by 90.8% between 2010 and 2020, driven by the commitment of the National Center for Parasitology, Entomology and Malaria (CNM) and the achievements of the roll-out of a village malaria worker programme. However, in the first seven months of 2018, CNM identified a 207% increase (11,969 to 36,778) in confirmed malaria cases compared to the same months in the previous year. To address this increase, CNM developed the “Intensification Plan” (IP), implemented between October 2018 and December 2020.

The structure of the IP was summarized, including the selection of sites, the interventions implemented in the selected health facility catchment areas (HFCAs) and the monitoring and evaluation process. Data on IP interventions were collected by CNM and civil society organisations. Data on malaria cases and tests from all HFCAs in Cambodia from January 2018 to December 2020 were sourced from the Cambodia Malaria Information System (MIS) and WHO Malaria Elimination Database. Malaria data from IP HFCAs and non-IP HFCAs was analysed and compared to present the changes in malaria testing and confirmed cases before and during implementation of the IP.

Between October 2018 and December 2020, through the IP 16,902 forest packs and 293,090 long-lasting insecticide treated nets were distributed. In the 45 HFCAs included in the IP, 431,143 malaria tests were performed and 29,819 malaria cases were diagnosed, 5364 (18%) of which were Plasmodium falciparum /mixed cases. During the intervention period, over all HFCAs included in IP, P. falciparum /mixed cases declined from 1029 to 39, a 96.2% decrease, and from 25.4 P. falciparum /mixed cases per HFCA to 0.9. HFCAs not included in IP declined from 468 to 43 cases, a 90.8% decrease, showing that routine malaria activities in Cambodia were also playing an important contribution to malaria control.

Conclusions

Over the course of IP implementation there was a substantial increase in malaria testing and both overall malaria cases and P. falciparum /mixed cases decreased month on month. The initiative yields lessons learned for Cambodia to reach the final stage of elimination as well as for other countries aiming to accelerate their malaria control programmes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04234-2.

Cambodia has made significant progress in malaria control over the last decade. Confirmed malaria cases declined from 106,228 to 9771 cases between 2010 and 2020, a 90.8% decrease. Cambodia still accounted for 13.4% of cases in the Southeast Asia region in 2020 [ 1 , 2 ], and has received particular attention from the global malaria community since artemisinin resistance was confirmed in 2008 [ 3 ], requiring continued vigilance and rapid malaria control to ensure resistance does not derail Cambodia’s elimination efforts or spread to other global regions. In 2011, the National Strategic Plan for Malaria Elimination (NSP 2011–2025) was signed by the Prime Minister, setting the ambitious goal of achieving malaria elimination in Cambodia by 2025 [ 4 ].

In Cambodia, from 2010 to 2014 malaria cases reduced by 47% [ 1 ] and malaria-related deaths reduced by 88.1% (151 to 18) [ 5 ]. This decline was attributed to distribution of insecticide-treated nets (ITNs) as well as the high number of tests performed and cases detected through the village malaria worker (VMW) programme, introduced in 2004 [ 6 ]. As malaria cases have decreased in Cambodia, infection has become increasingly focal in hotspots across the country and in populations that are routinely harder to reach and further from points of care [ 3 , 7 , 8 ]. According to the 2013 Cambodia Malaria Indicator Survey, forest-goers (people who work and/or sleep in the forest) and those who travelled had higher odds of malaria infection diagnosed through PCR (odds ratio of 5.8 and 2.3, respectively) [ 9 ]. Forests represent a hot spot for malaria transmission and, therefore, mobile and migrant populations involved in forest activities are at high risk of contracting the disease [ 10 ].

The VMW programme was suspended from 2014 to 2017. The years following 2014 saw a substantial increase in malaria cases, with a particularly large increase of 102% between 2016 and 2017 [ 11 ]. Following the reinstatement of the VMW programme, this increase continued into 2018, culminating in a 207% increase (11,969 to 36,778) in cases January–July 2018 compared to 2017 [ 11 ]. This was likely facilitated by a 35% increase in testing (213,585 to 289,325) between 2017 and 2018 [ 12 ]. The Malaria Elimination Action Framework (MEAF) 2016–2020 [ 1 ], written by the National Center for Parasitology, Entomology and Malaria (CNM), highlighted the implementation of aggressive approaches to reduce malaria in high-risk populations. Informed by the MEAF, to combat this high level of cases, CNM, the Ministry of Health (MoH) and the World Health Organization (WHO) determined that an intensive response was required that targeted hotspots of increased malaria transmission. This plan eventually came to be known as the “Intensification Plan” (IP). The IP took place from October 2018 to December 2020 in 45 health facility catchment areas (HFCAs) across Cambodia.

In this paper, the methods of the Intensification Plan, including objectives, sites, interventions, and M&E through routine data collection and monthly data reviews are presented. Both routine malaria surveillance data and data collected specifically for the IP are used to present the achievements of the IP and analyse change in malaria cases, with a focus on Plasmodium falciparum /mixed infections, both in the IP HFCAs themselves and in comparison to the rest of the country.

Objectives of the Intensification Plan

The IP had two objectives aimed at reducing transmission in the areas of the country with the highest malaria burden: (1) improving programme coordination to ensure full implementation of the country’s Malaria Elimination Action Framework (MEAF) (2016–2020) and (2) implementing aggressive approaches to deploy interventions that would rapidly reduce the parasite reservoir among high-risk populations. The IP focused on reaching forest goers and migrant and mobile populations (MMPs) who may enter the forest for logging or other economic purposes and can stay in the forest for up to 2 weeks on each trip. The first phase of IP (IP1) took place from October 2018 to October 2019. The second phase of IP (IP2) took place from November 2019 to December 2020.

To determine the geographical area of intervention, CNM and partners used MIS data to identify provinces, operational districts (ODs) and villages with the highest reported burden of malaria cases. IP1, seven provinces and nine ODs were selected (Fig.  1 ). In the selected ODs, the 30 highest burden HFCAs were chosen to be included in IP. These 30 HFCAs accounted for 75% of all malaria cases in the country in 2018 and 2019. Sites were reselected at the beginning of IP2; six out of seven provinces remained the same, with one change replacing Preah Vihear for Preah Sihanouk given improvement in the situation in Preah Vihear. 12 ODs with the highest P. falciparum cases (as opposed to malaria cases of any species) were selected and 36 HFCAs within these 12 ODs. These HFCAs represented 77% of P. falciparum cases in the country from January 2018 to June 2019 and was deemed the maximum number of HFCAs that was programmatically feasible to run and manage the intensified activities. Overall, 45 HFCAs were included over the duration of the IP; 21 HFCAs in both IP1 and IP2, 9 HFCAs in IP1 only and 15 HFCAs in IP2 only. The full list of HFCAs included in IP are provided in Additional file 1 : Table S1. CNM used the MIS data and consultations with each HFCA to identify “village hotspots”, areas where at-risk populations of forest-goers resided or transited through. These 141 hotspots (Additional file 1 : Table S1) became the focus geography sites for the IP to conduct interventions. Each site received technical support from CNM, the World Health Organization (WHO), the Clinton Health Access Initiative (CHAI), and from a Civil Society Organization based in the corresponding geographic area, namely Catholic Relief Services, CARE, Population Services International (PSI), University Research Co. (URC).

Selected sites to receive Intensification Plan interventions and number of mobile malaria workers (MMWs) assigned based on identified malaria hotspots

Interventions

Under the primary objective of the IP, implementing ODs were provided additional support from CNM, WHO and CSOs to improve programme coordination and ensure the effective implementation of case management, including high levels of malaria testing, complete treatment for all those diagnosed with malaria, and effective referral for any severe cases. At the beginning of each phase of IP, long-lasting insecticide treated nets (LLINs) were distributed to any households in the target villages that did not have enough (less than one net per 1.8 people). Additional LLINs were then available for continuous distribution over the course of the IP. The IP included additional technical support and supervision from CNM to ODs, verifying optimal coverage of LLINs in the villages with high incidence and ensuring full attendance at VMW monthly meetings. VMWs conducted monthly meetings to set testing targets and refill case management supplies. ODs were encouraged to attend the meetings to review data and coach on performance.

The second objective of the IP was to implement aggressive approaches to target high-risk populations and hasten the decline of P. falciparum cases in the target sites. The main intervention was hiring additional MMWs that were targeted to IP sites and identified hotspots. MMWs were based closer to forested areas where MMPs usually travel and conducted specialized activities focused on forest workers and mobile migrant populations. Performance of MMWs was continuously tracked through monthly VMW/MMW meetings. MMWs also attended several trainings over the course of IP to ensure their knowledge on testing and treating of malaria was up to date and to expand their toolkit (e.g. adding paracetamol and mebendazole to treat those testing negative for malaria). There were also a certain number of MMWs within the targeted sites that were not managed through CNM and the IP, but through the Malaria Consortium [ 13 ]. In the following analyses these MMWs are deemed MMW (Not IP).

Responsibilities of MMW included the following:

• Test: Perform rapid diagnostic tests (RDTs) on all suspected cases according to CNM’s criteria, namely anyone with fever or who had travelled to the forest in the last 1 week.
• Treat: Provide anti-malarial treatment according to national guidelines, including single low dose primaquine (SLDP) for all P. falciparum /mix cases in eligible individuals [ 14 ]. The IP expanded access to SLDP for non-pregnant, non-breastfeeding individuals weighing 20 kg and above, where previously the weight requirement was 50 kg, and actively followed-up with MMWs to ensure all P. falciparum /mix cases had received SLDP.
• Track: Keep complete records of all activities including patient consultations on case reporting forms, active case detection (ACD) activities, questionnaires, and forest pack registries.
• Refer: Refer severe cases to health facilities immediately.
• Malaria knowledge: Attend trainings and routine monthly meetings for VMW/MMW to ensure good knowledge of malaria diagnosis and treatment.
• Work over extended hours especially when forest-goers are active, this means being accessible 24 h if a patient requests a service.
• Active test and treat: Twice a month, travel to malaria hot spots in the forest to conduct ACD.
• Commodity supply: Keep adequate stocks of RDTs and malaria drugs; attend monthly meetings to report stock status, provide paper reports, and replenish stocks.
• Forest pack distribution: Distribute forest packs to target populations. Forest packs included a backpack, information, education and communication/behavior change communication (IEC/BCC) materials, a hammock net, and (added in IP2) insect repellent. Insect repellent top-ups were also available. The first forest pack distribution took place in May 2019.
• Perform IEC/BCC activities: Lead information sessions to educate the community about malaria signs and symptoms, provide health education to patients during consultations, play loudspeaker recordings regularly and display educational posters.
• Offering optional products for negative malaria cases , such as paracetamol for fever reduction and mebendazole for de-worming according to national treatment guidelines (IP2 only).
• Identifying co-travellers: any MMP that testing positive was asked by the MMW for the contact information of their co-travellers. The co-travellers were invited for testing and were provided malaria prevention messages (IP2 only).

For MMWs to perform their responsibilities effectively, the supply chain for RDTs, artemisinin combination therapies (ACTs) (artesunate-mefloquine [ASMQ] and primaquine) and forest packs needed to be improved. At central level, CNM and key partners such as UNOPS, WHO and the implementing CSOs joined together to conduct monthly supply chain meetings to ensure the pipeline of supplies was being accurately forecasted, ordered and distributed timely to subnational levels, in coordination with the Central Medical Stored and subnational partners. The working group also monitored corresponding supplies that MMW need such as weight scales, thermometers, gloves and uniforms for MMW to identify themselves (in IP2).

In non-IP sites, the national surveillance and case management guidelines were followed. Briefly, standard of care was RDT or microscopy testing of all suspected cases, ACT treatment for all cases ( P. falciparum , Plasmodium vivax and mixed infections), SLDP for P. falciparum /mix cases, and referral to a hospital for any severe cases. VMWs were situated in the highest burden villages, informed by the national stratification (3025 in 2018, 3376 in 2019, 3675 in 2020). All malaria cases from HCs were entered into the MIS at the time of diagnosis and all cases from VMWs were entered on a monthly basis, after the monthly VMW meetings which also served as regular supervision of VMWs.

For the majority of the IP period, radical cure was not available in Cambodia and P. vivax cases were treated with ACT. From November 2019 to December 2020, radical cure was piloted in four provinces, one of which (Kampong Speu) was also included in IP. Over the pilot, any adult male P. vivax cases were referred to the nearest HC and tested for G6PD deficiency. If they were G6PD normal they were treated with 14-day primaquine. All other cases were treated with ACT.

Monitoring and evaluation

Data on malaria testing and cases was routinely entered into the data management system by health centres (HCs), VMWs and MMWs. Each partner involved in IP also collected malaria testing and case data, disaggregated by cadre, in a “CSO Scorecard” to send to CNM and verify against their data, as well as data on IP interventions such as number of forest packs distributed, number of ACD visits and attendance at VMW/MMW monthly meetings. MIS data was compared to CSO Scorecard data and any errors or discrepancies (for example—missing data, more cases than tests, incorrect summation of malaria species to total cases) were clarified with the CSO and corrected in the relevant database. Central CNM staff, with support of WHO and CHAI, analysed the malaria data on a monthly basis (including mapping case data to track any changes in malaria epidemiology). CNM led partner meetings for problem solving and decision making. These “Data Review and Action Meetings” had the goal to provide consistent data review, providing feedback to CSOs and facilitating timely action such as responding to stock outs and flagging HCs/MMWs not performing the target number of outreach visits.

Data analysis

The timeline for data analysis covers pre-IP (January 2018–September 2018), IP1 (October 2018–October 2019) and IP2 (November 2019–December 2020). Data were collated from the CSO Scorecards, the Cambodia Malaria Information System (MIS) and from the WHO Malaria Elimination Database (MEDB) for all HFCAs in Cambodia. This includes IP intervention data (number of MMWs, number of MMW outreach visits, forest packs distributed, LLINs distributed, repellents distributed) and malaria epidemiology data (tests, treatments, cases). Information on forest packs was collected throughout the IP using “MMW Forest Pack questionnaires”. In March 2020, a review of these questionnaires was conducted, providing further information on forest pack distribution during IP.

To analyse whether the IP had been a factor in driving a decline in malaria cases in the implementing HFCAs, the change in P. falciparum /mix cases was compared before and during IP. For this analysis, HFCAs were treated as an IP HFCA if they had been included in any phase of IP (n = 45). Firstly, a segmented interrupted time series was carried out by fitting separate Poisson regression models (log link) to P. falciparum /mix cases in (1) Non-IP HFCAs, (2) IP HFCAs (pre-IP rollout) and (3) IP HFCAs (post-IP rollout). The counterfactual trend for IP HFCAs was extrapolated with the pre-IP intercept and gradient parameters. Secondly, a controlled interrupted time series analysis was carried out by fitting a Poisson regression model to P. falciparum /mix cases in IP HFCAs with fixed terms for month (to account for seasonality), P. falciparum /mix cases in non-IP HFCAs (to control for decline outside of IP) and timepoint interacting with IP Phase (pre/post IP rollout). To account for autocorrelation, standard errors and confidence intervals were calculated with the Newey-West method with a lag of 1. A formula published by Altman and Bland [ 15 ] was used to calculate the statistical significance of the difference between rate ratios. Data analysis was completed and figures prepared using RStudio (v 4.0.2, Vienna, Austria).

To track the deployment of IP interventions and assess epidemiological impact, data was reported to by all health cadres. If monthly data had not been submitted, they were actively followed up by central CNM staff and the responsible CSO. As such, reporting completeness from HCs was 100% over the course of the IP. Data from VMWs and MMWs were collated during monthly meetings. These meetings were tracked via IP surveillance. 788 VMW/MMW meetings out of a possible 893 (88.2%) took place over the course of the IP, attendance was 90.4%. Reporting completeness from VMWs and MMWs was lower than HCs, at 82.2% over the course of IP. There was a drop-off in reporting completeness from VMWs and MMWs between IP1 and IP2, from 96 to 84%.

Intensification Plan interventions

To reinforce the implementation of the interventions, 141 MMWs (one per village) were recruited over the IP, with an average of 8.8 MMWs active per OD. Over the course of the IP 16,902 forest packs and 293,090 LLINs were distributed (Table ​ (Table1). 1 ). The forest-pack survey shows that between May 2019 (when forest packs were distributed) and March 2020 78.7% of MMPs sleeping overnight in the forest had received a forest pack from a MMW; 71.8% of eligible P. falciparum /mix cases received SLDP, increasing from 65.4% in IP1 to 86.7% in IP2. The proportion of correctly treated P. falciparum /mix infections was variable across provinces; from 80.7% in Pursat to 62.1% in Stung Treng.

Malaria cases and interventions over the intensification plan (IP), stratified by IP phase and province

HF: health facility; Pf/mix: Plasmodium falciparum /mixed; SLDP: single low-dose primaquine; MMW: mobile malaria worker; LLIN: long-lasting insecticide treated net

*Patients were eligible for SLDP treatment if they weighed over or equal to 20 kg, weren’t pregnant and weren’t breastfeeding. Data on Pf/mix cases eligible for treatment shows some discrepancies so has not been included

**Insect repellent top-ups were available when MMPs ran out, this is why number of repellents is higher than number of forest packs

Over the course of IP 431,143 malaria tests were performed (Table ​ (Table1), 1 ), the majority of these tests were performed by VMWs (47.4%) and IP MMWs (23.4%) (Fig.  2 ). Between the two phases of IP, testing increased by 101.6% with average tests per HC per month increasing from 366.5 to 571.9. HCs had the highest positivity rate at 16.2%, followed by VMWs (7.2%), MMWs (3.7%) and MMWs not hired through IP (2.4%). Of the total tests conducted during IP, 81,462 (18.9%) were during ACD activities with a test positivity rate (TPR) of 2.5%.

Number of malaria tests performed in intensification plan (IP) health facility catchment areas before and during IP, stratified by health cadre. Total: All tests (cadre disaggregation not available for pre-IP data); HC: health center; MMW (Not IP): mobile malaria workers in IP sites but not managed directly through IP, MMW: mobile malaria workers managed through IP; VMW: volunteer malaria worker. Pre-IP includes IP Phase 1 HFCAs only. IP Phase 1 (30 HFCAs), IP Phase 2 (36 HFCAs)

Malaria epidemiology

Over IP there were 29,819 malaria cases diagnosed, 5817 (19.5%) of which were P. falciparum /mix cases (Fig.  3 ). Between IP1 and IP2 P. falciparum /mix cases decreased by 76.9% (4725 to 1092) and from 12.1 cases per HFCA per month to 2.2. In the 30 IP1 HFCAs, P. falciparum /mix cases decreased from 762 to 284 (62.7%) from October 2018 to October 2019. In the 36 IP2 HFCAs cases decreased from 278 to 23 (91.7%) from November 2019 to November 2020.

Number of Plasmodium falciparum /mix malaria cases (grey bars) and test positivity rate (TPR—red solid line) in intensification plan (IP) health facility catchment areas (HFCAs) over the course of the IP. Left of black dotted line: IP Phase 1 (30 HFCAs); right of black dotted line: IP Phase 2 (36 HFCAs)

Plasmodium falciparum /mix cases decreased on a HFCA level as well as overall (Fig.  4 ). In the first three months of IP1 there were 63.5 P. falciparum /mix cases per IP1 HFCA. This declined to 23.4 in the last three months of IP1 with 15 HFCAs with zero P. falciparum /mix cases in this time. Over IP2, there were 14.8 P. falciparum /mix cases per IP2 HFCA in the first three months of IP2, dropping to 2.25 in the last three months of IP2 and 19 HFCAs with zero P. falciparum /mix cases in those three months.

Number of Plasmodium falciparum /mix malaria cases (red dots) in intensification plan (IP) health facility catchment areas (HFCAs). Left) Beginning of IP (IP1 HFCAs)—October 2018 and Right) End of IP (IP2 HFCAs)—October 2020. Blue polygons: IP operational districts; green polygons: non-IP operational districts

On an OD level, the annual parasite incidence per 1000 people (API) in 2018 was 7.7 in IP ODs and 0.3 in non-IP ODs. By 2020 this had decreased to 0.4 in IP ODs (94.7%) and 0.01 in non-IP ODs (96.4%). Non-IP ODs in the same province as IP ODs saw a greater decrease in API than ODs in other provinces (99.5% and 95.9%, respectively), suggesting a spillover effect of the IP interventions into neighbouring areas, possibly due to the IP interventions targeting MMPs, such as forest-goers, that may spread malaria beyond high transmission areas.

The IP was targeted at the HFCAs with the highest burden of P. falciparum /mix cases in Cambodia in an attempt to hasten the reduction of cases and achieve elimination. Figure  5 shows the cumulative P. falciparum /mix cases from all HFCAs in Cambodia, stratified by whether they are non-IP HFCAs (n = 897) or IP HFCAs (irrespective of IP phase, n = 45). The change in cases over the IP periods (pre and during IP) were quantified by rate ratios (RR). From a controlled interrupted time series analysis, incorporating non-IP HFCAs as a control and adjusting for seasonality, the RR pre-IP was 0.90 (95% CI 0.86–0.93, p  < 0.0001) and during IP was 0.88 (95% CI 0.86–0.89, p  < 0.0001). The difference between the two RRs is not statistically significant ( p  = 0.3). This indicates that, even for controlling for the decline in areas where IP was not carried out, IP areas were experiencing a decline in malaria cases. There is evidence for an acceleration in decline, a reduction in the RR, post-IP but the difference is not statistically significant.

Cumulative number of P. falciparum /mix cases in all health facility catchment areas (HFCAs) in Cambodia. Black dashed line: rollout date of IP. Red: IP HFCAs (n = 45); Blue: Non-IP HFCAs (n = 897). Red dashed line: extrapolated counterfactual from pre-IP model. HFCAs are classified as an IP HFCA if they were included in either/both of Phase 1 or Phase 2

While malaria cases increased by more than 100% from 2016 to 2017, over the course of the Intensification Plan (October 2018 to December 2020) there was a 91.6% decline in malaria cases nationwide [ 11 ] with a 95.7% decline in IP HFCAs alone. Whilst causality between IP interventions and the change in malaria cases cannot be guaranteed, there has been a substantial decline in malaria cases in the IP HFCAs. This decline has been concurrent with a decline in non-IP HFCAs. Results from the statistical analysis indicates that there was a reduction in IP areas on top of the reduction seen in non-IP areas. There is evidence that the rate of malaria decline accelerated post rollout of IP, however there is no statistical difference between the RRs pre and during IP. One interpretation of these results is that whilst IP has not caused a reduction that is faster than in non-IP HFCAs, it has brought the IP HFCAs in line with the already impressive reduction in malaria cases in the rest of the country. Areas that were once struggling with malaria control have received the added boost they required to be in line with national malaria decline. P. falciparum /mix cases remain clustered in mostly the same HFCAs as when IP began, 63.2% of reported P. falciparum /mix cases in 2021, were in HFCAs included in IP. However, the impact of IP in the HFCAs has been sustained after it ended; of the 45 HFCAs included in IP, 17 reported zero P. falciparum /mix cases in 2021 and a further 17 have reported less than five P. falciparum /mix cases.

Evidence from both malaria surveillance and research studies indicate that malaria infection is becoming increasingly focalized in specific populations and that onwards transmission is perpetuated by those deemed “hard-to-reach” [ 16 , 17 ]. The IP took a novel approach to fill this gap by expanding the number of MMWs and targeting their operations towards to the highest burden areas. The increased flexibility of MMWs, both through their base location and through the services they could provide (distributing forest packs, mebendazole and paracetamol) allowed them to access groups of people that were previously missed by HCs and VMWs. Throughout the IP, MMWs contributed 23.4% of tests and 12.7% of malaria cases. Several other operational and research studies have examined the effectiveness of MMW or forest malaria workers (FMWs) in Cambodia, finding similar results that MMWs are able to achieve high testing rates and reach those populations deemed at most risk of malaria infection [ 13 , 18 ]. It is clear that engagement of the target populations, who may be engaging in illegal forest-based activity, is required to ensure these more mobile workers are accepted and trusted [ 18 ].

Whilst the application of new and expanded malaria control interventions was a major advantage of the IP, another focus from CNM was to improve the use of data through monitoring and evaluation. Included in training of HCs, VMWs and MMWs was a particular focus on routine data reporting and how that data would be used to continually monitor performance and rectify issues. The IP initiated a data review and action cycle that brought together CNM and all implementing partners to share and analyse data on a monthly basis. The meeting allowed all parties to share challenges from the field, propose solutions and collectively determining the priorities for the upcoming month. Through this mechanism all partners have transparency, accountability and a shared vision of addressing the most critical and urgent issues. A major achievement of the IP has been to strengthen monitoring, evaluation and response using timely data to ensure interventions are being implemented to reach the forest goer populations in Cambodia. Such a strong focus on M&E resulted in 100% data reporting from the IP health centres.

The IP focused on the reduction of P. falciparum /mix malaria cases. Due to the nationwide reduction in these cases, P. vivax is now the dominant malaria species in Cambodia, 86.5% of total cases in 2020 [ 11 ], and is targeted for elimination by 2025. In this analysis we have focused on P. falciparum /mix cases, however, from October 2018 to October 2020 P. vivax cases in the 45 IP HFCAs also decreased by 84.9%. Ensuring effective case management, vector control and universal access to care is not malaria species specific. As such, interventions such as those included in the IP are necessary for P. vivax elimination as well as P. falciparum . Following a pilot in 2019, radical cure for P. vivax through primaquine treatment was scaled-up nationwide in December 2020. The strengthening of the VMW programme through programmes such as IP will support other interventions, such as radical cure, through well-trained VMWs and a strong data collection pathway.

The implementation of IP faced several operational challenges. Delays in procurement of repellents meant that the distribution of forest packs happened after May 2019, and repellents were only distributed as part of IP2. While IEC/BCC messages were recorded and distributed on loudspeakers for MMWs to play in the forest, more effort is required to measure the impact of IEC/BCC activities and how they can be better targeted in future programmes. Given the transient nature of MMP and often illegal activities conducted in the forest, it can be difficult to reach the target population with IEC messages. The rainy season in remote areas may have caused data to be delayed in entering into MIS where it was captured in the following month, which can prevent timely analysis and response during these periods. Finally, as with all health programmes, the emergence of the COVID-19 pandemic at the beginning of 2020 impacted the implementation of both routine and IP malaria programmes. For example, in-person meetings with VMWs and MMWs were adapted to COVID-19 measures (e.g. solo instead of group meetings, held in open spaces) and health workers in some areas were reassigned from malaria to COVID activities (e.g. testing and quarantine). CNM applied mitigation measures in accordance with the national guidance on COVID-19 issued by the Royal Government of Cambodia and took steps to limit the exposure of health personnel to COVID-19 including procurement of personal protective equipment and reducing subnational travel [ 19 ]. Another limitation of the analysis is the potential impact that COVID-19 may have had on malaria transmission and epidemiology. Cambodia closed its borders in March 2020 and inter-province travel was restricted. This could have impacted malaria transmission due to reduced travel between high-risk areas. However, as there were very few reported COVID cases over the course of 2020 in Cambodia, travel did not seem to be severely impacted and this has not been treated as a significant factor to explain malaria decline. There was also a brief reduction in malaria testing between March and April, however testing remained above pre-pandemic levels. In the analysis presented here how malaria cases changed over the course of the IP, and in comparison to areas not included in IP, has been described. However, causality between IP and decline in malaria cases cannot be guaranteed as other factors, such as climate, have not been included in the analysis.

CNM initially aimed to achieve elimination of P. falciparum by 2020, however this has now been extended to 2023 [ 3 ]. Valuable lessons were learned from the IP which will be applied to achieve this goal, namely the importance of targeting forest-based populations and the importance of the VMW/MMW cadre. At the end of 2020, CNM, technically supported by WHO, are implementing a programme known as “last mile”, reinforcing foci management activities to accelerate malaria elimination [ 20 , 21 ]. Based on the vulnerability and receptivity of active foci, additional interventions are implemented. This includes targeted drug administration and intermittent preventive treatment for at-risk populations, as well as weekly fever screening of village-based populations and LLIN/LLIHN distribution. In addition, continuing to support routine malaria case management and surveillance remains essential in achieving elimination. CNM, WHO and CSOs will continue to work to build capacity of health staff at all levels, as well as implementing strong financial management and operational planning to ensure all activities, both routine and one-off, are implemented on time and to the highest standard.

Through population-targeted activities and routine use of malaria surveillance data P. falciparum /mix cases declined by 97.4% (1029 to 27) between October 2018 and October 2020 in the 45 IP HCs. CNM will continue to focus on capacity building for HCs, VMWs and MMWs to determine malaria hotspots as well as fostering collaboration with HCs and local authorities to better track and target MMPs to provide preventive and treatment services. Vector control and raising awareness of malaria prevention and treatment to MMPs and forest goers are continuing priorities for the last mile of malaria elimination in Cambodia.

Acknowledgements

The authors are grateful to the staff from the respective Provincial Health Districts, Operational Districts, Health Centres participating in the intensification plan. Village Malaria Workers and Mobile Malaria Workers who conducted the package of interventions deserve appreciation. The authors also acknowledge the United Nations Office for Project Services (UNOPS) for their contributions to financial management and procurement.

Abbreviations

Author contributions.

SS, HR, MB, GM, JOG, LT conceived and designed the interventions; SS, SP, SM, KS implemented the interventions. SS, PN, SP, SM, KS, VK carried out data collection, data entry and data cleaning. SS, MB, VK, JD conceptualized the manuscript and designed the analysis. VK and JCD carried out the analysis. SS, MB, VK, JCD drafted the manuscript. All authors reviewed and edited the manuscript. All authors read and approved the final manuscript.

Funding for the Intensification Plan was provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria. This work was supported, in part, by the Bill and Melinda Gates Foundation [Grant Number INV-002736]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. The funders had no role in the study design, data collection, data analysis, interpretation or writing the manuscript.

Availability of data and materials

Declarations.

Not applicable.

The authors declare no competing interests.

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