SummaryBaseline epidemiological survey for parasite infections was conducted with 155 villagers in a rural commune in Hoa Binh province, Vietnam. The prevalence of A. lumbricoides, T. trichiura and hookworm infection was 13.5%, 45.2% and 58.1%, respectively. 72.3% of the samples detected at least one of the parasites. We found no association between the infection with A. lumbricoides or T. trichiura and engagement in agriculture, while hookworm infection was more prevalent in population having a frequent contact with soil. Agricultural use of nightsoil was not correlated with any of the infections. We suggest that the consumption of vegetables fertilized with human nightsoil, rather than direct reuse of nightsoil, led to contamination of crops and the subsequent high infection rates with A. lumbricoides and T. trichiura. This also explains the high infection prevalence despite high latrine coverage (98.1%) in the study population: presence of latrines alone is not sufficient to reduce the prevalence in a rural agricultural community if fresh nightsoil is used as fertilizer.

Background Hookworm infections are significant public health issues in South-East Asia. In women of reproductive age, chronic hookworm infections cause iron deficiency anaemia, which, upon pregnancy, can lead to intrauterine growth restriction and low birth weight. Low birth weight is an important risk factor for neonatal and infant mortality and morbidity. Methodology We investigated the association between neonatal birth weight and a 4-monthly deworming and weekly iron-folic acid supplementation program given to women of reproductive age in north-west Vietnam. The program was made available to all women of reproductive age (estimated 51,623) in two districts in Yen Bai Province for 20 months prior to commencement of birth weight data collection. Data were obtained for births at the district hospitals of the two intervention districts as well as from two control districts where women did not have access to the intervention, but had similar maternal and child health indicators and socio-economic backgrounds. The primary outcome was low birth weight. Principal Findings The birth weights of 463 infants born in district hospitals in the intervention (168) and control districts (295) were recorded. Twenty-six months after the program was started, the prevalence of low birth weight was 3% in intervention districts compared to 7.4% in control districts (adjusted odds ratio 0.29, 95% confidence interval 0.10 to 0.81, p = 0.017). The mean birth weight was 124 g (CI 68 - 255 g, p<0.001) greater in the intervention districts compared to control districts. Conclusions/Significance The findings of this study suggest that providing women with regular deworming and weekly iron-folic acid supplements before pregnancy is associated with a reduced prevalence of low birth weight in rural Vietnam. The impact of this health system-integrated intervention on birth outcomes should be further evaluated through a more extensive randomised-controlled trial.

In 2001, Urbani and Palmer published a review of the epidemiological situation of helminthiases in the countries of the Western Pacific Region of the World Health Organization indicating the control needs in the region. Six years after this inspiring article, large-scale preventive chemotherapy for the control of helminthiasis has scaled up dramatically in the region. This paper analyzes the most recent published and unpublished country information on large-scale preventive chemotherapy and summarizes the progress made since 2000. Almost 39 million treatments were provided in 2006 in the region for the control of helminthiasis: nearly 14 million for the control of lymphatic filariasis, more than 22 million for the control of soil-transmitted helminthiasis, and over 2 million for the control of schistosomiasis. In general, control of these helminthiases is progressing well in the Mekong countries and Pacific Islands. In China, despite harboring the majority of the helminth infections of the region, the control activities have not reached the level of coverage of countries with much more limited financial resources. The control of food-borne trematodes is still limited, but pilot activities have been initiated in China, Lao People's Democratic Republic, and Vietnam.

Vietnam is one of the countries in the world most affected by Soil Transmitted Helminthiasis. Large areas of the country, like the Northern uplands or the North and Central Coast, are reported as having 75-85% of infection for Ascaris lumbricoides, 38-40% infection for Trichuris trichiura and 27-28% for hookworm infections. Periodical de-worming of schoolchildren is therefore strongly recommended.The managers of the Helminth Control Programme decided to apply a number of measures to improve cost-efficiency in order to deworm as many schoolchildren as possible with the availability of limited financial resources.This low-cost intervention targeted over 2.7 million schoolchildren. Coverage was estimated at over 95% and the cost for each treated child was 0.03 USD, which represents a saving of about 50% of costs presently reported in literature. The article describes the measures applied that resulted in cost containment but maintained high treatment coverage.

SummaryClonorchiasis is an emerging food-borne trematode infection in Vietnam. Due to the absence of cost-effective preventive measures its control largely relies on morbidity reduction by chemotherapy with praziquantel. We performed a comparative cost estimation of three different diagnostic and intervention approaches in areas of high and low prevalence of clonorchiasis in northern Vietnam in order to select more cost-effective chemotherapy. Our study confirmed that a questionnaire investigating the habit of eating raw, freshwater fish was a rapid, cost-effective and operationally feasible tool for identifying individuals at risk of clonorchiasis in both highprevalence and low-prevalence areas. The cost of diagnosis and intervention per person and per true positive case was 20-fold higher in low-prevalence areas, regardless of the type of approach. Geographical mapping of high-risk areas prior to screening is, therefore, recommended to maximize the cost-effectiveness of the intervention activities.

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