SummaryThe Kato-Katz technique, a (semi) quantitative stool examination technique, is generally recommended for diagnosis and evaluation of Schistosoma mansoni infection by schistosome experts. However, egg counts are subject to important variability. In order to quantify the reproducibility of egg counts using the Kato-Katz technique, ®eld data of 1255 observations on 299 subjects infected with Schistosoma mansoni were analysed. Agreement between repeated observations was assessed both categorically (kappa statistic) and continuously (analysis of variance). The day-to-day variation of egg counts was much greater than the variation due to different observers or different slides. The quantitative reproducibility was low: the weighted kappa statistic was 0.39 between specimens of different days, 0.62 between slides of the same specimen and 0.81 between observers of the same slide. Therefore the classi®cation of individual patients into groups based on egg counts, used as a measure of morbidity, must be interpreted with great care, especially in longitudinal studies. Usefulness of the Kato-Katz technique appears limited. Its reproducibility is low. It cannot be recommended as a routine test in a primary health care setting or in a hospital laboratory because safety and detection of other parasites are better assured by other techniques. It can be used in epidemiological studies and evaluation of schistosomiasis control programmes, but here too, other techniques might be preferred.keywords Kato-Katz technique, Schistoma mansoni, stool examination, reproducibility correspondence P. Van

Elucidating the complex taxonomic status of the major malaria vector taxa and characterising the individual species within each complex is important for understanding the complexity of the vector system in the south-east Asian region and will allow to estimate the impact of vector control measures. This applies to countries such as Laos, Cambodia and Vietnam that spend about 60% of their malaria control budget on implementing vector control activities. We used isozyme electrophoresis to clarify the Anopheles minimus s.l. species composition in northern Vietnam and identify behavioural divergences of individual species. Using different collection methods, adult mosquitoes were caught at monthly intervals from June to November 1995 in four villages. An. minimus s.l. could be distinguished from closely related species, An. aconitus and An. jeyporiensis, at the Octanol dehydrogenase (Odh) enzyme locus. Significant positive Fis values gave clear evidence of nonrandom mating within the An. minimus s.l. population. The highest heterozygote deficiency was observed at locus Odh, which was diagnostic for 2 sympatric An. minimus species in Vietnam similar to the An. minimus A and C species known from Thailand. We found no evidence for restricted gene flow between monthly samples, villages, or collection methods in either of the two An. minimus species. They occurred in sympatry, but in different proportions depending on the collection site, and had dissimilar resting and biting behaviours. Thus a vector control strategy will have a nonuniform effect on the various components of this diverse vector system.

SummaryWe surveyed the prevalence of parasitic infections in the mountainous province of Hoa Binh, north-west Vietnam, involving 526 households of six ethnic groups: Muong, Kinh, Dao, Thai, Tay and Hmong. Eggs or cysts of at least one parasite species were detected in 88% of stool samples (n ¼ 2522). Prevalences of nematodes were high among all ethnic groups: hookworm (52%), Trichuris trichiura (50%) and Ascaris lumbricoides (45%). Ascaris infection appeared to be lower in households owning a latrine, was highest among children and decreased with age. Prevalence of hookworm rose during childhood, remained high until old age, was highest among adult women, but was not linked to anaemia. Eggs of Chlonorchis spp. were found in 126 (5%) individuals (of the Muong, Kinh or Thai groups only). Chlonorchiasis increased with age and was highest among adult men. Taenia eggs were found in three individuals (0.1%). Giardia lamblia was found in all districts and among all groups and the prevalence of infection was estimated at 3%.keywords intestinal parasites, Vietnam

Since the turn of the century, the global community has made great progress towards the elimination of gambiense human African trypanosomiasis (HAT). Elimination programs, primarily relying on screening and treatment campaigns, have also created a rich database of HAT epidemiology. Mathematical models calibrated with these data can help to fill remaining gaps in our understanding of HAT transmission dynamics, including key operational research questions such as whether integrating vector control with current intervention strategies is needed to achieve HAT elimination. Here we explore, via an ensemble of models and simulation studies, how including or not disease stage data, or using more updated data sets affect model predictions of future control strategies.

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SummaryA group of 110 individuals with Schistosoma mansoni infection was investigated. Patients were allocated to one of three treatment groups and given artesunate or praziquantel alone or both in combination. Combined artesunate-praziquantel significantly increased the number of individuals cured at 5 weeks post-treatment, but at 12 weeks was only better than artesunate alone and at 24 weeks there was no statistically significant difference between the three groups. Egg count reduction rate was similar to the rate obtained with praziquantel used alone.

SummaryThe cost of permethrin-treated bednets (50% EC; 0.2 g/m 2 , 2 rounds per year) was compared to the cost of residual spraying with lambdacyhalothrin 10% WP (0.03 g/m 2 , once yearly) in Hoa Binh, a mountainous province in northern Vietnam. Calculations of the amounts of insecticides needed were based on national guidelines, on data from a cross-sectional survey and on district activity reports. The actual cost of insecticide required per person per year was lower for impregnation (US$ 0.26) than for spraying (US$ 0.36), but the difference was smaller than expected. The total cost for impregnated bednets per person per year amounted to US$ 0.90 compared to US$ 0.47 for spraying. The determining factor was the cost of the net, amounting to US$ 0.58 per person per year, assuming a 5-year life of the net. Other material (excluding nets), labour and transport combined, accounted for only 17% of the impregnation cost and 23% of spraying expenses. However, for the National Malaria Control Programme of Vietnam, the cost per person per year for impregnated bednets amounted to US$ 0.32 only, because the vast majority of nets are bought by the population. For spraying, the programme had to bear the entire cost.keywords malaria, vector control, insecticide-treated bednets, cost analysis, Vietnam