SummaryPopulation coverage of insecticide-treated nets (ITNs) in Africa falls well below the Abuja target of 60% while coverage levels achieved during vaccination campaigns in the same populations typically exceed 90%. Household (HH) cost of ITNs is an important barrier to their uptake. We investigated the coverage, equity and cost of linking distribution of free ITNs to a measles vaccination campaign. During a national measles vaccination campaign in Zambia, children in four rural districts were given a free ITN when they received their measles vaccination. In one urban district, children were given a voucher, which could be redeemed for a net at a commercial distribution site. About 1700 HHs were asked whether they received vaccination and an ITN during a measles campaign, as well as questions on assets (e.g. type roofing material or bicycle ownership) to assess HH wealth. Net ownership was calculated for children in each wealth quintile. In the rural areas, ITN coverage among children rose from 16.7% to 81.1% and the equity ratio from 0.32 to 0.88 and in the urban area from 50.7% to 76.2% (equity ratio: 0.66-1.19). The operational cost per ITN delivered was $0.35 in the rural area with direct distribution and $1.89 in the urban areas with voucher distribution. Mass distribution of ITNs through vaccination campaigns achieves rapid, high and equitable coverage at low cost.

Summaryobjective To assess the cost-effectiveness (CE) of annual targeted larviciding campaigns from 2001 to 2005 against the dengue vector Aedes aegypti in two urban areas of Cambodia with a population of 2.9 million people.methods The intervention under analysis consisted of annual larviciding campaigns targeting medium to large water storage containers in households and other premises. The CE compared the intervention against the hypothetical alternative of no intervention. The CE was calculated as the ratio of disability adjusted life years (DALYs) saved to the net cost of the intervention (in 2005 US dollars) by year. A sensitivity analysis explored the range of study parameters.results The intervention reduced the number of dengue cases and deaths by 53%. It averted an annual average of 2980 dengue hospitalizations, 11 921 dengue ambulatory cases and 23 dengue deaths, resulting in a saving of 997 DALYs per year.

Plasmodium falciparum chloroquine resistance was first detected in Cambodia in the early sixties. Treatment with chloroquine was abandoned 20 years ago. In vitro chloroquine sensitivity monitoring indicates that all eastern Cambodian isolates were sensitive to chloroquine, whereas most isolates collected from western provinces displayed reduced susceptibility to chloroquine. This indicates that the rate of chloroquine resistance remains high and stable in this region in the absence of chloroquine pressure. Characterization of codons 72 to 78 and 218 to 220 of pfcrt revealed six distinct haplotypes, four of which had never been described. The frequency of each haplotype depended on the geographical origin of the samples. The CVIETIF//ISS haplotype was detected in 92% of western Cambodian isolates and in 11% of isolates collected from the eastern province, where CVMNKIF//ISA and CVIDTIF//ISS predominate. The detection of an intermediate haplotype from a susceptible area with 76T/220A, suggests that acquisition of chloroquine resistance might be a stepwise process, during which accumulation of point mutations modulates the response to chloroquine. The association of the K76T mutation with chloroquine resistance was not clear. The mutation was detected in resistant and susceptible samples, suggesting that additional factors are involved in chloroquine resistance. By contrast, the pfcrt D/N75E mutation was strongly associated with the in vitro chloroquine resistance in Cambodian isolates. The N86 allelic form of pfmdr1 was detected in all isolates, consistent with a poor association with resistance to chloroquine. This indicates that in vitro resistance to chloroquine was associated with accumulation of point mutations in pfcrt.

Vorndam, J. Clin. Microbiol. 30:545-551, 1992) is used worldwide for diagnosis and surveillance. However, it failed to detect DENV-1 variants in Cambodia due to a point mutation. We describe an improvement of the method that allows the detection of additional DENV-1 strains, including potential variants.Dengue virus (Flaviviridae, genus Flavivirus) serotypes 1 to 4 are transmitted to humans mainly by Aedes aegypti mosquitoes. Human infection leads to a clinical picture ranging from asymptomatic infection or mild dengue fever to severe dengue hemorrhagic fever (DHF) or dengue shock syndrome. Dengue is a major public health problem of increasing concern, as evidenced by the estimate of 50 million infections annually, including 400,000 DHF cases, and 2.5 billion individuals at risk (16). Southeast Asia, including Cambodia, is a an area of dengue hyperendemicity, where the four serotypes are circulating simultaneously and DHF cases are reported each year. Since no vaccine is available to prevent the disease, its control relies mainly on surveillance, vector control, and case management (16).Laboratory diagnosis of dengue infection includes molecular techniques such as reverse transcription (RT)-PCR, for which more than 16 different protocols have been published (9). One protocol, developed by Lanciotti et al. (10), a seminested RT-PCR, targets the C and pre-M region. It uses universal outer dengue primers D1 and D2, followed by a subsequent serotype-specific seminested PCR combining primer D1 with one of the following internal primers: TS1, TS2, TS3, or TS4. This assay is known to exceed the sensitivity of virus isolation when aliquots of the same sample are used (8) and is widely used for diagnosis and surveillance of dengue, particularly in Southeast Asian countries (2-5, 7, 13, 15).In Cambodia, our laboratory surveillance of dengue utilizes hemagglutination inhibition and immunoglobulin M capture enzyme-linked immunosorbent assays, virus isolation on AP61 and Vero E6 cells (12), and seminested RT-PCR by the method of Lanciotti et al. (10) with slight modifications. Briefly, 100 l of serum was extracted by using Trizol LS reagent (Life Technologies, Gaithersburg, Md.), according to the manufacturer's instructions. The resulting RNA pellet was resuspended in 30 l of RNase-free water and incubated for 10 min at 55°C, and then 5 l was used in an RT reaction in a 15-l mixture containing 500 M deoxynucleoside triphosphate (dNTP), 0.25 M D2 primer, 20 U of RNasin (Promega, Madison, Wis.), 5 U of avian myeloblastosis virus reverse transcriptase (Promega), 5ϫ RT buffer, and RNase-free water. RT was carried out at 42°C for 1 h. The first-round PCR was carried out in a 50-l volume containing 2.5 mM MgCl 2 , 0.2 mM (each) dNTPs (Boehringer Mannheim, Mannheim, Germany), 0.2 M (each) D1 and D2 outer primers, 1ϫ Taq buffer, 2 U of Taq polymerase (Promega), 5 l of the RT product, and PCR-grade water. The PCR program started with 5 min of denaturation at 95°C, followed by 35 cycles consisting of 94°C for 1 min, 55°C for 1 min, an...

This paper explores warning system options in the landslide-prone community of Gmunden/Gschliefgraben in Upper Austria. It describes stakeholder perspectives on the technical, social, economic, legal and institutional characteristics of a warning system. The perspectives differ on issues such as responsibility allocation in decisions regarding warnings, technologies used for monitoring and forecasting, costs and financial aspects, open data policies and the role of the residents. Drawing on the theory of plural rationality and based on a desk study and interviews, stakeholder perspectives and discourses on the warning system problem and its solution were elicited. The perspectives formed the basis for the specification of three technical policy options for a warning system in Gschliefgraben: a minimal-cost and cost-effective system; a technical-expert system; and a resident-centered system. The case demonstrates the importance of accounting for a plurality of values and preferences and of giving voice to competing discourses in communities contemplating warning systems or other public good policies. This paper concludes that understanding the different and often conflicting perspectives and technical policy options is the starting point for formulating an agreed compromise for an effective warning system. We describe the compromise solution in an accompanying paper included in this Special Issue.