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Les méningo-encéphalocèles (MEC) sincipitaux sont des malformations congénitales rares qui se manifestent par une hernie de tissu cérébral ou méningé à travers une ouverture dans l'étage antérieur de la base du crâne. Ces malformations touchent toujours l'os frontal, plus précisément la région glabellaire et l'angle naso-frontal. Une collaboration entre Médecins du Monde et le Children's Surgical Center de Phnom Penh a permis de prendre en charge plus de quatre cents cas sur vingt ans. Les patients n'ont généralement pas eu d'examens radiologiques, les stratégies chirurgicales étant basées sur les observations cliniques et peropératoires. Il existe plusieurs formes cliniques de MEC : naso-frontales, naso-ethmoïdales, et naso-orbitaires. La classification de Suwanwela de 1972 reste la plus pertinente. Les MEC naso-frontales sont souvent associés à une importante expansion cutanée sans déformation osseuse majeure, contrairement aux MEC naso-ethmoïdales, qui entraînent des déformations significatives et sont les plus fréquentes. Les MEC naso-orbitaires, plus rares, provoquent le plus souvent une augmentation du volume orbitaire. La nature du tissu hernié et le volume de la hernie sont déterminants pour la stratégie chirurgicale. La canthopexie, un élément clé de la reconstruction, doit être précise et répond à des règles strictes pour assurer un résultat esthétique. Le remodelage fronto-nasal finalise la réparation. La chirurgie des MEC suit des principes bien codifiés. Le contexte humanitaire influence la prise en charge, avec un accent sur la sécurité chirurgicale et la transmission des compétences. Le traitement repose sur une vision clinique plus que radiologique, même si les avancées en imagerie sont aujourd'hui disponibles au Cambodge. Le suivi à long terme, surtout chez les enfants, reste un défi à documenter pour évaluer les impacts sur la croissance et la stabilité des résultats chirurgicaux. Sincipital meningoencephaloceles (MECs) are rare congenital malformations characterized by the herniation of brain or meningeal tissue through an opening in the anterior floor of the skull base. These malformations always affect the frontal bone, specifically the glabellar region and the naso-frontal angle. A collaboration between Médecins du Monde and the Children's Surgical Center in Phnom Penh has enabled the treatment of over four hundred cases over twenty years. Patients typically have not undergone radiological examinations, with surgical strategies based on clinical and intraoperative observations. There are several clinical forms of MECs: naso-frontal, naso-ethmoidal, and naso-orbital. The 1972 classification by Suwanwela remains the most relevant. Naso-frontal MECs are often associated with significant skin expansion without major bone deformity, unlike naso-ethmoidal MECs, which lead to significant deformities and are the most common. Naso-orbital MECs, being rarer, most frequently result in an increased orbital volume. The nature of the herniated tissue and the volume of the hernia are critical in determining the surgical strategy. Canthopexy, a key element of reconstruction, must be precise and adhere to strict rules to ensure an aesthetic result. The fronto-nasal remodeling completes the repair. The surgery for MECs follows well-codified principles. The humanitarian context influences management, with an emphasis on surgical safety and skill transmission. Treatment relies more on clinical assessment than radiological, although imaging advancements are now available in Cambodia. Long-term follow-up, especially in children, remains a challenge to document in order to evaluate the impacts on growth and the stability of surgical outcomes. [ABSTRACT FROM AUTHOR]

Drawing on 203 quantitative surveys with women workers in Cambodia and a further set of semi-structured interviews with 60 original participants, this paper is one of the very first to present empirically grounded research from garment workers on the financial challenges of navigating the first year of the COVID-19 pandemic. We show how in the making of clothes to be worn by Western consumers, poorly paid garment workers are reducing their eating to repay long-term debts and those newly taken on to cope with wage reductions resulting from factory closures, suspensions, and cuts in working hours. In its examination of this phenomenon, the paper improves understanding of the gendered contingencies of the COVID-19 pandemic and the 'wearing out' of garment workers through their attempts to reproduce life under (pre-existing) conditions of privation. We argue that the debt-hunger nexus is not new but reflects problems within Cambodia's capitalist development, and capitalism itself, as the costs of social reproduction and risk are privatised and financialised in the body politic. The COVID-19 pandemic is consolidating relations with financialised life such that they will outlast its duration and have long-lasting implications for workers and their families globally. [ABSTRACT FROM AUTHOR]

This paper advances existing research on both the geographies of fashion and the geographies of waste, utilising their shared interests in commodity biography. Empirically, it documents the use of textile waste from export-oriented garment factories in the peri-urban areas of Phnom Penh, Cambodia as fuel for nearby brick-kilns supplying the city's booming construction sector. Interviews and documentary photography present the forms of living, labour and harm at both the brick-kilns and the garment dump from which the textile waste is sourced. Substantively, the paper argues for the consideration of preconsumer garment waste to complement the dominant preoccupation with postconsumer waste and reuse. Conceptually, the paper argues for geographical biographies of commodity culture that are attentive to things' material dynamics of becoming, unbecoming and transformation across spaces, sectors and material forms: that is, to their 'patch geographies'. [ABSTRACT FROM AUTHOR]

This article offers a case study in Battambang province that examines agrarian and land dynamics in an irrigated command area. Building on the "powers of exclusion" framework developed by Hall, Hirsch and Li, we show how irrigation reshapes socio-spatial configurations locally and reinforces the dynamics of social differentiation between smallholder farmers. We argue that the uneven geography of water and the transformation of land ownership structures to which the irrigation project in question contributes run in the opposite direction of a pathway that would support the development of inclusive pro-smallholder irrigation. [ABSTRACT FROM AUTHOR]

Ces dernières années, la Fédération nationale des syndicats de Chine (FNSC), le seul syndicat autorisé en Chine, n'a eu de cesse d'affirmer sa présence sur la scène internationale. Les amendements successifs apportés à sa constitution imposent non seulement à la FNSC de soutenir l'Initiative Belt and Road aux côtés des autorités chinoises, mais aussi d'imprimer sa marque sur le mouvement syndical international. À travers les témoignages de syndicalistes locaux, cet article examine comment la FNSC s'efforce d'atteindre ces objectifs au Cambodge, pays où le volume des investissements chinois est très important. Il montre comment la Fédération soutient avec constance les acteurs cambodgiens locaux pro-gouvernementaux, habituellement négligés par le mouvement syndical international, en leur fournissant une aide matérielle ainsi que des opportunités de voyage à l'étranger. L'article soutient que l'impact de ces activités ne doit pas être négligé dans la mesure où leur alignement avec l'agenda illibéral des autorités cambodgiennes et les priorités des employeurs pourrait bouleverser le paysage du syndicalisme au Cambodge. [ABSTRACT FROM AUTHOR]

Rapid economic growth, declining fertility and changes in family structures have encouraged the Kingdom of Cambodia to reform its old‐age pension system. The Government of Cambodia reached an important milestone in 2019, when the Law on Social Security was promulgated. The Law includes provisions for a compulsory defined benefit pension scheme, establishing a sound framework for extending compulsory pension coverage beyond the public sector to formal private‐sector workers. As a future step, the compulsory pension scheme should be extended to informal workers. To accompany the reform, the investment policy for the pension scheme's reserve funds, including the supervisory regime and investment strategy, will be essential for the modernization of the Cambodian social security system. In this regard, Cambodia has successfully sought policy advice. However, the country should continue to seek further advice, and to act on this. Otherwise, the necessary and increasingly pressing policy ambitions of Cambodia to develop an adequate and sustainable social protection system may not be fully realized. [ABSTRACT FROM AUTHOR]

The Royal Government of Cambodia recently launched its National Social Protection Policy framework to strengthen and expand social security and assistance. To inform social health protection policy, we examine socio‐economic survey data and administrative coverage data to assess the coverage potential of existing coverage mechanisms and current gaps; and compare equitable contribution rates. Over 53 per cent of the population currently has no social health protection coverage mechanism, and about 16 per cent of the population who do have access to a mechanism are not yet enrolled. Current expansion efforts focus on the formal employee scheme, primarily benefiting individuals from higher income households. In addition, recent coverage expansion to some informal workers leaves significant gaps, particularly among the informal sector. We find out‐of‐pocket health care expenditure to be an excessive share of income among lower wealth quintile individuals and conclude they are financially vulnerable. Finally, we illustrate that an equitable approach to individual, monthly health care contributions among the lower three quintiles has a severely limited potential for revenue generation, and collection costs could exceed the amount collected. Therefore, we recommend that vulnerable groups should be exempted from contribution payments as social health protection is expanded. [ABSTRACT FROM AUTHOR]

The Government of Cambodia is implementing ambitious reform initiatives to improve the country's social health protection system. In January 2018, it was announced that the Health Equity Fund (HEF), which is fully subsidized by a joint government‐donor initiative for the reimbursement of user fees for the poor at public health facilities, is to be expanded to some segments of informal workers belonging to associations, as well as to commune and village chiefs. Since 2017, the National Social Security Fund (NSSF) has provided social health insurance for formal economy workers in enterprises with eight employees or more. In January 2018, it was expanded to civil servants and all employees regardless of the size of the enterprise. However, this article highlights that the new ambitious reforms are not accompanied by careful planning as regards funding, service delivery, human resources and institutional design. This article therefore aims to examine key policy issues and challenges for Cambodia's ambitious reform of its social health protection system in terms of resource generation, population coverage, strategic purchasing and governance. [ABSTRACT FROM AUTHOR]

For over three decades, the model of participatory irrigation management promoted by the government and donors faces severe difficulties. Considering that irrigation management has both social and technical dimensions, this paper uses political ecology and science and technology studies to show how public policy can assume many forms, depending on the material conditions it faces on the ground. Four irrigation systems in Cambodia are documented on the basis of qualitative interviews; these enabled us to show that water user associations emerge as irrigation management actors only if they can exert control over water sharing infrastructures that we call "anchor points". Whether water user associations play a significant role in irrigation management largely hinges on (1) the process followed for their establishment and the support they receive, (2) the process followed to design irrigation infrastructures and (3) the relations between the water user associations and other power holders. This paper highlights that a hybrid political ecology approach that would not only look at social structuring forces (e.g. power) but also at the material conditions of the environment (e.g. infrastructures) is particularly adapted to study irrigation sociotechnical dynamics, and notably the way water user associations and irrigators engage with their environment through a process of "inscription", that is of building "into infrastructures" their expectations about how these have to be used. [ABSTRACT FROM AUTHOR]

The discovery of several rare coins inscribed with Lavo pura confirms the existence of a city and province described under the name Lohu (or Lohuk) in Chinese records of the Yuan (Mongol) Dynasty (1260-1368) and in Vietnamese historical records as Lộ Hạc. This city and the province to which it gave its name were evidently the “province of Locach” described in the Travels of Marco Polo, the location of which remained a riddle to the mapmakers and navigators of the Age of Discovery. [ABSTRACT FROM AUTHOR]

Intentional dental modifications are known to have occurred on several continents at different periods and have been used as a diachronic bio-cultural marker to reconstruct the history of human settlement on different geographical scales. Such practices, present since the Neolithic in Southeast Asia, are thought to have originated in China and to co-exist in different forms in archaeological sites. There are many gaps and the proportion of archaeological evidence of these practices varies, making it impossible to trace their history and evolution perfectly. However, in Cambodia, cases of dental ablations are known from the Neolithic, the Metal Age and historical periods, and joint cases of dental abrasions or ablations have been attested since the Metal Age. As cases of dental abrasion were documented right up to the end of the twentieth century, this article aims to provide information on the still living memory of the motivations and techniques used by the mountain populations of Cambodia. As a complement and in comparison, we will present the unpublished cases of the Neolithic burials at the Laang Spean site, which bear witness to similar practices and raise questions about their relationship with those that persist today among certain ethnic groups. [ABSTRACT FROM AUTHOR]

L'Hoabinhien est un faciès sur galet emblématique des régions forestières et tropicales d'Asie du Sud-Est de la fin du Pléistocène supérieur jusqu'au milieu de l'Holocène. Dans une région marquée par l'existence de plusieurs humanités, il apparaît puis disparaît lorsque seuls les humains modernes sont encore présents. Ce phénomène technique se caractérise par la taille préférentiellement unifaciale d'outils lourds et épais sur galet comme des unifaces, des choppers , des chopping tools , des hémi-galets (splits) avec plus rarement des pièces bifaciales ou convergentes. Aucune armature, aucun projectile ou pointe de flèche ne sont représentés dans le lithic tool-kit de ces derniers chasseurs-cueilleurs-foragers paléolithiques des forêts tropicales. Ainsi, en Asie du Sud-Est, il ne semble pas y avoir d'évolution technique des industries lithiques ni aucune trace archéologique d'armatures de pierre pour la chasse entre 40 000 et 4000 BP, ce qui place les galets taillés hoabinhiens comme une réponse partielle à un questionnement plus vaste concernant l'adaptation humaine : le comportement technique, cynégétique, la subsistance en forêt tropicale. Comparé au Paléolithique supérieur contemporain en Occident, ces industries sur galet pourraient apparaître comme une inertie technico-temporelle, un « retard » sans changement majeur voire une régression cognitive. Sans invoquer quelque déterminisme écogéographique, nous sommes en présence d'un choix technique singulier et radical né de/dans/par la forêt qui résulte d'un dialogue entre la technique et l'environnement tropical. Le cas de l'Hoabinhien est un phénomène qui exprime un équilibre entre le minéral et un végétal en particulier, le bambou. L'invisible archéologique dans la matière lithique (armes pointues et armatures) s'est, en toute logique, exprimé dans de la matière végétale parfois siliceuse comme l'est par sa composition, le bambou. L'Hoabinhien porte en lui une complexité et une modernité sans précédent que seul l' Homo sapiens a su inventer. La pérennité de ce phénomène technique en contexte tropical humide associé à des matériaux périssables contraste avec le récit préhistorique habituel porté par le monde occidental. À partir d'exemples pris dans le matériel hoabinhien de fouilles récentes réalisées au Cambodge dans la grotte de Laang Spean par la Mission Préhistorique Franco-Cambodgienne du MEAE, nous illustrerons l'originalité et la diversité des chaînes opératoires lithiques sur galet des Gens de l'Hoabinhien. Nous proposerons également des hypothèses de fonctionnement de ce gros outillage à partir d'une analyse structurelle utilisant la modélisation 3D. The Hoabinhian represents an iconic pebble facies associated with the tropical forest regions of Southeast Asia, dating from the end of the Upper Pleistocene to the middle of the Holocene. In a region distinguished by the existence of multiple human populations, it emerges and then vanishes when only modern humans remain. This technical phenomenon is defined by the crafting of weighty, thick tools from pebbles, including unifaces, choppers, chopping tools, and splits, with bifacial pieces appearing less frequently. Notably absent from this last Paleolithic hunter-gatherer-forager toolkit are armatures, projectiles, or arrowheads. Therefore, in Southeast Asia, there seems to be a lack of technical evolution in lithic industries and no archaeological evidence of hunting projectiles from 40,000 to 4000 BP. This positions the Hoabinhian pebble tools as a part of the broader question concerning human adaptation, specifically technical behavior, forest subsistence, and life in the tropics. Compared to the contemporary Upper Palaeolithic in the West, these pebble industries might seem to exhibit technical-temporal inertia without significant change, or even a cognitive regression. However, without invoking any eco-geographical determinism, we find ourselves examining a unique and radical technical choice that originated in the forest, representing a dialogue between technology and the tropical environment. The Hoabinhian case is a phenomenon that signifies a balance between the mineral world and a specific plant, namely bamboo. The archaeological invisibility of lithic material (like pointed weapons and armatures) is logically offset by plant material, sometimes siliceous like bamboo. The Hoabinhian technique represents a novel complexity and modernity that only modern Homo sapiens has managed to invent. The persistence of this technical phenomenon in a humid tropical context, associated with perishable materials, contrasts sharply with the conventional prehistoric narrative of the Western world. By using examples taken from Hoabinhian material uncovered during recent excavations in the Laang Spean cave in Cambodia by the MEAE's "Mission Préhistorique Franco-Cambodgienne", we aim to illustrate the originality and diversity of lithic reduction sequences on pebbles. We will also propose functional hypotheses for these pebbles using a structural approach based on 3D modeling. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether adherence to antiretroviral treatment (ART) can be explained not only by individual factors but also by health care facilities' characteristics, among a sample of people living with HIV (PLWH) treated with PI-based regimens in Cambodia.Methods: The ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 health care facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Health care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to ART.Results: A total of 17% of participants did not adhere to ART. Patients in health care facilities outside the capital Phnom Penh were six times more likely to be non-adherent than those treated in health care facilities in the capital (OR: 6.15, 95% CI [1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in health care facilities (OR: 0.62, 95% CI [0.43, 0.89]). Financial constraints were the main individual factor preventing adherence.Conclusions: Our results suggest that inefficiencies in health care delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital. [ABSTRACT FROM AUTHOR]

Objective Antibiotic resistance is a prominent public and global health concern. We investigated antibiotic use in children by determining the proportion of unselected children with antibacterial activity in their urine attending a paediatric outpatient department in Siem Reap, Cambodia. Methods Caregiver reports of medication history and presence of possible infection symptoms were collected in addition to urine samples. Urine antibiotic activity was estimated by exposing bacteria to urine specimens, including assessment against multiresistant bacteria previously isolated from patients in the hospital (a methicillin-resistant Staphylococcus aureus ( MRSA), a multiresistant Salmonella typhi and an extended-spectrum β-lactamase ( ESBL)-producing Escherichia coli isolate). Results Medication information and urine were collected from 775 children. Caregivers reported medication use in 69.0% of children in the preceding 48 h. 31.7% samples showed antibacterial activity; 16.3% showed activity against a local multiresistant organism. No specimens demonstrated activity against an ESBL-producing E. coli. Conclusions Antibiotics are widely used in the community setting in Cambodia. Parents are often ill-informed about drugs given to treat their children. Increasing the regulation and training of private pharmacies in Cambodia may be necessary. Regional surveillance of antibiotic use and resistance is also essential in devising preventive strategies against further development of antibiotic resistance, which would have both local and global consequences. [ABSTRACT FROM AUTHOR]

Between 2011 and 2013, the International Labour Organization, in collaboration with governments and several United Nations agencies working as part of the Social Protection Floor Initiative, conducted social protection assessment-based national dialogue ( ABND) exercises in Cambodia, Indonesia, Thailand and Viet Nam. The exercises were carried out in order to take stock of existing social protection realities in the respective countries, including social insurance, social assistance and anti-poverty programmes. These inventories present a comprehensive picture of what elements of national social protection floors ( SPFs) are in place, where 'holes' in national floors exist, and provide a framework within which to propose recommendations for the further design and implementation of social protection provisions that guarantee at least the SPF to the entire population. This article describes the methodology for conducting ABND exercises, the situational analysis of the SPF in four countries, and the policy recommendations that were formulated for achieving basic health care and income security for children, the working-age population and the elderly. The results of preliminary calculations of the cost of implementing proposed policy options are also outlined. [ABSTRACT FROM AUTHOR]

Cambodian society, which is mainly Khmer and Buddhist, faces an inevitable diversification of its religious landscape. With one-third of its population below the poverty line, Cambodia has become a favoured target of Pentecostal churches with their salvation theology. The author will focus on analyzing both the temporary and structural limits of the penetration mode of Foursquare Church into Ratanakiri, a multiethnic and multilinguistic province in north-eastern Cambodia. The socialization, various types of proselytism and conversion trajectories performed by this Pentecostal church all reveal different facets of how to study the individuation process and the adaptation of the initial signs of this religious identity group (speaking in tongues, preaching, etc.). [ABSTRACT FROM PUBLISHER]

This paper addresses the politics of memory in post-genocide Cambodia. Since 1979 genocide has been selectively memorialized in the country, with two sites receiving official commemoration: the Tuol Sleng Museum of Genocide Crimes and the killing fields at Choeung Ek. However, the Cambodian genocide was not limited to these two sites. Through a case study of two unmarked sites—the Sre Lieu mass grave at Koh Sla Dam and the Kampong Chhnang Airfield—we highlight the salience, and significance, of taking seriously those sites of violence that have not received official commemoration. We argue that the history of Cambodia's genocide, as well as attempts to promote transitional justice, must remain cognizant of how memories and memorials become political resources. In particular, we contend that a focus on the unremarked sites of past violence provides critical insight into our contemporary understandings of the politics of remembering and of forgetting. [ABSTRACT FROM PUBLISHER]

Objective In Southeast Asia, malaria vectors bite outside the houses before bedtime, and forest dwellers rarely use insecticide-treated nets (ITNs). Thus, we tested the protection of long-lasting insecticidal hammocks (LLIH) using Olyset™ technology against exophagic vectors in two forest villages of Cambodia. Methods In each village, we conducted two entomological surveys (middle and end of the rainy season), each lasting 10 consecutive nights. These comprised human landing collections during the whole night by people sitting outside in the hammocks. Five households were selected per village, and for each household, two fixed positions were allocated: one for the control and one for the treated hammock. Results In total, 6449 mosquitoes were collected from control hammocks compared to 4481 in treated hammocks. Personal protection conferred by the hammocks was 46% (CI 95%: 35–55%) against the bites of Anopheles minimus. A significant reduction of An. dirus bites (46% CI 95%: 25–62%) was only observed at the end of the rainy season. An. maculatus and culicines bites were only reduced in one of the two study sites. Conclusion Even if this LLIH is not inducing full protection against the bites of malaria vectors, it could prove effective in protecting forest workers and villagers before sleeping time. LLIH can be an additional and valuable tool in eliminating artemisinin-resistant malaria in the region. [ABSTRACT FROM AUTHOR]

Objectives To identify and describe the distribution of dengue vectors and factors affecting this distribution in Cambodia, with a view to practicing rational, evidence-based dengue outbreak prevention activities. Methods Entomological survey with a questionnaire component in 100 randomly selected households in each of 13 clusters of high or low human population density of seven Cambodian provinces. Entomological and other indices were calculated, and statistical methods used to describe factors of potential outbreak risk. Results Aedes aegypti was the principle dengue vector in all clusters, making up 95.5% (20 555 of 21 325) of the Aedes pupae population. The majority of pupae were recovered either from large concrete water storage jars (16 230; 76.1%) or concrete water storage tanks (2819; 13.2%). There were small but significantly higher levels of dengue vector infestation in rural than urban areas. The mean pupae density over the survey was 16.4/house, which ranged between clusters from 5.2/house to 56.9/house. The ‘pupae-per-person’ index was 2.4 and 3.6 in urban and rural areas, respectively, and was independent of mean human population density or household water container distribution. Conclusions High populations of household-associated dengue vectors were present in all surveyed clusters. The highly skewed distribution of pupae in a limited number of key containers suggests adoption and further development of community-based control measures targeting these containers holds most potential chance of controlling dengue outbreaks in Cambodia. [ABSTRACT FROM AUTHOR]

Objectives To assess the effects of a user fee scheme, and related fee exemption system, on the health care seeking behaviour, the out-of-pocket expenditure and the coping mechanisms of fee-exempted patients (FEP) at Kirivong Referral Hospital in Cambodia. Methods A pre-coded structured questionnaire administered to pre-identified FEP and fee-paying patients (PP) of the same age group and with the same medical condition, who were paired for comparison. Survey data were supplemented with unstructured in-depth interviews. Results 199 pairs of patients were compared. The timing of the start of health care seeking was equal for FEP and PP, although significantly more FEP consulted first-line public health providers than PP. Only a third of interviewees who visited public health facilities prior to hospitalization were referred. The direct costs of health care seeking were US$4.3 for FEP and US$15.3 for PP. FEP borrowed at a ratio of 3.4:1 to direct costs incurred, vs. 0.74:1 for PP. Hospitalization rates were 32.5/1000 population and 18.4/1000 population for FEP and PP, respectively. Conclusions User fee exemption schemes can be pro-poor provided that the fee exemption system is based on effective pre-identification of intended beneficiaries, that these beneficiaries are informed of their right to free health care and that health care providers are reimbursed for the revenue foregone due to exemptions. To be effective in the Cambodian context, exemption schemes need to be underpinned by a range of additional interventions. [ABSTRACT FROM AUTHOR]

Objective 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. The gross cost of the intervention was US$ 567 800 per year, or US$ 0.20 per person covered. As the intervention averted considerable medical care, the annual net cost of the intervention was US$ 312 214 (US$ 0.11 per person covered) from a public sector perspective and US$ 37 137 (US$ 0.01 per person covered) from a societal perspective. The resulting CE ratios were: US$ 313/DALY gained from the public perspective and US$ 37/DALY gained from the societal perspective. Even under the most conservative assumption, the intervention remained cost effective from both perspectives. Conclusions Annual, targeted larviciding campaigns appear to have been effective and cost-effective medium-term interventions to reduce the epidemiologic and economic burden of dengue in urban areas of Cambodia. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of artemether–lumefantrine malaria treatment, as an alternative to artesunate + mefloquine, which is becoming ineffective in some areas of the Thai–Cambodian border. Methods Two studies were conducted to monitor the efficacy of artemether–lumefantrine in Sampov Lun referral hospital, Battambang Province, in 2002 and 2003, and one study was conducted to assess the efficacy of mefloquine + artesunate in 2003 for comparison. The studies were performed according to the WHO standardized protocol with a follow-up of 28 days. The therapeutic efficacy tests were complemented with in vitro tests and in 2003, with the measurement of lumefantrine plasma concentration at day 7 for the patients treated with artemether–lumefantrine. Results A total of 190 patients were included: 55 were treated with artemether–lumefantrine in 2002 (AL2002), 80 with artemether–lumefantrine and food supplementation in 2003 (AL2003) and 55 with artesunate + mefloquine in 2003 (AM2003). With the per-protocol analysis, the cure rate was 71.1% in study AL2002, 86.5% in study AL2003 and 92.4% in study AM2003. All the data were PCR corrected. The artemether–lumefantrine cure rate was unexpectedly low in 2002, but it increased with food supplementation in 2003. There was a significant difference ( P = 0.02) in lumefantrine plasma concentrations between adequate clinical and parasitological responses and treatment failure cases. In vitro susceptibility to lumefantrine was reduced for isolates sampled from patients presenting with treatment failure, but the difference was not statistically different from isolates sampled from patients who were successfully treated. Conclusion Treatment failure cases of artemether–lumefantrine are most probably because of low levels of lumefantrine blood concentration. Further investigations are necessary to determine whether resistance of Plasmodium falciparum isolates to lumefantrine is present in the region. [ABSTRACT FROM AUTHOR]

Abstract: The kouprey (Bos sauveli Urbain, 1937) is a very rare bovid species of Cambodia, which may be extinct in the wild, as no living specimen has been observed for a long time. Here, we describe a complete taxidermy mount, which presents astonishing morphological similarities with the kouprey. The animal was mounted in 1871 at the National Museum of Natural History in Paris, where it was referenced as No. 1871-576. It was deposited at the Natural History Museum of Bourges, France, in 1931, where it is still conserved today. To clarify the taxonomic status of the specimen of Bourges, DNA was extracted from a piece of bone taken on the mandible, and two different fragments of the mitochondrial cytochrome b gene were independently amplified and sequenced. The phylogenetic analyses show that the specimen of Bourges is robustly associated with the holotype of the kouprey, and that both are related to other wild species of Bos found in Indochina, i.e., banteng (B. javanicus) and gaur (B. frontalis). Because of doubts for sexing the animal, we applied a molecular test based on the PCR amplification of a DNA fragment specific to the Y chromosome. The results indicate that the specimen of Bourges is a male. The comparisons with male kouprey previously described in the literature reveal important differences concerning the body size, general coloration and horns. As these differences involve phenotypic traits that are strongly selected in case of domestication, we suggest that the specimen of Bourges was a domestic ox. This implies therefore that the kouprey may have been domesticated in Cambodia, and that several extant local races may be directly related to the kouprey. To cite this article: A. Hassanin et al., C. R. Biologies 329 (2006). [Copyright &y& Elsevier]

Objective Sexually transmitted infection (STI) services were offered by the nongovernmental organization Médecins Sans Frontières-Holland in Banteay Meanchey province, Cambodia, between 1997 and 1999. These services targeted female sex workers but were available to the general population. We conducted an evaluation of the operational performance and costs of this real-life project. Methods Effectiveness outcomes (syndromic cure rates of STIs) were obtained by retrospectively analysing patients' records. Annual financial and economic costs were estimated from the provider's perspective. Unit costs for the cost-effectiveness analysis included the cost per visit, per partner treated, and per syndrome treated and cured. Findings Over 30 months, 11 330 patients attended the clinics; of these, 7776 (69%) were STI index patients and only 1012 (13%) were female sex workers. A total of 15 269 disease episodes and 30 488 visits were recorded. Syndromic cure rates ranged from 39% among female sex workers with genital ulcers to 74% among men with genital discharge; there were variations over time. Combined rates of syndromes classified as cured or improved were around 84-95% for all syndromes. The total economic costs of the project were US$ 766 046. The average cost per visit over 30 months was US$ 25.12 and the cost per partner treated for an STI was US$ 50.79. The average cost per STI syndrome treated was US$ 48.43, of which US$ 4.92 was for drug treatment. The costs per syndrome cured or improved ranged from US$ 46.95-153.00 for men with genital ulcers to US$ 57.85-251.98 for female sex workers with genital discharge. Conclusion This programme was only partly successful in reaching its intended target population of sex workers and their male partners. Decreasing cure rates among sex workers led to relatively poor cost-effectiveness outcomes overall despite decreasing unit costs. [ABSTRACT FROM AUTHOR]