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Schematic showing the range of confounders potentially influencing faecal egg count reduction (FECR) following anthelmintic treatment, and hence classification of anthelmintic resistance (AR). These are divided into host, parasite and technical factors, which together affect actual reduction in faecal egg count (1). Technical considerations also influence the accuracy with which FECR is observed (2), and hence the detection of anthelmintic resistance (3). Technical refinements to the FECRT have very much focused on improving the accuracy with which actual FECR is measured and translated into AR classification (step 3), even though many factors other than AR can strongly influence actual FECR. These risk confounding the FECRT and should be borne in mind when designing, conducting and interpreting the test, whether in standardised form for detection of AR, or in modified forms to monitor anthelmintic effectiveness.
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