Table of Contents:

1.0  Introduction
2.0  Recent WHO press releases
3.0  New WHO publications from HQ and regional offices
4.0  Information from recent WHO periodicals
5.0  Information from WHO-produced newsletters
6.0  New WHO documents

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3.0 New WHO Publications from Headquarters
3.1 Community involvement in health development : a review of the concept and practice.
H.M. Kahssay and P. Oakley. (Public health in action no. 5)
1999, 160p. ISBN 92 4 156193 9
Price in developing countries Swfr. 36.40
The concept of community involvement is a central feature of the health-for-all philosophy that has guided WHO's work during the past two decades. This book examines the theme by focusing on three case studies in Bolivia, Nepal and Senegal which represent collaborative efforts on the part of international health development workers and their in-country counterparts. Substantial effort was devoted to elucidating the factors - political, sociological, organizational or economic - that had impact on these community health development projects.

3.2 Community emergency preparedness : a manual for managers and policy-makers.
1999, 141p. ISBN 92 4 154519 4
Price in developing countries Swfr.29.40
Natural and man-made disasters - including earthquakes, floods, chemical and nuclear incidents and warfare - occur throughout the world, often without warning. Any programme of disaster prevention and preparedness should promote optimum coordination between various governmental,
nongovernmental and private organizations involved. This manual is therefore aimed primarily at local managers and decision-makers in the various sectors, including health, that need to cooperate in the process. It provides an overall view of all aspects of disaster management,
including policy development, vulnerability assessment, ranking of potential hazards, analysis of available resources, definition of roles and responsibilities, etc.

3.3 Quality assurance of pharmaceuticals : a compendium of guidelines and related materials. Vol. 2 Good manufacturing practices and inspection.
1999, 196p. ISBN 92 4 154526 7
Price in developing countries Swfr. 43.30
To respond to the global need for adequate quality assurance of pharmaceuticals, WHO's Expert Committee on Specifications for Pharmaceutical Preparations has over the years made numerous
recommendations to establish standards and guidelines and to promote the effective functioning of national regulation and control systems and the implementation of internationally agreed standards by trained personnel. This compendium brings together many of the relevant documents providing
guidance covering all aspects of good manufacturing practices including important texts on inspection.

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4. Information from Recent WHO Periodicals
4.1 BULLETIN OF THE WORLD HEALTH ORGANIZATION, 1999, 77(10)
Unsafe injections in the developing world and transmission of bloodborne pathogens: a review.
L. Simonsen, A. Kane et al.
Pp. 789-797
Unsafe injections are suspected to occur routinely in developing countries. We carried out a literature review to quantify the prevalence of unsafe injections and to assess the disease burden of bloodborne infections attributable to this practice. Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports. The transmissibility of hepatitis B and C viruses and human immunodeficiency virus (HIV) was estimated using data from studies of needle-stick injuries. Finally, all epidemiological studies that linked unsafe injections and bloodborne infections were evaluated to assess the attributable burden of bloodborne infections. It was estimated that each person in the developing world receives 1.5 injections per year on average. However, institutionalized children, and children and adults who are ill or hospitalized, including those infected with HIV, are often exposed to 10-100 times as many injections. An average of 95% of all injections are therapeutic, the majority of which were judged to be unnecessary. At least 50% of injections were unsafe in 14 of 19 countries (representing five developing world regions) for which data were available. Eighteen studies reported a convincing link between unsafe injections and the transmission of hepatitis B and C, HIV, Ebola and Lassa virus infections and malaria. Five studies attributed 20-80% of all new hepatitis B infections to unsafe injections, while three implicated unsafe injections as a major mode of transmission of hepatitis C. In conclusion, unsafe injections occur routinely in most developing world regions, implying a significant potential for the transmission of any bloodborne
pathogen. Unsafe injections currently account for a significant proportion of all new hepatitis B and C infections. This situation needs to be addressed immediately, as a political and policy issue, with responsibilities clearly defined at the global, country and community levels.

Transmission of hepatitis B. Hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates.
A. Kane, J. Lloyd et al.
Pp. 801-805
Thousand of millions of injections are delivered every year in developing countries, many of them unsafe, and the transmission of certain bloodborne pathogens via this route is thought to be a major public health problem. In this article we report global and regional estimates of the number of
hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections that may occur from unsafe injections in the developing world. The estimates were determined using quantitative data on unsafe injection practices, transmission efficiency and disease burden of HBV, HCV and HIV and the prevalence of injection use obtained from a review of the literature. A simple mass-action model was used consisting of a generalized linear equation with variables accounting for the prevalence of a pathogen in a population, susceptibility of a population, transmission efficiency of the pathogen, proportion of injections that are unsafe, and the number of injections received. The model was applied to world census data to generate conservative estimates of incidence of transmission of bloodborne pathogens that may be attributable to unsafe injections. The model suggests that approximately 8-16 million HBV, 2.3-4.7 million HCV and 80 000-160 000 HIV infections may result every year from unsafe injections. The estimated range for HBV infections is in accordance with several epidemiological studies that attributed al least 20% of all new HBV infections to unsafe injections in developing countries. Our results suggest that unsafe injections may lead to a high number of infections with bloodborne pathogens. A major initiative is therefore needed to improve injection safety and decrease injection overuse in many countries.

Sterilizable syringes: excessive risk or cost-effective option?
A. Battersby, R. Feilden et al.
Pp. 812-817
In recent years, many poorer countries have chosen to use disposable instead of sterilizable syringes. Unfortunately, the infrastructure and management systems that are vital if disposables are to be used safely do not exist. WHO estimates that up to 30% of injections administered are
unsafe. The traditional sterilizable syringe had many disadvantages, some of which have been minimized through better design and the use of modern materials; others have been overcome because staff are able to demonstrate that they have performed safely. For example, the time-steam saturation-temperature (TST) indicator has enabled staff to demonstrate that a sterilizing cycle has been successfully completed. Health facility staff must be able to sterilize equipment, and the sterilizable syringe remains the least costly means of administering an injection. Data from countries that have acceptable systems for processing clinical waste indicate that safe and environmentally acceptable disposal, destruction and final containment cost nearly as much as the original cost of a disposable syringe. By careful supervision of staff behaviour and good management, some countries have demonstrated that they are able to administer safe injections with sterilizable syringes at a price they can afford.

Quantitative bacterial examination of domestic water supplies in the Lesotho Highlands:
water quality, sanitation, and village health.
J.D. Kravitz, M. Nyaphisi et al.
Pp. 829-833
Reported are the results of an examination of domestic water supplies for microbial contamination in the Lesotho Highlands, the site of a 20-year-old hydroelectric project, as part of a regional epidemiological survey of baseline health, nutritional and environmental parameters. The population's hygiene and health behaviour were also studied. A total of 72 village water sources were classified as unimproved (n=23), semi-improved (n=37), or improved (n=12). Based on the estimation of total coliform, which is a nonspecific bacterial indicator of water quality, all unimproved and semi-improved water sources would be considered as not potable. Escherichia coli, a more precise indicator of faecal pollution, was absent (P=<0.001) in most of the improved water sources. Among 588 queried households, only 38% had access to an "improved" water supply. Sanitation was a serious problem, e.g. fewer than 5% of villagers used latrines and 18% of under-5-year-olds had suffered a recent diarrhoeal illness. The study demonstrates that protection of water sources can improve the hygienic quality of rural water supplies , where disinfection is not feasible. Our findings support the WHO recommendation that E.coli should be the principal microbial indicator for potability of untreated water. Strategies for developing safe water and sanitation systems must include public health education in hygiene and water source protection, practical methods and standards for water quality monitoring, and a resource centre for project information to facilitate programme evaluation and planning.

Mass vaccination with a two-dose oral cholera vaccine in a refugee camp.
D.Legros, C. Paquet et al.
Pp. 837-841
In refugee settings, the use of cholera vaccines is controversial since a mass vaccination campaign might disrupt other priority interventions. We therefore conducted a study to assess the feasibility of such a campaign using a two-dose oral cholera vaccine in a refugee camp. The campaign, using killed whole-cell/recombinant B-subunit cholera vaccine, was carried out in October 1997 among 44000 south Sudanese refugees in Uganda. Outcome variables included the number of doses administered, the drop-out rate between the two rounds, the proportion of vaccine wasted, the speed of administration, the cost of the campaign, and the vaccine coverage. Overall, 63220 doses of vaccine were administered. At best, 200 vaccine doses were administered per vaccination site and per hour. The direct cost of the campaign amounted to US$ 14 655, not including the vaccine itself.
Vaccine coverage, based on vaccination cards, was 83.0% and 75.9% for the first and second rounds, respectively. Mass vaccination of a large refugee population with an oral cholera vaccine therefore proved to be feasible. A pre-emptive vaccination strategy could be considered in stable refugee settings and in urban slums in high-risk areas. However, the potential cost of the vaccine and the absence of quickly accessible stockpiles are major drawbacks for its large-scale use.

Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.
L.L. Boulanger, L.A. Lee et al.
Pp. 852-857
Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death.
To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$).
Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions of phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used.

Preventing mother-to-child transmission of HIV in Africa.
P. Piot & A. Coll-Seck.
Pp. 869-870
One of the most chilling, if relatively unknown impacts of the acquired immuno-deficiency syndrome (AIDS) epidemic is that it is eroding the improvements in child survival achieved in Africa over the past few decades. Last year, for example, over 0.5 million neonates were infected by their mothers with human immunodeficiency virus (HIV). Of the ten countries worldwide with the greatest numbers of infected children, the top nine are all in sub-Saharan Africa: these range from Ethiopia in first position with an estimated 140 000 HIV-infected children, through Nigeria with 99 000, South Africa, United Republic of Tanzania, Uganda, Kenya, Zimbabwe and Mozambique, to the Democratic Republic of Congo with 49 000 infected children. According to the United Nations Population Division, 64% of all deaths of under-5-year-olds in Botswana will be caused by AIDS between 2000 and 2005. The projected figure for south Africa and Zimbabwe is 50% and for Namibia, 48%.

Reducing perinatal HIV transmission in developing countries through antenatal and delivery care, and breastfeeding: supporting infant survival by supporting women's survival.
M. Berer.
Pp. 871-876
In 1998, a joint UNAIDS/UNICEF/WHO working group announced an initiative to pilot test an intervention to reduce perinatal transmission of human immunodeficiency virus (HIV), based on new guidelines on HIV and infant feeding. This intervention for developing countries includes short-course perinatal zidovudine (AZT) treatment and advice to HIV-positive women not to breastfeed their infants, where this can be done safely. The present paper raises questions about the extent of the public benefit of this intervention, even though it may be cost-effective, due to the limited capacity of antenatal and delivery services to implement it fully. It argues that it is necessary to provide universal access to replacement feeding methods and support in their safe use, not only for women who have tested HIV-positive during pregnancy, but also for untested women who may also decide not to breastfeed, some of whom may be infected with HIV or may
acquire HIV during the breastfeeding period. It further argues that additional funding, more staff, staff training, and improved capacity and resources are also needed to integrate this intervention successfully into antenatal and delivery care. The intervention will prevent some infants from getting HIV even in the absence of many of these changes. However, a comprehensive approach to HIV prevention and care in developing countries that includes both women and infants would promote better health and survival of women, which would in turn contribute to greater infant health
and survival. If combination antiretroviral therapy in the latter part of pregnancy and/or during the breastfeeding period can be shown to be safe for infants, preliminary evidence suggests that it might reduce perinatal HIV transmission as effectively as the current intervention and, in addition, might allow the practice of breastfeeding to be preserved.

4.2 BULLETIN OF THE WORLD HEALTH ORGANIZATION, 1999, 77(11)
Anaemia during pregnancy in Burkina Faso, West Africa, 1995-96:
prevalence and associated factors.
N. Meda, L. Mandelbrot et al.
Pp. 916-920
We report the results of a cross-sectional study carried out in 1995-96 on anaemia in pregnant women who were attending two antenatal clinics in Bobo-Dioulasso, Burkina-Faso, as part of a research programme including a clinical trial of zidovudine (ZDV) in pregnancy (ANRS 049 Clinical Trial). For women infected with human immunodeficiency virus (HIV) in Africa, anaemia is of particular concern when considering the use of ZDV to decrease mother-to-child transmission of HIV. The objectives were to determine the prevalence of and risk factors for maternal anaemia in the study population, and the effect of HIV infection on the severity of maternal anaemia. HIV counselling and testing were offered to all women, and haemograms were determined for those women who consented to serological testing. Haemoglobin (Hb) levels were available for 2308 of the 2667 women who accepted HIV testing. The prevalence of HIV infection was 9.7% (95% confidence interval(CI): 8.6-10.8%). The overall prevalence of anaemia during pregnancy (Hb level<11g/dl) was 66% (95% Cl:64-68%). The prevalence of mild (10g/dl<=Hb<11g/dl), moderate (7g/dl<=Hb<10g/dl) and severe (Hb<7g/dl) anaemia was 30.8%, 33.5% and 1.7%, respectively. The prevalence of anaemia was 78.4% in HIV-infected women versus 64.7% in HIV-seronegative
women (P<0.001). Although the relative risk of HIV-seropositivity increased with the severity of anaemia, no significant association was found between degree of anaemia and HIV serostatus among the study women with anaemia.
Logistic regression analysis showed that anaemia was significantly and independently related to HIV infection, advanced gestational age, and low socioeconomic status. This status confirms the high prevalence of anaemia during pregnancy in Burkina Faso. Antenatal care in this population must include iron supplementation. Although HIV-infected women had a higher prevalence of anaemia, severe anaemia was infrequent, possibly because few women were in the advanced stage of HIV disease. A short course regimen of ZDV should be well tolerated in this population.

Decrease in the prevalence of hepatitis B and a low prevalence of hepatitis C virus infections in the general population of the Seychelles.
P. Bovet, C. Yersin et al.
Pp. 923-926
A serological survey of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections was carried out on a random sex-and age-stratified sample of 1006 individuals aged 25-64 years in the Seychelles islands. Anti-HBc and HCV antibodies were detected using commercially available enzyme-linked immunosorbent assays (ELISA), followed by a Western blot assay in the case of a positive result for anti-HCV. The age-adjusted seroprevalence of anti-HBc antibodies was 8.0% (95% CI:6.5-9.9%) and the percentage prevalence among males/females increased from 7.0/3.1 to 19.1/13.4 in the age groups 25-34 to 55-64 years, respectively. Two men and three women were positive for anti-HCV antibodies, with an age-adjusted seroprevalence of 0.34% (95% CI:o.1-0.8%). Two out of these five subjects who were positive for anti-HCV also had anti-HBc antibodies. The seroprevalence of anti-HBc was significantly higher in unskilled workers, persons with low education, and heavy drinkers. The age-specific seroprevalence of anti-HBc in this population-based survey, which was conducted in 1994, was approximately three times lower than in a previous patient-based survey carried out in 1979. Although there are methodological differences between the two surveys, it is likely that the substantial decrease in anti-HBc prevalence during the last 15 years may be due to significant socioeconomic development and the systematic screening of blood donors since 1981. Because hepatitis C virus infections are serious and the cost of treatment is high, the fact that the prevalence of anti-HCV antibodies is at present
low should not be an argument for not screening blood donors for anti-HCV and eliminating those who are positive.

4.3 BULLETIN OF THE WORLD HEALTH ORGANIZATION, 1999, 77(12)
Incidence and outcome of injury in Ghana: a community-based survey.
C.N. Mock, F. Abantanga et al.
Pp. 955-962
Injury is an increasingly significant health problem in most low-income countries. However, strategies for preventing injury have not been well addressed. The present study was carried out to measure the incidence and outcome of various mechanisms of injury in Ghana in order to provide data for use in developing priorities for injury prevention efforts. For this purpose, using two-stage cluster sampling and household interviews, we surveyed 21 105 persons living in 431 urban and rural sites. During the preceding year, 1609 injuries resulting in one or more days of loss of normal activity were reported. Injury-related mortality was slightly higher in the urban (83 per 100 000) than in the rural area (53 per 100 000).
However, the burden of disability from non fatal injuries, as assessed by disability days, was higher in the rural (4697 disability days per 1000 person-years) than in the urban area (2671 days per 1000 person-years). Based on incidence rates and disability times, the major types of injury in
the urban area were transport-related injury and falls. In the rural area, agricultural injuries predominated, followed by falls and transport-related injury. In rural and urban areas combined, 73% of motor vehicle-related injuries involved commercial vehicles. In this and other similar developing-country settings, injury prevention efforts should focus on falls and on transport safety in both urban and rural areas, with special attention being paid to commercial vehicles. In rural areas, agricultural injuries contributed the largest burden of morbidity, and should be a priority for prevention efforts.

Prevalence of hepatitis C virus antibodies and genotypes in asymptomatic, first-time blood donors in Namibia.
E. Vardas, F. Sitas et al.
Pp. 965-970
Reported is the prevalence of hepatitis C virus (HCV) in Namibia as determined using a third-generation enzyme-linked immunosorbent assay (ELISA) on samples of blood collected from all asymptomatic, first-time blood donors between 1 February and 31 July 1997 (n=1941). The HCV seroprevalence was 0.9% (95% confidence interval (CI):0.5-1.5%) and no associations were detected between a positive HCV serostatus and the person's sex, region of residence, or previous hepatitis B exposure or hepatitis B carrier status, as determined by hepatitis B surface antigen (HBsAg). The only significant association in a logistic regression model was an increase in HCV positivity with increasing age (P=0.04). Viral RNA was amplified from 2 out of 18 (11.1%) specimens that were ELISA positive.
Genotyping of these specimens, by restriction fragment length polymorphism (RFLP), showed the presence of genotypes 5 and 1a. The positive predictive value of using HBsAg positivity as a surrogate screening marker for HCV in Namibian blood donors was poor (1.6%), with low sensitivity (16.7%) and specificity (89.3%), and detecting only 3 out of 18 serologically HCV-positive specimens. The results of this first study of the prevalence and epidemiology of HCV infection in Namibia suggest that donor blood should be screened for HCV by ELISA in order to prevent the transmission of hepatitis C virus.

Assessment of cell culture and polymerase chain reaction procedures for the detection of polioviruses in wastewater.
W.O.K. Grabow, K.L. Botma et al.
Pp. 973-978
WHO considers that environmental surveillance of wild-type polioviruses is potentially important for surveillance for acute flaccid paralysis as a means of confirming eradication of poliomyelitis. The present study investigated methods for detecting polioviruses in a variety of water environments in south Africa. Most polioviruses were isolated on L20B mouse cells, which, however, were not selective: 16 reoviruses and 8 enteroviruses, apparently animal strains, were also isolated on these cells. Vaccine strains of polioviruses were isolated from surface waters during and shortly after two rounds of mass vaccination of children in an informal settlement where there was no sewerage. The results demonstrated the feasibility of poliovirus surveillance in such settlements. It was also evident that neither poliovirus vaccine strains nor other viruses were likely to interfere significantly with the detection of wild-type polioviruses. Optimal isolation of polioviruses was accomplished by parallel inoculation of L20B mouse cells and at least the PLC/PRF/5 human
liver and buffalo green monkey (BGM) kidney cell lines. Analysis of cell cultures using the polymerase chain reaction revealed that 319 test samples contained at least 263 human enteroviruses that failed to produce a cytopathogenic effect. This type of analysis thus significantly increased the sensitivity of enterovirus detection.

Strategies for safe injections.
A. Battersby, R. Feilden et al.
Pp. 996-998
In 1998, faced with growing international concern, WHO set out an approach for achieving injection safety that encompassed all elements from patients' expectations and doctors' prescribing habits to waste disposal. This article follows that lead and describes the implications of the approach for two injection technologies: sterilizable and disposable. It argues that focusing on any single technology diverts attention from the more fundamental need for health services to develop their own comprehensive strategies for safe injections. National health authorities will only be able to ensure that injections are administered safely if they take an approach that encompasses the whole system, and choose injection technologies that fit their circumstances.

Auto-disable syringes for immunization: issues in technology transfer.
J.S. Lloyd & J.B. Milstien.
Pp. 1001-1005
WHO and its partners recommend the use of auto-disable syringes, "bundled" with the supply of vaccines when donor dollars are used, in all mass immunization campaigns, and also strongly advocate their use in routine immunization programmes. Because of the relatively high price of auto-disable syringes, WHO's Technical Network for Logistics in Health recommends that activities be initiated to encourage the transfer of production technology for these syringes as a means of promoting their use nd enhancing access to the technology. The present article examines factors influencing technology transfer, including feasibility, corporate interest, cost, quality assurance, intellectual property considerations, and probable time frames for implementation. Technology transfer activities are likely to be complex and difficult, and may not result in lower prices for syringes. Guidelines are offered on technology transfer initiatives for auto-disable syringes to ensure the quality of the product, the reliability of the supply, and the feasibility of the technology transfer activity itself.

4.4 WEEKLY EPIDEMIOLOGICAL RECORD
No. 46 of 19 November consists of a policy statement and detailed review on Preventive therapy against tuberculosis in people living with HIV. Preventive therapy (PT) against tuberculosis is the use of one or more antituberculosis drugs given to individuals with latent infection with Mycobacterium tuberculosis in order to prevent the progression to active disease. HIV is the most powerful known risk factor for that progression and this is the major cause of the large increase over the past decade in the incidence of tuberculosis in populations with a high prevalence of HIV
infection. Several large randomized controlled trials have now demonstrated that PT is effective in preventing TB in individuals dually infected with HIV and M. Tuberculosis. However, studies of the feasibility of PT demonstrate that the process required to target appropriate individuals, to exclude active tuberculosis, to deliver PT and to achieve adherence is complex and inefficient. This article presents the recommendations arising from a meeting in February 1998 convened by WHO and UNAIDS. It gives a detailed reviews of the data leading to these recommendations.
The latest figures for reported cases in the Global AIDS Surveillance can be found in nos 47 and 48. (26 November and 3 December) WHO and UNAIDS have estimated that by the end of 1999, 33.6 million people will be living with HIV/AIDS worldwide and that during 1999 5.6 million people became infected (of whom 3.8 million live in Sub-Saharan Africa, the hardest-hit region).
A total of 16.3 million adults and children will have died because of HIV/AIDS since the beginning of the epidemic. In 1999 approximately one-fifth of these deaths occurred in children and 51% of the estimated adult deaths were in women. 85% of the global total of deaths occurred in the African region even though only one-tenth of the world population lives there. In no. 48, a more detailed analysis of the distribution of reported AIDS cases is presented by age and sex and by assumed mode of transmission.
In sub-Saharan Africa 91% of reported AIDS cases are transmitted heterosexually and 8% by perinatal transmission.
Incidence of poliomyelitis is reported in no. 49 (10 December) where a total of 2600 cases were indicated for the African region in 1999; of those, 1087 were in Angola and 755 in Nigeria.

4.5 WHO DRUG INFORMATION 1999, VOL. 13, NO. 3
Leishmaniasis : will new technology provide a breakthrough?
F. Modabber
(p.150-151)
It is now apparent that the prevalence and impact of leishmaniasis have been grossly underestimated and the recent expanded use of surveillance centres demonstrates that urbanization, man-made environmental changes and HIV infection are contributing to increased transmission and prevalence in many countries. This article describes drug treatment and vaccine
development. Composed vaccines of killed parasite with or without BCG as adjuvant are presently in clinical trial and recombinant molecules or genetically engineered organisms are still undergoing preclinical development.

Medical products and the Internet : a guide to finding reliable information
(p. 163-167)
The WHO document WHO/EDM/QSM/99.4, reproduced in this issue, was developed by WHO in collaboration with drug regulatory authorities, drug information experts, consumer organizations and the pharmaceutical industry. It is intended to serve as a model for adaption by Member States and modified as the local situation demands. Comments on the practical use of this guide would be welcome: E-mail: reggiv@who.int or to WHO/EDM, 1211 Geneva 27, Switzerland.

5.0 Information from WHO-Produced Newsletters
5.1 ESSENTIAL DRUGS MONITOR 1999, NO. 27
Crack down on illegal sale of medicines in Benin (p.5)
Drug poisoning is on the increase in Benin as in many countries - usually as a direct result of medicines bought on the parallel market. Yet in spite of the dangers, Benin's National Office of Health Protection estimates that 85% of the population buy drugs on the parallel market. The most requested products are antibiotics, antimalarials and anthelminthics and all are of doubtful origin. In collaboration with WHO the health authorities have began a series of information and training sessions for community leaders on the potential dangers of drugs and their illegal sale.

South Africa: getting essential medicines to the people. (p. 6-7)
One important milestone in South Africa's National Drug Policy, launched in 1996, is the standard treatment guidelines and the resulting essential drug list which have been recently published and are available on the Internet at www.sadap.org.za/edl/ The guidelines and EDL are not "set in stone" but will be a dynamic process with regular updates and an EDL Executive Committee was appointed by the Minister of Health in August 1999 to continue this process.

People and medicines in East Africa (p.8)
A one-week workshop was held in November 1998 organized by the Makerere Institute of Social Research in Mbale, Uganda where researchers from East Africa as well as the USA and Europe presented their findings on the use of medicines in East African societies. Detailed studies on the social and cultural context of medicine use revealed the important influence of social relations, religious beliefs and spiritual experience. For a report on the workshop and further information on the informal network contact Dr P. Wenzel Geissler at E-mail: wg@bilharziasis.dk

WHO gets mandate to tackle trade impacts on health (p. 18)
Concern has been mounting for some time in developing countries over the potential impact of new global trade agreements, such as the Agreement on Trade-Related aspects of Intellectual Property Rights (TRIPS) on access to essential medicines. Adoption of a resolution on WHO's Revised Drug Strategy at last year's World Health Assembly gives the Organization the go-ahead to expand its work on a range of issues that affect access, quality and rational use of drugs.
To be added to the mailing list of the Essential Drugs Monitor, please contact the Editor at WHO/EDM, 1211 Geneva 27, Switzerland or E-mail: DAPMAIL@who.ch