In this month's Bulletin

Methods for assessing malaria status of pregnant women found feasible (pp. 316–323)

By collecting data on the parasitaemia levels of pregnant women and the conditions in health care facilities in Kenya, health workers can provide the information on which to base malaria control policy for this population group. The methodology for doing so was tested in five clinics in Kisumu and four in Mombasa, the two districts being chosen for their contrasting social, epidemiological and geographical conditions. Malaria being one of the few causes of low birth weight that is amenable to intervention once a woman has become pregnant, the information helps health authorities to make the best use possible of scarce resources. The findings support the widespread use of intermittent doses of sulfadoxine-pyrimethamine for pregnant women at the clinic.

Biethrin may be the best pyrethroid for impregnating nets (pp. 324–333)

Seven pyrethroid insecticides were compared in laboratory conditions to obtain information on which were more suitable for impregnating mosquito nets. The mosquitoes exposed to these substances were Anopheles gambiae, the major malaria vector in Africa, and Culex quinquefasciatus, a nuisance mosquito which keeps people awake at night and provides the main motivation for using bednets. Of the seven insecticides, the authors found that biethrin had a much stronger impact on the nuisance mosquito than the others, and might therefore be the best one to use for impregnating nets. The other insecticides tested were alpha-cypermethrin, cyfluthrin, deltamethrin, etofenprox, lambdacyhalothrin, and permethrin.

It saves money to vaccinate against Japanese encephalitis in Shanghai (pp. 334–342)

There is a strong economic rationale for vaccinating against Japanese encephalitis in Shanghai: in a hypothetical cohort of 100 000 children born in 1997, immunization with inactivated vaccine (P3) would prevent 420 cases and 105 deaths from the disease over a 30-year period, and with live attenuated vaccine (SA 14-14-2) would prevent 427 cases and 107 deaths. This would save 6456 and 6556 disability-adjusted life years per 100 000 people, respectively. Vaccination with SA 14-14-2 would therefore save US$ 512 456, and with P3 it would save US$ 348 246, in comparison to no vaccination. Japanese encephalitis is a mosquito-borne viral infection which remains a public health problem in Asia, causing 16 000–50 000 episodes of illness and 5000–10 000 deaths annually.

How to delay resistance to anthelminthic drugs in Zanzibar (pp. 343–352)

In recent findings, mebendazole had significantly lower cure and egg reduction rates against hookworm infections than in a study made before the practice of periodical chemotherapy. However, its efficacy and that of levamisole against intestinal nematode infections was comparable to that found in previous trials. Combined treatment with these two drugs had a significantly higher efficacy against hookworm than either one used separately. It may delay resistance to benzimidazoles, whose use is preferred because they can be given as a single-dose tablet without weighing the children. The conclusions were drawn from a randomized placebo-controlled trial with 914 primary-school children in Zanzibar.

Leishmaniasis treatment: the ointment may be better than the injections (pp. 353– 359)

Four weeks of aminosidine ointment might be the most effective first-line treatment for uncomplicated cutaneous leishmaniasis due to Leishmania major in Iran. Injectable antimonials could then be reserved for the one- third of patients not cured after treatment with the ointment. This would significantly reduce the costs and side-effects associated with antimonial drugs. The conclusion comes from a double-blind randomized trial comparing four weeks of treatment with aminosidine with two weeks of the same, and with two weeks of placebo. Cutaneous leishmaniasis is a common skin disorder in many parts of south-west Asia, and first-line treatment at present is with antimonials, which involve multiple injections, high cost and possible toxicity.

Culture does more than science to ensure maternal well-being (pp. 360–366)

The psychosocial well-being of mothers in Eritrea depends primarily on customs and a culture of social support that are mostly outside the domain of statutory primary care. Traditional birth attendants provide a link between the two systems. Formal training for them, with regular supplies of sterile delivery kits, appears to be a viable option in the face of a ruined infrastructure and an overstretched workforce in the maternity health services. Group discussions with 104 women and 124 men in seven locations in Eritrea led to these conclusions. The main research questions asked were about local perceptions of statutory and non-statutory health services, the factors thought to mitigate war-induced anxiety and distress, and the difference between men's and women's perceptions of mental well-being.

It is usually best not to suppress fever (pp. 367–374)

Antipyretics, including paracetamol, are commonly prescribed for children with pyrexia (fever) but there is no evidence that this is beneficial. Some studies, on the contrary, suggest that fever may have beneficial effects in infection, but this has not been proved. Paracetamol in therapeutic doses is generally safe, but hepatoxicity has occurred in children taking recommended dosages. There are not enough data to show whether it is safe to use paracetamol in situations where malnutrition is common. Treatment should only be given to children in obvious pain or discomfort. The question of whether fever represents a beneficial or harmful response to illness has been debated for hundreds of years, but the evidence to date suggests that in most circumstances it is beneficial.

A Thai province demonstrates how to eliminate rabies (pp. 375–381)

In Phetchabun Province, Thailand, deaths from rabies were eliminated by means of a multipronged strategy. The main elements were: increasing access to treatment for humans exposed to rabid animals; fully documenting post-exposure treatment; public education on rabies through the media and the schools; reducing canine rabies by monitoring the dog population and vaccinating and sterilizing as required; increasing cooperation between the ministries of health, agriculture and education at the provincial level; and assessing the impact of the programme by following up patients exposed to rabid animals. No rabies deaths occurred during the last three years of the five-year programme.