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The mechanism of action, safety, and efficacy of IUDs were reviewed by a WHO Scientific Group in 1986. The Scientific Group concluded that the IUD should continue to be supported, in both developed and developing countries, as a safe, reliable method of fertility regulation. The newer copper-releasing devices are comparable to oral contraceptives in terms of safety and efficacy. When compared to women who use other reversible methods of contraception, IUD users have the lowest mortality resulting from deaths directly attributable to those methods or to the consequences of unwanted pregnancy. In the past decade, research has concentrated on the development of new devices that have both higher continuation rates and lower rates of expulsion and removal for bleeding abnormalities. An important recent concern has been the possible increased risk of pelvic inflammatory disease (PID) and subsequent tubal infertility associated with IUD use. However, it now appears that methodological problems have caused the IUD-associated risk of PID to be overestimated. The increased risk with IUDs seems to be limited to the 1st 4 months of use. No increased risk of tubal infertility has been found among IUD users in stable, monogamous sexual relationships. The use of a copper IUD after the 1st pregnancy is not associated with secondary infertility due to tubal disease. Finally, the newer copper IUDs have low rates of ectopic pregnancy.

A comprehensive guide to the technical and practical factors that need to be considered when designing and implementing programmes for the control of schistosomiasis. Noting the success of strategies focused on morbidity control, the report shows how the spectrum of programme goals can now be broadened to include reductions in the prevalence and intensity of established infections and decreases in the intensity of transmission. Throughout, emphasis is placed on knowledge and experiences that can help programme managers establish feasible goals and then select control options in line with the form of infection, its public health importance, the degree and type of morbidity, available resources, and integration into the primary health care system. Information is specific to the different types of schistosomiasis and the distinctive epidemiological features, clinical manifestations, and response to treatment of each. The report has three main parts. The first, which is devoted to strategies for control, gives programme managers a concise, yet complete review of all factors that need to be considered when establishing priorities and deciding on the most appropriate options for control. Emphasis is placed on the many recent advances, including experiences with praziquantel, that have strengthened the tools available for prevention, diagnosis, treatment, and cure. While noting the severe financial constraints faced in many endemic countries, the report cites recent findings and experiences that make it possible for each endemic country to take action against schistosomiasis, even when resources are scarce and health services limited. The second part gives specialists a detailed state-of-the-art review of all technical developments relevant to control. Separate sections describe the distinctive patterns of morbidity and mortality seen in each form of infection, update knowledge about the parasite and its mammalian hosts, and summarize what is known about the snail intermediate host and its susceptibility to control by molluscicides, biological agents, and environmental management. Other sections describe a range of advances in diagnostic tools, from hospital-based radiological investigations to the use of portable ultrasound equipment at the village level, and issue advice on treatmet and retreatment schedules for chemotherapy with praziquantel, metrifonate, and oxamniquine. The final part uses profiles of control programmes in 23 countries to document the feasibility of control and illustrate the diversity of approaches that can be applied according to different national conditions, forms and prevalence of infection, health care systems, and available resources.

Continuing education systems can improve the performance of health workers in countries around the world and support the functioning of district health systems. Continuing education guides health personnel toward the principles and methods of primary health care and improves their work with the community and family to attain an adequate level of health. The components of the district health system continuing education are planning and management, community involvement, financing and resource allocation, and district human resources development. Factors affecting continuing education at district level are: (1) system organization; (2) political and financial commitment; (3) health systems and personnel; (4) educational needs and levels; (5) target groups; (6) involvement; (7) problem solving; (8) resource persons; (9) evaluation; and (10) performance assessment. Both the World Health Organization and its Member States should encourage operational and action research on continuing education and health services to be used in future health planning. (16 references) (NLA).

This report presents the recommendations of the WHO Expert Committee responsible for updating the WHO Model List of Essential Medicines. The first part contains an update on the revised procedures for updating the Model List and the development of the WHO Essential Medicines Library. It continues to present a summary of the Committee's considerations and justifications for additions and changes to the 12th Model List, including its recommendation to add ten antiretroviral medicines. The annexes include the 12th WHO Model List of Essential Medicines in its usual presentation and, for the first time, in the five-level Anatomical Therapeutic Chemical (ATC) classification system.