Seroepidemiology has several proven applications in malaria endemic areas. In this study, it was used to assess the effectiveness of a community-based malaria control program in the focus of malaria transmission. The first serological survey was done before the implementation of a community-based malaria control program (pre-intervention), and the second one was done after 5 years of intervention in the study area. Comparison of the distribution of the indirect fluorescent antibody (IFA) titers showed a reduction in the high titer-responses after the intervention. Moreover, there was a statistically significant reduction in the geometric mean reciprocal titer (GMRT) after the intervention. These findings were suggestive of a reduction in malaria transmission resulting from the intervention. Results of a parallel parasitologic study revealed the same findings. Therefore, seroepidemiology, when used to complement the parasitologic measurement, is valuable in monitoring the effectiveness of malaria control measures.

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Tuberculosis is a major public health problem in Bangladesh. It is estimated that about 52, 000 deaths due to tuberculosis and 300, 000 new tuberculosis cases occurred in 1997 in Bangladesh. Bangladesh Rural Advancement Committee (BRAC), a Bangladeshi non government organization is implementing a community based program for tuberculosis since 1984 in collaboration with the national tuberculosis program. Community health workers are the nucleus of this initiative. All of them are female and selected from rural community. They identify suspected persons for sputum test and provide treatment to the patients in their own community. In the middle of 1998 this program was reviewed, and the achievements in 1996 and 1997 were analyzed. Treatment outcomes were evaluated through cohort analysis according to WHO/International Union Against Tuberculosis and Lung Disease (IUATLD) guidelines. Outcome indicators defined by WHO/IUATLD were used. A total of 7, 946 patients were detected in 34 thanas in 1996 and 1997. Out of them, 6, 163 (77.6%) were new sputum positive patients. Their sputum conversion and cure rates were about 90% and 86.7% respectively. This program has achieved the WHO target of 85% cure rate. Community health workers are playing a key role to control tuberculosis in this approach. Thus this model could reduce burden on health facilities, reduce patient's costs and increase case detection and cure rate.

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A survey was conducted in Oriental Mindoro, Philippines in 1997 and 1998 for the purpose of estimating the current situation of schistosomiasis japonica in the area. The prevalence rate in schoolchil dren determined by enzyme-linked immunosorbent assay detecting the parasite egg-specific immuno-globulin G revealed that the disease was more highly endemic in Malabo (70.7%) than in the other villages studied (31.8% in San Pedro and 36.4% in San Narciso), in spite of the fact that all of these villages were located near to each other. The prevalence rates determined by stool examination or necropsy of animal reservoirs in San Pedro, San Narciso and Malabo were as follows; dogs : 9.7%, 7.4% and 19.2%; rats : 10.4%, 8.7% and 26.1%, respectively. Water buffaloes were all negative in all villages. These results showed that the prevalences of schistosomiasis japonica in animal reservoirs have intimate correlation with that in schoolchildren. In Malabo, the colonies of intermediate-host snails were located very close to the resident area, which might be the major cause of high prevalence of the disease.

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Clinical manifestations of malaria are nonspecific and range from asymptomatic to severe. The clinical presentations reflect complex interactions between the host, the environment, and the parasites. Signs and symptoms include fever, headache, muscle pain, abdominal pain, anorexia, nausea, vomiting, hepatosplenomegaly, jaundice and dark urine. In mild malaria, these signs and symptoms cannot differentiate malaria from common cold, influenza or other systemic diseases. Fever and malaise in malaria are believed to result from the release of endogenous cytokines [e. g. interleukin 1, 6 and 8 (IL-1, IL-6, IL-8) and tumor necrotic factor-α (TNF-α)] in response to parasite antigens. Other signs and symptoms of malaria are also associated with the rupture of parasitized red cells. In severe malaria, the clinical manifestations included cerebral malaria, pulmonary edema, renal failure, anaemia, and jaundice. Signs and symptoms of cerebral malaria are as follow alteration of consciousness, coma, dysconjugated eyeballs and convulsions. Among fatal cases, 80% died within the first 48 hrs of admission while the rest, death resulted from complications such as acute renal failure, pulmonary edema, bacterial infection, and lactic acidosis. 92% of the survivors had completed recovery. Treatment of multidrug resistant falciparum malaria in Thailand is complicated. New antimalarial drugs have been investigated at the Hospital for Tropical Diseases in the recent years. Artemisinine derivatives such as artesunate, artemether, arteether, dihydroartemisinin are also tested at the Bangkok Hospital for Tropical Diseases. Artesunate and artemether alone with a total dose of 600 to 750 mg produced cure rates of 80 to 95%. Artesunate suppositories have been proved successfully for the treatment of severe malaria. The artemisinin derivatives when used in combination with mefloquine cure rates improved to 95-100%. Dihydroartemisinin alone with a total dose of 480 mg given over 5 days gave a cure rate of 90%. At present, studies with the combination of artemisinin derivatives plus mefloquine in various doses and duration of treatment are being investigated. Until proven otherwise, the drug combinations are still recommended for all adult patients suffering from acute uncomplicated falciparum malaria contracted in multidrug resistant areas.
In severe malaria, the choice of antimalarial chemotherapy depends on the clinical severity, the drug sensitivity of the parasites, and the availability and preparation of the drug. Quinine is widely available drug. Qinghaosu and its derivatives have been used successfully in treating both uncomplicated and severe falciparum malaria. Their effectiveness in eliminating the parasites have been extensively documented, however, the recrudescent rate is rather high (10-30%). In treating severe malaria, early diagnosis and early treatment are vital and the aim is to save patient's life. Prompt administration of an adequate and effective antimalarial drug is needed once the diagnosis is made. Other symptomatic and supportive treatment includes careful monitoring of fluid intake and urine output, frequent observations for complications with appropriate treatment and good nursing care.

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Descriptions and illustrations of male, pupa and mature larva of a black-fly species, Simulium (Nevermannia) bonninense (Shiraki, 1935), from the Ogasawara (Bonin) Islands in Japan are given for the first time; the female adult is also redescribed. Within the subgenus Nevermannia, this species is assigned to the vernum-group by the combination of the following characters : male genitalia with a lamellate ventral plate without median keel, an elongate style with a large, broad, inwardly-twisted apex, a single parameral hook per side, and an inverted Y-shaped median sclerite; pupal gill with four slender filaments per side; and larval mandible with supernumerary serrations. Interestingly, this species has the katepisternum haired in both sexes of adults, female genital fork with a prominent projection directed forwards on each arm, and pupal frons with two trichomes on each side, all of which are rare in this species-group. Brief notes on adult blood-feeding, and larval habitats of S. (N.) bonninense are given.

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Redescriptions for the female and male, and descriptions for the pupa and mature larva, of Simulium (Gomphostilbia) palauense Stone are given based on reared adults and immature stages recently collected from Palau, Micronesia. S. palauense has several remarkable pupal and larval characters, which have not (or very rarely) been found in any other species of the subgenus Gomphostilbia, such as, in the pupa, the reduced number (i.e., four) of the gill filaments and the absence of spine-combs on the abdomen; in the larva, the presence of serrations on the lateral margins of the hypostomium, supernumerary mandibular serrations, and accessory sclerites, and the absence of a postgenal cleft. Ecological notes on immature stages are also given.

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