Malaria

713 After a chapter on aetiology and pathogenesis of AIDS, there are sections on epidemiology, clinical features, opportunistic infections and tumours, HIV infection in children, diagnosis, management of patients, counselling, and prevention and control. All aspectsare included, as one would expect, but the emphasesare sometimes odd. The important section on the clinical spectrum of AIDS is described from an America-European perspective with only nods towards Africa. This is corrected somewhat in a later chapter on opportunistic infections and tumours, where some prevalences in African patients are indicated, But why not amalgamate the 2 sections and deal with African HIV disease properly? To give some examples: the most frequent neurological disorder in patients with HIV infection is not subacute encephalopathy in Africa; vacuolar myelopathy does not develop in 20% of AIDS patients in Africa (no one knows); there is not an association between HIV infection and cervical cancer (i.e., invasive tumour) anywhere, let alone in Africa; diagnosis of oral hairy leucoplakia is not based on biopsy; there is no hard evidence that lymphocytic interstitial pneumonitis is common in African HIV-positive children; I am not aware that Kaposi’s sarcomain HIV-positive patients in Africa is associatedwith other secondary cancers. These comments are not sour grapesbecauseI was not asked to contribute to the manual: the data, although incomplete, were available at the time of writing. On the plus side, due emphasis is given to tuberculosis, the most important opportunistic disease in HIV-infected adults in Africa, and empirical therapy against toxoplasmosis is properly recommended for patients with focal neurological syndromes. The chemotherapies for the opportunistic diseases-where appropriate-are given, with dosages. However, how could the writers permit 6 of the (only) 9 text lines on the medical management of HIV-infected children to be devoted to the use-ofAZT? The text is fulsomely provided with Tables and Figures: casedefinitions for AIDS casesurveillance, clinical staging systems, diagrams explaining HIV virology and serology, chemotherapy dosages,and so on. But why are the WHO managment guidelines for diseasein organ systems not given in full in the manual-an obvious place for their dissemination? All we get is the ‘respiratory disease’ algorithm, and an address to write to for the rest. In the final chanter. the fears of health care workers in Africa are addressed with respect to the acquisition of HIV infection from patients, and sensible guidelines are offered, basedon universal precautions. The clinical illustrations are in colour; most are dermatological, some are oddly tinted, and too many are devoted to Kaposi’s sarcoma. As the book’s introduction says, ‘it is hoped that a future edition will be based more on local experience and will include guidelines for case management that are more specific to the African situation’. Quite; although all the authors are doctors and a nurse with great experience of AIDS in Africa, the text devoted to clinical issues does not have the ‘hands on’ feel that the WHO must have wanted. For example, spaceis given to the management of patients with early HIV infection. But what about terminal care, which in many locations is the more pressing practical problem? In these regards, ‘local’ manuals such as AIDS Care: Diagnostic and Treatment Strategies for Health Workers bv Katabira and Goodgame (AIDS-CO&Ol Programme; Kampala: Uganda Ministry of Health. 1989)are more nractical. S. Lucas

A. J. Knell for The Wellcome Trust. New York: Oxford University Press, 1991. 89pp. Price f8.95. ISBN 0-19-854-742-O. The 1987-1988 Malaria Exhibition at the Wellcome Tropical Institute was a great success. There were panels, photographs, diagrams and explanatory text which gave an unusually broad and clear view of what we know about malaria. But exhibitions have limitations: you have to go to the right place at the right time; you cannot do Malaria.

the whole thing justice at one visit; you have to be standing up; and you cannot refer back to points of interest the next day or week, unless you live around the corner. Fortunately the exhibition has been beautifully reproduced in the form of this slim, glossy volume, and we can all now studv it at leisure. The book gives a compressed overview of the subject and of the many disciplines that contribute to our understanding. It is particularly impressive as a demonstration of how parasite, vector, environment and host collaborate to fashion the disease. There are many high-quality illustrations, taken from the exhibition, including photographs, original diagrams and electron micrographs. Space is allocated about equally to text and pictures; the text outlines current knowledge succinctly. Chapters on malaria in the community and on control measuresare helpful becausespecific examples are used-mosquito control in Papua New Guinea, malaria eradication in County Rong, China. Inevitably this multidisciplinary approach leaves gaps, and there are some errors and inaccuracies. Few would agreewith the statement that ‘the anopheline mosquito is the only practicable target for malaria control’ or that ‘sequestration is much reduced in people indigenous to endemic malarious areas’. The statement that ‘malaria is the world’s worst health problem’ needs to be defended rather than simply reiterated in several parts of the book. I would have liked to see more emphasis on the burden of morbidity and mortality due to malaria in communities; the ‘malaria survey’ is said to consist of recording parasite rates, spleen rates and average enlarged spleen indices-classical measures which should now be subsidiary to records of mortality, severemorbidity, foetal loss and low birth weights. Malaria-related chronic anaemia as a problem in young children is not mentioned . This book, at its low price, will be an excellent companion to any who work with patients or communities afflicted by malaria. Teachers will find its diagrams and illustrations useful. For those studying malaria or its control, it will be a helpful introduction to the enormous literature on this subject. M. E. Molyneux

Control of Chagas Disease. Report of a WHO Expert Committee. Geneva: World Health Organization., 1991.

Technical Report Series, no. 811. vi+95 pp. Prtce SW. fr. 14/US$ 12.60 (in developing countries SW. fr. 9.80). ISBN 92-4-120811-2. [Available in English; French and Spanish versions in preparation.] This report is the result of the first meeting of a World Health Organization (WHO) expert committee on the control of Chagas disease that met in Buenos Aires on 16-21 October3989. Like the earlier report on the control of the leishmaniases (Technical Renort Series, no. 793, 1990) it is a valuable book, and superb in many ways. It is probably the best synopsis of information on Chagas disease in the English language since Hoare’s chapter on Schizottypanum in The Trypanosomes of Mammals (Oxford: Blackwell Scientific Publications. 1972). As such it deservesa place on the shelves of all those with a broad interest in Chagasdisease. After a brief introduction, sections 2-6 of the report give a wealth of background information on the disease, the parasites, its vectors, animal reservoirs, geographical distribution and modes of transmission. Two sections that follow (7 and 8) concern aspects more directly related to control methods and control strategies. There is brief coverageof the importance of training for both diseasecontrol and effective research (section 9) followed by a statement of perceived research priorities and a brief list of recommendations (sections 10 and 11). There are 22 references and 6 annexes. It is remarkable that such a volume could result from a meeting of a few days duration by 8 committee members, with 5 of the WHO Secretariat and a temporary adviser on triatomine bugs. In general the view of Chagas diseasethat is presented here is well balanced. The report attempts to be all-embracing but is nevertheless of a consistently high stand-