The London School of Hygiene and Tropical Medicine

12

Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 75 (Supplement) 2982

The London School of Hygiene and Tropical C. E. GORDON

Medicine

SMITH

London School of Hygiene and Tropical Medicine,

London WC1 E 7HT

The London School of Hygiene and Tropical Medicine is the University of London’s postgraduate school of international preventive medicine, community health, occupational medicine and hygiene, and tropical medicine. On a world-wide basis it seeks to develop and promote the application of science to the protection of populations from hazards posed by infections, by the physical environment and by human behaviour; to elucidate the aetiology, pathogenesis, diagnosis and epidemiology of acute and chronic diseases; and to promote health by contributions to the planning, medical management and evaluation of health services and of interventions designed to control or prevent diseases. In addition, the School’s denartments of Clinical Tronical Medicine and Human Nutrition are concerned with the care of patients and with treatment of their diseases. All these activities involve research, teaching (primarily of teachers, research workers and senior medical administrators) and participation in many service and advisory roles which provide active contact with current developments and problems. The School’s uniqueness, nationally and internationally, lies in the wide range of problems, of both industrialized and developing countries, in which it is interested and in its pattern of complementary disciplines which, together with appropriate resources from elsewhere in the University, enable it to offer a comprehensive approach to preventive medicine and community health world-wide. Studies of the aetiology and prevention of acute and chronic diseases as they affect communities and of optimal ways for their amelioration demand an understanding of the ecological, social, behavioural, demographic and economic aspects, as well as of the microbiological, parasitological, nutritional and epidemiological as ects of preventive medicine and community hea Pth. Thus its core departments are (i) those that can measure effects in opulations (epidemiology, statistics, demogra hy P, (ii) those concerned with laboratory subjects Pmicrobiology, immunology, helminthology, protozoology, biochemical aspects of nutrition) and (iii) those concerned with field subjects (occupational medicine and hygiene, public health, nutritional policy, planning and epidemiological studies, environmental sanitation, disease control programmes, maternal and child health, evaluation, planning and organization of health services, health service economics and operational research). Education The SchooI provides a range of M.Sc. and Diploma courses, shorter courses, and research training-for MPhil. and Ph.D. degrees as well as for many visit-

ing workers (Tables I and II). Nearly all these courses and activities are attended by students from developing countries; the ratio of such students to those from industrialized countries varies with the subject. Students from developing countries provide about 55% of the School’s full-time students (on average 212 a year over the past five years) and almost 23% of all its students (on average 958 part-time students a year over the same period). Students also come from countries elsewhere in Europe and from North America to acquire the skills to work in and for developing countries. Over-all, foreign students make up about 72% of the School’s full-time students, and 26% of its part-time students. The strength of the School, in teaching, research and service, depends heavily on the knowledge and experience that this mix of postgraduate students from many different backgrounds contributes, and on the extensive international network of coliaboration and communication they provide. Many of the School’s achievements would not have been possible if it had not established a host of collaborative relationships with other bodies. Links with the National Health Service are numerous and close. The School collaborates extensively with the World Health Organization, the World Bank, numerous other international agencies, and universities and national agencies throughout the Third World. Indeed, much of British influence on the health activities of the international agencies is exerted by the substantial involvement of the School’s staff in their committees and programmes of action. Continuation of this work will depend on a continuing international reputation, on the continuing ability to attract staff of quality and on the development of their international interests. In teaching and research, the School collaborates not only with medical schools and institutes of the University of London (and elsewhere) but also with several non-medical schools, especially the London School of Economics, Bedford College, Birkbeck College and University College. Students came from about 80 developing countries over the past five years (Table III). Despite the rise in fees, the number of overseas students in 198X31 indicates that the demand for these courses remains unchanged. All the students are postgraduates, often with considerable exnerience. and it is the School’s declared policy to foc’us on teaching teachers, researchers and senior medical administrators. The fulltime students from developing countries are supported from a variety of sources (Table IV); for the past two academic years 14% of them have been self-supporting. In 1980-81 the School, from unearmarked benefactions, provided a fund of E77,OOO

C. E. GORDON

for bursaries in part-relief of fees, giving priority to students who are (a) self-su porting, (b) from poorer countries or with oersonal ri nancial backine. and (c) attending more eipensive courses (i.e. th% clinical and laboratory courses). Costs for overseas students have also risen sharply with inflation in the UK and with the strength of the pound. Minimal living costs alone in London for a single person are currently estimated at !Z3,500 per annum (these exclude a recommended additional E500 on arrival to cover items such as books, clothing and deposits for accommodation). For subsequent years the School is making an appeal for such bursaries: its staff has already offered about E40,OOOfrom their own salaries; former students and other possible benefactors are now being asked for help. The School believes that the training it can offer in a multidisciplinary and multinational (developing and industrialized countries) context is unique and could not easily be reproduced in the context of a developing country within the foreseeable future-it is thus not in competition with developing medical and health institutions in developing countries but supportive of their development and of the development of their countries towards self-reliance in medico-scientific expertise by technical assistance. Research All departments of the School conduct a considerable amount of research and its income from research grants (Table V) more or less equals its income from other sources. These funds are obtained from various UK and international sources, few of which vrovide more than minimal overhead costs. The abilit; of the School to bear the administrative costs of accepting short-term grants will fall into serious doubt if the income from grants and student fees falls sharply as a result of the new Government policy on overseas student fees. The main tropical research interests of departments are set out in Table VI. Technical Assistance and Advisory Activities Technical assistance to developing countries is largely in support of Overseas Development Administration (ODA) activities or through one of the international organizations, mainly WHO. In the case of wealthier developing countries technical assistance is sometimes arranged directly. Recent activities in support of ODA range from primary health care in The Gambia to the impact of fishfarming on schistosomiasis and filariasis in Egypt; these activities were greatly enhanced by ODA’s provision of Technical Cooperation Lectureshipsregrettably now being reduced in number by budgetarv pressure on ODA. With regard to direct technical assistance, the School has acc;pted two major tasks in Saudi Arabia: the design of equipment and the provision of training and supervision for the treatment of heat stroke on the pilgrimage to Mecca; and a ioint scheme of trainina for Hosvital Administrators in collaboration with thg University of Riyadh. The School plays a major advisory and policy development role in the international organizations.

SMITH

13

Consider the World Health Organization’s Special Programme for Research and Training in Tropical Diseases: in addition to undertaking research projects on behalf of the Programme, members of the School staff are extensive1 involved in its committee structure. The Dean, Yor example, is Chairman of the Research Strengthening Group which is responsible for enhancing the ability of institutions and research workers in developing countries to participate as fully as possible in the research of the Programme. Other members of staff participate in the Scientific Working Groups (SWGs). In the Programme on the control of diarrhoeal disease, members of the staff are Chairman and a member of the SWG on Environmental Health and Diarrhoeal Disease Prevention and of the SWG on Child Care Practices Related to Diarrhoeal Diseases. The School also provides WHO Consultants on many aspects of health and has WHO reference or collaborating laboratories for several important disease problems of developing countries: viral hepatitis, malaria, trypanosomiasis, filariasis, medical mycology. It also contributes (expertise to the WHO Expanded Immunization Programme and on family planning policy. For the World Bank and the WHlO, the School is headquarters of the Independent Commission (of which the Dean is Chairman) planning the long-term future of the Onchocerciasis Control Programme in West Africa. ODA is a major contributor to this Programme; the World Bank administers the fund and WHO is the executive agency. The School has enjoyed close working relationships with the World Bank over several years. These have mainly taken the form of advisory work on the health aspects of Bank-supported agricultural or rural development schemes. Recent examples concern malaria and schistosomiasis control in Egypt, the Philippines and Tanzania. Since 1976 close ties have been formed between the School and the World Bank in collaborative research in the health aspects of excreta and wastewater management. The main point of contact for this collaborative research has been the Ross Institute, but the Departments, of Entomology, Medical Helminthology, Medical Microbiology and Medical Protozoology have also been involved. A major desk study, review and bibliography has been completed entitled “Health Aspects of Excreta and Wastewater Management” and will be published by the World Bank during 1982. Studies have also been conducted into the technical and economic aspects of sanitation systems in six African countries, Concurrently the association between the levels of sanitary investment and intestinal parasitism in Gaborone, Ndola and Kumasi was studied. Since mid-1978, the Ross Institute has been a major collaborator with the World Bank. in executing a United Nations Development Programme project to advise the governments of 12 countries on low-cost sanitation projects. The Ross Institute has been primarily concerned with work in Egypt, Botswana, Lesotho and Tanzania. The project is partly a preparation for the United Nations International Drinking

14

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Water Supply and Sanitation Decade (19&l-1990). It is expected that the research and advisory work of the Ross Institute in water supply and sanitation will continue to expand during the decade and that a fruitful collaboration with the World Bank will continue. For the United Nations Environment Programme the School recently prepared the section on “Health” in a report on the state of global environment in the decade after the UN Conference on the Human Environment convened at Stockholm in 1972. The School is also advising the Programme on the environmental impact of industrialization in developing countries. There is lesser involvement with many other UN organizations and charities. British companies operating in developing countries also receive much advice and assistance. Exampies are the continuing advisory services of the Ross Institute to the plantation industries of India, Bangladesh, Malaysia and Indonesia. Frequent requests are received from engineering firms bidding for overseas contracts, which have a health component (usually of an environmental nature), to write into their proposal a member of the School staff or a Department, as an official adviser. Such requests were received in relation to, for example, a sewage disposal survey in Cairo, a project for the re-cycling of sewage effluent in Kuwait, and water supply projects for new towns in Saudi Arabia. Pharmaceutical companies seek advice and help in screening new remedies or vector control methods from the School’s parasitological departments. Advice on food and occupational problems is also sought. Commercial firms ask for advice on the preservation of the health of their expatriate staff while overseas and of their indigenous labour force. Many firms retain the Ross Institute as advisers and correspond frequently on health matters. Many of the staffs of companies are treated or receive health checks at the Hospital for Tropical Diseases on return from duty overseas. The medical profession in much of Great Britain, and certainly in the south, look to the School as their resource for advice on matters of tropical medicine, asking for advice about patients going overseas or who have returned from overseas. The Malaria Reference Laboratory, situated in the School, fulfils a most important diagnostic service and is the national malaria epidemiological centre. Many enquiries are received from hospital doctors. The general public make very great use of the School’s advisory services, especially those who travel overseas. Many do so on their own initiative: others are asked to do so by their doctors. The School as a whole handles probably some 600 to 700 enquiries a month. Career prospects The School is concerned with industrialized countries (especially the UK) as well as developing countries and many of its staff are concerned with problems affecting both. However, the proportion of staff who are predominantly concerned with problems of tropical developing countries is set out in Fig. 1. It can

AND TROPICAL

MEDICINE

be seen that (a) of 25 academic posts paid by university funds, 50% of the occupants are aged over 45 and that only eight are due to retire within the next 10 years (retiring age 65); (b) of IO Technical Cooperation lecturers eight are aged over 41 and on1 one of them is due to retire in the next 10 years; and rc), of 42 posts funded on a short-term basis 50% of the occupants are aged under 30 and, even if all retirements were used to take them up, 34 would remain without tenure in 10 years’ time. This is, of course, an artificial interpretation, as not all of these staff would be expected to remain until retirement age but, depending on the suualv of “soft” monev. thev will continue to”be recruite’d and at least a proportion will be of a quality deserving tenure. This situation is being aggravated by attrition of the number of Technical Cooperation lecturer posts owing to cuts in the ODA budget. Similar figures are set out for posts predominantly concerned with health problems which are cosmopolitan or mainly in industrialized countries, especially the UK. The over-all situation is similar although the staff on “soft’‘-money appointments are younger. The major difference, however, is that the latter group of staff probably have much greater opportunities of finding jobs elsewhere in the UK than those concerned with the tropics because of the very small number of departments and posts concerned with these subject areas, posts which presumably are occupied by staff with an age structure similar to that for tropical posts in the School. Finance The income pattern of the London School of Hygiene and Tropical Medicine over the past five years is set out in Table VII. It is estimated that over the years 1976-77 to 1978-80,48% of this income was expended on activities predominantly concerned with the problems of tropical developing countries. In 1979-80 this income was made up as follows: 44% from the UGC grant, 40% in research grants, 6% in student fees and 6% from services rendered. As from 1980-81 this picture is expected to change profoundly as a result of the Government’s policy to recover the full cost of the education of foreign students in fees. The implication of the policy is that the UGC grant will support only the teaching of home students, the teaching of overseas students being paid for by their fees. In 1980-81 the UGC grant was reduced by 36% but, had it not been for abatement of the severity of the cuts prescribed by the formula, the reduction could have been as laree as 64%. The formula on which the cost of an o;erseas student is calculated ignores the fact that many of the School’s activities are concerned with research and in technical assistance to the British Government, to many developing countries and to the international organizations. In response to Government instructions, fees for foreign students for 198tP81 have been raised from El,230 in 1979-80 to between E5,OOOfor courses with clinical instruction and E2,500 for courses requiring neither clinical nor laboratorv facilities. Although in 198CQl the School has attracted about the same number of overseas students as in recent years, the increased

C. E. GORDON

indeed. In these circumstances, without special assistance, the very existence of the School would be in serious jeopardy. The School is meantime doing everything possible to make economies, and (including two chairs) are being left vacant to acrtsieve these economies. It is also endeavouring to increase income by increasing the number of students and by exploiting its courses and its consultancy and technical assistance activities more commercially. However, it is doubtful whether the size and rate of the proposed resource reductions would all’ow the School to survive in anything resembling its present form.

revenue from fees will not cover the reduction in UGC grant. In 1980431 this gap may be filled from a special subvention of E5 x lo6 to the Universities to alleviate effects of the new policy during its first year. However, unless the promised review by Government in the autumn of 1981 revises the proposed policy or makes special arrangements for institutions like the London School of Hygiene and Tropical Medicine, a further substantial reduction of the UGC grant in 198142 could not be recovered by a further increase of fees-these would have to be at least doubled and the prospect of attracting enough foreign students at such levels would be very slight

Posts

Predominantly

Problems

0

<25

25 -30

-35

15

SMITH

Related

Of Developing

-40 -I5 -50 AGE GROUPS

Posts

Predominantly

Problems Mainly

Which

U. K ,

AGE GROUPS

-55

-60

Related Are

In Industrialized

( Especially

To Health

Countries

-65

To Health

Cosmopolitan Countries

Or

THE

LONDON

SCHOOL

OF

HYGIENE

AND

TROPICAL.

MEDICINE

courses

755

-

xx 234 345

989

97

16 31

*Centre f?r Extension Traming m Communily Medkw.

Total part-time students

Totals by domicile

Other Short Courses Tropical Medicine and Hygiene Occupational Medicine and Hygiene CETCM” Population Refugee Camps 137

10 68 1 ._

17

14

6

6 3

6 4 7 7 3

12 _.

5 7 36

DC 6 8

10 5

EIC

23 11

UK

1975-76

681

40 34 533

2

00

7x

20 21 1

9

10 2 x 1

4 6 33 1

3 3

EIC

21 7

UK

1976-77

141

-

3

11 50

23

13 17

IO 1

10 3

DC

~-

636

31 2’) 483 -

7

37 2

;

27 12

-.-. UK

871

95

17 21 1 -

18

16 1 1 8 1

8 3

HC

140

lb

26

5

24

15 3 4 20 8

14 5

DC

741

-

50 21 583

8

5 4 41 3

31 15

UK

1058

96

22 13 -

28

10 5

11

7 -

EIC

1978-79

221

-

2 53 83

19

8 2 32 8

11 3

DC

739

57

54 2s 501

973

95

19 14 -

28

14 1

37 1 9

10 1

8 -

ElC

4 b

25 17

UK

197F80

countries (EM3 and developing countries (DC)

1977-78

courses: numbers of students attending from UK, Europe and other industrialized

M.Sc. Courses Diploma Industrial Health Medical Statistics and Epidemiology Medical Statistics Vital Rr Health Statistics Ph.D. and M.Phil. Research Diploma in Tropical Medicine & Hygiene

Part-time

Table II-Part-time

139

6 39 1 4 -

24

31 15

1 -

14 4

DC

n m 2 :

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OF HYGIEKE

Table III-Developing countries from which students have come over the five academic years 1975-76 to 1979-80 Afghanistan Algeria Angola Argentina Bahrein Bangladesh Bhutan Bolivia Botswana Brazil Brunei Burma Chile Colombia Costa Rica Cuba Cyprus Ecuador El Salvador Ethiopia Fiji The Gambia Ghana Guatemala Guyana Honduras Hong Kong

India Indonesia Iran Iraq Israel Jamaica Jordan Kenya Korea Kuwait Lebanon Lesotho Liberia Libya Malawi Malaysia Mauritius Mexico Namibia Nepal Nigeria Oman Pakistan Panama Papua New Guinea People’s Republic of China

Peru Philippines St. Lucia Saudi Arabia Sierra Leone Singapore Somalia Sri Lanka Sudan Surinam Swaziland Syria Taiwan Tanzania Thailand Trinidad & Tobago Turkey Uganda United Arab Emirates Uruguay Venezuela Western Samoa Yemen (PDRY) Zaire Zambia Zimbabwe

Table IV-Sources

of fees of full-time

students from developing

Egypt

Sponsoring

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Table V-Main sources of income and health (1979-80)

for tropical

medicine

f1,257,740 171,766

UGC grant (say, 50% of total) Students fees (say, 50% of total)

E1,429,506 Research grants: Medical Research Council Overseas Development Administration Wellcome Trust World Health Organization Industry Others

6306,182 389,815 253,927 279,275 3,238 119,092 El,351,529 Total

countries

E2,781,035

for 197%79 and 1979-80 1978-79

Organizations

1979-80

British Council (Bursaries, Fellowships and Scholarships) Overseas Development Administration (Technical Co-operation Training, Commonwealth Tropical Medicine Research Scholarships, Fee Support Scheme, Natural Resources Postgraduate Studentship) Commonwealth Scholarship and Fellowship Plan Commonwealth universities and governments European Economic Commission (European Development Fund) Foreign universities and governments World Health Organization (Fellowships, Research Grants) Religious organizations Industrial and commercial companies Others

4

3

17 3 20 2 23 22 3 3 1

34 1 13 1 32 16 0 2 6

Total number of sponsored students Number of students who were self-supported

98 16

110 18

114

128

Total number of student from developing

countries

19

C. E. GORDON SMITH Table

VI-Major

research

interests

and

activities

of departments

Clinical Tropical Medicine Anaemia as a consequence of parasitic infection; Epidemiology and pathogenesis of toxocariasis; Viral infections and pyrexial illnesses in Africa; Protozoa1 infections (particularly Giurdia lamblia) in intestinal damage and malabsorption; Sero-epidemiology and the distribution of malaria and of some other protozoa1 infections in the tropics; Drug resistance of malaria. Entomology WHO Collaborating Centre for Anopheline Mosquitoes; Identification of malaria vectors, especially in sibling species complexes; Mechanisms of insecticide resistance in mosquitoes, crossresistance characteristics; Filariasis: vector-parasite relationships; Sanitation entomology, blowflies and mosquitoes; Insecticides for louse and flea control; Mosquito control by insect growth regulators; Taxonomy and ecology of phlebotomine sandflies in the epidemiology of visceral and cutaneous leishmaniasis; The ecology of Glossinu species and the epidemiology/ epizootiology of African trypanosomiases; The ecology of triatomine bugs and the epidemiology of Chagas’s disease; Biological control of insect vectors; Characterization and in vitro rapid diagnosis of arboviruses; In vitro cultivation of tropical pathogens in cell cultures; The control of tick infestations by chemical and other methods; Acarines and disease. Human Nutrition Changes in protein metabolism in response to: (a) diet and nutritional state in normal volunteers, obese patients (Hospital for Tropical Diseases) and in malnourished children (University of the West Indies, Jamaica); (b) infection in children in Nigeria and at Great Ormond Street Hospital; injury in patients undergoing elective operations at (4 St. Mark’s Hospital, London; Gastroenteritis, nutrition and water supply in Northern Nigeria; Effects of distributing dried skim milk in infant welfare clinics in Khartoum (with Ross Institute and Tropical Epidemiology Unit); Introducing nutritional activities in rural development programmes in Orissa and Nepal (with ODA); Nutrition policy and planning in Sri Lanka and Turkey; A nutritional and demographic information system in Costa Rica; Malabsorption and folic acid deficiency. Medical Helminthology Schistosomiasis Schistosomu huemufohium: immunology, pathology and chemotherapy in hamsters and primates; vaccination of baboons using attenuated schistosomula or cercariae in Nairobi, Kenya; bladder cancer;

of LSHTM

S.

munsoni: immune-dependence of egg excretion; hepatotoxins in eggs; egg antigens in human serodiagnosis; heterogeneity within and between geographical isolates; S. juponicum: immunology and chemotherapy in mice; S. bovis: development and field evaluation of the irradiated vaccine in the Sudan; Immunity in relation to chemotherapy; organophosphorus compounds in chemotherapy;

Filariasis Chemotherapy: screening of novel compounds; evalua’ tion of filaricides; modes of action of filaricides; Immunology: antigen-antibody complexes, vaccination, immunopathology, effects of antibody and cells on living filariae in vitro; assay of cuhcular antigens by antibody-mediated cell adhesion or by surface labelling with iodine; granulocyte interactions with Brugti pahungi; Immunology in cats; Onchocerciasis Parasitology of 0. gutfurosu; immunity in rodents. Eye pathology due to 0. ceroicalis; Differentiation of Onchocerca larvae; antigens of 0. volvulus; immunodiagnosis of onchocerciasis; cultivation of Onchocercu in vitro; correlation of cllinical observations and immune status in human onchocerciasis; Opisthorciasis Role in the induction of bile duct carcinoma; relationship between worm burdens and clinical ‘disease.

Medical Microbiology Molecular genetics of Vibrio cholerae to establish mechanisms of gene transfer in vibrios and the relationship to pathogenicity, and to produce recipients for genetically manipulated plasmids coding for cholera toxin, for possible vaccine development; Dietary factors affecting the establishment of the intestinal microflora in Nigeria and the UK; Bacterial colonization of the intestine in tropical sprue; Survey of mycoses in the Eastern Caribbean area; serodiagnosis of sporotrichosis and mycetoma; Structural, immunochemical and biochemical analysis of Pichinde virus; monoclonal antibodies for serological characterization of the arenaviruses and the development of sensitive diagnostic techniques; Strain variation in human mycobacteriosis in Libya; Stabilization of measles virus vaccines and studies on the thermostability of poliovirus vaccines for the WHO Expanded Programme on Immunization; Immunochemical characterization and significance of immune complexes in onchocerciasis; Viral hepatitis: development of hepatitis B polypeptide vaccines; isolation and propagation of hepatitis viruses in tissue culture; pathogenesis of acute and #chronic liver damage and the immune response to infection with the hepatitis viruses; role of hepatitis B in primary liver cancer; treatment of the persistent hepatitis B carrier.

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Table VI (continued) Medical Protozoology Malaria: chemotherapy, new compounds, modes of action; biochemistry, especially chloroquine resistance; culture of Plasmodium fulciparum; immunology, especially sexual stages; Identification of different strains (xymodemes) of the protozoans Typanosoma, Entamoeba, Giardia, Leishmania and Trichomonas, and the nematode Onchocerca to distinguish those that are pathogenic; New stages of development of Typanosoma in the vertebrate and invertebrate hosts; Epidemiology of leishmaniasis and trypanosomiasis in Brazil; Environmental and socio-economic aspects of disease control, especially trypanosomiasis; Viral haemorrhagic fevers (Lassa, Ebola, etc.): ultrastructure; Immunology of amoebiasis; Immunology of Chagas’s disease. Medical Statistics and Epidemiology Tropical Epidemiology Unit Malaria prophylaxis and immune response in children in Nigeria; Maternity deliveries in a Tanzanian hospital; Longitudinal study of schistosomiasis in Gambian villages; Epidemiology of onchocerciasis in West Africa; Transmission potential of vectors of onchocerciasis; Epidemiology of sickle-cell disease in Jamaica; Epidemiology of leptospirosis in Trinidad and Barbados; Evaluation of BCG against tuberculosis by case-control studies;

Table VII-Income Tropical Medicine Year 1974-75 1975-76 1976-77 1977-78 1978-79 197980 1980-81 (provisional)

Assessment of the importance of various diseases in less developed countries; Epidemiology of malaria in West Thailand; New methods for tropical disease epidemiology; Epidemiology Section Wellcome Trust Kenya Hypertension Project; WHO study of oral contraceptives and disease-fhilippines, Hong Kong, Mexico;

vascular

Occupational Health Special interests include: Problems of hot industries in the tropics (with ILO); Design of climatic chamber facilities for the Indonesian Government (with WHO); Ross Institute Filariasis: epidemiology in Egypt and West Africa; Cholera: environmental epidemiology in Bangladesh; Schistosomiasis: epidemiology and consequences in Tanzania; Leishmaniasis: epidemiology in Iraq; Malaria: epidemiology of drug resistance; Anopheline genetics, environmental and chemical control in Sri Lanka and Tanzania; Leprosy: epidemiology in Malawi and South India; Excreta disposal and health in developine. countries; Water supply technology and health m Tanzania, Egypt and other developing countries; Evaluation of village health workers in Tanzania; Evaluation and planning of heaith services in refugee camps in Somalia, Cameroon and Thailand; Role of traditional healers in Malaysia and Ecuador; Costs of “health for all by the year 2000”.

of the London School of Hygiene for the years 1974-1981 Court grants (EOOO)

1665 1660 1797 2313 2037

and

Research grants (f 000) 1013 1274 1399 1509 1881 2287