WHO News and activities

WHO News and activities Reducing alcohol-related problems a With the significant exceptions of France, Italy, and Portugal, where the consumption of wine has fallen, and some North African countries, where less wine has been produced, the production and consumption of beer, wine, and spirits are growing in almost all countries. Since this growth has usually outpaced that in population, the per capita consumption of alcohol has been increasing globally. Although Europe and North America still retain their prominence as large-scale producers and consu- mers of alcohol, some countries in West Africa and in the Western Pacific region have experienced steep rates of increase in alcohol consumption, which if sustained will shortly lead to high per capita levels. The implications of these trends are disturbing in view of the high levels of alcohol-related problems and associated social costs found in developed coun- tries that have high per capita levels of alcohol con- sumption. The rapid growth in alcohol consump- tion in developing countries is therefore likely to be followed by a similar increase in alcohol-related problems that will severely strain their economic and social resources. In order to identify current trends in alcohol- related problems, review the application of tech- niques to reduce them, and prepare guidelines for technology transfer leading to the development of national and international policies and programmes, WHO held an Inter-regional Meeting on Alcohol- related Problems, in Tokyo, on 2-8 April 1991. -Below are summarized the recommendations made by the participants. * Member States should develop and regularly up- date their national alcohol policies and programmes. Such policies should promote health and well-being and achieve measurable goals by specified dates. * Alcohol policies and programmes should be based on the costs, in health, social and economic terms, of alcohol-related problems to a country. WHO should a Based on: Inter-regional Meeting on Alcohol-related Problems, Tokyo, 2-8 April 1991: report. WHO unpublished document WHO/PSA/91 .7. Reprint No. 5258 play a lead role in improving the methods used to estimate these costs in both developed and develop- ing countries. * WHO should continue to collaborate with Member States in developing their capacity to gather the information needed to describe and measure alcohol consumption and alcohol-related problems, especial- ly among high-risk groups. * National policies and programmes on alcohol- related problems should address all sectors of the population and not just heavy drinkers. * Member States should select a combination of measures to reduce alcohol-related problems, based on their needs. Educational, legislative, and techno- logical measures should complement each other. * The following legislative control measures have been found to be particularly effective in reducing alcohol-related problems: - a minimum legal drinking age; - price and tax increases; and - control of alcohol availability. Member States should also consider banning the sale of alcoholic beverages at petrol stations. * Peer education, comprehensive school health edu- cation and responsible beverage service, in combina- tion with community-based education programmes, should be promoted. * Public-health aspects should be given adequate consideration in alcohol marketing strategies, particularly those targeted at women and young people. In developing countries, attention should be directed at the likely impact of advertising and pro- motion aimed at the expansion of markets * Opportunities should be sought for dialogue with the producers of alcoholic beverages, particularly in connection with the promotion among consumers of more responsible drinking practices. * Research should be carried out on the following: - the effect of the forthcoming harmonization of alcohol taxation in the European Economic Community: - investigation of the size, characteristics, and time-trends of groups that cause special concern, e.g., known problem-drinkers; - the characteristics of prevention and intervention programmes and of the persons they affect; Bulletin of the World Health Organization, 70 (1): 135-138 (1992) © World Health Organization 1992 135 WHO News and activities - efficacy rates or outcome measures of preven- tion and rehabilitation; and - the increased use of breathalysers and the recently developed dry chemical techniques for estimating the total alcohol content of blood, urine, and saliva, as well as their application in determining the contribution of alcohol to road- traffic and other accidents and crime. * WHO Collaborating Centres should increase their research and training activities directed at preventing and treating alcohol-related problems. Technical and financial support should be sought from national and intemational sources to facilitate cooperation between Collaborating Centres working to reduce alcohol-related problems. * Member States should give special attention to the development of national policies and programmes aimed at reducing alcohol-impaired driving. * Opportunities for collaboration should be sought between the health, law-enforcement, education, and social-welfare sectors and the alcoholic beverage and hospitality industries to reduce the problems of excess alcohol consumption and its association with violence and criminal activity. * Member States should take steps to ensure that health and other professionals acquire the skills necessary to implement early identification of prob- lem-drinkers and of minimal intervention techniques. Such measures are particularly recommended for special populations, including young people, women, and the elderly; in special situations, including the workplace and road traffic; and in relation to crimi- nal behaviour. Prevention of blindness b The Ninth Meeting of the WHO Programme Advisory Group on the Prevention of Blindness was held, at the invitation of the Govemment of Gambia, in Banjul on 5-8 March 1991. In addition to the members of the Group, the meeting was attended by representatives of UNDP and of a number of intema- tional nongovemmental organizations. Below are summarized the major conclusions and recommendations made by the participants. Manpower development A centre for training in community eye care should be set up in the African Region; in Portuguese- b Based on: Report of the Ninth Meeting of the WHO Programme Advisory Group on the Prevention of Blindness, Banjul, 5-8 March 1991. WHO unpublished document WHO/PBU91 .22. speaking African countries, where there is a paucity of eye care personnel at all levels, manpower de- velopment efforts should be initiated. * Ongoing training programmes in ophthalmology do not uniformly include the development of surgical skills, even for cataract surgery; this is particularly true of the shorter courses of postgraduate training. All postgraduate courses in ophthalmology should therefore allow those participants who have had no previous surgical training the opportunity to develop such skills during a post-diploma period of surgical apprenticeship. The International Council of Ophthalmology should be requested to consider this issue particularly in relation to ophthalmic practice in developing countries. Eye medication * Techniques for the local small-scale preparation of eye drops have been developed by the Christoffel Blindenmission, and formal guidelines and instruc- tion material are available from the WHO Prevention of Blindness Programme (PBL). Countries that ex- perience difficulties in obtaining a regular supply of eye drops are strongly urged to consider this ap- proach, which enables a range of commonly used drops to be prepared at very low cost. For this pur- pose local workshops could be set up in hospital pharmacies or elsewhere, with possible support from nongovernmental organizations or UNICEF. Vitamin A deficiency * Despite reports of wide coverage with high-dose supplements to control vitamin A deficiency, in most developing countries there are pockets where chil- dren are at a high risk of blindness. In developing countries it is therefore imperative that supplies of high-potency vitamin A capsule/oil be made avail- able at all levels of the community health delivery system. The initiative to administer a single dose of vitamin A supplement together with measles vac- cination, as part of the Expanded Programme on Immunization (EPI), was supported at the meeting. Further research into alternative supplementation schemes should be encouraged. * There is a need to create an awareness among child health workers and ophthalmologists of the magnitude of the problem posed by xerophthalmia and the possible interventions available, with par- ticular emphasis on dietary approaches to the control of vitamin A deficiency. Ivermectin * Progress is being achieved in the large-scale dis- tribution of ivermectin in several countries where 136 WHO Bulletin OMS. Vol 70 1992 WHO News and activities onchocerciasis is endemic, particularly within the area covered by the WHO Onchocerciasis Control Programme in West Africa. There is, however, still a need to determine optimally satisfactory strategies for the distribution of the drug, in particular the role that can be played by nongovernmental organiza- tions. Low vision - The problems posed by low vision have not yet been addressed by WHO; the focus by PBL should be first on the needs of children. Improved data on the extent of the problem should be gathered, using criteria based on functional vision rather than visual acuity. Particular attention should be paid to determi- ning near vision. * There is a need to review and refine a commonly acceptable definition of low vision in infancy and childhood, based on functional vision. This issue should be addressed in consultation with the International Council for Education of the Visually Handicapped and the International Federation of Ophthalmological Societies. Data collection * The collection of blindness data in a manner that provides for standardization and comparability is important, not only in terms of the global data bank, but also as a realistic starting point for local pro- gramme development and evaluation. * A WHO eye examination card and an instruction manual have been prepared, and a software package for data analysis is available for use with the eye examination card. The Group recommended the fol- lowing: - countries, groups or individuals setting out to perform surveys, either nationally or locally, should use this standard eye examination form; - a standard form should be developed for the spe- cific collection of data on childhood blindness and its causes. Evaluation of trachoma control Over the last three decades only scant and irregular information has been available on the global problem posed by trachoma. A systematic review of available data on trachoma should therefore be carried out, and a questionnaire on its prevalence, severity, and the endemic areas should be prepared by PBL in consul- tation with interested Collaborating Centres and for- warded to selected countries for collection of data. New training material on a simplified grading scheme for trachoma should be made available to all these countries. Global surveillance network for gonococcal antimicrobial susceptibilityc Gonorrhoea is a major global problem with serious health, social, and economic consequences. Inad- equate control and therapy can result in complica- tions such as pelvic inflammatory disease, leading to infertility or ectopic pregnancy, and neonatal infec- tion, which causes blindness. The problems presented by gonorrhoea are most serious in those countries that are least able to deal with them, and in many developing countries 5-10% of the entire drugs budget is used just to treat gonorrhoea. The problem is compounded by the ability of the gonococcus to become resistant to antibiotics, and both plasmid- and chromosomal-mediated resistance occurs. Comprehensive, up-to-date regional data on gonococcal resistance are not available; however, it is clear that in many countries relatively cheap thera- pies such as penicillin and tetracyclines are largely ineffective because of the high rates of gonococcal resistance. Use of these antibiotics is now only recommended where the resistance rates are known to be low. Local variations in resistance to thera- peutic agents such as thiamphenicol and sulfa- methoxazole + trimethoprim also occur. None of the currently recommended main treat- ment regimens for gonorrhoea (ceftriaxone, cipro- floxacin, and spectinomycin) is cheap; however, this needs to be set against the overall cost to a country of using cheaper but inadequate initial therapy, which results in the further spread of the infection and of resistant strains. In order to make decisions on the most appropriate cost-effective gonococcal thera- py, health administrators need to have information about the current local pattems of gonococcal anti- microbial susceptibility. Pattems of gonococcal resistance vary in differ- ent areas, but the clinical efficacy of most antibiotics against gonorrhoea can be correlated with the in vitro sensitivity of the gonococcus. Gonococcal resistance to a particular antibiotic or antibiotic group in a given region or country can develop rapidly, and the emergence of new forms of resist- ance can be unpredictable. Today, the ease and extent of intemational travel means that such resist- ant gonococcal strains can spread quickly. An inter- national approach is therefore needed to monitor gonococcal susceptibility to the antimicrobial agents that are in current clinical use and to relate this to the c Based on: Global surveillance network for gonococcal anti- microbial susceptibility. WHO unpublished document WHO/UDT/90.452. WHO Bulletin OMS. Vol 70 1992 137 WHO News and activities probable clinical efficacy of these drugs. A global surveillance network for this purpose is now being set up under the auspices of WHO, as outlined below. Structure and operation of the surveillance network The core of the network consists of the WHO Sexually Transmitted Diseases (STD) programme manager, two central coordinators, and interregional coordinating centres. The central coordinators pro- vide the link between the STD programme man- ager and the rest of the network. At present the network has three interregional coordinating centres: Dr I. Lind, WHO Collaborating Centre for Reference and Research in Gonococci, Statens Seruminstitut, Copenhagen, Denmark, is res- ponsible for covering the European, African and Eastern Mediterranean Regions; Dr J. Tapsall, Department of Microbiology, Eastern Sydney Area Health Service, Randwick, Australia, covers the South-East Asia and Western Pacific Regions; and Dr J. Dillon, National Laboratory for Sexually Transmitted Disease, Ottawa, Canada, is responsible for the Americas. However, it is eventually intended that each WHO Region will have its own coor- dinating centre. The coordinating centres are responsible for recruiting network participants from within their own regions and for the organization of quality control and technical support. The network aims to encourage the participation of laboratories in developing countries, where exper- tise and facilities may be limited. This will result in the involvement of laboratories that have widely dif- ferent levels of technical skill, and the training of staff from developing countries is one of the objec- tives of the programme. Technical guidelines for laboratory work and data analysis are currently being drafted to assist participating laboratories to generate reliable susceptibility data. Quality control will be particularly important in this respect. The network is being built up gradually and ini- tially the three coordinating centres are determining what recent gonococcal susceptibility data are cur- rently available from the countries in their region and what methods were used to collect them. Laboratories that are willing/able to participate in the network are also being identified together with their level of technical expertise and available facilities. The development of the network, as described above, will depend on obtaining extra-budgetary resources and specific donor support. WHO Bulletin OMS. Vol 70 1992138 Notes et activites OMS Reduire les problemes lies a I'alcoola La production et la consommation d'alcool (biere, vin et spiritueux) ont augmente dans presque tous les pays, a quelques importantes exceptions pres: la consommation du vin a diminue en France, en Italie et au Portugal, de meme que sa production dans cer- tains pays d'Afrique du Nord. Cette croissance ayant generalement depasse celle de la population, il en decoule que la consommation d'alcool par habitant a globalement augmente. Si l'Europe et l'Amerique du Nord demeurent encore les premiers producteurs et consommateurs d'alcool, l'augmentation rapide de la consommation enregistree dans certains pays de l'Afrique de l'Ouest et du Pacifique occidental conduira sous peu, si elle se maintient, 'a des taux eleves de consomma- tion par habitant. La tendance a de quoi inquieter, quand on songe 'a tous les problemes poses par I'alcool et aux depenses sociales qui y sont liees dans les pays industrialises oiu la consommation d'alcool par habitant est elevee. L'accroissement rapide de cette consommation dans les pays en deve- loppement risque donc fort d'etre suivi d'une aug- mentation similaire des probl'emes lies 'a l'alcool, qui grevera lourdement les ressources economiques et sociales de ces pays. Une reunion interregionale sur les problemes lies 'a l'alcool a ete organisee 'a Tokyo par l'OMS, du 2 au 8 avril 1991, pour identifier les tendances actuelles dans les problemes lies 'a I'alcool, faire le point des techniques propres 'a reduire ces problemes et preparer des directives pour le transfert de techno- logies conduisant 'a la mise au point de politiques et programmes nationaux et intemationaux. On trouve- ra ci-dessous un resume des recommandations for- mulees par les participants. I1 faudrait que les Etats Membres elaborent, et revisent periodiquement, des politiques et pro- grammes nationaux concemant l'alcool. Ces poli- tiques devraient viser ia promouvoir la sante et le bien-etre, et atteindre des objectifs mesurables dans des de'lais specifi6s. a D'apres: Inter-regional Meeting on Alcohol-related Problems, Tokyo, 2-8 April 1991: report. Document OMS non pubIi6 WHO/PSA/91 .7. NO de tire a part: 5259 * Les politiques et programmes nationaux concer- nant l'alcool devraient etre etablis sur la base du cou't sanitaire, social et economique des problemes lies 'a l'alcool dans le pays. L'OMS devrait jouer un role de premier plan dans l'amelioration des methodes utilisees pour evaluer ces couts dans les pays deve- loppes ou en developpement. * L'OMS devrait continuer 'a collaborer avec les Etats Membres en vue de developper leur aptitude a reunir les informations necessaires pour decrire et mesurer la consommation d'alcool et les problemes qui y sont lies, surtout dans les groupes a haut risque. * Les politiques et programmes nationaux concer- nant les problemes lies 'a 'alcool devraient s'adresser a tous les secteurs de la population et non pas seule- ment aux gros buveurs. * Pour reduire les problemes lies 'a 'alcool, les Etats Membres devraient choisir une combinaison de mesures en fonction de leurs besoins. Les mesures educatives, legislatives et techniques doivent se com- pleter reciproquement. * Les mesures legislatives suivantes se sont mon- trees particulierement efficaces pour reduire les pro- blemes lies 'a l'alcool; - fixation d'un age minimal pour la consommation d'alcool; - augmentation du prix de l'alcool et des taxes; - restriction des possibilites d'achat d'alcool. Les Etats Membres devraient egalement envisa- ger d'interdire la vente de boissons alcoolisees dans les stations-service. * Il conviendrait de promouvoir, en association avec des programmes a base communautaire, 1'education par les pairs, une education sanitaire tres poussee a l'ecole, et l'education des vendeurs ou distributeurs de boissons pour qu'ils sachent assumer leurs res- ponsabilites. * Les strategies de commercialisation de l'alcool, en particulier celles qui s'adressent aux femmes et aux jeunes, devraient faire entrer la sante publique en ligne de compte. Dans les pays en developpement, il faudrait examiner attentivement l'impact probable des activites publicitaires et promotionnelles axees sur l'elargissement des marches. * Il faudrait rechercher toutes les occasions de dia- logue avec les fabricants de boissons alcoolisees, Bulletin de lOrganisation mondiale de la Sant6, 70(1): 139-142 (1992) © Organisation mondiale de la Sante 1992 139 Notes et activit6s OMS notamment en ce qui concerne la promotion chez leurs clients d'habitudes de consommation plus res- ponsables. * Des recherches devraient etre menees sur les points suivants: - l'effet de l'harmonisation prevue des taxes sur l'alcool au sein de la Communaute economique europeenne; la dimension, les caracteristiques et les ten- dances dans le temps des groupes qui suscitent des preoccupations particulieres, par exemple les buveurs 'a problemes; les caracteristiques des programmes de preven- tion et d'intervention, et des personnes qu'ils visent; l'efficacite ou les resultats des mesures de pre- vention et de readaptation; -l'extension de l'usage des ethylometres et les techniques chimiques par voie s'eche recemment mises au point pour estimer la teneur totale en alcool du sang, de l'urine et de la salive, ainsi que leur utilisation en vue de determiner la contribution de I'alcool aux accidents (de la cir- culation et autres) et 'a la criminalite. * Les Centres collaborateurs de l'OMS devraient developper leurs activites de recherche et de forma- tion visant 'a prevenir et combattre les probl'emes lies 'a l'alcool. I1 faudrait rechercher un appui technique et financier aupres de sources nationales et intema- tionales pour faciliter la cooperation entre Centres collaborateurs travaillant ia reduire les problemes lies ia l'alcool. * Les Etats Membres devraient s'interesser tout spe- cialement ia l'elaboration de politiques et pro- grammes nationaux destines ia faire baisser la fre- quence de la conduite sous l'emprise de l'alcool. * I1 faudrait rechercher les occasions de collabora- tion entre les secteurs s'occupant de la sante, de l'application des lois, de l'education et de la protec- tion sociale, les fabricants de boissons alcoolisees, et les hoteliers, restaurateurs et cafetiers pour reduire les problemes de la consommation excessive d'alcool et son association avec la violence et la cri- minalite. * Les Etats Membres devraient faire le necessaire pour que les professionnels de la sante et autres acquierent les competences leur permettant d'identi- fier rapidement les buveurs ia probl'emes et les tech- niques d'intervention minimales. Ces mesures sont particulierement ia recommander pour des groupes speciaux de population, dont les jeunes, les femmes et les personnes agees, ainsi que dans des situations speciales (notamment au travail et sur la route), ou en rapport avec la delinquance. Prevention de la CeCiteb Le Groupe consultatif OMS sur la prevention de la cecite a tenu sa neuvieme reunion du 5 au 8 mars 1991 'a Banjul, 'a l'invitation du Gouvemement gam- bien. Outre les membres du Groupe, des represen- tants du PNUD et d'un certain nombre d'organisa- tions intemationales non gouvemementales ont participe a cette reunion. Ses principales conclusions et recommandations sont resumees ci-apres. Developpement des personnels * I1 faudrait creer dans la Region africaine un centre de formation aux soins ophtalmologiques commu- nautaires, et entreprendre le developpement de per- sonnels ophtalmologiques dans les pays africains lusophones, oiu ces agents sont rares a tous les niveaux. * Tous les programmes de formation en ophtalmolo- gie, et notamment les cours abreges de formation postuniversitaire, ne prevoient pas le developpement de competences chirurgicales, meme pour l'opera- tion de la cataracte; il conviendrait que dans tous les cours postuniversitaires d'ophtalmologie, les partici- pants qui n'ont pas dej"a re,u une formation chirurgi- cale aient la possibilite d'acquerir ces competences en suivant apres leur diplome un stage de chirurgie. I1 faudrait demander au Conseil international d'Ophtalmologie d'etudier la question, notamment en relation avec la pratique ophtalmologique dans les pays en developpement. Medicaments ophtalmologiques - Des techniques pour la preparation locale de petites quantites de collyres ont ete mises au point par la Christoffel Blindenmission, et l'on peut se procurer des directives officielles ainsi que du mate- riel d'instruction aupres du Programme OMS de pre- vention de la cecite (PBL). I1 est vivement recom- mande aux pays qui ont des difficultes 'a s'approvisionner regulierement en collyres d'envisa- ger de recourir a ce moyen, qui permet d'obtenir pour un prix de revient tres faible toute une serie de collyres d'usage courant. On pourrait ouvrir a cette fin des ateliers locaux dans les pharmacies des hopi- taux ou ailleurs, avec eventuellement l'appui d'orga- nisations non gouvernementales ou de 1'UNICEF. Carence en vitamine A - Malgre les rapports faisant etat d'une large couver- b D'apres: Rapport de la neuvieme r6union du Groupe consulta- tif de l'OMS sur la prevention de la cecit6, Banjul, 5-8 mars 1991. Document OMS non publie WHO/PBL/91.22. 140 WHO Bulletin OMS. Vol 70 1992 Notes et activit6s OMS battre la carence en vitamine A, il subsiste dans la plupart des pays en developpement des foyers oiu la cecite est un grand risque pour les enfants. II est donc imperatif, dans les pays en developpement, de mettre 'a la disposition des services, a tous les niveaux du systeme de sante communautaire, des stocks de capsules ou d'huile 'a forte teneur en vita- mine A. Les participants ont approuve l'initiative d'administrer un supplement de vitamine A (dose unique) au moment de la vaccination antirougeoleuse dans le cadre du Programme elargi de vaccination (PEV). Il faudrait encourager la poursuite de recherches sur d'autres schemas de supplementation. -II est necessaire d'amener les agents des services de sante infantile et les ophtalmologistes a prendre conscience de l'ampleur du probleme que pose la xerophtalmie, et des interventions possibles, en insis- tant particulierement sur la methodes dietetiques de lutte contre la carence en vitamine A. Ivermectine * Des progres ont ete enregistres concemant la dis- tribution a grande echelle d'ivermectine dans plu- sieurs pays d'endemie onchocerquienne, notamment dans la zone couverte par le Programme OMS de lutte contre l'onchocercose en Afrique de l'Ouest. II reste cependant encore a determiner les strategies optimales de distribution du medicament, et en parti- culier le role que peuvent jouer 'les organisations non gouvemementales. Malvoyance * L'OMS ne s'est pas encore attaquee a la question de la malvoyance; PBL devrait mettre pour commen- cer l'accent sur les besoins des enfants. II faudrait rassembler des donnees plus precises sur l'etendue du probleme, en prenant pour critere la vision fonc- tionnelle plutot que l'acuite visuelle, et en portant une attention particuliere a la determination de la vision de pres. * Il est necessaire de revoir et d'affiner une defini- tion communement acceptable de la malvoyance chez le nourrisson et l'enfant, en se basant sur la vision fonctionnelle. C'est un point qui pourrait etre 6tudie en consultation avec le Conseil intemational pour l'education des handicapes de la vue et la Federation intemationale des societes d'ophtalmolo- gie. Collecte de donnees * Il est important que les donnees concemant la ceci- te soient rassemblees d'une maniere qui en permette la standardisation et la comparabilite, non seulement dans l'optique de la banque mondiale de donnees mais aussi pour foumir une base realiste au develop- pement et 'a 1'evaluation des programmes locaux. * Une fiche d'examen ophtalmologique et un manuel d'instructions ont ete prepares par l'OMS, et il existe aussi un module logiciel d'analyse des donnees 'a uti- liser avec la fiche d'examen. Le Groupe a recom- mande 'a cet egard: - que les pays, groupes ou individus entreprenant des enquetes, 'a l'echelon national ou local, utili- sent cette fiche standard d'examen ophtalmolo- gique; - qu'un formulaire normalise soit mis au point pour la collecte specifique de donnees sur la cecite chez les enfants et ses causes. Evaluation de la lutte contre le trachome * Les informations recueillies ces trente demieres annees sur le probleme du trachome dans le monde sont succintes et episodiques. I1 faudrait proceder a un examen systematique des donnees dont on dispo- se; il faudrait aussi que PBL, en liaison avec des Centres collaborateurs interesses, prepare et adresse a differents pays un questionnaire sur la prevalence du trachome, sa gravite et les regions oui il est ende- mique, en meme temps que de nouveaux materiels pedagogiques sur un systeme simplifie de classifica- tion du trachome. Reseau mondial de surveillance de la sensibilite des gonocoques aux antimicrobiensc La blennorragie constitue dans le monde entier un probleme majeur, qui a d'importantes consequences sanitaires, sociales et economiques. En l'absence de mesures adequates, ses complications peuvent etre graves: infections genitales hautes aboutissant a la sterilite ou a une grossesse extra-uterine, infections neonatales entrainant la cecite. Les problemes les plus serieux se posent precisement dans les pays qui sont le moins en mesure d'y faire face; dans une grande partie du tiers monde, le traitement de la blennorragie absorbe a lui seul 5 a 10% de l'ensemble du budget des medicaments. Le probleme est complique par la capacite qu'a le gonocoque de devvelopper face aux antibiotiques une resistance a mediation plasmidique aussi bien que chromosomique. On ne possede pas sur cette resistance de donnees regionales completes et a jour, mais on sait tres bien qu'en de nombreux endroits des traitements relativement peu cou'teux, par la penicilline ou la tetracycline par exemple, ont large- c D'apres: Global surveillance network for gonococcal antimicro- bial susceptibility. Document OMS non publie WHONDT/90.452. 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