[From tropical medicine to medicine in the tropics--priorities in the control of transmissible diseases].

The major health problems of developing countries are still caused by communicable diseases. Along with the raise of the living standards and substantial urbanization processes in many parts of the third world, a shift towards chronic noncommunicable diseases of adults, which are costly to control, can be expected. Health priorities are not only determined by the biomedical view assessing morbidity and mortality patterns, but also by the ranking of perceived health problems, symptoms and signs by the population concerned. Incorporating these aspects greatly increases the acceptance of health interventions and can stimulate community involvement. The recent advances in the field of diagnosis, therapy, prophylaxis as well as in the implementation of primary health care imply the need to emphasize the operational aspects of intervention programmes such as diagnostic accuracy, compliance of providers and users and coverage. These elements are the crucial determinants of the community effectiveness of any technology and will provide the cornerstones for sustainability besides careful evaluation and monitoring of a health intervention.