For the purposes of this article the Caribbean region is considered as: all the islands in the Caribbean Sea and those adjoining mainland areas which are politically, historically and culturally associated with the islands (i.e. Belize and the Guyanas). This partly artificial division excludes two continental latin-american countries, Brazil and Venezuela, with endemic schistosomiasis. The Caribbean region, as defined above, includes several hundred islands divided among more than 20 governing units. The region has a complex political and cultural history which has resulted in intra-regional heterogeneity of ethnic origins and cultural alliances. This heterogeneity extends to economic and demographic variation between countries: the Gross National Product in 1979 ranged from more than US $5000 to less than US $250 per capita; the population of some countries is less than 10 5 whilst in others it approaches 10 7 ; the national population density ranges from 07 to 557 persons/km 2 (Table 1). Standards of sanitation, domestic water supplies and health delivery services reflect this heterogeneity in socioeconomic development.