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Biomedical subjects

C Moreira

Publications and source records attributed to C Moreira.

At least 19 recordsLinked to original sources
PubMed2006

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal].

BACKGROUND: Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up. METHODS: We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities. RESULTS: Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second. CONCLUSIONS: The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

Acute Disease↗
PubMed2005

Mouse hepatitis virus 3 binding to macrophages correlates with resistance to experimental infection.

Mouse hepatitis virus 3 (MHV3) infection of A/J and BALB/c mice has been used as a model of resistance/susceptibility. A/J mice recover from a mild disease after 4-6 days of infection and the BALB/c mice develop an acute hepatitis and die after 3-4 days of infection. In view of studying the MHV3 binding to cells or cell extracts, we performed an enzyme-linked immunosorbent assay-like virus-binding assay, preparing microplates with L929 cells, A/J or BALB/c mouse macrophages and also with proteins extracted from these cells. Higher MHV3 bindings were observed to proteins of BALB/c macrophages than to the A/J ones. The interferon-gamma (IFN-gamma) activation led to a reduction of MHV3 binding only to proteins of resistant A/J mouse macrophages. Our experiments contribute to the hypothesis that IFN-gamma activation of macrophages plays an important role against MHV3 infection by downregulating the expression of viral receptors.

Animals↗
PubMed2004

Drawing-up of pesticide selectivity lists to beneficial arthropods for IPM programmes in potato.

In order to promote IPM programmes in potato, the toxicity of 19 fungicides, 4 herbicides and 11 insecticides commonly used in this crop in Belgium was assessed on three beneficial arthropods. These species were representative of the most important aphid specific natural enemies encountered in potatoes: a parasitic wasp--Aphidius rhopalosiphi (De Stefani-Perez) (Hym., Aphidiidae), a ladybird--Adalia bipunctata (L.) (Col., Coccinellidae) and a hoverfly--Episyrphus balteatus (Dipt., Syrphidae). In a first time, pesticides were tested on glass plates on A. rhopalosiphi adults and A. bipunctata and E. balteatus larvae. For each insect, products inducing corrected mortality (Mc) lower than 30% were directly classified in a positive list for harmless products (green list). The other compounds were further tested on plants and listed in toxicity classes according to mortalities induced during this extended laboratory test: harmless (Mc < 30%), slightly harmful (30% < Mc < 60%), moderately harmful (60% < Mc < 80%) and harmful (Mc > 80). A chemical determination of pesticides residues was also performed for each experiment in order to determine the exposure of beneficial arthropods to pesticide residues and to validate the application of chemicals on tested substrates. On the basis of the results of acute toxicity tests, the period of each pesticide use according to normal agricultural practices and the abundance and importance of the three different groups of aphid natural enemies at different periods of the year, four pesticides lists were built up. Each list corresponded to a different period of pesticides application: Period I--from seedling to beginning of June (based on A. rhopalosiphi tests), Period II--beginning to end of June (based on A. rhopalosiphi tests), Period III beginning to end of July (based on E. balteatus and A. bipunctata tests) and Period IV--August to harvest (no exposure of beneficials). Results showed that herbicides were not toxic to the three species and can be used according to normal agricultural practices without restrictions. All fungicides can also be used without restrictions at recommended rates. Only the mixture Metalaxyl-M + Fluazinam was slightly harmful to A. bipunctata but had no effects on A. rhopalosiphi and E. balteatus. Results were more contrasted for insecticides and none of them was totally selective for all the 3 beneficial arthropods. Therefore, they can only be used with restrictions at periods II and III, according to the beneficial species that need to be protected.

Animals↗
PubMed2003

[Epidemiology and prognosis of childhood cancers in Dakar, Senegal].

Childhood cancer has often been considered as a problem mainly affecting industrialized countries. In reality more than half of cases occur in developing countries where management and diagnosis are major issues. This retrospective study includes 130 children (0.3% of admissions) between the ages of 0 and 15 years hospitalized for malignant disease at the Principal Hospital in Dakar, Senegal between January 1, 1990 and December 31, 2000. Mean age was 97 months and M/F sex ratio was 1.2. Mean delay for admission was 3 months. The five most frequent cancers, accounting for 75% of cases, were leukemia (n = 28), lymphoma (n = 21), nephroblastoma (n = 21), retinoblastoma (n = 16) and osteochondrosarcoma (n = 10). Treatment was completed in 18% of cases. Half of patient were lost from follow-up. The cure rate was 10% overall and 50% for patients receiving complete treatment. The highest cure rate was achieved for nephroblastoma, i.e., 58% of cases treated. Management of childhood cancer in Africa is confronted with numerous problems, namely, paucity of specialized staff, absence of expert centers, shortage of anticancer drugs, lack of financial resources, and delay in treatment. These factors associated with frequent malnutrition and recurrent infectious diseases, greatly lower cure rates in comparison with industrialized countries.

Adolescent↗
PubMed2002

Interval breast cancers in New South Wales, Australia, and comparisons with trials and other mammographic screening programmes.

OBJECTIVE: To present information on 1st year interval breast cancer from the New South Wales mammographic screening programme and to compare with published results from trials and services. SETTING: New South Wales data were derived from a population based biennial mammographic screening programme, which achieved statewide coverage in 1995. Women aged 50-69 years screened during 1995-7 were included. METHODS: Bilateral two view mammography with reading by two radiologists is used for biennial screening examinations. Interval cancers were detected by the screening programme and by linkage with the statewide cancer registry. In situ carcinoma was excluded. Incidence of interval cancer was estimated as a proportion of the expected underlying incidence of breast cancer. Comparative data were derived from the published literature and meta-analyses were performed. RESULTS: Although randomised trials of screening have a proportional incidence by meta-analysis of 19% (95% confidence interval (95% CI) 12% to 25%), service studies yield a proportional incidence by meta-analysis of 27% (95% CI 25% to 30%), and more than half report proportional incidences greater than 25%. In the New South Wales mammographic screening programme the proportional incidence of interval breast cancer was 33% (95% CI 29% to 38%) for ages 50-59 years, 28% (95% CI 24% to 32%) for ages 60-69 years, and 31% (95% CI 28% to 34%) for ages 50-69 years combined. Proportional incidence in the New South Wales programme for ages 50-69 years was not significantly different from the rate for service studies by meta-analysis. CONCLUSIONS: Effectiveness of mammographic screening for reducing mortality from breast cancer needs to be examined relative to rates of interval cancer from actual service situations as trials may concentrate resources and expertise in ways which may be less replicable in routine delivery of the service.

Aged↗
PubMed2002

[Management problems of malignant hemopathies among children in Senegal].

Malignant hemopathies are not considered as public health priority in Senegal because of their infrequency in comparison with infections and malnutrition. However they remain usually lethal instead of a great improvement of their prognosis in suitable therapeutic conditions. The objective of this study was to determine the epidemiologic and evolutionnal profile of these pathologies, and identify practical management problems in a reference public pediatric service in Senegal. We retrospectively analysed hospitals registers and records of all patients followed up in Albert Royer Children Hospital of Dakar from january 1989 to december 1998. During this ten years period 25 cases of malignant hemopathies were diagnosed among 32,789 hospitalised children, representing an hospital prevalence of 0.08 per cent. Mean age at the desease diagnosis was 9.5 years and sex ratio 2.57 (18 boys and 7 girls). The malignant type was acute leukemia (AL) in 11 cases (44%) including 9 cases of of acute lymphoblastic leukemia (ALL) and 2 cases of acute myeloblastic leukemia (AML); chronic myeloid leukemia (CML) in 2 cases (8%), Hodgkin's desease (HD) in 9 cases (36%) and non hodgkinian lymphoma (NHL) in 3 cases. NHLwere Burkitt type in 2casesand lymphoblastic type in 1 case. Their was no maxillary or facial localisation in Burkitt type lymphoma. The mean duration between the first clinical symptomes and the diagnosis of the disease was 4 months and delayed diagnosis was mainly due to delayed transfer from peripheral health services to hospital. Among 19 patients whose records were available, 17 were subjected to chemotherapy. However reference protocols were completely applyed in only 2 cases, one with HD and an other with lymphoblastic lymphoma. Transfusion managementwas not sufficient because of the lack of blood derived products (packed platelets or leucocytes) when needed. Thirteen patients died while followed up and mean survival after first hospitalisation in these cases was 120 days in ALL, 38 days in AML, 2.5 years in HD and 18 months in NHL The other patients were lost of sight and presumed to be dead at home. Eventually, this study showed that, in our hospital, children with malignant hemopathies did not derive benefit of therapeutic progress enregistered long time ago in developed countries, since they remain constantly lethal. The main factors of lethality could be delayed transfer to hospital because of lack of knowledge about these pathologies in the peripheral health services and poor therapeutic conditions in reference hospitals. Creation of specialised clinical haematology department could enable us to improve the prognosis of these affections by an optimal use of available human and material ressources.

Adolescent↗
PubMed2001

School immunisation certificates--a review over time in a disadvantaged community.

OBJECTIVES: To compare proportions of kindergarten children in Auburn presenting School Immunisation Certificates (SIC) or other school-entry immunisation documentation over time, and to examine the immunisation status of these children. METHODS: Immunisation records of kindergarten children enrolled in all primary schools in the Auburn local government area were reviewed in 1994 and 1998. RESULTS: Eight hundred and thirty-three and 737 school entry records of children enrolled in kindergarten were reviewed in 1998 and 1994 respectively. There was no change in the overall proportion of children with immunisation documentation and SICs. Sixty-nine per cent (571/833) of children had SICs in 1998, compared with 72% (531/737) in 1994. Thirteen per cent of children had other immunisation documentation in 1998, compared with 11% in 1994. The proportion of invalid certificates fell from 39.2% in 1994 to 12.6% in 1998 (p<0.001). The 1998 survey indicated that 80.2% of children provided a certificate indicating they were completely immunised compared with 56.7% in 1994 (p<0.001). IMPLICATIONS: Although SICs play an important role in promoting the importance of immunisation among parents and in the school community, there continues to be a substantial number of children whose immunisation status is unknown. In the event of an outbreak, an effective public health response may need to incorporate the use of additional objective measures, such as the Australian Childhood Immunisation Register or personal health records.

Child, Preschool↗
PubMed2001

[A home nutritional rehabilitation trial for severly malnourished children].

A nutritional rehabilitation trial for severely malnourished children aged 6 to 36 months (weight/height index using Z-score of less than -3 as the reference mean) was conducted in the poor suburban areas of Dakar, Senegal. Its purpose was to determine the effectiveness of a rehabilitation programme delivered in the home as compared to one provided in a nutritional recovery center (CREN). Ninety-seven children benefited from rehabilitation at home and 51 at the CREN. At the end of two months of rehabilitation and after five months of charting their weight, the average weight gain was better in the group followed at home, but it still remained well under the 50 g/day recommended by WHO. Within the two groups, all of the children stayed underweight, with an average weight/height index Z-score of less than -2.5 in the group followed at home, and a Z-score of less than -2.9 in the other group. The dropouts and the death rates in the two groups were comparable. The presence and availability of the mother as well as health education sessions adapted to each specific case through interpersonal communication seem to be the elements favouring the most effective rehabilitation being in the home.

Adult↗
PubMed2001

[Hemolytic uremic syndrome: a complication of acute gastroenteritis in children].

Hemolytic uremic syndrome (HUS) is an nonexceptional complication of infectious gastroenteritis. No one has already been reported in Senegalese publications. We made a retrospective study of the record of 7 patients with HUS among 256 cases of children with bloody diarrhea presenting to the pediatric unit of Aristide Le Dantec between august 1998 and july 1999. The mean age of the children was 33,14+/-25 months and the weight was -2,29 DS. The diagnosis is supported by the findings of an acute renal failure with urea at 1,28+/-0,51g/ l and creatinine at 41,46+/-25,48mg/l. An hemolytic anemia was constant, the blood film revealed schizocytes. We found a thrombocytemia only in two cases. A hight white blood cell count (more than 50000/mm3) was noted in for cases. Only one child made a good recovery. We insist on preventing gastroenteritis and aggressive and adapted management of the HUS.

Acute Disease↗