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J Cliff

Publications and source records attributed to J Cliff.

At least 19 recordsLinked to original sources
PubMed1998

Cyanogenic potential of cassava flour: field trial in Mozambique of a simple kit.

The cyanogenic potential (ppm HCN equivalents) of 80 samples of cassava flour (obtained from the Mujocojo and Terrene-A areas of Nampula Province and the markets of Nampula City in Mozambique) were determined using a new simple kit, based on the use of picric acid paper (Egan et al., 1997). The kit is compact, requires only a small amount of water and is very simple to use in the field. Comparison with the results of a semi-quantitative method shows a mean deviation between the two methods of 20% (SD 12%). All samples fitted a single population distribution with a mean value of 45 ppm HCN equivalents (SD 37). Two maxima were observed in the distribution curve at 11-20 and 41-50 ppm. Five samples exceeded 100 ppm with two values of 200 ppm. The WHO safe level for cyanogens in cassava flour is 10 ppm. The lowest levels (2 and 6 ppm) were obtained from cassava flour prepared from sweet cassava. Over 76 samples the mean value of the cyanogenic potential of cassava flour produced by heap fermentation is only one half as large as that produced by sun-drying (P < 0.005). Interventions needed to reduce cyanogen levels are (1) improvements in processing methods, such as replacement of sun-drying by heap fermentation, (2) introduction of additional vegetables, pulses and fruit to alleviate the monotonous cassava diet of the people and (3) introduction of high-yielding, disease-resistant, low-cyanide cultivars.

Cyanides↗
PubMed1997

Konzo associated with war in Mozambique.

We report an epidemic of konzo, symmetric spastic paraparesis associated with cassava consumption and cyanide exposure: 384 patients were treated in rehabilitation centres; the prevalence rate in a badly affected area was 30/1000. Most patients were children over 3 and women. Owing to war, communities turned to bitter cassava as their staple and took shortcuts in its processing. When the war ended, they continued to depend on inadequately processed bitter cassava. The epidemic lasted 2 years (the last year of war and the first of peace) with peaks each year during the cassava harvest. Although most cases were reported from rural inland areas, patients also came from small towns and the coast. School children had raised urinary thiocyanate and linamarin and low inorganic sulphate concentrations. Urinary thiocyanate values were lower than those previously reported in konzo epidemics, probably because we collected specimens before the cassava harvest and epidemic peak. The necessary conditions for konzo were present: intensive cultivation of bitter casava, insufficient processing, a probable high cyanide intake, and a low intake of protein-rich foods.

Adolescent↗
PubMed1997

CD40: a pivotal receptor in the determination of life/death decisions in B lymphocytes.

CD40 is a 48 kDa glycoprotein predominantly expressed on B cells in both mouse and man, which interacts with a counterligand (CD40L), expressed on activated CD4+ T cells. CD40/CD40L interactions are now known to be essential for the initiation of antibody responses to T-dependent antigens. In this review we discuss the immunobiology of CD40, with a special emphasis on our own studies in the mouse. These have focused on signal transduction via CD40, the role of cytokines (both T cell-derived and B cell-derived) in CD40-mediated B cell activation, and the role of CD40 in protecting B cells from apoptotic cell death. The available data indicate clearly that this protein is a pivotal receptor on B cells, both for the delivery of activating signals and for promoting B cell survival.

Agammaglobulinaemia Tyrosine Kinase↗
PubMed1995

Changing patterns in pediatric mortality, Maputo Central Hospital, Mozambique, 1980-1990.

OBJECTIVES: To present an analysis of the Department of Paediatrics' statistics on hospital mortality, covering the period through 1980-1990. METHODS: Basic information was recollected from logbooks of the Department's wards. Descriptive statistics are estimated on death and its main causes. The proportion of deaths in relation to total admissions and in relation to global in-hospital mortality are computed and their changes over time documented. RESULTS: The data show an important decrease of in-hospital global mortality in spite of the increase of the number of admissions over time. The pattern of the main causes of death changed, and the authors postulate that the change is attributed to a dramatic change in the epidemiological pattern of childhood morbidity in Maputo City, especially due to measles vaccination. In parallel, the study suggests an increase in the prevalence of severe malnutrition. CONCLUSIONS: Hospital statistics, while dependent on socio-economic conditions, can be significantly changed by Public Health interventions. Monitoring and analysing hospital statistics is important for documenting epidemiological changes, and also to suggest community interventions. From that point of view, epidemiological surveillance and hospital statistics are complementary.

Child↗
PubMed1994

Measles control in Maputo, Mozambique, using a single dose of Schwarz vaccine at age 9 months.

In Maputo city, immunization is available at government health facilities, all contacts being used to vaccinate children. Door-to-door mobilization is conducted to identify eligible children and refer them for immunization. Card-documented measles vaccine coverage, estimated by community surveys, rose from 48% in 1982 to 86% in 1986 and 92% in 1992. The median age at measles vaccination was 10.2 months in 1986 and 9.2 months in 1992. The reported measles incidence rates per 100,000 population fell by 92% from 569 in 1977-78 (pre-vaccination) to 44 in 1990-92, and the reported inpatient measles mortality fell from 19.8 to 0.7 per 100,000. Among children whose age at measles onset was known, the proportion of reported measles cases in children under 9 months of age fell from 2162 (20.3% of 10,636 cases) in 1982-85 to 1695 (17.8% of 9501 cases) in 1986-92. The proportion of cases in children aged > or = 5 years increased from 15.2% to 32.8% in the corresponding periods. The global goals for measles control can be achieved by a single dose of Schwarz vaccine at 9 months of age.

Child, Preschool↗
PubMed1993

The impact of war on children's health in Mozambique.

Since 1982, South African destabilization of Mozambique has caused children's health to deteriorate. Destabilization has functioned through support of a surrogate movement and economic pressure. Attacks on economic and civilian targets have included the health services, leading to closure of 48% of the primary health care network. The war has caused displacement of over 3,000,000 persons and an estimated 494,000 excess childhood deaths between 1981 and 1988. An estimated 200,000 children have been separated from their families or orphaned; many children have also witnessed atrocities and suffered violence. A deepening economic crisis has been followed by an economic structural adjustment programme. Responses to the war include changes in vaccination strategy and programmes to reunite families and heal psychological trauma.

Child↗
PubMed1990

The use of evaluation to improve the Expanded Programme on Immunization in Mozambique.

Reported are the results of an evaluation of process indicators and outputs for the Expanded Programme on Immunization (EPI) in Mozambique which were used to modify immunization strategies from 1985 to 1987. In 1986 according to cluster sample surveys, 84% of children in Maputo, the capital, were fully vaccinated. In other cities in the country, vaccination coverage increased from an average of 36% in 1985 to 55% in 1987. The major determinants of low vaccination coverage were provision of vaccination services at health centres on less than 3 days per week; missed opportunities; and vaccinating too early or with too short an interval between doses. The results of sentinel site surveillance in Maputo indicated that EPI had a marked impact on neonatal tetanus and to a lesser extent on poliomyelitis and measles. Evaluation led to changes in EPI policy in Mozambique (e.g., adoption of a uniform national vaccination schedule and discontinuation of the use of expired vaccine) and strategies (elaboration of different strategies for urban areas, rural areas, and displaced people). Also, performance was improved by involving programme managers and implementors in evaluation, and by providing timely and widespread feedback of results to policy-makers, peripheral health workers, and the community.

Child↗
PubMed1990

Surveillance of urinary thiocyanate concentration after epidemic spastic paraparesis in Mozambique.

A large epidemic of spastic paraparesis in Mozambique during a drought was attributed to cyanide exposure from cassava. Active surveillance in one of the villages most affected by the epidemic detected four new cases in the first year after the epidemic, and none in the second year. In apparently healthy schoolchildren in the same village, surveillance of urinary thiocyanate concentration, an indicator of cyanide exposure, showed high peak values of 1175 and 673 mumols l-1 in succeeding years, with a gradual return to near-normal values in the third year. A marked seasonal variation in thiocyanate concentration was present, with the highest value coinciding with the dry season, the period of the epidemic, and the cassava harvest. Lower values were found in the neighbouring unaffected semi-urban centre. As cassava cultivation increases in many drought-affected countries, we recommend monitoring urinary thiocyanate concentration to estimate cyanide exposure and identify populations at risk for spastic paraparesis epidemics.

Child↗
PubMed1988

Health as a target: South Africa's destabilization of Mozambique.

Since 1982 attacks on the health services have been an integral part of South African destabilization of Mozambique. After independence in 1975, Mozambique began successfully to implement a primary health care policy. By attacking primary health care units, kidnapping and killing health workers and destroying transport, a South African supported rebel movement has attempted to undermine this policy. The combined effects of the negative economic consequences of the war, the forced displacement of over a million people and the destruction and disruption of health services have worsened the health of the Mozambican people. Preventive programmes have been severely disrupted. Effects on health include an increase in mortality rates, famine and infectious disease epidemics. Similarities exist between this war and the low intensity conflict in Nicaragua. Given the intensity of the onslaught, the primary health care system has proved remarkably resistant to destruction.

Black People↗
PubMed1988

Evaluating the management of diarrhoea in health centres in Mozambique.

An evaluation of the health centre management of paediatric cases of diarrhoea, comprising observation of the consultation, interview of the guardian immediately afterwards and home follow-up was performed in one rural and three urban areas of Mozambique. Oral Rehydration Therapy was advised for 83% of patients, of whom 71% received ORS packets. Eighty-seven per cent of mothers followed up stated that they had given ORT, but only 37% had a solution present at the time of interview. The main weakness in case management was the lack of health education, especially about the quantity of fluid to give, which was reflected in the mothers' belief that ORT is a medicine to 'stop the diarrhoea' and their consequent administration of it like a syrup, one teaspoonful three times a day. The results of the evaluation have facilitated the design of more appropriate health education and health worker training materials and methods.

Child, Preschool↗
PubMed1986

Thyroid function in a cassava-eating population affected by epidemic spastic paraparesis.

Thyroid function was studied in a rural population in Mozambique that had been affected by an epidemic of spastic paraparesis attributed to dietary cyanide exposure from cassava. Laboratory investigation on a sample of this population demonstrated very high levels of serum and urinary thiocyanate, indicating a heavy exposure to cyanide. The urinary excretion of iodine was within normal limits, indicating an adequate intake of iodine. The serum levels of FT4I were somewhat decreased and serum FT3I, T3/T4 ratio and TSH were somewhat raised. This hormone pattern suggests an adaptation to the antithyroid effect of thiocyanate, but not overt hypothyroidism. A follow-up study on school children was performed, and it also demonstrated high thiocyanate exposure, adequate intake of iodine, and absence of endemic goitre. The results show that if iodine supply is adequate, the thyroid gland is capable of adaptation to a heavy body burden of thiocyanate without development of overt hypothyroidism or goitre.

Adolescent↗
PubMed1985

Association of high cyanide and low sulphur intake in cassava-induced spastic paraparesis.

Urinary excretion of sulphur compounds was studied in children from a population in Mozambique that had been affected, during a drought, by an epidemic of spastic paraparesis attributed to cyanide exposure from cassava. The children had increased thiocyanate and decreased inorganic sulphate excretion, indicating high cyanide and low sulphur-containing amino-acid intake. Children from a neighbouring cassava-eating area, where no cases of spastic paraparesis had occurred, had lower thiocyanate excretion but higher inorganic sulphate excretion. These results support the hypothesis that the epidemic was due to the combined effects of high dietary cyanide exposure and sulphur deficiency.

Child↗