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Organization and education in occupational safety and health in Maghreb countries.

The Maghreb consists of five countries of North Africa (Mauritania, Morocco, Algeria, Tunisia and Libya) which are members of a socio-economical community called the Union of Arab Maghreb. This paper discusses the organisation of occupational health, medical protection of workers and training in occupational safety and health in these countries. After a review of socio-economic and demographic data and legislative aspects, we report epidemiological and analytic data specific to each country concerning organisation and training in occupational health. Occupational medicine in Algeria, Morocco and Tunisia has progressed but some deficiencies are still observed at several levels. Like countries of the European Union, cooperation between the Maghreb countries in occupational health and safety seems indispensable.

Africa, Northern↗

Prediction of areas around the Mediterranean at risk of bluetongue by modelling the distribution of its vector using satellite imaging.

Bluetongue is an infectious disease of ruminants caused by a virus transmitted by biting midges, one species of which, Culicoides imicola, is the major vector in the Old World. Following an epizootic of African horse sickness,a related disease, in Iberia and Morocco between 1987 and 1991, C imicola was trapped for two years at 44 sites in the affected region and models were developed for predicting the abundance of C imicola at these sites. Discriminant analysis was applied to identify the best model of three levels of abundance from 40 Fourier-processed remotely sensed variables and a digital elevation model. The best model correctly predicted the abundance level at 41 of the 44 sites. The single most important variable was the phase of the annual cycle of the normalised difference vegetation index. The model was used to predict the abundances of C imicola elsewhere around the Mediterranean and predicted high levels of abundance in many areas recently affected by bluetongue, including the Balearics, Sardinia, Sicily, eastern Greece, western Turkey, Tunisia and northern Algeria. The model suggests that eastern Spain, the island of Ibiza, the provinces of Lazio and Puglia in Italy, the Peloponnese and parts of northern Algeria and Libya may be at risk of bluetongue in 2001.

Animals↗

[An Egyptian national survey on international labor migration (1974-1985)].

International labor migration from Europe is analyzed based on data from the Egyptian Emigration Survey of 1985. "In all, roughly 2 million Egyptians emigrated, as workers or their dependents, between 1974 and 1985, and 1.5 million were abroad at the time of the survey....Emigrants tend to be unaccompanied males (average age 32 years), probably because of tight controls on dependents and difficult living conditions in the receiving countries. The majority are nevertheless married....Both workers and their dependents are increasingly well educated. Destinations have changed over the decade: Libya and Jordan have declined in importance, following political and economic upheavals respectively, while Kuwait and Saudi Arabia are now taking larger numbers of Egyptian workers. Emigration to Iraq seems to be more modest than sometimes reckoned (500,000), and almost entirely made up of single males." The impact of emigration on Egypt is also considered. (SUMMARY IN ENG AND SPA)

Africa↗

African Charter on Human and Peoples' Rights.

This Convention contains provisions relating to women's rights, pay equity, health, education, the family, the aged, freedom of movement, and asylum. Algeria ratified the Convention on 20 March 1987, Benin on 25 February 1986, Botswana on 22 July 1986, Burkina Faso on 21 September 1984, Cape Verde on 6 August 1987, Central African Republic on 27 July 1986, Chad on 11 November 1986, Comoros on 18 July 1986, Egypt on 3 April 1984, Equatorial Guinea on 18 August 1986, Gabon on 26 June 1986, Guinea-Bissau on 6 March 1986, Libya on 26 March 1987, Sao Tome and Principe on 28 July 1986, Sierra Leone on 27 January 1984, Somalia on 20 March 1986, Sudan on 11 March 1986, Tanzania on 9 March 1984, Uganda on 27 May 1986, Zaire 28 July 1987, Zambia on 2 February 1984, and Zimbabwe on 12 June 1986.

Adult↗

Vaccine development: the biological weapon imperative.

The biological warfare capabilities of state and non-state actors continue to grow worldwide, both in sophistication and breadth. More than a dozen nations, including Iraq, Iran, Libya, Syria and North Korea, are either actively pursuing or possess biological weapons for use against their enemies. There is also a heightened awareness of the use of such agents by terrorist groups, a possibly deleterious side-effect of an increased awareness by the general public. This paper looks at the growing threat of the use of biological agents by both national programmes and non-state actors, the possible agents which might be considered for use, and the potential role that vaccine development may have in protecting both military and civilian populations against biological weapons attacks in the future.

Biological Warfare↗

Prevalence of hepatitis C virus antibodies among different populations of relative and attributable risk.

OBJECTIVES: To determine the prevalence of hepatitis C virus (HCV) antibodies among 5 different population groups including; healthy individuals, blood donors, hospital health care workers, renal dialysis patients and multiple blood transfusion group. To compare the ratios, relative and attributable risk among these groups. To outline a specific policy to reduce the potential risk of HCV among the different groups studied. METHODS: A prospective study was carried out in the Department of Microbiology, Faculty of Medicine, Tripoli, Libya, over a 2 year period for 1999 to 2001, to determine the prevalence of HCV-antibodies in sera collected from 5 distinct groups using enzyme-linked immunosorbent assay test. The groups included 800 healthy adults, 1200 individuals of blood donors, 459 hospital health care workers, 200 patients on renal dialysis and multiple blood transfusion group which included 250 patients. The prevalence of HCV was correlated with relative and attributable risk that contributed to the infectivity of HCV. RESULTS: A total of 2909 individuals participated in this study with 1.6:1 male to female ratio. The prevalence of HCV varied from one group to another. It was found to be 1.6% among the general population, 1.2% among blood donors, 2% among hospital health care workers, 20.5% among renal dialysis patients and 10.8% in the multiple blood transfusion group. The relative risk and attributable risk among these groups varies from 1.25 to 12.8 and from 0.4-18.9. CONCLUSIONS: This study underlines the prevalence of HCV among different groups. The prevalence varies from one group to another, being the lowest among the blood donors and general population and the highest among the higher risk group in particular the renal dialysis patients. Specific measures should be implemented to reduce such risks. These may include specific programs for medical education, a meticulous infection control system in the hospitals, a registry program and clinical follow-up for patients positive for HCV.

Female↗

A new host and locality records of the two trematodes Gymnotergestia chaetodipteri and Opechona sardinellae described by Nahhas and Cable in 1964, with review of the two genera.

The two trematode genera Gymnotergestia Nahhas and Cable, 1964 and Opechona Looss, 1907 were reviewed and discussed. Gymnotergestia chaetodipteri Nahhas and Cable, 1964 and Opechona sardinellae Nahhas and Cable, 1964 were redescribed from Serranus scriba and Labrus bergylata respectively from Libya. This represents a new host record and new locality. A comparison between the original description and the present work was presented.

Animals↗

Commodities consumed in Italy, Greece and other Mediterranean countries compared with Australia in 1960s and 1990s.

Consumption figures for 15 major commodities (cereals, wheat, rice, maize, potato, pulses, olive oil, other vegetable oils, vegetables, fruits, wine, meats, animal fats, milk + products, and fish + seafood) were collected from FAO Food Balance Sheets during the 1960s (1961-1969) and late 1990s (1995-1999). For some nutritionists the "model Mediterranean diet" is the Italian or Greek diet of the 1960s, for others the concept of Mediterranean countries is more general. Analysis shows: (1) In the 1960s, Australia consumed more meat, milk, animal fat than Italy or Greece and less cereals, wheat, pulses, olive oil, vegetables, fruits and wine. (2) In the 1960s, Australia's olive oil, vegetables, fruits and wine consumption were within the range for all 18 Mediterranean countries (i.e. Spain, France, Italy, Malta, Croatia, Bosnia, Albania, Greece, Cyprus, Turkey, Syria, Lebanon, Israel, Egypt, Libya, Tunisia, Algeria and Morocco). (3) In the 1990s, food consumptions have evolved; Australia's wine and milk consumption is now similar to Italy and Greece; consumption of wheat, olive oil, vegetables, fruits and fish are lower; consumption of potato, pulses, other vegetable oils and meat are higher than Italy or Greece. (4) Australia's consumption of the 15 commodities is within the range of all Mediterranean countries in the late 1990s, except wheat consumption was lower.

Australia↗

Serum electrolytes and osmolality in diabetes mellitus.

Fasting plasma glucose levels, serum osmolality and serum concentrations of sodium and potassium were determined in 73 Libyan diabetic patients attending the outpatient clinic of the Diabetes Hospital, Tripoli, Libya. The respective mean values were 234.8 +/- 9.7 mg.dl-1, 288.5 +/- 2 m0sm.L-1, 134.7 +/- 0.8 mEq.L-1 and 4.2 +/- 0.07 mEq.L-1. Statistically significant correlations were present between fasting plasma glucose and serum osmolality as well as the concentrations of serum sodium and potassium. There is is an increase in osmolality and levels of sodium and potassium concentration with an increase in plasma glucose concentration.

Blood Glucose↗

[Program fo the eradication of Cochliomyia hominivorax in Northern Africa].

The New World Screwworm (NWS, Cochliomyia hominivorax) is an obligate parasite of warm-blooded animals. The female lays up to 300 eggs in any break in the skin, and the resulting larvae (screwworms) burrow into surrounding living flesh. Infested animals frequently die, while the annual cost of controlling the pest in domestic animals is about US $10 per head. NWS is endemic in tropical Latin America. In 1988, it was detected in Libya, presumable introduced with imported sheep. By 1990, the infestation had spread to an area of 25,000 km2 containing some 2 million livestock. In early 1991, an internationally funded eradication programme was undertaken by FAO, using sterile insects. Each week, 40 million pupae were flown from a production plant in Mexico, and the emerged adults were distributed by over the infested area. Within a few months, the infestation has been eradicated. Whereas 12,000 infested animals were found in 1990, only 6 were detected in 1991. The programme involved the shipping and distribution of 1.3 billion sterile insects, animal inspections totalling 40 million and laboratory examination of 280,000 trapped flies. While the programme cost close to US $75 million, a benefit/cost ration of 50:1 has been estimated.

Africa, Northern↗

Minimal Y-chromosome haplotypes plus DYS287 in Jewish populations.

POPULATION: A total of 71 Jewish individuals obtained from the collection of The National Laboratory for the Genetics of Israeli Populations at Tel-Aviv University: 14 Ashkenazi, 21 Sephardic (from Turkey), 23 North African (from Morocco, Libya and Tunicia) and 13 Oriental (from Iraq and Iran).

Chromosomes, Human, Y↗

HIV transmission during paediatric health care in sub-Saharan Africa--risks and evidence.

Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV-infected children, but also to prevent transmission of HIV to other children and health care workers through contaminated medical procedures and needlestick accidents. HIV-infected children aged to 1 year typically have high viral loads, making them dangerous reservoirs for iatrogenic transmission. Most vertically infected children experience HIV-related symptoms early, though many survive beyond 5 years. This leads to high HIV prevalence among inpatient and outpatient children. In nine African studies, HIV prevalence in inpatient children ranged from 8.2% to 63%, roughly 1-3 times the prevalence in antenatal women. Investigations of large iatrogenic outbreaks in Russia, Romania, and Libya demonstrate efficient HIV transmission through paediatric health care. Unexplained HIV infections in African children are not rare-studies published through 2003 have recorded more than 300 HIV-infected children with HIV-negative mothers. In addition, several studies have reported much higher HIV prevalence in children 5-14 years old than could be expected from mother-to-child transmission alone. Research is required to determine the extent of iatrogenic HIV infection among African children as well as to identify high-risk procedures and settings. Such research can motivate and direct prevention efforts.

Adolescent↗

The pattern of renal vessels in live related potential donors pool. A multislice computed tomography angiography review.

OBJECTIVE: To assess the renal vessel anatomy, compare the findings with the perioperative findings, to determine the sensitivity of multislice computed tomography (CT) angiography in the work-up of live potential donors and to discuss and compare the results of the present study with the reported results using single slice CT, magnetic resonance (MRI) and conventional angiography (CA). METHODS: Retrospective analysis of the angiographic data of 118 of prospective live related kidney donors was carried out from October 2004 to August 2005 at the National Organ Transplant Centre, Tripoli Central Hospital, Libya. All donors underwent renal angiography on multislice (16-slice) CT scan using 80 cc intravenous contrast with 1.25 mm slice thickness followed by maximum intensity projection (MIP) and volume rendering techniques (VRT) post-processing algorithms. The number of vessels, vessel bifurcation, vessel morphology and venous anatomy were analyzed and the findings were compared with the surgical findings. RESULTS: Multislice spiral CT angiography (MSCTA) showed clear delineation of the main renal arteries in all donors with detailed vessel morphology. The study revealed 100% sensitivity in detection of accessory renal vessels, with an overall incidence of 26.7%, which is the most common distribution in the parahilar region. CONCLUSION: The present study showed 100% sensitivity in the visualization and detection of main and accessory renal vessels. These results were comparable with conventional angiography which has so far been considered as the gold standard and were found superior in specificity and accuracy to the use of single slice CT (SSCT) and MR in the angiographic work-up of live renal donors. Due to improved detection of accessory vessels less than 2 mm in diameter, a higher incidence of aberrant vessels was seen on the right side as has been suggested so far.

Adult↗

Omentoplasty or tube drainage for the management of the residual cavity following the removal of an hepatic hydatid cyst.

We have reviewed a series of 124 consecutive cases of hepatic hydatid cysts in 102 patients treated surgically in Benghazi, Libya, over a period of five years. Overall mortality was 3.9%. The rate of post-operative complications was 37.5%. Cysts already complicated with infection, intrabiliary communication or intra-peritoneal rupture accounted for 30.6% of the cases. They were all treated by means of removing the endocyst and external tube drainage of the residual cavity. In this subgroup, the post-operative complications' rate was 89%. In the 74 uncomplicated cysts, removal of the parasite was followed by omentoplasty in 25 cases and external tube drainage in 49 cases. Postoperative complications occurred in 16% of the omentoplasty group and 8.2% of the drainage group. It is concluded that omentoplasty for the obliteration of the residual cavity may be used in uninfected and relatively inaccessible cysts. In the majority of cases, however, external tube drainage retains its value as a simple and safe procedure.

Adolescent↗

[Clinical and laboratory aspects of 2 cases of cutaneous leishmaniasis].

Two cases of cutaneous leishmaniasis in a mother and her son, contracted during a trip in Libya, are reported. The diagnosis was established on the basis of the clinical aspect and epidemiological data, and confirmed by laboratory tests. A specific treatment with Fuadin was applied.

Adult↗

[Imbalance of distribution of physicians in the Arab world].

The Arab world, as a whole, now has 8.5 medical doctors per 10,000 population. This average covers a great diversity of national situations; for example 0.6 doctors per 10,000 population in Somalia, and 17.5 doctors per 10,000 population in Qatar. From the viewpoint of medical staffing, the Arab countries can be grouped into four categories: (i) Countries with low medical density: their national staff is scarce, they do not have a long academic tradition, and they have to rely on foreign physicians (Yemen, Djibouti, Somalia, Mauritania). (ii) Countries with acceptable medical density: they have strengthened their medical training system during the last decades, their production of medical graduates is now fairly high, and there is seemingly a threat of oversupply (Algeria, Tunisia, Syria, Iraq). (iii) Countries with relatively high medical density: their medical staffing is below that of developed countries, but their economic possibilities are reduced, which leads to an oversupply; these countries are exporters of medical manpower (Egypt, Jordan). (iv) Countries that import medical manpower although their own medical density is quite high: their medical training is recent or non-existent and their health system relies to a great extent on foreign doctors (Saudi Arabia, Bahrain, Qatar, United Arab Emirates, Libya, Kuwait). They are all oil producers. In brief, a shortage and an oversupply of medical doctors coexist in the Arab world, and concerted action is required.

Africa, Northern↗

[Hysterectomy in obstetrics. Analysis and comparison of a group of cases from the Italian and the international literature (536 cases)].

The Authors made a comparison between the frequency of obstetric hysterectomies carried out at the "La Sapienza" University Obstetrics and Gynaecology Departments and of those reported in international publications regarding Great Britain, USA, Australia, Saudi Arabia and Libya. Data obtained covered the 462 hysterectomies effected out of the 442,174 births from 1972 to 1895. Results were compared as under: general frequency per number of births, reasons for surgery, type of operation carried out, age of the patient, gestation period, obstetrical history and complications.

Adolescent↗

Common bile duct exploration in a Libyan hospital. Utilization of choledochoscopy in an effort to improve results.

Over a three-year period, 849 patients had a cholecystectomy for gallstones, at the Central Hospital, Tripoli, Libya. In 133 patients the common bile duct was explored. Under the particular circumstances in which the operation is performed, choledochoscopy was shown to have important advantages to the patient in both locating common duct stones and in ensuring that none is left behind.

Adult↗