Assessment of viral and bacterial contamination of fresh and ripened semi-hard cheeses.

This study aimed to evaluate viral and bacterial contamination from typical Brazilian cheeses, such as Minas (fresh) and Prato (ripened), commercially obtained in the Greater Metropolitan Region of the State of Rio de Janeiro, Brazil. Minas [30], Prato [30] and sliced Prato [30] cheese samples were investigated for norovirus genogroup I and II (NoV GI-II) and human adenovirus (HAdV) by direct nucleic acid extraction using TRIzol and amplification by TaqMan based quantitative polymerase chain reaction. Listeria monocytogenes, Salmonella spp., coagulase-positive staphylococci (CPS) and fecal coliforms were also assessed by using standard counting methods. NoV GI and GII were detected in one sample (1.1%) each and HAdV in nine samples (10.0%) while bacteriological analysis revealed five samples (5.5%) contaminated with L. monocytogenes, 27 (30.0%) with fecal coliforms and 10 (11.1%) with CPS. Salmonella spp. was not detected in any sample. Viruses were detected in 11 samples (12.2%), of which 9 met the microbiological criteria used to evaluate the microbiological quality of the cheeses, stressing the importance of considering virological parameters for monitoring this food matrix.

Quality assurance of a diarrhoea control programme in northeastern Brazil.

In this study quality assurance methods were used in an evaluation of a programme for Control of Diarrhoeal Diseases (CDD) in northeastern Brazil. Seventy-eight randomly selected public primary care facilities in four states were assessed by trained surveyors. Problems observed in the facilities were lack of information on target population and coverage, lack of equipment to permit rehydration in the premises, and frequent unavailability of trained professionals. Health workers showed deficiencies in history taking, physical examination and knowledge on diarrhoea management. Many caretakers had difficulties in recalling information given to them in the health facilities. Eighty-four percent of the cases were treated with oral rehydration, but 90% were sent home immediately and not kept in the facilities to practice rehydration under guidance as recommended by the national CDD programme. An overuse of the medical treatment was observed. More than two-thirds of health professionals gave wrong indications for use of antibiotics. The study showed that oral rehydration therapy is well established in the government health services in the region but that the CDD programme needs to take early action to correct deficiencies in logistics, case management and health education.

PIP: The 9 states in the northeast of Brazil were divided into 4 groups based on population size and geographical distribution. In the capital cities of each state, 5-8 health units treating children with diarrhea were chosen at random. Overall, 78 health care units were studied. University-trained nurses evaluated each health care unit regarding diarrhea management and conducted interviews using questionnaires for the data collection. The survey team was split into groups of 4, each group covering 1 state. The field-work was carried out in May 1989 and took 4-6 weeks to complete. 88% of facilities surveyed were health centers, while the rest were outpatient departments in hospitals. In 40% of the facilities, the number of monthly consultations of children was known, while only 22% had information on the number of children attending for diarrhea each month. 62% of facilities had a special oral rehydration therapy (ORT) place for children. Utensils for administration of ORT were available in only half of the facilities. In 1/5 of the facilities the sugar-salt-solution packets were never or seldom available. In 32 of 65 facilities, the most recent shipment of ORS packets had arrived in the last month. 10 facilities had not received ORS for more than 6 months. In 67 facilities (86%) a physician, and in 9 a health auxiliary, was responsible for managing childhood diarrhea. 75 visits for childhood diarrhea were observed in 42 health facilities. 58 of the attendances (77%) were managed by doctors, 12 by health auxiliaries, and 5 by nurses. 90% of the patients were sent home, while the rest were treated. In 84% of cases oral rehydration therapy was prescribed, usually oral rehydration salts (ORS). Antimicrobial drugs were prescribed in 21% of the cases. Other drugs like metochlopramide, caolin-pectin, aspirin and vitamins were prescribed in 41% of the cases.

Management of childhood diarrhoea at the household level: a population-based survey in north-east Brazil.

The management of childhood diarrhoea at the household level was studied in a population-based survey in four states in north-east Brazil. Of a representative sample of 6524 children under 5 years of age, 982 (15.1%) had diarrhoea on the day of the interview or had had diarrhoea at some time during the previous 15 days. A total of 66% of the children were not taken for treatment, while government health services were used by 14%, private doctors by 1%, and traditional healers (rezadeiras) by 24%. Oral rehydration therapy was given to 24.3% of the children as follows: solutions of oral rehydration salts (ORS) were received by 6.8%, salt-and-sugar solutions by 14.7%, and solutions of commercial ORS brands by 4.3%. Although 95% of the caretakers knew about rehydration solutions, only 18% prepared them correctly, the most common error being the use of insufficient water. Of the rehydration solutions used, 39% had a sodium concentration that was potentially dangerous (greater than 120 mmol/l), and 8% had a sodium concentration that was very low. Of those solutions prepared using ORS, 38% had too high a sodium concentration, while 14% of the salt-and-sugar solutions prepared using either the "scoop-and-pinch" approach or a plastic spoon were too concentrated. However, potentially the most dangerous were the salt-and-sugar solutions prepared using nonstandard recipes. More than half of these had an unacceptably high sodium concentration or osmolarity.