Factores de risco associados á transmissão de diarreia em crianças dos 6 meses aos 7 anos no bairro do Xipamanine

As diarreias continuam a ser em Moçambique e em muitos paises em desenvolvimento um dos problemas de Saúde pública mais importantes. São doenças transmissiveis não preveniveis por vacina eque ocorrem com frequencia de forma isolada ou associada à malnutrição e malaria causando elevadas taxas de mortalidade nos países em desenvolvimento. Para cada caso foi escolhido um controle constituido por indivíduos do mesmo sexo e idade que o casos, e residentes na mesma area, sem historia de dejecções liquidas nos ultimos 60 dias anteriores á data de recolha de dados. A área de estudo foi o Bairro do Xipamanine. Motivou a escolha desta zona o facto de este bairro ter durante anos consecutivos registado o maior número de casos das diarreias ocorridas na Cidade de Maputo. De acordo com dados da Direcção de Saude da Cidade do Maputo, em 1996, por exemplo, registaram-se 34.095 casos de diarrea nesta zona, dos quais 25.406 (75%) em crianças do 0-14 anos

Prevalence of sexually transmitted infections in women attending antenatal care in Tete province, Mozambique

Objective. To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in pregnant women. Methods. A cross-sectional study was conducted among women attending antenatal care clinics (ANCs). Blood samples were tested for syphilis using the rapid plasma reagin (RPR) and treponemal haemagglutination (TPHA) tests; CT and NG were diagnosed using a manual polymerase chain reaction assay on first-void urine samples. A socio-demographic questionnaire was completed. Results were compared with previous published data on sexually transmitted infection (STI) prevalence in Mozambique. Results. Blood and urine samples were collected from 1119 and 835 women, respectively. The prevalence of CT was 4.1%, and that of NG 2.5%. The RPR test was positive in 5.2% of the women, and 7.1% had a positive TPHA test. Active syphilis was found in 4.7%. In univariate analysis, CT was associated with having had any level of education (p25. Multivariate analysis did not show any significant association. In comparison with published data from 1993, a decline was observed for CT (p<0.05), NG and syphilis (p<0.001). Conclusions. Compared with available data, a decline of STI prevalence was observed in our setting. This might be the result of community-based education programmes focusing on changes to sexual behaviour, as well as the widespread use of the syndromic approach to managing STIs and the expansion of syphilis screening in primary health care settings. However, STI rates are still high, and the problem needs more concrete and sustained efforts for its control

Role of Genital Infections on pregnancy outcome with emphasis on syphilis

OBJECTIVES: To elucidate the role of genital infections in last trimester pre-labour foetal death and the role and aetiology of chorioamnionitis in stillbirth in Maputo, Mozambique. To determine the role of current syphilis as a risk factor for foetal death in Maputo and the prevalence and risk factors for syphilis and HIV infection in displaced pregnant women in rural Zambezia province. To evaluate RPR predictive values in the diagnosis of syphilis during pregnancy. To evaluate an alternative screening approach among pregnant women. RESULTS: The frequency of histological chorioamnionitis was 1.4 times higher among cases compared to referents. Vasculitis was seen in 21% of the cases and 5% of the referents (OR=4.8%). Preterm birth was significantly higher among cases with chorioamnionitis compared with referents. Bacterial pathogens, particularly E.coli were recovered more frequently among cases with inflammation of the membranes or in the chorionic plate (OR=4.03 and OR=4.09). Seroreactivity in both RPR and MHA-TP occurred in 42% of cases and in 12% of controls (OR=5.3).In 32% of women with serological evidence of present or recently past syphilis (7 cases and 2 referents) placental morphological changes indicated syphilitic infection. The seroprevalence of syphilis and HIV among the displaced pregnant women was 12.2% and 2%. History of past STD, genital ulcers, vaginal discharge, genital warts and HIV infection were associated with TPHA seroreactivity; reported practice of anal sex , history of past STD and positive syphilis serology were correlated with HIV infection. Calculated RPR sensitivity, specificity and negative predictive value were 70.3%, 98.7% and 96.0%.The perinatal mortality rate was significantly higher in the control group than in the intervention group (p=0.03). CONCLUSION: Chorioamnionitis and preterm birth were strongly correlated with stillbirth. Recovery of any bacterial species from the placenta or the internal organs of stillborn was associated with stillbirth. E. coli was significantly associated with stillbirth and with chorioamnionitis among stillborns. In 12 stillborn and 3 newborn vasculitis was histologically detected, strongly supporting that infection took place when the foetus was alive. Syphilis seroprevalence was high among pregnant women, and syphilis is a risk factor for stillbirth in Maputo. Serological evidence of present or past syphilis was significantly associated with history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genital warts

Infertile Women in Developing Countries at Potentially High Risk of HIV Transmission

One hundred infertile women and 200 proven fertile women were recruited in Montepuez District, northern Mozambique, in order to elucidate the risk of syphilis and HIV seropositivity. TPHA seropositivity occurred in 55.0 per cent of infertile and 18.5 per cent of fertile women (OR 4.7; 95% CI 3.0-7.4). Among women with 2 lifetime spouses, 64.6 per cent of infertile women were TPHA seropositive, compared to 22.3 per cent of fertile women (OR 7.1; 95% CI 3.6-14.1). Three women (all infertile had HIV-1 antibodies and one, fertile, had HIV-2 antibodies. It concluded that infertile women constitute a group at potentially high risk of HIV infection once this infection is introduced into the community. (Afr J Reprod Health 1999; 3 (1): 98 - 102) Key Words: Infertility, syphilis, HIV infectio

Mycobacterium tuberculosis resistance to antituberculosis drugs in Mozambique,

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in Mozambique. METHODS: We analyzed secondary data from the National Tuberculosis Referral Laboratory, in the city of Maputo, Mozambique, and from the Beira Regional Tuberculosis Referral Laboratory, in the city of Beira, Mozambique. The data were based on culture-positive samples submitted to first-line drug susceptibility testing (DST) between January and December of 2011. We attempted to determine whether the frequency of DST positivity was associated with patient type or provenance. RESULTS: During the study period, 641 strains were isolated in culture and submitted to DST. We found that 374 (58.3%) were resistant to at least one antituberculosis drug and 280 (43.7%) were resistant to multiple antituberculosis drugs. Of the 280 multidrug-resistant tuberculosis cases, 184 (65.7%) were in previously treated patients, most of whom were from southern Mozambique. Two (0.71%) of the cases of multidrug-resistant tuberculosis were confirmed to be cases of extensively drug-resistant tuberculosis. Multidrug-resistant tuberculosis was most common in males, particularly those in the 21-40 year age bracket. CONCLUSIONS: M. tuberculosis resistance to antituberculosis drugs is high in Mozambique, especially in previously treated patients. The frequency of M. tuberculosis strains that were resistant to isoniazid, rifampin, and streptomycin in combination was found to be high, particularly in samples from previously treated patients

HIV-1 Genetic Diversity and Transmitted Drug Resistance in Health Care Settings in Maputo, Mozambique

Objectives: To characterize HIV-1 diversity and transmitted drug resistance in persons with access to care and treatment in Maputo, Mozambique. Methods: Samples were collected in 2002-2004 from 144 drugnaive patients attending public hospitals and private. - Fundacao para a Ciencia c Tecnologia, Portugal [PSIDA/ESP/49699]. - Supported by Fundacao para a Ciencia c Tecnologia, Portugal (project PSIDA/ESP/49699). I.B., C.R., and A.B.A. are Supported by PhD grants from Fundacao para a Ciencia e Teenologia

Bacterial vaginosis, alterations in vaginal flora and HIV genital shedding among HIV-1-infected women in Mozambique

Objectives. We investigated whether abnormal vaginal flora, including bacterial vaginosis (BV), are associated with detection of cervical HIV-1 RNA among HIV-infected women in Mozambique. Methods. We obtained clinical data and vaginal specimens from HIV-infected women registering for their first visit at one of two HIV care clinics in Mozambique. We compared women with detectable cervical HIV viral load (≥40 copies/ml) with women with undetectable cervical HIV. Results. We enrolled 106 women. Women with abnormal vaginal flora (intermediate Nugent scores, 4 - 6) were more likely to have detectable cervical HIV RNA then women with normal vaginal flora (adjusted odds ratio 7.2 (95% confidence interval 1.8 - 29.1), adjusted for CD4 count). Women with BV had a non-significantly higher likelihood of detectable cervical HIV than women with normal flora. Conclusions. Abnormal vaginal flora were significantly associated with cervical HIV expression. Further research is needed to confirm this relationship

Pathogenic enteric Escherichia coli in children with and without diarrhea in Maputo, Mozambique

A study was conducted on the circulation of potentially diarrheagenic Escherichia coli in two groups of children, both under the age of seven. The first group (548 children) suffered from mild diarrhea and attended the Xipamanine Health Center of Maputo, in Mozambique. The second group (380 children) included randomly chosen, asymptomatic, children from the same population. A total of 503 E coli strains were isolated from the two groups of children (n = 375 and 128, respectively). All E coli strains were genotypically and phenotypically screened. The presence of virulence-associated genes was assessed by a set of multiplex PCR specific for st and It genes of enterotoxic Escherichia coli (ETEC), eae and bfpA genes of enteropathogenic E. coli (EPEC), stx(1) and stx(2) of enterohemorrhagic E. coli (EHEC), ial of enteroinvasive E. coli (EIEC) and the species-specific gene uidA. Adhesion and citotoxicity of isolated E. coli were evaluated in vitro on different cell cultures. A total of 37 isolates harbored virulence-associated genes: 18 were classified as ETEC, (15 from symptomatic, and three from asymptomatic children), 16 as EPEC (respectively, 13 and 3) and three EIEC in the symptomatic group. No stx(1) or stx(2) genes, associated with enterohemorrhagic E coli were found. On the basis of the adhesion pattern on HeLa cells, 167 E coli were classified as diffusely adhering, (125 in patients and 42 in controls) and 67 as enteroaggregative, (50 and 17, respectively). To the best of our knowledge, this is the first report in the literature on the circulation of potentially diarrheagenic K coli in Mozambique. (C) 2004 Federation of European Microbiological Societies. Published by Elsevier B.V. All rights reserved