187 research outputs found
Low frequency of enterohemorrhagic, enteroinvasive and diffusely adherent Escherichia coli in children under 5 years in rural Mozambique: a case-control study
BACKGROUND NlmCategory: BACKGROUND content:
Diarrheagenic Escherichia coli (DEC) are among the leading
pathogens associated with endemic diarrhea in low income
countries. Yet, few epidemiological studies have focused the
contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive
E. coli (EIEC) and diffusely adherent E. coli (DAEC). - Label:
METHODS NlmCategory: METHODS content: "We assessed the
contribution of EHEC, EIEC and DAEC isolated from stool samples
from a case-control study conducted in children aged
<\xE2\x80\x895\xE2\x80\x89years in Southern Mozambique
between December 2007 and November 2012. The isolates were
screened by conventional PCR targeting stx1 and stx2 (EHEC), ial
and ipaH (EIEC), and daaE (DAEC) genes." - Label: RESULTS
NlmCategory: RESULTS content: "We analyzed 297 samples from
cases with less-severe diarrhea (LSD) matched to 297 controls,
and 89 samples from cases with moderate-to-severe diarrhea (MSD)
matched to 222 controls, collected between November 3, 2011 and
November 2, 2012. DEC were more common among LSD cases (2.7%,
[8/297] of cases vs. 1.3% [4/297] of controls;
p\xC2\xA0=\xE2\x80\x890.243]) than in MSD cases (0%, [0/89] of
cases vs. 0.4%, [1/222]\xC2\xA0of controls;
p\xC2\xA0=\xE2\x80\x891.000). Detailed analysis revealed low
frequency of EHEC, DAEC or EIEC and no association with diarrhea
in all age strata. Although the low frequency, EIEC was
predominant in LSD cases aged 24-59\xE2\x80\x89months (4.1% for
cases vs. 0% for controls), followed by DAEC in similar
frequency for cases and controls in infants (1.9%) and lastly
EHEC from one control. Analysis of a subset of samples from
previous period (December 10, 2007 and October 31, 2011) showed
high frequency of DEC in controls compared to MSD cases (16.2%,
[25/154] vs. 11.9%, [14/118], p\xC2\xA0=\xE2\x80\x890.383,
respectively). Among these, DAEC predominated, being detected in
7.7% of cases vs. 17.6% of controls aged
24-59\xE2\x80\x89months, followed by EIEC in 7.7% of cases vs.
5.9% of controls for the same age category, although no
association was observed. EHEC was detected in one sample from
cases and two from controls." - Label: CONCLUSIONS NlmCategory:
CONCLUSIONS content: Our data suggests that although EHEC, DAEC
and EIEC are less frequent in endemic diarrhea in rural
Mozambique, attention should be given to their transmission
dynamics (e.g. the role on sporadic or epidemic diarrhea)
considering that the role of asymptomatic individuals as source
of dissemination remains unknown
Hypoxaemia in Mozambican children < 5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models
OBJECTIVE: To determine the prevalence of hypoxaemia among
under-five children admitted to hospital with clinical severe
pneumonia, and to assess the performance to diagnose hypoxaemia
of models based on clinical signs. METHODS: We conducted a
hospital-based survey in a district hospital from Southern
Mozambique. RESULTS: A total of 825 children were recruited
after obtaining an informed consent. The prevalence of
hypoxaemia on admission was 27.9%, and 19.8% of these children
died (OR compared to non-hypoxaemic children 3.22, 95%CI 1.98 -
5.21, p<0.001). The model with larger area under the ROC
curve (AUC-ROC) to predict hypoxaemia included cyanosis or
thoracoabdominal breathing or respiratory rate >/= 70 breaths
per minute. None of the models performed well when tested in
different case scenarios of oxygen availability through
mathematical modelling, with over 50% of hypoxaemic children not
receiving oxygen even in favourable case scenarios. CONCLUSIONS:
Clinical signs alone or in combination are not suitable to
diagnose hypoxaemia. The use of pulse oximeters should be
strongly encouraged. This article is protected by copyright. All
rights reserved
Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique.
There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique
Antibiotic resistance and molecular characterization of Shigella isolates recovered from children less than 5 years in Manhiça, Southern Mozambique
The objective of this study was to assess antibiotic resistance and the molecular epidemiology of shigella isolates from a case-control study of diarrhoea, conducted from 2007 to 2012 in children aged less than 5 years in Manhiça district, southern Mozambique. All isolates were tested for antimicrobial susceptibility using the disc diffusion method. Polymerase chain reaction was used to detect different molecular mechanisms of antibiotic resistance. Serotyping was performed using specific antisera. The clonal relationship of Shigella flexneri and Shigella sonnei was assessed by pulsed-field gel electrophoresis (PFGE). Of the 67 shigella isolates analysed, 59 were diarrhoeal cases and eight were controls. S. flexneri (70.1%; 47/67) was the most common species, followed by S. sonnei (23.9%; 16/67). The most prevalent S. flexneri serotypes were 2a (38.3%; 18/47), 6 (19.2%; 9/47) and 1b (14.9%; 7/47). High rates of antimicrobial resistance were observed for trimethoprim-sulfametoxazole (92.5%; 62/67), tetracycline (68.7%; 46/67), chloramphenicol (53.7%; 36/67) and ampicillin (50.7%; 34/67). Multi-drug resistance (MDR) was present in 55.2% (37/67) of the isolates and was associated with a case fatality rate of 8.1% (3/37). PFGE revealed 22 clones (16 S. flexneri and 6 S. sonnei), among which P1 (31.9%; 15/47), P9 (17%; 8/47) and P2 (10.6%; 5/47) were the most prevalent clones of S. flexneri. In conclusion, S. flexneri was the most prevalent species, with MDR isolates mainly belonging to three specific clones (P1, P9 and P2). The case fatality rate observed among MDR isolates is a matter of concern, indicating the need for appropriate treatment
Reengagement of HIV-infected children lost to follow-up after active mobile phone tracing in a rural area of Mozambique
Introduction: Retention in care and reengagement of lost to follow-up (LTFU) patients are priority challenges in pediatric HIV care. We aimed to assess whether a telephone-call active tracing program facilitated reengagement in care (RIC) in the Manhiça District Hospital, Mozambique.
Methods: Telephone tracing of LTFU children was performed from July 2016 to March 2017. Both ART (antiretroviral treatment) and preART patients were included in this study. LTFU was defined as not attending the clinic for ≥120 days after last attended visit. Reengagement was determined 3 months after an attempt to contact. Results: A total of 144 children initially identified as LTFU entered the active tracing program and 37 were reached by means of telephone tracing. RIC was 57% (95% CI, 39–72%) among children who could be reached versus 18% (95% CI, 11–26%) of those who could not be reached (p = 0.001). Conclusion: Telephone tracing could be an effective tool for facilitating reengagement in pediatric HIV care. However, the difficulty of reaching patients is an obstacle that can undermine the program
Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique
Hypoglycemia is a life-threatening complication of several
diseases in childhood. We describe the prevalence and incidence
of hypoglycemia among admitted Mozambican children, establishing
its associated risk factors. We retrospectively reviewed
clinical data of 13 years collected through an ongoing
systematic morbidity surveillance in Manhica District Hospital
in rural Mozambique. Logistic regression was used to identify
risk factors for hypoglycemia and death. Minimum community-based
incidence rates (MCBIRs) for hypoglycemia were calculated using
data from the demographic surveillance system. Of 49,089
children < 15 years hospitalized in Manhica District
Hospital, 45,573 (92.8%) had a glycemia assessment on admission.
A total of 1,478 children (3.2%) presented hypoglycemia (< 3
mmol/L), of which about two-thirds (972) were with levels <
2.5 mmol/L. Independent risk factors for hypoglycemia on
admission and death among hypoglycemic children included
prostration, unconsciousness, edema, malnutrition, and
bacteremia. Hypoglycemic children were significantly more likely
to die (odds ratio [OR] = 7.11; P < 0.001), with an
associated case fatality rate (CFR) of 19.3% (245/1,267).
Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child
years at risk (CYAR), significantly decreasing throughout the
study period. Newborns showed the highest incidences (9.47
episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a
hazardous condition for African children. Symptoms and signs
associated to hypoglycemia should trigger the verification of
glycemia and the implementation of life-saving corrective
measures
Malaria in rural Mozambique. Part II: children admitted to hospital
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens
Pediatric HIV care cascade in southern mozambique: Missed opportunities for early ART and re-engagement in care
© 2020 Wolters Kluwer Health, Inc. All rights reserved. Background: There are 170,000 children living with HIV in 2017 in Mozambique. Scaling-up HIV care requires effective retention along the cascade. We sought to evaluate the pediatric cascade in HIV care at the Manhiça District Hospital. Methods: A prospective cohort of children <15 years was followed from enrollment in HIV care (January 2013 to December 2015) until December 2016. Loss to follow-up (LTFU) was defined as not attending the HIV hospital visits for ≥90 days following last visit attended. Results: From the 438 children included {median age at enrollment in care of 3,6 [interquartile range (IQR): 1.1-8.6] years}, 335 (76%) were antiretroviral therapy (ART) eligible and among those, 263 (78%) started ART at enrollment in HIV care. A total of 362 children initiated ART during the study period and the incidence rate of LTFU at 12, 24, and 36 months post-ART initiation was 41 [95% confidence interval (CI): 34-50], 34 (95% CI: 29-41), and 31 (95% CI: 27-37) per 100 children-years, respectively. Median time to LTFU was 5.8 (IQR: 1.4-12.7) months. Children 5-9 years of age had a lower risk of LTFU compared with children <1 year [adjusted subhazard ratio 0.36 (95% CI: 0.20-0.61)]. Re-engagement in care (RIC) was observed in 25% of the LTFU children. Conclusions: The high LTFU found in this study highlights the special attention that should be given to younger children during the first 6 months post-ART initiation to prevent LTFU. Once LTFU, only a quarter of those children return to the health unit. Elucidating factors associated with RIC could help to fine tune interventions which promote RIC
Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by Shigella in children less than 5 years in Manhiça District, rural Mozambique
Objectives: During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by Shigella was studied among children <5 years of age residing in Manhiça District, Southern Mozambique.
Materials and methods: Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with Shigella positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome.
Results: A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. Shigella was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. Shigella was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (P=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (P<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86–9.24) among children aged 12–23 months. Clinical symptoms associated to Shigella among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby’s food, and mother as caretaker were the protective factors against acquiring diarrhea caused by Shigella. Antibiotic treatment on admission was associated with a positive children outcome.
Conclusion: Shigella remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to Shigella
Under treatment of pneumonia among children under 5 years of age in a malaria-endemic area: population-based surveillance study conducted in Manhica district- rural, Mozambique
BACKGROUND: Integrated Management of Childhood Illness (IMCI)
guidelines were developed to decrease morbidity and mortality,
yet implementation varies across settings. Factors associated
with poor adherence are not well understood. METHODS: We used
data from Manhica District Hospital outpatient department and
five peripheral health centers to examine pneumonia management
for children <5 years old from January 2008 to June 2011.
Episodes of IMCI-defined pneumonia (cough or difficult breathing
plus tachypnea), severe pneumonia (pneumonia plus chest wall
in-drawing), and/or clinician-diagnosed pneumonia (based on
discharge diagnosis) were included. RESULTS: Among severe
pneumonia episodes, 96.2% (2,918/3,032) attended in the
outpatient department and 70.0% (291/416) attended in health
centers were appropriately referred to the emergency department.
Age<1 year, malnutrition and various physical exam findings
were associated with referral. For non-severe pneumonia
episodes, antibiotics were prescribed in 45.7% (16,094/35,224).
Factors associated with antibiotic prescription included age
<1 year, abnormal auscultatory findings, and clinical
diagnosis of pneumonia; diagnosis of malaria or gastroenteritis
and pallor were negatively associated with antibiotic
prescription. CONCLUSION: Adherence to recommended management of
severe pneumonia was high in a hospital outpatient department,
but suboptimal in health centers. Antibiotics were prescribed in
fewer than half of non-severe pneumonia episodes, and diagnosis
of malaria was the strongest risk factor for incorrect
management
- …