Profile of Children with Undernutrition Admitted in Two Secondary-Level Hospitals in Maputo City, Mozambique

This research was undertaken as part of a Ph.D. program. This was funded by the FlemishInternational Cooperation Agency (FICA) under the Building Institutional Capacity Mozambican INS (BICMINS) project within ITM and INS (DiV-PA-20140910).Mozambique has one of the highest child undernutrition rates in Sub-Saharan Africa. The aim of this study was to characterize the profile of children from 1 to 14 years old hospitalized for undernutrition and to explore associated risk factors. Clinical, demographic, socioeconomic, and environmental data were collected. Anthropometric measurements and stool samples were collected from a child and their caretaker. The wealth index was determined using Principal Components Analysis. A total of 449 children and their caretakers were enrolled. The children had a median age of 1.0 year [IQR: 1.0-2.0], and 53.9% (242/449) were male. Most were admitted with severe undernutrition (35.7%, 159/449 kwashiorkor and 82.0%, 368/449 with -3SD Z-score indexes). The most common co-morbidities were HIV (30.0%, 120/400), diarrhea (20.0%; 80/400), and anemia (12.5%; 50/400). Among the caretakers, 9.5% (39/409) were underweight, 10.1% (40/397) were overweight, and 14.1% (56/397) were obese. Intestinal parasites were found in 24.8% (90/363) children and in 38.5% (77/200) caretakers. The majority of children (60.7%, 85/140) came from low- to middle-wealth households. Most were severely undernourished, suggesting that they seek medical care too late. The finding of overweight/obese caretakers in combination with undernourished children confirms that Mozambique is facing a double burden of malnutrition.publishersversionpublishe

A Hospital Based Cross-Sectional Study, 2015–2019

792. The Global Alliance for Vaccine and Immunization through the Health System Strengthening (HSS) project. The Flandres Government, BICMINS project. The Calouste Gulbenkian Foundation from where J?lia Sambo, Marta Cassocera and Assuc?nio Chissaque have a PhD fellowship. Acknowledgments: We would like to thank the parents or guardians who consented for their children to be enrolled in the surveillance and all ViNaDia team for their dedication and effort with recruitment, data collection and shipment of specimens to the central laboratory in Maputo: Miguel Bambo, Carlos Guilamba, Celina Nhamuave, M?rcia Nhaca, Judite Sal?ncia, Herm?nio Cossa, F?lix Gundane, Aun?sia Marurele, Angelina Pereira, Mulaja Kabeya ?tienne, Celso Gabriel, Titos Maulate, Julieta Ernesto, Siasa Mendes, H?rcio Simbine, Susete de Carvalho, Marcos Joaquim, Elvira Sarguene, Fernando Vilanculos, Felicidade Martins, Dulce Gra?a, Edma Samuel, Vivaldo Pedro, L?cia Matabel, Aida Junta, Gilda Maria Safrina, Nat?rcia Abreu, Vanessa da Silva, Nazareth Mabutana, Delcio Muteto, Benilde Munlela and Carolina Conjo. A special thank you also to Timothy Kellogg for all the guidance during the initial data analysis process. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Diarrhoea is associated with undernutrition and this association is related to increased morbidity and mortality in children under-five. In this analysis we aimed to assess the frequency and associated factors of undernutrition in children under-five with diarrhoea. A hospital-based cross-sectional study was conducted from January 2015 to December 2019 through a surveillance system in five sentinel hospitals in Mozambique. Sociodemographic and clinical information was collected, including anthropometry. A total of 963 children were analysed. The overall undernutrition frequency was 54.1% (95% CI: 50.9–57.2), with 32.5% (95% CI: 29.6–35.5) stunting, 26.6% (95% CI: 23.9–29.6) wasting and 24.7% (95% CI: 22.1–27.5) underweight. Children from Nampula province had 4.7 (p = 0.016) higher odds for stunting compared with children from Maputo and Zambézia. Children whose mother was illiterate had higher odds of being underweight 5.4 (p < 0.001). Children born under 2500 g of weight had 2.85 (p = 0.001), 2.97 (p < 0.001) and 2.19 (p = 0.013) higher odds for being underweighted, wasted and stunted, respectively. The HIV positive status of the children was associated with higher odds of being underweight 2.88 (p = 0.005), wasted 2.24 (p = 0.025), and stunted 2.89 (p = 0.004). The province, caregiver education level, child’s birthweight and HIV status were factors associated with undernutrition in children with diarrhoea. These findings emphasise the need for additional caregiver’s education on the child’s nutrition and associated infectious diseases. More studies are needed to better understand the social context in which a child with diarrhoea and undernutrition is inserted.publishersversionpublishe

Maternal malaria but not schistosomiasis is associated with a higher risk of febrile infection in infant during the first 3 months of life: A mother-child cohort in Benin.

BACKGROUND: Malaria and schistosomiasis represent two of the most prevalent and disabling parasitic infections in developing countries. Few studies have evaluated the effect of maternal schistosomiasis and malaria in the peri-conceptional period on infant's risk of infection. METHODS: In Benin, women were followed from the preconception period until delivery. Subsequently, their children were followed from birth to 3 months of age. Pre-pregnancy malaria, malaria in pregnancy (MiP)-determined monthly using a thick blood smear-and urinary schistosomiasis-determined once before pregnancy and once at delivery using urine filtration-were the main maternal exposures. Infant's febrile infection (fever with respiratory, gastrointestinal and/or cutaneous clinical signs anytime during follow-up) was the main outcome. In a secondary analysis, we checked the relation of malaria and schistosomiasis with infant's hemoglobin (Hb) concentration. Both effects were separately assessed using logistic/mixed linear regression models. RESULTS: The prevalence of MiP was 35.7% with 10.8% occurring during the 1st trimester, and the prevalence of schistosomiasis was 21.8%. From birth to 3 months, 25.3% of infants had at least one episode of febrile infection. In multivariate analysis, MiP, particularly malaria in the 1st trimester, was significantly associated with a higher risk of infant's febrile infection (aOR = 4.99 [1.1; 22.6], p = 0.03). In secondary results, pre-pregnancy malaria and schistosomiasis were significantly associated with a lower infant's Hb concentration during the first 3 months. CONCLUSION: We evidenced the deleterious effect of maternal parasitic infections on infant's health. Our results argue in favor of the implementation of preventive strategies as early as in the peri-conception

Evolution de l'épidémiologie et des critères diagnostiques du paludisme clinique à Dielmo de 1990 à 2010

En Afrique tropicale, là où le paludisme est fortement endémique, la plupart des individus sont semi-immuns et les infections asymptomatiques sont très répandues. Ainsi la détection de parasites dans le sang de malades fébriles n'est pas un critère suffisant pour distinguer le paludisme des autres causes de fièvre. A Dielmo, un village du Sénégal d'environ 500 habitants en 2010, un suivi épidémiologique continu très étroit du paludisme a débuté en 1990. Dans ce village où la transmission est pérenne, la mise en place de moyens de lutte et de prévention contre le paludisme de plus en plus efficaces a profondément transformé l'épidémiologie du paludisme. Dans ce travail, nous analysons l'impact de ces interventions sur les prévalences parasitaires, les densités parasitaires et les critères diagnostiques du paludisme et nous mesurons l'évolution du paludisme clinique à Plasmodium falciparum, P. malariae et P. ovale de juin 1990 à décembre 2010. Les données parasitologiques et cliniques ont été analysées par régression logistique à effet aléatoire pour étudier la relation entre les densités parasitaires et le risque de fièvre. Les prévalences parasitaires des trois espèces plasmodiales ont considérablement diminué lors de l'abandon de la chloroquine en traitement de première ligne et de son remplacement par des combinaisons thérapeutiques, puis sont devenues presque nulles après la mise en place de moustiquaires imprégnées d'insecticides à longue durée d'action. Les seuils pyrogéniques calculés nous ont permis de mesurer la densité d'incidence des accès palustres et d'étudier l'impact des mesures de lutte sur la morbidité palustre dans la population.In tropical Africa, where malaria is highly endemic, most people are semi-immune and asymptomatic infections are widespread. Thus, the detection of malaria parasites in the blood of febrile patients is not a sufficient criterion for distinguishing malaria from other causes of fever. In Dielmo, a Senegalese village of about 500 inhabitants in 2010, a very closely continuous epidemiological monitoring of malaria began in 1990. In this village where the transmission is perennial, the establishment of more effective means of control and prevention against malaria have profoundly changed the epidemiology of malaria. In this work, we analyze the impact of these interventions on the parasite prevalences, the parasite densities and the malaria diagnostic criteria and we measure the evolution of Plasmodium falciparum, P. malariae and P. ovale clinical malaria from June 1990 to December 2010 in Dielmo. Parasitological and clinical data are analyzed in a random effect logistic regression to investigate the relationship between parasite density and fever risk. The prevalence of the three Plasmodium species decreased dramatically with the abandonment of chloroquine as first line treatment and his replacing with the combination therapies and became almost zero after the introduction of long lasting insecticidal nets. Pyrogenic thresholds calculated enabled us to measure the incidence density of malaria and to study the impact of intervention methods on malaria morbidity in the population

A 20-year longitudinal study of Plasmodium ovale and Plasmodium malariae prevalence and morbidity in a West African population

Background: Plasmodium ovale and Plasmodium malariae have long been reported to be widely distributed in tropical Africa and in other major malaria-endemic areas of the world. However, little is known about the burden caused by these two malaria species. Methods and Findings: We did a longitudinal study of the inhabitants of Dielmo village, Senegal, between June, 1990, and December, 2010. We monitored the inhabitants for fever during this period and performed quarterly measurements of parasitemia. We analyzed parasitological and clinical data in a random-effect logistic regression model to investigate the relationship between the level of parasitemia and the risk of fever and to establish diagnostic criteria for P. ovale and P. malariae clinical attacks. The prevalence of P. ovale and P. malariae infections in asymptomatic individuals were high during the first years of the project but decreased after 2004 and almost disappeared in 2010 in relation to changes in malaria control policies. The average incidence densities of P. ovale and P. malariae clinical attacks were 0.053 and 0.093 attacks per person per year in children = 15 years, respectively. These two malaria species represented together 5.9% of the malaria burden. Conclusions: P. ovale and P. malariae were a common cause of morbidity in Dielmo villagers until the recent dramatic decrease of malaria that followed the introduction of new malaria control policies. P. ovale and P. malariae may constitute an important cause of morbidity in many areas of tropical Africa

Changing malaria epidemiology and diagnostic criteria for Plasmodium falciparum clinical malaria.

BACKGROUND: In tropical Africa, where malaria is highly endemic, low grade infections are asymptomatic and the diagnosis of clinical malaria is usually based on parasite density. Here we investigate how changes in malaria control and endemicity modify diagnostic criteria of Plasmodium falciparum attacks. METHODS AND FINDINGS: Parasitological and clinical data from the population of Dielmo, Senegal, monitored during 20 years, are analyzed in a random-effect logistic regression model to investigate the relationship between the level of parasitemia and risk of fever. Between 1990 and 2010, P. falciparum prevalence in asymptomatic persons declined from 85% to 1% in children 0-3 years and from 34% to 2% in adults ≥50 years. Thresholds levels of parasitemia for attributing fever episodes to malaria decreased by steps in relation to control policies. Using baseline threshold during following periods underestimated P. falciparum attacks by 9.8-20.2% in children and 18.9-40.2% in adults. Considering all fever episodes associated with malaria parasites as clinical attacks overestimated P. falciparum attacks by 42.2-68.5% in children and 45.9-211.7% in adults. CONCLUSIONS: Malaria control modifies in all age-groups the threshold levels of parasitemia to be used for the assessment of malaria morbidity and to guide therapeutic decisions. Even under declining levels of malaria endemicity, the parasite density method must remain the reference method for distinguishing malaria from other causes of fever and assessing trends in the burden of malaria

Relationship between <i>Plasmodium ovale</i> parasitemia and risk of fever.

a<p>Parasites/µl of blood.</p>b<p>Fisher's exact test. p values shown in bold are significantly associated with an increased risk of fever.</p><p>Dielmo, 1990–2004 and 2005–2010.</p

Mean yearly incidence density of <i>P. ovale</i> clinical attacks by age group.

<p>Dielmo, 1990–2010.</p

Trends in yearly incidence density of <i>P. ovale</i> clinical attacks. Dielmo, 1990–2010.

<p>Trends in yearly incidence density of <i>P. ovale</i> clinical attacks. Dielmo, 1990–2010.</p

<i>P. ovale</i> prevalence by year and age group from 1990 to 2010.

<p><i>P. ovale</i> prevalence by year and age group from 1990 to 2010.</p