Malnutrition and enteric infections in children in Bengo province, Angola-a four-arm experimental study

Introdução: À semelhança de outros países de baixo-médio rendimento, em Angola, a malnutrição e a doença diarreica estão entre as principais causas de mortes em crianças menores de cinco anos, nomeadamente na província do Bengo. Objectivos: i) identificar a etiologia da diarreia e fatores associados em crianças menores de cinco anos atendidas no Hospital Geral do Bengo (HGB); ii) fornecer informações sobre a caracterização molecular de rotavírus, antes da introdução da vacina; iii) fornecer uma caracterização molecular de Giardia lamblia; e iv) investigar se o tratamento de parasitas intestinais (com ou sem diagnóstico prévio) em dois níveis diferentes (individual ou a nível do agregado familiar) tem impacto sobre o estado nutricional de crianças de 2-5 anos, após seguimento de dois anos no Bengo. Métodos: Um estudo transversal (ET) foi implementado para investigar a presença de vírus, bactérias e parasitas nas fezes diarreicas de 344 crianças atendidas no HGB (2012- 2013), recolhendo dados sociodemográficos, nutricionais e clínicos, explorados por modelos de regressão logística simples e múltipla. Posteriormente, realizaram-se métodos moleculares para identificação dos genótipos circulantes de rotavírus e genótipos e subgenótipos de G. lamblia. Entre 2013 e 2017, um estudo longitudinal e experimental (RCT) com quatro braços em paralelo foi realizado em crianças infetadas com pelo menos um parasita intestinal patogénico (ISRCTN-72928001). As 121 crianças com critérios de inclusão foram distribuídas aleatoriamente (1:1:1:1) - Braço1: albendazol anual a nível individual; Braço2: albendazol anual ao agregado familiar; Braço3: diagnóstico e tratamento quadrimestral de parasitas intestinais a nível individual; Braço4: diagnóstico e tratamento quadrimestral de parasitas intestinais ao nível do agregado familiar. No início do estudo, aos 4, 8, 12, 16, 20 e 24 meses de acompanhamento avaliou-se: a altura, o peso, estatura-para-idade, peso-para-altura e peso-para-idade em Z-score. A análise por intenção-de-tratar foi realizada seguindo as diretrizes CONSORT, após a análise de valores omissos (IBM SPSS). Dada a falha dos pressupostos da análise paramétrica de medidas repetidas, uma abordagem não paramétrica (nparLD) e os modelos LMM e GEE foram explorados no programa R. Resultados: Nos dois estudos, as crianças viviam principalmente em áreas urbanas (>90%) e mais de 20% não tinha latrina. A água mais usada para beber provinha do rio, da torneira no quintal e de tanques. A desnutrição crónica ocorreu em 38% (ET) e 31% (RCT) das crianças. No ET, 67% das crianças estavam infetadas por um agente enteropatogénico, principalmente por Cryptosporidium spp. (30%), rotavírus (25%) e G. lamblia (22%). Cryptosporidium spp. e rotavírus foram mais frequentes em menores de 12 meses. Os principais genótipos circulantes de rotavírus foram: G1P [8] (47%), G1P [6] (29%) e G2P [4] (13%). O genótipo B de G. lamblia foi predominante em relação ao genótipo A. No RCT, no início do estudo, as crianças estavam infetadas principalmente com G. lamblia (57%) e Ascaris lumbricoides (26%). Diferentes modelos não forneceram nenhuma evidência ou fraca evidência do efeito das intervenções nas medições antropométricas, embora tenha ocorrido uma evolução temporal significativa. Contudo, nota-se uma redução da desnutrição ligeira ao longo do estudo, apesar de, em média, as crianças permaneceram com valores padronizados (z-scores) negativos para os índices antropométricos.Conclusão: Várias infeções entéricas foram identificados nos dois estudos. No RCT, nenhuma das estratégias de tratamento de parasitoses intestinais se destacou com efeito significativo nos indicadores antropométricos estudados. A duração do RCT e o tamanho da amostra podem não ter sido suficientes para observar diferenças significativas. Por outro lado, realça-se a importância de uma abordagem multifatorial integrada com vista à melhoria do estado nutricional (e.g., WASH, educação, alimentação adequada e acesso a cuidados de saúde).Background: Similar to other low- and middle-income countries, in Angola, malnutrition and diarrhoeal disease are among the major causes of deaths in children under-five, namely in Bengo province. Aims: i) identify the aetiology of diarrhoea and associated factors in under-five children attending the Bengo General Hospital (HGB); ii) provide information on the molecular characterization of rotavirus, before the vaccine introduction; iii) provide a molecular characterization of Giardia lamblia; and iv) investigate if treatment of intestinal parasites (with or without previous diagnosis) in two different levels (individual or household) impacts on nutritional status of children 2-5 years, after a two-year follow-up in Bengo. Methods: A cross-sectional study (CSS) was conducted to investigate the presence of virus, bacteria and parasites in diarrhoeal stools of 344 children attending HGB (2012-2013), collecting sociodemographic, nutritional and clinical data, analysed by simple and multiple logistic regression models. Then, molecular methods were performed for the identification of rotavirus circulating genotypes and G. lamblia assemblages and subassemblages. Between 2013 and 2017, a four-arm randomised controlled trial (RCT, registration ISRCTN-72928001) was conducted longitudinally in children infected with at least one pathogenic intestinal parasite. 121 children meeting inclusion criteria were randomly assigned (1:1:1:1) - Arm1: annual albendazole at individual level; Arm2: annual albendazole at household level; Arm3: four-monthly screening and treatment of intestinal parasites at individual level; Arm4: four-monthly screening and treatment of intestinal parasites at household level. Height, weight, height-for-age, weight-for-height, and weight-for-age Z-score were assessed at baseline, 4, 8, 12, 16, 20, and 24 months of follow-up. Intention-to-treat analysis was performed following CONSORT guidelines, after a missing value analysis (IBM SPSS). Given the failure of assumptions for parametric repeated measurements, nonparametric rank-based method (nparLD), LMM and GEE models were performed in R program. Results: In both studies, children lived mainly in urban areas (>90%) and more than 20% did not have a latrine. The most commonly drinking water sources were the river, the tap in the yard and tank. Near 38% (CSS) and 31% (RCT) of children were stunted. In the CSS, 67% of children were infected with an enteropathogen, mostly with Cryptosporidium spp. (30%), rotavirus (25%) and G. lamblia (22%). Cryptosporidium spp. and rotavirus were more frequent in children under 12 months. The main rotavirus circulating genotypes were: G1P[8] (47%), G1P[6] (29%) and G2P[4] (13%). G. lamblia assemblage B was predominant compared with assemblage A. In the RCT, at baseline, children were mainly infected with G. lamblia (57%) and Ascaris lumbricoides (26%). Different models provided no evidence or weak evidence of the effect of interventions on anthropometric measurements, although a significant temporal effect occurred. A reduction in mild malnutrition occurred throughout the study, although, on average, children remained with negative z-scores for anthropometric indices. Conclusion: Several enteric infections were identified in both studies. In the RCT, none of the treatment strategies targeting intestinal parasites stood out with significant effect on the anthropometric indices studied. The duration of the RCT and the sample size may not have been sufficient to observe significant differences. On the other hand, it highlights the importance of an integrated multifactorial approach to improving nutritional status (eg, WASH, education, adequate food and access to health care)

Diarreia em crianças menores de cinco anos no Hospital Geral do Bengo

A doença diarreica constitui uma das principais causas de morte em crianças menores de cinco anos em Angola. O presente estudo assume como principal objectivo identificar os agentes patogénicos causadores de diarreia, entre eles vírus, parasitas e bactérias, das crianças admitidas no Hospital Geral do Bengo. Material de estudo - O estudo iniciou-se em Setembro de 2012, tendo sido incluídas crianças menores de 5 anos admitidas no Hospital Geral do Bengo por diarreia (serviço de urgência e consulta externa) até Outubro de 2013, sem história de antibioterapia

Parasitoses intestinais e sua relação com a desnutrição moderada e severa em crianças dos 0 aos 59 meses internadas no hospital pediátrico de Lubango, Angola

Introdução: A desnutrição e as parasitoses intestinais nas crianças constituem um importante problema de saúde, principalmente nos países em desenvolvimento, como é o caso de Angola. Contudo, e não obstante a relevância, há escassez de estudos de base hospitalar sobre esta questão. A problemática em estudo é a associação entre as infecções por parasitas intestinais em crianças dos 0-59 meses e a desnutrição severa e moderada, internadas no Hospital Pediátrico do Lubango, Angola. Material, População e Métodos: O estudo realizou-se durante o mês de Março de 2011 no Hospital Pediátrico do Lubango, onde se avaliou o estado nutricional de 92 crianças, com desnutrição moderada e severa (Z-score<-2) para pelo menos um dos indicadores antropométricos de desnutrição: aguda, baixo-peso e crónica. Efectuou-se a análise microscópica das fezes para a detecção de parasitas intestinais, bem como a realização do teste rápido de detecção de antigénio de Entamoeba spp., Giardia lamblia e Cryptosporidium spp. A exploração da associação entre a desnutrição moderada e severa e a infecção por parasitas intestinais foi efectuada recorrendo a métodos estatísticos. Resultados obtidos: Em 92 crianças, 54 (58,7%) eram do sexo masculino e 38 (41,3%) do sexo feminino, tendo-se verificado que 43,5% (40/92) tinha até 12 meses, 41,3% (38/92) entre 12 e 24 meses e 15,2% (14/92) entre 24 e 59 meses de idade. Foram identificadas 65,2% (60/92) de crianças com desnutrição aguda moderada a severa, 68,6% (48/70) com baixo-peso moderado a severo e 68,5% (63/92) com desnutrição crónica moderada a severa. O exame parasitológico das fezes identificou que 20,7% das crianças (19/92) estavam parasitadas com infecções simples por: G. lamblia (14,13%), Entamoeba spp (1,09%) e Ascaris lumbricoides (2,17%); e com infecções mistas por G. lamblia e Entamoeba spp. (2,17%) e G.lamblia e Schistosoma haematobium (1,09%). Entre as crianças parasitadas por G.lamblia (simples e mistas) observou-se uma diferença considerável na sua distribuição pela desnutrição aguda moderada e severa: 6,25% (1/16) e 50% (8/16), respectivamente. Não foi encontrada associação estatisticamente significativa entre o grau de desnutrição severa e moderada e a infecção por parasitas intestinais patogénicos, a infecção simples e mista por G.lamblia (microscopia) e a presença de antigénio para G.lamblia Discussão e Conclusões: Destaca-se a diferença observada entre as crianças com desnutrição aguda severa infectadas com parasitas intestinais em relação às crianças com desnutrição aguda moderada, apesar da associação não ter sido estatisticamente significativa. O número reduzido da amostra e o tempo limitado do estudo podem ter contribuído para o facto de não se ter encontrado nenhuma associação entre as infecções e outros tipos de desnutrição. Contudo, dada a escassez da informação sobre esta problemática, este estudo de investigação contribuiu com os seus dados, a partir do qual se podem desenhar outros estudos de base hospitalar.Introduction: Malnutrition and intestinal parasites in children are an important health problem, especially in developing countries, as is the case of Angola. However, despite the relevance, there is a lack of hospital-based studies on this issue. The problem under study is the association between intestinal parasitic infections in children with 0-59 months of age and the severe and moderate malnutrition, admitted to the Paediatric Hospital of Lubango, Angola. Material, Population and Methods: The study was conducted in March 2011 at the Pediatric Hospital of Lubango and included 92 children with moderate and severe malnutrition (Z-score<-2) at least one of anthropometric indices: acute, underweight and chronic malnutrition. The microscopic analysis of stool for detecting intestinal parasites was performed, as well as the antigen rapid test for the detection of Entamoeba spp., Giardia lamblia and Cryptosporidium spp. The association between severe and moderate malnutrition and intestinal parasitic infection was performed using statistical methods. Achievements: In 92 children, 54 (58,7%) were males and 38 (41,3%) females and found it had up to 43,5% (40/92) 12 months, 41,3% (38/92) between 12 and 24 months, and 15,2% (14/92) between 24 and 59 months of age. We identified 65.2% (60/92) of children with moderate to severe acute malnutrition, 68.6% (48/70) with moderate to severe underweight and 68.5% (63/92) with moderate to severe chronic malnutrition. The parasitological examination of feces has identified that 20,7% (19/92) were parasitized with simple infections by G.lamblia (14,13%), Entamoeba spp (1.09%) and Ascaris lumbricoides (2.17%); and with mixed infections by Giardia and Entamoeba spp. (2,17%) and Giardia and S.haematobium (1.09%). Among children that are parasitized by G.lamblia (simple and mixed infections) noted a significant difference in its distribution by the severe and moderate malnutrition:6,25% (1/16) and 50% (8/16), respectively. No statistically significant association was found between severe and moderate malnutrition and infection by pathogenic intestinal parasites, simple and mixed infection with G.lamblia (microscopy) and the presence of Antigen for G.lamblia. Discussion and conclusions: the difference observed between children with severe acute malnutrition infected with intestinal parasites when compared with children with moderate acute malnutrition is one of the most important results, although the association was not statistically significant. The small sample size and limited time of the study may have contributed to have found no association between other types of infections and malnutrition. However, given the paucity of information on this issue, this research study contributed with relevant data, useful for future hospital-based studies

Sistema de vigilância de morbilidade pediátrica no Hospital Geral do Bengo

Angola tem registado avanços significativos na redução da mortalidade infantil. Não obstante, verifica-se ainda a necessidade de implementar novas medidas no sentido de reduzir a morbimortalidade infantil. Para atingir este objectivo foi implementado um Sistema de Vigilância de Morbilidade (SVM) no serviço de Pediatria do Hospital Geral do Bengo (HGB). O objectivo deste trabalho é a identificação das doenças mais frequentes detectadas no serviço de urgência do HGB

Wasting, stunting, and anemia in angolan children after deworming with albendazole or a test-and-treat approach for intestinal parasites: binary longitudinal models with temporal structure in a four-arm randomized trial

Undernutrition, anemia, and intestinal parasitic infections are public health problems in Angola, especially in pre-school children. We analyzed binary data from a longitudinal four-arm randomized parallel trial conducted in Bengo Province, northern Angola, over the course of two years, with seven follow-up assessments to explore the effects of four interventions (deworming and a test-and-treat approach for intestinal parasites, at both the individual and household levels) on wasting and stunting, and to understand their indirect benefits for anemia, malaria, diarrhea, and vomiting. A total of 121 children with intestinal parasitic infections received baseline treatment, and were allocated to the four arms (1:1:1:1). Using continuous outcome variables of height-for-age (HAZ) and weight-for-height (WHZ) statistical approaches did not reveal a clear benefit of any particular arm (Pathogens 2021, 10, 309). Next, HAZ and WHZ were transformed into binary variables of stunting and wasting, respectively, considering their mild-to-severe (Z-score bild, fitted models revealed the potential benefit of a test-and-treat approach at the individual level for wasting compared with annual albendazole at the individual level, especially considering mild-to-severe forms (ORadj = 0.27; p = 0.007). All arms showed similar effects on stunting, compared with annual albendazole, at a 5% significance level. Time and age at baseline presented favorable effects in the percentage of stunting using both severity degrees. Results showed a decreased chance of having anemia and diarrhea over time, although with no significant differences between arms. Data from longitudinal studies are essential to study the direct and indirect effects of interventions, such as deworming, and to explore additional approaches aiming at better understanding the temporal structure of nutrition and health outcomes in children.info:eu-repo/semantics/publishedVersio

Aetiology of diahrroea in children under five at the Bengo General Hospital, Angola

Diarrhoea is the second leading cause of death in children under five years being responsible for 760.000 deaths, corresponding to 9% of the total deaths in this age group. Africa is the region with more deaths due to diarrhoea (46%), followed by South Asia (38%). Three quarters of the total of deaths occurs within only 15 countries and Angola is in the 15th position with a record of 20,000 annual childhood deaths. Diarrhoeal disease can be caused by bacterial, viral and parasitic infectious agents and can be transmited through contaminated food or drinking water, or directly from person to person. Rotavirus and Escherichia coli were shown the most frequent pathogenic agents in developing countries. This study aims to identify the most frequent pathogenic agents of diarrhoea in children under five atttending the Bengo General Hospital (BGH).

Recreation and alcohol consumption in Sub-Saharan Africa: addressing gender and age differences in urban areas (Praia, Cabo Verde)

Background: Reducing alcohol consumption and improving urban planning in African cities are public health priorities. The aim of this study was to explore gender and age differences in recreational activity participation and their link with self-reported alcohol consumption in three urban areas of Praia. Methods: A questionnaire was applied to a probabilistic sample of 1912 adults, with a median age of 35.0 (IQR: 26.0–48.8) years, living in informal, transition, and formal areas of the capital of Cabo Verde. Results: More than 80% of the participants reported rarely or never participating in recreational activities. Going daily or weekly to the café was the most reported recreational activity, regardless of the urban area. Participation in recreational activities was higher in men than women, decreasing with age in both cases. Alcohol consumption was significantly higher in men than in women (72.4% versus 47.4%, p < 0.001). Multiple logistic regression models showed that going at least once to the bar/nightclub (for men and women) and going to the café (for women) were associated with alcohol consumption. Furthermore, age (for women), in a protective way, and having children (for men) appeared to be associated with alcohol consumption. Conclusions: This study provides new data on the recreational environment in Praia and can contribute to the development of local and national public health policies and interventions in line with several SDGs to reduce alcohol consumption, enhance healthy leisure/recreation practices, and promote better living conditions for its inhabitants.info:eu-repo/semantics/publishedVersio

Molecular characterization of Giardia lamblia in children less than 5 years of age with diarrhoea attending the Bengo General Hospital, Angola

Introduction - Giardia lamblia is a pathogenic intestinal protozoan with high prevalence in developing countries, especially among children. Molecular characterization has revealed the existence of eight assemblages, with A and B being more commonly described in human infections. Despite its importance, to our knowledge, this is the first published molecular analysis of G. lamblia assemblages in Angola. Methods - The present study aimed to identify the assemblages of G. lamblia in children with acute diarrhoea presenting at the Bengo General Hospital, Angola. A stool sample was collected and microscopy and immunochromatographic tests were used. DNA was extracted and assemblage determination was performed through amplification of the gene fragment ssu-rRNA (175 bp) and β-giardin (511 bp) through polymerase chain reaction and DNA sequencing. Results - Of the 16 stool samples screened, 12 were successfully sequenced. Eleven isolates were assigned to assemblage B and one to assemblage A. Subassemblage determination was not possible for assemblage B, while the single isolate assigned to assemblage A was identified as belonging to subassemblage A3. Conclusion - This study provides information about G. lamblia assemblages in Bengo Province, Angola and may contribute as a first step in understanding the molecular epidemiology of this protozoan in the country. GenBank accession numbers for the ssur-RNA gene: MF479750, MF479751, MF479752, MF479753, MF479754, MF479755, MF479756, MF479757, MF479758, MF479759, MF479760, MF479761. GenBank accession numbers for the β-giardin gene: MF565378, MF565379, MF565380, MF565381.info:eu-repo/semantics/publishedVersio

Characterization of rotavirus infection in children with acute gastroenteritis in Bengo province, Northwestern Angola, prior to vaccine introduction

Rotavirus group A (RVA) is considered the leading cause of pediatric diarrhea, responsible for the high burden of diarrheal diseases in sub-Saharan Africa. Despite recent studies, the existent data are scarce for some African countries like Angola, a country with one of the highest RVA-related death estimates. The aim of this study was to determine the RVA detection rate and circulating genotypes in children less than five years of age with acute gastroenteritis attended at the Bengo General Hospital in Caxito, Bengo province, Angola, before vaccine introductionThis work was supported by Camões— Institute for Cooperation and Language, Calouste Gulbenkian Foundation, Angolan Ministry of Health, Bengo Provincial Government and the Ministry of Health of Angola

Treponema pallidum infection rate in patients attending the general hospital of Benguela, Angola

Publisher Copyright: Copyright © 2023 Yefimenko et al.Introduction: The objectives of this study were to estimate the rate of infection by Treponema pallidum and co-infection with Human Immunodeficiency Virus (HIV) in individuals attending the General Hospital of Benguela (GHB), Angola, to verify the Rapid Plasma Reagin (RPR) test performance for its diagnosis when compared with other RPR tests, and to compare a rapid treponemal test with the Treponema pallidum hemagglutination assay (TPHA). Methodology: This is a cross-sectional study carried out between August 2016 and January 2017, at the GHB, 546 individuals attending the emergency room, the outpatient service or hospitalized at the GHB were included. All the samples were tested at the GHB with the routine hospital RPR test and a rapid treponemal test. The samples were then transported to the Institute of Hygiene and Tropical Medicine (IHMT) where RPR testing and TPHA testing were performed. Results: The rate of T. pallidum active infection, demonstrated by a reactive RPR and TPHA result, was 2.9%, of which 81.2% corresponded to indeterminate latent syphilis and 18.8% to secondary syphilis. HIV co-infection was detected in 62.5% of individuals diagnosed with syphilis. Past infection, defined as a non-reactive RPR and reactive TPHA test, was diagnosed in 4.1% of individuals. Conclusions: The high rate of syphilis/HIV co-infection emphasizes the urgent requirement for adequate sexually transmitted infections (STIs) screening, prevention and treatment programs. In addition, implementation of quality control measures within RPR testing protocols at GHB are needed, including training for laboratory personnel, adequate equipment and introduction of other rapid testing.publishersversionpublishe