Epidemiologic transition in northern Angola: discussion of cumulative results from CISA (Health Research Centre of Angola)

The 41 years of armed conflict (1961 to 2002) resulted in a poor development of the health care and education infrastructures, and forced the relocation of people to safer places, namely major urban cities like Luanda. This phase was characterized by typical demographic, nutritional and epidemiological profiles. With the end of this period Angola has been repeatedly ranked as one of the three fastest growing economies in the world, and along with the social stabilization and globalization, the country is facing the introduction of new medical technologies, improvement of health sys-tems and services, better access to them, and overall better quality of life. These changes could also be translating into socio-cultural, demographic and nutritional changes which in turn may leading to changes in the epidemiological profile of the country. Thus, the emergence of non-communicable diseases are likely to become an increasingly im-portant public health problem in Angola. Also, considering that several infectious diseases persist, our weakened health system will have to face a double burden. Thus, disease surveillance data on non-communicable diseases to determine their prevalence and impact, along with the major behavioural risk factors like consumption of tobacco, alcohol, diets and physical inactivity are urgently needed

Plasmodium falciparum drug resistance in Angola

Facing chloroquine drug resistance, Angola promptly adopted artemisinin-based combination therapy as the first-line to treat malaria. Currently, the country aims to consolidate malaria control, while preparing for the elimination of the disease, along with others African countries in the region. However, the remarkable capacity of Plasmodium to develop drug resistance represents an alarming threat for those achievements. Herein, the available, but relatively scarce and dispersed, information on malaria drug resistance in Angola, is reviewed and discussed. The review aims to inform but also to encourage future research studies that monitor and update the information on anti-malarial drug efficacy and prevalence of molecular markers of drug resistance, key fields in the context and objectives of elimination

Zinc Deficiency Interacts with Intestinal/Urogenital Parasites in the Pathway to Anemia in Preschool Children, Bengo-Angola

This article belongs to the Section Micronutrients and Human Health.In host organisms with normal micronutrient status, nutritional immunity is a strongly regulated response aiming at decreasing the progression and severity of infections. Zinc deficiency may disturb this balance, impairing immune responses to infections, which may indirectly increase infection-related anemia. Since zinc deficiency may associate directly with anemia, the role of infections is often overlooked. Herein, we investigated the participation of infections (or inflammation) in the causal pathway between zinc deficiency and anemia. This transversal study, conducted in 2015 in Bengo-Angola, enrolled 852 under-3-year-old children. Logistic regression models were used to investigate interaction and mediation effects, and significance was confirmed by the Sobel test. In sum, 6.8% of children had zinc deficiency, 45.9% had anemia, and 15.6% had at least one intestinal/urogenital parasite. Furthermore, we found (1) no evidence that inflammation mediates or interacts with zinc deficiency to cause anemia, and (2) zinc deficiency interacts with infections, significantly increasing the odds of anemia (OR: 13.26, p = 0.022). This interaction was stronger among children with iron deficiency anemia (OR: 46.66, p = 0.003). Our results suggest that zinc deficiency may impair the immune response to infections and/or that intestinal parasites could have developed mechanisms to avoid zinc-limited environments. Further studies are needed to corroborate these suggestions.This study had financial support from the Fundação Calouste Gulbenkian and Camões IP, Instituto da Cooperação e da Língua from Portugalinfo:eu-repo/semantics/publishedVersio

Anemia in preschool children from Angola

Angola is one of the southern African countries with the highest prevalence of anemia, and despite the high geographic heterogeneity of its distribution across the country, it was reported to be indicative of a severe public health problem in some areas, mainly in children. Despite the relevance of this condition in the country, there is still an important gap regarding scientific evidence and knowledge systematization in the indexed literature, that could be used to inform and optimize national public health policies willing to address it. Furthermore, the changes in anemia epidemiology among African preschool children and the late updates in nutrition-specific and nutrition-sensitive preventive strategies in the continent are of imperative relevance, as they could contribute to design context-specific national approaches to reduce anemia's morbidity and mortality. In this study, we intend to perform a systematic review regarding the sparse evidence available on the country regarding the prevalence of anemia, its associated factors, the prevention, and/or control strategies with the potential to reduce anemia that was implemented, and to discuss interventions targeting infections and/or nutrition conducted in other African countries.info:eu-repo/semantics/publishedVersio

Zinc Deficiency Interacts with Intestinal/Urogenital Parasites in the Pathway to Anemia in Preschool Children, Bengo-Angola

This article belongs to the Section Micronutrients and Human Health.In host organisms with normal micronutrient status, nutritional immunity is a strongly regulated response aiming at decreasing the progression and severity of infections. Zinc deficiency may disturb this balance, impairing immune responses to infections, which may indirectly increase infection-related anemia. Since zinc deficiency may associate directly with anemia, the role of infections is often overlooked. Herein, we investigated the participation of infections (or inflammation) in the causal pathway between zinc deficiency and anemia. This transversal study, conducted in 2015 in Bengo-Angola, enrolled 852 under-3-year-old children. Logistic regression models were used to investigate interaction and mediation effects, and significance was confirmed by the Sobel test. In sum, 6.8% of children had zinc deficiency, 45.9% had anemia, and 15.6% had at least one intestinal/urogenital parasite. Furthermore, we found (1) no evidence that inflammation mediates or interacts with zinc deficiency to cause anemia, and (2) zinc deficiency interacts with infections, significantly increasing the odds of anemia (OR: 13.26, p = 0.022). This interaction was stronger among children with iron deficiency anemia (OR: 46.66, p = 0.003). Our results suggest that zinc deficiency may impair the immune response to infections and/or that intestinal parasites could have developed mechanisms to avoid zinc-limited environments. Further studies are needed to corroborate these suggestions.This study had financial support from the Fundação Calouste Gulbenkian and Camões IP, Instituto da Cooperação e da Língua from Portugalinfo:eu-repo/semantics/publishedVersio

Efficacy of Nutrition and WASH/Malaria Educational Community-Based Interventions in Reducing Anemia in Preschool Children From Bengo, Angola: Study Protocol of a Randomized Controlled Trial

Angola reports one of the highest infant mortality rates in the world, and anemia represents one of its important causes. Recent studies, in under-five children from the Bengo province of Angola, described high prevalence’s, suggesting malaria, undernutrition and urogenital schistosomiasis as important contributors for the occurrence and spatial variations of anemia. Educational community-based interventions, either in Nutrition and Water, Sanitation, Hygiene and Malaria are recommended to correct anemia. Herein, we designed a cluster-randomized controlled trial to study the efficacy of two educational-plus-therapeutic interventions in the reduction of anemia: one in nutrition and the other in WASH/Malaria. Socioeconomic, nutritional, anthropometric, parasitological and biochemical data will be collected from all willing-to-participate children, aging under four and resident in the Health Research Center of Angola study area. Considering the multifactorial causes of this condition, determining the efficacy of both interventions might help documenting weaknesses and opportunities for planning integrated strategies to reduce anemia.The promoters of CISA providing financial support for this study are as follows: Camões, Institute of Cooperation and Language, Portugal; Calouste Gulbenkian Foundation, Portugal; Government of Bengo Province; Angolan Ministry of Health. Additionally, this investigation also receives financial support from TDR, The Special Programmed for Research and Training in Tropical Diseases, co-sponsored by UNICEF, UNDP, the World Bank and WHO (for molecular analyses) and from Bank Foment of Angola (for determining the serum micronutrient levels). Representing the Angolan Ministry of Health, the National Malaria Control Program and the National Neglected Tropical Diseases Control Program agreed to provide rapid malaria diagnostic tests, mosquito bed nets, antimalarial drugs and also drugs for intestinal parasites and schistosomiasis for this study. At the local level, the General Hospital of Bengo will provide the facilities for biochemical analysis and facilities for consultations, and will also receive and manage the pediatric emergency cases referred by the study’s field nurses. Furthermore, the David Bernardino Paediatric Hospital agreed to provide the Molecular Biology Laboratory for the molecular analyses.info:eu-repo/semantics/publishedVersio

Prevalence and determinants of under and overnutrition among under five children in Bengo Province, Angola

Introduction - Children malnutrition is a major public health problem in developing countries. Identifying the risk factors of malnutrition and determining their magnitude is necessary to develop nutritional interventions to confront this problem. Aim - The aim of this study is to assess the determinants associated to under and overnutrition in children under 5 years in Bengo Province, Angola. Methods - A community-based cross-sectional study was used during August to September 2014. A questionnaire adapted from ProPAN 14, willing to collect data on children’s general health care, breastfeeding and feeding practices, food ingestion in the previous 24 hours, socioeconomic characteristics and water supply, was applied. Anthropometric measures were collected from all children and mothers to determine their nutritional status Univariate and multivariate analysis were performed to identify factors related to malnutrition. Results - The survey was conducted during 30 days and comprehended 808 children aged 0 to 59 months, from which 50.5% were male Infant wasting, stunting, and underweight prevalence were 7.7%, 35.8%, and 15.2% respectively. The prevalence of overnutrition was 4.2%, with 3.4% of overweight and 0.8% obese. Risk factors significantly associated with stunting were increased age of children (OR = 4.45, 95%CI 1.98, 9.95), low birth weight (OR = 2.23; 95%CI 1.20, 4.11), insufficient information about child feeding among caregivers (OR = 2.23; 95%CI 1.20, 4.15), and non-exclusive breastfeeding (OR = 1.88; 95%CI 1.30, 2.76). Inadequate dietary diversity was significantly associated with a higher risk of wasting (OR = 2.97; 95%CI 1.21, 7.32). Both stunting and wasting were significantly associated with diarrhea in the previous two weeks (OR = 1.50; 95%CI 1.07, 2.08 and OR = 3.08; 95%CI 1.48, 6.41, respectively) and living in a household with more than two children aged under five (OR = 1.50; 95%CI 1.04, 2.18 and OR = 3.19; 95%CI 1.51, 6.77, respectively). Conclusion - Undernutrition is common among children under 5 years in Bengo province. Age, birth weight, child feeding knowledge, type of breastfeeding, dietary diversity, diarrhea morbidity and the number of under-five children living at household were related to undernutrition. The presented results evidence the need of nutritional interventions in order to control children malnutrition risk factors.info:eu-repo/semantics/publishedVersio

Impacto de uma formação na qualidade do diagnóstico microscópico de malária em Angola

A malária é uma doença endémica em Angola responsável por elevada morbilidade e mortalidade, especialmente entre crianças menores de cinco anos. Uma boa performance das técnicas de diagnóstico de malária é essencial uma vez que reduz o uso irracional de antimaláricos e melhora a qualidade da vigilância epidemiológica. A microscopia é o método de diagnóstico de referência, no entanto, a qualidade dos resultados varia consideravelmente entre laboratórios principalmente devido ao nível da experiência dos técnicos, qualidade dos reagentes e equipamentos. Neste estudo pretendemos avaliar a performance da microscopia no diagnóstico da malária, antes e após a realização de um curso de formação de 3 dias, utilizando o qPCR como método de referência

Impact of a training course on the quality of malaria diagnosis by microscopy in Angola

Background: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method. Methods: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy. Results: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed. Discussion: The findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel