Browsing by Author "Barros, Henrique"
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- Anemia in preschool children from AngolaPublication . Fançony, Cláudia; Lavinha, João; Brito, Miguel; Barros, HenriqueAngola 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 in 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.
- CardioBengo study protocol: a population based cardiovascular longitudinal study in Bengo Province, AngolaPublication . Pedro, João M.; Rosário, Edite; Brito, Miguel; Barros, HenriqueBackground: Cardiovascular diseases and other non-communicable diseases are major causes of morbidity and mortality, responsible for 38 million deaths in 2012, 75 % occurring in low- and middle-income countries. Most of these countries are facing a period of epidemiological transition, being confronted with an increased burden of non-communicable diseases, which challenge health systems mainly designed to deal with infectious diseases. With the adoption of the World Health Organization “Global Action Plan for the Prevention and Control of non-communicable diseases, 2013–2020”, the national dimension of risk factors for non-communicable diseases must be reported on a regular basis. Angola has no national surveillance system for non-communicable diseases, and periodic population-based studies can help to overcome this lack of information. CardioBengo will collect information on risk factors, awareness rates and prevalence of symptoms relevant to cardiovascular diseases, to assist decision makers in the implementation of prevention and treatment policies and programs. Methods: CardioBengo is designed as a research structure that comprises a cross-sectional component, providing baseline information and the assembling of a cohort to follow-up the dynamics of cardiovascular diseases risk factors in the catchment area of the Dande Health and Demographic Surveillance System of the Health Research Centre of Angola, in Bengo Province, Angola. The World Health Organization STEPwise approach to surveillance questionnaires and procedures will be used to collect information on a representative sex-age stratified sample, aged between 15 and 64 years old. Discussion: CardioBengo will recruit the first population cohort in Angola designed to evaluate cardiovascular diseases risk factors. Using the structures in place of the Dande Health and Demographic Surveillance System and a reliable methodology that generates comparable results with other regions and countries, this study will constitute a useful tool for the surveillance of cardiovascular diseases. Like all longitudinal studies, a strong concern exists regarding dropouts, but strategies like regular visits to selected participants and a strong community involvement are in place to minimize these occurrences.
- Cardiovascular risk assessment in Angolan adults: a descriptive analysis from CardioBengo, a community-based surveyPublication . Pedro, João Mário; Brito, Miguel; Barros, HenriqueFrom a community-based survey conducted in Angola, 468 individuals aged 40 to 64 years and not using drug therapy were evaluated according to the World Health Organisation STEPwise Approach to Chronic Disease Risk Factor Surveillance. Using data from tobacco use, blood pressure, blood glucose, and total cholesterol levels, we estimated the 10-year risk of a fatal or nonfatal major cardiovascular event and computed the proportion of untreated participants eligible for pharmacological treatment according to clinical values alone and total cardiovascular risk. The large majority of participants were classified as having a low (<10%) 10-year cardiovascular risk (87.6%), with only 4.5% having a high (≥ 20%) cardiovascular risk. If we consider the single criteria for hypertension, 48.7% of the population should be considered for treatment. This value decreases to 22.0% if we apply the risk prediction chart. The use of hypoglycaemic drugs does not present any differences (19.0% in both situations). The use of lipid-lowering drugs (3.8%) is only recommended by the risk prediction chart. This study reveals the need for integrated approaches for the treatment of cardiovascular disorders in this population. Risk prediction charts can be used as a way to promote a better use of limited resources.
- Effectiveness of nutrition and WASH/malaria educational community-based interventions in reducing anemia in children from AngolaPublication . Fançony, Cláudia; Soares, Ânia; Lavinha, João; Barros, Henrique; Brito, MiguelWe found no published data in Angola regarding the effect of combining nutrition-specific and nutrition-sensitive approaches in the reduction of anemia in preschool children. Thus, we implemented a cluster-randomized controlled trial to determine the effectiveness of two educational-plus-therapeutic interventions, in Nutrition and WASH/Malaria, in reducing anemia. We compared them to (1) a test-and-treat intervention and (2) with each other. A block randomization was performed to allocate 6 isolated hamlets to 3 study arms. A difference-in-difference technique, using Fit Generalized estimating models, was used to determine differences between the children successfully followed in all groups, between 2015 and 2016. We found no significant differences in anemia´s and hemoglobin variability between educational and the control group. However, the WASH/Malaria group had 22.8% higher prevalence of anemia when compared with the Nutrition group, having also higher prevalence of P. falciparum. Thus, our results suggest that adding a 12-month educational Nutrition or a WASH/Malaria component to a test-and-treat approach may have a limited effect in controlling anemia. Possibly, the intensity and duration of the educational interventions were not sufficient to observe the amount of behavior change needed to stop transmission and improve the general child feeding practices.
- 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 trialPublication . Fançoni, Cláudia; Soares, Ânia; Lavinha, João; Barros, Henrique; Brito, MiguelAngola 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 to document weaknesses and opportunities for planning integrated strategies to reduce anemia.
- Gender and socio-demographic distribution of body mass index: the nutrition transition in an adult Angolan communityPublication . Pedro, João Mário; Brito, Miguel; Barros, HenriqueThis cross-sectional survey with 2357 subjects aged 15 to 64 years from a rural-urban community in Bengo Province, Angola, aimed to evaluate the gender differences in the prevalence of body mass index categories and how socio-demographic characteristics influence it. Women presented a significantly higher prevalence of obesity (10.5% versus 2.8%) but the underweight frequency was similar to men (10.2% versus 12.4%). Overweight and obesity increased with age, with underweight being more prevalent in the age group 15 to 24 years. Obesity was more prevalent among individuals living with a companion (in a marital relation), decreased with education (in women), but was higher in rural areas, and for those with a higher family monthly income, in both genders. The prevalence of obesity and underweight were similar in women, reflecting a nutrition transition state. Like in other African communities, women present a higher prevalence of overweight and obesity them men, but the values of underweight are similar between genders. This stresses the need for designed health interventions for women, to face the double burden and accumulation of risk factors in women.
- Integrated community-based intervention for urinary schistosomiasis and soil-transmitted helminthiasis in children from Caxito, AngolaPublication . Lemos, Manuel; Fançony, Cláudia; Moura, Sofia; Mirante, Clara; Sousa, Pinto de; Barros, Henrique; Nery, Susana; Brito, MiguelBackground: Schistosomiasis and soil-transmitted helminths (STH) infections are major public health problems. We aimed to study the 6-mo impact of mass drug administration with praziquantel and albendazole on urinary schistosomiasis and STH. Methods: We examined children (aged 2–15 y) from one hamlet, who provided urine and feces samples at baseline (n=197), 1 mo (n=102), and 6 mo (n=92); 67 completed the protocol. Results: At baseline, 47/67 (70.1%) children presented Schistosoma haematobium (75.8% in the baseline total sample) and 12/67 (17.9%) with STH (30.5% in the initial sample, p=0.010). Among the children, 47.3% had heavy Schistosoma haematobium infection. The most frequent STH was Trichuris trichiura in 9.0%. We also found Hymenolepis nana (13.2%) and Plasmodium falciparum (9.1%) infections and anemia (82.1%). One mo after chemotherapy there was a significant (p=0.013) reduction of Schistosoma haematobium prevalence (23.5%) and a high egg reduction rate (86.9%). Considering the sample of 67 children, the mean egg concentration was 498 at baseline, 65 at 1 mo, and 252 at 6 mo (p<0.05). We also observed a reduction in STH infections, 50% in Ascaris lumbricoides, 33.3% in T. trichiura, and 50% in hookworms. At 6 mo, the prevalence of Schistosoma haematobium (76.1%) was similar to the baseline and the STH reduction was not significant. Conclusions: Longitudinal studies have reported many losses in these settings, but we were able to show that mass drug administration for control of schistosomiasis and STH presents low effectiveness, that reinfections occur rapidly and that stand-alone anthelmintic therapy is not a sustainable choice.
- Iron deficiency anaemia among 6-to-36-month children from northern AngolaPublication . Fançony, Cláudia; Soares, Ânia; Lavinha, João; Barros, Henrique; Brito, MiguelBackground: Angola is one of the southern African countries with the highest prevalence of anemia. Identifying anemia determinants is an important step in the design of evidence-based control strategies. In this study, we aim at documenting the factors associated with Iron Deficiency Anaemia (IDA) in 948 children recruited at the Health Research Center of Angola study area during 2015. Methods: Data on demographic, socio-economic, and parental practices regarding water, sanitation, hygiene, malaria infection, and infant and young child feeding were collected, as well as parasitological, biochemical, and molecular data. Total and age-stratified multivariate multinomial regression models were fitted to estimate the magnitude of associations between anemia and its determinants. Results: Anaemia was found in 44.4% of children, of which 46.0% had IDA. Overall, regression models associated IDA with age, gender and inflammation and non-IDA with age, zinc deficiency and overload, P. falciparum infection, sickle cell trait/anemia. Among 6-to-23-month-old children, IDA was associated with continued breastfeeding, and among 24-to-36-month-old children, IDA was associated with stunting. Furthermore, zinc deficiency was associated with non-IDA among both age groups children. Inflammation was associated with IDA and non-IDA in either 6-to-23 and 24-to-36 months old children. Conclusion: The main variables associated with IDA and non-IDA within this geographic setting were commonly reported in Africa, but not specifically associated with anemia. Additionally, the associations of anemia with inflammation, zinc deficiency, and infections could be suggesting the occurrence of nutritional immunity and should be further investigated. In age groups, zinc overload was observed to protect under 6 months children from Non-IDA, while continued breastfeeding was associated with increased IDA prevalence in 6-to-23 months children, and stunting was suggested to increase the odds of IDA in 24-to-36 month children. This site-specific etiology profile provides an essential first set of evidences able to inform the planification of preventive and corrective actions/programs. Nevertheless, regional and country representative data is needed.
- Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia among adults in Dande municipality, AngolaPublication . Pedro, João Mário; Brito, Miguel; Barros, HenriqueObjectives: To estimate the prevalence, awareness, treatment, and control of hypertension, diabetes and hypercholesterolaemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics. Methods: A total of 2 354 individuals were assessed for behavioural, sociodemographic and physical characteristics in a cross-sectional, community-based survey. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the conditions were calculated using logistic regression models. Results: Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled. Conclusions: The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment, and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population.
- Schistosomiasis and soil-transmitted helminthiasis preventive chemotherapy: adverse events in children from 2 to 15 years in Bengo province, AngolaPublication . Lemos, Manuel; Pedro, João M.; Fançony, Cláudia; Moura, Sofia; Brito, Miguel; Nery, Susana Vaz; Sousa, Carlos Pinto; Barros, HenriquePreventive chemotherapy campaigns with praziquantel and albendazole are being implemented in Angola, as a high-priority public health intervention. However, there are no published data regarding adverse events associated with these medications. In this context, we analyzed adverse events due to co-administration of praziquantel and albendazole in endemic areas of schistosomiasis and soil-transmitted helminths in Bengo, Angola. In the context of a targeted drug administration, between December 2012 and September 2013, we conducted two surveys after co-administrating single oral doses of praziquantel and albendazole tablets to children 2 to 15 years of age. About 24 hours after each treatment, participants answered a questionnaire about adverse events. At baseline, 605 children (55.0% male; mean age: 9.7 years) were treated; 460 were interviewed and 257 (55.9%) reported at least one adverse event, 62.3% (160/257) of children being infected with Schistosoma haematobium. After six months of treatment, among 339 children surveyed, 184 (54.3%) reported adverse events, with 49.5% (91/184) of infected children. Adverse events were most common in preschool-aged children, with no significant difference between genders. The most frequent adverse events in the two surveys were abdominal pain (18.5%, 25.7%), headache (20.9%, 23.0%) and dizziness (15.7%, 19.8%). Children aged 12 to 15 years (adjusted OR = 0.40, p = 0.040) and those with mixed infection (adjusted OR = 0.04, p = 0.011) had lower odds of adverse events. After the second treatment, those with heavy infection (adjusted OR = 2.72, p = 0.018) and aged 9-11 years (adjusted OR = 2.01, p = 0.049) had significantly fewer adverse events. About 2.0% of children experienced severe adverse events. This study adds evidence that preventive chemotherapy for schistosomiasis and soil-transmitted helminths control is safe, but cases of adverse events are expected. Standardized methodologies to discriminate drug-related adverse events from the clinical manifestations of the infections are needed.