Loading...
38 results
Search Results
Now showing 1 - 10 of 38
- Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adultsPublication . NCD Risk Factor Collaboration (NCD-RisC); Brito, MiguelBackground: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia, Micronesia, and countries in the Middle East and North Africa. Obesity prevalence was higher than underweight with a posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with the highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were Polynesia Micronesia and the Caribbean for both sexes and Chile and Qatar for boys. Combined prevalence was also high in some countries in South Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in South Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of being underweight while curbing and reversing the increase in obesity.
- Prevalence and determinants of under and overnutrition among under five children in Bengo Province, AngolaPublication . Brito, Miguel; Tamayo, Sara; Fançony, Cláudia; Soares, ÂniaIntroduction - 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.
- Molecular characterization of Giardia lamblia in children less than 5 years of age with diarrhoea attending the Bengo General Hospital, AngolaPublication . Gasparinho, Carolina; Ferreira, Filipa S.; Mayer, António Carlos; Mirante, Maria Clara; Vaz Nery, Susana; Santos-Reis, Ana; Portugal-Calisto, Daniela; Brito, MiguelIntroduction - 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.
- Comparative efficacy and safety of pharmacological interventions for managing sickle cell disease complications in children and adolescents: a systematic review with network meta-analysesPublication . Tonin, Fernanda; Ginete, Catarina; Ferreira, Joao; Delgadinho, Mariana; Fernandez-Llimos, Fernando; Brito, MiguelObjectives: Sickle cell disease (SCD), an inherited hemoglobinopathy that causes anemia, severe pain, and vaso-occlusive crisis (VOC), is currently recognized as a global public health concern, being the leading cause of pediatric stroke. Our aim was to synthesize the evidence on the efficacy and safety of interventions for managing SCD in this population. Methods: A systematic review with searches in PubMed, Scopus, and Web of Science was performed (April-2022). Randomized controlled trials comparing disease-modifying agents in SCD patients under 18 years old were included. For each outcome of interest, data were pooled by means of Bayesian network meta-analyses with the surface under the cumulative ranking curve analyses (SUCRA). Results were reported as odds ratio (OR) with 95% credibility intervals (CrI). Results: Seventeen trials (1982-2022) mostly from African countries (65%) and North America (53%), assessing the effect of different interventions’ regimens (hydroxyurea [n=6 trials], L-arginine [n=3], antiplatelets [n=2], immunotherapy/monoclonal antibodies [n=2], sulfates [n=2], docosahexaenoic acid [n=1], niprisan [n=1]) and placebo were included. No statistical differences among treatments were found for the main outcomes. SUCRA revealed that immunotherapy/monoclonal antibodies and hydroxyurea 20 mg/kg are potentially more effective against acute chest syndrome (83% and 76% probabilities, respectively), VOC (71% and 80%, respectively) and needing of transfusions (72% and 75%, respectively), while L-arginine (100-200 mg/kg) and placebo were more prone to these events. Although therapies were overall considered safe, antiplatelet and sulfates may lead to more discontinuations and severe adverse events (uncertainty evidence). Results were similar between age subgroups (<10 years vs. 10-19 years). Conclusions: The available evidence on the effect of drugs on managing SCD in children and adolescents is insufficient and weak. No clear definition for some outcomes exists. Hydroxyurea may remain the standard of care for this population, however, long-term well-designed, and well-reported trials comparing new immunotherapy/monoclonal antibodies should be performed.
- 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.
- How hydroxyurea alters the gut microbiome: a longitudinal study involving Angolan children with sickle cell anemiaPublication . Delgadinho, Mariana; Ginete, Catarina; Santos, Brígida; Fernandes, Carolina; Silva, Carina; Miranda, Armandina; Vasconcelos, Jocelyne Neto de; Brito, MiguelSickle cell anemia (SCA) is an inherited hematological disorder and a serious global health problem, especially in Sub-Saharan Africa. Although hydroxyurea (HU) is the leading treatment for patients with SCA, its effects on the gut microbiome have not yet been explored. In this context, the aim of this study was to investigate this association by characterizing the gut microbiome of an Angolan SCA pediatric population before and after 6 months of HU treatment. A total of 66 stool samples were obtained and sequenced for the 16S rRNA gene (V3-V4 regions). Significant associations were observed in alpha and beta-diversity, with higher values of species richness for the children naïve for HU. We also noticed that children after HU had higher proportions of several beneficial bacteria, mostly short-chain fatty acids (SCFAs) producing species, such as Blautia luti, Roseburia inulinivorans, Eubacterium halli, Faecalibacterium, Ruminococcus, Lactobacillus rogosae, among others. In addition, before HU there was a higher abundance of Clostridium_g24, which includes C. bolteae and C. clostridioforme, both considered pathogenic. This study provides the first evidence of the HU effect on the gut microbiome and unravels several microorganisms that could be considered candidate biomarkers for disease severity and HU efficacy.
- Lack of association between asthma, atopy and helminthic infection in school-age children in the province of Bengo, AngolaPublication . Arrais, Margarete; Sachicola, Ofélia; Quifica, Francisca; Gama, Jorge; Taborda-Barata, Luis; Brito, MiguelBackground: Epidemiological studies conducted in several countries worldwide and in some African countries have shown that there is controversy in the relationship between asthma, atopy, and helminthic infection. The aim of this study was to fully evaluate such a relationship in children living in areas of high and moderate helminthic prevalence. Method: Cross-sectional study using the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), conducted from September to November 2017, in the Province of Bengo, Angola. From a total of 33 schools, five (15%), three in urban and two in rural areas were randomly selected. Atopy was defined by positive skin prick tests and/or specific IgE to aeroallergens (Phadiatop), and helminthic infection was defined by the presence of helminths in feces. Data were obtained regarding the helminthic load, types of helminths, previous infections, and anti-helminthic treatments, and were analyzed with SPSS Statistics v25.0. Results: The sample consisted of 1023 children, 48% female, 58% 10 to 14 years old, and 61% living in urban areas. About 9% had asthma, 22% had rhinitis, 16% had eczema, 8% were atopic and 36% were infected by helminths. The most frequently detected helminths were Ascaris lumbricoides (23% of children), Hymenolepsis nana (6%), and Trichuris trichiuria (4%). No relationship was detected between the prevalence of asthma, rhinitis, or atopy and parameters of helminthic infection. Conclusion: No relationship was apparent between the prevalence of asthma, atopy, and helminth infection. Further studies are warranted, namely, cohort studies with long follow-up monitoring since birth.
- 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.
- 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.
- Effect of deworming on hemoglobin concentration in children from 2 to 15 years from the Bengo Province, AngolaPublication . Brito, Miguel; Lemos, Manuel; Mirante, Clara; Moura, Sofia; Mayer, CarlosThe most common causes of anemia are micronutrient deficiencies, but other factors may influence namely inflammation, parasitic infections and inherited disorders. One strategy to combat micronutrient deficiencies is supplementation, yet, in zones with high prevalence of Schistosomiasis or Soil Transmitted Helminthes (STH), supplementation could be not sufficient. The aim of this study was to evaluate the effects of deworming, on hemoglobin concentration, in children from 2 to 15 years, from Bengo.