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- Sistema de vigilância de morbilidade pediátrica no Hospital Geral do BengoPublication . Oliveira, Ana; Gasparinho, Carolina; Mayer, António Carlos; Ribeiro, Natália; Brito, MiguelAngola 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.
- 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.
- Estudo dos agentes causais de diarreia em crianças menores de 5 anos no Hospital Geral do BengoPublication . Gasparinho, C.; Mirante, M.C.; Lima, S.; Nery, S.; Istrate, C.; Mayer, A. C.; Brito, MiguelA diarreia pode ser causada por vírus, parasitas e bactérias e constitui uma das principais causas de doença e morte em crianças menores de cinco anos em Angola. O presente estude assume como principal objectivo identificar os agentes patogénicos causadores de diarreia em crianças admitidas no Hospital Geral do Bengo.
- Effectivity of wash/malaria educational community-based intervention in reducing anemia among preschool children from Bengo, AngolaPublication . Fançony, Claudia; Soares, Ania; Brito, MiguelExclusive therapeutic approaches promptly clear infections, however, in heavily contaminated environments high reinfections and incidence rates may occur limiting the sustainability of these approaches. Integrating therapeutic and preventive WASH/malaria educational strategies can simultaneously treat infections and reduce disease transmission, resulting in reduced anemia. This study, nested into a major research project investigating the efficacy of educational approaches in reducing anemia, was conducted in 2015 /2016 in CISA's study area, located in Bengo - Angola, and included 312 children randomized to the WASH/Malaria arm. Demographic, socio-economic, Water, Sanitation, Hygiene, and Malaria parental practices, and parasitological and biochemical data were collected at baseline and at 12-month follow-up. These moments were intercalated with 3 monthly domiciliary educational visits aiming at increasing the health literacy of caretakers and collect indicators of changed/improved behavior. T-student, McNemar Test, and Chi-2 tests were used to determine variations on the primary and secondary outcomes. 202 children have completed the study. Despite that, the mean hemoglobin increased levels and total anemia prevalence reduction were not statistically significant (from 11.2g/dL to 11.4g/dL, p=0.21 and from 38.6 to 33.2%, p= 0.21 respectively), an 8.4% reduction in the Iron Deficiency Anemia prevalence was observed (p=0.01). A significant increase in the prevalence of infections was observed, mainly P. falciparum (1.5 to 6.4%), G.lamblia (9.2 to 20.6%), and A. lumbricoides (6.1 to 26.7%). 50.5% of children’s hands and 43.4% of the household’s observations scored 5-6 points for the cleaning state of the nails and for the cleaning state of latrines, respectively. 81.2% of the households scored 0-1 point regarding having water in the latrine to wash hands, 53.3%, 60.1%, and 78.5% were observed to have garbage, loose domestic animals, or puddles in the home surroundings. Neither the reduction of IDA nor the increased infection prevalence were found to be statistically associated with the educational process indicators collected here.
- 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.
- Unusual β-globin haplotype distribution in newborns from Bengo, AngolaPublication . Borges, Eliana; Tchonhi, Chissengo; Couto, Cátia S. B.; Gomes, Verónica; Amorim, Antonio; Prata, Maria João; Brito, MiguelMutations on the HBB gene are a common cause of hemoglobinopathies, including sickle cell anemia, a severe genetic condition that constitutes a major public health concern. The aim of this study was to determine the prevalence of sickle cell anemia and β-globin haplotype distribution in newborns from the Bengo region. The first two exons of β-globin gene were sequenced, and the variability at the single nucleotide polymorphism (SNP) defining the Hb S (HBB: c.20A>T) haplotypes, was analyzed by a SNaPshot® Multiplex system. About 3.3% of the children were homozygous for Hb S, and 82.2% had as background the Bantu/Central African Republic (BAN/CAR) haplotype, 11.2% the Benin (BEN) and 6.6% the Senegal (SEN). The estimate of Hb S reached the very high value of 0.1476 ± 0.0133, with the aggravating factor of 82.2% of the sickle alleles being anchored in the BAN/CAR haplotype, associated with the more severe sickle cell anemia phenotypes. Also, the high prevalence of the SEN haplotype was not expected, having therapeutic consequences since is associated with more severe outcomes. In addition, two β-thalassemia (β-thal) variants were also detected, IVS I-110 (G>A) (HBB: c.93-21G>A) and codon 39 (C>T) (HBB: c.118C>T), together totaling a frequency of 1.3%. Some of the newborns with these mutations were compound heterozygotes for Hb S, likely carrying genotypes consistent with sickle cell disease. As a whole, infants molecularly diagnosed with sickle cell disease accounted for 4.5% of newborns from Bengo, Angola, a figure that per se, highlights the urgent need of implementing policies warranting surveillance of these children, in parallel with community education in the region.
- 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.
- Clinical, serological and DNA testing in Bengo Province, Angola further reveals low filarial endemicity and opportunities for disease eliminationPublication . Paulo, Rossely; Brito, Miguel; Van-Dunem, Pedro; Martins, António; Novak, Robert J.; Jacob, Benjamin; Molyneux, David M.; Unnasch, Thomas R.; Stothard, J. Russell; Kelly-Hope, LouiseThe prevalence of Loa loa, Onchocerca volvulus, and Wuchereria bancrofti infections in an under-surveyed area of Bengo Province, Angola, was determined by surveying 22 communities with a combination of clinical, serological, and DNA diagnostics. Additional information was collected on participants' duration of residency, access to mass drug administration, knowledge of insect vectors, and use of bednets. A total of 1616 individuals (38.1% male: 61.9% female), with an average age of 43 years, were examined. For L. loa, 6.2% (n = 100/16616) individuals were found to have eyeworm, based on the rapid assessment procedure for loiasis (RAPLOA) surveys, and 11.5% (n =178/1543) based on nested PCR analyses of venous blood. L. loa prevalences in long-term residents (>10 years) and older individuals (>60 years) were significantly higher, and older men with eyeworm were better informed about Chrysops vectors. For O. volvulus, 4.7% (n = 74/1567) individuals were found to be positive by enzyme-linked immunosorbent assay (Ov 16 ELISA), with only three individuals reporting to have ever taken ivermectin. For W. bancrofti, no infections were found using the antigen-based immunochromatographic test (ICT) and real-time PCR analysis; however, 27 individuals presented with lymphatic filariasis (LF) related clinical conditions (lymphoedema = 11, hydrocoele = 14, both = 2). Just under half (45.5%) of the participants owned a bednet, with the majority (71.1%) sleeping under it the night before. Our approach of using combination diagnostics reveals the age-prevalence of loiasis alongside low endemicity of onchocerciasis and LF. Future research foci should be on identifying opportunities for more cost-effective ways to eliminate onchocerciasis and to develop innovative surveillance modalities for clinical LF for individual disease management and disability prevention.
- Tobacco consumption and nicotine dependence in Bengo Province, Angola: a community-based surveyPublication . Pedro, João de Almeida; Brito, Miguel; Barros, HenriqueThere is concern about the potentially increasing use of tobacco in Angola. However, information on the frequency and determinants of this use is not systematized. This study aimed to estimate the prevalence of tobacco consumption and nicotine dependence among smokers in an Angolan population and considering individual socio-demographic and behavioral characteristics. A community-based survey of 2,472 respondents (age range: 15-64 years) was conducted in 2013-2014 in the country's Bengo Province. The collection methodology for assessing each type of tobacco consumption and its daily quantification followed the World Health Organization STEPwise approach to chronic disease risk factor surveillance. The Fagerström Test for Nicotine Dependence was also used to assess smokers. Mean values for the prevalence of tobacco use and nicotine dependence were estimated by sex and by previously defined variables. Daily smoking (6.1%) was found to be higher for males (10.0%) them among females (2.6%), and the number of ex-smokers (7.5%) was higher them smokers. Only 0.2% of those surveyed reported the use of smokeless (chewing) tobacco. One-third of ever-smokers reported having started smoking daily before age 18. Nicotine dependence levels were classified as very low or low in 83.6% of the smokers. Daily smoking prevalence increased with age and was higher in rural areas and among individuals with no formal education, lower incomes, and alcohol consumption. This population presented a low smoking prevalence, along with a low number of daily smoked cigarettes and low levels of nicotine dependency, despite the low prices of, and easy access to, manufactured cigarettes. These two factors conjugated with the current absence of an Angolan policy for tobacco control, enhance the susceptibility to rising overall tobacco use in the near future.
- Comparing concentration methods: Parasitrap® versus Kato-Katz for studying the prevalence of helminths in Bengo province, AngolaPublication . Mirante, Clara; Clemente, Isabel; Zambu, Graciette; Alexandre, Catarina; Ganga, Teresa; Mayer, Carlos; Brito, MiguelBackground: Helminth intestinal parasitoses are responsible for high levels of child mortality and morbidity. Hence, the capacity to diagnose these parasitoses and consequently ensure due treatment represents a factor of great importance. Objectives: The main objective of this study involves comparing two methods of concentration, parasitrap and Kato-Katz, for the diagnosis of intestinal parasitoses in faecal samples. Methods: Sample processing made recourse to two different concentration Methods: the commercial parasitrap® method and the Kato-Katz method. Results: We correspondingly collected a total of 610 stool samples from pre-school and school age children. The results demonstrate the incidence of helminth parasites in 32.8% or 32.3% of the sample collected depending on whether the concentration method applied was either the parasitrap method or the Kato-Katz method. We detected a relatively high percentage of samples testing positive for two or more species of helminth parasites. We would highlight that in searching for larvae the Kato-Katz method does not prove as appropriate as the parasitrap method. Conclusion: Both techniques prove easily applicable even in field working conditions and returning mutually agreeing results. This study concludes in favour of the need for deworming programs and greater public awareness among the rural populations of Angola.