The Epidemiology of Diarrhea in Children Under 5 Years of Age in Mozambique

Chissaque, Assucênio; Deus, Nilsa de; Vubil, Delfino; Mandomando, Inácio

doi:10.1007/s40475-018-0146-6

Cited by 29 publications

(36 citation statements)

References 51 publications

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“…Among intestinal parasites, Cryptosporidium spp. is most common in children with diarrhea, followed by Giardia lamblia and Entamoeba histolytica [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

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Background Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection. Methodology We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immuneenzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection. Results Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value < 0.01); animal contact (children with animal contact PLOS NEGLECTED TROPICAL DISEASES

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“…Among intestinal parasites, Cryptosporidium spp. is most common in children with diarrhea, followed by Giardia lamblia and Entamoeba histolytica [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

et al. 2020

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“…In 2008, strategies such as RED and National Health Week -where several immunization activities (vaccination in primary schools, health services to child and women in childbearing age, vaccine education, and mobilization) are carried out -, were implemented in order to increase coverage and reduce inequities related to the provision of vaccination services 20,21 . Moreover, community health workers (CHW) have supported many health programs, including EPI by extending its services to the most vulnerable and disadvantaged population, thus achieving more satisfactory public health 16 .…”

Section: Characteristics Of Epi and Immunization Policies In Mozambiquementioning

confidence: 99%

“…A recent analysis showed that due to several actions implemented in the country including vaccination against rotavirus, a significant reduction in the burden of diarrhea in Mozambique is observed 21 .…”

Section: • Rotavirusmentioning

confidence: 99%

40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives

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In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.

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“…In Mozambique, despite the trend of diarrheal decline over the years (1997–2011), it remains among the major causes of morbidity and mortality in children aged less than 5 years [ 12 ], particularly in Manhiça district [ 13 ]. Studies reporting the occurrence of DEC in Mozambique remain scarce, and often focus on molecular screening of the three most common pathotypes (EAEC, ETEC and EPEC) [ 5 , 11 , 14 – 17 ] rather than all DEC. As part of the Global Enteric Multicenter Study (GEMS) we have previously demonstrated that ETEC, producing stable toxin (ST-ETEC) was the only E. coli pathotype associated to moderate-to-severe diarrhea (MSD) [ 16 ] and less-severe diarrhea (LSD) [ 17 ] in toddlers (12–23 months) in Mozambique.…”

Section: Introductionmentioning

confidence: 99%

Low frequency of enterohemorrhagic, enteroinvasive and diffusely adherent Escherichia coli in children under 5 years in rural Mozambique: a case-control study

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Background Diarrheagenic Escherichia coli (DEC) are among the leading pathogens associated with endemic diarrhea in low income countries. Yet, few epidemiological studies have focused the contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (DAEC). Methods We assessed the contribution of EHEC, EIEC and DAEC isolated from stool samples from a case-control study conducted in children aged < 5 years in Southern Mozambique between December 2007 and November 2012. The isolates were screened by conventional PCR targeting stx1 and stx2 (EHEC), ial and ipaH (EIEC), and daaE (DAEC) genes. Results We analyzed 297 samples from cases with less-severe diarrhea (LSD) matched to 297 controls, and 89 samples from cases with moderate-to-severe diarrhea (MSD) matched to 222 controls, collected between November 3, 2011 and November 2, 2012. DEC were more common among LSD cases (2.7%, [8/297] of cases vs. 1.3% [4/297] of controls; p = 0.243]) than in MSD cases (0%, [0/89] of cases vs. 0.4%, [1/222] of controls; p = 1.000). Detailed analysis revealed low frequency of EHEC, DAEC or EIEC and no association with diarrhea in all age strata. Although the low frequency, EIEC was predominant in LSD cases aged 24–59 months (4.1% for cases vs. 0% for controls), followed by DAEC in similar frequency for cases and controls in infants (1.9%) and lastly EHEC from one control. Analysis of a subset of samples from previous period (December 10, 2007 and October 31, 2011) showed high frequency of DEC in controls compared to MSD cases (16.2%, [25/154] vs. 11.9%, [14/118], p = 0.383, respectively). Among these, DAEC predominated, being detected in 7.7% of cases vs. 17.6% of controls aged 24–59 months, followed by EIEC in 7.7% of cases vs. 5.9% of controls for the same age category, although no association was observed. EHEC was detected in one sample from cases and two from controls. Conclusions Our data suggests that although EHEC, DAEC and EIEC are less frequent in endemic diarrhea in rural Mozambique, attention should be given to their transmission dynamics (e.g. the role on sporadic or epidemic diarrhea) considering that the role of asymptomatic individuals as source of dissemination remains unknown.

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The Epidemiology of Diarrhea in Children Under 5 Years of Age in Mozambique

Cited by 29 publications

References 51 publications

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives

Low frequency of enterohemorrhagic, enteroinvasive and diffusely adherent Escherichia coli in children under 5 years in rural Mozambique: a case-control study

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