Geographic Distribution and Prevalence of Schistosomiasis and Soil-Transmitted Helminths among Schoolchildren in Mozambique

Augusto, Gerito; Nalá, Rassul; Casmo, Verónica; Sabonete, Acácio; Mapaco, Lourenço; Monteiro, Judite

doi:10.4269/ajtmh.2009.08-0344

Cited by 80 publications

(87 citation statements)

References 6 publications

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“…Factors such as poor nutritional status, genetic red blood cell disorders or parasitic infections have been suggested to account for low Hb values. While a fairly low frequency of sickle cell trait (5.6%) was reported in an early study of pregnant women in Mozambique [32], a recent national survey of schistosomiasis and soil-transmitted helminthes showed that parasitic infections are common [33].…”

Section: Discussionmentioning

confidence: 90%

Reference Values for Clinical Laboratory Parameters in Young Adults in Maputo, Mozambique

et al. 2014

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BackgroundClinical laboratory reference values from North American and European populations are currently used in most Africans countries due to the absence of locally derived reference ranges, despite previous studies reporting significant differences between populations. Our aim was to define reference ranges for both genders in 18 to 24 year-old Mozambicans in preparation for clinical vaccine trials.MethodsA cross-sectional study including 257 volunteers (102 males and 155 females) between 18 and 24 years was performedat a youth clinic in Maputo, Mozambique. All volunteers were clinically healthy and human immunodeficiency virus, Hepatitis B virus and syphilis negative.Median and 95% reference ranges were calculated for immunological, hematological and chemistry parameters. Ranges were compared with those reported based on populations in other African countries and the US. The impact of applying US NIH Division of AIDS (DAIDS) toxicity tables was assessed.ResultsThe immunology ranges were comparable to those reported for the US and western Kenya.There were significant gender differences in CD4+ T cell values 713 cells/µL in males versus 824 cells/µL in females (p<0.0001). Hematologic values differed from the US values but were similar to reports of populations in western Kenya and Uganda. The lower and upper limits of the ranges for hemoglobin, hematocrit, red blood cells, white blood cells and lymphocytes were somewhat lower than those from these African countries. The chemistry values were comparable to US values, with few exceptions. The upper limits for ALT, AST, bilirubin, cholesterol and triglycerides were higher than those from the US. DAIDStables for adverse events predicted 297 adverse events and 159 (62%) of the volunteers would have been excluded.ConclusionThis study is the first to determine normal laboratory parameters in Mozambique. Our results underscore the necessity of establishing region-specific clinical reference ranges for proper patient management and safe conduct of clinical trials.

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Section: Discussionmentioning

confidence: 90%

Reference Values for Clinical Laboratory Parameters in Young Adults in Maputo, Mozambique

et al. 2014

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“…In a previous report, we demonstrated that urinary schistosomiasis, hookworm disease and other intestinal parasitic infections are highly prevalent in Mozambican schoolchildren in most provinces of the country 1 . Our survey aims to assess hookworm infection and urinary schistosomiasis associated anemia in schoolchildren living in three provinces of northern Mozambique.…”

Section: Introductionmentioning

confidence: 86%

The Effect of Hookworm Infection and Urinary Schistosomiasis on Blood Hemoglobin Concentration of Schoolchildren Living in Northern Mozambique

Casmo

Augusto

Nalá

et al. 2014

Rev. Inst. Med. trop. S. Paulo

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This study aims to assess the association between schistosomiasis and hookworm infection with hemoglobin levels of schoolchildren in northern Mozambique. Through a cross-sectional survey, 1,015 children from five to 12 years old in the provinces of Nampula, Cabo Delgado and Niassa were studied. Hookworm infection and urinary schistosomiasis were diagnosed, through Ritchie and filtration methods, with a prevalence of 31.3% and 59.1%, respectively. Hemoglobin levels were obtained with a portable photometer (Hemocue®). The average hemoglobin concentration was 10.8 ± 1.42 g/dL, and 62.1% of the children presented levels below 11.5 g/dL, of which 11.8% of the total number of children had hemoglobin levels below 9 g/dL. A multiple linear regression analysis demonstrated negative interactions between hemoglobin levels and ancylostomiasis, this being restricted to the province of Cabo Delgado (β = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (β = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17-3.00) and moderate/severe anemia (OR = 2.71; 95% CI = 1.50 - 4.89). We concluded that, in the province of Cabo Delgado, hookworm and Schistosoma haematobium infections negatively influence hemoglobin levels in schoolchildren. Periodical deworming should be considered in the region. Health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in soil-transmitted helminthiases and schistosomiasis prevalence rates.

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“…30,31 Malaria and intestinal helminthes are prevalent, and iron-deficiency anemia is thought to be common. [32][33][34] During Mozambique's initial response to the HIV epidemic, first-level health workers used a 2005 Mozambican guideline adapted from a standard World Health Organization guideline recommending that anemia (or pallor) be treated with presumptive iron supplementation, anthelminthics, and antimalarials. 35 In 2009, the Mozambican Ministry of Health (MISAU) updated its anemia guideline to address several concerns: overprescription of antimalarials, underdetection of treatable HIV-associated causes of anemia, and possible increases in malaria and mortality risk resulting from overprescription of iron.…”

Section: Introductionmentioning

confidence: 99%

Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline

Brentlinger¹,

Silva

Vermund

et al. 2016

AIDS Research and Human Retroviruses

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Mozambique's updated guideline for management of HIV-associated anemia prompts clinicians to consider opportunistic conditions, adverse drug reactions, and untreated immunosuppression in addition to iron deficiency, intestinal helminthes, and malaria. We prospectively evaluated this guideline in rural Zambézia Province. Likely cause(s) of anemia were determined through prespecified history, physical examination, and laboratory testing. Diagnoses were ''etiologic'' if laboratory confirmed (sputum microscopy, blood culture, Plasmodium falciparum malaria rapid test) or ''syndromic'' if not. To assess hemoglobin response, we used serial point-of-care measurements. We studied 324 ambulatory, anemic (hemoglobin <10 g/dl) HIV-infected adults. Study clinicians treated nearly all [315 (97.2%)] for suspected iron deficiency and/or helminthes; 56 (17.3%) had laboratory-confirmed malaria. Other assigned diagnoses included tuberculosis [30 (9.3%)], adverse drug reactions [26 (8.0%)], and bacteremia [13 (4.1%)]. Etiologic diagnosis was achieved in 79 (24.4%). Of 169 (52.2%) subjects who improved (hemoglobin increase of ‡1 g/dl without indications for hospitalization), only 65 (38.5%) received conventional management (iron supplementation, deworming, and/or antimalarials) alone. Thirty (9.3%) died and/or were hospitalized, and 125 (38.6%) were lost to follow-up. Multivariable linear and logistic regression models described better hemoglobin responses and/or outcomes in subjects with higher CD4 + T-lymphocyte counts, pre-enrollment antiretroviral therapy and/or co-trimoxazole prophylaxis, discontinuation of zidovudine for suspected adverse reaction, and smear-positive tuberculosis. Adverse outcomes were associated with fever, low body mass index, bacteremia, esophageal candidiasis, and low or missing CD4 + T cell counts. In this severely resource-limited setting, successful anemia management often required interventions other than conventional presumptive treatment, thus supporting Mozambique's guideline revision.

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Geographic Distribution and Prevalence of Schistosomiasis and Soil-Transmitted Helminths among Schoolchildren in Mozambique

Cited by 80 publications

References 6 publications

Reference Values for Clinical Laboratory Parameters in Young Adults in Maputo, Mozambique

Reference Values for Clinical Laboratory Parameters in Young Adults in Maputo, Mozambique

The Effect of Hookworm Infection and Urinary Schistosomiasis on Blood Hemoglobin Concentration of Schoolchildren Living in Northern Mozambique

Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline

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