Regional Differences in Intestinal Parasitic Infections among Army Recruits in a Southern Mozambique Training Center: A Cross-Sectional Study.

Due to the high prevalence and diversity of clinical manifestations, intestinal parasitic infections (IPIs) represent a public health problem. The objective of the work was to determine the prevalence of IPIs among army recruits at a practice and training center in southern Mozambique. Sociodemographic information was obtained through semi-structured interviews. Single urine and stool samples were collected from 362 recruits. Parasite diagnosis was made by filtration, formaldehyde-ether and Kato-Katz techniques. Positive individuals underwent abdominal ultrasound. Then, descriptive statistics and cross-tabulations were performed, and p-values < 0.05 were considered significant. The prevalence of infection with at least one parasite was 25.1% (95% CI: 20.5-29.6; n = 91). The most common parasites were Entamoeba coli (10.7%; 95% CI: 7.4-13.7; n = 37) and Trichuris trichiura (6.1%; 95% CI: 4.6-9.9; n = 25). Parasitic infection was associated with the origin of the participant (p-value < 0.001), and the province of Sofala had the highest prevalence among the provinces studied (70.6%; 95% CI: 47.0-87.8; 12/17). Since oral fecal transmission occurs for several parasites, routine screening and deworming prior to enrollment at the army training center is recommended to reduce transmission of intestinal parasites among recruits.

Effects of an urban sanitation intervention on childhood enteric infection and diarrhea in Maputo, Mozambique: A controlled before-and-after trial.

We conducted a controlled before-and-after trial to evaluate the impact of an onsite urban sanitation intervention on the prevalence of enteric infection, soil transmitted helminth re-infection, and diarrhea among children in Maputo, Mozambique. A non-governmental organization replaced existing poor-quality latrines with pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before and 12 and 24 months after the intervention, with concurrent measurement among children in a comparable control arm. Despite nearly exclusive use, we found no evidence that intervention affected the prevalence of any measured outcome after 12 or 24 months of exposure. Among children born into study sites after intervention, we observed a reduced prevalence of Trichuris and Shigella infection relative to the same age group at baseline (<2 years old). Protection from birth may be important to reduce exposure to and infection with enteric pathogens in this setting.

Prevalência de Parasitoses Intestinais em Crianças nas Escolas Primárias da Província de Sofala, Moçambique / Prevalence of Intestinal Parasitosis in Primary School Children in Sofala Province Province, Mozambique

Introdução: O complexo de infecções intestinais parasitárias é causado por organismos que podem ser biologicamente classificados em protozoários ou helmintos. Os parasitas constituem o maior grupo de organismos responsável por infecções em humanos. A província de Sofala localiza-se na região centro de Moçambique e está dividida em 13 distritos (incluindo a Cidade da Beira). O presente estudo foi realizado com o objectivo de determinar a prevalência de parasitoses intestinais nas escolas primárias dos distritos da província de Sofala. Métodos: O estudo decorreu de Agosto de 2005 a Junho de 2007 em escolas primárias dos distritos da província de Sofala. Tratou-se de um estudo transversal, de amostragem multietápica que teve como alvo crianças em idade escolar. Foram colhidas amostras de fezes e estas foram processadas por técnicas de Ritchie e Kato-Katz. O estudo foi aprovado pelo Comité Nacional de Bioética para Saúde de Moçambique e todos os princípios éticos foram seguidos. Os dados foram analisados utilizando o pacote estatístico SPSS na sua versão 15.0 e o software Microsoft Office Excel 2007. Resultados: Foram envolvidos um total de 5.748 alunos. A prevalência global de parasitoses ao nível da província foi de 34,4%. O distrito de Muanza foi a mais prevalente com 59,4% e o distrito de Dondo a menos prevalente com 14,1%. As espécies Entamoeba coli (23,6%), T. trichiura (16,0%), A. duodenale (14,0%) e A. lumbricoides (12,7%) foram as mais prevalentes. Observaram-se diferenças estatisticamente significativas em relação a idade e o nível de escolaridade e à prevalência de parasitas intestinais (p <0,001). Discussão e Conclusões: A prevalência de parasitoses intestinais em crianças nas escolas primárias da província de Sofala foi elevada. A presença Entamoeba coli é um indicativo epidemiológico de ocorrência de contaminação fecal. Há necessidade de se realizar estudos mais detalhados considerando as características e disposições ambientais onde elas vivem.

Occurrence of Cryptosporidium spp. and Cystoisospora belli among adult patients with diarrhoea in Maputo, Mozambique.

Infections with Cryptosporidium spp. and Cystoisospora belli are important causes of diarrhoea in HIV patients. Nevertheless, information concerning these two parasites is scarce in many African countries, including Mozambique. In this study occurrence of Cryptosporidium spp. and C. belli was investigated by microscopy of stool specimens from 108 adult diarrhoeal patients, most with a confirmed HIV diagnosis. The Cryptosporidium isolates were further characterized by molecular methods. Cryptosporidium and C. belli oocysts were found in 8.3% (9/108), and 25.0% (27/108) of the study participants, respectively. Species identification was possible for all Cryptosporidium isolates with available DNA. The following Cryptosporidium species were detected (number of cases within parentheses): C. parvum (3), C. hominis (3), C. felis (1), and C. hominis/C. parvum (1). Subtyping targeting the gp60 gene revealed two C. hominis isolates with subtype IaA23R3, one C. parvum isolate with IIcA5G3d, and one with IIeA12G1. In summary the occurrence of C. hominis and anthroponotic subtypes of C. parvum indicates that the main route of Cryptosporidium transmission in the present study population was human to human (direct or via food and water). The high prevalence of C. belli highlights the need for early diagnosis of this parasite, for which a treatment exists.

The effect of hookworm infection and urinary schistosomiasis on blood hemoglobin concentration of schoolchildren living in northern Mozambique.

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 (ß = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (ß = -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.

The effect of hookworm infection and urinary scistosomiasis on blood hemoglobiin concentration of schoolchildren living in northern Mozambique / Infecções por ancilostomídeos e Schistosoma haematobium e sua correlação com a concentração sanguínea de hemoglobina em crianças moçambicanas

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.

Este estudo tem como objetivo avaliar a relação entre a ancilostomíase e a esquistossomíase urinária com as concentrações sanguíneas de hemoglobina em crianças escolares no norte de Moçambique. Em estudo transversal, 1.015 crianças com idade entre cinco e 12 anos foram incluídas, nas Províncias de Nampula, Cabo Delgado e Niassa. A ancilostomíase e a esquistossomíase urinária foram diagnosticadas através das técnicas de Ritchie e de filtração da urina, respectivamente; prevalências de 31,3% e 59,1% foram observadas. As concentrações sanguíneas de hemoglobina foram obtidas com um fotômetro portátil (Hemocue). A concentração média de hemoglobina foi 10,8 ± 1.42 g/dL, 62,1% das crianças apresentaram concentração abaixo de 11,5 g/dL e 11,8% apresentaram nível abaixo de 9 g/dL. A regressão linear múltipla demonstrou interações negativas entre os níveis de hemoglobina e i) a infecção por ancilostomídeos (β = -0,55; p < 0,001) e ii) a esquistossomíase urinária (β = -0,35; p = 0,016), ambas associações restritas à Província de Cabo Delgado. Também em Cabo Delgado, o modelo de regressão logística demonstrou que a infecção por ancilostomídeos representa um preditor de anemia leve (OR = 1,87; 95% CI = 1,17-3,00) e anemia moderada/grave (OR = 2,71; 95% CI = 1,50 - 4,89). O estudo conclui que em Cabo Delgado, Moçambique, as infecções por ancilostomídeos e Schistosoma haematobium estão significativamente associadas a uma menor concentração sanguínea de hemoglobina em crianças em idade escolar. A administração periódica de anti-helmínticos deve ser feita regularmente. Melhorias na infraestrutura sanitária das regiões estudadas são as medidas mais eficazes para controle destas parasitoses.

The effect of hookworm infection and urinary schistosomiasis on blood hemoglobin concentration of schoolchildren living in northern mozambique / The effect of hookworm infection and urinary schistosomiasis on blood hemoglobin concentration of schoolchildren living in northern mozambique

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 (ß = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (ß = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17­3.00) 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

Geographic distribution and prevalence of schistosomiasis and soil-transmitted helminths among schoolchildren in Mozambique.

Schistosomiasis and soil-transmitted helminths (STHs) are most prevalent in developing countries. In Mozambique, the first and only national survey of the distribution and prevalence of schistosomiasis and STHs was conducted in 1952 and 1957. Only occasional surveys in restricted areas have been conducted since the 1950s. The objective of our survey was to update information on the geographic distribution and prevalence of schistosomiasis and STHs in this country. During August 2005-June 2007, the Schistosomiasis and STH Laboratory of National Institutes of Health of the Ministry of Health undertook an epidemiologic survey among schoolchildren. A total of 83,331 persons attending primary schools were sampled. The mean age was 11.36 years (range: 7-22 years). Stool and urine samples were collected and examined by using Kato-Katz and filtration and Ritchie and Willis techniques. Results indicate a widespread occurrence of Schistosoma haematobium (overall prevalence = 47.0%) and STHs (prevalence = 53.5%). Prevalence varied dramatically across the country, with the highest prevalence in districts in northern provinces (Cabo Delgado, Niassa, Nampula, and Zambezia) and in certain provincial capital cities. Districts in the southern region of the country were less affected. Schistosoma mansoni was less common, with prevalence of 1%. We conclude that schistosomiasis and STHs are widely distributed in Mozambique and confirm the need for a national helminth control program.