Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea - a cross-sectional study in four provinces of Mozambique.

BACKGROUND: Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. METHODS: The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). RESULTS: Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. CONCLUSIONS: The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.

Intestinal protozoa in hospitalized under-five children with diarrhoea in Nampula - a cross-sectional analysis in a low-income setting in northern Mozambique.

BACKGROUND: In Mozambique, infection by intestinal parasites is reported all over the country. However, infection in children with diarrhoea is mostly focused in the southern region of Mozambique. This work aims to determine the frequency and potential risk factors for infection by Cryptosporidium spp., Giardia lamblia, and Entamoeba histolytica in children under-five years hospitalized with diarrhoea in Hospital Central de Nampula, northern Mozambique. METHODS: A cross-sectional hospital-based surveillance was conducted between March 2015 and January 2018 in children admitted with diarrhoea in Hospital Central de Nampula. Sociodemographic information was obtained through semi-structured interviews applied to the children's caregivers. A single stool sample was collected from each child to detect antigens from Cryptosporidium spp., G. lamblia, and E. histolytica using an immune-enzymatic technique. Crude and adjusted odds ratios (with 95% Confidence Intervals) were obtained by logistic regression models to identify factors associated with infection by Cryptosporidium spp. and G. lamblia. RESULTS: The median age and interquartile intervals of our sample population was 12 months (8-20). Intestinal protozoa were detected in 21.4% (59/276). Cryptosporidium spp. was the most common protozoa (13.9% - 38/274), followed by G. lamblia (9.1% - 25/274) and E. histolytica (0.4% - 1/275). Children with illiterate caregiver's (p-value = 0.042) and undernourished (p-value = 0.011) were more likely to be infected by Cryptosporidium spp. G. lamblia was more common in children living in households with more than four members (p-value = 0.039). E. histolytica was detected in an eleven month's child, co-infected with Cryptosporidium spp. and undernourished. CONCLUSION: Cryptosporidium spp. and Giardia lamblia were the most common pathogenic intestinal protozoa detected in children with diarrhoea hospitalized in the Hospital Central de Nampula. Our findings obtained highlight the importance of exploring the caregiver's education level, children's nutritional status for infections with Cryptosporidium spp., and living conditions, namely crowded households for infections with G. lamblia in children younger than five years.

High Frequency of Cryptosporidium hominis Infecting Infants Points to A Potential Anthroponotic Transmission in Maputo, Mozambique.

Cryptosporidium is one of the most important causes of diarrhea in children less than 2 years of age. In this study, we report the frequency, risk factors and species of Cryptosporidium detected by molecular diagnostic methods in children admitted to two public hospitals in Maputo City, Mozambique. We studied 319 patients under the age of five years who were admitted due to diarrhea between April 2015 and February 2016. Single stool samples were examined for the presence of Cryptosporidium spp. oocysts, microscopically by using a Modified Ziehl-Neelsen (mZN) staining method and by using Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) technique using 18S ribosomal RNA gene as a target. Overall, 57.7% (184/319) were males, the median age (Interquartile range, IQR) was 11.0 (7-15) months. Cryptosporidium spp. oocysts were detected in 11.0% (35/319) by microscopy and in 35.4% (68/192) using PCR-RFLP. The most affected age group were children older than two years, [adjusted odds ratio (aOR): 5.861; 95% confidence interval (CI): 1.532-22.417; p-value < 0.05]. Children with illiterate caregivers had higher risk of infection (aOR: 1.688; 95% CI: 1.001-2.845; p-value < 0.05). An anthroponotic species C. hominis was found in 93.0% (27/29) of samples. Our findings demonstrated that cryptosporidiosis in children with diarrhea might be caused by anthroponomic transmission.

Epidemiologia e caracterização molecular de rotavirus A em crianças menores de cinco anos com diarreia aguda, antes e depois da introdução da vacina em moçambique (2013-2018) / Epidemiology and molecular characterization of rotavirus A in children under five with acute diarrhea, before and after the introduction of the vaccine in Mozambique (2013-2018)

A doença diarreica aguda permanece como um dos principais problemas de saúde pública no mundo, onde cerca de 37% das crianças menores de cinco anos morrem por ano, principalmente, em países com baixa renda. Dentre os diferentes agentes etiológicos, os rotavírus são considerados os principais causadores dessa doença. Duas vacinas já foram licenciadas contra a infecção por rotavírus, a vacina pentavalente RotaTeq e a monovalente Rotarix. Ambas as vacinas têm a capacidade para reduzir a gravidade da doença diarreica em crianças menores de cinco anos. O estudo multicêntrico Entérico Global mostrou que o rotavírus é um dos principais agentes causadores da doença diarreica em Moçambique. A fim de se reduzir a gravidade da infecção poro rotavírus A Moçambique introduziu, em setembro de 2015, no seu Programa Alargado de Vacinação, a vacina monovalente Rotarix. O objetivo deste trabalho foi determinar o impacto da vacina na prevenção da infecção e na diversidade dos genótipos de RVA antes e após a introdução da vacina na cidade de Maputo. Para efeito, foi realizado um estudo descritivo transversal em crianças menores de cinco anos de idade, internadas com diarreia aguda nos Serviços de Pediatria do Hospital Central de Maputo, entre os anos de 2013 e 2018. No estudo, as características epidemiológicas e clínicas das crianças selecionadas foram obtidas através de um formulário padronizado

A identificação dos casos positivos para rotavírus em amostras de fezes foi realizado usando o teste de ELISA. As amostras positivas foram submetidas a genotipagem por semi-nested RT-PCR e, parte das amostras, foram posteriormente submetidas a análise de sequenciamento nucletídico. Os dados recolhidos foram introduzidos na base de dados do pacote estatístico Excel 2010 e analisados através do programa estatístico SPSS versão 20 e pacote estatístico R. Foram viii coletadas 802 amostras de fezes durante o período pré-vacinal (2013 - 2015) e 196 no período pós-vacinal (2016 - 2018), onde observou-se uma redução da mediana de casos de hospitalização por diarreia de 76%, diminuindo de 28,7% (82/284) no período pré-vacinal para 15,5% (10/66) no período pós-vacinal, (p <0,05) em todas as faixas etárias. De forma similar, houve uma redução da mediana de 53,89% na proporção de internação por diarreia por rotavírus em crianças <12 meses de idade, de (28,3%) no período pré-vacinal para 13,04% no período pós-vacinal. Após a introdução da vacina verificou-se alteração dos picos sazonais habitualmente observados. As combinações de genótipos de rotavirus mais prevalentes no período pré-vacinal foram: G2P[4] em 2013,62/86 (72,0%), G1P[8]31/48 (65,0%) em 2014, G9P[8],48 (69,0%) em 2015 e no período pós - vacinal foram: G1P [8] 5/10 (50,0%) em 2016 e 5/8(62,2%) 2017;3G3P[8], G3P[4], G4P[6] 1/3 (33,0%) em 2018Em Moçambique, após a introdução da vacina contra o rotavírus, foi observada uma redução nas hospitalizações associadas a rotavírus em todos os grupos etários com mais destaque em crianças <12 meses de idade. Uma grande diversidade de cepas de rotavírus circulou nos períodos pré e pós-introdução da vacina. Os resultados deste estudo sustentam evidências do impacto da vacinação contra o rotavírus destacando a importância na continuidade do programa assim como nos estudos de monitoramento de genótipos de rotavírus depois da introdução da vacina em Moçambique. (AU)