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Avaliação do tratamento massivo no controlo da filaríase linfática, schistosomíase e das geohelmintíases no distrito de Murrupula e cidade de Nampula, Moçambique
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A Filaríase Linfática (FL), a Schistosomíase (SCH) e as geohelmintíases (ou helmintíases transmitidas pelo solo - HTS) são doenças negligenciadas que afetam principalmente as comunidades de baixo rendimento e representam um problema sério de saúde pública em Moçambique. Este estudo teve como objetivo principal, avaliar a situação epidemiológica dessas doenças numa área urbana (Nampula) e numa área rural (Murrupula) e o impacto das intervenções terapêuticas na redução da prevalência dessas doenças assim como o efeito destas medidas na redução da anemia e subnutrição em crianças dos cinco aos 14 anos de idade.
O estudo decorreu de 2012 a 2014. Nos três anos participaram no total 4870 indivíduos. No primeiro ano realizou-se um inquérito sociodemográfico por entrevista onde participaram 786 indivíduos de ambos os géneros e idade de cinco a 89 anos. No total, foi feita a avaliação da prevalência da FL em 2800 indivíduos a partir dos cinco anos de idade, utilizando o teste imunocromatográfico rápido, pesquisa de microfilárias no sangue periférico por análise microscópica e avaliação da morbilidade. No estudo epidemiológico da SCH e HTS participaram no total 2558 crianças de ambos os géneros dos cinco aos 14 anos de idade. Foram colhidas amostras de urina para a pesquisa de ovos de Schistosoma haematobium pelo método de filtração e utilizada a fita reativa para a deteção de hematúria microscópica. Foram colhidas, também, amostras de fezes para a pesquisa de ovos de S. mansoni e de espécies de geohelmintas (Ascaris lumbricoides, Trichuris trichiura e ancilostomídeos) utilizando a técnica de Kato-Katz. Foi igualmente obtida uma amostra de sangue para a quantificação da hemoglobina pelo aparelho “Hemocue” e feita avaliação do peso e estatura das crianças.
Os resultados revelaram prevalências elevadas de FL, SCH e HTS em ambos os locais de estudo no primeiro ano, tendo-se verificado uma redução significativa com as intervenções terapêuticas. A prevalência de FL foi de 56.4%, 42.6% e 23.3% do primeiro ao terceiro ano do estudo, respetivamente. Quanto à SCH, a prevalência nos três anos foi de 69,8%, 60,8% e 34,2% respetivamente e, no caso das HTS, as prevalências foi de 58,6%, 42,2% e 24,4% nos três anos, respetivamente. Verificou-se uma associação significativa entre o grau de anemia e a intensidade de infeção por S. haematobium e geohelmintas, bem como entre o grau de subnutrição e a ocorrência de poliparasitismo das espécies estudadas. A prevalência e morbilidade causada por estas parasitoses foram predominantes na população de Murrupula, o que reflete as condições sociais mais desfavorecidas das comunidades rurais.
Este estudo evidencia o efeito positivo dos tratamentos massivos na redução destas parasitoses bem como dos indicadores de morbilidade (anemia e subnutrição). A integração de intervenções adicionais a nível social e a monitorização regular dessas doenças são aspetos a considerar para o seu controlo e potencial eliminação.
Lymphatic filariasis (LF), Schistosomiasis (SCH) and Soil Transmitted Helminthiasis (STH) are neglected diseases that mainly affect low income communities and represent a serious public health problem in Mozambique. The main objective of this study was to evaluate the epidemiological situation of these diseases in both an urban (Nampula) and rural area (Murrupula) and the impact of therapeutic interventions. in decreasing the prevalence of these diseases, as well as the effect of these measures in reducing anemia and sub nutrition in children from five to 14 years of age. The study was carried out from 2012 to 2014. During the three years, a total of 4870 people were included. In the first year, a sociodemographic survey was conducted through an interview to 786 people of both genders and ages, ranging from five to 89 years. In total, the prevalence of LF was evaluated in 2800 people with five years or above, using the rapid immunochromatographic test, microscopic analysis of microfilariae in the peripheral blood and morbidity evaluation. In the SCH and STH epidemiological study, a total of 2558 children of both genders from five to 14 years of age were included. Urine samples were collected for visualization of Schistosoma haematobium eggs by filtration methodology and the reagent strip test was used for the detection of microscopic hematuria. The Kato-Katz technique was used to detect S. mansoni eggs and geohelminth species (Ascaris lumbricoides, Trichuris trichiura and hookworms) in faecal samples. A blood sample was also obtained for the quantification of hemoglobin by the "Hemocue" device. Children weight and height were also evaluated. Results showed a high prevalence of LF, SCH and STH in both study sites in the first year, with a significant decrease after the therapeutic interventions. The prevalence of the LF was 56.4%, 42.6% and 23.3% from the first to the third year of the study, respectively. In relation to SCH, the prevalence during the three years of the study was 69.8%, 60.8% and 34.2% and with respect to STH, the prevalence was 58.6%, 42.2% and 24.4%, respectively. There was a significant association between the degree of anemia and the intensity of infection due to S. haematobium and geohelminths, as well as between the degree of malnutrition and the occurrence of polyparasitism of the species studied. The prevalence and morbidity caused by these parasitosis were mostly found in the population of Murrupula, which reflects the most disadvantaged social conditions of rural communities. This study emphasizes the positive effect of mass treatment on the decrease of these parasitosis, as well as on the morbidity indicators (anemia and malnutrition). The integration of additional social interventions and the regular monitoring of these diseases are aspects to be considered in their control and potential elimination. Key-words: lymphatic filariasis; schistosomiasis; soil transmitted helminthiasis; treatment intervention; Mozambique.
Lymphatic filariasis (LF), Schistosomiasis (SCH) and Soil Transmitted Helminthiasis (STH) are neglected diseases that mainly affect low income communities and represent a serious public health problem in Mozambique. The main objective of this study was to evaluate the epidemiological situation of these diseases in both an urban (Nampula) and rural area (Murrupula) and the impact of therapeutic interventions. in decreasing the prevalence of these diseases, as well as the effect of these measures in reducing anemia and sub nutrition in children from five to 14 years of age. The study was carried out from 2012 to 2014. During the three years, a total of 4870 people were included. In the first year, a sociodemographic survey was conducted through an interview to 786 people of both genders and ages, ranging from five to 89 years. In total, the prevalence of LF was evaluated in 2800 people with five years or above, using the rapid immunochromatographic test, microscopic analysis of microfilariae in the peripheral blood and morbidity evaluation. In the SCH and STH epidemiological study, a total of 2558 children of both genders from five to 14 years of age were included. Urine samples were collected for visualization of Schistosoma haematobium eggs by filtration methodology and the reagent strip test was used for the detection of microscopic hematuria. The Kato-Katz technique was used to detect S. mansoni eggs and geohelminth species (Ascaris lumbricoides, Trichuris trichiura and hookworms) in faecal samples. A blood sample was also obtained for the quantification of hemoglobin by the "Hemocue" device. Children weight and height were also evaluated. Results showed a high prevalence of LF, SCH and STH in both study sites in the first year, with a significant decrease after the therapeutic interventions. The prevalence of the LF was 56.4%, 42.6% and 23.3% from the first to the third year of the study, respectively. In relation to SCH, the prevalence during the three years of the study was 69.8%, 60.8% and 34.2% and with respect to STH, the prevalence was 58.6%, 42.2% and 24.4%, respectively. There was a significant association between the degree of anemia and the intensity of infection due to S. haematobium and geohelminths, as well as between the degree of malnutrition and the occurrence of polyparasitism of the species studied. The prevalence and morbidity caused by these parasitosis were mostly found in the population of Murrupula, which reflects the most disadvantaged social conditions of rural communities. This study emphasizes the positive effect of mass treatment on the decrease of these parasitosis, as well as on the morbidity indicators (anemia and malnutrition). The integration of additional social interventions and the regular monitoring of these diseases are aspects to be considered in their control and potential elimination. Key-words: lymphatic filariasis; schistosomiasis; soil transmitted helminthiasis; treatment intervention; Mozambique.
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Medicina tropical Doenças tropicais Filaríse linfática Schistosomíase Geohelmintíases Murrupula Nampula Moçambique