RESUMEN
Background: Plasmodium falciparum infection in pregnant women in sub-Saharan Africa is often asymptomatic. As these forms of malaria are often submicroscopic and difficult to diagnose by conventional methods (microscopy and/or rapid diagnostic test), diagnosis requires the use of molecular techniques such as polymerase chain reaction (PCR). This study analyses the prevalence of subclinical malaria and its association with adverse maternal and neonatal outcomes, a topic that has been scarcely evaluated in the literature. Methods: A cross-sectional study was conducted using semi-nested multiplex PCR to assess the presence of P. falciparum in placental and peripheral blood of 232 parturient pregnant women at the Hospital Provincial de Tete, Mozambique between March 2017 and May 2019. Multivariate regressions were performed to assess the associations of maternal subclinical malaria with several maternal and neonatal outcomes after controlling for the presence of preeclampsia/eclampsia (PE/E) and HIV infection, as well as for other maternal and pregnancy characteristics. Results: In total, 17.2% (n = 40) of the women studied had positive PCR for P. falciparum (7 in placental blood only, 3 in peripheral blood only). We found a significant association between subclinical malaria and a higher peripartum mortality risk, which persisted after controlling for maternal comorbidity and maternal and pregnancy characteristics (adjusted odds ratio: 3.50 [1.11-10.97]). In addition, PE/E and HIV infections were also significantly associated with several adverse maternal and neonatal outcomes. Conclusion: This study demonstrated the association of subclinical malaria, as well as of PE/E and HIV, in pregnant women with adverse maternal and neonatal outcomes. Therefore, molecular methods may be sensitive tools to identify asymptomatic infections that can reduce the impact on peripartum mortality and their contribution to sustained transmission of the parasite in endemic countries.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Lactante , Infecciones por VIH/epidemiología , Malaria Falciparum/tratamiento farmacológico , Malaria/epidemiología , Placenta , Embarazo , Mortalidad Infantil , Mortalidad , Periodo Periparto , MozambiqueRESUMEN
The archipelago of the Canary Islands is one of the so-called ultra-peripheral territories of the European Union due to its geographical location away from the continent. Although the level of socioeconomic development and lifestyle of this region is comparable to that of any other of the European Union, it is just 100 km off the coast of Morocco, in the African continent. The population of the Canaries has been extensively studied with respect to their levels of POPs, and it has been described that their levels are relatively high compared to other European regions. It has been speculated with that the proximity to Africa may be associated with this level of contamination, but so far this theory has not been verified. This paper describes for the first time the levels of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in a sample of the population of Morocco (n = 131), which were compared with those of a similar sample of the population of permanent residents in the Canary Islands (n = 100) in order to check this hypothesis. Our results showed that Moroccans have higher median values of OCPs than the residents in the Canaries (∑ OCP = 150.2 ng/g lw vs. 83.4 ng/g lw, p = 0.0001). Regarding the PCBs, although recent studies have reported that new environmental sources of PCBs exist in several African countries (including Morocco), the plasma levels of most congeners were significantly higher in Canarians than in Moroccans, especially for the dioxin-like PCBs (median = 7.3 ng/g lw vs. 0.0 ng/g lw, p = 0.0001). The detailed analysis of our results suggests that the levels of these pollutants in the Canarian people are more influenced by their lifestyle and the previous use of these chemicals in the archipelago than by its geographical vicinity with Morocco.
Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/metabolismo , Humanos , Hidrocarburos Clorados/metabolismo , Estilo de Vida , Marruecos , Plaguicidas/metabolismo , Bifenilos Policlorados/metabolismo , Hidrocarburos Policíclicos Aromáticos/metabolismo , EspañaRESUMEN
Several studies of environmental samples indicate that the levels of many persistent organic pollutants (POPs) are increasing in Africa, but few studies have been conducted in humans. Simultaneously, many African countries are experiencing a rapid economic growth and implementing information and communication technologies (ICT). These changes have generated high amounts of electronic waste (e-waste) that have not been adequately managed. We tested the hypothesis that the current levels of two main classes of POPs in Western and Central African countries are affected by the degree of socioeconomic development. We measured the levels of 36 POPs in the serum of recent immigrants (N=575) who came from 19 Sub-Saharan countries to the Canary Islands (Spain). We performed statistical analyses on their anthropometric and socioeconomic data. High median levels of POPs were found in the overall sample, with differences among the countries. Organochlorine pesticide (OCP) and polychlorinated biphenyl (PCB) levels increased with age. People from low-income countries had significantly higher OCP levels and much lower PCB levels than those from high-income countries. We found a significant association between the implementation of ICT and PCB contamination. Immigrants from the countries with a high volume of imports of second-hand electronic equipment had higher PCB levels. The economic development of Africa and the e-waste generation have directly affected the levels of POPs. The POP legacies of these African populations most likely are due to the inappropriate management of the POPs' residues.
Asunto(s)
Exposición a Riesgos Ambientales/análisis , Contaminantes Ambientales/metabolismo , Hidrocarburos Clorados/metabolismo , Plaguicidas/metabolismo , África , Exposición a Riesgos Ambientales/estadística & datos numéricos , Humanos , Bifenilos Policlorados/metabolismo , Factores SocioeconómicosRESUMEN
We have recently evaluated an ELISA for the diagnosis of human schistosomiasis using S. bovis adult worm antigens (AWA Sb), showing a sensitivity of 94% and a specificity of 97% for patients diagnosed by egg detection. Nevertheless, the comparison of this AWA Sb ELISA with direct parasitological findings as the gold standard could introduce a selection bias, due to the well-known lack of sensitivity of direct methods in the detection of acute schistosomiasis and of low burden infections. The objective of the present work is to compare it with parasitological methods and commercial indirect haemagglutination test using S. mansoni antigens (WA Sm IHA) in 254 immigrants and travellers with different clinical settings; in addition, to find specific bands in the EITB of different phases of schistosomiasis. The AWA Sb ELISA showed 72% of seropositivity in patients with Katayama fever, while patients with eosinophilia and genito-urinary complaints showed 27% and 93%, respectively. The diagnosis yield was globally higher than direct egg detection or WA Sm IHA test with regard to the clinical setting. Finally, the utilization of EITB with S. bovis AWA permits the confirmation of diagnosis in chronic and acute phases of the disease.