RESUMEN
The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7%, 8.7%, and 7.5%, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5% children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6% and 43.5% of the children, respectively. Evidence of anemia was found in only 47.6% of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum.
Asunto(s)
Anemia Ferropénica/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Parasitosis Intestinales/epidemiología , Anemia Ferropénica/diagnóstico , Brasil/epidemiología , Trastornos de la Nutrición del Niño/diagnóstico , Preescolar , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Parasitosis Intestinales/diagnóstico , Masculino , Prevalencia , Factores SocioeconómicosRESUMEN
The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7 percent, 8.7 percent, and 7.5 percent, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5 percent children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6 percent and 43.5 percent of the children, respectively. Evidence of anemia was found in only 47.6 percent of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum.
As prevalências de desnutrição, parasitoses intestinais, anemia e deficiência de ferro foram avaliadas, por meio de inquéritos transversais de base populacional, em pré-escolares na área urbana de dois municípios das Amazônia Ocidental Brasileira, Assis Brasil (n = 200) e Acrelândia (n = 477). Os índices antropométricos peso/estatura (P/E), peso/idade (P/I) e estatura/idade (E/I) foram calculados como escores z, com base na população de referência do National Center for Health Statistics de 1977. Diagnosticaram-se déficits nutricionais segundo índices P/E, P/I e E/I em 3,7 por cento, 8,7 por cento e 7,5 por cento das crianças, respectivamente. Encontraram-se parasitas intestinais em 32,5 por cento das 554 amostras examinadas, sendo raras as infecções por helmintos. Com base nos níveis de hemoglobina sangüínea e níveis plasmáticos de ferritina e receptor solúvel de transferrina, diagnosticaram-se anemia e deficiência de ferro em 30,6 por cento e 43,5 por cento das crianças, respectivamente. Somente 47,6 por cento das crianças com deficiência de ferro tinham anemia, indicando que a medida isolada de hemoglobina sangüínea subestima a magnitude da deficiência de ferro nesta população. Nos dois municípios, a anemia e a desnutrição foram significantemente mais prevalentes entre as crianças de famílias dos estratos sócio-econômicos mais baixos.
Asunto(s)
Humanos , Preescolar , Deficiencias de Hierro/diagnóstico , Parasitosis Intestinales/diagnóstico , Estado Nutricional , Trastornos de la Nutrición del Niño/diagnóstico , Anemia Ferropénica , Antropometría , Brasil/epidemiología , Estudios Transversales , PrevalenciaRESUMEN
We investigated the prevalence and risk factors for wheezing and asthma in young Amazonian children. A population-based cross-sectional survey of 606 children aged 6-59 months was performed in two small towns in Acre State, Northwestern Brazil. Information on outcome variables (recent wheezing and medical diagnosis of asthma) and demographic, socioeconomic, environmental, maternal and nutritional variables was obtained by interviewing children's mothers or guardians. Infections with intestinal parasites and antibodies to the zoonotic nematode Toxocara were diagnosed using standard laboratory techniques. Multiple unconditional logistic regression models were used to describe associations between independent variables and outcomes. The prevalence of recent wheezing (one or more reported episodes in the past 12 months) was 42.6%, but only 19.8% of wheezing children were also reported to have a medical diagnosis of asthma (prevalence, 8.5%); 21.5% of the children examined had antibodies to Toxocara. Increased risk of asthma was independently associated with early introduction of bottle feeding, defined as <4 months of exclusive breastfeeding [adjusted odds ratio (aOR) = 2.21, 95% confidence interval (95% CI), 1.07-4.59, P = 0.033], and seropositivity to Toxocara (aOR = 2.37, 95% CI 1.17-4.77, P = 0.016), suggesting two potential targets for public health interventions.
Asunto(s)
Asma/etiología , Alimentación con Biberón/efectos adversos , Ruidos Respiratorios , Toxocara/aislamiento & purificación , Animales , Asma/parasitología , Brasil/epidemiología , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Toxocara/patogenicidadRESUMEN
The merozoite surface protein-2 (MSP-2) of Plasmodium falciparum comprises repeats flanked by dimorphic domains defining the allelic families FC27 and IC1. Here, we examined sequence diversity at the msp-2 locus in Brazil and its impact on MSP-2 antibody recognition by local patients. Only 25 unique partial sequences of msp-2 were found in 61 isolates examined. The finding of identical msp-2 sequences in unrelated parasites, collected 6-13 years apart, suggests that no major directional selection is exerted by variant-specific immunity in this malaria-endemic area. To examine antibody cross-reactivity, recombinant polypeptides derived from locally prevalent and foreign MSP-2 variants were used in ELISA. Foreign IC1-type variants, such as 3D7 (currently tested for human vaccination), were less frequently recognized than FC27-type and local IC1-type variants. Antibodies discriminated between local and foreign IC1-type variants, but cross-recognized structurally different local IC1-type variants. The use of evolutionary models of MSP-2 is suggested to design vaccines that minimize differences between local parasites and vaccine antigens.