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Free Content Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique

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Abstract:

Summary Objective  To measure the disease burden and epidemiological characteristics of invasive in rural Mozambican children. Methods  As part of the clinical management of children admitted to Manhiça District Hospital, blood and cerebrospinal fluid samples were collected between May 2001 and April 2005 for children aged <5 years. The level of antibiotic resistance of the isolates was analysed. Results  During the surveillance period, there were 106 episodes of invasive disease. The estimated minimum incidence rate of invasive disease among children <5 years of age was 125/100 000 per child-year-at-risk. Fifty-six (59/106) per cent of cases were infants aged 3 to <12 months. Confirmed meningitis explained 16% of the episodes ( = 17) but was probably underestimated, as meningitis surveillance was not well implemented in the setting during the study. The case-fatality-rate was 21%, being highest among children with meningitis (odds ratio = 4.38,  = 0.011). Resistance to the antibiotics most commonly used in Mozambique was high – chloramphenicol 39%, ampicillin 35% and cotrimoxazol 74%– and had increased over the years ( < 0.001 for chloramphenicol). Conclusion  Invasive disease is of considerable public health importance in Mozambique; implementing type b vaccination in sub-Saharan Africa has the potential to increase child survival.

French
Maladie invasive àHaemophilus influenzae chez les enfants de moins de 5 ans à Manhiça, une zone rurale du sud du Mozambique Objectif 

Mesurer la charge de morbidité et les caractéristiques épidémiologiques des maladies invasives àHaemophilus influenzae chez des enfants de zones rurales au Mozambique. Méthodes 

Dans le cadre de la prise en charge clinique des enfants admis à l’hôpital du district de Manhiça, des échantillons de sang et de liquide céphalorachidien (LCR) ont été recueillis entre mai 2001 et avril 2005 chez les enfants de moins de 5 ans. Le taux de la résistance aux antibiotiques des isolats a été analysé. Résultats 

Durant la période de surveillance, il y a eu 106 épisodes de la maladie invasives àH. influenzae. Le taux d’incidence minimum estimé pour les maladies invasives chez les enfants de moins de 5 ans était de 125/100 000 enfants année à risque. 58% des cas étaient des nourrissons âgés de 3 à moins de 12 mois. Les méningites confirmées représentaient 16% des épisodes (n = 17), mais étaient probablement sous-estimées, comme la surveillance de la méningite n’était pas instaurée dans cet endroit au cours de l’étude. Le taux de létalitéétait de 21%, étant plus élevé chez les enfants atteints de méningite (OR = 4,38; p = 0,011). La résistance aux antibiotiques les plus couramment utilisés au Mozambique était élevée – chloramphénicol 39,5%, ampicilline 35% et cotrimoxazol 74% - et augmentait avec les années (p <0,001 pour le chloramphénicol). Conclusion 

Les maladies invasives àH. influenzae sont d’une grande importance pour la santé publique au Mozambique, l’instauration de la vaccination anti-Hib en Afrique subsaharienne pourrait augmenter la survie des enfants.

Keywords: H. influenzae; Haemophilus influenzae; Mozambique; antibiotic resistance; children; enfants; niños; resistencia antimicrobiana; résistance aux antibiotiques

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2008.02061.x

Affiliations: 1:  Centro de Investigação em Saúde da Manhiça, Ministerio de Saúde, Maputo, Mozambique 2:  Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, MD, USA

Publication date: June 1, 2008

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