Angolan Children Research Articles

Quantitative trait locus analysis of parasite density reveals that HbS gene carriage protects severe malaria patients against Plasmodium falciparum hyperparasitaemia.

BackgroundHaemoglobin S (HbS) is the gene known to confer the strongest advantage against malaria morbidity and mortality. Multiple HbS effects have been described resulting in protection against parasitaemia and reduction of severe malaria risk. This study aimed to explore HbS protection against severe malaria and Plasmodium falciparum parasitaemia in Angolan children exhibiting different severe malaria syndromes.MethodsA case–control study was designed with 430 malaria cases (n = 288 severe malaria and n = 142 uncomplicated malaria) and 319 uninfected controls, attending a central paediatric hospital in Luanda. Severe malaria syndromes were cerebral malaria (n = 130), severe malaria anaemia (n = 30) and hyperparasitaemia (n = 128). Quantitative trait locus analysis was carried out to study HbS association to parasite densities.ResultsPreviously reported HbS protection against severe malaria was confirmed in case–control analysis (P = 2 × 10−13) and corroborated by transmission disequilibrium test (P = 4 × 10−3). High parasite density protection conferred by HbS was detectable within severe malaria patients (P = 0.04). Stratifying severe malaria patients according parasite densities, it was found that HbS was highly associated to hyperparasitaemia protection (P = 1.9 × 10−9) but did not protect non-hyperparasitaemic children against severe malaria complications, namely cerebral malaria and severe malaria anaemia. Many studies have shown that HbS protects from severe malaria and controls parasite densities but the analysis further suggests that HbS protection against severe malaria syndromes was at a large extent correlated with control of parasitaemia levels.ConclusionsThis study supports the hypothesis that HbS confers resistance to hyperparasitaemia in patients exhibiting severe malaria syndromes and highlights that parasitaemia should be taken into account when evaluating HbS protection in severe malaria.

NOS2 Variants Reveal a Dual Genetic Control of Nitric Oxide Levels, Susceptibility to Plasmodium Infection, and Cerebral Malaria

Nitric oxide (NO) is a proposed component of malaria pathogenesis, and the inducible nitric oxide synthase gene (NOS2) has been associated to malaria susceptibility. We analyzed the role of NOS2 polymorphisms on NO bioavailability and on susceptibility to infection, Plasmodium carrier status and clinical malaria. Two distinct West African sample collections were studied: a population-based collection of 1,168 apparently healthy individuals from the Príncipe Island and a hospital-based cohort of 269 Angolan children. We found that two NOS2 promoter single-nucleotide polymorphism (SNP) alleles associated to low NO plasma levels in noninfected individuals were also associated to reduced risk of pre-erythrocytic infection as measured anti-CSP antibody levels (6.25E-04 < P < 7.57E-04). In contrast, three SNP alleles within the NOS2 cistronic region conferring increased NO plasma levels in asymptomatic carriers were strongly associated to risk of parasite carriage (8.00E-05 < P < 7.90E-04). Notwithstanding, three SNP alleles in this region protected from cerebral malaria (7.90E-4 < P < 4.33E-02). Cohesively, the results revealed a dual regimen in the genetic control of NO bioavailability afforded by NOS2 depending on the infection status. NOS2 promoter variants operate in noninfected individuals to decrease both NO bioavailability and susceptibility to pre-erythrocytic infection. Conversely, NOS2 cistronic variants (namely, rs6505469) operate in infected individuals to increase NO bioavailability and confer increased susceptibility to unapparent infection but protect from cerebral malaria. These findings corroborate the hypothesis that NO anti-inflammatory properties impact on different steps of malaria pathogenesis, explicitly by favoring infection susceptibility and deterring severe malaria syndromes.

Prevalencia de deficits nutricionais em criancas menores de cinco anos em Angola

To estimate the prevalence of nutritional deficiencies in Angolan children. A cross-sectional population based study. World Health Organization (2006) criteria were used to classify nutritional state. A high prevalence of low height for age, weight for height and weight for age was observed (22%, 13% and 7%, respectively) among the children. Nutritional deficiencies in children represents a serious public health problem in Bom Jesus, Angola.

IFNAR1 Controls Progression to Cerebral Malaria in Children and CD8+ T Cell Brain Pathology in Plasmodium berghei–Infected Mice

Development of cerebral malaria (CM), a severe and fatal form of clinical Plasmodium falciparum infection, results from a damaging cascade of vascular, inflammatory, and immunological host responses that leads to brain injury. Progression to CM can be modified by host genetic factors. Our case-control study in Angolan children aimed at highlighting the role of IFN (α, β) receptor 1 (IFNAR1) in progression to CM. We report a robust association between IFNAR1 and CM protection, as well as detailed studies showing analogous protection from experimental CM in Ifnar1(-/-) mice infected with P. berghei ANKA. We developed a novel cell-transfer protocol that enables spleen cell priming in the absence of disease. This led to the discovery that IFNAR1 expression in CD8(+) T cells is crucial and can abrogate resistance to experimental CM in Ifnar1(-/-) mice. Splenic CD8(+) T cells from Ifnar1(-/-) mice are functionally activated upon infection, yet are unable to mediate experimental CM development within the brain tissue. Our findings prove that IFNAR1 signaling unleashes CD8(+) T cell effector capacity, which is vital for CM, and raises the hypothesis that the cohesive role of IFNAR1 in both human and mouse CM operates through CD8(+) T cell triggering.

Sedation with intranasal midazolam of Angolan children undergoing invasive procedures

Ambulatory surgery is a daily requirement in poor countries, and limited means and insufficient trained staff lead to the lack of attention to the patient's pain. Midazolam is a rapid-onset, short-acting benzodiazepine which is used safely to reduce pain in children. We evaluated the practicability of intranasal midazolam sedation in a suburban hospital in Luanda (Angola), during the surgical procedures. Intranasal midazolam solution was administered at a dose of 0.5 mg/kg. Using the Ramsay's reactivity score, we gave a score to four different types of children's behaviour: moaning, shouting, crying and struggling, and the surgeon evaluated the ease of completing the surgical procedure using scores from 0 (very easy) to 3 (managing with difficulty). Eighty children (median age, 3 years) were recruited, and 140 surgical procedures were performed. Fifty-two children were treated with midazolam during 85 procedures, and 28 children were not treated during 55 procedures. We found a significant difference between the two groups on the shouting, crying and struggling parameters (p < 0.001). The mean score of the ease of completing the procedures was significantly different among the two groups (p < 0.0001). These results provide a model of procedural sedation in ambulatory surgical procedures in poor countries, thus abolishing pain and making the surgeon's job easier.

Fifth Forum 2011 on Angolan children: a perspective viewpoint

This paper is intended to be a descriptive account of the Fifth Forum on Angolan children. The Forum took place in the city of Luanda, Angola in 2011. Our participation in the event allowed us to observe that it is important to understand the context in which children live to improve the effectiveness of public policy regarding their development.

Transforming Growth Factor Beta 2 and Heme Oxygenase 1 Genes Are Risk Factors for the Cerebral Malaria Syndrome in Angolan Children

BackgroundCerebral malaria (CM) represents a severe outcome of the Plasmodium falciparum infection. Recent genetic studies have correlated human genes with severe malaria susceptibility, but there is little data on genetic variants that increase the risk of developing specific malaria clinical complications. Nevertheless, susceptibility to experimental CM in the mouse has been linked to host genes including Transforming Growth Factor Beta 2 (TGFB2) and Heme oxygenase-1 (HMOX1). Here, we tested whether those genes were governing the risk of progressing to CM in patients with severe malaria syndromes.Methodology/Principal FindingsWe report that the clinical outcome of P. falciparum infection in a cohort of Angolan children (n = 430) correlated with nine TGFB2 SNPs that modify the risk of progression to CM as compared to other severe forms of malaria. This genetic effect was explained by two haplotypes harboring the CM-associated SNPs (Pcorrec. = 0.035 and 0.036). In addition, one HMOX1 haplotype composed of five CM-associated SNPs increased the risk of developing the CM syndrome (Pcorrec. = 0.002) and was under-transmitted to children with uncomplicated malaria (P = 0.036). Notably, the HMOX1-associated haplotype conferred increased HMOX1 mRNA expression in peripheral blood cells of CM patients (P = 0.012).Conclusions/SignificanceThese results represent the first report on CM genetic risk factors in Angolan children and suggest the novel hypothesis that genetic variants of the TGFB2 and HMOX1 genes may contribute to confer a specific risk of developing the CM syndrome in patients with severe P. falciparum malaria. This work may provide motivation for future studies aiming to replicate our findings in larger populations and to confirm a role for these genes in determining the clinical course of malaria.

Survey of iodine deficiency and intestinal parasitic infections in school-going children: Bie Province, Angola

To obtain baseline pre-intervention prevalence levels of iodine deficiency and parasitic and helminth infections in school-going children in Bie Province, Angola. A cross-sectional study conducted in randomly selected schools. The target population was children aged 6-10 years. Bie Province, Angola. A total of 1029 children sampled, with 791 stool samples and 826 urine samples collected from twenty-four schools. Widespread severe and moderate deficiencies in iodine. Children in five schools were severely iodine deficient. All sampled schoolchildren were iodine deficient to a greater or lesser extent. In all, 80 % of all children across the twenty-four schools were infected with one or a combination of intestinal helminths and intestinal protozoa. These findings have serious implications for the cognitive development of Angolan children, as well as for Angola's development in terms of productivity and economic potential. It is strongly recommended that the provincial and national Ministries of Health, in collaboration with international health agencies, immediately plan and implement a strategy to provide sufficient iodine through iodised oil capsules and iodised salt to the iodine-deficient population. National coalitions need to be strengthened among the government, partners and salt producers. It is also recommended that all the children in schools be de-wormed for multiple helminth species at least twice a year.

The use of partial exchange blood transfusion and anaesthesia in the management of sickle cell disease in a perioperative setting: two case reports.

IntroductionHomozygous sickle cell carriers have an increased perioperative mortality. Some indications may justify an exchange blood transfusion to reduce the proportion of haemoglobin S. The advantages of general blood transfusion in a perioperative setting have not been proven and thus remain controversial. It is not clear whether reducing the proportion of haemoglobin S minimizes perioperative complications or whether patients with sickle cell disease in a stable clinical condition benefit from an exchange blood transfusion in a perioperative setting.Case presentationWe report the case of two Angolan children aged 10 and 11 respectively, of African origin with sickle cell anaemia who underwent surgery to treat chronic necrosis, fistula of the bones and bone destruction. This presentation describes the perioperative course, including general anaesthesia. A partial exchange blood transfusion decreased S-haemoglobin levels from 81% to 21% and simultaneously treated the anaemia.ConclusionThere is a consensus that imbalances in homoeostasis, including operative procedures, can cause a critical exacerbation of sickle cell disease. The case presented here illustrates a strategy for successfully managing sickle cell disease in the perioperative period to minimize its complications. It is important for the anaesthesiologist to carefully manage pulmonary gas exchange and to ensure sufficient tissue perfusion, balanced fluid resuscitation and normothermia, while keeping in mind the level of organ impairment in order to prevent an acute exacerbation of sickle cell disease.We performed a partial exchange blood transfusion due to the following factors: high haemoglobin S-fraction, anaemia, operating procedure at several sites, and difficult management of body temperature. Esmarch ischemia is an established tool for preventing uncontrolled blood loss. There is no known contraindication for this, but attention must be paid to prevent uncontrolled tissue ischemia and acidosis. The use of regional anaesthesia should be considered for postoperative pain management.

Editorial

Editorial Sylvia Vardell (bio) and Catherine Kurkjian (bio) CIAO Annyong haseyo Griezi Salaam SHALOM Barev Goeie dag Nín hâo Dear Bookbird Readers, We are honored to take on the stewardship of Bookbird as its new editors. We offer our heartfelt thanks and admiration to Valerie and Siobhán for their extraordinary talent and skill in making Bookbird the outstanding journal that it is today. We will work to maintain and build on the multiple perspectives and voices from around the world already in evidence in Bookbird, as well as strive to maintain its literary and artistic qualities. We use the term “stewardship” because we understand that the editorship of Bookbird has been entrusted to us for only a moment in time. Call it kismet, destiny or just coincidence; we believe that what we have done individually and collectively prepares us for this new and exciting challenge; that we are in the right place at the right time. We are deeply committed to and passionate about our work as editors of Bookbird. We also recognize that we are one part of IBBY’s international mission and Jella Lepman’s legacy of providing children with access to books around the world, especially in developing countries. Feature articles This first issue of our editorship presents literature from five continents and while each piece is unique to its specific cultural context, we find a convergence and intersection of themes that surface in this collection. One theme that ribbons through this set of articles relates to the key role that stories from multiple perspectives play in developing culturally sensitive global citizens. Sometimes we are looking from the inside-out from our personal frame of reference and cultural identity as discussed in Kathy Short’s Critically Reading the Word and the World: Building Intercultural Understanding through Literature. At other times we are looking from the outside-in through a window into another cultural perspective as presented in Mare Müürsepp’s Edgar Valter: Estonia’s [End Page ii] Master of Art and Imagination in Picture Books. In any case, the articles in this issue speak to the value of story in promoting the appreciation and understanding of the self and others. The role of stories as a shaper of identity and as a means to map our inner and outer landscapes is another theme that surfaces frequently in this issue as well. Clearly this theme is powerfully addressed in Josefine Ottesen’s The Story of History: Being One of “Them.” Ottesen uses fantasy as a metaphor to help her readers become aware of and master both their inner and outer demons. The reader is left in awe by the power of stories that can serve to enslave as well as to liberate. Bent Rasmussen outlines Ottesen’s contributions to literature in The Life and Work of Josefine Ottesen. While the emphasis of Ottesen’s work is on our interior landscapes, Robin Morrow focuses on the exterior. In Mapping Australia’s Past in Picture Books, she examines four picture books that provide narratives from diverse settings and perspectives and when taken together contribute to an inclusive and richly layered landscape of Australian history. Like Morrow, Ondjaki maps outer landscapes. In Let’s Share the Dream: Stories for Children in Angola, he outlines complex historical, social and political factors in shaping cultural identity in the development and rebirth of Angolan children’s literature. In the process, the reader can get a taste of Angolan children’s literature and of Ondjaki’s work as a professional writer of children’s books. Finally, in From Victory to Victimization: The Sino-Japanese War (1937–1945) as Depicted in Chinese Youth Literature, Minjie Chen speaks to the political nature of literature as a shaper of identity. This article calls for multiple voices and perspectives to create a balanced historical view. The departments We are pleased to report that Bookbird maintains continuity in retaining departments and department editors of Postcards from Around the World, Books on Books and Focus IBBY. Glenna Sloan continues to bring us children’s literature from around the globe through brief postcard reviews submitted by a variety of contributors. The featured books include themes that range from...

Let’s Share the Dream: Stories for Children in Angola

Ondjaki shares a brief history of Angolan children’s literature along with his place in that literary and historic landscape, the basis for his speech given at the IBBY 31st World Congress held in Denmark in September, 2008.

Avoid severe acute malnutrition among Angolan children; trying to find a way

Avoid severe acute malnutrition among Angolan children; trying to find a way

Factors associated with sicle cell disease mortality among hospitalized Angolan children and adolescents

Sickle cell disease complications are an important mortality cause in children mainly in Africa and India. Notwithstanding the magnitude of the problem on the African continent, studies identifying factors related to the adverse outcomes of sickle cell disease in the pediatric population are still scarce. To identify prognostic factors associated with mortality in children and adolescent aged under fifteen years with diagnosis of sickle cell disease. Patients meeting inclusion criteria were listed and randomly selected. Clinical and laboratory data collected at time of admission were collected from medical records through the use of standard forms. The association between mortality and explanatory variables was tested using univariable and multivariable analysis. The overall mortality rate was 64 (12.9%), and bacterial infections 26 (40.1%) were the most common cause of death. Place of residence out of Luanda, lack of outpatient follow-up, symptoms onset more than three days, disease manifestation before age of eighth months and hemoglobin level of < 7 g/dl were independent risk factors related to death. In the study population, sickle cell related deaths were related to quality of health care and access to care. The creation of regional sickle cell disease centers to support those afflicted by the disorder and their families would contribute to reduce the burden associated with the disease.

Transnational networks of care: Angolan children in fosterage in Portugal

This article is about the informal circulation of children who migrate from Angola to Portugal without their birth parents or primary caretakers. It explores the motivations underlying kinship care, and the relationships through which child circulation is negotiated. In this discussion, I also look at how this practice is transformed by migration, turning local relations into transnational networks of care. Finally, I argue that child circulation as a social practice can create, maintain or lessen the amount of social capital of the people implicated.

Imported Cutaneous Diphtheria, Germany, 1997–2003

To the Editor: The March 2004 report by de Benoist et al. on the incidence of imported cutaneous diphtheria in the United Kingdom (1) prompted us to describe the situation of cutaneous diphtheria in Germany and to analyze the cases reported to the German Consiliary Laboratory on Diphtheria since its establishment at our institute in 1997. The laboratory provides advisory and diagnostic services mainly to microbiologic laboratories throughout Germany. From 1997 to 2003, 6 cases of cutaneous infections caused by toxigenic Corynebacterium diphtheriae were documented (Table). None of these was accompanied by secondary diphtheria infection. Toxigenicity was determined by both dtx polymerase chain reaction and Elek test (2). As in the United Kingdom, all cases for which clinical information was available (N = 5) were imported. Three were found in tourists who had traveled to tropical countries: a 20-year-old diver had injured her heel after stepping on coral in Thailand; a 60-year-old tourist had a chronic ulcer in the thigh after a trip to Indonesia (no history of an insect bite); and a 39-year-old traveler to Kenya returned with a purulent ear infection with no memory of trauma or insect bite. The remaining imported C. diphtheriae skin infections were reported in 2 Angolan children, 5 and 10 years of age, who were brought to Germany by a humanitarian organization for surgery on severe gun wounds to their lower extremities (foot and thigh with chronic osteomyelitis, respectively). To our knowledge, these reports are the first of cutaneous diphtheria in gunshot wounds in recent years. Moreover, in the patient with the thigh wound, C. diphtheriae was also isolated from a deep fistula, which suggests involvement of C. diphtheriae in the chronic osteomyelitis. Table Cutaneous diphtheria cases caused by toxigenic Corynbacterium diphtheriae in Germany, reported to the German Consiliary Laboratory, 1997–2003 As in the United Kingdom, all cases of diphtheria reported since 1997 were caused by C. diphtheriae mitis. In 4 of 5 cutaneous diphtheria patients who had an available medical history, mixed infections with Staphylococcus aureus and Streptococcus pyogenes were found; 3 of 5 patients were not sufficiently vaccinated against diphtheria as recommended. Systemic symptoms, such as malaise and general weakness, developed in the 20-year-old Thailand tourist, although she had received a booster dose just before her travel. Cutaneous diphtheria must be expected even in vaccinated patients; for instance, among serum samples of 287 healthy German adults with a complete record of basic immunization against diphtheria, only 42.2% showed full serologic protection as indicated by antitoxin levels >0.1 IU/mL (3). As de Benoist et al. outline, cutaneous diphtheria might be difficult to diagnose because of its unspecific clinical appearance and the presence of mixed infections in chronic nonhealing skin lesions. Because of the nearly complete disappearance of cutaneous diphtheria in many parts of the western world, microbiologists lack experience in identifying C. diphtheriae grown from specimens. From 1997 to 2003, approximately one fifth of the strains sent to our Consiliary Laboratory on Diphtheria for species identification and toxin testing were either nondiphtheria Corynebacterium spp. or noncoryneform bacteria of different genera (including lactobacilli, Dermabacter hominis, and Propionibacterium acnes). Clinicians (4) and microbiologists (5) should be aware of the possibility of cutaneous diphtheria in chronically infected skin lesions in patients returning from disease-endemic regions. Medical personnel should include this in civilian as well as military health services, since our cases indicate that toxigenic C. diphtheriae might affect not only travel-related skin injuries caused by leisure or tourist activities but also wounds in patients from war regions in diphtheria-endemic areas.

Genetic diversity among strains of Moraxella catarrhalis cultured from the nasopharynx of young and healthy Brazilian, Angolan and Dutch children.

The present study describes the carriage patterns and genetic variability of Moraxella catarrhalis strains isolated from children living in different countries. Moraxella catarrhalis is genetically heterogeneous, but little is known about its geographic distribution and phenotypic and genetic diversity in warm-climate countries. A collection of 99 isolates from 30 Brazilian, 19 Angolan and 50 Dutch healthy children, all less than 5 years of age, was investigated for phenotypic and genotypic relatedness. The isolates from the three countries were similar where biochemical reactivity was concerned: 89 strains were beta-lactamase-producing and 87 were complement-resistant as determined by phenotype. There was no geographical difference in the prevalence of beta-lactamase-producing isolates, but the carriage rate of complement-resistant strains was significantly higher in Dutch than in Angolan children (P=0.004). Complement resistance of 66 randomly selected strains was genetically confirmed in a Southern hybridization assay by a novel DNA probe that is specific for complement-resistant strains and that demonstrated a sensitivity of 97% and a specificity of 100%. PCR amplification based on the probe sequence had a sensitivity of 98% and a specificity of 57% when compared to the outcome of a conventional culture spot test. PCR restriction fragment length polymorphism analysis of the MU 46 locus and pulsed-field gel electrophoresis of SpeI DNA macrorestriction fragments revealed genetic heterogeneity of strains from within and between the three countries, and no geographical clustering could be established. In conclusion, similar phenotypic characteristics but genotypic heterogeneity was found among Moraxella catarrhalis strains colonizing children in three different continents.

Striking differences in the nasopharyngeal flora of healthy Angolan, Brazilian and Dutch children less than 5 years old

Community-acquired pneumonia from enteric gram-negative bacilli is more common in developing than in industrialized countries. We investigated the nasopharyngeal flora in healthy children from Angola, Brazil and The Netherlands to see whether enteric gram-negative bacilli are more often part of the commensal flora in developing countries. Nasopharyngeal specimens were collected from children aged between 4 months and 5 years in day-care centres and immunization clinics. Children who had received antibiotics or were malnourished were excluded. Brazilian and Angolan children had a higher number of household members than Dutch children (5.5 and 7 vs 3.9 mean number of household members, respectively) (p < 0.0001). Enteric and non-fermentative gram-negative bacilli were much more prevalent in Brazilian (50%) and Angolan (57%) children than in Dutch (4%) children (p < 0.0001). By univariate analysis, carriage of enteric gram-negative bacilli was associated with the number of household members (r = 0.26; p < 0.001). The high carriage rate of enteric gram-negative bacilli in children from Angola and Brazil may explain why enteric gram-negative bacilli are a common cause of pneumonia in developing countries.