Resumen de The epidemiology and clinical presentation of invasive bacterial infection among children admitted to a rural hospital in mozambique
Although invasive bacterial infection (IBI) is an ¡mportant cause of childhood mortallty in sub-Saharan África, there is limited recognition of the disease burden. The etiological causes of child mortality are usually poorly investigated in the developing world, due to the lack of facilitles, especially to carry out microbiological diagnosis. IBI in particular those caused by Non-Typhoidal Salmonella (NTS), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae and Neisseria meningitidls (meningococcus), might play an important role in children mortallty as a cause of bacteremia or septicemia, acute bacterial meningitis (ABM) and invasive bacterial pneumonía.
Effectíve vaccines (conjúgate vaccines) against pneumococcus, Híb and meningococcus are currently a reality. However, coverage of these vaccines in the African continent is very low. On the other hand, antibiotic treatment of IBI needs to be empiric due to the lack of microbiological data on the pattem of antimicrobial resistance to the antibíotics available in these poor countries.
In order to guide deployment of effective prevention and treatment strategies and to monitor these strategies after their introduction, health polícy makers requíre accurate information on the burden of IBI disease, main etiologies and pattems of antibiotic susceptibilíty.
Mozambique is one of the poorest sub-Saharan Africa's countries, with an under-five mortality rate of 138 deaths per 1,000 líve births in 2006 and a lífe expectancy of 42 years. More than 40 per cent of children young than five years of age suffer modérate to severe malnutrition. HIV prevalence of the adult population ¡s very high. Data from the Manhíca Dístrict Hospital (MDH) indicates that approximately one In four pregnant women are HIV infected (data obtained between 2001 and 2003). Two-thirds of the population lives in rural áreas having limited access to essential health-care services. The country has not yet introduced Hib, pneumococcal or meningococcal conjúgate vaccines in their Expanded Program of Immunization (EPI) for infants. Therefore, although data on IBI are not available, we expect a high burden of IBI.
The objectives of this thesis are to genérate epídemiologícal, microbiological and clinical data on the presentation of IBI among children admitted to the Manhica Dístrict Hospital (MDH), as a tool to prioritize Public Health Interventions in the country.
A hospital-based surveíllance of IBI was ímplemented at the MDH, startíng in 1998. Blood culture and cerebrospínal fluid (CSF) samples were collected among admitted children less than 15 years of age, with suspicion of meningitis or septicemia. Also, over a 24 months period (2004 - 2006), children less than 2 years of age meetíng clinical criteria for severe pneumonia, had a ful) work-up íncluding a chest radiography and HIV testíng.
