Epidemiology, species composition and genetic diversity of tetra- and octonucleated Entamoeba spp. in different Brazilian biomes.

BACKGROUND: Entamoeba species harbored by humans have different degrees of pathogenicity. The present study explores the intra- and interspecific diversity, phylogenetic relationships, prevalence and distribution of tetra- and octonucleated cyst-producing Entamoeba in different Brazilian regions. METHODS: Cross-sectional studies were performed to collect fecal samples (n = 1728) and sociodemographic data in communities located in four Brazilian biomes: Atlantic Forest, Caatinga, Cerrado, and Amazon. Fecal samples were subjected to molecular analysis by partial small subunit ribosomal DNA sequencing (SSU rDNA) and phylogenetic analysis. RESULTS: Light microscopy analysis revealed that tetranucleated cysts were found in all the studied biomes. The highest positivity rates were observed in the age group 6-10 years (23.21%). For octonucleated cysts, positivity rates ranged from 1 to 55.1%. Sixty SSU rDNA Entamoeba sequences were obtained, and four different species were identified: the octonucleated E. coli, and the tetranucleated E. histolytica, E. dispar, and E. hartmanni. Novel haplotypes (n = 32) were characterized; however, new ribosomal lineages were not identified. The Entamoeba coli ST1 subtype predominated in Atlantic Forest and Caatinga, and the ST2 subtype was predominant in the Amazon biome. E. histolytica was detected only in the Amazon biome. In phylogenetic trees, sequences were grouped in two groups, the first containing uni- and tetranucleated and the second containing uni- and octonucleated cyst-producing Entamoeba species. Molecular diversity indexes revealed a high interspecific diversity for tetra- and octonucleated Entamoeba spp. (H ± SD = 0.9625 ± 0.0126). The intraspecific diversity varied according to species or subtype: E. dispar and E. histolytica showed lower diversity than E. coli subtypes ST1 and ST2 and E. hartmanni. CONCLUSIONS: Tetra- and octonucleated cyst-producing Entamoeba are endemic in the studied communities; E. histolytica was found in a low proportion and only in the Amazon biome. With regard to E. coli, subtype ST2 was predominant in the Amazon biome. The molecular epidemiology of Entamoeba spp. is a field to be further explored and provides information with important implications for public health.

Socioenvironmental Factors Influencing Distribution and Intensity of Soil-Transmitted Helminthiasis in the Brazilian Amazon: Challenges for the 2030 Agenda.

Soil-transmitted helminthiasis (STHs) are poverty-related diseases with high prevalence rates in developing countries. The present study aims to describe the epidemiological scenario of STHs in an urban population in the Brazilian Amazon. A cross-sectional survey (n = 349 children aged 1-15 years) was carried out to obtain faecal samples and sociodemographic and sanitation data. Among the children, 143 (41%) were positive for at least one STH. Prevalence rates of infections by A. lumbricoides, T. trichiura, and hookworms were 24.4%, 42.6%, and 9%, respectively. A logistic regression multivariate model showed that infection with A. lumbricoides is significantly more frequent in children aged 11-15 years (odds ratio [OR] = 2.38; 95% confidence interval [CI] = 1.15-4.94; p=0.018) and the presence of latrines inside houses is a protection factor against ascariasis (OR = 0.38; 95% CI = 0.17-0.85; p=0.019). Positivity for T. trichiura is higher in the 5-10 (OR = 3.31; 95% IC = 1.85-5.89; p=0.001) and 11-15 age groups (OR = 3.16; 95% IC = 1.66-6.00; p=0.001), in children living in poor families (OR = 1.78; 95% IC = 1.01-3.14; p=0.045) and practicing open evacuation (OR = 2.07; 95% IC = 1.07-3.99; p=0.029). Hookworm infection is more frequent in children aged 11-15 years (OR = 6.70; 95% IC = 1.91-23.43; p=0.002), males (OR = 6.35; 95% IC = 2.00-20.14; p=0.002), and those living in stilt houses (OR = 3.52; 95% IC = 1.22-10.12; p=0.019). The use of albendazole in the last six months was a protection factor against hookworm infection (OR = 0.31; 95% IC = 0.10-0.96; p=0.042). The proportion of mild, moderate, and severe infections was 55.2%, 37.8%, and 7%, respectively, for A. lumbricoides, 72.4%, 24.3%, and 3.3% for T. trichiura, and 93.8%, 3.1%, and 3.1% for hookworms. Significantly higher worm burdens in T. trichiura and hookworm infections were associated with practicing open defecation and living in stilt houses. The data points to the need to improve sanitation infrastructure in Amazonian cities with similar sociodemographic and environmental characteristics.

Interactions between malnutrition, soil-transmitted helminthiasis and poverty among children living in periurban communities in Maranhao State, Northeastern Brazil.

Poverty, malnutrition and neglected tropical diseases such as soil-transmitted helminthiases (STHs) interact in a multi-causal feedback network. This study aimed to assess the relationships between STHs, income and nutritional status of children in impoverished communities in the city of Caxias, Maranhao State, Northeastern Brazil. A cross-sectional survey (n=259 children) was carried out with the collection of fecal samples and assessment of sociodemographic, anthropometric, dietary and sanitation data. Hookworm infection and ascariasis presented prevalence rates of 14.3% and 9.3%, respectively. The logistic regression analysis showed that hookworm infection was more frequent in males (odds ratio [OR]=3.43; 95% confidence interval [CI]=1.45-8.08), children aged 11-15 years old (OR=3.72; 95% CI=1.19-11.62), children living in poor families (OR=2.44; 95% CI=1.04-5.68) and those living in rented houses (OR=5.74; 95%CI=1.91-17.25). Concerning ascariasis, living in the Caldeiroes community (OR=0.01; 95%CI=0-0.17) and belonging to the 11-15 years age group (OR=0.21; 95%CI=0.04-1.02) were protection factors. Poor children have a significantly lower frequency of consumption of meat, milk, vegetables, tubers and fruits than not poor children. The frequent consumption of meat, milk and tubers was associated with significant higher values in the parameter height-for-age, whereas the consumption of meat and milk positively influenced the weight-for-age. The frequencies of stunting, underweight and wasting were 8.1%, 4.9% and 2.9%, respectively. The multivariate model demonstrated that stunting was significantly associated with economic poverty (OR=2.82; 95%CI=1.03-7.70) and low weight was associated with male sex (OR=6.43; 95% CI=1.35-30.68). In conclusion, the study describes the interactions between the dimensions of development represented by income, STHs and nutritional status revealing the importance of raising income levels to improve the living conditions of families in impoverished communities in Northeastern Brazil.

Parasitismo intestinal e estado nutricional de crianças: estudo transversal em comunidades periurbanas no Maranhão / Intestinal parasitism and nutritional status of children: a cross-sectional study in peri-urban communities in Maranhão

Pobreza, desnutrição e doenças tropicais negligenciadas, como helmintíases transmitidas pelo solo (HTS), interagem em uma rede de retroalimentação multicausal. Este estudo teve como objetivo avaliar as relações entre HTS, renda e estado nutricional de crianças em comunidades carentes da cidade de Caxias, estado do Maranhão, nordeste do Brasil. Realizou-se inquérito transversal (n=259 crianças) com coleta de amostras fecais e avaliação de dados sociodemográficos, antropométricos, dietéticos e sanitários. A ancilostomíase e ascaridíase apresentaram prevalências de 14,3% e 9,3%, respectivamente. A análise de regressão logística mostrou que a infecção por ancilostomíase foi mais frequente em homens (odds ratio [OR] = 3,43; intervalo de confiança de 95% [IC] = 1,45-8,08), crianças de 11-15 anos (OR = 3,72; IC 95% = 1,19-11,62), crianças de famílias pobres (OR = 2. 44; IC95% = 1,04-5,68) e residentes em casa alugada (OR = 5,74; IC95% = 1,91-17,25). Em relação à ascaridíase, residir na comunidade Caldeirões (OR = 0,01; IC95% = 0-0,17) e pertencer à faixa etária de 11-15 anos (OR = 0,21; IC95% = 0,04-1,02) foram fatores de proteção. Crianças pobres consomem em menor frequência carne, leite, vegetais, tubérculos e frutas do que crianças não pobres. O consumo frequente de carne, leite e tubérculos foi associado a valores significativamente maiores no parâmetro altura para idade, enquanto o consumo de carne e leite influenciou positivamente no peso para idade.

As frequências de nanismo, baixo peso e emaciação foram de 8,1%, 4,9% e 2,9%, respectivamente. O modelo multivariado demonstrou que a baixa estatura foi significativamente associada à pobreza econômica (OR = 2,82; IC 95% = 1,03-7. 70) e baixo peso foi associado ao sexo masculino (OR = 6,43; IC95% = 1,35-30,68). Em conclusão, o estudo descreve as interações entre as dimensões do desenvolvimento representadas pela renda, HTS e estado nutricional revelando a importância da elevação dos níveis de renda para melhorar as condições de vida das famílias em comunidades empobrecidas no nordeste do Brasil. (AU)

Assistência de enfermagem na doença falciforme na estratégia saúde da família / Cuidados de enfermería en enfermedad de células falciformes en la estrategia sanitaria familia / Nursing care in sickle cell disease in the family health strategy

Objective: to evaluate the care provided by nurses people living with Sickle Cell Anemia. Methods: An exploratory and descriptive study with 28 nurses in the city of Caxias (MA). Data analysis was carried out through the Iramuteq software. The study was approved by the Institute of Education and Health Sinop EIRELI with CAAE: 47406315.9.0000.5685. Results and Discussion: There was a predominance of female and aged between 31 to 40 years. Most nurses in the study demonstrated a knowledge of the subject sickle cell anemia, but said they do not provide the support the carriers of the disease people or the lack of patients in UBS’s coverage area, is the lack of staff training to provide a quality care the same. Conclusion: The study showed that nurses do not provide adequate assistance to people with sickle cell anemia.

Objetivo: avaliar os cuidados realizados por enfermeiros as pessoas vivendo com Anemia Falciforme. Métodos: Estudo exploratório e descritivo realizado com 28 enfermeiros na cidade de Caxias (MA). A análise dos dados ocorreu por meio do software Iramuteq. O estudo foi aprovado pelo Instituto Superior de Educação e Saúde Sinop Eireli com CAAE: 47406315.9.0000.5685. Resultados: Houve predominância do sexo feminino e idade variando entre 31 a 40 anos. A maioria dos enfermeiros do estudo demonstraram ter conhecimento acerca da temática anemia falciforme, porém afirmaram que não prestam a assistência às pessoas portadoras da doença, seja pela falta de pacientes na área de abrangência da UBS, seja pela falta de preparo dos profissionais em prestar uma assistência de qualidade as mesmos. Conclusão: O estudo mostrou que os enfermeiros não prestam uma assistência adequada às pessoas portadoras de anemia falciforme.

Objetivo: evaluar la atención proporcionada por enfermeras personas que viven con anemia de células falciformes. Métodos: Un estudio exploratorio y descriptivo con 28 enfermeras en la ciudad de Caxias (MA). El análisis de datos se realizó mediante el software Iramuteq. El estudio fue aprobado por el Instituto de Educación y Salud Sinop EIRELI con CAAE: 47406315.9.0000.5685. Resultados y Discusión: Se encontró un predominio del sexo femenino y con edades comprendidas entre 31 y 40 años. La mayoría de las enfermeras en el estudio demostraron un conocimiento de la anemia de células falciformes sujeto, pero dijeron que no proporcionan el apoyo a los portadores de las personas de la enfermedad o la falta de los pacientes en el área de cobertura de UBS, es la falta de capacitación del personal en pago calidad de la Atención de la misma. Conclusión: El estudio mostró que las enfermeras no proporcionan asistencia adecuada a las personas con anemia de células falciformes.

Violência obstétrica institucional no parto: percepção de profissionais da saúde / Institutional obstetric violence in birth: perception of health professionals

Objetivo: avaliar os saberes e práticas sobre violência obstétrica na percepção dos profissionais da saúde. Método: estudo descritivo, exploratório, de abordagem qualitativa, realizado por meio de entrevista com 20profissionais da saúde. A análise dos dados ocorreu por meio da técnica de Análise de Conteúdo. Resultados: apenas 40% dos profissionais da saúde já tiveram ou ainda têm contato com tema violência obstétrica e apenas 15% relataram ter cometido o ato da violência obstétrica, demonstrando que o tema violência obstétrica ainda é desconhecido pelos profissionais da saúde e vários são os motivos para a existência desse problema, como má estruturação das instituições de saúde, carga horária excessiva e falta de comunicação entre o profissional e cliente. Conclusão: a grande maioria dos profissionais se mostrou desconhecedora do tema violência obstétrica. Por meio da análise dos discursos, sugere-se que a solução do problema da violência obstétrica está na humanização da assistência.