Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea - a cross-sectional study in four provinces of Mozambique

Assucenio Chissaque, Marta Cassocera, Carolina Gasparinho, Jeronimo Souzinho Langa, Adilson Fernando Loforte Bauhofer, Jorfelia Jose Chilaule, Eva Dora Joao, Benilde Antonio Munlela, Julia Assiat Monteiro Sambo, Simone Salvador Boene, Marlene Bernardo Djedje, Elda Muianga Anapakala, Esperanca Lourenco Guimaraes, Diocreciano Matias Bero, Lena Vania Manhique-Coutinho, Idalecia Cossa-Moiane, Timothy A. Kellogg, Luzia Augusta Pires Goncalves, Nilsa de Deus

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    Background: Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique.

    Methods: The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR).

    Results: Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value <0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed.

    Conclusions: The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.

    Original languageEnglish
    Article number18
    JournalBMC Infectious Diseases
    Issue number1
    Number of pages13
    Publication statusPublished - 2021


    • Animals
    • Breast Feeding
    • Child Nutrition Disorders/epidemiology
    • Child, Preschool
    • Comorbidity
    • Cross-Sectional Studies
    • Diarrhea/epidemiology
    • Family Characteristics
    • Feces/virology
    • Female
    • Humans
    • Infant
    • Infant, Newborn
    • Male
    • Malnutrition/epidemiology
    • Mozambique/epidemiology
    • Prevalence
    • Risk Factors
    • Rotavirus Infections/epidemiology
    • Rotavirus Vaccines/therapeutic use
    • Rotavirus/immunology


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