Cucurbitane-type triterpenoids from the African plant Momordica balsamina

Phytochemical investigation of the aerial parts of Momordica balsamina led to the isolation of five new cucurbitane-type triterpenoids (1-5) and two known analogues (6, 7). Their structures were elucidated on the basis of spectroscopic methods including 2D NMR experiments (COSY, HMQC, HMBC, and NOESY). The new compounds feature unusual oxidation patterns in the cucurbitane skeleton, such as at C-29 (1-3) and C-12 (4, 5). Compounds 1-4, 6, and 7 were evaluated for in vitro cytotoxicity against human breast cancer cells (MCF-7), using the MTT assay.

Combining indoor residual spraying and insecticide-treated net interventions

Does scaling up of malaria control by combining indoor residual spraying (IRS) and long-lasting insecticidal nets (LLIN) enhance protection to populations? Results from a literature search and from recent household surveys in Bioko, Equatorial Guinea, and Zambezia, Mozambique are presented. Five out of eight previous studies reported a reduced risk of infection in those protected by both interventions compared with one intervention alone. Surveys in Bioko and Zambezia showed strong evidence of a protective effect of IRS combined with nets relative to IRS alone (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.59-0.86 for Bioko, and OR = 0.63, 95% CI = 0.50-0.79, for Zambezia). The effect of both interventions combined, compared with those who had neither, was OR = 0.46, (95% CI = 0.76-0.81) in Bioko and 0.34 (95% CI = 0.21-0.56) in Zambezia. Although the effects of confounding cannot be excluded, these results provide encouragement that the additional resources for combining IRS and LLIN are justified.

[First record of Aedes albopictus, vector of arboviruses in the Eparse Islands of the Mozambique Channel and updating of the inventory of Culicidae]

This is the first description of Ae. albopictus in Grande Glorieuse and Juan de Nova, which are two isolated French islands of the Mozambique Channel. The recent introduction of this species is underlined by its absence in the inventories realised between 2000 and 2003. The last severe arbovirus epidemic of chikungunya (2005-2006), vectored by Ae. albopictus, which occurred in the area of the Indian Ocean emphasized the epidemiological role of this vector. So that, notifying its presence might help to target potential exotic arboviruses that could be introduced into the island. Furthermore this study allowed us to update the culicidae inventory, not only with this species, but also with the first observation of Culex sitiens in Europa and the confirmation of Ae. dufouri on this island. In order to determine the different species at the adult and/or at the larval stage, the authors propose keys of identification for mosquito species of the Eparse islands. All the described species on these islands are allochthonous species and some are being a nuisance. Sanitary recommendations together with biological and mechanical controls are proposed in order to reduce the nuisance and to prevent from any new introduction on these islands.

Discussion and revision of the mathematical modeling tool described in the previously published article "Modeling HIV Transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy"

Mathematical models are increasingly used in social and behavioral studies of HIV transmission; however, model structures must be chosen carefully to best answer the question at hand and conclusions must be interpreted cautiously. In Pearson et al. (2007), we presented a simple analytically tractable deterministic model to estimate the number of secondary HIV infections stemming from a population of HIV-positive Mozambicans and to evaluate how the estimate would change under different treatment and behavioral scenarios. In a subsequent application of the model with a different data set, we observed that the model produced an unduly conservative estimate of the number of new HIV-1 infections. In this brief report, our first aim is to describe a revision of the model to correct for this underestimation. Specifically, we recommend adjusting the population-level sexually transmitted infection (STI) parameters to be applicable to the individual-level model specification by accounting for the proportion of individuals uninfected with an STI. In applying the revised model to the original data, we noted an estimated 40 infections/1000 HIV-positive persons per year (versus the original 23 infections/1000 HIV-positive persons per year). In addition, the revised model estimated that highly active antiretroviral therapy (HAART) along with syphilis and herpes simplex virus type 2 (HSV-2) treatments combined could reduce HIV-1 transmission by 72% (versus 86% according to the original model). The second aim of this report is to discuss the advantages and disadvantages of mathematical models in the field and the implications of model interpretation. We caution that simple models should be used for heuristic purposes only. Since these models do not account for heterogeneity in the population and significantly simplify HIV transmission dynamics, they should be used to describe general characteristics of the epidemic and demonstrate the importance or sensitivity of parameters in the model.

Phytoliths in woody plants from the Miombo woodlands of Mozambique

BACKGROUND AND AIMS

There are no descriptions of phytoliths produced by plants from the 'Zambezian' zone, where Miombo woodlands are the dominant element of the largest single phytochorion in sub-Saharan Africa. The preservation of phytoliths in fossil records of Africa makes phytoliths a tool to study early plant communities. Paleo-ethnobotanical interpretation of phytoliths relies on the comparison of ancient types with morphotypes extracted from living reference collections.

METHODS

Phytoliths were extracted from plant samples representing 41 families, 77 genera and 90 species through sonic cleaning, dry ashing and acid treatment; and phytoliths thus extracted were quantified. For each species, an average of 216 phytoliths were counted. The percentage of each morphotype identified per species was calculated, and types were described according to the descriptors from the International Code for Phytolith Nomenclature. Phytolith assemblages were subject to discriminant analysis, cluster analysis and principal component analysis.

KEY RESULTS

Phytoliths were grouped into 57 morphotypes (two were articulated forms and 55 were discrete shapes), and provide a reference collection of phytolith assemblages produced by Miombo woody species. Common and unique morphotypes are described and taxonomic and grouping variables are looked into from a statistical perspective.

CONCLUSIONS

The first quantitative taxonomy of phytoliths from Miombos is presented here, including new types and constituting the most extensive phytolith key for any African ecoregion. Evidence is presented that local woody species are hypervariable silica producers and their phytolith morphotypes are highly polymorphic. The taxonomic significance of these phytoliths is largely poor, but there are important exceptions that include the morphotypes produced by members from >10 families and orders. The typical phytolithic signal that would allow scientists to identify ancient woodlands of 'Zambezian' affiliation comprises only half of the original number of phytoliths originally produced and might favour the more resilient blocky, cylindroid, globular and tabular forms.

Efficacy of sulphadoxine-pyrimethamine with or without artesunate for the treatment of uncomplicated Plasmodium falciparum malaria in southern Mozambique: a randomized controlled trial

BACKGROUND

An artemisinin-based combination therapy, artesunate (AS) plus sulphadoxine-pyrimethamine (SP), was compared to SP monotherapy to provide evidence of further treatment options in southern Mozambique.

METHODS

Between 2003 and 2005, 411 patients over one year and 10 kg with uncomplicated Plasmodium falciparum malaria were randomly allocated SP (25/1.25 mg per kg day 0) or AS/SP (as above plus 4 mg/kg artesunate days 0, 1 and 2). Allocation was concealed, but treatment was open-label except to microscopists. The primary objective was the relative risk of treatment failure, which was assessed using World Health Organization response definitions modified to a 42-day follow-up.

RESULTS

Of the 411 subjects enrolled, 359 (87.3%) completed the follow up period (SP n = 175, AS/SP n = 184). A survival analysis including 408 subjects showed that the polymerase chain reaction-adjusted cure rates were 90.4% (95% confidence interval [CI] 84.9%-93.9%) and 98.0% (95% CI 94.8%-99.3%) for SP and AS/SP respectively. Multivariable analysis showed that treatment with AS/SP decreased the relative hazard of treatment failure by 80% compared to SP (hazard ratio [HR] 0.2; 95% CI 0.1-0.6) and age over seven years decreased the relative hazard of failure by 70% (HR 0.3; 95% CI 0.1-0.9), when compared to younger age. However, having a quintuple dhfr/dhps mutation increased the relative hazard of failure compared to fewer mutations (HR 3.2; 95% CI 1.3-7.5) and baseline axillary temperature increased the relative hazard of failure by 50% for each degree C increase (HR 1.5; 95% CI 1.1-2.2).

CONCLUSION

While both treatments were efficacious, AS plus SP significantly decreased the relative hazard of treatment failure compared to SP monotherapy Artesunate plus sulphadoxine-pyrimethamine, but not sulphadoxine-pyrimethamine monotherapy, met the current WHO criteria of >95% efficacy for policy implementation.

TRIAL REGISTRATION

NCT00203736 and NCT00203814.

PMTCT, HAART, and childbearing in Mozambique: an institutional perspective

Maternal and Child Health (MCH) units, where VCT/PMTCT/HAART have been integrated with traditional services, play a critical role in the connection between the massive HAART rollout and reproductive behavior. In this article, we use data from semi-structured interviews with MCH workers and ethnographic observations carried out in southern Mozambique to explore this role from the institutional perspective. We find that, along with logistical and workload problems, the de facto segregation of PMTCT/HAART clients within the "integrated" MCH system and the simplistic and uncompromising message discouraging further fertility and stressing condom-based contraception may pose serious challenges to a successful formulation and implementation of reproductive goals among seropositive clients. Although the recency of PMTCT/HAART services may partly explain these challenges, we argue that they are due largely to cultural miscommunication between providers and clients. We show how the cultural gap between the two is bridged by community activists and peer interactions among clients.

Tabernines A-C, beta-carbolines from the leaves of Tabernaemontana elegans

Three novel beta-carboline indole alkaloids (1-3) have been isolated from a MeOH extract of the leaves of Tabernaemontana elegans. The structures were established by means of spectroscopic techniques including 2D NMR experiments. Compounds 1 and 2 contain a two-carbon unit, attached to a structurally related beta-carboline skeleton, as part of an additional six-membered ring in 1 and a seven-membered ring in 2. To the best of our knowledge, this is the first report of beta-carboline indole alkaloids from the genus Tabernaemontana. Compounds 1-3 were evaluated for their ability to modulate multidrug resistance in mouse lymphoma cell lines. Compounds 1 and 3 exhibited a weak activity.

Development and climate change: a mainstreaming approach for assessing economic, social, and environmental impacts of adaptation measures

The paper introduces the so-called climate change mainstreaming approach, where vulnerability and adaptation measures are assessed in the context of general development policy objectives. The approach is based on the application of a limited set of indicators. These indicators are selected as representatives of focal development policy objectives, and a stepwise approach for addressing climate change impacts, development linkages, and the economic, social and environmental dimensions related to vulnerability and adaptation are introduced. Within this context it is illustrated using three case studies how development policy indicators in practice can be used to assess climate change impacts and adaptation measures based on three case studies, namely a road project in flood prone areas of Mozambique, rainwater harvesting in the agricultural sector in Tanzania and malaria protection in Tanzania. The conclusions of the paper confirm that climate risks can be reduced at relatively low costs, but the uncertainty is still remaining about some of the wider development impacts of implementing climate change adaptation measures.

Impact of maternal human immunodeficiency virus infection on birth outcomes and infant survival in rural Mozambique

We assessed the effect of maternal human immunodeficiency virus (HIV) infection on birth outcomes and infant survival in rural Mozambique. Pregnant women attending the antenatal clinic were recruited. These women and their infants were followed-up for one year. Birth outcomes were assessed at delivery and infant HIV status was determined at 1 and 12 months of age. Women positive for HIV were more likely to have anemia at delivery than women negative for HIV (51.3% versus 35.4%; P < 0.001). Infants born to HIV-positive mothers had a significantly higher post-neonatal mortality rate than infants born to HIV-negative mothers (7.8% versus 1.9%; P < 0.001). The rate of transmission of HIV by breastfeeding during the first year of life was 15.1% (95% confidence interval = CI 7.6-22.4). Assessment of the impact of HIV infection on birth outcomes in rural Africa is essential for tailoring public health measures to reduce mother-to-child transmission of HIV and excess infant mortality.

Insights into long-lasting protection induced by RTS,S/AS02A malaria vaccine: further results from a phase IIb trial in Mozambican children

BACKGROUND

The pre-erythrocytic malaria vaccine RTS,S/AS02A has shown to confer protection against clinical malaria for at least 21 months in a trial in Mozambican children. Efficacy varied between different endpoints, such as parasitaemia or clinical malaria; however the underlying mechanisms that determine efficacy and its duration remain unknown. We performed a new, exploratory analysis to explore differences in the duration of protection among participants to better understand the protection afforded by RTS,S.

METHODOLOGY/PRINCIPAL FINDINGS

The study was a Phase IIb double-blind, randomized controlled trial in 2022 children aged 1 to 4 years. The trial was designed with two cohorts to estimate vaccine efficacy against two different endpoints: clinical malaria (cohort 1) and infection (cohort 2). Participants were randomly allocated to receive three doses of RTS,S/AS02A or control vaccines. We did a retrospective, unplanned sub-analysis of cohort 2 data using information collected for safety through the health facility-based passive case detection system. Vaccine efficacy against clinical malaria was estimated over the first six-month surveillance period (double-blind phase) and over the following 12 months (single-blind phase), and analysis was per-protocol. Adjusted vaccine efficacy against first clinical malaria episodes in cohort 2 was of 35.4% (95% CI 4.5-56.3; p = 0.029) over the double-blind phase and of 9.0% (-30.6-36.6; p = 0.609) during the single-blind phase.

CONCLUSIONS/SIGNIFICANCE

Contrary to observations in cohort 1, where efficacy against clinical malaria did not wane over time, in cohort 2 the efficacy decreases with time. We hypothesize that this reduced duration of protection is a result of the early diagnosis and treatment of infections in cohort 2 participants, preventing sufficient exposure to asexual-stage antigens. On the other hand, the long-term protection against clinical disease observed in cohort 1 may be a consequence of a prolonged exposure to low-dose blood-stage asexual parasitaemia.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00197041.

Distribution, colour polymorphism and habitat use of the African killifish Nothobranchius furzeri, the vertebrate with the shortest life span

Intensive collection in southern Mozambique across and outside the potential range of Nothobranchius furzeri, the species with the shortest recorded life span among vertebrates used as a model in ageing research, revealed that, contrary to previous data, it is a widespread species. It occurs in small freshwater pools south of the Save River and north of the Incomati River, including basins of the Limpopo, Changane, Chefu, Mazimechopes and Vaneteze Rivers. During collection in February 2008 (the second part of the rainy season), populations were strongly female biased (mean, 28% of males across 19 populations), and there was a spatial pattern in female bias among metapopulations. Populations varied in the proportion of male colour morphs. Fourteen populations were composed exclusively of the red male phenotype, three populations of the yellow male phenotype and 12 populations were mixed. Overall, the red phenotype was more common, but there was strong geographical variation in morph proportion, with yellow males more abundant at the periphery and red male dominance in the centre of the range of N. furzeri in the Limpopo basin. Nothobranchius furzeri was sympatric with Nothobranchius orthonotus (35% of investigated pools) and Nothobranchius rachovii (27% of sites). Analysis of habitat use of N. furzeri is presented; N. furzeri was associated with pools containing a soft muddy substratum and turbid water.

Measles-specific neutralizing antibodies in rural Mozambique: seroprevalence and presence in breast milk

In Mozambique, as in many sub-Saharan countries, measles remains a public health problem. We conducted cross-sectional surveys in which we assessed measles-specific antibodies in serum and breast milk by plaque reduction neutralization (PRN) assay and measles secretory IgA in breast milk by enzyme-linked immunosorbent assay. A total of 151 persons < 1 month to 23 years of age were surveyed; 81 (53.6%) of 151 had PRN titers equal to or above the protective level (>/= 200 mIU/mL). We found many serosusceptible persons, including 20.5% in whom no PRN antibody was detected. Almost all (96%) infants 6-8 months of age had non-protective PRN titers. Overall, 20.7% (6 of 29) of persons known to have received measles vaccine had non-protective titers. The geometric mean titer (GMT) of breast milk PRN antibodies was 41.6 mIU/mL (95% confidence interval [CI] = 34.0-51.0 mIU/mL) and the secretory IgA GMT was 227.6 (EU/mL) (95% CI = 179.1-289.1 EU/mL). The PRN titers of breast milk tended to increase with age. A notable proportion of the population in Manhiça, Mozambique apparently remains susceptible to clinical measles despite recent mass vaccination campaigns.

Musculoskeletal trauma services in Mozambique and Sri Lanka

There is currently an escalating epidemic of trauma-related injuries due to road traffic accidents and armed conflicts. This trauma occurs predominantly in rural areas where most of the population lives. Major ways to combat this epidemic include prevention programs, improved healthcare facilities, and training of competent providers. Mozambique and Sri Lanka have many common features including size, economic system, and healthcare structure but have significant differences in their medical education systems. With six medical schools, Sri Lanka graduates 1000 new physicians per year while Mozambique graduates less than 50 from their singular school. To supplement the low number of physicians, a training course for surgical technicians has been implemented. Examination of district hospital staffing and the medical education in these two countries might provide for improving trauma care competence in other developing countries. Musculoskeletal education is underrepresented in most medical school curricula around the world. District hospitals in developing countries are commonly staffed by recently graduated general medical officers, whose last formal education was in medical school. There is an opportunity to improve the quality of trauma care at the district hospital level by addressing the musculoskeletal curriculum content in medical schools.

Feasibility of water purification technology in rural areas of developing countries

Water scarcity is threatening social and economic growth in rural areas of developing countries. There are potential markets for water purification technologies in these regions. The main focus of this article is to evaluate the social, economic and political feasibilities of providing water purification technologies to rural areas of developing countries. The findings of this research can serve as the basis for private investors interested in entering this market. Four representative regions were selected for the study. Economic, demographic, and environmental variables of each region were collected and analyzed along with domestic markets and political information. Rural areas of the developing world are populated with poor people unable to fulfill the basic needs for clean water and sanitation. These people represent an important group of potential users. Due to economic, social, and political risks in these areas, it is difficult to build a strong case for any business or organization focusing on immediate returns on capital investment. A plausible business strategy would be to approach the water purification market as a corporate responsibility and social investing in the short term. This would allow an organization to be well positioned once the economic ability of individuals, governments, and donor agencies are better aligned.

Vaginal practices: eroticism and implications for women's health and condom use in Mozambique

This paper analyses two female sexual practices in Tete Province, Mozambique: (1) the practice of elongating the labia minora and (2) what is sometimes called 'dry sex' involving the insertion of natural and/or synthetic products into the vagina or the ingestion of these products orally. These practices are fundamental to the construction of female identity, eroticism and the experience of pleasure. Notions such as 'closed/open', 'dry/damp', 'hot/cold', 'heavy/light', 'life/death', 'wealth/poverty' and 'sweet/not sweet' are central to local understandings of sexual practices and reproduction. These notions may affect the women's sexual health because they influence preferences for sex without a condom. These practices may also be associated with the alteration of the vaginal flora and vaginal lesions that may make women more vulnerable to sexually transmitted infections.

Differential effect of regional drug pressure on dihydrofolate reductase and dihydropteroate synthetase mutations in southern Mozambique

The prevalence and frequency of the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) mutations associated with sulfadoxine-pyrimethamine (SP) resistance at 13 sentinel surveillance sites in southern Mozambique were examined regularly between 1999 and 2004. Frequency of the dhfr triple mutation increased from 0.26 in 1999 to 0.96 in 2003, remaining high in 2004. The dhps double mutation frequency peaked in 2001 (0.22) but declined to baseline levels (0.07) by 2004. Similarly, parasites with both dhfr triple and dhps double mutations had increased in 2001 (0.18) but decreased by 2004 (0.05). The peaking of SP resistance markers in 2001 coincided with a SP-resistant malaria epidemic in neighboring KwaZulu-Natal, South Africa. The decline in dhps (but not dhfr) mutations corresponded with replacement of SP with artemether-lumefantrine as malaria treatment policy in KwaZulu-Natal. Our results show that drug pressure can exert its influence at a regional level rather than merely at a national level.