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Sacoor C, Vitorino P, Nhacolo A, Munguambe K, Mabunda R, Garrine M, Jamisse E, Magaço A, Xerinda E, Sitoe A, Fernandes F, Carrilho C, Maixenchs M, Chirinda P, Nhampossa T, Nhancale B, Rakislova N, Bramugy J, Nhacolo A, Ajanovic S, Valente M, Massinga A, Varo R, Menéndez C, Ordi J, Mandomando I, Bassat Q. Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique. Gates Open Res 2024; 7:4. [PMID: 39233704 PMCID: PMC11374382 DOI: 10.12688/gatesopenres.13931.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2024] [Indexed: 09/06/2024] Open
Abstract
The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.
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Affiliation(s)
- Charfudin Sacoor
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Pio Vitorino
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Ariel Nhacolo
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Khátia Munguambe
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Maputo, Mozambique
| | - Rita Mabunda
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Marcelino Garrine
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Edgar Jamisse
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Amílcar Magaço
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Elísio Xerinda
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - António Sitoe
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Fabíola Fernandes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Maputo, Mozambique
| | - Carla Carrilho
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Maputo, Mozambique
| | - Maria Maixenchs
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Percina Chirinda
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Tacilta Nhampossa
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Bento Nhancale
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Justina Bramugy
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Arsénio Nhacolo
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Sara Ajanovic
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Marta Valente
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Arsénia Massinga
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Rosauro Varo
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- National Institute of Health, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Quique Bassat
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- ICREA, Barcelona, Spain
- Pediatric Department, Hospital Sant Joan de Deu- Universitat de Barcelona, Barcelona, Spain
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Holcomb DA, Knee J, Sumner T, Adriano Z, de Bruijn E, Nalá R, Cumming O, Brown J, Stewart JR. Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique. Int J Hyg Environ Health 2020; 226:113496. [PMID: 32135507 PMCID: PMC7174141 DOI: 10.1016/j.ijheh.2020.113496] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Identifying the origin of fecal contamination can support more effective interventions to interrupt enteric pathogen transmission. Microbial source tracking (MST) assays may help to identify environmental routes of pathogen transmission although these assays have performed poorly in highly contaminated domestic settings, highlighting the importance of both diagnostic validation and understanding the context-specific ecological, physical, and sociodemographic factors driving the spread of fecal contamination. We assessed fecal contamination of compounds (clusters of 2-10 households that share sanitation facilities) in low-income neighborhoods of urban Maputo, Mozambique, using a set of MST assays that were validated with animal stool and latrine sludge from study compounds. We sampled five environmental compartments involved in fecal microbe transmission and exposure: compound water source, household stored water and food preparation surfaces, and soil from the entrance to the compound latrine and the entrances to each household. Each sample was analyzed by culture for the general fecal indicator Escherichia coli (cEC) and by real-time PCR for the E. coli molecular marker EC23S857, human-associated markers HF183/BacR287 and Mnif, and GFD, an avian-associated marker. We collected 366 samples from 94 households in 58 compounds. At least one microbial target (indicator organism or marker gene) was detected in 96% of samples (353/366), with both E. coli targets present in the majority of samples (78%). Human targets were frequently detected in soils (59%) and occasionally in stored water (17%) but seldom in source water or on food surfaces. The avian target GFD was rarely detected in any sample type but was most common in soils (4%). To identify risk factors of fecal contamination, we estimated associations with sociodemographic, meteorological, and physical sample characteristics for each microbial target and sample type combination using Bayesian censored regression for target concentration responses and Bayesian logistic regression for target detection status. Associations with risk factors were generally weak and often differed in direction between different targets and sample types, though relationships were somewhat more consistent for physical sample characteristics. Wet soils were associated with elevated concentrations of cEC and EC23S857 and odds of detecting HF183. Water storage container characteristics that expose the contents to potential contact with hands and other objects were weakly associated with human target detection. Our results describe a setting impacted by pervasive domestic fecal contamination, including from human sources, that was largely disconnected from the observed variation in socioeconomic and sanitary conditions. This pattern suggests that in such highly contaminated settings, transformational changes to the community environment may be required before meaningful impacts on fecal contamination can be realized.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Zaida Adriano
- We Consult, Maputo, Mozambique; Departamento de Geografia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Rassul Nalá
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Capone D, Adriano Z, Berendes D, Cumming O, Dreibelbis R, Holcomb DA, Knee J, Ross I, Brown J. A localized sanitation status index as a proxy for fecal contamination in urban Maputo, Mozambique. PLoS One 2019; 14:e0224333. [PMID: 31652287 PMCID: PMC6814227 DOI: 10.1371/journal.pone.0224333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/10/2019] [Indexed: 11/24/2022] Open
Abstract
Sanitary surveys are used in low- and middle-income countries to assess water, sanitation, and hygiene conditions, but have rarely been compared with direct measures of environmental fecal contamination. We conducted a cross-sectional assessment of sanitary conditions and E. coli counts in soils and on surfaces of compounds (household clusters) in low-income neighborhoods of Maputo, Mozambique. We adapted the World Bank's Urban Sanitation Status Index to implement a sanitary survey tool specifically for compounds: a Localized Sanitation Status Index (LSSI) ranging from zero (poor sanitary conditions) to one (better sanitary conditions) calculated from 20 variables that characterized local sanitary conditions. We measured the variation in the LSSI with E. coli counts in soil (nine locations/compound) and surface swabs (seven locations/compound) in 80 compounds to assess reliability. Multivariable regression indicated that a ten-percentage point increase in LSSI was associated with 0.05 (95% CI: 0.00, 0.11) log10 fewer E. coli/dry gram in courtyard soil. Overall, the LSSI may be associated with fecal contamination in compound soil; however, the differences detected may not be meaningful in terms of public health hazards.
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Affiliation(s)
- Drew Capone
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Zaida Adriano
- WE Consult, Maputo, Mozambique
- Departamento de Geografia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David A. Holcomb
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jackie Knee
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Ian Ross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joe Brown
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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