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Jaén-Sánchez N, González-Azpeitia G, Carranza-Rodriguez C, Manwere N, Garay-Sánchez P, Vallejo-Torres L, Pérez-Arellano JL. Increased peripartum mortality associated with maternal subclinical malaria in Mozambique. Malar J 2023; 22:182. [PMID: 37309000 DOI: 10.1186/s12936-023-04613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Plasmodium falciparum infection in pregnant women in sub-Saharan Africa is often asymptomatic. As these forms of malaria are often submicroscopic and difficult to diagnose by conventional methods (microscopy and/or rapid diagnostic test), diagnosis requires the use of molecular techniques such as polymerase chain reaction (PCR). This study analyses the prevalence of subclinical malaria and its association with adverse maternal and neonatal outcomes, a topic that has been scarcely evaluated in the literature. METHODS A cross-sectional study was conducted using semi-nested multiplex PCR to assess the presence of P. falciparum in placental and peripheral blood of 232 parturient pregnant women at the Hospital Provincial de Tete, Mozambique between March 2017 and May 2019. Multivariate regressions were performed to assess the associations of maternal subclinical malaria with several maternal and neonatal outcomes after controlling for the presence of preeclampsia/eclampsia (PE/E) and HIV infection, as well as for other maternal and pregnancy characteristics. RESULTS In total, 17.2% (n = 40) of the women studied had positive PCR for P. falciparum (7 in placental blood only, 3 in peripheral blood only). We found a significant association between subclinical malaria and a higher peripartum mortality risk, which persisted after controlling for maternal comorbidity and maternal and pregnancy characteristics (adjusted odds ratio: 3.50 [1.11-10.97]). In addition, PE/E and HIV infections were also significantly associated with several adverse maternal and neonatal outcomes. CONCLUSION This study demonstrated the association of subclinical malaria, as well as of PE/E and HIV, in pregnant women with adverse maternal and neonatal outcomes. Therefore, molecular methods may be sensitive tools to identify asymptomatic infections that can reduce the impact on peripartum mortality and their contribution to sustained transmission of the parasite in endemic countries.
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Affiliation(s)
- Nieves Jaén-Sánchez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gloria González-Azpeitia
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Pediatric Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Cristina Carranza-Rodriguez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Nicholas Manwere
- Department of Health Sciences, University of Zambeze, Beira, Mozambique
| | | | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José-Luis Pérez-Arellano
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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2
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Ruiz-Castillo P, Imputiua S, Xie K, Elobolobo E, Nicolas P, Montaña J, Jamisse E, Munguambe H, Materrula F, Casellas A, Deng X, Marathe A, Rabinovich R, Saute F, Chaccour C, Sacoor C. BOHEMIA a cluster randomized trial to assess the impact of an endectocide-based one health approach to malaria in Mozambique: baseline demographics and key malaria indicators. Malar J 2023; 22:172. [PMID: 37271818 DOI: 10.1186/s12936-023-04605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Many geographical areas of sub-Saharan Africa, especially in rural settings, lack complete and up-to-date demographic data, posing a challenge for implementation and evaluation of public health interventions and carrying out large-scale health research. A demographic survey was completed in Mopeia district, located in the Zambezia province in Mozambique, to inform the Broad One Health Endectocide-based Malaria Intervention in Africa (BOHEMIA) cluster randomized clinical trial, which tested ivermectin mass drug administration to humans and/or livestock as a potential novel strategy to decrease malaria transmission. METHODS The demographic survey was a prospective descriptive study, which collected data of all the households in the district that accepted to participate. Households were mapped through geolocation and identified with a unique identification number. Basic demographic data of the household members was collected and each person received a permanent identification number for the study. RESULTS 25,550 households were mapped and underwent the demographic survey, and 131,818 individuals were registered in the district. The average household size was 5 members and 76.9% of households identified a male household head. Housing conditions are often substandard with low access to improved water systems and electricity. The reported coverage of malaria interventions was 71.1% for indoor residual spraying and 54.1% for universal coverage of long-lasting insecticidal nets. The median age of the population was 15 years old. There were 910 deaths in the previous 12 months reported, and 43.9% were of children less than 5 years of age. CONCLUSIONS The study showed that the district had good coverage of vector control tools against malaria but sub-optimal living conditions and poor access to basic services. The majority of households are led by males and Mopeia Sede/Cuacua is the most populated locality in the district. The population of Mopeia is young (< 15 years) and there is a high childhood mortality. The results of this survey were crucial as they provided the household and population profiles and allowed the design and implementation of the cluster randomized clinical trial. Trial registration NCT04966702.
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Affiliation(s)
| | | | - Kexin Xie
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Eldo Elobolobo
- Centro de Investigaçao em Saúde de Manhiça, Manhiça, Mozambique
| | - Patricia Nicolas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçao em Saúde de Manhiça, Manhiça, Mozambique
| | - Julia Montaña
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigaçao em Saúde de Manhiça, Manhiça, Mozambique
| | - Edgar Jamisse
- Centro de Investigaçao em Saúde de Manhiça, Manhiça, Mozambique
| | | | | | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Xinwei Deng
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Achla Marathe
- Network Systems Science and Advanced Computing Division, Biocomplexity Institute, University of Virginia, Charlottesville, VA, USA
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Regina Rabinovich
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Francisco Saute
- Centro de Investigaçao em Saúde de Manhiça, Manhiça, Mozambique
| | - Carlos Chaccour
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Ciberinfec, Madrid, Spain
- Universidad de Navarra, Pamplona, Spain
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3
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Mehejabin F, Rahman MS. Knowledge and perception of breast cancer among women of reproductive age in Chattogram, Bangladesh: A cross‐sectional survey. Health Sci Rep 2022; 5:e840. [PMID: 36189418 PMCID: PMC9488900 DOI: 10.1002/hsr2.840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 07/14/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Breast cancer is the second leading cause of cancer death in women worldwide. The significantly higher mortality rate has been considered due to poor knowledge of women, delay in diagnosis, and initiation of treatment. Therefore, this hospital‐based cross‐sectional study aimed to understand the knowledge and perception of women with breast cancer in Bangladesh. Methods Data was collected using a questionnaire‐based interview from 357 women aged 15–49 years attending two tertiary care hospitals in Chattogram city of Bangladesh. Results Neighbors (18.6%) and relatives (18.1%) were the leading sources of information on breast cancer. Among the total, 69.5% knew about breast cancer however, only 14% of them knew about screening tests and 61.5% were unaware of risk factors for developing breast cancer. Pain in the breast, painless lump, and nipple discharge were the most recognized clinical symptoms by the participants. Exercise and weight control, the practice of breastfeeding, and taking medicine were the three most known prevention practices. Women perceived wrong conceptions that Breast cancer is only found in older age (42.3%) and women (15.7%) and that it causes losing one's breast (3.1%). A significant correlation was found between the education level of participants and their knowledge of risk factors related to breast cancer. Conclusion Although the majority of the participants have heard about breast cancer, they do not possess enough knowledge regarding the risk factor, symptoms, and preventive methods of breast cancer. We suggest interventions targeting a community‐based awareness program
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Affiliation(s)
- Fatema Mehejabin
- Asian University for Women Chattogram Bangladesh
- One Health Center for Research and Action Chattogram Bangladesh
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Factors Associated with Caesarean and Peripartum Complications at Southern Mozambique’s Rural Hospitals: A Cross-Sectional Analytical Study. Healthcare (Basel) 2022; 10:healthcare10061013. [PMID: 35742065 PMCID: PMC9223089 DOI: 10.3390/healthcare10061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients’ files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had “high obstetric-risk” and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8; 95% Confidence Interval (95%CI) = 1.3–2.6], preeclampsia [aOR (95%CI) = 2.0 (1.2–3.3)], age [aOR (95%CI) = 0.96 (0.93–0.99)] and “high obstetric-risk” [aOR (95%CI) = 0.54 (0.37–0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8–2.6)], “high obstetric-risk” [aOR (95%CI) = 1.6 (1.3–1.96)], preeclampsia [aOR (95%CI) = 1.5 (1.2–1.8), mother’s age [aOR (95%CI) = −2% (−3%, −0.1%)] and gestational age [aOR (95%CI) = −8% (−13%, −6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals’ performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads.
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Boene H, Valá A, Kinshella MLW, La M, Sharma S, Vidler M, Magee LA, von Dadelszen P, Sevene E, Munguambe K, Payne BA. Implementation of the PIERS on the Move mHealth Application From the Perspective of Community Health Workers and Nurses in Rural Mozambique. Front Glob Womens Health 2021; 2:659582. [PMID: 34816216 PMCID: PMC8593977 DOI: 10.3389/fgwh.2021.659582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background:mHealth is increasingly regarded as having the potential to support service delivery by health workers in low-resource settings. PIERS on the Move (POM) is a mobile health application developed to support community health workers identification and management of women at risk of adverse outcomes from pre-eclampsia. The objective of this study was to evaluate the impact of using POM in Mozambique on community health care workers' knowledge and self-efficacy related to caring for women with pre-eclampsia, and their perception of usefulness of the tool to inform implementation. Method: An evaluation was conducted for health care workers in the Mozambique Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized trial from 2014 to 2016 in Maputo and Gaza provinces (NCT01911494). A structured survey was designed using themes from the Technology Acceptance Model, which describes the likelihood of adopting the technology based on perceived usefulness and perceived ease of use. Surveys were conducted in Portuguese and translated verbatim to English for analysis. Preliminary analysis of open-ended responses was conducted to develop a coding framework for full qualitative analysis, which was completed using NVivo12 (QSR International, Melbourne, Australia). Results: Overall, 118 community health workers (44 intervention; 74 control) and 55 nurses (23 intervention; 32 control) were surveyed regarding their experiences. Many community health workers found the POM app easy to use (80%; 35/44), useful in guiding their activities (68%; 30/44) and pregnant women received their counseling more seriously because of the POM app (75%; 33/44). Almost a third CHWs reported some challenges using the POM app (30%; 13/44), including battery depletion after a full day's activity. Community health workers reported increases in knowledge about pre-eclampsia and other pregnancy complications and increases in confidence, comfort and capacity to advise women on health conditions and deliver services. Nurses recognized the increased capacity of community health workers and were more confident in their clinical and technological skills to identify women at risk of obstetric complications. Conclusions: Many of the community health workers reported that POM improved knowledge, self-efficacy and strengthened relationships with the communities they serve and local nurses. This helped to strengthen the link between community and health facility. However, findings highlight the need to consider program and systematic challenges to implementation.
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Affiliation(s)
- Helena Boene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Michelle La
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.,Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.,Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Beth A Payne
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Guber RS, Gonzalez Mac Donald M, Aleman MN, Luciardi MC, Mentz P, Wierna A, Ansonnaud C, Garcia V, Ansonnaud AM, Soria A. Evaluation of salivary protein patterns among a rural population exposed and non-exposed to arsenic-contaminated drinking water in areas of Tucumán (Argentina): a pilot study. J Appl Oral Sci 2021; 29:e20200939. [PMID: 34495104 PMCID: PMC8425895 DOI: 10.1590/1678-7757-2020-0939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arsenic contamination in the environment and groundwater is a major global public health problem. Several researchers suggest that the toxicity of arsenic could be related to oral cancer development, usually resulting from potentially malignant lesions. During pathological processes, salivary proteins suffer modifications, which could lead to the discovery of new biomarkers. OBJECTIVE To analyze the protein profile in human saliva samples from a rural population exposed to high levels of arsenic in drinking water and its association with potentially malignant lesions. METHODOLOGY This observational, analytic and cross-sectional design included 121 patients from the state of Graneros (Tucumán, Argentina). Arsenic concentration in drinking water was determined and, according to the values obtained, individuals were divided into 2 groups: exposed group and non-exposed group. Saliva samples were obtained, and total protein concentration was measured by Bradford method. Finally, Laemmli SDS-polyacrylamide gel electrophoresis was conducted to obtain the protein profile. RESULTS Total protein concentration in saliva was lower in the exposed group than in the non-exposed group. Average areas of 20 and 42 KDa bands were significantly lower in exposed group than non-exposed group. CONCLUSION Chronic intake of high arsenic concentrations in drinking water produces changes in the salivary protein profile, which is associated with the presence of potentially malignant lesions.
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Affiliation(s)
- Rosa Silvina Guber
- Universidad Nacional de Tucumán, Facultad de Bioquímica, Química y Farmacia, Argentina
| | | | | | | | - Paula Mentz
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | - Alicia Wierna
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | - Carlos Ansonnaud
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | - Veronica Garcia
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | | | - Analía Soria
- Universidad Nacional de Tucumán, Facultad de Bioquímica, Química y Farmacia, Argentina
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Sevene E, Boene H, Vidler M, Valá A, Macuacua S, Augusto O, Fernandes Q, Bique C, Macete E, Sidat M, von Dadelszen P, Munguambe K. Feasibility of task-sharing with community health workers for the identification, emergency management and referral of women with pre-eclampsia, in Mozambique. Reprod Health 2021; 18:145. [PMID: 34229709 PMCID: PMC8259411 DOI: 10.1186/s12978-021-01192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Maternal mortality is an important public health problem in low-income countries. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited evidence on the role of community health workers in the management of pregnancy complications. This study aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and document healthcare facility preparedness to respond to referrals. Method The study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial. This was a mixed-methods study. The quantitative data was collected through self-administered questionnaires completed by community health workers and a health facility survey; this data was analysed using Stata v13. The qualitative data was collected through focus group discussions and in-depth interviews with various community groups, health care providers, and policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community health worker policies, guidelines, reports and manuals. Results Community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for referrals, no transport was available from the community to the healthcare facility. Conclusions This study showed that task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia were deemed feasible and acceptable at the community-level, but an effort should be in place to address challenges at the health system level. Maternal mortality is an important public health problem in Mozambique. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. We conducted a study to describe the feasibility of task-sharing the screening and initiation of management for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and to document healthcare facility preparedness to respond to referrals. The study was done to inform a future intervention trial known as the Community-Level Interventions for Pre-eclampsia (CLIP) study. We interviewed community health workers, women, various community groups, health care providers, and policymakers and assessed health facilities in Maputo and Gaza provinces, Mozambique. Our results showed that community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they were not trained or equipped to provide obstetric emergencies care prior to referral. Nurses at primary health facilities were supportive of task-sharing with community health workers; however, some barriers mentioned include a lack of equipment, shortage of supervisors, and irregular drug availability. Local stakeholders emphasized the need for comprehensive training and supervision of community health workers to take on new tasks. Task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia was deemed feasible at the community level in southern Mozambique, but still, to be addressed some health system level barriers to the management of pregnancies complications.
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Affiliation(s)
- Esperança Sevene
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique. .,Department of Physiologic Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
| | - Helena Boene
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and The Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada
| | - Anifa Valá
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Salésio Macuacua
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Orvalho Augusto
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Cassimo Bique
- Ministério da Saúde, Maputo, Mozambique.,Hospital Central de Maputo, Maputo, Mozambique
| | - Eusébio Macete
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Ministério da Saúde, Maputo, Mozambique
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Khátia Munguambe
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique
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Berrueta M, Ciapponi A, Bardach A, Cairoli FR, Castellano FJ, Xiong X, Stergachis A, Zaraa S, Meulen AST, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review. BMC Pregnancy Childbirth 2021; 21:217. [PMID: 33731029 PMCID: PMC7968860 DOI: 10.1186/s12884-021-03686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most post-licensure vaccine pharmacovigilance in low- and middle-income countries (LMICs) are passive reporting systems. These have limited utility for maternal immunization pharmacovigilance in LMIC settings and need to be supplemented with active surveillance. Our study's main objective was to identify existing perinatal data collection systems in LMICs that collect individual information on maternal and neonatal health outcomes and could be developed to inform active safety surveillance of novel vaccines for use during pregnancy. METHODS A scoping review was performed following the Arksey and O'Malley six-stage approach. We included studies describing electronic or mixed paper-electronic data collection systems in LMICs, including research networks, electronic medical records, and custom software platforms for health information systems. Medline PubMed, EMBASE, Global Health, Cochrane Library, LILACS, Bibliography of Asian Studies (BAS), and CINAHL were searched through August 2019. We also searched grey literature including through Google and websites of existing relevant perinatal data collection systems, as well as contacted authors of key studies and experts in the field to validate the information and identify additional sources of relevant unpublished information. RESULTS A total of 11,817 records were identified. The full texts of 264 records describing 96 data collection systems were assessed for eligibility. Eight perinatal data collection systems met our inclusion criteria: Global Network's Maternal Newborn Health Registry, International Network for the Demographic Evaluation of Populations and their Health; Perinatal Informatic System; Pregnancy Exposure Registry & Birth Defects Surveillance; SmartCare; Open Medical Record System; Open Smart Register Platform and District Health Information Software 2. These selected systems were qualitatively characterized according to seven different domains: governance; system design; system management; data management; data sources, outcomes and data quality. CONCLUSION This review provides a list of active maternal and neonatal data collection systems in LMICs and their characteristics as well as their outreach, strengths, and limitations. Findings could potentially help further understand where to obtain population-based high-quality information on outcomes to inform the conduct of maternal immunization active vaccine safety surveillance activities and research in LMICs.
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Affiliation(s)
- Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Fabricio J Castellano
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA, 98195-7631, USA
| | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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Fuente-Soro L, Fernández-Luis S, López-Varela E, Augusto O, Nhampossa T, Nhacolo A, Bernardo E, Burgueño B, Ngeno B, Couto A, Guambe H, Tibana K, Urso M, Naniche D. Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique. BMC Public Health 2021; 21:520. [PMID: 33731061 PMCID: PMC7970736 DOI: 10.1186/s12889-021-10568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally.. Methods A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model. Results Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death. Conclusions In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10568-4.
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Affiliation(s)
- Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. .,Barcelona Institute for Global Health, Barcelona, Spain. .,ISGlobal, Barcelona Institute for Global Health, Rossello, 132, 08036, Barcelona, Spain.
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Edson Bernardo
- Manhiça District Health Services, Maputo, Mozambique.,Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
| | | | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Aleny Couto
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | - Helga Guambe
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | | | - Marilena Urso
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
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10
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Varela C, Young S, Groen RS, Banza L, Mkandawire N, Moen BE, Viste A. Deaths from surgical conditions in Malawi - a randomised cross-sectional Nationwide household survey. BMC Public Health 2020; 20:1456. [PMID: 32977777 PMCID: PMC7519556 DOI: 10.1186/s12889-020-09575-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. Methods The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. Results The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. Conclusion In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.
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Affiliation(s)
- Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou S Groen
- Department of Obstetrics and Gynaecology, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynaecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi.,Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Bente Elisabeth Moen
- Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Clinical Medicine, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
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11
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Sevene E, Sharma S, Munguambe K, Sacoor C, Vala A, Macuacua S, Boene H, Mark Ansermino J, Augusto O, Bique C, Bone J, Dunsmuir DT, Lee T, Li J, Macete E, Singer J, Wong H, Nathan HL, Payne BA, Sidat M, Shennan AH, Tchavana C, Tu DK, Vidler M, Bhutta ZA, Magee LA, von Dadelszen P. Community-level interventions for pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial. Pregnancy Hypertens 2020; 21:96-105. [PMID: 32464527 PMCID: PMC7471842 DOI: 10.1016/j.preghy.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Pregnancy hypertension is the third leading cause of maternal mortality in Mozambique and contributes significantly to fetal and neonatal mortality. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. STUDY DESIGN The Mozambique Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 administrative posts (clusters) in Maputo and Gaza Provinces. The CLIP intervention (6 clusters) consisted of community engagement, community health worker-provided mobile health-guided clinical assessment, initial treatment, and referral to facility either urgently (<4hrs) or non-urgently (<24hrs), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of CLIP contacts. MAIN OUTCOME MEASURES 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. RESULTS 15,013 women (15,123 pregnancies) were recruited in intervention (N = 7930; 2·0% loss to follow-up (LTFU)) and control (N = 7190; 2·8% LTFU) clusters. The primary outcome did not differ between intervention and control clusters (adjusted odds ratio (aOR) 1·31, 95% confidence interval (CI) [0·70, 2·48]; p = 0·40). Compared with intervention arm women without CLIP contacts, those with ≥8 contacts experienced fewer primary outcomes (aOR 0·79 (95% CI 0·63, 0·99); p = 0·041), primarily due to improved maternal outcomes (aOR 0·72 (95% CI 0·53, 0·97); p = 0·033). INTERPRETATION As generally implemented, the CLIP intervention did not improve pregnancy outcomes; community implementation of the WHO eight contact model may be beneficial. FUNDING The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337).
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Affiliation(s)
- Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique.
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Anifa Vala
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Salésio Macuacua
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Direcção Provincial de Saúde, Ministério da Saúde, Av. Eduardo Mondlane n(o) 1008, CP 264 Maputo, Mozambique
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - J Mark Ansermino
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Cassimo Bique
- Departamento de Ginecologia e Obstetrícia, Hospital Central de Maputo, Av. Agostinho Neto n(o) 167, CP 1164 Maputo, Mozambique
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Dustin T Dunsmuir
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Distrito de Marracuene, Estrada Nacional N(o) 1, Maputo, Mozambique
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Beth A Payne
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Mohsin Sidat
- Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Corssino Tchavana
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Domena K Tu
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto M5G 2L3, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
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12
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Jaén-Sánchez N, González-Azpeitia G, Saavedra-Santana P, Saavedra-Sanjuán E, Manguiza AA, Manwere N, Carranza-Rodriguez C, Pérez-Arellano JL, Serra-Majem L. Adolescent motherhood in Mozambique. Consequences for pregnant women and newborns. PLoS One 2020; 15:e0233985. [PMID: 32492055 PMCID: PMC7269336 DOI: 10.1371/journal.pone.0233985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn. Aims To identify the factors associated with adolescent motherhood in Tete (Mozambique). Methods This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn. Results The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040–0.110), pregnancy follow-up (OR 0.29; CI 0.173–0.488) and previous abortions (OR 4.419; 95% CI 1.931–10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn. Conclusion Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.
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Affiliation(s)
- Nieves Jaén-Sánchez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Univer-sitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gloria González-Azpeitia
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Pediatric Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra-Santana
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Esther Saavedra-Sanjuán
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Cristina Carranza-Rodriguez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Univer-sitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- * E-mail:
| | - José Luis Pérez-Arellano
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Univer-sitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Lluis Serra-Majem
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Ciber OBN (CB06/03), Instituto Carlos III, Spanish Government, Madrid, Spain
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13
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Boene H, Mocumbi S, Högberg U, Hanson C, Valá A, Bergström A, Sevene E, Munguambe K. Obstetric fistula in southern Mozambique: a qualitative study on women's experiences of care pregnancy, delivery and post-partum. Reprod Health 2020; 17:21. [PMID: 32005268 PMCID: PMC6995132 DOI: 10.1186/s12978-020-0860-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula is still common in low- and middle-income countries (LMIC) despite the on-going shift to increased facility deliveries in the same settings. The social behavioural circumstances in which fistula, as well as its consequences, still occur are poorly documented, particularly from the perspective of the experiences of women with obstetric fistula. This study sought to describe women's experiences of antenatal, partum and post-partum care in southern Mozambique, and to pinpoint those experiences that are unique to women with fistula in order to understand the care-seeking and care provision circumstances which could have been modified to avoid or mitigate the onset or consequences of fistula. METHODS This study took place in Maputo and Gaza provinces, southern Mozambique, in 2016-2017. Qualitative data were collected through in-depth interviews conducted with 14 women with positive diagnoses of fistula and an equal number of women without fistula. All interviews were audio-recorded and transcribed verbatim prior to thematic analysis using NVivo11. RESULTS Study participants had all attended antenatal care (ANC) visits and had prepared for a facility birth. Prolonged or obstructed labour, multiple referrals, and delays in receiving secondary and tertiary health care were common among the discourses of women with fistula. The term "fistula" was rarely known among participants, but the condition (referred to as "loss of water" or "illness of spillage") was recognised after being prompted on its signs and symptoms. Women with fistula were invariably aware of the links between fistula and poor birth assistance, in contrast with those without fistula, who blamed the condition on women's physiological and behavioural characteristics. CONCLUSION Although women do seek antenatal and peri-partum care in health facilities, deficiencies and delays in birth assistance, referral and life-saving interventions were commonly reported by women with fistula. Furthermore, weaknesses in quality of care, not only in relation to prevention, but also the resolution of the damage, were evident. Quality improvement of birth care is necessary, both at primary and referral level. There is a need to increase awareness and develop guidelines for prevention, early detection and management of obstetric fistula, including early postpartum treatment, availability of fistula repair for complex cases, and rehabilitation, coupled with the promotion of community consciousness of the problem.
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Affiliation(s)
- Helena Boene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | - Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Agostinho Neto 679, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Ulf Högberg
- Department of Women's and Children's Health, Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | - Anna Bergström
- Department of Women's and Children's Health, Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Community Health, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
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14
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Fuente-Soro L, Iniesta C, López-Varela E, Cuna M, Guilaze R, Maixenchs M, Bernardo EL, Augusto O, Gonzalez R, Couto A, Munguambe K, Naniche D. Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique. PLoS One 2019; 14:e0222028. [PMID: 31560689 PMCID: PMC6764678 DOI: 10.1371/journal.pone.0222028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
Background The implementation of quality HIV control programs is crucial for the achievement of the UNAIDS 90-90-90 targets and to motivate people living with HIV (PLWHIV) to link and remain in HIV-care. The aim of this mixed method cross-sectional study was to estimate the linkage and long-term retention in care of PLWHIV and to identify factors potentially interfering along the HIV-care continuum in southern Mozambique. Methods A home-based semi-structured interview was conducted in 2015 to explore barriers and facilitators to the HIV-care cascade among individuals that had been newly HIV-diagnosed in community testing campaigns in 2010 or 2012. Linkage and long-term retention were estimated retrospectively through client self-reports and clinical records. Cohen's Kappa coefficient was calculated to measure the agreement between participant self-reported and documented cascade outcomes. Results Among the 112 interviewed participants, 24 (21.4%) did not disclose their HIV-positive serostatus to the interviewer. While 84 (75.0%) self-reported having enrolled in care, only 69 (61.6%) reported still being in-care 3–5 years after diagnosis of which 17.4% reported having disengaged and re-engaged. An important factor affecting optimal continuum in HIV-care was the impact of the fear-based authoritarian relationship between the health system and the patient that could act as both driver and barrier. Conclusion Special attention should be given to quantify and understand repeated cycles of patient disengagement and re-engagement in HIV-care. Strategies to improve the relationship between the health system and patients are still needed in order to optimally engage PLWHIV for long-term periods.
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Affiliation(s)
- Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Carlos Iniesta
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Mauro Cuna
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rui Guilaze
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Edson Luis Bernardo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Direcção Distrital em Saúde, Manhiça, Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Raquel Gonzalez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Aleny Couto
- National STI-HIV/AIDS Program, Ministry of Health, Maputo, Mozambique
| | - Khatia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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15
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Mocumbi S, Högberg U, Lampa E, Sacoor C, Valá A, Bergström A, von Dadelszen P, Munguambe K, Hanson C, Sevene E. Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique. BMC Pregnancy Childbirth 2019; 19:303. [PMID: 31426758 PMCID: PMC6701029 DOI: 10.1186/s12884-019-2449-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background Client satisfaction is an essential component of quality of care. Health system factors, processes of care as well as mothers’ characteristics influence the extent to which care meets the expectations of mothers and families. In our study, we specifically aimed to address the mothers’ experiences of, and satisfaction with, care during childbirth. Methods A population-based cross-sectional study, using structured interviews with published sequences of questions assessing satisfaction, including 4358 mothers who gave birth during the 12 months before June 2016 to estimate satisfaction with childbirth care. Regression analysis was used to determine the predictors of client satisfaction. Results Most mothers (92.5%) reported being satisfied with care during childbirth and would recommend that a family member to deliver at the same facility. Specifically, 94.7% were satisfied with the cleanliness of the facility, 92.0% reported being satisfied with the interaction with the healthcare providers, but only 49.8% felt satisfied with the assistance to feed their baby. Mothers who had negative experiences during the process of care, such as being abandoned when needing help, disrespect, humiliation, or physical abuse, reported low levels of satisfaction when compared to those who had not had such experiences (68.5% vs 93.5%). Additionally, they reported higher levels of dissatisfaction (20.1% vs 2.1%). Regression analysis revealed that mothers who gave birth in primary level facilities tended to be more satisfied than those who gave birth in hospitals, and having a companion increased, on average, the overall satisfaction score, with 0.06 in type II health centres (CI 0.03–0.10) and with 0.05 in type I health centres (CI − 0.02 – 0.13), compared to − 0.01(CI -0.08 – 0.07) in the hospitals, irrespective of age, education and socio-economic background. Conclusion Childbirth at the primary level facilities contributes to the level of satisfaction. The provision of childbirth care should consider women’s preferences and needs, including having a companion of choice. We highlight the challenge in balancing safety of care versus satisfaction with care and in developing policies on the optimum configuration of childbirth care. Interventions to improve the interaction with providers and the provision of respectful care are recommended. Electronic supplementary material The online version of this article (10.1186/s12884-019-2449-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Salvador Allende 702, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Erik Lampa
- Uppsala Clinical Research Centre, Uppsala University, Dag Hammarskjölds väg 38, 751 85, Uppsala, Sweden
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique
| | - Anna Bergström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique.,Department of Public Health, Faculty of Medicine, Universidade Eduardo Mondlane, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Av. Salvador Allende 702 R/C, Maputo, Mozambique
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16
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Dube YP, Ruktanonchai CW, Sacoor C, Tatem AJ, Munguambe K, Boene H, Vilanculo FC, Sevene E, Matthews Z, von Dadelszen P, Makanga PT. How accurate are modelled birth and pregnancy estimates? Comparison of four models using high resolution maternal health census data in southern Mozambique. BMJ Glob Health 2019; 4:e000894. [PMID: 31354980 PMCID: PMC6623987 DOI: 10.1136/bmjgh-2018-000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 11/06/2022] Open
Abstract
Background Existence of inequalities in quality and access to healthcare services at subnational levels has been identified despite a decline in maternal and perinatal mortality rates at national levels, leading to the need to investigate such conditions using geographical analysis. The need to assess the accuracy of global demographic distribution datasets at all subnational levels arises from the current emphasis on subnational monitoring of maternal and perinatal health progress, by the new targets stated in the Sustainable Development Goals. Methods The analysis involved comparison of four models generated using Worldpop methods, incorporating region-specific input data, as measured through the Community Level Intervention for Pre-eclampsia (CLIP) project. Normalised root mean square error was used to determine and compare the models’ prediction errors at different administrative unit levels. Results The models’ prediction errors are lower at higher administrative unit levels. All datasets showed the same pattern for both the live birth and pregnancy estimates. The effect of improving spatial resolution and accuracy of input data was more prominent at higher administrative unit levels. Conclusion The validation successfully highlighted the impact of spatial resolution and accuracy of maternal and perinatal health data in modelling estimates of pregnancies and live births. There is a need for more data collection techniques that conduct comprehensive censuses like the CLIP project. It is also imperative for such projects to take advantage of the power of mapping tools at their disposal to fill the gaps in the availability of datasets for populated areas.
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Affiliation(s)
- Yolisa Prudence Dube
- Faculty of Science and Technology, Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
| | | | | | - Andrew J Tatem
- Department of Geography and Environment, University of Southampton, Southampton, UK.,Flowminder Foundation, Stockholm, Sweden
| | | | - Helena Boene
- Centro de Investigacao em Saude de Manhica, Manhica, Mozambique
| | | | | | - Zoe Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | - Prestige Tatenda Makanga
- Faculty of Science and Technology, Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
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17
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Risk factors for death among children 0-59 months of age with moderate-to-severe diarrhea in Manhiça district, southern Mozambique. BMC Infect Dis 2019; 19:322. [PMID: 30987589 PMCID: PMC6466733 DOI: 10.1186/s12879-019-3948-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/03/2019] [Indexed: 02/06/2023] Open
Abstract
Background Despite major improvements in child survival rates, the number of deaths due to diarrhea remains unacceptably high. We aimed to describe diarrhea-associated mortality and evaluate risk factors for death among Mozambican children with moderate-to-severe diarrhea (MSD). Methods Between December 2007 and November 2012, children under-five with MSD were enrolled in Manhiça district, as part of the Global Enteric Multicenter study (GEMS). Clinical, epidemiological, and socio-demographic characteristics were collected. Anthropometric measurements were performed and stool samples collected upon recruitment. A follow-up visit ~ 60 days post-enrolment was conducted and verbal autopsies performed in all death cases. Results Of the 916 MSD-cases analyzed; 90% (821/916) completed 60 days follow-up and 69 patients died. The case fatality rate at follow-up was 8% (69/821), and the mortality rate 10.2 (95%CI: 7.75–13.59) deaths per 1000 persons-week at risk. Nearly half of the deaths 48% (33/69) among study participants clustered within 2 weeks of the onset of diarrhea. Typical enteropathogenic Escherichia coli (typical EPEC) and Cryptosporidium were the two pathogens associated to an increased risk of death in the univariate analysis with (HR = 4.16, p = 0.0461) and (H = 2.84, p = 0.0001) respectively. Conversely, Rotavirus infection was associated to a decreased risk of death (HR = 0.52, p = 0.0198). According to the multivariate analysis, risk factors for death included co-morbidities such as malnutrition (HR = 4.13, p < 0.0001), pneumonia/lower respiratory infection (HR = 3.51, p < 0.0001) or invasive bacterial disease (IBD) (HR = 6.80, p = 0.0009), presenting on arrival with lethargy or overt unconsciousness (HR = 1.73, p = 0.0302) or wrinkled skin (HR = 1.71, p = 0.0393), and cryptosporidium infection (HR = 2.14, p = 0.0038). When restricting the analysis to those with available HIV results (n = 191, 22% of the total study sample), HIV was shown to be a significant risk factor for death (HR = 5.05, p = 0.0009). Verbal autopsies were conducted in 100% of study deaths, and highlighted diarrhea as the main underlying cause of death 39%, (27/69); followed by HIV/AIDS related deaths 29.0% (20/69) and sepsis 11.6% (8/69). Conclusion Preventive strategies targeting Cryptosporidium, malnutrition and early identification and treatment of associated co-morbidities could contribute to the prevention of the majority of diarrhea associated deaths in Mozambican children. Electronic supplementary material The online version of this article (10.1186/s12879-019-3948-9) contains supplementary material, which is available to authorized users.
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Makanga PT, Sacoor C, Schuurman N, Lee T, Vilanculo FC, Munguambe K, Boene H, Ukah UV, Vidler M, Magee LA, Sevene E, von Dadelszen P, Firoz T. Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study. BMJ Open 2019; 9:e024042. [PMID: 30782892 PMCID: PMC6367983 DOI: 10.1136/bmjopen-2018-024042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique. DESIGN Retrospective cohort study. Choice of variables informed by literature and Delphi consensus. SETTING Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers. PARTICIPANTS A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12-49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies. PRIMARY AND SECONDARY OUTCOME MEASURES A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies. RESULTS A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71. CONCLUSIONS The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration. TRIAL REGISTRATION NUMBER NCT01911494.
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Affiliation(s)
- Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
| | | | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Tang Lee
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Khatia Munguambe
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Helena Boene
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Ugochinyere Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marianne Vidler
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, Kings College London, London, London, UK
| | - Esperanca Sevene
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, Kings College London, London, London, UK
| | - Tabassum Firoz
- Department of Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
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Saldanha V, Saldanha G, Reys RP, Benson CA, Noormahomed EV. Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia. EC MICROBIOLOGY 2018; 14:736-740. [PMID: 31681909 PMCID: PMC6824723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several studies suggest that neurocysticercosis might be one of the main reasons for onset of seizures in adolescents and young adults in Mozambique, however, no studies have evaluated the burden and impact of the disease in women of childbearing age. This is also true for other parasitic diseases such as toxoplasmosis, toxocariasis and onchocerciasis, although the latter has been reported in some regions in central and northern Mozambique. We describe herein an 18 year old female who was admitted to Hospital Central de Quelimane, Zambézia Province in Mozambique, 8 days after delivery with a misdiagnosis of eclampsia that turned out to be neurocysticercosis. We discuss challenges in the diagnosis of neurocysticercosis in women of childbearing age and the potential for missed diagnosis in those who present with eclampsia and other conditions associated with seizures.
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Affiliation(s)
| | | | | | - Constance Ann Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, USA
| | - Emília Virgínia Noormahomed
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, USA
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
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