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Cossa-Moiane I, Roucher C, Campos-Ponce M, Doak C, Bauhofer A, Chissaque A, Prista A, de Deus N, Polman K. Profile of Children with Undernutrition Admitted in Two Secondary-Level Hospitals in Maputo City, Mozambique. Nutrients 2024; 16:1056. [PMID: 38613090 PMCID: PMC11013278 DOI: 10.3390/nu16071056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Mozambique has one of the highest child undernutrition rates in Sub-Saharan Africa. The aim of this study was to characterize the profile of children from 1 to 14 years old hospitalized for undernutrition and to explore associated risk factors. Clinical, demographic, socioeconomic, and environmental data were collected. Anthropometric measurements and stool samples were collected from a child and their caretaker. The wealth index was determined using Principal Components Analysis. A total of 449 children and their caretakers were enrolled. The children had a median age of 1.0 year [IQR: 1.0-2.0], and 53.9% (242/449) were male. Most were admitted with severe undernutrition (35.7%, 159/449 kwashiorkor and 82.0%, 368/449 with -3SD Z-score indexes). The most common co-morbidities were HIV (30.0%, 120/400), diarrhea (20.0%; 80/400), and anemia (12.5%; 50/400). Among the caretakers, 9.5% (39/409) were underweight, 10.1% (40/397) were overweight, and 14.1% (56/397) were obese. Intestinal parasites were found in 24.8% (90/363) children and in 38.5% (77/200) caretakers. The majority of children (60.7%, 85/140) came from low- to middle-wealth households. Most were severely undernourished, suggesting that they seek medical care too late. The finding of overweight/obese caretakers in combination with undernourished children confirms that Mozambique is facing a double burden of malnutrition.
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Affiliation(s)
- Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), EN1, Marracuene 3943, Mozambique; (A.B.); (A.C.); (N.d.D.)
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium; (C.R.); (K.P.)
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Clémentine Roucher
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium; (C.R.); (K.P.)
| | - Maiza Campos-Ponce
- Department of Health Sciences, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
| | - Colleen Doak
- Center for Health Sciences Education, College of Health Sciences, St. Ambrose University, 1320 W. Lombard Street, Davenport, IA 52803, USA;
| | - Adilson Bauhofer
- Instituto Nacional de Saúde (INS), EN1, Marracuene 3943, Mozambique; (A.B.); (A.C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), EN1, Marracuene 3943, Mozambique; (A.B.); (A.C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - António Prista
- Faculty of Physical Education and Sports, Universidade Pedagógica, Maputo 1100, Mozambique;
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), EN1, Marracuene 3943, Mozambique; (A.B.); (A.C.); (N.d.D.)
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo 1100, Mozambique
| | - Katja Polman
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium; (C.R.); (K.P.)
- Department of Health Sciences, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
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Bauhofer AFL, Sambo J, Chilaúle JJ, Conjo C, Munlela B, Chissaque A, Isaías T, Djedje M, de Deus N. Examining comorbidities in children with diarrhea across four provinces of Mozambique: A cross-sectional study (2015 to 2019). PLoS One 2023; 18:e0292093. [PMID: 37751426 PMCID: PMC10522033 DOI: 10.1371/journal.pone.0292093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Comorbidities are defined as the simultaneous occurrence of two or more diseases within the same individual. Comorbidities can delay a patient's recovery and increase the costs of treatment. Assessing comorbidities can provide local health care policy-makers with evidence of the most common multi-health impairments in children. This could aid in redirecting and integrating care and treatment services by increasing health facilities the awareness and readiness of health facilities. The present analysis aims to determine the frequency and associated factors of comorbidities in children with diarrhea in Mozambique. A cross-sectional hospital-based analysis was conducted between January 2015 and December 2019 in children up to 59 months of age who were admitted with diarrhea in six reference hospitals in Mozambique. These hospitals are distributed across the country's three regions, with at least one hospital in each province from each region. Sociodemographic and clinical data were obtained through semi-structured interviews and by reviewing the child clinical process. Descriptive statistics, and Mann-Whitney-U tests were used. Crude and adjusted logistics regression models were built. P-values < 0.05 were considered statistically significant. Comorbidities were observed in 55.5% of patients (389/701; 95%CI: 51.8-59.1). Wasting was the most common comorbidity (30.2%; 212/701) and pneumonia was the least common (1.7%; 12/701). Children born with a low birth weight were 2.420 times more likely to have comorbidities, adjusted odds ratio: 2.420 (95% CI: 1.339-4374). The median (interquartile range) duration of hospitalization was significantly higher in children with comorbidities than without comorbidities, 5 days (3-7) and 4 days (3-6), respectively (p-value < 0.001). One in every two children with diarrhea in Mozambique has an additional health impairment, and this increases the length of their hospital stay.
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Affiliation(s)
- Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jorfélia J. Chilaúle
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Carolina Conjo
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Benilde Munlela
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Telma Isaías
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Marlene Djedje
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo Cidade, Mozambique
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Girmay AM, Weldetinsae A, Mengesha SD, Adugna EA, Alemu ZA, Wagari B, Serte MG, Awoke KS, Bedada TL, Weldegebriel MG, Dinssa DA, Alemayehu TA, Kenea MA, Tekulu KT, Gobena W, Fikresilassie G, Wube W, Melese AW, Redwan E, Hoffmann V, Tessema M, Tollera G. Associations of WHO/UNICEF Joint Monitoring Program (JMP) Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e071296. [PMID: 37500269 PMCID: PMC10387618 DOI: 10.1136/bmjopen-2022-071296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To determine the associations of WHO/UNICEF Joint Monitoring Program Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia. DESIGN A community-based cross-sectional study. SETTING Bishoftu town, Ethiopia, January-February 2022. PARTICIPANTS A total of 1807 mothers with at least one child under 5 years were included. Sociodemographic and WASH variables were collected using a structured questionnaire. 378 drinking water samples were collected. OUTCOME The response variable was diarrhoeal disease among children under 5 years. RESULTS The 2-week prevalence of diarrhoeal disease among children under 5 years was 14.8%. Illiteracy (adjusted OR 3.15; 95% CI 1.54 to 6.47), occupation (0.35; 0.20 to 0.62), mother's age (1.63; 1.15 to 2.31), family size (2.38; 1.68 to 3.39), wealth index (5.91; 3.01 to 11.59), residence type (1.98; 1.35 to 2.90), sex of the child (1.62; 1.17 to 2.24), child's age (3.52; 2.51 to 4.93), breastfeeding status (2.83; 1.74 to 4.59), food storage practice (3.49; 1.74 to 8.26), unimproved drinking water source (8.16; 1.69 to 39.46), limited drinking water service (4.68; 1.47 to 14.95), open defecation practice (5.17; 1.95 to 13.70), unimproved sanitation service (2.74; 1.60 to 4.67), limited sanitation service (1.71; 1.10 to 2.65), no hygiene service (3.43; 1.91 to 6.16) and limited hygiene service (2.13; 1.17 to 3.86) were significantly associated with diarrhoeal disease. CONCLUSION In this study, diarrhoea among children is a significant health issue. Child's age, drinking water service, residence type and hygiene service were the largest contributors with respect to the prevalence of diarrhoeal disease. This investigation provides information that could help to inform interventions to reduce childhood diarrhoea. The findings suggest that state authorities should initiate robust WASH strategies to achieve the Sustainable Development Goal 3 agenda.
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Affiliation(s)
- Aderajew Mekonnen Girmay
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abel Weldetinsae
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sisay Derso Mengesha
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ermias Alemayehu Adugna
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zinabu Assefa Alemu
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bedasa Wagari
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melaku Gizaw Serte
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kaleab Sebsibe Awoke
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tesfaye Legesse Bedada
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mesaye Getachew Weldegebriel
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Danial Abera Dinssa
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tsigereda Assefa Alemayehu
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Moa Abate Kenea
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kirubel Tesfaye Tekulu
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Waktole Gobena
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getinet Fikresilassie
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wendayehu Wube
- Department of Hygiene and Environmental Health, Ministry of Health, Addis Ababa, Ethiopia
| | - Abayew Wassie Melese
- Department of Hygiene and Environmental Health, Ministry of Health, Addis Ababa, Ethiopia
| | - Ekram Redwan
- Department of Hygiene and Environmental Health, Ministry of Health, Addis Ababa, Ethiopia
| | - Vivian Hoffmann
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
- Department of Economics and School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada
| | - Masresha Tessema
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getachew Tollera
- Department of Nutrition and Environmental Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Sambo J, Chicumbe S, de Deus N, Gonçalves L. Quality of routine data for monitoring nutrition and diarrhoea indicators of children under 5 in Mozambique: an ecological study over a 5-year period. BMJ Open 2023; 13:e073239. [PMID: 37479521 PMCID: PMC10364158 DOI: 10.1136/bmjopen-2023-073239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Undernutrition and diarrhoea have a high burden in children under 5 in low/middle-income countries. Having data-driven quality health services for these two diseases is key in order to address the high burden of diseases; therefore, health systems must provide data to monitor, manage, plan and decide on policies at all levels of health services. OBJECTIVE We aimed to assess the quality of nutrition and diarrhoea routine data on children under 5 in Mozambique. DESIGN A longitudinal ecological study was implemented. Secondary data were used to assess the quality of moderate acute malnutrition (MAM), deworming and rotavirus vaccine indicators based on the data's completeness, presence of outliers and consistency, and seasonality analysis in the form of time series analysis was performed. SETTING We used monthly district-level count data from 2017 to 2021, from all health facilities, from the Mozambican health information system (Sistema de Informação de Saúde para Monitoria e Avaliação, or District Health Information System version 2). RESULTS The rotavirus vaccine indicators presented better completeness when compared with other indicators under analysis. Extreme outliers were observed for deworming and rotavirus vaccines, with a higher number of outliers in the Zambezia and Nampula Provinces. Better consistency over time was observed when analysing the period before the COVID-19 pandemic, for all of the indicators and across provinces. Indicators of MAM and MAM-recovered showed more consistency issues over time in both periods of 2017-2019 and 2018-2021. In terms of seasonality analysis, for the MAM and MAM-recovered indicators, lower variation was observed, and heterogeneous patterns were seen across provinces for the rotavirus vaccine, which had the most pronounced negative seasonality components in Maputo City. CONCLUSION Major deficits regarding the analysed quality indicators were observed for Cabo Delgado, Nampula, Zambezia, Tete, Manica, and Maputo City and Province.
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Affiliation(s)
- Júlia Sambo
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sérgio Chicumbe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Maputo, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Luzia Gonçalves
- Universidade Nova de Lisboa, Lisbon, Portugal
- Universidade de Lisboa, Lisbon, Portugal
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Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare (Basel) 2022; 10:healthcare10071200. [PMID: 35885727 PMCID: PMC9319856 DOI: 10.3390/healthcare10071200] [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: 04/21/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.
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