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Ribeiro GDC, Lages DDS, Lages ATC, de Souza VB, Marega A, Lana FCF, Rocha MODC. Profile of the leprosy endemic in the district of Murrupula, Nampula, Mozambique: A population-based study. Rev Soc Bras Med Trop 2023; 56:e0321. [PMID: 36820655 PMCID: PMC9957143 DOI: 10.1590/0037-8682-0321-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Leprosy is a neglected chronic infection caused by Mycobacterium leprae, that is curable. The magnitude of the disease and severity of the debilitation it causes renders leprosy a public health problem. This study aimed to analyze the endemic profile of leprosy in the Murrupula district and evaluate the socioeconomic, clinical, and serological profiles of leprosy contacts. METHODS A cross-sectional study of patients with leprosy diagnosed between 2013 and 2017 and their household and community contacts was conducted in Murrupula District, Nampula Province, Mozambique. Interviews, simplified dermatoneurological examinations, Mycobacterium leprae flow (ML Flow) tests, and Mitsuda tests were performed. RESULTS Most of the leprosy cases were multibacillary. The patients had some degree of physical disability. ML Flow positivity was more common in household contacts of the patients diagnosed with leprosy and in community individuals who spontaneously presented for testing. In total, 17 patients were diagnosed with leprosy. CONCLUSIONS This study revealed an active chain of transmission, hidden prevalence, and operational deficiencies in leprosy surveillance and care. The results suggest that the implementation of a public health policy for leprosy prevention and control in Nampula Province is necessary. In future, the possibility of expanding the policy to the entire country should be considered.
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Affiliation(s)
- Gabriela de Cássia Ribeiro
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Enfermagem, Diamantina, MG, Brasil
| | - Daniele dos Santos Lages
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil, Belo Horizonte, MG, Brasil
| | - Ana Thereza Chaves Lages
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
| | | | - Abdoulaye Marega
- Universidade Lúrio, Faculdade de Ciências da Saúde, Nampula, Moçambique
| | - Francisco Carlos Félix Lana
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Departamento de Enfermagem Materno-Infantil, Belo Horizonte, MG, Brasil
| | - Manoel Otávio da Costa Rocha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
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Marega A, Hambridge T, Stakteas YP, Schoenmakers A, van Wijk R, Mieras L, das Neves Martins Pires PH, Muloliwa AM, Mitano F, Richardus JH. Leprosy indicators and diagnosis delay in Mogovolas, Meconta and Murrupula district of Nampula Province, Mozambique: A baseline survey. LEPROSY REV 2022. [DOI: 10.47276/lr.93.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Abdoulaye Marega
- Lúrio University, Nampula, Mozambique
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thomas Hambridge
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Anne Schoenmakers
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- NLR, Amsterdam, The Netherlands
| | - Robin van Wijk
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- NLR, Amsterdam, The Netherlands
| | | | | | | | - Fernando Mitano
- Lúrio University, Nampula, Mozambique
- Ministry of Health, Provincial Health Directorate, Nampula, Mozambique
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Schoenmakers A, Hambridge T, van Wijk R, Kasang C, Richardus JH, Bobosha K, Mitano F, Mshana SE, Mamo E, Marega A, Mwageni N, Letta T, Muloliwa AM, Kamara DV, Eman AM, Raimundo L, Njako B, Mieras L. PEP4LEP study protocol: integrated skin screening and SDR-PEP administration for leprosy prevention: comparing the effectiveness and feasibility of a community-based intervention to a health centre-based intervention in Ethiopia, Mozambique and Tanzania. BMJ Open 2021; 11:e046125. [PMID: 34446483 PMCID: PMC8395349 DOI: 10.1136/bmjopen-2020-046125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. METHODS AND ANALYSIS PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. ETHICS AND DISSEMINATION Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. TRIAL REGISTRATION NUMBER NL7294 (NTR7503).
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Affiliation(s)
| | - Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin van Wijk
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| | - Christa Kasang
- Deutsche Lepra- und Tuberkulosehilfe e.V, Wuerzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fernando Mitano
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Ephrem Mamo
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Nelly Mwageni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Taye Letta
- Ministry of Health Ethiopia, Addis Ababa, Ethiopia
| | - Artur Manuel Muloliwa
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | | | | | | | - Blasdus Njako
- Deutsche Lepra- und Tuberkulosehilfe e.V. Tanzania, Dar es Salaam, United Republic of Tanzania
| | - Liesbeth Mieras
- Medical Technical Department, NLR, Amsterdam, The Netherlands
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Marega A, Pires PDN, Mucufo J, Muloliwa A. Hansen's disease deformities in a high risk area in Mozambique: A case study. Rev Soc Bras Med Trop 2019; 52:e20180103. [PMID: 30726314 DOI: 10.1590/0037-8682-0103-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 12/27/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hansen's disease is no longer a public health problem in Mozambique, since 2008 (incidence under 1 / 10,000 inhabitants). The country is one of the most affected in the world and Nampula province's Murrupula district (incidence 1.7 / 10,000) has a high deformity rate (22% in 2010). This study aimed to identify high deformity rate associated determinants and proposals for better health program results. METHODS This study involved a descriptive quantitative survey, systematic observation of patients and health professionals, and a survey of community volunteers. Data were analyzed using Epi Info 7.2. Pearson's chi-square and Fisher's exact test were used to assess statistical association with deformity, with a significance level of 5% and 95% confidence interval. Ethical procedures followed the Helsinki declaration (2013). RESULTS Among 238 subjects, 175 were patients and 63 leprosy health staff. Most patients relied on subsistence agriculture facing social exclusion (43, 25%). The waiting time from first symptoms to diagnosis was over one year for 63%. Deformity affected 116 subjects (68%), particularly those who considered the disease as God's desire (p = 0.01), and practiced traditional treatments (p = 0.001). Among leprosy health staff, 35 (52%) were not trained on diagnosis and management. CONCLUSIONS High deformity rate is associated with low economic status, the belief that the disease is God's desire, the use of traditional healers, late diagnosis, and poor disease management. A health education program targeting professionals and population, with infection screening and self-care groups can prevent deformities.
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Affiliation(s)
- Abdoulaye Marega
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | | | - Jaibo Mucufo
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Artur Muloliwa
- Nampula Provincial Health Directorate, Ministry of Health, Nampula, Mozambique
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Das Neves Martins Pires PH, Marega A, Creagh JM. Contributions des tradipraticiens de santé au traitement antirétroviral : Étude de cas à Nampula, Mozambique. Afr J Prim Health Care Fam Med 2018; 10:e1-e6. [PMID: 30456971 PMCID: PMC6244362 DOI: 10.4102/phcfm.v10i1.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 11/13/2022] Open
Abstract
Contexte L’épidémie du virus de l’immunodéficience humaine au Mozambique est un problème grave de santé publique et le Ministère de la Santé a étendu le traitement antirétroviral à tous les districts du pays. Cependant, on constate un nombre élevé d’abandon du traitement encore insuffisamment évalué. L’Organisation Mondiale de la Santé recommande que les tradipraticiens de santé collaborent avec les systèmes nationaux de santé dans les pays en développement, pour combattre cette épidémie, mais il existe peu d’actions dans ce domaine à ce jour. Objectif Évaluer la connaissance des tradipraticiens sur l’infection et leur disponibilité à coopérer avec les services de santé dans la Province de Nampula au Mozambique, pour améliorer les résultats du traitement antirétroviral. Lieux Cinq centres de santé des districts de la Province de Nampula, au Nord du Mozambique, avec des taux élevés d’incidence du virus d’immunodéficience humaine et d’abandon du traitement. Méthodes Une étude mixte transversale, utilisant des interviews ciblés et des discussions de groupes focaux. Les données quantitatives étaient traitées par fréquence et les données qualitatives par analyse de discours et ethnographie locale. Résultats Nous avons interviewé 79 tradipraticiens de santé. La perte de poids était souvent considérée comme le signal principal de suspicion d’infection par le virus d’immunodéficience humaine et certains tradipraticiens ne pas les signes de la maladie ; la majorité pensait que les antirétroviraux améliorent la qualité de vie des patients, ne prétendait pas traiter l’infection, savait qu’elle n’est pas curable, avait une idée sur le concept de bonne adhésion au traitement et référait les cas compliqués au centre de santé. En ce qui concerne l’alimentation, la moitié considérait exclusivement les céréales comme l’aliment principal ; les fruits étaient importants pour un quart ; l’eau potable est ignorée. La majorité était prête à collaborer avec le système de santé et avait des propositions de coopération pratique : la qualification et la reconnaissance individuelle et la formation intégrée avec les professionnels de santé. Conclusion Les tradipraticiens connaissaient l’infection par le virus d’immunodéficience humaine et les facteurs associés, mais il y a des lacunes. Ils ont signalé qu’ils utilisaient principalement les plantes médicinales, ce qui peut contribuer au traitement des infections opportunistes et la majorité référait déjà des patients au centre de santé ; mais la collaboration nécessite une procédure éducative et une articulation structurée. Les lacunes de connaissance empêchent une coopération efficace dans le combat contre l’épidémie. Le groupe est disponible pour coopérer avec le système de santé pour améliorer les résultats du traitement antirétroviral, mais pour ça il est nécessaire d’informer et former les tradipraticiens dans un processus intégré de collaboration avec les professionnels de santé conventionnels.
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Marega A, Fregonese C, Tulissi P, Vallone C, Gropuzzo M, Toniutto PL, Baccarani U, Bresadola F, Toso F, Montanaro D. Preemptive liver-kidney transplantation in von Gierke disease: a case report. Transplant Proc 2011; 43:1196-7. [PMID: 21620087 DOI: 10.1016/j.transproceed.2011.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Type 1a glycogen storage disease (GSD 1a), or von Gierke disease, is a rare, autosomal-recessive disease caused by a deficiency of glucose-6-phosphatase, which leads to glycogen accumulation in the liver, kidney, and intestinal mucosa. Clinical manifestations include hypoglycemia, growth retardation, hepatomegaly, lactic acidemia, hyperlipidemia, and hyperuricemia. Long-term complications include renal disease, gout, osteoporosis, pulmonary hypertension, short stature, and hepatocellular adenomas, which may undergo malignant transformation. Herein we have described the management and the clinical course of a GSD1a patient who underwent simultaneous preemptive liver- kidney transplantation (SPLKT), which solved the liver and renal disease. We confirmed the rapid normalization of glucose metabolism, and correction of hyperlipemia after liver transplantation. In our opinion uremic patients with GSD 1a with or without adenomas must be considered for SPLKT. To our knowledge this is the fifth case of SPLKT and the first preemptive one to be described in the literature.
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Affiliation(s)
- A Marega
- Department of Nephrology, Azienda Ospedaliero Universitaria S Maria della Misericordia, Udine, Italy.
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Savoldi S, Sereni L, Bertok S, Ianche M, Bianco F, Marega A, Vianello S, Zanchi R, Klein P, Cicinato P, Pacor G, Gennari M, Bosutti A, Biolo G, Amoroso A, Panzetta G. [The hemodiafiltration with infusion of acetate-free dialysis fluid can modify the inflammatory response in patients "high responders" to inflammatory stimuli?]. G Ital Nefrol 2004; 21 Suppl 30:S122-7. [PMID: 15747295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE This study aimed to verify the effects of paired hemodiafiltration on-line (PHF-AF) on inflammation in patients who were "high responders" to inflammatory stimuli: elevated C-reactive protein (CRP), genetic polymorphisms influencing a low transcription for interleukin-10 (IL-10) and a high transcription for IFN-gamma. METHODS Ten patients selected as high responders for IFN-gamma and low responders for IL-10 were included in a crossover study to compare PHF-AF and standard bicarbonate hemodialysis (BHD). At study entry and before the start of each dialysis session the following examinations were performed: CRP, albumin, fibrinogen, ferritin, transferrin, prealbumin and serum levels of IL-6, IL-10, IFN-gamma, tumor necrosis factor-alpha (TNF-alpha). After the 1st and 3rd week of the study, the blood samples were also collected after the dialysis session. RESULTS . There was a significant reduction in albumin and prealbumin in PHF-AF patients during the study; none of the other parameters were changed in both patient groups. CRP tended to be elevated after dialysis in both PHF-AF and BHD. While IL-6, IL-10 and IFN-gamma were unchanged during the dialysis session, there was a significant variation in TNF-alpha levels, which were increased in BHD (from 10.9 +/- 3.1 to 14.7 +/- 4.1 pg/mL; p=0.004) and reduced in PHF-AF (from 11.9 +/-2.8 to 6.3 +/- 2.2 pg/mL; p=0.0004). CONCLUSION Although the cytokine levels were unchanged during the study in both BHD and PHF-AF, the modification of TNF-alpha during the dialysis session was considered as inflammatory significance.
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Affiliation(s)
- S Savoldi
- S.C. di Nefrologia e Dialisi, Università e Ospedali Riuniti, Trieste.
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