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Nhacolo A, Magaço A, Amosse F, Hunguana A, Matsena T, Nhacolo A, Xerinda E, Bassat Q, Sacoor C, Mandomando I, Munguambe K. Perceptions and compliance with COVID-19 preventive measures in Southern and Central regions of Mozambique: A quantitative in-person household survey in the districts of Manhiça and Quelimane. PLoS One 2024; 19:e0278439. [PMID: 38743657 PMCID: PMC11093319 DOI: 10.1371/journal.pone.0278439] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
The COVID-19 pandemic has prompted countries to swiftly implement rigorous preventive measures on a population-wide scale worldwide. However, in low-income countries like Mozambique this was difficult, coupled with a generalised lack of knowledge on how the population understood and complied with these measures. This study assessed community perceptions and implementation of anti-COVID-19 measures recommended by Mozambican authorities in Manhiça and Quelimane districts, including confinement, social distancing, frequent handwashing, mask wearing, and quarantine as the key practices to evaluate. We conducted a cross-sectional quantitative survey in October 2020 and February 2021, interviewing heads of households, face-to-face. The data collected included self-evaluation of compliance and existence of handwashing facilities and face-masks in the households, aided by observations. We present descriptive statistics on perceptions and compliance at individual and household levels. Out of the 770 participants, nearly all (98.7%) were aware of Coronavirus disease, including the term COVID-19 (89.2%). Knowledge varied between districts, with Manhiça participants showing higher levels of sufficient ability to define the disease. The symptoms most mentioned were dry cough (17.8%), fever (15.7%), flu-like symptoms (14.2%), breathing difficulties (13.6%), and headache (13.1%). Participants recognized various transmission modes, including touching infected objects and inhaling infected air. Preventive measures like handwashing with soap or sanitizing hands with alcohol, wearing masks, and social distancing were acknowledged, but the understanding varied. Compliance with these measures was generally low, with fewer than half of respondents reporting adherence to them. Only 30.4% of households had handwashing facilities (of which only 41.0% had water), and masks were often limited to one per person aged 6 years or more. Community members in Manhica and Quelimane were aware of COVID-19 but had limited understanding of what the preventive measures meant, and had lower levels of compliance. Understanding and addressing the factors affecting the proper implementation of these measures is crucial for improving community adherence in preventing infectious diseases with epidemic potential.
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Affiliation(s)
- Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Amílcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Felizarda Amosse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Aura Hunguana
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Teodimiro Matsena
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Arsénio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Garcia Gomez E, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Chowdhury MAI, Islam KM, Assefa N, Scott JAG, Madrid L, Tilahun Y, Orlien S, Kotloff KL, Tapia MD, Keita AM, Mehta A, Magaço A, Torres-Fernandez D, Nhacolo A, Bassat Q, Mandomando I, Ogbuanu I, Cain CJ, Luke R, Kamara SIB, Legesse H, Madhi S, Dangor Z, Mahtab S, Wise A, Adam Y, Whitney CG, Mutevedzi PC, Blau DM, Breiman RF, Tippett Barr BA, Rees CA. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months. PLOS Glob Public Health 2024; 4:e0002494. [PMID: 38329969 PMCID: PMC10852234 DOI: 10.1371/journal.pgph.0002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
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Affiliation(s)
- Elisa Garcia Gomez
- Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | | | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kazi Munisul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Stian Orlien
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Torres-Fernandez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Dianna M. Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
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Nhacolo A, Madewell ZJ, Muir JA, Sacoor C, Xerinda E, Matsena T, Jamisse E, Bassat Q, Whitney CG, Mandomando I, Cunningham SA. Knowledge of COVID-19 symptoms, transmission, and prevention: Evidence from health and demographic surveillance in Southern Mozambique. PLOS Glob Public Health 2023; 3:e0002532. [PMID: 37910574 PMCID: PMC10619866 DOI: 10.1371/journal.pgph.0002532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
Understanding community members' knowledge of SARS-CoV-2 transmission and prevention is essential for directing public health interventions to reduce disease spread and improve vaccination coverage. Here, we describe knowledge of COVID-19 transmission, prevention, and symptoms among community residents in Mozambique. We conducted a cross-sectional survey among 33,087 households in a Health and Demographic Surveillance System in Manhiça, Mozambique. Participants were recruited in April 2021 before the Delta variant wave to the peak of Omicron cases in February 2022. Principal components analysis was used to create scores representing knowledge of COVID-19 symptoms, transmission, and prevention. Multiple imputation and quasi-Poisson regression were used to examine associations between demographic characteristics and sources of COVID-19 information, and knowledge of COVID-19 symptoms, transmission, and prevention. We examined whether sources of COVID-19 information mediated the relationship between educational attainment and knowledge of symptoms, transmission, and prevention. Across this rural community, 98.2%, 97.0%, and 85.1% of respondents reported knowing how COVID-19 could be prevented, that SARS-CoV-2 can cause disease, and how SARS-CoV-2 is transmitted, respectively. The most recognized COVID-19 symptoms were cough (51.2%), headaches (44.9%), and fever (44.5%); transmission mechanisms were saliva droplets (50.5%) or aerosol (46.9%) from an infected person; and prevention measures were handwashing (91.9%) and mask-wearing (91.8%). Characteristics associated with greater knowledge of symptoms, transmission, and prevention included having at least primary education, older age, employment, higher wealth, and Christian religion. Respondents who had experienced COVID-19 symptoms were also more likely to possess knowledge of symptoms, transmission, and prevention. Receiving information from television, WhatsApp, radio, and hospital, mediated the relationship between educational attainment and knowledge scores. These findings support the need for outreach and for community-engaged messaging to promote prevention measures, particularly among people with low education.
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Affiliation(s)
- Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Edgar Jamisse
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | | | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Maputo, Mozambique
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Augusto O, Fernández-Luis S, Fuente-Soro L, Nhampossa T, Lopez-Varela E, Nhacolo A, Bernardo E, Guambe H, Tibana K, Juga AJC, Cowan JG, Urso M, Naniche D. Using testing history to estimate HIV incidence in mothers living in resource-limited settings: Maximizing efficiency of a community health survey in Mozambique. PLOS Glob Public Health 2023; 3:e0001628. [PMID: 37256868 DOI: 10.1371/journal.pgph.0001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/24/2023] [Indexed: 06/02/2023]
Abstract
Obtaining rapid and accurate HIV incidence estimates is challenging because of the need for long-term follow-up for a large cohort. We estimated HIV incidence among women who recently delivered in southern Mozambique by leveraging data available in routine health cards. A cross-sectional household HIV-testing survey was conducted from October 2017 to April 2018 among mothers of children born in the previous four years in the Manhiça Health Demographic Surveillance System area. Randomly-selected mother-child pairs were invited to participate and asked to present documentation of their last HIV test result. HIV-testing was offered to mothers with no prior HIV-testing history, or with negative HIV results obtained over three months ago. HIV incidence was estimated as the number of mothers newly diagnosed with HIV per total person-years, among mothers with a prior documented HIV-negative test. Among 5000 mother-child pairs randomly selected, 3069 were interviewed, and 2221 reported a previous HIV-negative test. From this group, we included 1714 mothers who had taken a new HIV test during the survey. Most of mothers included (83.3%,1428/1714) had a previous documented HIV test result and date. Median time from last test to survey was 15.5 months (IQR:8.0-25.9). A total of 57 new HIV infections were detected over 2530.27 person-years of follow-up. The estimated HIV incidence was 2.25 (95% CI: 1.74-2.92) per 100 person-years. Estimating HIV incidence among women who recently delivered using a community HIV-focused survey coupled with previous HIV-testing history based on patients' clinical documents is an achievable strategy.
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Affiliation(s)
- Orvalho Augusto
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sheila Fernández-Luis
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Tacilta Nhampossa
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Elisa Lopez-Varela
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
| | - Edson Bernardo
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
- Manhiça District Health Services, Maputo Province, Mozambique
| | - Helga Guambe
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Kwalila Tibana
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Adelino Jose Chingore Juga
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Jessica Greenberg Cowan
- Maternal and Child Health Branch Chief, Mozambique, Division of Global HIV and TB, Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Marilena Urso
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Denise Naniche
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Sacoor C, Vitorino P, Nhacolo A, Munguambe K, Mabunda R, Garrine M, Jamisse E, Magaço A, Xerinda E, Sitoe A, Fernandes F, Carrilho C, Maixenchs M, Chirinda P, Nhampossa T, Nhancale B, Rakislova N, Bramugy J, Nhacolo A, Ajanovic S, Valente M, Massinga A, Varo R, Menéndez C, Ordi J, Mandomando I, Bassat Q. Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.13931.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using, among other tools, the innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS). Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.
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Fernández-Luis S, Fuente-Soro L, Nhampossa T, Lopez-Varela E, Augusto O, Nhacolo A, Vazquez O, Saura-Lázaro A, Guambe H, Tibana K, Ngeno B, Juga AJC, Cowan JG, Urso M, Naniche D. Prompt HIV diagnosis and antiretroviral treatment in postpartum women is crucial for prevention of mother to child transmission during breastfeeding: Survey results in a high HIV prevalence community in southern Mozambique after the implementation of Option B+. PLoS One 2022; 17:e0269835. [PMID: 35917332 PMCID: PMC9345360 DOI: 10.1371/journal.pone.0269835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Objective World Health Organization recommends promoting breastfeeding without restricting its duration among HIV-positive women on lifelong antiretroviral treatment (ART). There is little data on breastfeeding duration and mother to child transmission (MTCT) beyond 24 months. We compared the duration of breastfeeding in HIV-exposed and HIV-unexposed children and we identified factors associated with postpartum-MTCT in a semi-rural population of Mozambique. Methods This cross-sectional assessment was conducted from October-2017 to April-2018. Mothers who had given birth within the previous 48-months in the Manhiça district were randomly selected to be surveyed and to receive an HIV-test along with their children. Postpartum MTCT was defined as children with an initial HIV positive result beyond 6 weeks of life who initiated breastfeeding if they had a first negative PCR result during the first 6 weeks of life or whose mother had an estimated date of infection after the child’s birth. Cumulative incidence accounting for right-censoring was used to compare breastfeeding duration in HIV-exposed and unexposed children. Fine-Gray regression was used to assess factors associated with postpartum-MTCT. Results Among the 5000 mother-child pairs selected, 69.7% (3486/5000) were located and enrolled. Among those, 27.7% (967/3486) children were HIV-exposed, 62.2% (2169/3486) were HIV-unexposed and for 10.0% (350/3486) HIV-exposure was unknown. Median duration of breastfeeding was 13.0 (95%CI:12.0–14.0) and 20.0 (95%CI:19.0–20.0) months among HIV-exposed and HIV-unexposed children, respectively (p<0.001). Of the 967 HIV-exposed children, 5.3% (51/967) were HIV-positive at the time of the survey. We estimated that 27.5% (14/51) of the MTCT occurred during pregnancy and delivery, 49.0% (2551) postpartum-MTCT and the period of MTCT remained unknown for 23.5% (12/51) of children. In multivariable analysis, mothers’ ART initiation after the date of childbirth was associated (aSHR:9.39 [95%CI:1.75–50.31], p = 0.001), however breastfeeding duration was not associated with postpartum-MTCT (aSHR:0.99 [95%CI:0.96–1.03], p = 0.707). Conclusion The risk for postpartum MTCT was nearly tenfold higher in women newly diagnosed and/or initiating ART postpartum. This highlights the importance of sustained HIV screening and prompt ART initiation in postpartum women in Sub-Saharan African countries. Under conditions where HIV-exposed infants born to mothers on ART receive adequate PMTCT, extending breastfeeding duration may be recommended.
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Affiliation(s)
- Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Olalla Vazquez
- Hospital Clínico Universitario de Santiago de Compostela, Santiago, Spain
| | - Anna Saura-Lázaro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Helga Guambe
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Kwalila Tibana
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Bernadette Ngeno
- U.S Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | | | | | - Marilena Urso
- U.S Centers for Disease Control and Prevention (CDC), 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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Guinovart C, Sigaúque B, Bassat Q, Loscertales MP, Nhampossa T, Acácio S, Machevo S, Maculuve S, Bambo G, Mucavele H, Soriano-Gabarró M, Saifodine A, Nhacolo A, Nhalungo D, Sacoor C, Saúte F, Aponte JJ, Menéndez C, Macete E, Alonso PL. The epidemiology of severe malaria at Manhiça District Hospital, Mozambique: a retrospective analysis of 20 years of malaria admissions surveillance data. The Lancet Global Health 2022; 10:e873-e881. [DOI: 10.1016/s2214-109x(22)00125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
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Grau-Pujol B, Cano J, Marti-Soler H, Casellas A, Giorgi E, Nhacolo A, Saute F, Giné R, Quintó L, Sacoor C, Muñoz J. Neighbors' use of water and sanitation facilities can affect children's health: a cohort study in Mozambique using a spatial approach. BMC Public Health 2022; 22:983. [PMID: 35578273 PMCID: PMC9109333 DOI: 10.1186/s12889-022-13373-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 05/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Impact evaluation of most water, sanitation and hygiene (WASH) interventions in health are user-centered. However, recent research discussed WASH herd protection - community WASH coverage could protect neighboring households. We evaluated the effect of water and sanitation used in the household and by household neighbors in children's morbidity and mortality using recorded health data. METHODS We conducted a retrospective cohort including 61,333 children from a district in Mozambique during 2012-2015. We obtained water and sanitation household data and morbidity data from Manhiça Health Research Centre surveillance system. To evaluate herd protection, we estimated the density of household neighbors with improved facilities using a Kernel Density Estimator. We fitted negative binomial adjusted regression models to assess the minimum children-based incidence rates for every morbidity indicator, and Cox regression models for mortality. RESULTS Household use of unimproved water and sanitation displayed a higher rate of outpatient visit, diarrhea, malaria, and anemia. Households with unimproved water and sanitation surrounded by neighbors with improved water and sanitation high coverage were associated with a lower rate of outpatient visit, malaria, anemia, and malnutrition. CONCLUSION Household and neighbors' access to improve water and sanitation can affect children's health. Accounting for household WASH and herd protection in interventions' evaluation could foster stakeholders' investment and improve WASH related diseases control. Distribution of main water and sanitation facilities used during study period.
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Affiliation(s)
- Berta Grau-Pujol
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique ,Mundo Sano Foundation, Buenos Aires, Argentina
| | - Jorge Cano
- grid.463718.f0000 0004 0639 2906Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Helena Marti-Soler
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain
| | - Aina Casellas
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona (UB), Casanova 143, 08036 Barcelona, Spain
| | - Emanuele Giorgi
- grid.9835.70000 0000 8190 6402Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW UK
| | - Ariel Nhacolo
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Francisco Saute
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ricard Giné
- grid.454010.40000 0001 1009 1661Stockholm International Water Institute, Stockholm, Sweden
| | - Llorenç Quintó
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Jose Muñoz
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain
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Opiyo M, Sherrard-Smith E, Malheia A, Nhacolo A, Sacoor C, Nhacolo A, Máquina M, Jamu L, Cuamba N, Bassat Q, Saúte F, Paaijmans K. Household modifications after the indoor residual spraying (IRS) campaign in Mozambique reduce the actual spray coverage and efficacy. PLOS Glob Public Health 2022; 2:e0000227. [PMID: 36962153 PMCID: PMC10021718 DOI: 10.1371/journal.pgph.0000227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Indoor residual spraying of insecticides (IRS) is a key malaria vector control strategy. Whilst human attitude towards IRS is monitored before or shortly after implementation, human activities leading to the modification of insecticide-treated walls post-IRS are not. This could inadvertently reduce the protective effects of IRS. We monitored the extent of modifications to the sprayed indoor wall surfaces by household owners for six months post-IRS campaigns in two districts targeted for malaria elimination in southern Mozambique. In parallel, we assessed building of any additional rooms onto compounds, and mosquito net use. We quantified the contribution of wall modifications, added rooms, prolonged spray campaigns, and product residual efficacies on actual IRS coverage and relative mosquito bite reduction, using a mechanistic approach. Household owners continually modified insecticide-treated walls and added rooms onto compounds. Household surveys in southern Mozambique showed frequent modification of indoor walls (0-17.2% of households modified rooms monthly) and/or added rooms (0-16.2% of households added rooms monthly). Actual IRS coverage reduced from an assumed 97% to just 39% in Matutuine, but only from 96% to 91% in Boane, translating to 43% and 5.8% estimated increases in relative daily mosquito bites per person. Integrating post-IRS knowledge, attitude, and practice (KAP) surveys into programmatic evaluations to capture these modification and construction trends can help improve IRS program efficiency and product assessment.
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Affiliation(s)
- Mercy Opiyo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Arlindo Malheia
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Mara Máquina
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Luis Jamu
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nelson Cuamba
- National Malaria Control Programme of Mozambique (NMCP), Ministry of Health, Maputo, Mozambique
- PMI VectorLink Project, Abt Associates Inc., Maputo, Mozambique
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Krijn Paaijmans
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, Arizona, United States of America
- The Biodesign Center for Immunotherapy, Vaccines, and Virotherapy, Arizona State University, Tempe, Arizona, United States of America
- Simon A. Levin Mathematical, Computational and Modeling Sciences Center, Arizona State University, Tempe, Arizona, United States of America
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10
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Nhampossa T, Fernández-Luis S, Fuente-Soro L, Bernardo E, Nhacolo A, Augusto O, Nhacolo A, Sacoor C, Saura-Lázaro A, Lopez-Varela E, Naniche D. The impact of the caregiver mobility on child HIV care in the Manhiça District, Southern Mozambique: A clinical based study. PLoS One 2021; 16:e0261356. [PMID: 34914769 PMCID: PMC8675651 DOI: 10.1371/journal.pone.0261356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Manhiça District, in Southern Mozambique harbors high HIV prevalence and a long history of migration. To optimize HIV care, we sought to assess how caregiver’s mobility impacts children living with HIV (CLHIV)´s continuation in HIV care and to explore the strategies used by caregivers to maintain their CLHIV on antiretroviral treatment (ART). Methods A clinic-based cross-sectional survey conducted at the Manhiça District Hospital between December-2017 and February-2018. We enrolled CLHIV with a self-identified migrant caregiver (moved outside of Manhiça District ≤12 months prior to survey) and non-migrant caregiver, matched by the child age and sex. Survey data were linked to CLHIV clinical records from the HIV care and treatment program. Results Among the 975 CLHIV screened, 285 (29.2%) were excluded due to absence of an adult at the appointment. A total of 232 CLHIV-caregiver pairs were included. Of the 41 (35%) CLHIV migrating with their caregivers, 38 (92.6%) had access to ART at the destination because either the caregivers travelled with it 24 (63%) or it was sent by a family member 14 (36%). Among the 76 (65%) CLHIV who did not migrate with their caregivers, for the purpose of pharmacy visits, 39% were cared by their grandfather/grandmother, 28% by an aunt/uncle and 16% by an adult brother/sister. CLHIV of migrant caregivers had a non-statistically significant increase in the number of previous reported sickness episodes (OR = 1.38, 95%CI: 0.79–2.42; p = 0.257), ART interruptions (OR = 1.73; 95%CI: 0.82–3.63; p = 0.142) and lost-to-follow-up episodes (OR = 1.53; 95%CI: 0.80–2.94; p = 0.193). Conclusions Nearly one third of the children attend their HIV care appointments unaccompanied by an adult. The caregiver mobility was not found to significantly affect child’s retention on ART. Migrant caregivers adopted strategies such as the transportation of ART to the mobility destination to avoid impact of mobility on the child’s HIV care. However this may have implications on ART stability and effectiveness that should be investigated in rural areas.
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Affiliation(s)
- Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde (INS), Maputo, Mozambique
- * E-mail:
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Edson Bernardo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Serviço Distrital de Saúde, Mulher e Acção Social de Manhiça, Maputo, Mozambique
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anna Saura-Lázaro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
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11
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Nhacolo A, Jamisse E, Augusto O, Matsena T, Hunguana A, Mandomando I, Arnaldo C, Munguambe K, Macete E, Alonso P, Saúte F, Sacoor C. Cohort Profile Update: Manhiça Health and Demographic Surveillance System (HDSS) of the Manhiça Health Research Centre (CISM). Int J Epidemiol 2021; 50:395. [PMID: 33452521 PMCID: PMC8128467 DOI: 10.1093/ije/dyaa218] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ariel Nhacolo
- Manhiça Health Research Center, Manhiça District, Mozambique
| | - Edgar Jamisse
- Manhiça Health Research Center, Manhiça District, Mozambique
| | - Orvalho Augusto
- Manhiça Health Research Center, Manhiça District, Mozambique
| | | | - Aura Hunguana
- Manhiça Health Research Center, Manhiça District, Mozambique
| | - Inácio Mandomando
- Manhiça Health Research Center, Manhiça District, Mozambique.,National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Carlos Arnaldo
- Eduardo Mondlane University, Mozambique, Maputo, Mozambique
| | - Khátia Munguambe
- Manhiça Health Research Center, Manhiça District, Mozambique.,Eduardo Mondlane University, Mozambique, Maputo, Mozambique
| | - Eusébio Macete
- Manhiça Health Research Center, Manhiça District, Mozambique.,National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - Pedro Alonso
- Manhiça Health Research Center, Manhiça District, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Francisco Saúte
- Manhiça Health Research Center, Manhiça District, Mozambique
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12
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Bernardo EL, Nhampossa T, Clouse K, Carlucci JG, Fernández-Luis S, Fuente-Soro L, Nhacolo A, Sidat M, Naniche D, Moon TD. Patterns of mobility and its impact on retention in care among people living with HIV in the Manhiça District, Mozambique. PLoS One 2021; 16:e0250844. [PMID: 34019556 PMCID: PMC8139482 DOI: 10.1371/journal.pone.0250844] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Retention in HIV care is a challenge in Mozambique. Mozambique´s southern provinces have the highest mobility levels of the country. Mobility may result in poorer response to HIV care and treatment initiatives. Methods We conducted a cross-sectional survey to explore the impact of mobility on retention for HIV-positive adults on ART presenting to the clinic in December 2017 and January 2018. Survey data were linked to participant clinical records from the HIV care and treatment program. This study took place in Manhiça District, southern Mozambique. We enrolled self-identified migrants (moved outside of Manhiça District ≤12 months prior to survey) and non-migrants, matched by age and sex. Results 390 HIV-positive adults were included. We found frequent movement: 45% of migrants reported leaving the district 3–5 times over the past 12 months, usually for extended stays. South Africa was the most common destination (71%). Overall, 30% of participants had at least one delay (15–60 days) in ART pick-up and 11% were delayed >60 days, though no significant difference was seen between mobile and non-mobile cohorts. Few migrants accessed care while traveling. Conclusion Our population of mobile and non-mobile participants showed frequent lapses in ART pick-up. Mobility could be for extended time periods and HIV care frequently did not continue at the destination. Studies are needed to evaluate the impact of Mozambique´s approach of providing 3-months ART among mobile populations and barriers to care while traveling, as is better education on how and where to access care when traveling.
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Affiliation(s)
- Edson L. Bernardo
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Tacilta Nhampossa
- Manhiça Health Research Center, Manhiça, Mozambique
- National Institute of Health of Mozambique, Maputo, Mozambique
| | - Kate Clouse
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt University School of Nursing, Nashville, Tennessee, United States of America
| | - James G. Carlucci
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Sheila Fernández-Luis
- Manhiça Health Research Center, Manhiça, Mozambique
- Barcelona Institute for Global Health, ISGlobal, Hospital Clinic, Universitat de Barcelona; Barcelona, Spain
| | - Laura Fuente-Soro
- Manhiça Health Research Center, Manhiça, Mozambique
- Barcelona Institute for Global Health, ISGlobal, Hospital Clinic, Universitat de Barcelona; Barcelona, Spain
| | | | - Mohsin Sidat
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Denise Naniche
- Manhiça Health Research Center, Manhiça, Mozambique
- Barcelona Institute for Global Health, ISGlobal, Hospital Clinic, Universitat de Barcelona; Barcelona, Spain
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Villanueva CM, Grau-Pujol B, Evlampidou I, Escola V, Goñi-Irigoyen F, Kuckelkorn J, Grummt T, Arjona L, Lazaro B, Etxeandia A, Ulibarrena E, Nhacolo A, Muñoz J. Chemical and in vitro bioanalytical assessment of drinking water quality in Manhiça, Mozambique. J Expo Sci Environ Epidemiol 2021; 31:276-288. [PMID: 33414480 DOI: 10.1038/s41370-020-00282-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/06/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The chemical quality of drinking water is widely unknown in low-income countries. OBJECTIVE We conducted an exploratory study in Manhiça district (Mozambique) to evaluate drinking water quality using chemical analyses and cell-based assays. METHODS We measured nitrate, fluoride, metals, pesticides, disinfection by-products, and industrial organochlorinated chemicals, and conducted the bioassays Ames test for mutagenicity, micronuclei assay (MN-FACS), ER-CALUX, and antiAR-CALUX in 20 water samples from protected and unprotected sources. RESULTS Nitrate was present in all samples (median 7.5 mg/L). Manganese, cobalt, chromium, aluminium, and barium were present in 90-100% of the samples, with median values of 32, 0.6, 2.0, 61, 250 μg/l, respectively. Manganese was above 50 μg/l (EU guideline) in eight samples. Arsenic, lead, nickel, iron, and selenium median values were below the quantification limit. Antimony, cadmium, copper, mercury, zinc and silver were not present. Trihalomethanes, haloacetic acids, haloacetonitriles and haloketones were present in 5-28% samples at levels ≤4.6 μg/l. DDT, dieldrin, diuron, and pirimiphos-methyl were quantified in 2, 3, 3, and 1 sample, respectively (range 12-60 ng/L). Fluoride was present in one sample (0.11 mg/l). Trichloroethene and tetrachloroethene were not present. Samples were negative in the in vitro assays. SIGNIFICANCE Results suggest low exposure to chemicals, mutagenicity, genotoxicity and endocrine disruption through drinking water in Manhiça population. High concentration of manganese in some samples warrants confirmatory studies, given the potential link to impaired neurodevelopment.
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Affiliation(s)
- Cristina M Villanueva
- ISGlobal, Barcelona, Spain.
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Berta Grau-Pujol
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
- Fundación Mundo Sano, Buenos Aires, Argentina
| | - Iro Evlampidou
- ISGlobal, Barcelona, Spain
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Valdemiro Escola
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Fernando Goñi-Irigoyen
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Health Department of Basque Government, Public Health Laboratory (Gipuzkoa), San Sebastian, Spain
- Biodonostia Health Research Institute, San Sebastian, Spain
| | - Jochen Kuckelkorn
- Toxicology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Tamara Grummt
- Toxicology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany
| | - Lourdes Arjona
- ISGlobal, Barcelona, Spain
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Beatriz Lazaro
- Health Department of Basque Government, Public Health Laboratory (Bizkaia), Derio, Spain
| | - Arsenio Etxeandia
- Health Department of Basque Government, Public Health Laboratory (Bizkaia), Derio, Spain
| | - Enrique Ulibarrena
- Health Department of Basque Government, Public Health Laboratory (Gipuzkoa), San Sebastian, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Jose Muñoz
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
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Lopez-Varela E, Augusto O, Fuente-Soro L, Sacoor C, Nhacolo A, Casavant I, Karajeanes E, Vaz P, Naniche D. Quantifying the gender gap in the HIV care cascade in southern Mozambique: We are missing the men. PLoS One 2021; 16:e0245461. [PMID: 33577559 PMCID: PMC7880488 DOI: 10.1371/journal.pone.0245461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND HIV-infected men have higher rates of delayed diagnosis, reduced antiretroviral treatment (ART) retention and mortality than women. We aimed to assess, by gender, the first two UNAIDS 90 targets in rural southern Mozambique. METHODS This analysis was embedded in a larger prospective cohort enrolling individuals with new HIV diagnosis between May 2014-June 2015 from clinic and home-based testing (HBT). We assessed gender differences between steps of the HIV-cascade. Adjusted HIV-community prevalence was estimated using multiple imputation (MI). RESULTS Among 11,773 adults randomized in HBT (7084 female and 4689 male), the response rate before HIV testing was 48.7% among eligible men and 62.0% among women (p<0.001). MI did not significantly modify all-age HIV-prevalence for men but did decrease prevalence estimates in women from 36.4%to 33.0%. Estimated proportion of HIV-infected individuals aware of their status was 75.9% for men and 88.9% for women. In individuals <25 years, we observed up to 22.2% disparity in awareness of serostatus between genders. Among individuals eligible for ART, similar proportions of men and women initiated treatment (81.2% and 85.9%, respectively). Fourfold more men than womenwere in WHO stage III/IV AIDS at first clinical visit. Once on ART, men had a twofold higher 18-month loss to follow-up rate than women. CONCLUSION The contribution of missing HIV-serostatus data differentially impacted indicators of HIV prevalence and of achievement of UNAIDS targets by age and gender and men were missing long before the second 90. Increased efforts to characterize missing men and their needs will and their needs will allow us to urgently address the barriers to men accessing care and ensure men are not left behind in the UNAIDS 90-90-90 targets achievement.
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Affiliation(s)
- Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Instituto de Salud Global de Barcelona, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Facultade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Instituto de Salud Global de Barcelona, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Paula Vaz
- Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Instituto de Salud Global de Barcelona, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
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16
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Magaço A, Munguambe K, Nhacolo A, Ambrósio C, Nhacolo F, Cossa S, Macete E, Mandomando I. Challenges and needs for social behavioural research and community engagement activities during the COVID-19 pandemic in rural Mozambique. Glob Public Health 2020; 16:153-157. [PMID: 33125306 DOI: 10.1080/17441692.2020.1839933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
After the Ebola outbreaks the world is again facing a challenge in which human behaviours and contact history play crucial roles in determining the trends in disease spreading within and across communities. With the onset of the recent coronavirus disease (COVID-19) pandemic, several issues related to conducting social behavioural sciences research and related community engagement activities arise, especially in rural areas of low-income countries, where the coverage of information and communication technologies (ICTs) is limited and their application on field-based research would imply a biased selection of relatively more privileged minorities with access to on-line and other communication platforms not requiring physical contact. This article enumerates and discusses the different technical challenges that social behavioural sciences research and community engagement activities face in times of public health emergencies caused by pandemics such as COVID-19. It also highlights the possibility of using alternative approaches to maintain the engagement with members of rural communities in research and social action activities, as well as the ethical challenges arising from such approaches.
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Affiliation(s)
- Amílcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Contardo Ambrósio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Felizarda Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Saquina Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,National Directorate of Public Health, Maputo, Mozambique
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
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17
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Cunningham SA, Shaikh NI, Nhacolo A, Raghunathan PL, Kotloff K, Naser AM, Mengesha MM, Adedini SA, Misore T, Onuwchekwa UU, Worrell MC, El Arifeen S, Assefa N, Chowdhury AI, Kaiser R, Madhi SA, Mehta A, Obor D, Sacoor C, Sow SO, Tapia MD, Wilkinson AL, Breiman RF. Health and Demographic Surveillance Systems Within the Child Health and Mortality Prevention Surveillance Network. Clin Infect Dis 2020; 69:S274-S279. [PMID: 31598663 PMCID: PMC6785673 DOI: 10.1093/cid/ciz609] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Indexed: 01/02/2023] Open
Abstract
Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.
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Affiliation(s)
| | - Nida I Shaikh
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Abu Mohd Naser
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Melkamu M Mengesha
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sunday A Adedini
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Uma U Onuwchekwa
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Mary Claire Worrell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Reinhard Kaiser
- US Centers for Disease Control and Prevention-Sierra Leone, Freetown, Sierra Leone
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amanda L Wilkinson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
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18
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Galatas B, Nhacolo A, Marti H, Munguambe H, Jamise E, Guinovart C, Cirera L, Amone F, Macete E, Bassat Q, Rabinovich R, Alonso P, Aide P, Saute F, Sacoor C. Demographic and health community-based surveys to inform a malaria elimination project in Magude district, southern Mozambique. BMJ Open 2020; 10:e033985. [PMID: 32371510 PMCID: PMC7228537 DOI: 10.1136/bmjopen-2019-033985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES A Demographic and Health Platform was established in Magude in 2015, prior to the deployment of a project aiming to evaluate the feasibility of malaria elimination in southern Mozambique, named the Magude project. This platform aimed to inform the design, implementation and evaluation of the Magude project, through the identification of households and population; and the collection of demographic, health and malaria information. SETTING Magude is a rural district of southern Mozambique which borders South Africa. It has nine peripheral health facilities and one referral health centre with an inpatient ward. INTERVENTION A baseline census enumerated and geolocated all the households, and their resident and non-resident members, collecting demographic and socio-economic information, and data on the coverage and usage of malaria control tools. Inpatient and outpatient data during the 5 years (2010 to 2014) before the survey were obtained from the district health authorities. The demographic platform was updated in 2016. RESULTS The baseline census conducted in 2015 reported 48 448 (92.1%) residents and 4133 (7.9%) non-residents, and 10 965 households. Magude's population is predominantly young, half of the population has no formal education and the main economic activities are agriculture and fishing. Houses are mainly built with traditional non-durable materials and have poor sanitation facilities. Between 2010 and 2014, malaria was the most common cause of all-age inpatient discharges (representing 20% to 40% of all discharges), followed by HIV (12% to 22%) and anaemia (12% to 15%). In early 2015, all-age bed-net usage was between 21.8% and 27.1% and the reported coverage of indoor residual spraying varied across the district between 30.7% and 79%. CONCLUSION This study revealed that Magude has limited socio-economic conditions, poor access to healthcare services and low coverage of malaria vector control interventions. Thus, Magude represented an area where it is most pressing to demonstrate the feasibility of malaria elimination. TRIAL REGISTRATION NUMBER NCT02914145; Pre-results.
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Affiliation(s)
- Beatriz Galatas
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Helena Marti
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | - Edgar Jamise
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Caterina Guinovart
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Laia Cirera
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Felimone Amone
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Regina Rabinovich
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Pedro Alonso
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Pedro Aide
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Francisco Saute
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
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19
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Fuente-Soro L, López-Varela E, Augusto O, Bernardo EL, Sacoor C, Nhacolo A, Ruiz-Castillo P, Alfredo C, Karajeanes E, Vaz P, Naniche D. Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study. Medicine (Baltimore) 2020; 99:e20236. [PMID: 32443358 PMCID: PMC7254184 DOI: 10.1097/md.0000000000020236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients lost to follow-up (LTFU) over the human immunodeficiency virus (HIV) cascade have poor clinical outcomes and contribute to onward HIV transmission. We assessed true care outcomes and factors associated with successful reengagement in patients LTFU in southern Mozambique.Newly diagnosed HIV-positive adults were consecutively recruited in the Manhiça District. Patients LTFU within 12 months after HIV diagnosis were visited at home from June 2015 to July 2016 and interviewed for ascertainment of outcomes and reasons for LTFU. Factors associated with reengagement in care within 90 days after the home visit were analyzed by Cox proportional hazards model.Among 1122 newly HIV-diagnosed adults, 691 (61.6%) were identified as LTFU. Of those, 557 (80.6%) were approached at their homes and 321 (57.6%) found at home. Over 50% had died or migrated, 10% had been misclassified as LTFU, and 252 (78.5%) were interviewed. Following the visit, 79 (31.3%) reengaged in care. Having registered in care and a shorter time between LTFU and visit were associated with reengagement in multivariate analyses: adjusted hazards ratio of 3.54 [95% confidence interval (CI): 1.81-6.92; P < .001] and 0.93 (95% CI: 0.87-1.00; P = .045), respectively. The most frequently reported barriers were the lack of trust in the HIV-diagnosis, the perception of being in good health, and fear of being badly treated by health personnel and differed by type of LTFU.Estimates of LTFU in rural areas of sub-Saharan Africa are likely to be overestimated in the absence of active tracing strategies. Home visits are resource-intensive but useful strategies for reengagement for at least one-third of LTFU patients when applied in the context of differentiated care for those LTFU individuals who had already enrolled in HIV care at some point.
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Affiliation(s)
- Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic –00 Universitat de Barcelona, Barcelona, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic –00 Universitat de Barcelona, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Edson Luis Bernardo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Manhiça District Health Services
| | | | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Paula Ruiz-Castillo
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic –00 Universitat de Barcelona, Barcelona, Spain
| | | | | | - Paula Vaz
- Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic –00 Universitat de Barcelona, Barcelona, Spain
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20
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Aide P, Candrinho B, Galatas B, Munguambe K, Guinovart C, Luis F, Mayor A, Paaijmans K, Fernández-Montoya L, Cirera L, Bassat Q, Mocumbi S, Menéndez C, Nhalungo D, Nhacolo A, Rabinovich R, Macete E, Alonso P, Saúte F. Setting the scene and generating evidence for malaria elimination in Southern Mozambique. Malar J 2019; 18:190. [PMID: 31170984 PMCID: PMC6554892 DOI: 10.1186/s12936-019-2832-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/04/2019] [Indexed: 03/31/2024] Open
Abstract
Mozambique has historically been one of the countries with the highest malaria burden in the world. Starting in the 1960s, malaria control efforts were intensified in the southern region of the country, especially in Maputo city and Maputo province, to aid regional initiatives aimed to eliminate malaria in South Africa and eSwatini. Despite significant reductions in malaria prevalence, elimination was never achieved. Following the World Health Organization’s renewed vision of a malaria-free-world, and considering the achievements from the past, the Mozambican National Malaria Control Programme (NMCP) embarked on the development and implementation of a strategic plan to accelerate from malaria control to malaria elimination in southern Mozambique. An initial partnership, supported by the Bill and Melinda Gates Foundation and the La Caixa Foundation, led to the creation of the Mozambican Alliance Towards the Elimination of Malaria (MALTEM) and the Malaria Technical and Advisory Committee (MTAC) to promote national ownership and partner coordination to work towards the goal of malaria elimination in local and cross-border initiatives. Surveillance systems to generate epidemiological and entomological intelligence to inform the malaria control strategies were strengthened, and an impact and feasibility assessment of various interventions aimed to interrupt malaria transmission were conducted in Magude district (Maputo Province) through the “Magude Project”. The primary aim of this project was to generate evidence to inform malaria elimination strategies for southern Mozambique. The goal of malaria elimination in areas of low transmission intensity is now included in the national malaria strategic plan for 2017–22 and the NMCP and its partners have started to work towards this goal while evidence continues to be generated to move the national elimination agenda forward.
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Affiliation(s)
- Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique. .,National Institute of Health, Ministry of Health, Maputo, Mozambique.
| | - Baltazar Candrinho
- National Malaria Control Programme, Ministry of Health, Maputo, Mozambique
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,Universidade de Eduardo Mondlane, Maputo, Mozambique
| | | | - Fabião Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Alfredo Mayor
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Krijn Paaijmans
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,School of Life Sciences, Center for Evolution and Medicine, Biodesign Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, USA
| | | | - Laia Cirera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
| | - Sonia Mocumbi
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Delino Nhalungo
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Regina Rabinovich
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - Pedro Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
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21
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Fuente‐Soro L, Lopez‐Varela E, Augusto O, Sacoor C, Nhacolo A, Honwana N, Karajeanes E, Vaz P, Naniche D. Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re-test during HIV-testing campaigns in rural Mozambique. J Int AIDS Soc 2018; 21:e25095. [PMID: 29652098 PMCID: PMC5898226 DOI: 10.1002/jia2.25095] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/20/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Awareness of HIV-infection goes beyond diagnosis, and encompasses understanding, acceptance, disclosure and initiation of the HIV-care. We aimed to characterize the HIV-positive population that underwent repeat HIV-testing without disclosing their serostatus and the impact on estimates of the first UNAIDS 90 target. METHODS This analysis was nested in a prospective cohort established in southern Mozambique which conducted three HIV-testing modalities: voluntary counselling and testing (VCT), provider-initiated counselling and testing (PICT) and home-based testing (HBT). Participants were given the opportunity to self-report their status to lay counsellors and HIV-positive diagnoses were verified for previous enrolment in care. This study included 1955 individuals diagnosed with HIV through VCT/PICT and 11,746 participants of a HBT campaign. Those who did not report their serostatus prior to testing, and were found to have a previous HIV-diagnosis, were defined as non-disclosures. Venue-stratified descriptive analyses were performed and factors associated with non-disclosure were estimated through log-binomial regression. RESULTS In the first round of 2500 adults randomized for HBT, 1725 were eligible for testing and 18.7% self-reported their HIV-positivity. Of those tested with a positive result, 38.9% were found to be non-disclosures. Similar prevalence of non-disclosures was found in clinical-testing modalities, 29.4% (95% CI 26.7 to 32.3) for PICT strategy and 13.0% (95% CI 10.9 to 15.3) for VCT. Prior history of missed visits (adjusted prevalence ratio (APR) 4.2, 95% CI 2.6 to 6.8), younger age (APR 2.5, 95% CI 1.4 to 4.4) and no prior history of treatment ((APR) 1.4, 95% CI 1.0 to 2.1) were significantly associated with non-disclosure as compared to patients who self-reported. When considering non-disclosures as people living with HIV (PLWHIV) aware of their HIV-status, the proportion of PLWHIV aware increased from 78.3% (95% CI 74.2 to 81.6) to 86.8% (95% CI 83.4 to 89.6). CONCLUSION More than one-third of individuals testing HIV-positive did not disclose their previous positive HIV-diagnosis to counsellors. This proportion varied according to testing modality and age. In the absence of an efficient and non-anonymous tracking system for HIV-testers, repeat testing of non-disclosures leads to wasted resources and may distort programmatic indicators. Developing interventions that ensure appropriate psychosocial support are needed to encourage this population to disclose their status and optimize scarce resources.
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Affiliation(s)
- Laura Fuente‐Soro
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobalBarcelona Institute for Global HealthHospital Clínic ‐ Universitat de BarcelonaBarcelonaSpain
| | - Elisa Lopez‐Varela
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobalBarcelona Institute for Global HealthHospital Clínic ‐ Universitat de BarcelonaBarcelonaSpain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Nely Honwana
- Centre for Disease Control and Prevention (CDC)MaputoMozambique
| | | | - Paula Vaz
- Fundação Ariel Glaser Contra o SIDA PediátricoMaputoMozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobalBarcelona Institute for Global HealthHospital Clínic ‐ Universitat de BarcelonaBarcelonaSpain
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22
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Marbán-Castro E, Sacoor C, Nhacolo A, Augusto O, Jamisse E, López-Varela E, Casellas A, Aponte JJ, Bassat Q, Sigauque B, Macete E, Garcia-Basteiro AL. BCG vaccination in southern rural Mozambique: an overview of coverage and its determinants based on data from the demographic and health surveillance system in the district of Manhiça. BMC Pediatr 2018; 18:56. [PMID: 29439702 PMCID: PMC5811981 DOI: 10.1186/s12887-018-1003-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022] Open
Abstract
Background Over the past four decades, the World Health Organization established the Expanded Programme on Immunization (EPI) to foster universal access to all relevant vaccines for all children at risk. The success of this program has been undeniable, but requires periodic monitoring to ensure that coverage rates remain high. The aim of this study was to measure the BCG vaccination coverage in Manhiça district, a high TB burden rural area of Southern Mozambique and to investigate factors that may be associated with BCG vaccination. Methods We used data from the Health and Demographic Surveillance System (HDSS) run by the Manhiça Health Research Centre (CISM) in the district of Manhiça. A questionnaire was added in the annual HDSS round visits to retrospectively collect the vaccination history of children under the age of 3 years. Vaccinations are registered in the National Health Cards which are universally distributed at birth. This information was collected for children born from 2011 to 2014. Data on whether a child was vaccinated for BCG were collected from these National Health Cards and/or BCG scar assessment. Results A total of 10,875 number of children were eligible for the study and 7903 presented the health card. BCG coverage was 97.4% for children holding a health card. A BCG-compatible scar was observed in 99.0% of all children and in 99.6% of children with recorded BCG in the card. A total of 93.4% of children had been vaccinated with BCG within their first 28 days of life. None of the factors analysed were found to be associated with lack of BCG vaccination except for living in the municipality of Maluana compared to living in the municipality of Manhiça; (OR = 1.89, 95% CI: 1.18-3.00). Coverage for other EPI vaccines during the first year of life was similarly high, but decreased for subsequent doses. Conclusions BCG coverage is high and timely administered. Almost all vaccinated infants develop scar, which is a useful proxy for monitoring BCG vaccine implementation. Electronic supplementary material The online version of this article (10.1186/s12887-018-1003-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Edgar Jamisse
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Elisa López-Varela
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Aina Casellas
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain
| | - John J Aponte
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
| | - Betuel Sigauque
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Alberto L Garcia-Basteiro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain. .,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique. .,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.
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23
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Sacoor C, Payne B, Augusto O, Vilanculo F, Nhacolo A, Vidler M, Makanga PT, Munguambe K, Lee T, Macete E, von Dadelszen P, Sevene E. Health and socio-demographic profile of women of reproductive age in rural communities of southern Mozambique. PLoS One 2018; 13:e0184249. [PMID: 29394247 PMCID: PMC5796686 DOI: 10.1371/journal.pone.0184249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/21/2017] [Indexed: 11/18/2022] Open
Abstract
Reliable statistics on maternal morbidity and mortality are scarce in low and middle-income countries, especially in rural areas. This is the case in Mozambique where many births happen at home. Furthermore, a sizeable number of facility births have inadequate registration. Such information is crucial for developing effective national and global health policies for maternal and child health. The aim of this study was to generate reliable baseline socio-demographic information on women of reproductive age as well as to establish a demographic surveillance platform to support the planning and implementation of the Community Level Intervention for Pre-eclampsia (CLIP) study, a cluster randomized controlled trial. This study represents a census of all women of reproductive age (12–49 years) in twelve rural communities in Maputo and Gaza provinces of Mozambique. The data were collected through electronic forms implemented in Open Data Kit (ODK) (an app for android based tablets) and household and individual characteristics. Verbal autopsies were conducted on all reported maternal deaths to determine the underlying cause of death. Between March and October 2014, 50,493 households and 80,483 women of reproductive age (mean age 26.9 years) were surveyed. A total of 14,617 pregnancies were reported in the twelve months prior to the census, resulting in 9,029 completed pregnancies. Of completed pregnancies, 8,796 resulted in live births, 466 resulted in stillbirths and 288 resulted in miscarriages. The remaining pregnancies had not yet been completed during the time of the survey (5,588 pregnancies). The age specific fertility indicates that highest rate (188 live births per 1,000 women) occurs in the age 20–24 years old. The estimated stillbirth rate was 50.3/1,000 live and stillbirths; neonatal mortality rate was 13.3/1,000 live births and maternal mortality ratio was 204.6/100,000 live births. The most common direct cause of maternal death was eclampsia and tuberculosis was the most common indirect cause of death. This study found that fertility rate is high at age 20–24 years old. Pregnancy in the advanced age (>35 years of age) in this study was associated with higher poor outcomes such as miscarriage and stillbirth. The study also found high stillbirth rate indicating a need for increased attention to maternal health in southern Mozambique. Tuberculosis and HIV/AIDS are prominent indirect causes of maternal death, while eclampsia represents the number one direct obstetric cause of maternal deaths in these communities. Additional efforts to promote safe motherhood and improve child survival are crucial in these communities.
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Affiliation(s)
- Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- * E-mail:
| | - Beth Payne
- University of British Columbia (UBC), Vancouver, Canada
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | | | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | | | | | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Tang Lee
- University of British Columbia (UBC), Vancouver, Canada
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Direcção Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, King’s College, London, United Kingdom
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
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24
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Sigaúque B, Kobayashi M, Vubil D, Nhacolo A, Chaúque A, Moaine B, Massora S, Mandomando I, Nhampossa T, Bassat Q, Pimenta F, Menéndez C, Carvalho MDG, Macete E, Schrag SJ. Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015. PLoS One 2018; 13:e0191193. [PMID: 29351318 PMCID: PMC5774717 DOI: 10.1371/journal.pone.0191193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/29/2017] [Indexed: 12/03/2022] Open
Abstract
Background Maternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001–2015, with a focus on GBS epidemiology and strain characteristics. Methods Community-level birth and mortality data were obtained from Manhiça’s demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhiça district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing. Results There were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001), but not for GBS (P = 0.17). In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births). Among 35 GBS isolates available for testing, 31 (88.6%) were highly related serotype III isolates within multilocus sequence types (STs) 17 (68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had elevated minimum inhibitory concentration (MIC) to penicillin (≥0.12 μg/mL) associated with penicillin-binding protein (PBP) 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone. Conclusion A notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies.
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Affiliation(s)
- Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- John Snow Inc. (JSI) on the Maternal and Child Survival Program–MCSP (USAID Grantee), Maputo, Mozambique
- * E-mail:
| | - Miwako Kobayashi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Delfino Vubil
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Alberto Chaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Benild Moaine
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Sérgio Massora
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Center for International Health Research, and Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Fabiana Pimenta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Center for International Health Research, and Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Stephanie J. Schrag
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
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25
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Boene H, Vidler M, Sacoor C, Nhama A, Nhacolo A, Bique C, Alonso P, Sawchuck D, Qureshi R, Macete E, Menéndez C, von Dadelszen P, Sevene E, Munguambe K. Community perceptions of pre-eclampsia and eclampsia in southern Mozambique. Reprod Health 2016; 13 Suppl 1:33. [PMID: 27357840 PMCID: PMC4943502 DOI: 10.1186/s12978-016-0135-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Sub-Saharan Africa has the highest maternal mortality ratio at 500 deaths per 100,000 live births. In Mozambique maternal mortality is estimated at 249-480 per 100,000 live births and eclampsia is the third leading cause of death. The objective of this study was to describe the community understanding of pre-eclampsia and eclampsia, as a crucial step to improve maternal and perinatal health in southern Mozambique. Methods This qualitative study was conducted in Maputo and Gaza Provinces of southern Mozambique. Twenty focus groups were convened with pregnant women, partners and husbands, matrons and traditional birth attendants, and mothers and mothers-in-law. In addition, ten interviews were conducted with traditional healers, matrons, and a traditional birth attendant. All discussions were audio-recorded, translated from local language (Changana) to Portuguese and transcribed verbatim prior to analysis with QSR NVivo 10. A thematic analysis approach was taken. Results The conditions of “pre-eclampsia” and “eclampsia” were not known in these communities; however, participants were familiar with hypertension and seizures in pregnancy. Terms linked with the biomedical concept of pre-eclampsia were high blood pressure, fainting disease and illness of the heart, whereas illness of the moon, snake illness, falling disease, childhood illness, illness of scaresand epilepsy were used to characterizeeclampsia. The causes of hypertension in pregnancy were thought to include mistreatment by in-laws, marital problems, and excessive worrying. Seizures in pregnancy were believed to be caused by a snake living inside the woman’s body. Warning signs thought to be common to both conditions were headache, chest pain, weakness, dizziness, fainting, sweating, and swollen feet. Conclusion Local beliefs in southern Mozambique, regarding the causes, presentation, outcomes and treatment of pre-eclampsia and eclampsia were not aligned with the biomedical perspective. The community was often unaware of the link between hypertension and seizures in pregnancy. The numerous widespread myths and misconceptions concerning pre-eclampsia and eclampsiamay induceinappropriatetreatment-seeking and demonstrate a need for increased community education regarding pregnancy and associated complications. Trial Registration NCT01911494 Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0135-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Boene
- 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, British Columbia, Canada
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Abel Nhama
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Cassimo Bique
- Ministério da Saúde, Maputo, Mozambique.,Hospital Central de Maputo, Maputo, Mozambique
| | - Pedro Alonso
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGlobal)/Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Ministério da Saúde, Maputo, Mozambique
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGlobal)/Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique. .,Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
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26
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Sacoor C, Nhacolo A, Nhalungo D, Aponte JJ, Bassat Q, Augusto O, Mandomando I, Sacarlal J, Lauchande N, Sigaúque B, Alonso P, Macete E, Munguambe K, Guinovart C, Aide P, Menendez C, Acácio S, Quelhas D, Sevene E, Nhampossa T. Profile: Manhiça Health Research Centre (Manhiça HDSS). Int J Epidemiol 2016; 42:1309-18. [PMID: 24159076 DOI: 10.1093/ije/dyt148] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Manhiça Health Research Centre, established in 1996 in a rural area of southern Mozambique, currently follows around 92 000 individuals living in approximately 20 000 enumerated and geo-positioned households. Its main strength is the possibility of linking demographic data and clinical data to promote and conduct biomedical research in priority health areas. Socio-demographic data are updated twice a year and clinical data are collected on a daily basis. The data collected in Manhiça HDSS comprises household and individual characteristics, household socio-economic assets, vital data, migration, individual health history and cause of death, among others. Studies conducted in this HDSS contributed to guide the health authorities and decision-making bodies to define or adjust health policies such as the introduction of Mozambique's expanded programme of immunization with different vaccines (Haemophilus influenzae type b, Pneumococcus) or the development of the concept of Intermittent Preventive Treatment for Infants (IPTi) that led to the World Health Organization recommendation of this method as best practice for the control of malaria among infants. Manhiça's data can be accessed through a formal request to Diana Quelhas (diana.quelhas@manhica.net) accompanied by a proposal that will be analysed by the Manhiça HDSS internal scientific and ethics committees.
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Affiliation(s)
- Charfudin Sacoor
- Manhiça Health Research Centre, Manhiça District, Mozambique, Barcelona Centre for International Health Research, Hospital Clínic/Universitat de Barcelona, Spain, National Directorate of Health, Ministry of Health, Maputo, Mozambique, National Institute of Health, Ministry of Health, Maputo Mozambique and Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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27
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Nhampossa T, Mandomando I, Acacio S, Quintó L, Vubil D, Ruiz J, Nhalungo D, Sacoor C, Nhabanga A, Nhacolo A, Aide P, Machevo S, Sigaúque B, Nhama A, Kotloff K, Farag T, Nasrin D, Bassat Q, Macete E, Levine MM, Alonso P. Diarrheal Disease in Rural Mozambique: Burden, Risk Factors and Etiology of Diarrheal Disease among Children Aged 0-59 Months Seeking Care at Health Facilities. PLoS One 2015; 10:e0119824. [PMID: 25973880 PMCID: PMC4431848 DOI: 10.1371/journal.pone.0119824] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022] Open
Abstract
Background Diarrheal disease remains a leading cause of illness and death, particularly in low-income countries. Its burden, microbiological causes and risk factors were examined in children aged 0–59 months living in Manhiça, rural southern Mozambique. Methods Trends of diarrhea-related burden of disease were estimated during the period 2001–2012. A prospective, age-stratified and matched (by age, gender and geographical origin), case-control study was conducted during 2007–2011. Clinical, epidemiology, anthropometric measurement and fecal samples obtained from recruited children were used to estimate moderate-to-severe diarrhea (MSD) weighted attributable fractions. Results Over the last decade the incidence of acute diarrhea has dropped by about 80%. Incidence of MSD per 100 child years at risk for the period 2007–2011 was 9.85, 7.73 and 2.10 for children aged 0–11, 12–23 and 24–59 months respectively. By adjusted population attributable fractions, most cases of MSD were due to rotavirus, Cryptosporidium, ETEC ST (ST only or ST/LT), Shigella and Adenovirus 40/41. Washing hands and having facilities to dispose child’s stools were associated with a reduced risk of MSD, while giving stored water to the child was associated with an increased risk of MSD. Conclusions Despite the predominantly decreasing trends observed throughout the last decade, diarrheal diseases remain today a major cause of morbidity among children aged 0–59 months living in this rural Mozambican area. Rotavirus, cryptosporidium, Shigella, ETEC ST and Adenovirus 40/41 were the most important aetiologies of MSD. Thus, well-known preventive strategies such as washing hands, improving the treatment of stored water, having facilities to dispose children stools, and accelerating the introduction of the rotavirus vaccine should be promoted on a wider scale to reduce the current burden of diarrheal diseases.
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Affiliation(s)
- Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
- * E-mail:
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Sozinho Acacio
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Llorenç Quintó
- Barcelona Center for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Delfino Vubil
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Joaquin Ruiz
- Barcelona Center for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Delino Nhalungo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Arnaldo Nhabanga
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Sónia Machevo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Abel Nhama
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Karen Kotloff
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Tamer Farag
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Center for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Myron M. Levine
- Center for Vaccine Development (CVD), University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Pedro Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Center for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
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28
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Nhampossa T, Mandomando I, Acacio S, Nhalungo D, Sacoor C, Nhacolo A, Macete E, Nhabanga A, Quintó L, Kotloff K, Levine MM, Nasrin D, Farag T, Bassat Q, Alonso P. Health care utilization and attitudes survey in cases of moderate-to-severe diarrhea among children ages 0-59 months in the District of Manhica, southern Mozambique. Am J Trop Med Hyg 2013; 89:41-48. [PMID: 23629927 PMCID: PMC3748500 DOI: 10.4269/ajtmh.12-0754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/21/2013] [Indexed: 11/07/2022] Open
Abstract
In the predominantly rural Manhiça district, in southern Mozambique, diarrhea is one of the leading causes of death among children under 5 years. Caretakers randomly selected from the Demographic Surveillance Database were invited to participate in a community-based survey on use of healthcare services for gastroenteritis. Of those caretakers reporting an episode of diarrhea during the recall period, 65.2% in the first survey and 43.8% in the second survey reported seeking care at a health facility. Independent risk factors for seeking care in health facilities in the first survey included the presence of diarrhea with fever and not knowing any sign of dehydration; having a television at home was related with an independent decreased use of the health facilities. In the second survey, the use of health services was significantly associated with diarrhea with fever and vomiting. Establishment of continuous prospective monitoring allows accounting for changes in healthcare use that may occur because of seasonality or secular events.
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Affiliation(s)
- Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; Barcelona Centre for International Health Research, Hospital Clínic, University of Barcelona, Barcelona, Spain; Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
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Sicuri E, Bardají A, Sigauque B, Maixenchs M, Nhacolo A, Nhalungo D, Macete E, Alonso PL, Menéndez C. Costs associated with low birth weight in a rural area of Southern Mozambique. PLoS One 2011; 6:e28744. [PMID: 22174885 PMCID: PMC3236214 DOI: 10.1371/journal.pone.0028744] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/14/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Low Birth Weight (LBW) is prevalent in low-income countries. Even though the economic evaluation of interventions to reduce this burden is essential to guide health policies, data on costs associated with LBW are scarce. This study aims to estimate the costs to the health system and to the household and the Disability Adjusted Life Years (DALYs) arising from infant deaths associated with LBW in Southern Mozambique. METHODS AND FINDINGS Costs incurred by the households were collected through exit surveys. Health system costs were gathered from data obtained onsite and from published information. DALYs due to death of LBW babies were based on local estimates of prevalence of LBW (12%), very low birth weight (VLBW) (1%) and of case fatality rates compared to non-LBW weight babies [for LBW (12%) and VLBW (80%)]. Costs associated with LBW excess morbidity were calculated on the incremental number of hospital admissions in LBW babies compared to non-LBW weight babies. Direct and indirect household costs for routine health care were 24.12 US$ (CI 95% 21.51; 26.26). An increase in birth weight of 100 grams would lead to a 53% decrease in these costs. Direct and indirect household costs for hospital admissions were 8.50 US$ (CI 95% 6.33; 10.72). Of the 3,322 live births that occurred in one year in the study area, health system costs associated to LBW (routine health care and excess morbidity) and DALYs were 169,957.61 US$ (CI 95% 144,900.00; 195,500.00) and 2,746.06, respectively. CONCLUSIONS This first cost evaluation of LBW in a low-income country shows that reducing the prevalence of LBW would translate into important cost savings to the health system and the household. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care.
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Affiliation(s)
- Elisa Sicuri
- Barcelona Centre for International Health Research CRESIB, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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Munguambe K, Pool R, Montgomery C, Bavo C, Nhacolo A, Fiosse L, Sacoor C, Nhalungo D, Mabunda S, Macete E, Alonso P. What drives community adherence to indoor residual spraying (IRS) against malaria in Manhiça district, rural Mozambique: a qualitative study. Malar J 2011; 10:344. [PMID: 22111698 PMCID: PMC3339361 DOI: 10.1186/1475-2875-10-344] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 11/23/2011] [Indexed: 11/27/2022] Open
Abstract
Background Malaria control remains a challenge in sub-Saharan Africa. In 2006, the World Health Organization (WHO) reinforced the recommendation of indoor residual spraying (IRS) with dichlorodiphenyltrichloroethane (DDT) to reduce malaria transmission. The National Malaria Control Programme has been reporting high coverage rates of IRS in Mozambique. It is important to establish to what extent these rates are a reflection of community acceptability, and to explore the factors associated with adherence, in order to recommend suitable approaches for interventions of this nature. Objective To understand the implementation process, reception and acceptability of the IRS program in Manhiça district, Southern Mozambique. Methods Qualitative data was collected through in-depth interviews, participant observation of IRS activities, informal interviews, and focus group discussions. Study participants comprised householders, community leaders, health care providers, sprayers, and community members. Qualitative data analysis was based on grounded theory. Secondary data from the Manhiça Demographic Surveillance System was used to complement the qualitative data. Results IRS was well received in most neighbourhoods. The overall coverage rates varied between 29% and 41% throughout the study period. The factors related to adherence to IRS were: immediate impact on insects in general, trust and obedience in the health authority, community leaders' influence, and acquaintance with the sprayers. Fighting malaria was not an important motivation for IRS adherence. There was a perception of limited efficacy of IRS against mosquitoes, but this did not affect adherence. Non-adherence to the intervention was mainly due to the unavailability of key householders, disagreement with the procedures, and the perception that spraying increased the burden of insects. Most respondents strongly favoured bed nets over IRS. Conclusion The study suggests that the contribution of IRS to malaria and mosquito control is not entirely perceived by the beneficiaries, and that other as cost effective interventions such as insecticide-treated nets are favoured over IRS. Adherence to IRS was found to be influenced by socio-political factors. There is a need to redefine the community sensitization approaches in order to make IRS a genuinely participative, acceptable, and sustainable programme.
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Affiliation(s)
- Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça, Rua 12, CP 1929 Manhiça, Mozambique.
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Ibarz-Pavón AB, Morais L, Sigaúque B, Mandomando I, Bassat Q, Nhacolo A, Quintó L, Soriano-Gabarró M, Alonso PL, Roca A. Epidemiology, molecular characterization and antibiotic resistance of Neisseria meningitidis from patients ≤15 years in Manhiça, rural Mozambique. PLoS One 2011; 6:e19717. [PMID: 21695194 PMCID: PMC3112148 DOI: 10.1371/journal.pone.0019717] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 04/14/2011] [Indexed: 11/19/2022] Open
Abstract
Background The epidemiology of meningococcal disease in Mozambique and other African countries located outside the “meningitis belt” remains widely unknown. With the event of upcoming vaccines microbiological and epidemiological information is urgently needed. Methods Prospective surveillance for invasive bacterial infections was conducted at the Manhiça District hospital (rural Mozambique) among hospitalized children below 15 years of age. Available Neisseria meningitidis isolates were serogrouped and characterized by Multilocus Sequence Typing (MLST). Antibiotic resistance was also determined. Results Between 1998 and 2008, sixty-three cases of confirmed meningococcal disease (36 meningitis, 26 sepsis and 1 conjunctivitis) were identified among hospitalized children. The average incidence rate of meningococcal disease was 11.6/100,000 (8/100,000 for meningitis and 3.7/100,000 for meningococcemia, respectively). There was a significant rise on the number of meningococcal disease cases in 2005–2006 that was sustained till the end of the surveillance period. Serogroup was determined for 43 of the 63 meningococcal disease cases: 38 serogroup W-135, 3 serogroup A and 2 serogroup Y. ST-11 was the most predominant sequence type and strongly associated with serogroup W-135. Two of the three serogroup A isolates were ST-1, and both serogroup Y isolates were ST-175. N. meningitidis remained highly susceptible to all antibiotics used for treatment in the country, although the presence of isolates presenting intermediate resistance to penicillin advocates for continued surveillance. Conclusions Our data show a high rate of meningococcal disease in Manhiça, Mozambique, mainly caused by serogroup W-135 ST-11 strains, and advocates for the implementation of a vaccination strategy covering serogroup W-135 meningococci in the country.
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Affiliation(s)
- Ana Belén Ibarz-Pavón
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail: (ABI); (AR)
| | - Luis Morais
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Betuel Sigaúque
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Instituto Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique
| | - Quique Bassat
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Llorenç Quintó
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, Spain
| | | | - Pedro L. Alonso
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Anna Roca
- Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- * E-mail: (ABI); (AR)
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Escaramís G, Carrasco JL, Aponte JJ, Nhalungo D, Nhacolo A, Alonso P, Ascaso C. Spatio-temporal analysis of mortality among children under the age of five in Manhiça (Mozambique) during the period 1997-2005. Int J Health Geogr 2011; 10:14. [PMID: 21332980 PMCID: PMC3050678 DOI: 10.1186/1476-072x-10-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 02/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background Reducing childhood mortality is the fourth goal of the Millennium Development Goals agreed at the United Nations Millennium Summit in September 2000. However, childhood mortality in developing countries remains high. Providing an accurate picture of space and time-trend variations in child mortality in a region might generate further ideas for health planning actions to achieve such a reduction. The purpose of this study was to examine the spatio-temporal variation for child mortality rates in Manhiça, a district within the Maputo province of southern rural Mozambique during the period 1997-2005 using a proper generalized linear mixed model. Results The results showed that childhood mortality in all the area was modified from year to year describing a convex time-trend but the spatial pattern described by the neighbourhood-specific underlying mortality rates did not change during the entire period from 1997 to 2005, where neighbourhoods with highest risks are situated in the peripheral side of the district. The spatial distribution, though more blurred here, was similar to the spatial distribution of child malaria incidence in the same area. The peak in mortality rates observed in 2001 could have been caused by the precipitation system that started in early February 2000, following which heavy rains flooded parts of Mozambique's southern provinces. However, the mortality rates at the end of the period returned to initial values. Conclusions The results of this study suggest that the health intervention programmes established in Manhiça to alleviate the effects of flooding on child mortality should cover a period of around five years and that special attention might be focused on eradicating malaria transmission. These outcomes also suggest the utility of suitably modelling space-time trend variations in a region when a point effect of an environmental factor affects all the study area.
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Affiliation(s)
- Geòrgia Escaramís
- Bioestadística, Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain
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Sicuri E, Bardají A, Nhampossa T, Maixenchs M, Nhacolo A, Nhalungo D, Alonso PL, Menéndez C. Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in southern Mozambique. PLoS One 2010; 5:e13407. [PMID: 20976217 PMCID: PMC2955525 DOI: 10.1371/journal.pone.0013407] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 09/16/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Malaria in pregnancy is a public health problem for endemic countries. Economic evaluations of malaria preventive strategies in pregnancy are needed to guide health policies. METHODS AND FINDINGS This analysis was carried out in the context of a trial of malaria intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP), where both intervention groups received an insecticide treated net through the antenatal clinic (ANC) in Mozambique. The cost-effectiveness of IPTp-SP on maternal clinical malaria and neonatal survival was estimated. Correlation and threshold analyses were undertaken to assess the main factors affecting the economic outcomes and the cut-off values beyond which the intervention is no longer cost-effective. In 2007 US$, the incremental cost-effectiveness ratio (ICER) for maternal malaria was 41.46 US$ (95% CI 20.5, 96.7) per disability-adjusted life-year (DALY) averted. The ICER per DALY averted due to the reduction in neonatal mortality was 1.08 US$ (95% CI 0.43, 3.48). The ICER including both the effect on the mother and on the newborn was 1.02 US$ (95% CI 0.42, 3.21) per DALY averted. Efficacy was the main factor affecting the economic evaluation of IPTp-SP. The intervention remained cost-effective with an increase in drug cost per dose up to 11 times in the case of maternal malaria and 183 times in the case of neonatal mortality. CONCLUSIONS IPTp-SP was highly cost-effective for both prevention of maternal malaria and reduction of neonatal mortality in Mozambique. These findings are likely to hold for other settings where IPTp-SP is implemented through ANC visits. The intervention remained cost-effective even with a significant increase in drug and other intervention costs. Improvements in the protective efficacy of the intervention would increase its cost-effectiveness. Provision of IPTp with a more effective, although more expensive drug than SP may still remain a cost-effective public health measure to prevent malaria in pregnancy. TRIAL REGISTRATION ClinicalTrials.gov NCT00209781.
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Affiliation(s)
- Elisa Sicuri
- Barcelona Centre for International Health Research (RESIB, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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Mandomando I, Macete E, Sigaúque B, Morais L, Quintó L, Sacarlal J, Espasa M, Vallès X, Bassat Q, Aide P, Nhampossa T, Machevo S, Ruiz J, Nhacolo A, Menéndez C, Kotloff KL, Roca A, Levine MM, Alonso PL. Invasive non-typhoidalSalmonellain Mozambican children. Trop Med Int Health 2009; 14:1467-74. [DOI: 10.1111/j.1365-3156.2009.02399.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chase C, Sicuri E, Sacoor C, Nhalungo D, Nhacolo A, Alonso PL, Menéndez C. Determinants of household demand for bed nets in a rural area of southern Mozambique. Malar J 2009; 8:132. [PMID: 19527505 PMCID: PMC2706254 DOI: 10.1186/1475-2875-8-132] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 06/15/2009] [Indexed: 11/16/2022] Open
Abstract
Background A key to making insecticide-treated nets (ITNs) a long-term, sustainable solution to the spread of malaria is understanding what drives their purchase and use. Few studies have analysed the determinants of demand for bed nets for malaria prevention at the household level, and in particular, how demand for nets compares with demand for other mosquito prevention methods. Methods This study uses a household survey to assess the determinants of demand for bed nets in an area of endemic malaria transmission in rural, southern Mozambique. The study looks at willingness to pay (WTP) for bed nets, net ownership, usage, and past purchase behaviour, alongside expenditure and frequency of use of alternate methods for malaria prevention. Results While overall net ownership in the sample is low, the evidence fails to suggest that poorer households are less likely to own bed nets, when controlling for covariates, nor does the likelihood of receiving a free net depend on socioeconomic status (SES). Formal schooling and market knowledge seem to indicate higher average willingness to pay, while use of alternate methods for malaria prevention, and receipt of Indoor Residual Spraying (IRS) are found to decrease demand for bed nets. Conclusion For long-term sustainability of ITNs to be realized, results suggest that either full or partial subsidies may be necessary in some contexts to encourage households to obtain and use nets. Given the possible substitution effects of combined malaria control interventions, and the danger of not taking into consideration household preferences for malaria prevention, successful malaria control campaigns should invest a portion of their funds towards educating recipients of IRS and users of other preventive methods on the importance of net use even in the absence of mosquitoes.
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Affiliation(s)
- Claire Chase
- Harvard School of Public Health, Department of Global Health and Population, Boston, MA, USA.
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Mandomando IM, Martins H, Naniche D, Levine MM, Nhacolo A, Alonso P, Kotloff KL, Vallès X, Pasetti MF, Cuberos L. Measles-specific Neutralizing Antibodies in Rural Mozambique: Seroprevalence and Presence in Breast Milk. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.79.787] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mandomando IM, Naniche D, Pasetti MF, Vallès X, Cuberos L, Nhacolo A, Kotloff KL, Martins H, Levine MM, Alonso P. Measles-specific neutralizing antibodies in rural Mozambique: seroprevalence and presence in breast milk. Am J Trop Med Hyg 2008; 79:787-792. [PMID: 18981523] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
In Mozambique, as in many sub-Saharan countries, measles remains a public health problem. We conducted cross-sectional surveys in which we assessed measles-specific antibodies in serum and breast milk by plaque reduction neutralization (PRN) assay and measles secretory IgA in breast milk by enzyme-linked immunosorbent assay. A total of 151 persons < 1 month to 23 years of age were surveyed; 81 (53.6%) of 151 had PRN titers equal to or above the protective level (>/= 200 mIU/mL). We found many serosusceptible persons, including 20.5% in whom no PRN antibody was detected. Almost all (96%) infants 6-8 months of age had non-protective PRN titers. Overall, 20.7% (6 of 29) of persons known to have received measles vaccine had non-protective titers. The geometric mean titer (GMT) of breast milk PRN antibodies was 41.6 mIU/mL (95% confidence interval [CI] = 34.0-51.0 mIU/mL) and the secretory IgA GMT was 227.6 (EU/mL) (95% CI = 179.1-289.1 EU/mL). The PRN titers of breast milk tended to increase with age. A notable proportion of the population in Manhiça, Mozambique apparently remains susceptible to clinical measles despite recent mass vaccination campaigns.
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Affiliation(s)
- Inácio M Mandomando
- Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique.
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Abellana R, Ascaso C, Aponte J, Saute F, Nhalungo D, Nhacolo A, Alonso P. Spatio-seasonal modeling of the incidence rate of malaria in Mozambique. Malar J 2008; 7:228. [PMID: 18976458 PMCID: PMC2584655 DOI: 10.1186/1475-2875-7-228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 10/31/2008] [Indexed: 11/15/2022] Open
Abstract
Background The objective was to study the seasonal effect on the spatial distribution of the incidence of malaria in children under 10 years old living in the Manhiça district, Mozambique. Methods The data of the clinical malaria incidence were obtained from a study of two cohorts of children followed from December 1996 to July 1999. The cases were obtained by the active detection method. Hierarchical Bayesian models were used to model the incidence of malaria, including spatial correlation nested to climatic season. The models were compared with the deviance information criterion. The age and gender of the children were also taken into account. Results The incidence of malaria is associated with age, period and climate season. The incidence presents a clear spatial pattern, with a higher incidence in the neighbourhoods situated in the north and northeast of the Manhiça area. The transmission of malaria is highest during the wet season but the spatial pattern of malaria does not differ from that during the dry season. Conclusion The incidence of malaria in Manhiça presents a spatial pattern which is independent of the seasonal climatic conditions. The climate modifies the incidence of malaria in the entire region but does not change the spatial pattern of the incidence of this disease. These findings may be useful for the planning of malaria control activities. These activities can be performed taking account that the neighbourhoods with more incidence of malaria do not change over the annual climate seasons.
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Affiliation(s)
- Rosa Abellana
- Bioestadistica, Departament de Salut Publica, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain.
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Roca A, Quintó L, Abacassamo F, Morais L, Vallès X, Espasa M, Sigaúque B, Sacarlal J, Macete E, Nhacolo A, Mandomando I, Levine MM, Alonso PL. Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique. Trop Med Int Health 2008; 13:818-26. [DOI: 10.1111/j.1365-3156.2008.02061.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bassat Q, Guinovart C, Sigaúque B, Aide P, Sacarlal J, Nhampossa T, Bardají A, Nhacolo A, Macete E, Mandomando I, Aponte JJ, Menéndez C, Alonso PL. Malaria in rural Mozambique. Part II: children admitted to hospital. Malar J 2008; 7:37. [PMID: 18302771 PMCID: PMC2275288 DOI: 10.1186/1475-2875-7-37] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 02/26/2008] [Indexed: 11/10/2022] Open
Abstract
Background Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community. Methods A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System. Results Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting. MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to <5 years and two in children aged ≥5 years. Conclusion Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.
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Affiliation(s)
- Quique Bassat
- Barcelona Center for International Health Research (CRESIB), Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Rosselló 132, E-08036 Barcelona, Spain.
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Guinovart C, Bassat Q, Sigaúque B, Aide P, Sacarlal J, Nhampossa T, Bardají A, Nhacolo A, Macete E, Mandomando I, Aponte JJ, Menéndez C, Alonso PL. Malaria in rural Mozambique. Part I: children attending the outpatient clinic. Malar J 2008; 7:36. [PMID: 18302770 PMCID: PMC2268704 DOI: 10.1186/1475-2875-7-36] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 02/26/2008] [Indexed: 11/30/2022] Open
Abstract
Background Malaria represents a huge burden for the health care services across Africa. Describing malaria attending health services contributes to quantify the burden and describe the epidemiology and clinical presentation. Methods Retrospective analysis of data collected through the Manhiça morbidity surveillance system (Mozambique) on all paediatric visits (<15 years) to the outpatient clinic from June 2003 to May 2005. Age-specific minimum community-based incidence rates (MCBIRs) of malaria were calculated using demographic surveillance system data. Malaria was defined as fever or history of fever in the preceding 24 hours with asexual Plasmodium falciparum parasitaemia of any density in the blood smear. Results A total of 94,941 outpatient visits were seen during the study period, of which 30.5% had malaria. Children younger than three years accounted for almost half of the total malaria cases and children aged ≥ 5 years represented 36.4% of the cases. Among children who presented with malaria, 56.7% had fever and among children who presented with fever or a history of fever only 37.2% had malaria. The geometric mean parasitaemia in malaria cases was 8582.2 parasites/μL, peaking in children aged two to three years. 13% of malaria cases had a PCV<25% and the mean PCV in malaria cases increased gradually with age, ranging from 27.8% in children aged 2–12 months to 34.4% in ≥ 5 years. The percentage of cases admitted or transferred showed a clear decreasing trend with age. MCBIRs of outpatient malaria per 1,000 child years at risk for the whole study period were of 394 in infants, 630 in children aged 1 to <5 years and 237 in children aged five years or more. A clustering of the cases was observed, whereby most children never had malaria, some had a few episodes and very few had many episodes. Conclusion Preventive measures should be targeted at children younger than three years, as they carry the highest burden of malaria. Children aged 5–15 years represent around a third of the malaria cases and should also be included in control programmes. Concern should be raised about presumptive treatment of fever cases with artemisinin-combination therapies, as many children will, according to IMCI guidelines, receive treatment unnecessarily.
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Affiliation(s)
- Caterina Guinovart
- Barcelona Center for International Health Research (CRESIB), Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Rosselló 132, E-08036 Barcelona, Spain.
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Sigaúque B, Roca A, Sanz S, Oliveiras I, Martínez M, Mandomando I, Vallès X, Espasa M, Abacassamo F, Sacarlal J, Macete E, Nhacolo A, Aponte J, Levine M, Alonso P. Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique. Acta Trop 2008; 105:21-7. [PMID: 17959132 DOI: 10.1016/j.actatropica.2007.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Revised: 01/03/2007] [Accepted: 01/05/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases. METHODS As part of the clinical management of children admitted to the Manhiça District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003. RESULTS During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol. CONCLUSIONS S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures.
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Abdullah S, Adazu K, Masanja H, Diallo D, Hodgson A, Ilboudo-Sanogo E, Nhacolo A, Owusu-Agyei S, Thompson R, Smith T, Binka FN. Patterns of Age-Specific Mortality in Children in Endemic Areas of Sub-Saharan Africa. Am J Trop Med Hyg 2007. [DOI: 10.4269/ajtmh.77.6.suppl.99] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Salim Abdullah
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Kubaje Adazu
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Honorati Masanja
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Diadier Diallo
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Abraham Hodgson
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Edith Ilboudo-Sanogo
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Ariel Nhacolo
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Seth Owusu-Agyei
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Ricardo Thompson
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Thomas Smith
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
| | - Fred N. Binka
- Ifakara Health Research and Development Centre, Tanzania; Center for Disease Control and Prevention, Kenya Medical Research Institute, Kenya; Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso; Navrongo Health Research Centre, Ghana; Centro de Investigacao em Saude de Manhica, Mozambique; Kintampo Health Research Centre, Ghana; Swiss Tropical Institute, Basel, Switzerland; INDEPTH Network Secretariat, Ghana
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Abdullah S, Adazu K, Masanja H, Diallo D, Hodgson A, Ilboudo-Sanogo E, Nhacolo A, Owusu-Agyei S, Thompson R, Smith T, Binka FN. Patterns of age-specific mortality in children in endemic areas of sub-Saharan Africa. Am J Trop Med Hyg 2007; 77:99-105. [PMID: 18165480] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Understanding of the age- and season- dependence of malaria mortality is an important prerequisite for epidemiologic models of malaria immunity. However, most studies of malaria mortality have aggregated their results into broad age groups and across seasons, making it hard to predict the likely impact of interventions targeted at specific age groups of children. We present age-specific mortality rates for children aged < 15 years for the period of 2001-2005 in 7 demographic surveillance sites in areas of sub-Saharan Africa with stable endemic Plasmodium falciparum malaria. We use verbal autopsies (VAs) to estimate the proportion of deaths by age group due to malaria, and thus calculate malaria-specific mortality rates for each site, age-group, and month of the year. In all sites a substantial proportion of deaths (ranging from 20.1% in a Mozambican site to 46.2% in a site in Burkina Faso) were attributed to malaria. The overall age patterns of malaria mortality were similar in the different sites. Deaths in the youngest children (< 3 months old) were only rarely attributed to malaria, but in children over 1 year of age the proportion of deaths attributed to malaria was only weakly age-dependent. In most of the sites all-cause mortality rates peaked during the rainy season, but the strong seasonality in malaria transmission in these sites was not reflected in strong seasonality in the proportion of deaths attributed to malaria, except in the two sites in Burkina Faso. Improvement in the specificity of malaria verbal autopsies would make it easier to interpret the age and season patterns in such data.
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Affiliation(s)
- Salim Abdullah
- Ifakara Health Research and Development Centre, Tanzania
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Roca A, Sigaúque B, Quintó L, Mandomando I, Vallès X, Espasa M, Abacassamo F, Sacarlal J, Macete E, Nhacolo A, Levine M, Alonso P. Invasive pneumococcal disease in children<5 years of age in rural Mozambique. Trop Med Int Health 2006; 11:1422-31. [PMID: 16930265 DOI: 10.1111/j.1365-3156.2006.01697.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To estimate the incidence and epidemiological characteristics of invasive pneumococcal disease (IPD) in children<5 years of age living in a rural area of southern Mozambique. METHODS As part of the clinical management of children admitted to Manhiça District Hospital, prospective surveillance for invasive bacterial disease was conducted from June 2001 to May 2003. The level of antibiotic resistance of the isolates was also analysed. RESULTS Pneumococcus was the most commonly isolated bacterium, accounting for 212 episodes. The estimated crude incidence rate of IPD in the study area among children<5 years of age was 416/100,000 per child-year at risk. The youngest age group (<3 months) had the highest incidence (779/100,000). Cases were detected during both rainy and dry seasons. The most common clinical diagnosis was pneumonia, made in 146/212 (69%) of the episodes of IPD. The overall case fatality rate was 10%, being highest among children with pneumococcal meningitis (5/9=56%). Pneumococcal isolates were highly susceptible to penicillin (86% susceptible and 14% with intermediate resistance) and chloramphenicol (98% susceptible). In contrast, up to 37% of the isolates tested were non-susceptible to cotrimoxazole. CONCLUSIONS Incidence rates of IPD and associated mortality shown in this study highlight the need for pneumococcal vaccines in rural Africa, which must be effective in infants and young children.
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Affiliation(s)
- A Roca
- Centre de Salut Internacional, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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