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Smith-Sreen J, Miller B, Kabaghe AN, Kim E, Wadonda-Kabondo N, Frawley A, Labuda S, Manuel E, Frietas H, Mwale AC, Segolodi T, Harvey P, Seitio-Kgokgwe O, Vergara AE, Gudo ES, Dziuban EJ, Shoopala N, Hines JZ, Agolory S, Kapina M, Sinyange N, Melchior M, Mirkovic K, Mahomva A, Modhi S, Salyer S, Azman AS, McLean C, Riek LP, Asiimwe F, Adler M, Mazibuko S, Okello V, Auld AF. Comparison of COVID-19 Pandemic Waves in 10 Countries in Southern Africa, 2020-2021. Emerg Infect Dis 2022; 28:S93-S104. [PMID: 36502398 DOI: 10.3201/eid2813.220228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, 2020-September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.
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Lasry A, Medley A, Behel S, Mujawar MI, Cain M, Diekman ST, Rurangirwa J, Valverde E, Nelson R, Agolory S, Alebachew A, Auld AF, Balachandra S, Bunga S, Chidarikire T, Dao VQ, Dee J, Doumatey LN, Dzinotyiweyi E, Dziuban EJ, Ekra KA, Fuller WB, Herman-Roloff A, Honwana NB, Khanyile N, Kim EJ, Kitenge SF, Lacson RS, Loeto P, Malamba SS, Mbayiha AH, Mekonnen A, Meselu MG, Miller LA, Mogomotsi GP, Mugambi MK, Mulenga L, Mwangi JW, Mwangi J, Nicoué AA, Nyangulu MK, Pietersen IC, Ramphalla P, Temesgen C, Vergara AE, Wei S. Scaling Up Testing for Human Immunodeficiency Virus Infection Among Contacts of Index Patients - 20 Countries, 2016-2018. MMWR Morb Mortal Wkly Rep 2019; 68:474-477. [PMID: 31145718 PMCID: PMC6542477 DOI: 10.15585/mmwr.mm6821a2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Waters KP, Mazivila ME, Dgedge M, Necochea E, Manharlal D, Zuber A, de Faria Leão B, Bossemeyer D, Vergara AE. eSIP-Saúde: Mozambique's novel approach for a sustainable human resources for health information system. Hum Resour Health 2016; 14:66. [PMID: 27814734 PMCID: PMC5097348 DOI: 10.1186/s12960-016-0159-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/28/2016] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. The purpose of this case presentation is to document for the first time Mozambique's novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. CASE PRESENTATION Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a "health extension" which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique's health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals' physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-à-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analyzing this situation to improve the retirement process and coordination with Social Security. CONCLUSION The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality.
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Affiliation(s)
- Keith P Waters
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E77, Atlanta, GA, 30329, United States of America.
| | | | - Martinho Dgedge
- Ministry of Health, Mozambique, Av. Eduardo Mondlane, No. 1008, Maputo, Mozambique
| | - Edgar Necochea
- Jhpiego/Johns Hopkins University, 1615 Thames Street, Baltimore, MD, 21231, United States of America
| | | | - Alexandra Zuber
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E77, Atlanta, GA, 30329, United States of America
| | | | | | - Alfredo E Vergara
- CDC Mozambique, JAT Complex 4, 7th Floor, Ave. Zedequias Manganhela 267, Maputo, Mozambique
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Paulin HN, Blevins M, Koethe JR, Hinton N, Vaz LME, Vergara AE, Mukolo A, Ndatimana E, Moon TD, Vermund SH, Wester CW. HIV testing service awareness and service uptake among female heads of household in rural Mozambique: results from a province-wide survey. BMC Public Health 2015; 15:132. [PMID: 25881182 PMCID: PMC4339241 DOI: 10.1186/s12889-015-1388-z] [Citation(s) in RCA: 29] [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: 06/27/2014] [Accepted: 01/09/2015] [Indexed: 01/12/2023] Open
Abstract
Background HIV voluntary counseling and testing (VCT) utilization remains low in many sub-Saharan African countries, particularly in remote rural settings. We sought to identify factors associated with service awareness and service uptake of VCT among female heads of household in rural Zambézia Province of north-central Mozambique which is characterized by high HIV prevalence (12.6%), poverty, and suboptimal health service access and utilization. Methods Our population-based survey of female heads of household was administered to a representative two-stage cluster sample using a sampling frame created for use on all national surveys and based on census results. The data served as a baseline measure for the Ogumaniha project initiated in 2009. Survey domains included poverty, health, education, income, HIV stigma, health service access, and empowerment. Descriptive statistics and logistic regression were used to describe service awareness and service uptake of VCT. Results Of 3708 women surveyed, 2546 (69%) were unaware of available VCT services. Among 1162 women who were aware of VCT, 673 (58%) reported no prior testing. In the VCT aware group, VCT awareness was associated with higher education (aOR = 2.88; 95% CI = 1.61, 5.16), higher income (aOR = 1.41, 95% CI = 1.06, 1.86), higher numeracy (aOR = 1.05, CI 1.03, 1.08), more children < age 5 in the home (aOR = 1.53; 95% CI = 1.07, 2.18), closer proximity to a health facility (aOR = 1.05; 95% CI = 1.03, 1.07), and mobile phone ownership (aOR = 1.37; 95% CI = 1.03, 1.84) (all p-values < 0.04). Having a higher HIV-associated stigma score was the factor most strongly associated with being less likely to test. (aOR = 0.41; 95% CI = 0.23, 0.71; p<0.001). Conclusions Most women were unaware of available VCT services. Even women who were aware of services were unlikely to have been tested. Expanded VCT and social marketing of VCT are needed in rural Mozambique with special attention to issues of community-level stigma reduction.
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Affiliation(s)
- Heather N Paulin
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1611 21st Avenue South, A-2200, Medical Center North, Nashville, TN, USA.
| | - Meridith Blevins
- Department of Biostatistics, Nashville, TN, USA. .,Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
| | - John R Koethe
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1611 21st Avenue South, A-2200, Medical Center North, Nashville, TN, USA.
| | | | - Lara M E Vaz
- Department of Preventive Medicine, Nashville, TN, USA. .,Friends in Global Health (FGH), Maputo, Mozambique. .,Save the Children, Washington, D.C., USA.
| | - Alfredo E Vergara
- Department of Preventive Medicine, Nashville, TN, USA. .,Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
| | - Abraham Mukolo
- Department of Preventive Medicine, Nashville, TN, USA. .,Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
| | | | - Troy D Moon
- Department of Pediatrics, Nashville, TN, USA. .,Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA. .,Friends in Global Health (FGH), Maputo, Mozambique.
| | - Sten H Vermund
- Department of Pediatrics, Nashville, TN, USA. .,Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
| | - C William Wester
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1611 21st Avenue South, A-2200, Medical Center North, Nashville, TN, USA. .,Vanderbilt University, Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
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Victor B, Blevins M, Green AF, Ndatimana E, González-Calvo L, Fischer EF, Vergara AE, Vermund SH, Olupona O, Moon TD. Multidimensional poverty in rural Mozambique: a new metric for evaluating public health interventions. PLoS One 2014; 9:e108654. [PMID: 25268951 PMCID: PMC4182519 DOI: 10.1371/journal.pone.0108654] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 07/04/2014] [Accepted: 08/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poverty is a multidimensional phenomenon and unidimensional measurements have proven inadequate to the challenge of assessing its dynamics. Dynamics between poverty and public health intervention is among the most difficult yet important problems faced in development. We sought to demonstrate how multidimensional poverty measures can be utilized in the evaluation of public health interventions; and to create geospatial maps of poverty deprivation to aid implementers in prioritizing program planning. METHODS Survey teams interviewed a representative sample of 3,749 female heads of household in 259 enumeration areas across Zambézia in August-September 2010. We estimated a multidimensional poverty index, which can be disaggregated into context-specific indicators. We produced an MPI comprised of 3 dimensions and 11 weighted indicators selected from the survey. Households were identified as "poor" if were deprived in >33% of indicators. Our MPI is an adjusted headcount, calculated by multiplying the proportion identified as poor (headcount) and the poverty gap (average deprivation). Geospatial visualizations of poverty deprivation were created as a contextual baseline for future evaluation. RESULTS In our rural (96%) and urban (4%) interviewees, the 33% deprivation cut-off suggested 58.2% of households were poor (29.3% of urban vs. 59.5% of rural). Among the poor, households experienced an average deprivation of 46%; thus the MPI/adjusted headcount is 0.27 ( = 0.58×0.46). Of households where a local language was the primary language, 58.6% were considered poor versus Portuguese-speaking households where 73.5% were considered non-poor. Living standard is the dominant deprivation, followed by health, and then education. CONCLUSIONS Multidimensional poverty measurement can be integrated into program design for public health interventions, and geospatial visualization helps examine the impact of intervention deployment within the context of distinct poverty conditions. Both permit program implementers to focus resources and critically explore linkages between poverty and its social determinants, thus deriving useful findings for evidence-based planning.
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Affiliation(s)
- Bart Victor
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Meridith Blevins
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Ann F. Green
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Edward F. Fischer
- Vanderbilt Center for Latin American Studies and Department of Anthropology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Alfredo E. Vergara
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Friends in Global Health, Maputo, Mozambique
| | - Omo Olupona
- World Vision International, Maputo, Mozambique
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Friends in Global Health, Maputo, Mozambique
- * E-mail:
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Mukolo A, Torres I, Bechtel RM, Sidat M, Vergara AE. Consensus on context-specific strategies for reducing the stigma of human immunodeficiency virus/acquired immunodeficiency syndrome in Zambézia Province, Mozambique. SAHARA J 2014; 10:119-30. [PMID: 24527744 PMCID: PMC4039134 DOI: 10.1080/17290376.2014.885847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 12/18/2022] Open
Abstract
Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambézia Province, Mozambique. Qualitative data gathering methods, including indepth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions.
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Affiliation(s)
- Abraham Mukolo
- a MSc, MPH, PhD, Clinical Assistant Professor, is affiliated to the Vanderbilt Institute for Global Health , Vanderbilt University , Nashville , TN , USA
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Mukolo A, Blevins M, Hinton N, Victor B, Vaz LM, Sidat M, Vergara AE. Negative labeling and social exclusion of people living with human immunodeficiency virus/acquired immune deficiency syndrome in the antiretroviral therapy era: insight from attitudes and behavioral intentions of female heads of households in Zambézia Province, Mozambique. AIDS Care 2013; 26:821-6. [DOI: 10.1080/09540121.2013.861570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ciampa PJ, Vaz LME, Blevins M, Sidat M, Rothman RL, Vermund SH, Vergara AE. The association among literacy, numeracy, HIV knowledge and health-seeking behavior: a population-based survey of women in rural Mozambique. PLoS One 2012; 7:e39391. [PMID: 22745747 PMCID: PMC3382184 DOI: 10.1371/journal.pone.0039391] [Citation(s) in RCA: 35] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 05/24/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limited literacy skills are common in the United States (US) and are related to lower HIV knowledge and worse health behaviors and outcomes. The extent of these associations is unknown in countries like Mozambique, where no rigorously validated literacy and numeracy measures exist. METHODS A validated measure of literacy and numeracy, the Wide Range Achievement Test, version 3 (WRAT-3) was translated into Portuguese, adapted for a Mozambican context, and administered to a cross-section of female heads-of-household during a provincially representative survey conducted from August 8 to September 25, 2010. Construct validity of each subscale was examined by testing associations with education, income, and possession of socioeconomic assets, stratified by Portuguese speaking ability. Multivariable regression models estimated the association among literacy/numeracy and HIV knowledge, self-reported HIV testing, and utilization of prenatal care. RESULTS Data from 3,557 women were analyzed; 1,110 (37.9%) reported speaking Portuguese. Respondents' mean age was 31.2; 44.6% lacked formal education, and 34.3% reported no income. Illiteracy was common (50.4% of Portuguese speakers, 93.7% of non-Portuguese speakers) and the mean numeracy score (10.4) corresponded to US kindergarten-level skills. Literacy or numeracy was associated (p<0.01) with education, income, age, and other socioeconomic assets. Literacy and numeracy skills were associated with HIV knowledge in adjusted models, but not with HIV testing or receipt of clinic-based prenatal care. CONCLUSION The adapted literacy and numeracy subscales are valid for use with rural Mozambican women. Limited literacy and numeracy skills were common and associated with lower HIV knowledge. Further study is needed to determine the extent to which addressing literacy/numeracy will lead to improved health outcomes.
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Affiliation(s)
- Philip J Ciampa
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
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Moon TD, Burlison JR, Blevins M, Shepherd BE, Baptista A, Sidat M, Vergara AE, Vermund SH. Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from president's emergency plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique. Int J STD AIDS 2012; 22:621-7. [PMID: 22096045 DOI: 10.1258/ijsa.2011.010442] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many countries in sub-Saharan Africa have made antiretroviral therapy (ART) available in urban settings, but the progress of treatment expansion into rural Africa has been slower. We analysed routine data for patients enrolled in a rural HIV treatment programme in Zambézia Province, Mozambique (1 June 2006 through 30 March 2009). There were 12,218 patients who were ≥15 years old enrolled (69% women). Median age was 25 years for women and 31 years for men. Older age and higher level of education were strongly predictive of ART initiation (P < 0.001). Patients with a CD4+ count of 350 cells/μL versus 50 cells/μL were less likely to begin ART (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.16-0.23). In rural sub-Saharan Africa, HIV testing, linkage to care, logistics for ART initiation and fears among some patients to take ART require specialized planning to maximize successes. Sustainability will require improved health manpower, infrastructure, stable funding, continuous drug supplies, patient record systems and, most importantly, community engagement.
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Affiliation(s)
- T D Moon
- Vanderbilt Institute for Global Health and Departments of Pediatrics, Biostatistics, and Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Audet CM, Burlison J, Moon TD, Sidat M, Vergara AE, Vermund SH. Sociocultural and epidemiological aspects of HIV/AIDS in Mozambique. BMC Int Health Hum Rights 2010; 10:15. [PMID: 20529358 PMCID: PMC2891693 DOI: 10.1186/1472-698x-10-15] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 06/08/2010] [Indexed: 11/21/2022]
Abstract
Background A legacy of colonial rule coupled with a devastating 16-year civil war through 1992 left Mozambique economically impoverished just as the human immunodeficiency virus (HIV) epidemic swept over southern Africa in the late 1980s. The crumbling Mozambican health care system was wholly inadequate to support the need for new chronic disease services for people with the acquired immunodeficiency syndrome (AIDS). Methods To review the unique challenges faced by Mozambique as they have attempted to stem the HIV epidemic, we undertook a systematic literature review through multiple search engines (PubMed, Google Scholar™, SSRN, AnthropologyPlus, AnthroSource) using Mozambique as a required keyword. We searched for any articles that included the required keyword as well as the terms 'HIV' and/or 'AIDS', 'prevalence', 'behaviors', 'knowledge', 'attitudes', 'perceptions', 'prevention', 'gender', drugs, alcohol, and/or 'health care infrastructure'. Results UNAIDS 2008 prevalence estimates ranked Mozambique as the 8th most HIV-afflicted nation globally. In 2007, measured HIV prevalence in 36 antenatal clinic sites ranged from 3% to 35%; the national estimate of was 16%. Evidence suggests that the Mozambican HIV epidemic is characterized by a preponderance of heterosexual infections, among the world's most severe health worker shortages, relatively poor knowledge of HIV/AIDS in the general population, and lagging access to HIV preventive and therapeutic services compared to counterpart nations in southern Africa. Poor education systems, high levels of poverty and gender inequality further exacerbate HIV incidence. Conclusions Recommendations to reduce HIV incidence and AIDS mortality rates in Mozambique include: health system strengthening, rural outreach to increase testing and linkage to care, education about risk reduction and drug adherence, and partnerships with traditional healers and midwives to effect a lessening of stigma.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, 37203 USA.
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Moon TD, Burlison JR, Sidat M, Pires P, Silva W, Solis M, Rocha M, Arregui C, Manders EJ, Vergara AE, Vermund SH. Lessons learned while implementing an HIV/AIDS care and treatment program in rural Mozambique. Retrovirology (Auckl) 2010; 3:1-14. [PMID: 25097450 PMCID: PMC4119752 DOI: 10.4137/rrt.s4613] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mozambique has severe resource constraints, yet with international partnerships, the nation has placed over 145,000 HIV-infected persons on antiretroviral therapies (ART) through May-2009. HIV clinical services are provided at > 215 clinical venues in all 11 of Mozambique's provinces. Friends in Global Health (FGH), affiliated with Vanderbilt University in the United States (US), is a locally licensed non-governmental organization (NGO) working exclusively in small city and rural venues in Zambézia Province whose population reaches approximately 4 million persons. Our approach to clinical capacity building is based on: 1) technical assistance to national health system facilities to implement ART clinical services at the district level, 2) human capacity development, and 3) health system strengthening. Challenges in this setting are daunting, including: 1) human resource constraints, 2) infrastructure limitations, 3) centralized care for large populations spread out over large distances, 4) continued high social stigma related to HIV, 5) limited livelihood options in rural areas and 6) limited educational opportunities in rural areas. Sustainability in rural Mozambique will depend on transitioning services from emergency foreign partners to local authorities and continued funding. It will also require "wrap-around" programs that help build economic capacity with agricultural, educational, and commercial initiatives. Sustainability is undermined by serious health manpower and infrastructure limitations. Recent U.S. government pronouncements suggest that the U.S. President's Emergency Plan for AIDS Relief will support concurrent community and business development. FGH, with its Mozambican government counterparts, see the evolution of an emergency response to a sustainable chronic disease management program as an essential and logical step. We have presented six key challenges that are essential to address in rural Mozambique.
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Affiliation(s)
- Troy D. Moon
- Vanderbilt University Institute for Global Health, Tennessee, USA
- Friends in Global Health, LLC, Maputo, Mozambique
| | - Janeen R. Burlison
- Vanderbilt University Institute for Global Health, Tennessee, USA
- Friends in Global Health, LLC, Maputo, Mozambique
| | - Mohsin Sidat
- University of Eduardo Mondlane, Maputo, Mozambique
| | - Paulo Pires
- Friends in Global Health, LLC, Maputo, Mozambique
| | - Wilson Silva
- Friends in Global Health, LLC, Maputo, Mozambique
| | - Manuel Solis
- Friends in Global Health, LLC, Maputo, Mozambique
| | | | | | - Eric J. Manders
- Vanderbilt University Institute for Global Health, Tennessee, USA
- Friends in Global Health, LLC, Maputo, Mozambique
| | - Alfredo E. Vergara
- Vanderbilt University Institute for Global Health, Tennessee, USA
- Friends in Global Health, LLC, Maputo, Mozambique
| | - Sten H. Vermund
- Vanderbilt University Institute for Global Health, Tennessee, USA
- Friends in Global Health, LLC, Maputo, Mozambique
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Abstract
We conducted a survey among nine geographically dispersed, large metropolitan refugee health programs to estimate the number of U.S. refugee arrivals during 1997 and 1998, the number receiving health assessments, and the percentage of sites offering health services. The nine sites received an estimated 40% of all U.S. refugee arrivals during the study period. Of these refugees, 76% received a health assessment. The completeness of health assessments, including services offered, varied by site; some services were provided by the private sector. Most sites offered services for infectious diseases and vaccinations. While 78% of the sites offered mental health care, but only 33% actually performed mental status examinations. These statistics show that such health services need to be provided on a broader basis and possibly reflect a need to address cultural and language barriers that might be preventing their delivery to this diverse population.
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Affiliation(s)
- Alfredo E Vergara
- Division of Global Migration and Quarantine, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Vergara AE, Fuortes L. Surveillance and epidemiology of occupational pesticide poisonings on banana plantations in Costa Rica. Int J Occup Environ Health 1998; 4:199-201. [PMID: 10026482 DOI: 10.1179/oeh.1998.4.3.199] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A review of one year's workers' compensation records from the Costa Rican National Insurance Institute was performed in a banana plantation region to determine rates of and risk factors for agrichemical poisonings. Review of 9,060 medical records revealed that the most commonly reported agrichemical-related injuries (n=800) were chemical burns (28%) and acute intoxications (21%). Other agrichemical-related injuries included eye injuries, chemical dermatoses, and chronic fungal infections. The incidences and types of injuries differed between male and female workers and workers of different age groups. Older female workers were more likely to report chemical dermatoses. Young male workers were more likely to experience acute intoxication. These differences seem to be attributable to divisions of labor by gender and age among plantation workers.
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Affiliation(s)
- A E Vergara
- The University of Iowa, Department of Preventive Medicine and Environmental Health, S-2800 Steindler Building, Iowa City, IA 52242, USA
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Vergara AE, Pertowski CA, Rosenblum LS. Lead poisoning: costs of care in the United States, 1988-1992. JAMA 1996; 276:1221. [PMID: 8849746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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