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Bauhofer AFL, Sambo J, Chilaúle JJ, Conjo C, Munlela B, Chissaque A, Isaías T, Djedje M, de Deus N. Examining comorbidities in children with diarrhea across four provinces of Mozambique: A cross-sectional study (2015 to 2019). PLoS One 2023; 18:e0292093. [PMID: 37751426 PMCID: PMC10522033 DOI: 10.1371/journal.pone.0292093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Comorbidities are defined as the simultaneous occurrence of two or more diseases within the same individual. Comorbidities can delay a patient's recovery and increase the costs of treatment. Assessing comorbidities can provide local health care policy-makers with evidence of the most common multi-health impairments in children. This could aid in redirecting and integrating care and treatment services by increasing health facilities the awareness and readiness of health facilities. The present analysis aims to determine the frequency and associated factors of comorbidities in children with diarrhea in Mozambique. A cross-sectional hospital-based analysis was conducted between January 2015 and December 2019 in children up to 59 months of age who were admitted with diarrhea in six reference hospitals in Mozambique. These hospitals are distributed across the country's three regions, with at least one hospital in each province from each region. Sociodemographic and clinical data were obtained through semi-structured interviews and by reviewing the child clinical process. Descriptive statistics, and Mann-Whitney-U tests were used. Crude and adjusted logistics regression models were built. P-values < 0.05 were considered statistically significant. Comorbidities were observed in 55.5% of patients (389/701; 95%CI: 51.8-59.1). Wasting was the most common comorbidity (30.2%; 212/701) and pneumonia was the least common (1.7%; 12/701). Children born with a low birth weight were 2.420 times more likely to have comorbidities, adjusted odds ratio: 2.420 (95% CI: 1.339-4374). The median (interquartile range) duration of hospitalization was significantly higher in children with comorbidities than without comorbidities, 5 days (3-7) and 4 days (3-6), respectively (p-value < 0.001). One in every two children with diarrhea in Mozambique has an additional health impairment, and this increases the length of their hospital stay.
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Affiliation(s)
- Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jorfélia J. Chilaúle
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Carolina Conjo
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Benilde Munlela
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Telma Isaías
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Marlene Djedje
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), Distrito de Marracuene, Província de Maputo, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo Cidade, Mozambique
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Sambo J, Chicumbe S, de Deus N, Gonçalves L. Quality of routine data for monitoring nutrition and diarrhoea indicators of children under 5 in Mozambique: an ecological study over a 5-year period. BMJ Open 2023; 13:e073239. [PMID: 37479521 PMCID: PMC10364158 DOI: 10.1136/bmjopen-2023-073239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Undernutrition and diarrhoea have a high burden in children under 5 in low/middle-income countries. Having data-driven quality health services for these two diseases is key in order to address the high burden of diseases; therefore, health systems must provide data to monitor, manage, plan and decide on policies at all levels of health services. OBJECTIVE We aimed to assess the quality of nutrition and diarrhoea routine data on children under 5 in Mozambique. DESIGN A longitudinal ecological study was implemented. Secondary data were used to assess the quality of moderate acute malnutrition (MAM), deworming and rotavirus vaccine indicators based on the data's completeness, presence of outliers and consistency, and seasonality analysis in the form of time series analysis was performed. SETTING We used monthly district-level count data from 2017 to 2021, from all health facilities, from the Mozambican health information system (Sistema de Informação de Saúde para Monitoria e Avaliação, or District Health Information System version 2). RESULTS The rotavirus vaccine indicators presented better completeness when compared with other indicators under analysis. Extreme outliers were observed for deworming and rotavirus vaccines, with a higher number of outliers in the Zambezia and Nampula Provinces. Better consistency over time was observed when analysing the period before the COVID-19 pandemic, for all of the indicators and across provinces. Indicators of MAM and MAM-recovered showed more consistency issues over time in both periods of 2017-2019 and 2018-2021. In terms of seasonality analysis, for the MAM and MAM-recovered indicators, lower variation was observed, and heterogeneous patterns were seen across provinces for the rotavirus vaccine, which had the most pronounced negative seasonality components in Maputo City. CONCLUSION Major deficits regarding the analysed quality indicators were observed for Cabo Delgado, Nampula, Zambezia, Tete, Manica, and Maputo City and Province.
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Affiliation(s)
- Júlia Sambo
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sérgio Chicumbe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Maputo, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Luzia Gonçalves
- Universidade Nova de Lisboa, Lisbon, Portugal
- Universidade de Lisboa, Lisbon, Portugal
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Manjate NJ, Sitoe N, Sambo J, Guimarães E, Canana N, Chilaúle J, Viegas S, Nguenha N, Jani I, Russo G. Testing for SARS-CoV-2 in resource-limited settings: A cost analysis study of diagnostic tests using different Ag-RDTs and RT-PCR technologies in Mozambique. PLOS Glob Public Health 2023; 3:e0001999. [PMID: 37310935 DOI: 10.1371/journal.pgph.0001999] [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: 12/08/2022] [Accepted: 05/09/2023] [Indexed: 06/15/2023]
Abstract
Early diagnosis of SARS-CoV-2 is fundamental to reduce the risk of community transmission and mortality, as well as public sector expenditures. Three years after the onset of the SARS-CoV-2 pandemic, there are still gaps on what is known regarding costs and cost drivers for the major diagnostic testing strategies in low- middle-income countries (LMICs). This study aimed to estimate the cost of SARS-CoV-2 diagnosis of symptomatic suspected patients by reverse transcription polymerase chain reaction (RT-PCR) and antigen rapid diagnostic tests (Ag-RDT) in Mozambique. We conducted a retrospective cost analysis from the provider's perspective using a bottom-up, micro-costing approach, and compared the direct costs of two nasopharyngeal Ag-RDTs (Panbio and Standard Q) against the costs of three nasal Ag-RDTs (Panbio, COVIOS and LumiraDx), and RT-PCR. The study was undertaken from November 2020 to December 2021 in the country's capital city Maputo, in four healthcare facilities at primary, secondary and tertiary levels of care, and at one reference laboratory. All the resources necessary for RT-PCR and Ag-RDT tests were identified, quantified, valued, and the unit costs per test and per facility were estimated. Our findings show that the mean unit cost of SARS-CoV-2 diagnosis by nasopharyngeal Ag-RDTs was MZN 728.00 (USD 11.90, at 2020 exchange rates) for Panbio and MZN 728.00 (USD 11.90) for Standard Q. For diagnosis by nasal Ag-RDTs, Panbio was MZN 547.00 (USD 8.90), COVIOS was MZN 768.00 (USD 12.50), and LumiraDx was MZN 798.00 (USD 13.00). Medical supplies expenditures represented the main driver of the final cost (>50%), followed by personnel and overhead costs (mean 15% for each). The mean unit cost regardless of the type of Ag-RDT was MZN 714.00 (USD 11.60). Diagnosis by RT-PCR cost MZN 2,414 (USD 39.00) per test. Our sensitivity analysis suggests that focussing on reducing medical supplies costs would be the most cost-saving strategy for governments in LMICs, particularly as international prices decrease. The cost of SARS-CoV-2 diagnosis using Ag-RDTs was three times lower than RT-PCR testing. Governments in LMICs can include cost-efficient Ag-RDTs in their screening strategies, or RT-PCR if international costs of such supplies decrease further in the future. Additional analyses are recommended as the costs of testing can be influenced by the sample referral system.
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Affiliation(s)
| | - Nádia Sitoe
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Júlia Sambo
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | | | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Giuliano Russo
- The Wolfson Institute for Population Health, Queen Mary University of London, London, The United Kingdom
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Bero DM, da Silva EE, Júnior IPDS, Nhassengo SA, Machado RS, Bauhofer AFL, Chilaúle JJ, Munlela B, Guimarães E, Cossa-Moiane I, Sambo J, Anapakala E, Cassocera M, Coutinho-Manhique L, Chissaque A, Langa JS, Burlandy F, de Deus N. Enterovirus detection in stool samples from Mozambican children with acute gastroenteritis. Acta Trop 2023; 238:106755. [PMID: 36379257 DOI: 10.1016/j.actatropica.2022.106755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
Enteroviruses (EV) are predominantly enteric viruses, present in all parts of the world causing disease in humans with a broad spectrum of clinical presentations. The purpose of this study was to identify non-polio enteroviruses (NPEV) in stool samples collected from children with acute gastroenteritis (AGE) symptoms of unknown etiology in four provinces (Maputo, Nampula, Sofala and Zambézia) of Mozambique. From June 2014 to March 2018, 327 stool samples were collected from children hospitalized with AGE in health care units. NPEVs were detected in 52 samples (52/327; 15.9%) and were more frequent in children under 5 years of age. The age group from 12 to 23 months was the most affected and showed more severity of disease. We also identified 26 different EV-types with the following detection pattern EV-B>EV-C>EV-A. The major EV-types were EV-A119 (9/52; 17.3%) and EV-C99 (8/52; 15.4%), accounting for 32.7% of the total. In addition to EV-A119, other uncommon EV-types were also identified, such as EV-B75, EV-B97 and EV-C113. The current study shows a high heterogeneity of EV types circulating in children with AGE in Mozambique as well as the identification of rarely described enteroviruses.
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Affiliation(s)
- Diocreciano Matias Bero
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique.
| | - Edson Elias da Silva
- Enterovirus Laboratory, Oswaldo Cruz Institute, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Ivanildo Pedro de Sousa Júnior
- Enterovirus Laboratory, Oswaldo Cruz Institute, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Sheila António Nhassengo
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
| | - Raiana Scerni Machado
- Enterovirus Laboratory, Oswaldo Cruz Institute, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jorfélia José Chilaúle
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
| | - Benilde Munlela
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
| | - Esperança Guimarães
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Idalécia Cossa-Moiane
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique; Institute of Tropical Medicine, Antwerp, Belgium
| | - Júlia Sambo
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Elda Anapakala
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
| | - Marta Cassocera
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Lena Coutinho-Manhique
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
| | - Assucênio Chissaque
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jerónimo S Langa
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
| | - Fernanda Burlandy
- Enterovirus Laboratory, Oswaldo Cruz Institute, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Vila de Marracuene, EN1, Parcela N° 3943, Província de Maputo, Moçambique
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Sitoe N, Sambo J, Mabunda N, Nguenha N, Chilaúle J, Rafael J, Macicame A, Chelene I, Mudenyanga C, Sacks J, Viegas S, Loquiha O, Jani I. Clinical Performance of Self-Collected Nasal Swabs and Antigen Rapid Tests for SARS-CoV-2 Detection in Resource-Poor Settings. Biomedicines 2022; 10:biomedicines10092327. [PMID: 36140429 PMCID: PMC9496276 DOI: 10.3390/biomedicines10092327] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background: In resource-poor countries, antigen-based rapid tests (Ag-RDTs) performed at primary healthcare and community settings improved access to SARS-CoV-2 diagnostics. However, the technical skills and biosafety requirements inherent to nasopharyngeal and oropharyngeal (OP) specimens limit the scale-up of SARS-CoV-2 testing. The collection of nasal-swabs is programmatically viable, but its performance has not been evaluated in resource-poor settings. Methods: We first evaluated the performance of SteriPack self-collected nasal swabs for the detection of SARS-CoV-2 by real-time PCR in 1498 consecutively enrolled patients with suspected infection. Next, we evaluated the clinical performance of three nasal swab-based Ag-RDTs against real-time PCR on OP specimens. Results: The sensitivity of nasal swabs was 80.6% [95% CI: 75.3−85.2%] compared to OP specimens. There was a good correlation (r = 0.58; p < 0.0001) between Ct values of 213 positive cases obtained using nasal and OP swabs. Our findings show sensitivities of 79.7% [95% CI: 73.3−85.1%] for Panbio COVID-19 Ag-RDT, 59.6% [95% CI: 55.2−63.8%] for COVIOS Ag-RDT, and 78.0% [95% CI: 73.5−82.0%] for the LumiraDx SARS-CoV-2 Ag-RDT. Conclusions: In our setting, the COVIOS Ag-RDT did not meet WHO requirements. Nasal swab-based Ag-RDTs for SARS-CoV-2 detection constitute a viable and accurate diagnostic option in resource-poor settings.
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Affiliation(s)
- Nádia Sitoe
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
- Correspondence:
| | - Júlia Sambo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
| | - Nédio Mabunda
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
| | - Neuza Nguenha
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
| | | | - Júlio Rafael
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
| | | | - Imelda Chelene
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
| | | | | | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
| | - Osvaldo Loquiha
- Clinton Health Access Initiative, Maputo City 592, Mozambique
| | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique
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Chilaúle JJ, Munlela B, Mans J, Mabasa VV, Marques S, Bauhofer AFL, Jane G, Anapakala E, Oliveira F, Cossa-Moiane I, Guimarães E, Sambo J, Bero DM, Chissaque A, de Deus N, Taylor MB. Norovirus Genetic Diversity in Children under Five Years Old with Acute Diarrhea in Mozambique (2014-2015). Viruses 2022; 14:v14092001. [PMID: 36146807 PMCID: PMC9502691 DOI: 10.3390/v14092001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
Norovirus (NoV) is the second most important cause of viral diarrheal disease in children worldwide after rotavirus and is estimated to be responsible for 17% of acute diarrhea in low-income countries. This study aimed to identify and report NoV genotypes in Mozambican children under the age of five years with acute diarrhea. Between May 2014 and December 2015, stool specimens were collected within the Mozambique Diarrhea National Surveillance (ViNaDia) and tested for NoV genogroups I (GI) and II (GII) using conventional reverse transcriptase-polymerase chain reaction (RT-PCR). Partial capsid and RNA-dependent RNA polymerase (RdRp) nucleotide sequences were aligned using the Muscle tool, and phylogenetic analyses were performed using MEGA X. A total of 204 stool specimens were tested for NoV. The detection rate of NoV was 14.2% (29/204). The presence of NoV was confirmed, by real-time RT-PCR (RT-qPCR), in 24/29 (82.8%) specimens, and NoV GII predominated (70.8%; 17/24). NoV GII.4 Sydney 2012[P31] was the predominant genotype/P-type combination detected (30.4%; 7/23). This is the first study which highlights the high genetic diversity of NoV in Mozambican children and the need to establish a continuous NoV surveillance system.
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Affiliation(s)
- Jorfélia J. Chilaúle
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Correspondence:
| | - Benilde Munlela
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Janet Mans
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Victor V. Mabasa
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Selma Marques
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Graziela Jane
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Elda Anapakala
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Fernanda Oliveira
- Hospital Militar de Maputo (HMM), Rua Samuel D. Khumbula Maputo, Maputo 592, Mozambique
| | - Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Institute of Tropical Medicine (ITM), 2000 Antwerp, Belgium
| | - Esperança Guimarães
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Diocreciano Matias Bero
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Av. Julius Nyerere–Campus Universitário, Maputo 257, Mozambique
| | - Maureen B. Taylor
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
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7
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Manhique-Coutinho L, Chiani P, Michelacci V, Taviani E, Bauhofer AFL, Chissaque A, Cossa-Moiane I, Sambo J, Chilaúle J, Guimarães EL, Salência J, Cassocera M, Bero DM, Langa JP, de Deus N. Molecular characterization of diarrheagenic Escherichia coli isolates from children with diarrhea: A cross-sectional study in four provinces of Mozambique: Diarrheagenic Escherichia coli in Mozambique. Int J Infect Dis 2022; 121:190-194. [PMID: 35489634 DOI: 10.1016/j.ijid.2022.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Analyze the frequency of diarrheagenic Escherichia coli (DEC) pathotypes and their antimicrobial resistance profiles among children aged <15 years with diarrhea in four Mozambican provinces. METHODS A cross-sectional hospital-based surveillance program of diarrhea was implemented in Maputo, Sofala, Zambézia, and Nampula. A single stool sample was collected from each child from May 2014 to May 2017. Culture methods and biochemical characterization were performed to detect E. coli strains. DEC pathotypes were determined by conventional polymerase chain reaction targeting specific virulence genes. Antimicrobial susceptibility was assessed by the Kirby-Bauer method. RESULTS From 723 specimens analyzed by culture, 262 were positive for E. coli. A total of 208 samples were tested by polymerase chain reaction for DEC identification, of which 101 (48.6%) were positive for a DEC pathotype. The predominant pathotypes were enteroaggregative (66.3%, 67/101), enteropathogenic (15.8%, 16/101), enterotoxigenic (13.9%, 14/101), and enteroinvasive E. coli (4.0%, 4/101). No Shiga toxin-producing E. coli was identified. Regardless of the province, the most frequent pathotype was enteroaggregative E. coli. Isolated DEC presented high frequency of resistance to ampicillin (97.8%), tetracycline (68.3%), chloramphenicol (28.4%), nalidixic acid (19.5%), and gentamicin (14.4%). CONCLUSION Children with diarrhea in Mozambique had DEC and higher resistance to ampicillin and tetracycline.
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Affiliation(s)
- Lena Manhique-Coutinho
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Universidade Eduardo Mondlane, Maputo 3453, Mozambique.
| | - Paola Chiani
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, 299, 0161, Rome, Italy
| | - Valeria Michelacci
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, 299, 0161, Rome, Italy
| | - Elisa Taviani
- Universidade Eduardo Mondlane, Maputo 3453, Mozambique
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Institute of Tropical Medicine (ITM), 2000 Antwerp, Belgium
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Jorfélia Chilaúle
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - Esperança Lourenço Guimarães
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Judite Salência
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Diocreciano Matias Bero
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - José Paulo Langa
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), Estrada Nacional EN1, Parcela n ͦ 3943, Distrito de Marracuene, Maputo, Mozambique.; Universidade Eduardo Mondlane, Maputo 3453, Mozambique
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Sitoe N, Sambo J, Nguenha N, Chilaule J, Chelene I, Loquiha O, Mudenyanga C, Viegas S, Cunningham J, Jani I. Performance Evaluation of the STANDARD TM Q COVID-19 and Panbio TM COVID-19 Antigen Tests in Detecting SARS-CoV-2 during High Transmission Period in Mozambique. Diagnostics (Basel) 2022; 12:diagnostics12020475. [PMID: 35204566 PMCID: PMC8871422 DOI: 10.3390/diagnostics12020475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Laboratory-based molecular assays are the gold standard to detect SARS-CoV-2. In resource-limited settings, the implementation of these assays has been hampered by operational challenges and long turnaround times. Rapid antigen detection tests are an attractive alternative. Our aim is to evaluate the clinical performance of two SARS-CoV-2 rapid antigen tests during a high transmission period. (2) Methods: A total of 1277 patients seeking SARS-CoV-2 diagnosis were enrolled at four health facilities. Nasopharyngeal swabs for rapid antigen and real time PCR testing were collected for each patient. Sensitivity, specificity, positive and negative predictive values, misclassification rate, and agreement were determined. (3) Results: The overall sensitivity of Panbio COVID-19 was 41.3% (95% CI: 34.6-48.4%) and the specificity was 98.2% (95% CI: 96.2-99.3%). The Standard Q had an overall sensitivity and specificity of 45.0% (95% CI: 39.9-50.2%) and 97.6% (95% CI: 95.3-99.0%), respectively. The positive predictive value of a positive test was 93.3% and 95.4% for the Panbio and Standard Q Ag-RDTs, respectively. A higher sensitivity of 43.2% and 49.4% was observed in symptomatic cases for the Panbio and Standard Q Ag-RDTs, respectively. (4) Conclusions: Despite the overall low sensitivity, the two evaluated rapid tests are useful to improve the diagnosis of symptomatic SARS-CoV-2 infections during high transmission periods.
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Affiliation(s)
- Nádia Sitoe
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
- Correspondence:
| | - Júlia Sambo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
| | - Neuza Nguenha
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
| | - Jorfelia Chilaule
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
| | - Imelda Chelene
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
| | - Osvaldo Loquiha
- Clinton Health Access Initiative, Maputo City 592, Mozambique; (O.L.); (C.M.)
| | | | - Sofia Viegas
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
| | - Jane Cunningham
- Global Malaria Program, World Health Organization, 1211 Geneva, Switzerland;
| | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (J.S.); (N.N.); (J.C.); (I.C.); (S.V.); (I.J.)
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Cossa-Moiane I, Cossa H, Bauhofer AFL, Chilaúle J, Guimarães EL, Bero DM, Cassocera M, Bambo M, Anapakala E, Chissaque A, Sambo J, Langa JS, Manhique-Coutinho LV, Fantinatti M, Lopes-Oliveira LA, Da-Cruz AM, de Deus N. High Frequency of Cryptosporidium hominis Infecting Infants Points to A Potential Anthroponotic Transmission in Maputo, Mozambique. Pathogens 2021; 10:pathogens10030293. [PMID: 33806380 PMCID: PMC8002024 DOI: 10.3390/pathogens10030293] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022] Open
Abstract
Cryptosporidium is one of the most important causes of diarrhea in children less than 2 years of age. In this study, we report the frequency, risk factors and species of Cryptosporidium detected by molecular diagnostic methods in children admitted to two public hospitals in Maputo City, Mozambique. We studied 319 patients under the age of five years who were admitted due to diarrhea between April 2015 and February 2016. Single stool samples were examined for the presence of Cryptosporidium spp. oocysts, microscopically by using a Modified Ziehl-Neelsen (mZN) staining method and by using Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) technique using 18S ribosomal RNA gene as a target. Overall, 57.7% (184/319) were males, the median age (Interquartile range, IQR) was 11.0 (7-15) months. Cryptosporidium spp. oocysts were detected in 11.0% (35/319) by microscopy and in 35.4% (68/192) using PCR-RFLP. The most affected age group were children older than two years, [adjusted odds ratio (aOR): 5.861; 95% confidence interval (CI): 1.532-22.417; p-value < 0.05]. Children with illiterate caregivers had higher risk of infection (aOR: 1.688; 95% CI: 1.001-2.845; p-value < 0.05). An anthroponotic species C. hominis was found in 93.0% (27/29) of samples. Our findings demonstrated that cryptosporidiosis in children with diarrhea might be caused by anthroponomic transmission.
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Affiliation(s)
- Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Correspondence: ; Tel.: +258-84-327-3270
| | - Hermínio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Unidade de Pesquisa Social, Manhiça Foundation (Fundação Manhiça, FM), Manhiça 1929, Mozambique;
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Jorfélia Chilaúle
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Esperança Lourenço Guimarães
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Diocreciano Matias Bero
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Miguel Bambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Elda Anapakala
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Jerónimo Souzinho Langa
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Lena Vânia Manhique-Coutinho
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Maria Fantinatti
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
| | - Luis António Lopes-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
| | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
- Disciplina de Parasitologia, Faculdade de Ciências Médicas, UERJ/RH, Rio de Janeiro 21040-900, Brazil
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo 3453, Mozambique
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Stone B, Sambo J, Sawadogo-Lewis T, Roberton T. When it rains, it pours: detecting seasonal patterns in utilization of maternal healthcare in Mozambique using routine data. BMC Health Serv Res 2020; 20:950. [PMID: 33059682 PMCID: PMC7559485 DOI: 10.1186/s12913-020-05807-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Climatic conditions and seasonal trends can affect population health, but typically, we consider the effect of climate on the epidemiology of communicable diseases. However, climate can also have an effect on access to care, particularly in remote rural areas of low- and middle-income countries. In this study, we investigate associations between the rainy season and the utilization of maternal health services in Mozambique. METHODS We examined patterns in the number of women receiving antenatal care (ANC) and delivering at a health facility for 2012-2019, using data from Mozambique's Health Management Information Systems. We investigated the association between seasonality (rainfall) and maternal health service utilization (ANC and institutional delivery) at national and provincial level. We fit a negative binomial regression model for institutional delivery and used it to estimate the yearly reduction in institutional deliveries due to the rainy season, with other factors held constant. We used the Lives Saved Tool (LiST) to model increases in mortality due to this estimated decrease in institutional delivery associated with the rainy season. RESULTS In our national analysis, the rate of ANC visits was 1% lower during the rainy season, adjusting for year and province (IRR = 0.99, 95% CI: 0.96-1.03). The rate of institutional deliveries was 6% lower during the rainy season than the dry season, after adjusting for time and province (IRR = 0.94, 95% CI: 0.92-0.96). In provincial analyses, all provinces except for Maputo-Cidade, Maputo-Province, Nampula, and Niassa showed a statistically significantly lower rate of institutional deliveries in the rainy season. None were statistically significantly lower for ANC. We estimate that, due to reductions in institutional delivery attributable only to the rainy season, there were 74 additional maternal deaths and 726 additional deaths of children under the age of 1 month in 2021, that would not have died if the mothers had instead delivered at a facility. CONCLUSION Fewer women deliver at a health facility during the rainy season in Mozambique than during the dry season. Barriers to receiving care during pregnancy and childbirth must be addressed using a multisectoral approach, considering the impact of geographical inequities.
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Affiliation(s)
- Briana Stone
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Júlia Sambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bauhofer AFL, Cossa-Moiane I, Marques S, Guimarães EL, Munlela B, Anapakala E, Chilaúle JJ, Cassocera M, Langa JS, Chissaque A, Sambo J, Manhique-Coutinho L, Bero DM, Kellogg TA, de Deus N. Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018. PLoS Negl Trop Dis 2020; 14:e0008195. [PMID: 32320399 PMCID: PMC7176080 DOI: 10.1371/journal.pntd.0008195] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 09/06/2019] [Accepted: 03/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection. METHODOLOGY We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immune-enzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection. RESULTS Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value < 0.01); animal contact (children with animal contact had a protective effect OR: 0.627; CI: 0.398-0.986; p-value < 0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310-4.069; p-value < 0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60-168 months (OR: 2.322; CI: 1.000-5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286-3.565, p-value < 0.01). CONCLUSIONS Parasitic infection is common among children with diarrhea. Routine testing, standard treatment, and assessment for risk exposure of children with diarrhea should be implemented at health facilities in Mozambique.
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Affiliation(s)
- Adilson Fernando Loforte Bauhofer
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Idalécia Cossa-Moiane
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Selma Marques
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Esperança L. Guimarães
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Benilde Munlela
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Elda Anapakala
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Jorfélia J. Chilaúle
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Marta Cassocera
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Jerónimo S. Langa
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Assucênio Chissaque
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Júlia Sambo
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Lena Manhique-Coutinho
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Diocreciano Matias Bero
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Timothy A. Kellogg
- Direcção de Inquéritos e Observação de Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nilsa de Deus
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
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Júnior JM, Cane RM, Gonçalves MP, Sambo J, Konikoff J, Fernandes Q, Ngale K, Roberton T. Projecting the lives saved by continuing the historical scale-up of child and maternal health interventions in Mozambique until 2030. J Glob Health 2019; 9:011102. [PMID: 31131106 PMCID: PMC6513506 DOI: 10.7189/jogh.09.011102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/16/2022] Open
Abstract
Background Over the past 20 years, Mozambique has achieved substantial reductions in maternal, neonatal, and child mortality. However, mortality rates are still high, and to achieve the Sustainable Development Goals (SDGs) for maternal and child health, further gains are needed. One technique that can guide policy makers to more effectively allocate health resources is to model the coverage increases and lives saved that would be achieved if trends continue as they have in the past, and under differing alternative scenarios. Methods We used historical coverage data to project future coverage levels for 22 child and maternal interventions for 2015-2030 using a Bayesian regression model. We then used the Lives Saved Tool (LiST) to estimate the additional lives saved by the projected coverage increases, and the further child lives saved if Mozambique were to achieve universal coverage levels of selected individual interventions. Results If historical trends continue, coverage of all interventions will increase from 2015 to 2030. As a result, 180 080 child lives (0-59 months) and 3640 maternal lives will be saved that would not be saved if coverage instead stays constant from 2015 to 2030. Most child lives will be saved by preventing malaria deaths: 40.9% of the mortality reduction will come from increased coverage of artemisinin-based compounds for malaria treatment (ACTs) and insecticide treated bednets (ITNs). Most maternal lives will be saved from increased labor and delivery management (29.4%) and clean birth practices (17.1%). The biggest opportunity to save even more lives, beyond those expected by historical trends, is to further invest in malaria treatment. If coverage of ACTs was increased to 90% in 2030, rather than the anticipated coverage of 68.4% in 2030, an additional 3456 child lives would be saved per year. Conclusions Mozambique can expect to see continued reductions in mortality rates in the coming years, although due to population growth the absolute number of child deaths will decrease only marginally, the absolute number of maternal deaths will continue to increase, and the country will not achieve current SDG targets for either child or maternal mortality. Significant further health investments are needed to eliminate all preventable child and maternal deaths in the coming decades.
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Affiliation(s)
- José Maiane Júnior
- Polana Caniço Health Research Center, Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Réka Maulide Cane
- Health Systems Cluster, Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | | | - Júlia Sambo
- Research Department, Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Jacob Konikoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Quinhas Fernandes
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Kátia Ngale
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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de Deus N, Chilaúle JJ, Cassocera M, Bambo M, Langa JS, Sitoe E, Chissaque A, Anapakala E, Sambo J, Guimarães EL, Bero DM, João ED, Cossa-Moiane I, Mwenda JM, Weldegebriel GG, Parashar UD, Tate JE. Early impact of rotavirus vaccination in children less than five years of age in Mozambique. Vaccine 2017; 36:7205-7209. [PMID: 29128381 DOI: 10.1016/j.vaccine.2017.10.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 09/04/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mozambique introduced rotavirus vaccine (Rotarix, GSK Biologicals) in the National Immunization Program in September 2015 with the objective of reducing the burden of total diarrheal disease and specifically severe rotavirus disease. This study aimed to evaluate the early impact of rotavirus vaccine in reducing all-cause diarrhea and rotavirus-specific hospitalizations. METHODS We analysed stool specimens collected from children under five years old, between January 2014 and June 2017 within the National Surveillance for Acute Diarrhea. We compared annual changes in rotavirus positivity, median age of children hospitalized for rotavirus and the number of all-cause for diarrheal hospitalizations. Rotavirus detection was performed using enzyme immunoassay. RESULTS During this period, 1296 samples were collected and analyzed. Rotavirus positivity before vaccine introduction was 40.2% (39/97) in 2014 and 38.3% (225/588) in 2015, then after vaccine introduction reduced to 12.2% and 13.5% in 2016 and 2017, respectively. The median age of children hospitalized for rotavirus was 9 and 11 months in 2014 and 2015 and 10 months in 2016 and 2017. Rotavirus hospitalizations exhibited a seasonal peak prior to vaccine introduction, between June and September in 2014 and 2015, coinciding with winter period in Mozambique. After vaccine introduction, the peak was delayed until August to December in 2016 and was substantially diminished. There was a reduction in all-cause acute diarrhea hospitalizations in children aged 0-11 months after vaccine introduction. CONCLUSION We observed a reduction in rotavirus positivity and in the number of all-cause diarrhea hospitalizations after vaccine introduction. The data suggest rotavirus vaccine is having a positive impact on the control of rotavirus diarrheal disease in Mozambique.
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Affiliation(s)
- Nilsa de Deus
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
| | | | - Marta Cassocera
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Miguel Bambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Ezequias Sitoe
- Hospital Central de Nampula, Ministério da Saúde, Nampula, Mozambique
| | | | - Elda Anapakala
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Júlia Sambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | | | - Eva Dora João
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique; Institute of Hygiene and Tropical Medicine, New University of Lisbon, Lisbon, Portugal
| | | | - Jason M Mwenda
- World Health Organization (WHO), Regional Office for Africa, Brazzaville, People's Republic of Congo
| | | | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Chilaule J, Moiane-Cossa I, Cassocera M, Guimarães E, Langa J, Langa J, Manhique L, Sambo J, Bero D, De Deus N. Etiology of diarrheal disease in children from 0 to 14 years old admitted in Hospital Geral Mavalane, Mozambique. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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