Cervical cytology and HPV distribution in Cape Verde: A snapshot of a country taken during its first HPV nation-wide vaccination campaign

Cervical cancer ranks as the third most common female cancer in Cape Verde and is the leading cause of cancer-related deaths among women in the country. While Human Papillomavirus (HPV) vaccination, which started in 2021, is anticipated to significantly reduce disease incidence, cervical screening remains crucial for non-vaccinated women. We retrospectively reviewed gynecologic cytology exams and HPV tests performed in Cape Verde between 2017 and April 2023 and processed at IMP Diagnostics. For this study, we considered 13035 women with cytology examinations performed and, 2013 of these, also with an HPV molecular test. Cytology diagnostics comprised 83 % NILM cases; 12 % ASC-US; 2.7 % LSIL; 1.2 % ASC-H; 0.5 % HSIL and 0.1 % SCC. In 505 (25.1 %) high-risk HPV infection was detected. Prevalence of HPV infection varied with age, peaking at young ages - ≤24 years old (55.5 %) and 25-35-year-old women (31.5 %) - and the lowest after 66 years old (9.7 %). Herein we present a comprehensive study regarding Cape Verde's cervical cytology and HPV distribution, aiming to provide a snapshot of the country's cervical cytology results and HPV distribution in recent years. Moreover, these data may contribute to establish a baseline to assess, in the future, the vaccination impact in the country.

Parallel anagenetic patterns in endemic Artemisia species from three Macaronesian archipelagos

Anagenetic speciation is an important mode of evolution in oceanic islands, yet relatively understudied compared to adaptive radiation. In the Macaronesian region, three closely related species of Artemisia (i.e. A. argentea, A. thuscula and A. gorgonum) are each endemic from a single archipelago (i.e. Madeira, Canary Islands and Cape Verde, respectively), representing a perfect opportunity to study three similar but independent anagenetic speciation processes. By analysing plastid and nuclear DNA sequences, as well as nuclear DNA amount data, generated from a comprehensive sampling in all the islands and archipelagos where these species are currently distributed, we intend to find common evolutionary patterns that help us explain the limited taxonomic diversification experienced by endemic Macaronesian Artemisia. Our time-calibrated phylogenetic reconstruction suggested that divergence among the three lineages occurred in a coincidental short period of time during the Pleistocene. Haplotype and genetic differentiation analyses showed similar diversity values among A. argentea, A. thuscula and A. gorgonum. Clear phylogeographic patterns-showing comparable genetic structuring among groups of islands-were also found within the three archipelagos. Even from the cytogenetic point of view, the three species presented similarly lower genome size values compared to the mainland closely related species A. arborescens. We hypothesize that the limited speciation experienced by the endemic Artemisia in Madeira, Canary Islands and Cape Verde archipelagos could be related to their recent parallel evolutionary histories as independent lineages, combined with certain shared characteristics of seed dispersal, pollen transport and type of habitat.

First isolation of Echinococcus granulosus sensu lato genotype 7 in the archipelago of Cape Verde

There are no scientific data available on the occurrence of the Echinococcus granulosus sensu lato (s.l.) cluster in definitive hosts (domestic dogs), intermediate hosts (domestic livestock) nor humans in Cape Verde. In this pilot study, environmental dog fecal samples (n = 369) were collected around food markets, official slaughterhouses, as well as home and small business slaughter spots in 8 of the 9 inhabited islands from the Cape Verde archipelago, between June 2021 and March 2022. Additionally, during the same period, 40 cysts and tissue lesions were opportunistically collected from 5 islands, from locally slaughtered cattle (n = 7), goats (n = 2), sheep (n = 1) and pigs (n = 26). Genetic characterization by a multiplex polymerase chain reaction assay targeting the 12S rRNA gene confirmed the presence of E. granulosus s.l. in fecal and tissue material. In total, 17 cyst samples from Santiago (n = 9), Sal (n = 7) and São Vicente (n = 1) and 8 G6/G7-positive dog fecal samples from Santiago (n = 4) and Sal (n = 4) were identified as E. granulosus s.l. G7 by sequence analysis (nad2, nad5 and nad1 genes). This study discloses the transmission of E. granulosus s.l. G7, in pig, cattle and dog in Cape Verde.

The Chemical Profile, and Antidermatophytic, Anti-Inflammatory, Antioxidant and Antitumor Activities of Withania chevalieri A.E. Gonç. Ethanolic Extract

Withania chevalieri, endogenous from Cape Verde, is a medicinal plant used in ethnomedicine with a large spectrum of applications, such as treating skin fungal infections caused by dermatophytes. The aim of this work was to chemically characterize the W. chevalieri crude ethanolic extract (WcCEE), and evaluate its bioactivities as antidermatophytic, antioxidant, anti-inflammatory and anticancer, as well as its cytotoxicity. WcCEE was chemically characterized via HPLC-MS. The minimal inhibitory concentration, minimal fungicidal concentration, time-kill and checkerboard assays were used to study the antidermatophytic activity of WcCEE. As an approach to the mechanism of action, the cell wall components, β-1,3-glucan and chitin, and cell membrane ergosterol were quantified. Transmission electron microscopy (TEM) allowed for the study of the fungal ultrastructure. WcCEE contained phenolic acids, flavonoids and terpenes. It had a concentration-dependent fungicidal activity, not inducing relevant resistance, and was endowed with synergistic effects, especially terbinafine. TEM showed severely damaged fungi; the cell membrane and cell wall components levels had slight modifications. The extract had antioxidant, anti-inflammatory and anti-cancer activities, with low toxicity to non-tumoral cell lines. The results demonstrated the potential of WcCEE as an antidermatophytic agent, with antioxidant, anti-inflammatory and anticancer activity, to be safely used in pharmaceutical and dermocosmetic applications.

Screening of natural Wolbachia infection in mosquitoes (Diptera: Culicidae) from the Cape Verde islands

BACKGROUND

Wolbachia pipientis is an endosymbiont bacterium that induces cytoplasmic incompatibility and inhibits arboviral replication in mosquitoes. This study aimed to assess Wolbachia prevalence and genetic diversity in different mosquito species from Cape Verde.

METHODS

Mosquitoes were collected on six islands of Cape Verde and identified to species using morphological keys and PCR-based assays. Wolbachia was detected by amplifying a fragment of the surface protein gene (wsp). Multilocus sequence typing (MLST) was performed with five housekeeping genes (coxA, gatB, ftsZ, hcpA, and fbpA) and the wsp hypervariable region (HVR) for strain identification. Identification of wPip groups (wPip-I to wPip-V) was performed using PCR-restriction fragment length polymorphism (RFLP) assay on the ankyrin domain gene pk1.

RESULTS

Nine mosquito species were collected, including the major vectors Aedes aegypti, Anopheles arabiensis, Culex pipiens sensu stricto, and Culex quinquefasciatus. Wolbachia was only detected in Cx. pipiens s.s. (100% prevalence), Cx. quinquefasciatus (98.3%), Cx. pipiens/quinquefasciatus hybrids (100%), and Culex tigripes (100%). Based on the results of MLST and wsp hypervariable region typing, Wolbachia from the Cx. pipiens complex was assigned to sequence type 9, wPip clade, and supergroup B. PCR/RFLP analysis revealed three wPip groups in Cape Verde, namely wPip-II, wPip-III, and wPip-IV. wPip-IV was the most prevalent, while wPip-II and wPip-III were found only on Maio and Fogo islands. Wolbachia detected in Cx. tigripes belongs to supergroup B, with no attributed MLST profile, indicating a new strain of Wolbachia in this mosquito species.

CONCLUSIONS

A high prevalence and diversity of Wolbachia was found in species from the Cx. pipiens complex. This diversity may be related to the mosquito's colonization history on the Cape Verde islands. To the best of our knowledge, this is the first study to detect Wolbachia in Cx. tigripes, which may provide an additional opportunity for biocontrol initiatives.

Essential Metals and Trace Elements in Cereals and Their Derivatives Commercialized and Consumed in Cape Verde

Cereals and their derivatives are basic foods in the human diet and a source of minerals, but the content of elements may vary depending on the type of cereal or its processing. The levels of Na, K, Ca, Mg, Fe, Cu, Zn, Mo, Co, and Mn have been determined in 126 samples of cereals and cereal derivatives (rice, corn gofio, corn flour, wheat flour, corn, and wheat) commercialized and consumed in Cape Verde using an inductively coupled plasma-optical emission spectrometer (ICP-OES) after a wet microwave digestion process. Some elements stand out in products such as corn gofio (K), wheat (Mg), and wheat flour (Fe). Negative correlations were found between Mo-Na and Na-Zn that could suggest interference between these elements. Bearing in mind the dietary intake evaluation and the guideline values provided by EFSA (European Food Safety Authority) or FAO (Food Authority Organization), the consumption of wheat (100 g/day) provides a notable contribution of Mo, Mn, Fe, and Mg. Considering the nutritional value of the analyzed essential and trace elements, the consumption of different cereals and their derivatives should be promoted.

Epidemiological investigations of diarrhea in children in Praia city, Cape Verde

Introduction

Diarrheal disease is a major cause of infant mortality and morbidity in Africa and results primarily from contaminated food and water sources, but its prevalence predictors in Cape Verde are not completely known. For this reason, this study aimed to identify the etiological agents of diarrhea in Cape Verdean children and assess its associated risk factors.

Methods

A survey questionnaire was used, and a total of 105 stool samples from children with diarrhea aged 0-12 years at the Central Hospital of Praia (Santiago, Cape Verde) were analyzed. The analyses were carried out using Biofire FilmArray Gastrointestinal Panels. Possible risk factors for these pathogens were analyzed using logistic regression, chi-square tests, or Fisher's exact test.

Results

Among the bacteria, enteroaggregative Escherichia coli (45.71%; 95% CI: 36.71-56.70), enteropathogenic E. coli (40%; 95% CI: 30.56-50.02), Shigella/enteroinvasive E. coli (29.52%; 95% CI: 21.02-39.22), E. coli enterotoxigenic (12.38%; 95% CI: 6.76-20.24), Campylobacter sp. (10.48%; 95% CI: 5.35-1.97), Vibrio sp. (4.76%; 95% CI: 1.56-10.76), Clostridioides difficile (3.81%; 95% CI: 1.05-9.47), Vibrio cholerae (2.86%; 0.59-8.12), Shiga-like toxin-producing E. coli (2.86%; 0.59-8.12) and Salmonella sp. (0.95%; 0.02-5.19) were identified; four viruses, Rotavirus A (28.57%; 95% CI: 20.18-38.21), Sapovirus I. II. IV and V (11.43%; 95% CI: 6.05-19.11), Norovirus GI.GII (6.67%; 95% CI: 2.72-13.25) and Adenovirus F 40.41 (6.67%; 95% CI: 2.72-13.25) were also observed. All the pathogens detected in this study were found in coinfections. Significant associations with risk factors were found; specifically, having a bathroom at home reduced the risk of Campylobacter sp., having animals at home increased the risk of Shigella/EIEC infection, and drinking bottled water reduced the risk of Sapovirus infection.

Discussion

From the findings of this study, it can be concluded that, in Cape Verde, there is a high prevalence and diversity of pathogens among children. Our results could help to establish an adequate diagnosis and effective treatments for diarrheal disease.

Abundance, composition and sources of beach litter on the Cape Verdean island São Vicente

This study represents the first assessment of beach litter on an island of the west African archipelagic state of Cape Verde. On five beaches of São Vicente, litter was collected along transects and classified according to the OSPAR protocol, with the Matrix Scoring Technique used to allocate it to four sources. Beach litter on São Vicente is highly variable in both amount and composition, while land- and sea-based sources contribute to litter loads to different extents depending on the use and geographic orientation of the beach. Four of the five surveyed beaches exhibited litter loads that were similar to pollution levels previously described for other oceanic islands, while a north-eastern-facing beach featured exceptionally high loads. This was presumably because it receives litter from distant sources due to its exposure to a major ocean surface current.

Cervical cancer in Cape Verde: reappraisal upon referral to a tertiary cancer centre

Background

Cervical cancer (CC) is the first cause of cancer-related deaths among Cape Verdean women. The absence of a national screening programme and a lack of dedicated cancer treatment facilities contribute to its high mortality rate. In an effort to improve the prognosis of these women, a health cooperation agreement was established between Portugal and Cape Verde (CV), allowing their evacuation to Portuguese hospitals. Our aim was to characterise CC among CV women, and to assess the response given to these patients in Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), so that their treatment and follow-up protocols can be optimised and overall prognosis improved.

Methods

Retrospective evaluation of women diagnosed with CC in CV that underwent therapy in IPOLFG between 2013 and 2020. Risk factors, demographic and tumour characteristics, treatment and outcomes were reviewed.

Results

Fifty-eight patients were included. Squamous cell carcinoma was the most frequent (91.5%) histological type. HPV DNA was present in 25 out of 26 samples.The agreement rate between the pathology analysis performed in CV and in Portugal was high (87.9%); however, the agreement regarding the FIGO stage was low (15.5%). This may be explained by both the time interval between diagnosis and treatment (around 6 months) and by the absence of resources to accurately stage the disease in CV. In IPOLFG, 77.6% of patients received combined chemo-radiotherapy. Post-treatment follow-up varied widely, due to disease-related and bureaucratic issues. Eighteen patients developed cancer-related complications and/or cancer-related death. The survival rate and median overall survival (OS) in our cohort were of 89.7% and 73.2 months, respectively.

Conclusions

Although most women had advanced-stage disease, the OS in our cohort was better than what has been reported for other African countries, probably because state-of-the-art treatment, frequently not accessible in those countries, was offered to all patients.

Myiasis by Cordylobia anthropophaga (Calliphoridae) in rodents from Cape Verde

Purpose

The tumbu fly, Cordylobia anthropophaga (Diptera: Calliphoridae), is widely distributed in continental tropical and subtropical Africa, being the most common cause of furuncular myiasis in Sub-Saharan Africa. The aim of the present work was to analyze the role of rodents as possible reservoirs of C. anthropophaga in Cape Verde, considering the zoonotic character of this fly species.

Materials and Methods

A total of 150 peridomestic rodents were studied in Santiago island. For the obtained larvae, morphological and molecular characters were analyzed.

Results

Cordylobia anthropophaga was found in 6.4% of the peridomestic Rattus rattus analyzed. The present work unveils the presence of C. anthropophaga in rodents of the African archipelago of Cape Verde, introduced probably with West African humans and/or animals.

Conclusion

The presence in peridomestic animals, and the wide range of species that this fly can affect, entails a zoonotic risk of myiasis by tumbu fly.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11686-022-00576-8.

Pathogenic free-living amoebae from water sources in Cape Verde

Free-living amoebae (FLA) are protozoa which have been reported in different countries worldwide from diverse sources (water, soil, dust, air), contributing to the environmental microbiological contamination. Most of the FLA species present a life cycle with two different phases: an active vegetative and physiologically form named trophozoite, and an extremely resistant phase called cyst. Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris, Sapinia pedata, Vahlkampfia spp., Paravahlkampfia spp. and Vermamoeba vermiformis have been reported not only as causal agents of several opportunistic diseases including fatal encephalitis or epithelial disorders, but also as capable to favour the intracellular survival of common pathogenic bacteria, which could avoid the typical water disinfection systems, non-effective against FLAs cysts. Even though Santiago Island possesses high levels of humidity compared to the rest of the archipelago of Cape Verde, the water resources are scarce. Therefore, it is important to carry out proper microbiological quality controls, which currently do not contemplate the FLA presence in most of the countries. In the present work, we have reported the presence of Acanthamoeba spp. (69.2%); Vannella spp. (15.4%); Vermamoeba vermiformis (7.7%) and the recently discovered Stenamoeba dejonckheerei (7.7%) in different water sources of Santiago Island.

Free-Living Amoebae in Soil Samples from Santiago Island, Cape Verde

Free-Living Amoebae (FLA) are widely distributed protozoa, which contain some groups considered as pathogenic microorganisms. These members are able to produce several opportunistic diseases including epithelial disorders, such as keratitis and fatal encephalitis. Even though they have been reported in numerous sources, such as soils, dust and water, there is no legislation related to the presence of these protozoa in soil-related environments worldwide. Therefore, there are no established prevention or disinfection protocols to advise the population regarding FLA infections or eliminate these microorganisms from human-related environments to date. Acanthamoeba spp. are the most common FLA isolated in soil samples, which is also the most common genera found in clinical cases. Thus, the aim of the present study was to evaluate the presence of potentially pathogenic FLA in human-related soil samples of Santiago Island, Cabo Verde. A total of 26 soil samples were seeded in non-nutrient agar plates (2%), incubated at 26 °C, and monitored daily to evaluate the presence of FLA. DNA was extracted from those plates on which there was suspected FLA growth, and PCR amplification of the 18S rRNA gene was carried out. A total of 17 from the 26 analysed samples were positive for FLA, where Acanthamoeba is the most abundant isolated genus (14/17; 82.4%), with the T4 genotype being the most common (13/14; 92.9%), followed by the T5 genotype, A. lenticulata (1/14; 7.1%). Moreover, Vermamoeba vermiformis, Stenamoeba dejonckheerei and Vannella pentlandi were isolated in three other samples. To the best of our knowledge, this is the first report of FLA presence in Cape Verde and the first report of V. vermiformis in beach sand worldwide.

Genomic Epidemiology of 2015-2016 Zika Virus Outbreak in Cape Verde

During 2015–2016, Cape Verde, an island nation off the coast of West Africa, experienced a Zika virus (ZIKV) outbreak involving 7,580 suspected Zika cases and 18 microcephaly cases. Analysis of the complete genomes of 3 ZIKV isolates from the outbreak indicated the strain was of the Asian (not African) lineage. The Cape Verde ZIKV sequences formed a distinct monophylogenetic group and possessed 1–2 (T659A, I756V) unique amino acid changes in the envelope protein. Phylogeographic and serologic evidence support earlier introduction of this lineage into Cape Verde, possibly from northeast Brazil, between June 2014 and August 2015, suggesting cryptic circulation of the virus before the initial wave of cases were detected in October 2015. These findings underscore the utility of genomic-scale epidemiology for outbreak investigations.

[Mosquitoes, Distribution and Specific Richness in Eight Countries of Africa: Cape Verde, Mauritania, Senegal, Gambia, Mali, Burkina Faso, Niger and Chad]

Mosquitoes (Diptera, Culicidae) form a family of insects of considerable public health importance. Mention of their presence/absence was tackled in the literature and by specialized websites for eight African countries: Cape Verde, Mauritania, Senegal, Gambia, Mali, Burkina Faso, Niger and Chad. In total, 216 species have been recorded belonging to 13 genera: Anopheles (48 species), Aedeomyia (2), Aedes (62), Coquillettidia (6), Culex (54), Culiseta (1), Eretmapodites (7), Ficalbia (3), Lutzia (1), Mansonia (2), Mimomyia (7), Toxorhynchites (4) and Uranotaenia (19). The presence of these species in the study area is certain except for three species whose presence is doubtful. This specific richness represents 6% of the world's richness. The countries with the highest specific richness are Burkina Faso (162 species), Senegal (143) and Mali (110); the country with the lowest richness is Cape Verde (11). This richness is lower in the north in hyper-arid climate and higher in the south in sub-humid climate. Chad is the least well inventoried country. All species are considered native, with the exception of Ae. (Stegomyia ) albopictus (the Asian tiger mosquito) introduced in 2016 into Mali and possibly Ae. (Ochlerotatus ) caspius into Mauritania and Ae. (Stg. ) aegypti introduced into Nouakchott, Mauritania. This synthesis of the knowledge may be useful for vector control, public health, and future research.

Whole-genome analysis uncovers loss of blaZ associated with carriage isolates belonging to methicillin-resistant Staphylococcus aureus (MRSA) clone ST5-VI in Cape Verde

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One of the first whole genome analyses of Staphylococcus aureus carriage isolates in an African country.

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Genome data allowed to place S. aureus isolates from Cape Verde in a phylogenetic context.

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Loss of blaZ-carrying plasmids and transposons is not rare, which is also evident in other international MRSA isolates.

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Steady increase in antimicrobial drug resistance in Cape Verde.

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Data provide genomic information for the design of intervention measures to decrease antimicrobial resistance.

Objectives

Surveillance studies for Staphylococcus aureus carriage are a primary tool to survey the prevalence of methicillin-resistant S. aureus (MRSA) in the general population, patients and healthcare workers. We have previously reported S. aureus carriage in various African countries, including Cape Verde.

Methods

Whole-genome sequences of 106 S. aureus isolates from Cape Verde were determined.

Results

Staphylococcus aureus carriage isolates in Cape Verde show high genetic variability, with the detection of 27 sequence types (STs) and three primary genetic clusters associated with ST152, ST15 and ST5. One transmission event with less than eight core-genome single nucleotide polymorphisms (cgSNP) differences was detected among the ST5-VI MRSA lineage. Genetic analysis confirmed the phenotypic resistance and allowed the identification of six independent events of plasmid or transposon loss associated with the deletion of blaZ in nine isolates. In the four ST5 MRSA isolates, loss of the blaZ plasmid coincided with the acquisition of SCCmec type VI and an unusual penicillin phenotype with a minimum inhibitory concentration (MIC) at the breakpoint, indicating an adaptation trend in this endemic lineage. Similar events of blaZ plasmid loss, with concomitant acquisition SCCmec elements, were detected among ST5 isolates from different geographical origins.

Conclusion

Overall, the genome data allowed to place isolates in a phylogenetic context and to identify different blaZ gene deletions associated with plasmid or transposon loss. Genomic analysis unveiled adaptation and evolution trends, namely among emerging MRSA lineages in the country, which deserve additional consideration in the design of future infection control protocols.

Toxic Metals in Cereals in Cape Verde: Risk Assessment Evaluation

Consumption of cereals and cereal-based products represents 47% of the total food energy intake in Cape Verde. However, cereals also contribute to dietary exposure to metals that may pose a risk. Strengthening food security and providing nutritional information is a high-priority challenge for the Cape Verde government. In this study, toxic metal content (Cr, Ni, Sr, Al, Cd, and Pb) is determined in 126 samples of cereals and derivatives (rice, corn, wheat, corn flour, wheat flour, corn gofio) consumed in Cape Verde. Wheat flour samples stand out, with the highest Sr (1.60 mg/kg), Ni (0.25 mg/kg) and Cr (0.13 mg/kg) levels. While the consumption of 100 g/day of wheat would contribute to 13.2% of the tolerable daily intake (TDI) of Ni, a consumption of 100 g/day of wheat flour would contribute to 8.18% of the tolerable weekly intake (TWI) of Cd. Results show relevant Al levels (1.17-13.4 mg/kg), with the highest level observed in corn gofio. The mean Pb average content in cereals is 0.03-0.08 mg/kg, with the highest level observed in corn gofio. Al and Pb levels are lower in cereals without husks. Without being a health risk, the consumption of 100 g/day of wheat contributes to 17.5% of the European benchmark doses lower confidence limit (BMDL) of Pb for nephrotoxic effects; the consumption of 100 g/day of corn gofio provides an intake of 1.34 mg Al/day (13.7% of the TWI) and 8 µg Pb/day (20% of the BMDL for nephrotoxic effects). A strategy to minimize the dietary exposure of the Cape Verdean population to toxic metals from cereals should consider the continuous monitoring of imported cereals on arrival in Cape Verde, the assessment of the population's total diet exposure to toxic metals and educational campaigns.

Surveillance of Aedes aegypti populations in the city of Praia, Cape Verde: Zika virus infection, insecticide resistance and genetic diversity

BACKGROUND

Aedes spp. are responsible for the transmission of many arboviruses, which contribute to rising human morbidity and mortality worldwide. The Aedes aegypti mosquito is a main vector for chikungunya, dengue and yellow fever infections, whose incidence have been increasing and distribution expanding. This vector has also driven the emergence of the Zika virus (ZIKV), first reported in Africa which spread rapidly to Asia and more recently across the Americas. During the outbreak in the Americas, Cape Verde became the first African country declaring a Zika epidemic, with confirmed cases of microcephaly. Here we investigate the prevalence of ZIKV and dengue (DENV) infected Ae. aegypti mosquitoes in the weeks following the outbreak in Cape Verde, and the presence of insecticide resistance in the circulating vector population. Genetic diversity in the mosquito population was also analysed.

METHODS

From August to October 2016, 816 Ae. aegypti mosquitoes were collected in several locations across Praia, Cape Verde, the major hot spot of reported ZIKV cases in the country. All mosquitoes were screened by reverse transcription PCR for ZIKV and DENV, and a subset (n = 220) were screened for knockdown insecticide resistance associated mutations in the voltage gated sodium channel (VGSC) gene by capillary sequencing. The mitochondrial NADH dehydrogenase subunit 4 (nad4) gene was sequenced in 100 mosquitoes. These data were compared to 977 global sequences in a haplotype network and a phylogenetic tree analysis.

RESULTS

Two Ae. aegypti mosquitoes were ZIKV positive (0.25%). There were no SNP mutations found in the VGSC gene associated with insecticide resistance. Analysis of the nad4 gene revealed 11 haplotypes in the Cape Verdean samples, with 5 being singletons. Seven haplotypes were exclusive to Cape Verde. Several of the remaining haplotypes were frequent in the global dataset, being present in several countries (including Cape Verde) across five different continents. The most common haplotype in Cape Verde (50.6 %) was also found in Africa and South America.

CONCLUSIONS

There was low-level Zika virus circulation in mosquitoes from Praia shortly after the outbreak. The Ae. aegypti population did not appear to have the kdr mutations associated with pyrethroid resistance. Furthermore, haplotype and phylogenetic analyses revealed that Cape Verde Ae. aegypti mosquitoes are most closely related to those from other countries in Africa and South America.

Genetic diversity, demographic history and neo-sex chromosomes in the Critically Endangered Raso lark

Small effective population sizes could expose island species to inbreeding and loss of genetic variation. Here, we investigate factors shaping genetic diversity in the Raso lark, which has been restricted to a single islet for approximately 500 years, with a population size of a few hundred. We assembled a reference genome for the related Eurasian skylark and then assessed diversity and demographic history using RAD-seq data (75 samples from Raso larks and two related mainland species). We first identify broad tracts of suppressed recombination in females, indicating enlarged neo-sex chromosomes. We then show that genetic diversity across autosomes in the Raso lark is lower than in its mainland relatives, but inconsistent with long-term persistence at its current population size. Finally, we find that genetic signatures of the recent population contraction are overshadowed by an ancient expansion and persistence of a very large population until the human settlement of Cape Verde. Our findings show how genome-wide approaches to study endangered species can help avoid confounding effects of genome architecture on diversity estimates, and how present-day diversity can be shaped by ancient demographic events.

Cancer in Santiago Island, Cape Verde: data from the Hospital Agostinho Neto Cancer Registry (2017-2018)

This report describes the cancer cases that occurred between 2017 and 2018 in Santiago Island, Cape Verde, according to the Hospital Agostinho Neto Cancer Registry. The five most common cancers were prostate, breast, stomach, cervix and oesophageal in order of frequency. There are no national data. Therefore, it is essential to create the conditions for the establishment of Cape Verde's population-based cancer registry as quickly as possible.

Phylogeography and invasion history of Aedes aegypti, the Dengue and Zika mosquito vector in Cape Verde islands (West Africa)

Aedes-borne arboviruses have spread globally with outbreaks of vast impact on human populations and health systems. The West African archipelago of Cape Verde had its first outbreak of Dengue in 2009, at the time the largest recorded in Africa, and was one of the few African countries affected by the Zika virus epidemic. Aedes aegypti was the mosquito vector involved in both outbreaks. We performed a phylogeographic and population genetics study of A. aegypti in Cape Verde in order to infer the geographic origin and evolutionary history of this mosquito. These results are discussed with respect to the implications for vector control and prevention of future outbreaks. Mosquitoes captured before and after the Dengue outbreak on the islands of Santiago, Brava, and Fogo were analyzed with two mitochondrial genes COI and ND4, 14 microsatellite loci and five kdr mutations. Genetic variability was comparable to other African populations. Our results suggest that A. aegypti invaded Cape Verde at the beginning of the Holocene from West Africa. Given the historic importance of Cape Verde in the transatlantic trade of the 16th-17th centuries, a possible contribution to the genetic pool of the founding populations in the New World cannot be fully discarded. However, contemporary gene flow with the Americas is likely to be infrequent. No kdr mutations associated with pyrethroid resistance were detected. The implications for vector control and prevention of future outbreaks are discussed.

Dichotomous keys to the species of Solanum L. (Solanaceae) in continental Africa, Madagascar (incl. the Indian Ocean islands), Macaronesia and the Cape Verde Islands

Solanum L. (Solanaceae) is one of the largest genera of angiosperms and presents difficulties in identification due to lack of regional keys to all groups. Here we provide keys to all 135 species of Solanum native and naturalised in Africa (as defined by World Geographical Scheme for Recording Plant Distributions): continental Africa, Madagascar (incl. the Indian Ocean islands of Mauritius, La Réunion, the Comoros and the Seychelles), Macaronesia and the Cape Verde Islands. Some of these have previously been published in the context of monographic works, but here we include all taxa. The paper is designed to be used in conjunction with the web resource Solanaceae Source (www.solanaceaesource.org) and hyperlinks provide access to online descriptions, synonymy and images (where available) of each species. All taxa treated and specimens seen are included in searchable Suppl. material 1, 2.

Knowledge, attitudes and practices about malaria in Cabo Verde: a country in the pre-elimination context

Background

Malaria in Cape Verde is unstable, with a sporadic and seasonal transmission of low endemicity. In this sense, the community perceptions regarding malaria transmission, their attitudes and practices against the disease are very important to understand and to better develop the best strategical policies to achieve malaria elimination goal. This study aim to assess the knowledge, attitudes and practices (KAP) of Cape Verdean population about malaria, a country in the elimination step of disease.

Methods

A cross-sectional malaria KAP Survey was performed at the household level. A structured open questionnaire was developed and applied to residents of randomly selected households from 5 islands and 15 municipalities in Cape Verde. Correlation analyses were performed using a logistic regression model to determine the factors that are associated with the complete knowledge of the population about malaria.

Results

A total of 1953 fully completed questionnaires were analysed, with majority of questionnaires administered in Santiago island (68.3%), mainly in the capital city of Praia, 38.43%. About 88% of the population knew the correct form of transmission, 96% had knowledge that the entire population is at risk of malaria and identified the main symptoms. Regarding the attitudes, 58% seek treatment atthe nearest health structure upon the apparition of the symptoms, 64% in the first 24 h and 88% within the first 48 h. More than 97% have heard about mosquito nets but only 19% used it. In practice, 53% use coils, 45% rely on household sprays and 43% have benefited from IRS. About 90% received information about malaria from media, mainly the TV and the radio (83 and 43%, respectively). In summary, 54% of the population has complete knowledge of the disease.

Conclusion

The population of Cape Verde has a high level of knowledge about malaria, including its transmission, main symptoms and preventive and control measures. However, some gaps and misunderstandings have been noticed and contribute to the insufficient community involvement in actions against malaria. Therefore, is necessary to increase the knowledge of the population, leading to their full ownership and participation in community actions to contribute to the malaria elimination in the country.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7130-5) contains supplementary material, which is available to authorized users.

Heavy Metals of Santiago Island (Cape Verde) Alluvial Deposits: Baseline Value Maps and Human Health Risk Assessment

The chemical composition of surface geological materials may cause metabolic changes and promote endemic diseases (e.g., oncological, gastrointestinal, neurological or cardiovascular diseases). The results of a geochemical survey is presented following the guidelines proposed by the International Project IGCP 259 performed on the alluvium of Santiago Island (Cape Verde) and focused on public health issues. Geochemical mapping is the base knowledge needed to determine critical contents of potential toxic elements and the potentially harmful regions in the planet. This work presents maps of baseline values of potentially toxic elements (As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, V, and Zn) in Santiago alluvium and the assessment of their human health risks. According to the results the Cd, Co, Cr, Ni and V baseline values are above the Canadian guidelines for stream sediments (for any proposal use) and for soils (for agricultural and residential proposal uses) and also above the target values of Dutch guidelines. Hazard indexes (HI) were calculated for children and adults. For children (HI) are higher than 1 for Co, Cr and Mn, indicating potential non-carcinogenic risk. For the other elements and for adults there is no potential non-carcinogenic risk. Cancer risk was calculated for Cd, Cr and Ni exposures, for adults and children, and the results are only slightly higher than the carcinogenic target risk of 1 × 10-6 for adults exposed to Cr by inhalation. However, these results may be underestimated because alluvial contaminants may be indirectly ingested by groundwater and by crop and vegetables consumption.

Marine debris as a barrier: Assessing the impacts on sea turtle hatchlings on their way to the ocean

Marine debris is dispersed worldwide and has a considerable impact on biodiversity. In this study, the effect of marine debris on the time needed for hatchling loggerheads to reach the ocean once they have emerged from the nest was investigated. After a preliminary census of marine debris on different beaches of Boa Vista Island, Cape Verde, a field test was carried out with four different scenarios: low density marine debris, medium density marine debris, high density marine debris, and a control scenario. The time that hatchlings required to cross the different scenarios was recorded (n = 232). The results showed that crawl times were affected by the different marine debris scenarios, with the "high density" scenario specifically showing a significant difference from the control, low density and medium density scenarios. This study provides information on the risks of marine debris for hatchling sea turtles and provides conservation recommendations to reduce this potential risk.

Low potassium and high sodium intakes: a double health threat to Cape Verdeans

BACKGROUND

Cape Verde presents a high rate of cardiovascular diseases. Low potassium and high sodium intakes are related to cardiovascular diseases. However, studies regarding these two micronutrients continue to be rare in African urban settings. This work aims to estimate potassium and sodium intakes and to analyse the self-reported salt intake by gender and by type of urban area in the city of Praia - the capital of Cape Verde.

METHODS

In the first stage (n = 1912), an intra-urban study was designed in two types of urban areas (formal and informal), using a sampling strategy based on random selection of geographical coordinates, in order to apply a questionnaire. In a second stage, a 24-h dietary recall and anthropometric measurements were performed by local nutritionists. Potassium and sodium intakes were estimated for 599 participants (149 men and 450 women). Non-parametric methods (including quantile regression) were used in the statistical analysis.

RESULTS

In informal areas, a higher percentage of women reported having hypertension (31.0%) compared to formal areas (19.7%). Based on 24-h dietary recall, median potassium intake for men was 2924.2 mg/day and for women and 2562.6 mg/day. Almost 70.0% of men and 80.0% of women ingested less than the recommended 3510 mg/day of potassium. In informal areas, men and women presented high medians of sodium intakes compared to formal areas (men: 4131.2 vs 3014.6 mg/day and women: 3243.4 vs 2522.4 mg/day). On the other hand, the percentage of participants exceeding 2000 mg/day for sodium was high (≥70.8%), even for participants that self-reported low-salt intake. Quantile regression models revealed effects of the type of urban area and gender in the potassium and sodium intakes, at least, in some quartiles, accounting for age, academic qualifications, and professional situation.

CONCLUSIONS

A low potassium intake and a high sodium intake were found in Praia. Thus, efficient health education campaigns and health promotion are needed and should be tailored considering gender and urban areas.

Achievement of malaria pre-elimination in Cape Verde according to the data collected from 2010 to 2016

Background

Malaria, despite being preventable and treatable, continues to be a major public health problem worldwide. The archipelago nation of Cape Verde is in a malaria pre-elimination phase with the highest potential to achieve the target goal of elimination in 2020.

Methods

Nationwide malaria epidemiological data were obtained from the Cape Verde health information system that includes the individual malaria case notification system from all of the country’s health structures. Each case is reported to the surveillance service then to the National Malaria Control Programme, which allowed for compilation in the national malaria case database. The database was analysed to assess the origin of the malaria cases, and incidence was calculated from 2010 to 2016 by sex and age. The health centre, health district and month of diagnosis were evaluated, as well as the sex and the age of the patients, allowing a direct descriptive analysis of national data to provide an up-to-date malaria epidemiological profile of the country. Malaria cases were classified as imported or indigenous, and then, geographical analyses were performed using a unique Geographical National Code with Quantum Geographic Information System 2.16.2 software to map the cases by municipalities. The overall temporal evolution of cases was analysed to assess their monthly and yearly variations from 2010 to 2016.

Results

Malaria is unstable in Cape Verde, with inter-annual variation and the majority of infections occurring in adult males (> 20 years). The indigenous cases are restricted to Santiago (96%) and Boavista (4%), while imported cases were recorded in all the nine inhabited islands, originating from neighbouring countries with ongoing malaria transmission; from Lusophone countries (25% from Angola, 25% from Guinea-Bissau), followed by the Republic of Senegal (12%) and Equatorial Guinea (10%). In 2010–2012, more imported (93 cases) than indigenous cases (26 cases) were observed; conversely, in 2013 and 2014, more indigenous cases (49) than imported cases (42) were reported. In 2015 there were 20 imported cases and only 7 indigenous cases. Finally, in 2016, there were 47 indigenous cases and 28 imported cases. The mapping of cases by municipality and country of origin was possible with GIS analyses.

Conclusion

While Cape Verde remains on track to achieve malaria elimination by 2020 owing to the reduction of the annual incidence to below 0.1%, the country still records cases of indigenous and imported malaria. However, the indigenous cases are exclusively confined to the Santiago and Boavista islands, while the imported cases recorded nationwide originate only from the African continent, mainly from adult men from the Lusophone countries. Cape Verde needs to target interventions to remove residual foci on Santiago and Boavista islands to reduce malaria lethality to zero and prevent its reintroduction from African countries via transmission across the archipelago. Cape Verde is a good example of local authority’s commitment to tackle malaria and work towards its elimination by strengthening the health and surveillance systems.

Beliefs on Marital Violence and Self-Reported Dating Violence: A Comparative Study of Cape Verdean and Portuguese Adolescents

In this study, we compare Portuguese and Cape Verdean youths' upholding of traditional beliefs about intimate partner violence (IPV) and the frequency of self-reported violent behavior in dating relationships. The sample (n = 404) consisted of 183 Cape Verdean and 221 Portuguese secondary school students of both sexes (56 % female; mean age = 16). We used two questionnaires that had previously been validated in the Portuguese population. The results revealed that young Cape Verdean adolescents uphold stronger traditional beliefs than Portuguese adolescents do, but there were no differences in overall prevalence of abuse between the two samples. The relationship between traditional beliefs and self-reported violence was significant only in the Cape Verdean sample, suggesting that campaigns against IPV have not, so far, been as effective in Cape Verde as in Portugal.

Microbial Diversity and Toxin Risk in Tropical Freshwater Reservoirs of Cape Verde

The Cape Verde islands are part of the African Sahelian arid belt that possesses an erratic rain pattern prompting the need for water reservoirs, which are now critical for the country’s sustainability. Worldwide, freshwater cyanobacterial blooms are increasing in frequency due to global climate change and the eutrophication of water bodies, particularly in reservoirs. To date, there have been no risk assessments of cyanobacterial toxin production in these man-made structures. We evaluated this potential risk using 16S rRNA gene amplicon sequencing and full metagenome sequencing in freshwater reservoirs of Cape Verde. Our analysis revealed the presence of several potentially toxic cyanobacterial genera in all sampled reservoirs. Faveta potentially toxic and bloom-forming Microcystis sp., dominated our samples, while a Cryptomonas green algae and Gammaproteobacteria dominated Saquinho and Poilão reservoirs. We reconstructed and assembled the Microcystis genome, extracted from the metagenome of bulk DNA from Faveta water. Phylogenetic analysis of Microcystis cf. aeruginosa CV01’s genome revealed its close relationship with other Microcystis genomes, as well as clustering with other continental African strains, suggesting geographical coherency. In addition, it revealed several clusters of known toxin-producing genes. This survey reinforces the need to better understand the country’s microbial ecology as a whole of water reservoirs on the rise.

First Report of the Lesion Nematodes: Pratylenchus Brachyurus and Pratylenchus Delattrei on Tomato (Solanum Lycopersicum L.) Plants in Cape Verde

Roots of Solanum lycopersicum L. were collected in growing season of year 2015, on the island of Santiago in Cape Verde. Morphological, morphometric and molecular (18S rDNA and 28S rDNA) studies revealed the presence of Pratylenchus brachyurus and P. delattrei in root systems and root zones of tomato plants. To our knowledge, this is the first record of the occurrence of these nematode species in Cape Verde.

Medical Training Experience and Expectations Regarding Future Medical Practice of Medical Students at the University of Cape Verde

INTRODUCTION

Cape Verde is a small insular developing state. Its first experience of undergraduate medical education began in October 2015. The purpose of this paper is to describe and analyze the professional expectations and profile of the first class of medical students at the University of Cape Verde.

MATERIAL AND METHODS

A piloted, standardized questionnaire, with closed and open-ended questions, was distributed to registered medical students attending classes on the day of the survey. All data were analyzed using SPSS.

RESULTS

Students decided to study medicine in their mid-teens with relatives and friends having had significant influence over their decisions. Other major reasons for choosing medical training include "to take care of other people", "fascination for the subject matters of medicine" and "I have always wanted to". The degree of feminization of the student population is extremely high (20/25; 80.0%). Medical students are in general satisfied with the training program, and have expectations that the training received will allow them to be good professionals. Nevertheless, they consider the course too theoretical. Medical students know that this represents an opportunity for them to contribute to public welfare. Nonetheless, their expectations are to combine public sector practice with private work. Medical students come mostly from Santiago Island where the Capital of the Country is located. They still do not know about their future area of specialization. But all of those who want to specialize want to do so abroad. They mostly expect to follow hospital careers rather than health administration or family and community medicine.

DISCUSSION

This study contributes to the growing body of knowledge about medical students' difficulties and expectations regarding medical schools or curriculums in lusophone countries. The decision to invest in the training of local physicians is justified by the need to be less dependent on foreigners. Local postgraduate medical training programs are already considered a priority for the immediate future.

CONCLUSION

Cape Verde is pursuing a bold strategy to deal with a shortage of medical doctors. The problems experienced by medical students provide an important insight to help the new medical school to provide a better learning environment for students. The fact that students are not sure about their future area of specialization is an opportunity to guide them towards the areas of the health system with pressing needs. The current feminization of the medical workforce will be sustained with the profile of the present intake, hence the need to take this into account in workforce planning.

Equilibrium Bird Species Diversity in Atlantic Islands

Half a century ago, MacArthur and Wilson proposed that the number of species on islands tends toward a dynamic equilibrium diversity around which species richness fluctuates [1]. The current prevailing view in island biogeography accepts the fundamentals of MacArthur and Wilson's theory [2] but questions whether their prediction of equilibrium can be fulfilled over evolutionary timescales, given the unpredictable and ever-changing nature of island geological and biotic features [3-7]. Here we conduct a complete molecular phylogenetic survey of the terrestrial bird species from four oceanic archipelagos that make up the diverse Macaronesian bioregion-the Azores, the Canary Islands, Cape Verde, and Madeira [8, 9]. We estimate the times at which birds colonized and speciated in the four archipelagos, including many previously unsampled endemic and non-endemic taxa and their closest continental relatives. We develop and fit a new multi-archipelago dynamic stochastic model to these data, explicitly incorporating information from 91 taxa, both extant and extinct. Remarkably, we find that all four archipelagos have independently achieved and maintained a dynamic equilibrium over millions of years. Biogeographical rates are homogeneous across archipelagos, except for the Canary Islands, which exhibit higher speciation and colonization. Our finding that the avian communities of the four Macaronesian archipelagos display an equilibrium diversity pattern indicates that a diversity plateau may be rapidly achieved on islands where rates of in situ radiation are low and extinction is high. This study reveals that equilibrium processes may be more prevalent than recently proposed, supporting MacArthur and Wilson's 50-year-old theory.

Assessment of the Cavidi ExaVir Load Assay for Monitoring Plasma Viral Load in HIV-2-Infected Patients

HIV plasma viral load is an established marker of disease progression and of response to antiretroviral therapy, but currently there is no commercial assay validated for the quantification of viral load in HIV-2-infected individuals. We sought to make the first clinical evaluation of Cavidi ExaVir Load (version 3) in HIV-2-infected patients. Samples were collected from a total of 102 individuals living in Cape Verde, and the HIV-2 viral load was quantified by both ExaVir Load and a reference in-house real-time quantitative PCR (qPCR) used in Portugal in 91 samples. The associations between viral load and clinical prognostic variables (CD4⁺ T cell counts and antiretroviral therapy status) were similar for measurements obtained using ExaVir Load and qPCR. There was no difference between the two methods in the capacity to discriminate between nonquantifiable and quantifiable HIV-2 in the plasma. In samples with an HIV-2 viral load quantifiable by both methods (n = 27), the measurements were highly correlated (Pearson r = 0.908), but the ExaVir Load values were systematically higher relative to those determined by qPCR (median difference, 0.942 log₁₀ copies/ml). A regression model was derived that enables the conversion of ExaVir Load results to those that would have been obtained by the reference qPCR. In conclusion, ExaVir Load version 3 is a reliable commercial assay to measure viral load in HIV-2-infected patients and therefore a valuable alternative to the in-house assays in current use.

[Coimbra Telemedicine Service Improves Access to Pediatric Cardiology in Cape Verde]

N/a.

[Implementation of Telemedicine in Cape Verde: Influencing Factors]

INTRODUCTION

Telemedicine is the provision of health services, where distance is a critical factor, using information and communication technologies. Cape Verde has bet on using this tool to increase access of the population of its islands to specialized care.

MATERIAL AND METHODS

Qualitative study, covering the period between 2013 and 2014. It uses document analysis, semi-structured interviews and focus groups to collect data and analysis of content for their analysis. The participant population includes doctors, nurses and professionals from some institutions related to telemedicine.

RESULTS

The priorities of the National Telemedicine Program are set, the cores and reference centers are operational, with trained personnel and equipment installed. Several other policy instruments and conditioning factors and facilitators of the program have been identified.

DISCUSSION

Telemedicine is contributing to the reduction of inequalities in access to health, in Cape Verde. However, the full adoption of a service based on a new technology depends on conditioning factors and facilitators, and several success factors of telemedicine, identified in the literature, are not observed and in conjunction with other existing weaknesses affect the overall development of the National Telemedicine Program. However the strengths and capabilities are highlighted opportunities to act.

CONCLUSION

Despite the progress, some telemedicine success factors highlighted on the literature are not seen in the country.

Young-onset rapidly progressive ALS associated with heterozygous FUS mutation

We report a 36-years-old Cape Verdean man who presented with respiratory insufficiency due to rapidly progressive sporadic amyotrophic lateral sclerosis (ALS), in whom FUS mutation c.1551C > G (p.Hist517Gln) in heterozygosity was identified, a finding previously described as non-pathogenic. The only previous report on this mutation was in a family from Cape Verde in which four members developed ALS; all were homozygous for the mutation. This case shows that this FUS mutation presents a highly variable penetrance and expressivity.

The evolution of the medical workforce in Cape Verde since independence in 1975

BACKGROUND

Cape Verdean doctors have always graduated abroad. The first experience of pre-graduate medical education in Cape Verde begun in October 2015. Counting how many doctors Cape Verde has, knowing who they are, and knowing how they are distributed are very important to help fine-tune the medical training. The aim of this study is to analyze the evolution of the medical workforce in Cape Verde to support medical education implementation.

METHODS

Secondary data on doctors, from July 1975 until December 2014, collected from the Ministry of Health, were entered into an SPSS 20 database and studied by a simple descriptive statistical analysis.

RESULTS

The database included data on 401 medical doctors. There was a predominance of females (n = 218; 54.4%). The overwhelming majority (n = 378; 94.3%) graduated from 5 of the 17 countries that contributed to the training of Cape Verdean doctors. All the islands of this archipelago country contributed to the 324 (80.8%) doctors born in the country. Of the 272 doctors still active in December 2014, 119 (43.6%) were general practitioners and 153 (56.4%) had specialized in one of the 31 specialties. The national ratio of doctors per 10 000 inhabitants was 5.25, but the reality varied significantly among islands. About one third of the doctors (n = 86; 32%) were at the primary care level, 38 (14%) at the secondary care level, and 144 (52%) in central hospitals. In 2053, all active physicians in 2014 will already be retired.

CONCLUSIONS

This is a unique study of the evolution of the medical workforce of a country over 40 years, from the first day of independence. The study illustrates the importance of international collaborations, particularly of Cuba, in sustaining the medical workforce in Cape Verde. It is an example of how this collaboration was used to equip the country with doctors in an increasingly more equitable distribution across all islands. The study further illustrates the progressive feminization of the medical workforce. The study clarifies the effort required from the emerging medical faculty to supply the national health system with the needed number of doctors.

Unmatched Case-Control Study on Late Presentation of HIV Infection in Santiago, Cape Verde (2004-2011)

Access to free antiretroviral therapy (ART) in Sub-Saharan Africa has been steadily increasing over the past decade. However, the success of large-scale ART programmes depends on timely diagnosis and early initiation of HIV care. This study characterizes late presenters to HIV care in Santiago (Cape Verde) between 2004 and 2011, and identifies factors associated with late presentation for care. We defined late presentation as persons presenting to HIV care with a CD4 count below 350 cells/mm³. An unmatched case-control study was conducted using socio-demographic and behavioural data of 368 individuals (191 cases and 177 controls) collected through an interviewer-administered questionnaire, comparing HIV patients late and early presented to care. Logistic regression was performed to estimate odds ratio and 95% confidence intervals. Results show that 51.9% were late presenters for HIV. No differences were found in gender distribution, marital status, or access to health services between cases and controls. Participants who undertook an HIV test by doctor indication were more likely to present late compared with those who tested for HIV by their own initiative. Also, individuals taking less time to initiate ART are more likely to present late. This study highlights the need to better understand reasons for late presentation to HIV care in Cape Verde. People in older age groups should be targeted in future approaches focused on late presenters to HIV care.

Manifestations of inflammatory bowel disease in patients of Haitian and Cape Verdean descent

OBJECTIVE

Several studies have reported unique ethnic phenotypes of inflammatory bowel disease (IBD). An appreciation of disease manifestations in different populations may improve clinical outcomes. There are no studies examining IBD in patients of Haitian or Cape Verdean descent. We sought to define the IBD phenotype in these populations.

MATERIALS AND METHODS

This was a retrospective review comparing Haitian and Cape Verdean immigrant IBD patients to Caucasians, all receiving care at Boston Medical Center in Boston, Massachusetts, USA. The following variables were analyzed: family history, smoking history, vaccinations/cancer screening, age of diagnosis, disease duration, disease location, medication use, and complications.

RESULTS

Thirty-one Haitians and 21 Cape Verdeans were matched to Caucasian controls. Haitians (mean age 42 years) and Cape Verdeans (mean age 47 years) with Crohn's disease were diagnosed with IBD later than Caucasians (mean age 31 years, p = 0.04 and 0.02, respectively). Haitians with Crohn's were less likely to have a history of tobacco use compared to Caucasians (13% vs. 51%, p = 0.02). Cape Verdeans with Crohn's were less likely to have perianal involvement (0% vs. 50%, p = 0.01). Haitians with IBD were less likely to have ever used glucocorticoids (48% vs. 76%, p = 0.02). There was no difference in vaccination rates, cancer screening, or disease complications.

CONCLUSIONS

This study demonstrates differences in IBD presentation and disease course among Haitians and Cape Verdeans. Our results suggest a more mild disease in these ethnic groups. Future studies are needed to identify the influence of environmental factors.

Staphylococcus aureus in former Portuguese colonies from Africa and the Far East: missing data to help fill the world map

The aim of the present study was to determine the prevalence and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among patients and healthcare workers in Angola (ANG), São Tomé and Príncipe (STP), Cape Verde (CV) and East Timor (ET), and to characterize the antimicrobial susceptibility, virulence content and population structure of all S. aureus. Despite the importance of MRSA as a major human pathogen, data from these former Portuguese colonies in Africa and Asia are scarce. A total of 2065 nasal swabs recovered between 2010-14 were included in the study. Antimicrobial susceptibility testing and molecular characterization of S. aureus showed: (i) a very high MRSA prevalence in ANG (61.6%), moderate in STP (25.5%), low in CV (5.6%) and null in ET; (ii) a high prevalence of Panton-Valentine leukocidin in STP (36.8%), ET (29.2%) and CV (28.3%) contrasting with ANG (7.9%); (iii) ST5-SCCmecIVa, ST8-IV/V and ST5-VI were the major MRSA clones in ANG (65.2%), STP (44.8%) and CV (50%), respectively; (iv) a high resistance to trimethoprim-sulfamethoxazole in ANG (66.5%) and STP (50.9%), to rifampin in ANG (77.3%), and to tetracycline in STP (26.3%) and ET (20.8%); (v) three major methicillin-susceptible S. aureus clones (ST15, ST508, ST152) were present in all four countries. Age <18 years (OR 2.03, 95% CI 1.24-3.31), previous surgery (OR 2.45, 95% CI 1.24-4.83), no smoking (OR 4.04, 95% CI 1.05-15.50), and longer hospitalization (OR 2.53, 95% CI 1.49-4.28) were risk factors for MRSA carriage. This study provided the first comprehensive overview on MRSA in former Portuguese colonies in Africa and Asia, missing data in the world map.

How do dual practitioners divide their time? The cases of three African capital cities

Health professionals dual practice has received increasing attention, particularly in the context of the universal health coverage movement. This paper explores the determinants of doctors' choices to become a dual practitioner and of dual practitioners' choices to allocate time to the private sector in the capital cities of Mozambique, Guinea Bissau and Cape Verde. The data are drawn from a survey conducted in 2012 among 329 physicians. We use a two-part model to analyse the decision of both public and private practitioners to become dual practitioners, and to allocate time between public and private sectors. We impute potential earnings in public and private practice by using nearest-neighbour propensity score matching. Our results show that hourly wage in the private sector, number of dependents, length of time as a physician, work outside city, and being a specialist with or without technology all have a positive association with the probability of being a dual physician, while number of dependents displays a negative sign. Level of salaries in the public sector are not associated with dual practice engagement, with important implications for attempts aimed at retaining professionals in the public sector through wage increases. As predicted by theory that recognises doctors' role in price setting, earnings rates are not significant predictors of private sector time allocation; personal characteristics of physicians appear more important, such as age, number of dependents, specialist without technology, specialist with technology, and three reasons for not working more hours in the private sector. Answers to questions about the factors that limit working hours in the private sector have significant predictive power, suggesting that type of employment in the private sector may be an underlying determinant of both dual practice engagement and time allocation decisions.

Monitoring organic and inorganic pollutants in juvenile live sea turtles: results from a study of Chelonia mydas and Eretmochelys imbricata in Cape Verde

Despite the current environmental concern regarding the risk posed by contamination in marine ecosystems, the concentrations of pollutants in sea turtles have not been thoroughly elucidated. In the current study, we determined the concentrations of 18 organochlorine pesticides (OCPs), 18 polychlorinated biphenyls (PCBs), 16 polycyclic aromatic hydrocarbons (PAHs) and 11 inorganic elements (Cu, Mn, Pb, Zn, Cd, Ni, Cr, As, Al, Hg and Se) for the first time in two sea turtle species (Chelonia mydas and Eretmochelys imbricata). Only five of the 18 analyzed OCPs were detected in both species. The average total OCP concentration was higher in green turtles than in hawksbills (0.33 ng/ml versus 0.20 ng/ml). Higher concentrations of individual congeners and total PCBs were also detected in green turtles than in hawksbills (∑PCBs=0.73ng/ml versus 0.19 ng/ml), and different PCB contamination profiles were observed in these two species. Concerning PAHs, we also observed a different contamination profile and higher levels of contamination in green turtles (∑PAHs=12.06 ng/ml versus 2.95 ng/ml). Di- and tri-cyclic PAHs were predominant in both populations, suggesting a petrogenic origin, rather than urban sources of PAHs. Additionally, all of the samples exhibited detectable levels of the 11 inorganic elements. In this case, we also observed relevant differences between both species. Thus, Zn was the most abundant inorganic element in hawksbills (an essential inorganic element), whereas Ni, a well-known toxicant, was the most abundant inorganic element in green turtles. The presence of contaminants is greater in green turtles relative to hawksbill turtles, suggesting a greater exposure to hazardous chemical contaminants for green turtles. These results provide baseline data for these species that can serve for future monitoring purposes outlined in the EU's Marine Strategy Framework Directive.

Potential adverse effects of inorganic pollutants on clinical parameters of loggerhead sea turtles (Caretta caretta): results from a nesting colony from Cape Verde, West Africa

A large number of nesting loggerhead sea turtles (n = 201) were sampled to establish the blood levels of 11 elements (Cu, Mn, Pb, Zn, Cd, Ni, Cr, As, Al, Hg, and Se). Almost all of the samples showed detectable levels of these 11 elements, and Zn and Se exhibited the highest concentrations (median values as high as 6.05 and 2.28 μg/g, respectively). The median concentrations of the most toxic compounds, As, Cd, Pb, and Hg, were relatively low (0.38, 0.24, 0.06, and 0.03 μg/g, respectively). We also determined the haematological and biochemical parameters in a subsample of 50 turtles to evaluate the potential effects of these contaminants on clinical parameters and found several associations. Our study reinforces the usefulness of blood for the monitoring of the levels of contaminating elements and their adverse effects on blood parameters in sea turtles.

Negotiating markets for health: an exploration of physicians' engagement in dual practice in three African capital cities

Scarce evidence exists on the features, determinants and implications of physicians’ dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians’ engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% ‘outside’ public facilities, 8% ‘inside’ and 16% both ‘outside’ and ‘inside’. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians’ decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians’ engagement in professional activities, and contributes to an evidence base for its regulation.

Distribution of polymorphisms IL4-590 C/T and IL4 RP2 in the human populations of Madeira, Azores, Portugal, Cape Verde and Guinea-Bissau

The IL4 gene is located on chromosome 5q23.3-31.2. Polymorphisms within this cytokine gene, like the derivative allele T of IL4-590, have been reported as being associated to elevated IgE serum levels and asthma. In the present work, the allelic and genotypic frequency of the IL4-590 and IL4 RP2 polymorphisms was carried out in 599 individuals from Madeira, Azores, Portugal mainland, Cape Verde and Guinea-Bissau and in a sample of 101 asthmatics from Madeira population. In all populations the polymorphisms were in LD and presented a significant dissimilar allelic and genotypic distribution (p<0.05) except between mainland Portugal and Madeira when compared to Azores. Significant differences regarding both loci were found between Madeira population and the group of asthmatics. Genotype 183183TT frequency is higher for African populations while 253253CC prevails in Caucasian populations. The existence of a Hardy-Weinberg Disequilibrium in Guinea-Bissau population not observed in neutral markers leads to the hypothesis of natural selection occurring in these loci probably associated to a rapid population growth an hypothesis strengthened by neutral STRs D5S818 and CSF1PO gene diversity.

Risk factors for perinatal death in Cape Verde

Risk factors for perinatal death in the Cape Verde islands were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case-control study in 1992-93. Prospectively gathered information on risk factors was obtained from medical records supplemented with post-partum interviews and anthropometric measurements of mothers and infants. No autopsies were performed. Multiple logistic regression analysis was applied. Out of 23 alleged maternal and two alleged infant risk factors, the following seven proved significantly and independently correlated with perinatal death: first pregnancy (odds ratio [OR] = 2.9); previous hypertensive disease (OR = 4.2); previous perinatal death (OR = 4.6); pre-eclampsia (OR = 7.0); non-cephalic fetal presentation (OR = 17.1); male infant (OR = 2.1) and maternal post-partum fever (OR = 3.1). The perinatal mortality rate was calculated as 37-46/1000 total births. A reduction in the mortality rate warrants antenatal and obstetric care with emphasis on primiparous women; improved detection and treatment of hypertensive disorders and genital infections; and improved intrapartum fetal observation and resuscitation routines.