RESUMO
BACKGROUND: HIV remains a critical global public health challenge. In 2022, it was estimated that approximately 39.0 million people worldwide were living with HIV, and of these, around 29.8 million were receiving antiretroviral therapy (ART). The objective was to evaluate the clinical and epidemiological profile and factors associated with viral load (VL) non-suppression in people living with HIV/AIDS at the Maputo Military Hospital (CITRA/MMH). METHODS: A retrospective cross-sectional analytical study was conducted on 9105 people aged 15 years and over. We use secondary data from participants on ART for at least 2 years being followed up between the years 2019-2020 at CITRA/MMH. Those recently enrolled (on ART < 1 year) were excluded and data analysis was performed using STATA version 16. Pearson's chi-square test and logistic regression were used for statistical modeling of viral non-suppression with a 95%/CI confidence interval and p < 0.05. RESULTS: Among a total of 9105 HIV participants included, 52.8% (n = 4808) were female and 13.6% (n = 1235) were military personnel. The average age was 47.9 years (standard deviation ± 12.1), with the most prevalent age group being individuals aged between 25 and 59, totalizing 7,297 (80.2%) participants. Only 5395 (100%) participants had VL results. Among these, 23.1% (n = 1247) had a result VL non-suppressed. Single marital status (Adjusted Odds Ratio [AOR] = 4.8, 95%CI: 3.93-5.76, p < 0.001), with active tuberculosis (AOR = 4.6, 95%CI: 3.15-6.63, p < 0.001) and current ART regimen in categories TDF + 3TC + EFV (AOR = 12.7, 95%CI: 9.74-16.63, p < 0.001), AZT + 3TC + NVP (AOR = 21.8, 95% CI: 14.13-33.59, p < 0.001) and "other" regimens (AOR = 25.8, 95%CI: 18.58-35.80, p < 0.001), when compared to the TDF + 3TC + DTG regime, were statistically significant for viral non- suppression. CONCLUSION: The study highlights the crucial role of ART adherence and ongoing monitoring to achieve viral suppression, particularly among adults aged 25 to 59. It underscores the need for transitioning eligible individuals to DTG-based regimens and addressing the implications of single marital status and comorbid conditions like active tuberculosis. The study emphasizes the importance of ARV adherence and continuous monitoring to meet the UNAIDS 95-95-95 targets and improve clinical outcomes for people living with HIV/AIDS.
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Infecções por HIV , Hospitais Militares , Carga Viral , Humanos , Feminino , Masculino , Adulto , Estudos Transversais , Estudos Retrospectivos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Pessoa de Meia-Idade , Adulto Jovem , Fármacos Anti-HIV/uso terapêutico , AdolescenteRESUMO
BACKGROUND: Mozambique is a malaria endemic country with an estimated prevalence of malaria in children 6-59 months old that is twice as high in rural areas (46.0%) as in urban areas (18.0%). However, only 46.0% of women aged 15-49 years had complete knowledge about malaria in 2018. This study aimed to identify the factors associated with malaria knowledge among women of reproductive age in a high malaria burden district. METHODS: Data from a cross-sectional study, using a population-based malaria research study in Mágoe District, 2019, were analysed. This analysis included women aged 15-49 years. A multivariate logistic regression model was developed to determine factors associated with complete knowledge of malaria that calculated adjusted odds ratio (aOR) and 95% confidence interval (CI) at a p < 0.05 significance level. Complete malaria knowledge was defined as when a woman correctly identified: fever as a malaria symptom, mosquito bites as the means of malaria transmission, mosquito nets as a tool for malaria prevention, malaria as curable, and were able to name an anti-malarial. RESULTS: A total of 1899 women were included in this analysis. There was complete malaria knowledge among 49% of the respondents. Seventy one percent mentioned fever as one of malaria symptoms, 92% mentioned mosquito bite as the cause of malaria infection, 94% identified that mosquito nets prevent malaria, 92% agreed that malaria has cure, and 76% were able to name at least one anti-malarial medicine. In the multivariate analysis, the following characteristics were associated with significantly higher odds of having complete malaria knowledge: having a secondary school or above education level (adjusted Odds Ratio, aOR = 2.5 CI [1.3-4.6] p = 0.005), being from the middle socioeconomic status group (aOR = 1.5 CI [1.1-2.1] p = 0.005), being from older age group of 35-39 (aOR = 1.9; CI [1.1-3.1] p < 0.001), having 1-2 children (aOR = 1.8; CI [1.2-2.6] p = 0.003), and having interviews completed in Portuguese or Cinyungwe (aOR = 2.3; CI [1.3-4.1] p = 0.004 and aOR = 2.1; CI [1.5-2.8] p < 0.001, respectively). CONCLUSION: Most women in this study had some malaria knowledge, but gaps in complete knowledge remained. In order to broaden knowledge, educational messages about malaria prevention should be more effectively targeted to reach younger, less-educated women and in non-dominant languages.
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Antimaláricos , Malária , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Malária/epidemiologia , Malária/prevenção & controle , Pessoa de Meia-Idade , Mosquiteiros , Moçambique/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. METHODS: We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group. RESULTS: Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. CONCLUSION: Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.
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Infecções por HIV , Profissionais do Sexo , Minorias Sexuais e de Gênero , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Homossexualidade Masculina , Humanos , Masculino , Moçambique/epidemiologia , Grupos PopulacionaisRESUMO
BACKGROUND: Accurate estimates of key population size are necessary to design programs and policies to prevent and reduce new HIV infections and to monitor the dynamics of the epidemic. The first bio-behavioral surveillance surveys, with population size estimation activities, were conducted in Mozambique in 2010 to 2014. METHODS: We used multiple methods-sequential sampling, unique object, unique event, and service multipliers-to estimate the numbers of men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID) living in major cities in Mozambique. Results were applied to population sizes to estimate the number of people living with HIV and those unaware of their status. RESULTS: Our results suggest that Maputo has 5182 MSM, which constitutes 1.0% of the adult male population (plausibility bounds, 0.5%-2.6%); Beira, 1796 (1.4%, 1.0%-2.2%); and Nampula, 874 (0.6%, 0.4%-1.6%). The number of FSW population is 1514 (0.6%; plausibility bounds, 0.4%-1.6% of adult female city population) in Maputo, 2616 (2.2%, 1.3%-6.0%) in Beira, and 2052 (1.4%, 0.8%-5.9%) in Nampula. The number of people who inject drugs is 2518 (0.4%; plausibility bounds, 0.3%-0.5% of adult male city population) in Maputo and 1982 (1.2%, 0.6%-1.9%) in Nampula. People living with HIV ranged from 25 to 497 MSM, 382 to 664 FSW, and 712 to 1340 PWID, whereas people living with HIV unaware of their HIV positive serostatus ranged from 24 to 486 MSM, 327 to 552 FSW, and 265 to 468 PWID. CONCLUSIONS: Although estimates generally fell within the range of those from the literature, the triangulation of survey and programmatic data over time will increasingly refine population size estimates and support the optimal allocation of limited resources.
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Infecções por HIV , Preparações Farmacêuticas , Profissionais do Sexo , Minorias Sexuais e de Gênero , Abuso de Substâncias por Via Intravenosa , Adulto , Cidades , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Moçambique/epidemiologia , Densidade Demográfica , Prevalência , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
Mineworkers are considered a population at risk for HIV due to risk behaviors associated with migratory work patterns. This was the first study in Mozambique to determine the prevalence of HIV and associated demographic and risk behaviors, and assess use and access to prevention and healthcare services among Mozambicans working in South African mines. Men who had worked in a South African mine in the past 12 months were recruited between February and May 2012 using time location sampling (TLS) at the Ressano Garcia border between Mozambique and South Africa. Demographic and behavioral data were collected through a standardized questionnaire, and HIV prevalence was estimated by testing dried blood spots (DBS) with two enzyme immunoassays. In total, 432 eligible mine workers were recruited. Mean age was 43 years. Most were married or cohabitating; among them, 12.6 % had two or more wives/marital partners in Mozambique. In the 12 months preceding the survey, 24.7 % had an occasional sexual partner, and 6.6 % had at least one partner who was a female sex worker. Only one in five (18.5 %) used a condom during last sex. HIV prevalence among mineworkers was 22.3 %, and 74.6 % of those who tested positive as part of the survey did not know their status. HIV prevalence was significantly higher (p = 0.018) among those that were uncircumcised (31.2 %) than those who were circumcised (18.5 %). Multiple partners (multiple spouses, cross-border relations, and multiple occasional partnerships), inconsistent condom use, and a high proportion of infected mineworkers who do not know their HIV status increases the risk of HIV transmission in this population. Combination strategies involving the promotion of condom use, HIV testing, and male circumcision should be strengthened among mineworkers.
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Emprego , Infecções por HIV/epidemiologia , Programas de Rastreamento/métodos , Assunção de Riscos , Comportamento Sexual , Migrantes , Adulto , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Mineração , Moçambique/etnologia , Prevalência , Parceiros Sexuais , Fatores Socioeconômicos , África do Sul/epidemiologia , Inquéritos e Questionários , Populações Vulneráveis , Adulto JovemRESUMO
Introduction: epidemiological estimates from the 2021 Joint United Nations Program on HIV/AIDS (UNAIDS) emphasize the existing gender disparities, where women face a higher risk of HIV/AIDS exposure. In Mozambique, as of 2021, the HIV prevalence rate among the adult population stood at 12.5%, with an even more concerning rate of 15.4% among women of reproductive age. Methods: a cross-sectional study was carried out with secondary data from the Survey on National Indicators of Vaccination, Malaria, and HIV/AIDS (IMASIDA 2015), where we included married women, both civil marriage and common law marriage of reproductive age 15-49 years. Statistical analyses, including chi-squared tests and logistic regression models, accounting for survey design, were employed to assess associations. Results: the study findings showed that HIV prevalence was higher among married women aged 35-49 years (aOR=2.5; 95% CI: 1.3-4.6; p=0.005), those without formal education (aOR=7.7; 95% CI: 1.1-52.9; p=0.038) and those with primary education (aOR=9.8; 95% CI: 1.6-60.1; p=0.014), those who experienced domestic violence (aOR=1.8; 95% CI: 1.0-3.2; p=0.04), had an uncircumcised partner (aOR=1.9; 95% CI: 1.2-3.1; p=0.008), and had three or more lifetime sex partners (aOR=3.6; 95% CI: 2.9-7.3; p<0.001). Women who were in one lifelong union had a lower risk of HIV positivity (aOR=0.5; 96%CI: 0.3-0.8, p=0.005). Conclusion: the findings of this study highlight sociodemographic, behavioral, and violent factors associated with HIV prevalence among women. These findings underscore the importance of targeted interventions and education programs aimed at reducing HIV transmission among females and promoting safer sexual practices.
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Escolaridade , Infecções por HIV , Casamento , Humanos , Feminino , Moçambique/epidemiologia , Adulto , Estudos Transversais , Adulto Jovem , Adolescente , Prevalência , Infecções por HIV/epidemiologia , Pessoa de Meia-Idade , Casamento/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Comportamento Sexual/estatística & dados numéricosRESUMO
The human immunodeficiency virus (HIV) is a global public health problem, disproportionally affecting sub-Saharan African countries including Mozambique. In 2019, of 150,000 estimated HIV-infected children in Mozambique, only 95,080 were on antiretroviral treatment and 73% virally suppressed. The objective of this study was to determine the characteristics associated with viral suppression in children. A cross-sectional study was carried out using records of viral load samples from children aged 0 to 14 years old who underwent viral load tests in 2019 in Mozambique. Secondary analyses were conducted on data obtained from Data Intensive Systems and Applications (DISA) of children enrolled in health facilities who had viral load tests registered. Viral suppression was defined as the presence of less than 1,000 copies/ml of blood. Multivariate logistic regression analysis was used to evaluate the characteristics associated with viral suppression. Of the 33,559 viral load sample records analyzed, 53% (17,794/33,559) were female. The average patient age was 8 (sd ± 4) years old. About 44% (14,888/33,559) of the children had a suppressed viral load, with 55% (8,258/14,888) being female and 16% (2,319/14,888) belonging to the 1-4 years old age group. Characteristics associated with viral suppression were the age groups of 5-9 years [AOR = 1.73; 95% CI 1.34-2.23; p<0.001] and 10-14 years old [AOR = 1.92; 95% CI 1.50-2.48; p<0.001] versus < 1 year. Other factors such as living in Maputo City [AOR = 1.61; 95% CI 1.26-2.05; p <0.001] versus Tete Province were also associated with viral suppression. Factors such as being male [AOR = 0.83; 95% CI 0.80-0.87; p <0.001)], living in the provinces of Niassa [AOR = 0.75; 95% CI 0.56-0.99; p <0.003], Cabo Delgado [AOR = 0.77; 95% CI 0.60-0.99; p <0.045] and Zambezia [AOR = 0.72 (95% CI: 0.56-0.92, p<0.008)] versus Tete Province, or being on ART for 2-5 years [AOR = 0.72 (95% CI: 0.61-0.85, p<0.001)] versus 11-14 years were associated with not being virally suppressed. More than half of children did not achieve viral suppression. The odds of viral suppression were highest among children aged 5-14 years and among children living in Maputo city. Further research is needed to better understand the challenges in achieving viral suppression in children.
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Infecções por HIV , Carga Viral , Humanos , Criança , Moçambique/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Infecções por HIV/epidemiologia , Feminino , Pré-Escolar , Adolescente , Masculino , Lactente , Estudos Transversais , Recém-Nascido , Fármacos Anti-HIV/uso terapêuticoRESUMO
INTRODUCTION: The use of face masks is one of the preventive measures that Mozambique adopted in order to limit the spread of COVID-19. A study carried out from May 25 to June 6, 2020 found that although many wore masks, incorrect use was observed in 27.5% of the population observed. This data collection aimed to measure the degree of mask use compliance during a more protracted, higher second wave of transmission. METHODOLOGY: A cross-sectional study was conducted in the City of Maputo from 19 to 28 October 2020 through direct observation of mask use of all individuals present in markets, supermarkets and bus terminals. The data were collected using mobile phones with the Open Data Kit Collect (ODK) data collection program. Sociodemographic characteristics, mask use, and type of mask used were documented. Factors associated with incorrect mask use were evaluated considering sex, age, observation period and location. RESULTS: A total of 49,404 individuals were observed, of whom 24,977(50.6%) were male, 46,484 (94.1%) were adults and 17,549 (35.5%) were observed in the markets. An observed 41,786 (84.6%) wore a mask, of whom 33,851 (81.0%) used it correctly. Not covering the mouth and nose was common; observed in 4,649 (58.5%) of those using incorrectly. Of different types of masks, fabric masks were most often used incorrectly 7,225 (21.4%). The factors associated with incorrect mask use were female gender (OR = 1.2 [1.1-1.3], p <0.001), observation in peri-urban versus urban areas (OR = 1.9 [1.8-2.1], p <0.001) and observation during the afternoon (OR = 1.5 [1.5-1.6], p <0. 001). CONCLUSION: A high proportion of observed individuals wore a mask in the context of prevention of COVID-19, however some non-use and incorrect use persists. Intensified public awareness of the correct use of the mask is recommended, especially in peri-urban areas and at the end of the day.
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COVID-19 , Adulto , Humanos , Masculino , Feminino , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Moçambique/epidemiologia , Máscaras , Meio AmbienteRESUMO
In the past ten years, the prevalence of primary Human Immunodeficiency Virus (HIV) drug resistance has ranged from zero to 25%, with higher and increasing rates in countries with access to antiretroviral therapy (ART), a specific case in Mozambique. World Health Organization (WHO) recommended that countries implement and routinely evaluate representative HIV drug resistance (HIVDR) research to monitor the emergency and transmission of HIV drug resistance mutations. This study aimed to describe the functioning of the system and also to identify gaps in the sensitivity, representativeness and quality of the data using the WHO methodology for Pre-Treatment and Acquired Approaches. We conducted a descriptive evaluation of the information system for surveillance of HIVDR in Mozambique in 2017-2018, based on updated guidelines for evaluating of public health surveillance systems from the Center for Disease Control and Prevention (CDC). The evaluation was conducted in all provinces using secondary data extracted from a cross-sectional survey database on HIVDR, with HIV positive cases at the beginning of ART aged ≥15 years. The system was described through informal conversations with HIVDR stakeholders and the simplicity, data quality and representativeness attributes were evaluated. With 322 positive cases at the beginning of ART (mean age=32.5 years, SD±11.1), about 63.0% (203/322) cases were women and 37.6% (121/322) men. The system was implemented in 25 health facilities distributed across all 11 Mozambican provinces and was considered representative. The system used two data collection instruments, the ART book and the form accompanying samples sent to the reference laboratory. The ART form, with 27 variables, was sent offline at two levels (health facility and National Institute of Health (NHI)), accompanied by dried blood spot samples for viral load testing and genotyping in the NHI virology laboratory, and was considered simple according to the standardized criteria. The system´s data quality was considered regular at 79.9%, with about 59.8% (1156/1932) of variable fields completed and 100% (1932/1932) consistency. The system used a single national laboratory to measure the prevalence of resistance to HIV drugs and was considered simple, with regular quality and representative data. We recommended public health efforts such as conducting genotyping tests be expanded to the provincial level, and periodic monitoring of system´s data collection procedures using forms.
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Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Masculino , Humanos , Feminino , Adulto , HIV-1/genética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Moçambique/epidemiologia , Estudos Transversais , Farmacorresistência Viral/genética , Antirretrovirais/uso terapêutico , Carga Viral , Prevalência , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêuticoRESUMO
Introduction: the prevalence of human immunodeficiency virus (HIV) in Mozambique has increased from 11.5% in 2009 to 13.2% in 2015. The Mozambique Ministry of Health (MOH) developed a 5-year strategy (2013-2017) for male voluntary medical circumcision (VMMC) to increase in the provinces where there is the greatest number of HIV. We aimed to evaluate the health information system for monitoring and evaluating VMMC in Mozambique from 2013-2019. Methods: we reviewed the records of the National Health Information System for Monitoring and Evaluation (SIS-MA) database for VMMC of the MOH. The evaluation was based on the updated guidelines for the evaluation of public health surveillance systems of the Centers for Disease Control and Prevention. Results: the coverage rate for VMMC in Mozambique in the period under study was (89%) (1,784,335/2,000,000). The system was expected to circumcise for the year 2019 (162,052) and 390,590 was reached, exceeding the target 241.0% (390,590/162,052). Of the total number of men circumcised, 0.7% (12,391/1,784,335) were HIV-positive (previously tested) and 0.4% (6,382/1,784,335) had a record of adverse events in the period under review (2013-2019). Zambézia Province had the highest VMMC coverage (in numbers) at 16.0% (396,876/2,476,395) while Maputo City had the least 19.7% (107,104/543,096). The system was able to operate both online and offline and continue functioning with introducing new changes (e.g. the new male circumcision complication reporting). Conclusion: the system was representative, flexible, simple, with good data quality and low acceptability. We recommended continuous and routine entry of quality data into the system, guide organizations for improved functioning.
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Circuncisão Masculina , Infecções por HIV , Soropositividade para HIV , Sistemas de Informação em Saúde , Humanos , Masculino , Moçambique , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controleRESUMO
Introduction: the risk of a worker becoming ill due to coronavirus disease 2019 (COVID-19) is related to occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the need to restore work activities in Mozambique, the study was conducted with the aim of identifying the occupational categories most affected by COVID-19 in the former in the period from March to July 2020. Methods: this is a cross-sectional descriptive study, in which data from professions of confirmed cases of COVID-19 from 22 March to 29 July 2020 in Mozambique were analyzed. The professionals' data were reported daily by the National Institute of Health (NIH) and merged into a single database and exported to Excel, the latter categorized according to standard operating procedure (SOP) and descriptive statistics performed for its analysis. Results: in the period under analysis, 1,127 professionals were diagnosed with COVID-19, divided into 11 categories. Nampula province had the highest frequency of cases with 25.00% (277). The highest frequency of cases was registered in the domestic professional category, which had 16.77% (189/1,127) with the female sex being more frequent, 79.37% (150/189); and defense and security had 14.20% (160/1,127) of cases and male gender with 91.25% (146/160); Health workers had 13.04% (147/1,127), and the maximum number of COVID-19 cases was recorded in June with 58.50% (86/147). Conclusion: the professional categories most affected by COVID-19 in the period under review correspond to those groups that carry out activities requiring a physical presence at the workplace and from this; it is recommended that professionals reinforce preventive measures.
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COVID-19 , Humanos , Masculino , Feminino , COVID-19/epidemiologia , SARS-CoV-2 , Estudos Transversais , Moçambique/epidemiologia , Local de TrabalhoRESUMO
Introduction: contact tracing is an important strategy to interrupt the spread of infectious disease and prevent new cases. After the confirmation of the first positive case of COVID-19 in Mozambique on March 22, 2020, case investigation and contact tracing were immediately initiated, which included clinical and laboratory monitoring of cases and contacts throughout the quarantine period. We aim to describe the methodology and impact of early investigation and contact tracing. Methods: in the context of implementation of the national COVID-19 preparedness and response plan, guidelines and forms for contact tracing were adapted from the existing World Health Organization (WHO) and The Centers for Disease Control and Prevention (CDC) guidelines. The case definition used was "patient with travel or residency history in a country reporting local transmission of COVID-19 during the 14 days prior to the onset of symptoms". The cases interviews were face to face and contacts were followed up daily by phone calls for 14 consecutive days: using a structured questionnaire. Data were entered in an electronic Excel database. We collected samples for diagnosis of those who developed symptoms and provided quarantine follow up. Results: a total of 8 cases were confirmed, of which 6 (75%) were male. The average age of the cases was 51, median 44 (range: 31 to 80) years old. The majority of cases presented common symptoms of COVID-19, including headaches (50%), cough (37.5%), and fever (25%). Our case series included the country´s index case, two close positive contacts, and 5 additional cases that were not epidemiologically linked to the others and identified by the COVID-19 national surveillance system. All of them were identified in Maputo City from March 22 to March 28. Cases had a total of 123 contacts and all of them were tracked; 79 were contacts of the first case. From all the contacts in follow up, two had laboratory confirmed COVID-19. All cases and contacts were quarantined and none of them developed severe symptoms or required hospitalization. Conclusion: timely case identification and systematic contact tracing can be effective in breaking the chain of COVID-19 transmission when there is strong collaboration between epidemiological, laboratory surveillance and case management.
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COVID-19 , Busca de Comunicante , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/epidemiologia , Busca de Comunicante/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Quarentena , SARS-CoV-2RESUMO
Cholera disproportionately affects the most vulnerable segments of the population, particularly those who have low or no access to basic water, sanitation, and hygiene (WASH). Despite some improvements in WASH conditions, cholera still represents a persistent challenge in Mozambique, where outbreaks occur almost every year, with high case fatality rates, posing a threat to the country's economic development. The Government of Mozambique has started developing a revised National Cholera Plan (NCP), which aligns with "ending cholera-a global roadmap to 2030" launched by the Global Task Force on Cholera Control (GTFCC) in 2017. Ending cholera represents a critical step towards achieving the sustainable development goals and requires effective prevention and control interventions, ensuring that no one is left behind. The NCP must use a multi-sector approach and broad stakeholder collaboration with well-coordinated roles and functions of different partners to address major areas for cholera elimination - water and sanitation, health care services and management, epidemiology and surveillance, and health and hygiene promotion. Every cholera death is preventable. In this review, we reiterate the need for effective coordinated actions to control and eliminate cholera in Mozambique and decrease the cholera burden, enabling a healthy population over the generations.
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Cólera , Humanos , Cólera/epidemiologia , Cólera/prevenção & controle , Moçambique/epidemiologia , Saneamento , Surtos de Doenças/prevenção & controle , ÁguaRESUMO
Introduction: Mozambique antiretroviral therapy is a database used to monitor patients receiving antiretroviral treatment (ART). This study's objective was to evaluate the system for the purpose to monitor patients receiving ART. Methods: data from 287,052 patients who started ART from January to December 2017 were verified, and retention in care was assessed for 2018 in Mozambique. The Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems were used to conduct the evaluation. Simplicity, flexibility, data quality, representativeness and stability attributes were evaluated. Results: a total of 93% (266,880/287,052) of patients on ART were adults ≥15 years old, and 65% (186,677/287,052) were female. The system was complex, it involved four organisations and its management was online. Data quality was moderate with 19% (1,533,885/8,037,456) of empty variable fields, 0.04% (123/287,052) observations with birth date later than the initial ART date, 0.2% (424/287,052) and 23% (68,039/287,052) with initial ART date and diagnosis date, later than the next ART pickup date. Nationally, 19%(31/161) of the districts did not have data in the information system. MozART cover health facilities with electronic patient tracking systems. Hence did not represent all patients on ART. While it was not possible to add variables of the electronic patient tracking, the system was stable as neither data or server interruptions were reported. Conclusion: the system was useful, stable, with moderate data quality, complex, not flexible and not representative. We recommend to health facilities and partners to develop and distribute procedures for data validation and completeness and report all patient tracking variables in the system.
Assuntos
Infecções por HIV , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Confiabilidade dos Dados , Bases de Dados Factuais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , MoçambiqueRESUMO
Introduction: multidrug-resistant tuberculosis (MDR-TB) remains a public health problem worldwide. In Mozambique, cases of MDR-TB have increased annually. In 2018, 1,206 cases were reported, as compared to 943 cases in 2017. The aim of this study was to assess the surveillance system for multidrug-resistant tuberculosis in Maputo City. Methods: an extract from the national database was considered for a cut-out of the City of Maputo in the period 2017-2018; the study was conducted per the guidelines of the Centers for Disease Control and Prevention, where the description of the system was carried out, and evaluation of the attributes. Each attribute was evaluated according to the established criteria and parameters. Results: the surveillance system is based on the collection of data in health centers. Four hundred and six cases of MDR-TB were notified, of which 56.8% (231/406) were male and 95.9% (386/406) were ≥15 years. The system was complex with 4 levels of information transmission. With regard to flexibility, there was no changing the variables in the database. Acceptability was good. The quality of the data was regular with discrepancy of data of 14.5%. The system was considered stable as there was no system interruption. Timeliness with case notification monthly. The system sensitivity was 72.9%, the positive predictive value (PPV) was 2.3% and regarding utility the system has fulfilled its objectives. Conclusion: the system was not flexible, the data quality was regular, had moderate sensitivity and low positive predictive value. Continuous assessment of data and scale up the diagnosis for the detection of cases of MDR-TB is recommended.
Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Antituberculosos/uso terapêutico , Bases de Dados Factuais , Feminino , Humanos , Masculino , Moçambique/epidemiologia , Saúde Pública , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
Since the announcement of the coronavirus disease (COVID-19) pandemic in January 30th 2020, 68 countries reported to the World Health Organization that they were experiencing disruptions in malaria diagnosis and treatment. This situation had the potential to lead to delays in diagnosis and treatment, which could result in an increase in severe cases and deaths. This analysis was based on findings from a field visit, carried out between June 30th and July 1st, 2020, to a warehouse, to two health facilities, and a meeting with a community health worker, and an descriptive epidemiologic data analysis of health information system (HIS) to evaluate trends of the number of people tested for malaria and number of malaria cases reported, by comparing data from 2018, 2019 and 2020 for the period between January and May. The two health facilities and the warehouse had about two months of stock of antimalarial drugs, and patients with malaria symptoms were being tested for malaria at the COVID-19 screening site. The HIS data showed that the number of reported malaria cases decreased by 3.0% (177.646/172.246) in April, and 7.0% (173.188/161.812) in May, when comparing 2019 and 2020 data. People tested for malaria in community increased by 39.0% (190.370/264.730), between 2019 and 2020. The COVID-19 may have had a negative impact on the diagnosis and treatment of malaria in health facility (HF). The decrease in people tested for malaria in the health facilities may have overwhelmed the activities of the community.
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COVID-19 , Malária/epidemiologia , Vigilância da População/métodos , Antimaláricos/administração & dosagem , Antimaláricos/provisão & distribuição , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , Programas de Rastreamento/métodos , Moçambique/epidemiologiaRESUMO
INTRODUCTION: migrant mine workers are susceptible to engage in risky sexual behaviour due to their high mobility, putting at risk their families and home communities. Because comprehensive knowledge about HIV/AIDS is a key factor in reducing HIV infections, this study aims to understand the current state of knowledge about HIV in these communities, estimate HIV prevalence and evaluate the risk behaviour associated with comprehensive knowledge. METHODS: secondary data analysis of a cross-sectional survey conducted in two communities of origin of mine workers in Gaza Province, targeting current and former mine workers of the South African mines and their relatives. Households were selected using simple random sampling methodology. Chi-squared tests and logistic regression analysis were used to assess statistical differences between comprehensive knowledge and categorical variables. RESULTS: from a total of 1,012 participants, only 22.0% of the respondents had comprehensive knowledge about HIV. The overall HIV prevalence in these communities was 24.2% and the HIV prevalence in individuals with comprehensive knowledge was 18.6%. Among the respondents with comprehensive knowledge, 33.1% were male, 22.0% have worked in a South African mine and the median age was 34 years old. Individuals from Muzingane were almost twice as likely (AOR 1.7; 95% IC 1.21-7.44, p=0.014) to have less comprehensive knowledge about HIV than their counterparts in Patrice Lumumba. CONCLUSION: the results demonstrate a low level of comprehensive knowledge about HIV amongst this population and reveal an association between comprehensive knowledge about HIV and prevalence. Therefore, it is important to improve knowledge about HIV, its transmission and prevention amongst this population.
Assuntos
Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Mineradores/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Prevalência , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricos , Adulto JovemRESUMO
INTRODUCTION: Mozambique has a generalized HIV epidemic, among pregnant women, HIV prevalence is estimated at 15.8% with a vertical transmission rate of 14%, more than double global targets. We evaluate electronic national health information system (SIS-MA) performance to verify if the data flow procedures met its objectives and evaluated the prevention of mother-to-child transmission (PMTCT) surveillance system to access its attributes and usefulness. METHODS: we conducted a descriptive, cross-sectional evaluation of the PMTCT surveillance system in eight facilities in Gaza and Inhambane provinces using the centers for disease control and prevention guidelines (2001). For data quality, we cross-referenced patient registries from health facilities against the SIS-MA. We also interviewed 34 health technicians, using a Likert scale, to assess the following attributes of the PMTCT surveillance system: simplicity, stability, flexibility, acceptability, timeliness and data quality, usefulness of the system and knowledge of PMTCT. RESULTS: regarding the simplicity measure, we verified that the registry books contain more than 30 variables. The system was 83% flexible in maintaining functionality with the introduction of new health facilities in the system. The completeness of the data was 50% and concordance of data from the register book and monthly reports was 89%. CONCLUSION: the PMTCT SIS-MA is useful in supporting the collection, analysis, interpretation and continuous and systematic dissemination of health data that are used to define and monitor public health policies in Mozambique. However, continued efforts are needed to improve data quality to ensure that the SIS-MA can adequately monitor the PMTCT program and contribute to reduced vertical transmission.
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Síndrome da Imunodeficiência Adquirida/prevenção & controle , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Síndrome da Imunodeficiência Adquirida/transmissão , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Sistemas de Informação em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Moçambique , Vigilância da População , Gravidez , Prevalência , Sistema de Registros , Inquéritos e QuestionáriosRESUMO
The ability to rapidly and effectively respond to public health emergencies, including outbreak investigations and natural disasters, is critical in a strengthened health system. In March and April 2019, the impact of tropical cyclones Idai and Kenneth in Southern Africa and subsequent flooding resulted in devastating consequences to the Mozambique health care system. In this article, we highlight the role of Mozambique's Field Epidemiology and Laboratory Training Program (FELTP) graduates as first responders during one of the most significant natural disasters on the African continent. The FELTP graduates played a key role in conducting risk assessments, active epidemiological surveillance for priority communicable diseases, and outbreak investigations and supporting the laboratory diagnosis system. The cyclone emergencies in Mozambique revealed the vulnerability of the health system. It is vital to continue the investment in increasing epidemiological capacity of health human resources, staff to adequately prepare for and respond to public health emergencies to mitigate the negative health impacts associated with those events.
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Tempestades Ciclônicas , Socorristas , Pessoal de Saúde/organização & administração , Pessoal de Laboratório/organização & administração , Socorristas/educação , Monitoramento Epidemiológico , Epidemiologia/educação , Pessoal de Saúde/educação , Humanos , Pessoal de Laboratório/educação , Moçambique , Saúde Pública/educação , Medição de Risco/métodosRESUMO
Pope Francis visited Mozambique from September 4-6, 2019. During the visit, a real-time surveillance system for mass gathering events was implemented in all places where people gathered in Maputo City for early detection of possible outbreaks and other health-related events. The system was implemented at four sites were mass gathering events occurred over the three-day visit. Data were collected by administering a simple questionnaire on a tablet, which collected information about sociodemographics, syndromic diagnoses, and outcomes of the patients that sought medical care. Additionally, a descriptive epidemiological assessment was performed during the event. A total of 150 individuals were attended at the designated places during the event. Of these, 56.7% were female and 90.7% aged > 15 years. The majority of the patients (74.7%) sought care on the third day of the event, which was held at the Zimpeto National Stadium. The most common diagnoses were hypertension (20.7%), hypothermia (15.3%), and headache (11.3%). Almost all cases (95.0%) were discharged, (4.0%) cases were transferred and (1.0%) case resulted in death on the way to the health facility. The surveillance system strategy developed to detect real-time public health events during the Pope?s visit was successfully implemented. No outbreak was identified during the event.