Investigation and contact tracing of the first cases of COVID-19 in Mozambique, 2020.

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.

Sociodemographic characteristics of professional categories most affected by COVID-19 in Mozambique from March to July 2020.

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.

Evaluation of the Mozambique Antiretroviral Therapy (MozART) database as an antiretroviral therapy patient surveillance system, 2017-2018.

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.

Challenges for malaria surveillance during the COVID-19 emergency response in Nampula, Mozambique, January - May 2020.

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.

Evaluation of prevention of mother-to-child transmission national health information system for HIV/AIDS, in southern region of Mozambique, April to November 2016.

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.