People with disabilities in Cabo Verde, an unresolved issue: HIV prevalence, knowledge, attitudes and practices.

This article provides evidence about profile of persons with disabilities in Cabo Verde, their Knowledge, attitudes and practice and their bio-behavioural vulnerability to HIV/AIDS. The Cape verdian population was estimated to be 537,661 inhabitants in 2020, with an HIV prevalence of about 0.6% in the general population. Data were collected from 5 islands and 8 municipalities with a proportion of people with disabilities greater than or equal to 5%. A total of 682 persons participated in the study, and 653 People with Disabilities (PwDs) were tested for HIV. The HIV prevalence rate was 2.3% (3.5% in men; 1.7% in women), and the most prevalent type of virus is HIV1. Over 90% PwDs have access to information about HIV. Most of PwDs (85.8%) have had sex and known protection methods against HIV, although there are some misconceptions and beliefs. About 80.0% never participated in HIV/AIDS prevention activities, and 96.3% said that their participation gave them a better understanding about HIV and AIDS. About 79% were unaware of the existence of HIV care, support and prevention facilities, and 36.7% do not know of any place for HIV screening. This first study in Cabo Verde highlights the reality about PwDs social and environmental situation.

Drug resistance profile and clonality of Plasmodium falciparum parasites in Cape Verde: the 2017 malaria outbreak.

BACKGROUND: Cape Verde is an archipelago located off the West African coast and is in a pre-elimination phase of malaria control. Since 2010, fewer than 20 Plasmodium falciparum malaria cases have been reported annually, except in 2017, when an outbreak in Praia before the rainy season led to 423 autochthonous cases. It is important to understand the genetic diversity of circulating P. falciparum to inform on drug resistance, potential transmission networks and sources of infection, including parasite importation. METHODS: Enrolled subjects involved malaria patients admitted to Dr Agostinho Neto Hospital at Praia city, Santiago island, Cape Verde, between July and October 2017. Neighbours and family members of enrolled cases were assessed for the presence of anti-P. falciparum antibodies. Sanger sequencing and real-time PCR was used to identify SNPs in genes associated with drug resistance (e.g., pfdhfr, pfdhps, pfmdr1, pfk13, pfcrt), and whole genome sequencing data were generated to investigate the population structure of P. falciparum parasites. RESULTS: The study analysed 190 parasite samples, 187 indigenous and 3 from imported infections. Malaria cases were distributed throughout Praia city. There were no cases of severe malaria and all patients had an adequate clinical and parasitological response after treatment. Anti-P. falciparum antibodies were not detected in the 137 neighbours and family members tested. No mutations were detected in pfdhps. The triple mutation S108N/N51I/C59R in pfdhfr and the chloroquine-resistant CVIET haplotype in the pfcrt gene were detected in almost all samples. Variations in pfk13 were identified in only one sample (R645T, E668K). The haplotype NFD for pfmdr1 was detected in the majority of samples (89.7%). CONCLUSIONS: Polymorphisms in pfk13 associated with artemisinin-based combination therapy (ACT) tolerance in Southeast Asia were not detected, but the majority of the tested samples carried the pfmdr1 haplotype NFD and anti-malarial-associated mutations in the the pfcrt and pfdhfr genes. The first whole genome sequencing (WGS) was performed for Cape Verdean parasites that showed that the samples cluster together, have a very high level of similarity and are close to other parasites populations from West Africa.

Human pegivirus 1 in Cabo Verde: prevalence and genotypic distribution among HIV-infected individuals.

Human pegivirus 1 (HPgV-1) belongs to the genus Pegivirus, family Flaviviridae, and until now has been considered a non-pathogenic agent, despite being considered a risk factor for non-Hodgkin lymphoma. However, a beneficial impact of HPgV-1 on HIV disease progression has been extensively reported. Given the high prevalence of HIV in sub-Saharan Africa and the scarcity of epidemiological data for many countries of West Africa, we conducted the first study of HPgV-1 in HIV-infected individuals from Cabo Verde. To obtain new data regarding prevalence and genetic diversity of HPgV-1 in Africa, serum samples from 102 HIV-infected Cabo Verdeans were tested for the presence of viral RNA, and the circulating genotypes were identified by sequencing of the 5' untranslated region. HPgV-1 RNA was detected in 19.6% (20/102) of the samples. In 72.2% (13/18) of the samples, the virus was identified as genotype 2 (11/13 subtype 2a and 2/13 subtype 2b), and in 27.8% (5/18), it was identified as genotype 1. The estimated substitution rate of HPgV-1 genotype 2 was 5.76 × 10-4, and Bayesian analysis indicated the existence of inner clusters within subtypes 2a and 2b. The prevalence of HPgV-1 viremia in Cabo Verde agrees with that reported previously in Africa. Genotypes 1 and 2 cocirculate, with genotype 2 being more common, and HIV/HPgV-1 coinfection was not associated with higher CD4 T cell counts in the studied population. This finding contributes for the expansion of the pegivirus research agenda in African countries.

Updates on malaria epidemiology and profile in Cabo Verde from 2010 to 2019: the goal of elimination.

BACKGROUND: Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the sixteenth century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterize the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases. METHODS: All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system. Individual-level data available included age, gender, municipality of residence, and the self-reported countries visited if travelled within the past 30 days, therby classified as imported. Trends in reported cases were visualized and multivariable logistic regression used to assess risk factors associated with a malaria case being imported and differences over time. RESULTS: A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, prior to 2017, when the epidemic occurred, 58.1% (95% CI 53.6-64.6) of infections were classified as imported, whereas during the post-epidemic period, 93.3% (95% CI 86.9-99.7) were imported. The last locally acquired case was reported in January 2018. Imported malaria cases were more likely to be 25-40 years old (AOR: 15.1, 95% CI 5.9-39.2) compared to those under 15 years of age and more likely during the post-epidemic period (AOR: 56.1; 95% CI 13.9-225.5) and most likely to be reported on Sao Vicente Island (AOR = 4256.9, 95% CI = 260-6.9e+4) compared to Boavista. CONCLUSIONS: Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterization of imported cases provides useful insight for programme and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

The prevalence of glucose-6-phosphate dehydrogenase deficiency in the Cape Verdean population in the context of malaria elimination.

Cabo Verde aims to eliminate malaria by 2020. In the country, Plasmodium falciparum had been the main parasite responsible for indigenous cases and primaquine is the first line treatment of cases and for radical cure. However, the lack of knowledge of the national prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency may be one of the constraints to the malaria elimination process. Hence, this first study determines the prevalence of G6PD deficiency (G6PDd) in the archipelago. Blood samples were collected from patients who voluntarily agreed to participate in the study, in the health facilities of eight municipalities on four islands, tested with G6PD CareStart ™ deficiency Rapid Diagnosis Test (RDT). All subjects found to be G6PDd by RDT then underwent enzyme quantification by spectrophotometry. Descriptive statistics and inferences were done using SPSS 22.0 software. A total of 5.062 blood samples were collected, in majority from female patients (78.0%) and in Praia (35.6%). The RDT revealed the prevalence of G6PD deficiency in 2.5% (125/5062) of the general population, being higher in males (5.6%) than in females (1,6%). The highest G6PDd prevalence was recorded in São Filipe, Fogo, (5.4%), while in Boavista no case was detected. The G6PDd activity quantification shown a higher number of partially deficient and deficient males (respectively n = 26 and n = 22) compared to females (respectively n = 18 and n = 7), but more normal females (n = 35) than males (n = 11). According to the WHO classification, most of the G6PDd cases belongs to the class V (34.5%), while the Classes II and I were the less represented with respectively 5.8% and zero cases. This study in Cabo Verde determined the G6PDd prevalence in the population, relatively low compared to other African countries. Further studies are needed to characterize and genotyping the G6PD variants in the country.

Zika virus-spread, epidemiology, genome, transmission cycle, clinical manifestation, associated challenges, vaccine and antiviral drug development.

Zika Virus (ZIKV) is a Flavivirus transmitted primarily via the bite of infected Aedes aegypti mosquitoes. Globally, 87 countries and territories have recorded autochthonous mosquito-borne transmission of ZIKV as at July 2019 and distributed across four of the six WHO Regions. Outbreaks of ZIKV infection peaked in 2016 and declined substantially throughout 2017 and 2018 in the Americas region. There is the likely risk for ZIKV to spread to more countries. There is also the potential for the re-emergence of ZIKV in all places with prior reports of the virus transmission. The current status of ZIKV transmission and spread is, however, a global health threat, and from the aforementioned, has the potential to re-emerge as an epidemic. This review summarizes the past and present spread of ZIKV outbreak-2007-2019, the genome, transmission cycle, clinical manifestations, vaccine and antiviral drug advancement.

Children's Sleep Habits Questionnaire in Two Subpopulations from Cape Verde and Mozambique: Exploratory and Regression Analysis.

INTRODUCTION: Children's sleep habits are profoundly affected by socio-economic, cultural, and environmental factors. We aim to describe the sleep habits of pediatric sub-populations from Cape Verde and Mozambique using the Children's Sleep Habits Questionnaire, and to ascertain the determinants of the questionnaire's score. MATERIAL AND METHODS: We conducted cross-sectional surveys in surveillance appointments in Cape Verde and in a school in Maputo (Mozambique). The Cape Verde sample included 206 children (mean age: 6.5) and the Mozambique sample 454 children (mean age: 8). The Portuguese version of the Children's Sleep Habits Questionnaire was used to evaluate the children's sleep habits. The distributions of the questionnaire's scores across different levels of the demographic variables were compared using the Mann-Whitney and the Kruskal-Wallis tests. We used regression models to quantify the relationship between the demographic variables and the questionnaire's scores. RESULTS: Cape Verde sample: Questionnaire median score: 50 (range 36 - 81). Prevalence of sleep problems: 29.9% (cut-off = 56). Prevalence of parent-reported sleep problems: 22.8%. Co-sleeping: 63%. Bedtime television: 30%. Daytime nap: 63%. Questionnaire scores are associated with the mother's educational level, the children's age group, and with the frequency of daytime napping. Mozambique Sample: Median Questionnaire score: 48 (range 35 - 77). Prevalence of sleep problems: 28.4% (cut-off: 52). Percentage of parent-reported sleep problems: 6.9%. Co-sleeping: 29%. Bedtime television: 33%. Daytime nap: 23%. Questionnaire scores are associated with the mother's nationality, the father educational level, and with the frequency of bedtime television. DISCUSSION: Parents tend to overestimate the quality of their children's sleep. The prevalence of sleep disturbances and the cut-off values are higher than observed in previous studies, which may be due to the existence of different standards and cultural expectations across populations. Bedtime television, typically associated with more disturbed sleep, is frequent in both samples. Co-sleeping and daytime napping are frequent in the Cape Verde sample; wetting the bed is common and more prevalent than in previous studies. Bed-sharing increases the parents' awareness of their children's sleep quality, contributing to the high prevalence of parent-reported sleep problems. CONCLUSION: Parent-reported sleep problems underestimate the Children's Sleep Habits Questionnaire results. This is not necessarily indicative of more disturbed sleep and might reflect differences in sleep behavior, childcare practice, and cognitions and attitudes towards the concept of 'normal' sleep.

Introdução: Os hábitos de sono são influenciados por diversos factores. Pretendemos descrever os hábitos de sono de duas populações de países africanos aplicando o Children's Sleep Habits Questionnaire e determinar quais são as variáveis que mais influenciam o score do questionário. Material e Métodos: Realizámos dois estudos transversais em consultas de saúde infantil em Cabo Verde e numa escola em Maputo, Moçambique. A amostra de Cabo Verde incluiu 206 crianças (idade média: 6,5 anos) e a amostra de Moçambique 445 crianças (idade média: 8 anos). Aplicámos a versão portuguesa do Children's Sleep Habits Questionnaire. As distribuições dos scores do questionário para diferentes níveis das variáveis demográficas foram avaliadas com os testes de Mann-Whitney e de Kruskal-Wallis. Utilizámos regressões lineares para quantificar a relação entre variáveis demográficas e o score do questionário. Resultados: Cabo Verde: Mediana do score: 50 (36 ­ 81). Problemas de sono identificados pelo questionário: 29,9% (cut-off: 56). Problemas de sono reportados pelos pais: 22,8%. Partilha de cama: 63%. Televisão antes de adormecer: 30%. Sesta: 63%. Moçambique: Mediana do score: 48 (35 ­ 77). Problemas de sono identificados pelo questionário: 28,4% (cut-off: 52). Problemas de sono reportados pelos pais: 6,9%. Partilha de cama: 29%. Televisão antes de adormecer: 33%. Sesta: 23%. Variáveis que influenciam o score: educação da mãe, faixa etária da criança e sestas (Cabo Verde); nacionalidade da mãe, educação do pai, e televisão para adormecer (Moçambique). Discussão: Os pais tendem a sobrestimar a qualidade do sono dos seus filhos. Encontrámos prevalências de problemas do sono e valores de corte mais elevados do que os obtidos em estudos anteriores, o que também se pode dever à existência de diferentes padrões e expectativas em populações com diferentes culturas. Ver televisão para adormecer é um hábito tipicamente associado a maiores perturbações no sono e é frequente em ambas as amostras. Partilha de cama e sestas são frequentes na amostra de Cabo Verde; enurese noturna também é comum e mais prevalente do que em estudos anteriores. A partilha de cama aumenta a perceção que os pais têm da qualidade do sono dos seus filhos, podendo contribuir para a elevada percentagem de problemas de sono reportada pelos pais. Conclusão: Os problemas de sono reportados pelos pais subestimam os resultados do Children's Sleep Habits Questionnaire, o que pode traduzir diferentes expectativas e atitudes face ao sono, e não necessariamente sono patológico. Estudos futuros devem estabelecer valores de corte do Children´s Sleep Habits Questionnaire adaptados a cada cultura.

Molecular detection of Hepatozoon felis in cats from Maio Island, Republic of Cape Verde and global distribution of feline hepatozoonosis.

BACKGROUND: Vector-borne diseases are emerging worldwide and have an important zoonotic relevance. In the last few years, the interest in vector-borne pathogens in cats has increased. However, studies on feline vector-borne pathogens on tropical islands are lacking. Islands differ from continental countries because they have an enclosed population of animals, with all year presence of the vectors and, most often, without vector control measures. This study focused on the molecular identification and phylogenetic analysis of vector-borne pathogens in autochthonous cats with a mixed indoor-outdoor lifestyle from Maio Island, Cape Verde archipelago. METHODS: Blood samples were collected from 80 asymptomatic cats, representing almost a quarter of the total cat population of the island. The presence of DNA of protozoa of the genus Hepatozoon and bacteria belonging to family Anaplasmataceae and to genus Bartonella was assessed by PCR and phylogenetic analysis was conducted. Statistical analysis was performed to identify risk factors associated with infection. For feline hepatozoonosis, a worldwide dataset of Hepatozoon felis sequences retrieved from mammal species and vectors along with Hepatozoon spp. sequences retrieved from felids was generated, phylogenetically analyzed and the geographical and host distribution was assessed. RESULTS: Hepatozoon felis genotype I was identified in 12 (15%) cats from Maio Island whereas none of the cats were PCR positive for the other pathogens tested. No significant association of H. felis infection with age, sex, location or presence of vectors was observed by statistical analysis in Cape Verde's cats. Phylogenetic analysis on the worldwide dataset of feline Hepatozoon sequences showed two significant distinct clades for H. felis genotype I and II. Different geographical distributions were assessed: H. felis genotype I was the only genotype found in Africa and has been reported worldwide, with the exception of Japan and Brazil where only H. felis genotype II has been reported. CONCLUSIONS: The identification of H. felis genotype I in cats in Maio Island highlights the need to further investigate the significance of H. felis genotypes and to clarify the epidemiological aspects of this infection.

Cardiovascular Disease Epidemiology in Portuguese-Speaking Countries: data from the Global Burden of Disease, 1990 to 2016.

BACKGROUND: Portuguese-speaking countries (PSC) share the influence of the Portuguese culture but have socioeconomic development patterns that differ from that of Portugal. OBJECTIVE: To describe trends in cardiovascular disease (CVD) morbidity and mortality in the PSC between 1990 and 2016, stratified by sex, and their association with the respective sociodemographic indexes (SDI). METHODS: This study used the Global Burden of Disease (GBD) 2016 data and methodology. Data collection followed international standards for death certification, through information systems on vital statistics and mortality surveillance, surveys, and hospital registries. Techniques were used to standardize causes of death by the direct method, as were corrections for underreporting of deaths and garbage codes. To determine the number of deaths due to each cause, the CODEm (Cause of Death Ensemble Model) algorithm was applied. Disability-adjusted life years (DALYs) and SDI (income per capita, educational attainment and total fertility rate) were estimated for each country. A p-value <0.05 was considered significant. RESULTS: There are large differences, mainly related to socioeconomic conditions, in the relative impact of CVD burden in PSC. Among CVD, ischemic heart disease was the leading cause of death in all PSC in 2016, except for Mozambique and Sao Tome and Principe, where cerebrovascular diseases have supplanted it. The most relevant attributable risk factors for CVD among all PSC are hypertension and dietary factors. CONCLUSION: Collaboration among PSC may allow successful experiences in combating CVD to be shared between those countries.

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.

Cardiovascular Disease Epidemiology in Portuguese-Speaking Countries: data from the Global Burden of Disease, 1990 to 2016 / Epidemiologia das Doenças Cardiovasculares em Países de Língua Portuguesa: Dados do "Global Burden of Disease", 1990 a 2016

Abstract Background: Portuguese-speaking countries (PSC) share the influence of the Portuguese culture but have socioeconomic development patterns that differ from that of Portugal. Objective: To describe trends in cardiovascular disease (CVD) morbidity and mortality in the PSC between 1990 and 2016, stratified by sex, and their association with the respective sociodemographic indexes (SDI). Methods: This study used the Global Burden of Disease (GBD) 2016 data and methodology. Data collection followed international standards for death certification, through information systems on vital statistics and mortality surveillance, surveys, and hospital registries. Techniques were used to standardize causes of death by the direct method, as were corrections for underreporting of deaths and garbage codes. To determine the number of deaths due to each cause, the CODEm (Cause of Death Ensemble Model) algorithm was applied. Disability-adjusted life years (DALYs) and SDI (income per capita, educational attainment and total fertility rate) were estimated for each country. A p-value <0.05 was considered significant. Results: There are large differences, mainly related to socioeconomic conditions, in the relative impact of CVD burden in PSC. Among CVD, ischemic heart disease was the leading cause of death in all PSC in 2016, except for Mozambique and Sao Tome and Principe, where cerebrovascular diseases have supplanted it. The most relevant attributable risk factors for CVD among all PSC are hypertension and dietary factors. Conclusion: Collaboration among PSC may allow successful experiences in combating CVD to be shared between those countries.

Resumo Fundamento: Os países de língua portuguesa (PLP) partilham a influência da cultura portuguesa com desenvolvimento socioeconômico diverso de Portugal. Objetivo: Descrever as tendências de morbidade e mortalidade por doenças cardiovasculares (DCV) nos PLP, entre 1990 e 2016, estratificadas por sexo, e sua associação com os respectivos índices sociodemográficos (SDI). Métodos: O estudo utilizou dados e metodologia do Global Burden of Disease (GBD) 2016. As informações seguiram padrões internacionais de certificação de óbito, através de sistemas de informação sobre estatísticas vitais e vigilância da mortalidade, pesquisas e registros hospitalares. Empregaram-se técnicas para padronização das causas de morte pelo método direto, e correções para sub-registro dos óbitos e garbage codes. Para determinar o número de mortes por cada causa, aplicou-se o algoritmo CODEm (Modelagem Agrupada de Causas de Morte). Estimaram-se os anos saudáveis de vida perdidos (DALYs) e o SDI (renda per capita, nível de escolaridade e taxa de fertilidade total) para cada país. Resultados: Existem grandes diferenças na importância relativa da carga de DCV nos PLP relacionadas principalmente às condições socioeconômicas. Entre as DCV, a doença isquêmica do coração foi a principal causa de morte nos PLP em 2016, com exceção de Moçambique e São Tomé e Príncipe, onde as doenças cerebrovasculares a suplantaram. Os fatores de risco atribuíveis mais relevantes para as DCV entre os PLP foram a hipertensão arterial e os fatores dietéticos. Um valor de p < 0,05 foi considerado significativo. Conclusão: A colaboração entre os PLP poderá permitir que experiências exitosas no combate às DCV sejam compartilhadas entre esses países.

Under-reporting of tuberculosis in Praia, Cape Verde, from 2006 to 2012.

SETTING: According to World Health Organization (WHO) estimates, the under-reporting rate for tuberculosis (TB) in Cape Verde between 2006 and 2012 was 49%. However, the WHO recognises the challenges associated with this estimation process and recommends implementing other methods, such as record linkage, to combat TB under-reporting. OBJECTIVES: To estimate and analyse under-reporting of cases by TB surveillance health units and to evaluate TB cases retrieved from other TB diagnostic sources in Praia, Cape Verde, from 2006 to 2012. DESIGN: This cross-sectional study evaluated under-reporting using the following data: 1) the under-reporting index from TB reporting health units (RHUs), where the number of validated TB cases from RHUs was compared with data from the National Programme for the Fight against Tuberculosis and Leprosy (NPFTL); and 2) the under-reporting index among overall data sources, or a comparison of the number of all validated TB cases from all sources with NPFTL data. RESULTS: The TB under-reporting rate was 40% in Praia during the study period, and results were influenced by laboratory findings. CONCLUSION: The TB under-reporting rate was very similar to the rate estimated by the WHO. TB surveillance must be improved to reduce under-reporting.

Desafios da tuberculose no concelho da Praia-Cabo Verde: determinantes da tuberculose no período de 2006 a 2012 / Tuberculosis Challenges in Praia' county - Cape Verde: TB determinants from 2006 to 2012

A presente tese objetiva mensurar a magnitude da subnotificação da tuberculose (TB) e identificar os determinantes sociais da incidência da doença em Praia, Cabo Verde, no período de 2006 a 2012. Foram considerados os casos suspeitos e casos diagnosticados validados de TB obtidos nos centros de saúde, no hospital central e nos laboratórios dos concelhos que deram origem a dois manuscritos. O primeiro manuscrito descreve um estudo seccional onde o número de casos de TB validados, identificados nas unidades de saúde, foi comparado com o número de casos registrados no Programa Nacional de Luta contra Tuberculose e Lepra (PNLTL). A subnotificação foi calculada combinando duas abordagens. Na primeira abordagem, o número de casos de TB validados dos centros de atenção primária e hospital central foi comparado com o número de casos do PNLTL. Na segunda abordagem todos os casos de TB validados de todas as fontes de TB foram comparados com casos de PNLTL. O resultado revelou uma importante subnotificação da TB e compatível com as estimativas de subnotificação da Organização Mundial da saúde (OMS) para o país. O segundo manuscrito teve o objetivo de identificar os determinantes sociais da TB. A análise exploratória e análise de regressão foram utilizadas para este fim.. Na análise exploratória foi feita a avaliação da normalidade e identificação de autocorrelação espacial. Na análise de regressão utilizou-se o modelo binomial negativa cujos dados indicam que existe associação entre determinante social e incidência da TB em Praia

Extremely low Plasmodium prevalence in wild plovers and coursers from Cape Verde and Madagascar.

BACKGROUND: Relatively little is known about the prevalence of blood parasites in shorebirds, especially those breeding in the tropics. The prevalence of blood parasites of the genera Plasmodium, Haemoproteus and Leucocytozoon was assessed in blood samples from Kentish plovers and cream-coloured coursers in Cape Verde, and samples of Kittlitz's plovers, Madagascar plovers and white-fronted plovers in Madagascar. RESULTS: Only two of these samples were positive for Plasmodium: a Kittlitz's plover was infected by a generalist lineage of Plasmodium that has already been reported in Europe and Africa, while in a white-fronted plover direct sequencing revealed a previously un-described Plasmodium lineage. CONCLUSION: Potential explanations for the low prevalence of blood parasites include the scarcity of vectors in habitats used by these bird species and their resistance to parasitic infections.

The occurrence of the filarial nematode Dirofilaria repens in canine hosts from Maio Island, Cape Verde.

The prevalence of canine Dirofilaria infection in Maio Island (Cape Verde) was analysed by serology, morphological and molecular identification of the parasite species. Blood and sera were collected from 150 dogs and 80 cats aged over 6 months from various localities of the island. DNA was extracted from blood and samples were screened by polymerase chain reaction (PCR) using microfilaria-specific primers. No Dirofilaria immitis was found in dogs while D. repens microfilariae were found in 5.3% of dogs and 6% were positive by PCR. The species identity was confirmed by sequencing of PCR products, which showed almost 100% homology with D. repens European sequences published in GenBank. No difference in Dirofilaria infection was observed between males and females or in dogs with different weights. However, older dogs and those from the western part of Maio Island were more frequently infected. No Dirofilaria was found in cats. This study represents the first evidence of D. repens in Cape Verde (West Africa) and highlights the need for implementing control measures and for a better surveillance of dirofilariosis in Africa.

Leptospira interrogans in Rodents from Cape Verde.

Leptospirosis is an important worldwide zoonotic disease that can infect both animals and humans. In most cases, leptospirosis is a nonspecific self-limiting illness, but some patients can develop a severe form with a high mortality. This study was carried out in Santiago Island, Cape Verde, in 2012-2013. A total of 62 wild rodents (Rattus rattus and Mus domesticus) were analyzed. The lipL32 gene, present only in pathogenic Leptospira spp., was amplified by PCR, and 16 samples were positive (25.8%). In both rodent species, Leptospira interrogans was identified. The results show the presence of pathogenic Leptospira in the three localities analyzed in Santiago. The presence of L. interrogans demonstrates a serious health risk for the population, since this species has been associated with the most severe form of leptospirosis, the Weil's disease in humans, a severe infection with jaundice, renal failure, and hemorrhage.

Molecular detection of Anaplasma platys, Ehrlichia canis, Hepatozoon canis and Rickettsia monacensis in dogs from Maio Island of Cape Verde archipelago.

Tick-borne diseases are emerging worldwide and have an important zoonotic relevance. Dogs play an important role in the epidemiology of several zoonotic tick-borne pathogens acting as sentinels and/or reservoirs. This study focused on the molecular identification of tick-borne pathogens in blood samples of 153 autochthonous asymptomatic dogs in Maio Island, Cape Verde archipelago. Eighty-four (54.9%) dogs were positive for one or more pathogens. Fifty-five (35.9%) dogs were infected with Hepatozoon canis, 53 (34.6%) with Anaplasma platys, five (3.3%) with Ehrlichia canis and Rickettsia monacensis, an emerging human pathogen, was also identified in a single dog (0.7%). The former three pathogens cause important canine tick-borne diseases that are transmitted or potentially transmitted by Rhipicephalus sanguineus s.l., the only hard tick identified in Cape Verde. Furthermore, Wolbachia spp. was amplified from the blood of one dog. None of the dogs were positive for Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato, Midichloria mitochondrii, Bartonella spp., Babesia spp. or Theileria spp. Fifty-four (35.3%) animals showed single infections and 30 (19.6%) co-infections, with A. platys and H. canis co-infection being the most frequent (28 dogs, 18.3%). The frequency of E. canis infection was statistically different among age groups (P=0.017), being higher among dogs older than 4 years compared to younger dogs. Infection by A. platys was also statistically different among age groups (P=0.031), being higher in dogs younger than 2 years compared to older dogs. The statistical analyses showed no significant association of PCR positivity with gender or location. The frequency of tick-borne pathogens detected in dogs in Maio Island, including R. monacensis, highlights the need to improve diagnosis and control in order to prevent the risk of transmission of these pathogens among dogs and humans living in or travelling to this touristic island.

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.