Phylogenomics of Dengue Virus Isolates Causing Dengue Outbreak, São Tomé and Príncipe, 2022.

We determined that the dengue outbreak in São Tomé and Príncipe during 2022 was caused by dengue virus serotype 3 genotype III. Phylogenomic analyses showed that the outbreak strain was closely related to the newly identified GIII-American-II lineage and that the virus probably was introduced from the Americas.

The spread of Aedes albopictus (Diptera: Culicidae) in the islands of São Tomé and Príncipe.

The mosquito Aedes albopictus (Diptera: Culicidae) is a vector species of the causal agents of Dengue, yellow fever, and Zika among other diseases pathogens. The species originated in Southeast Asia and has spread widely and rapidly in the last century. The species has been reported in localities from the Gulf of Guinea since the early 2000s, but systematic sampling has been scant. We sampled Ae. albopictus twice, in 2013 and 2023 across the altitudinal gradient in São Tomé and found that the species was present in all sampled years at altitudes up to 680 m. We also found some evidence of increases in proportional representation compared to Ae. aegypti over time. We report the presence of the species in Príncipe for the first time, suggesting that the range of Ae. albopictus is larger than previously thought. Finally, we use bioclimatic niche modeling to infer the potential range of Ae. albopictus and infer that the species has the potential to spread across a large portion of São Tomé and Príncipe. Our results suggest that Ae. albopictus has established itself as a resident species of the islands of the Gulf of Guinea and should be incorporated into the list of potential vectors that need to be surveyed and controlled.

Cuticular Waxes and Cutin in Terminalia catappa Leaves from the Equatorial São Tomé and Príncipe Islands.

This study presents for the first time an analysis of the content and chemical composition of the cuticular waxes and cutin in the leaves of the widespread and important tropical species Terminalia catappa. The leaves were collected in the equatorial Atlantic islands of São Tomé and Príncipe, in the Gulf of Guinea. The epicuticular and intracuticular waxes were determined via dichloromethane extraction and their chemical composition via GC-MS analysis, and the content and monomeric composition of cutin were determined after depolymerization via methanolysis. The leaves contained an epidermal cuticular coverage of 52.8 µg cm-2 of the cuticular waxes (1.4% of mass) and 63.3 µg cm-2 (1.5% of mass) of cutin. Cuticular waxes include mainly n-alkanols and fatty acids, with a substantial proportion of terpenes in the more easily solubilized fraction, and sterols in the more embedded waxes. Cutin is mostly constituted by C16 fatty acids and dihydroxyacids, also including aromatic monomers, suggesting a largely linear macromolecular arrangement. The high proportion of triacontanol, α-amyrin, ß-amyrin, germanicol, and lupeol in the easily solubilized cuticular fraction may explain the bioactive properties attributed to the T. catappa leaves via the popular medicine, which allows us to consider them as a potential source for the extraction of these compounds.

Trends in bio-behavioural risk factors of non-communicable diseases among adults in Sao Tome and Principe.

Background: Understanding national trends in risk factors of noncommunicable diseases (NCDs) may have health policy implications. The aim of the study was to assess the prevalence and social and demographic factors associated with risk factors of NCDs in adults from 2008 to 2019 in Sao Tome and Principe. Methods: In repeat cross-sectional national STEPS surveys 2,457 adults (median age 37 years) in 2008 and 1,893 adults (median age 38 years) in 2019 in Sao Tome and Principe responded to structured interviews, physical and biochemical measures. Logistic regressions were applied to estimate predictors of NCD risk factors. Results: Having three to seven NCD risk factors significantly decreased among men but not women from 36.6% in 2008 to 26.8% in 2019. The proportion of specific risk factors of NCD increased significantly for low physical activity from 17.4% in 2008 to 30.9% in 2019, and overweight/obesity from 37.3% in 2008 to 51.0% in 2019. Insufficient fruit/vegetable consumption decreased from 83.1% in 2008 to 53.3% in 2019, frequent alcohol use from 32.6% in 2008 to 24.8% in 2019, and diabetes from 3.1% in 2008 to 1.2% in 2019, while the proportion of current tobacco use and hypertension remained unchanged from 2008 to 2019. Men engaged more often than women in current tobacco use and frequent alcohol use, and women had higher rates of low physical activity and overweight/obesity than men. Higher educational levels were positively associated with overweight/obesity, and inversely associated with frequent alcohol use and inadequate fruit/vegetable intake. Conclusion: Between 2008 and 2019, the prevalence of seven risk factors for NCDs in Sao Tome and Principe declined among men, but not among women. Several associated variables have been identified for each individual risk factor of NCD that may help guide interventions.

Validation of a Questionnaire on Sexual and Reproductive Health Among Immigrant Vocational Education Students in Portugal from São Tomé and Príncipe.

Sexual and reproductive health interventions' effectiveness should be evaluated using a valid instrument. This study aimed to validate a questionnaire on sexual and reproductive health in adolescents and young adults from São Tomé and Príncipe who voluntarily enrolled in a vocational school in Portugal to complete their 12th school year and obtain a professional card.A questionnaire consisting of perception and knowledge sections was adapted from previous questionnaires. We followed the steps of psychometric analysis. Firstly, we assessed face validity and content validity. We used factorial analysis to validate the perceptions section (which included Likert-type questions). For the knowledge section (which consisted of multiple-choice questions), we used the key check, discrimination index, and difficulty index. We evaluated internal consistency through Cronbach's alpha for the perceptions section and the Kuder-Richardson score for the knowledge section.Out of 105 invited students, a total of ninety students were enrolled in this study, of whom 88 completed most of the questions. The exploratory analysis showed that most students agreed with the right to refuse intercourse. However, while approximately 23% disagreed that consensual sex among adult women or men is always wrong, around the same proportion agreed. A considerable number of students recognized condoms and pills as effective methods of contraception. However, most students were unfamiliar with other methods. Most knowledge questions showed acceptable difficulty levels, and the discrimination index varied among questions. The knowledge questions demonstrated good consistency levels. This study enabled us to develop an appropriate instrument for evaluating the effectiveness of public health interventions and identifying specific knowledge gaps in migrant populations from low-income countries. This will help prioritise topics to be addressed in sexual health education sessions.

Digitally managed larviciding as a cost-effective intervention for urban malaria: operational lessons from a pilot in São Tomé and Príncipe guided by the Zzapp system.

BACKGROUND: Once a mainstay of malaria elimination operations, larval source management (LSM)-namely, the treatment of mosquito breeding habitats-has been marginalized in Africa in favour of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). However, the development of new technologies, and mosquitoes' growing resistance to insecticides used in LLINs and IRS raise renewed interest in LSM. METHODS: A digitally managed larviciding (DML) operation in three of the seven districts of São Tomé and Príncipe (STP) was launched by the Ministry of Health (MOH) and ZzappMalaria LTD. The operation was guided by the Zzapp system, consisting of a designated GPS-based mobile application and an online dashboard, which facilitates the detection, sampling and treatment of mosquito breeding sites. During the operation, quality assurance (QA) procedures and field management methods were developed and implemented. RESULTS: 12,788 water bodies were located and treated a total of 128,864 times. The reduction impact on mosquito population and on malaria incidence was 74.90% and 52.5%, respectively. The overall cost per person protected (PPP) was US$ 0.86. The cost varied between areas: US$ 0.44 PPP in the urban area, and US$ 1.41 PPP in the rural area. The main cost drivers were labour, transportation and larvicide material. CONCLUSION: DML can yield highly cost-effective results, especially in urban areas. Digital tools facilitate standardization of operations, implementation of QA procedures and monitoring of fieldworkers' performance. Digitally generated spatial data also have the potential to assist integrated vector management (IVM) operations. A randomized controlled trial (RCT) with a larger sample is needed to further substantiate findings.

Burden of Malaria in Sao Tome and Principe, 1990-2019: Findings from the Global Burden of Disease Study 2019.

Background: Malaria is a parasitic infection transmitted by mosquito vectors, commonly found in tropical regions, and characterized by high morbidity and mortality. It causes a heavy disease burden in Sao Tome and Principe (STP), an island country in West Africa which at one time had a high incidence of malaria. Objective: This study aims to analyze the trend of disease burden of malaria in STP. Methods: The crude and age-standardized incidence, mortality, and disability-adjusted life years (DALYs) rate data of malaria were extracted from GBD 2019. Joinpoint 4.9 software was used to calculate the annual percentage change (APC) and the average annual percentage change (AAPC), which were also used to indicate the change in disease burden by different stages. Results: In general, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) of malaria presented a decreasing trend between 1990 and 2019, with an average annual decrease of 5.6%, 6.2%, and 10.7%, respectively, in STP. Specifically, all indicators first presented an increasing trend from 1990 to about 2000, followed by a decreasing trend until 2019, although the incidence rebounded slightly after 2015. Overall, the ASIR, ASMR, and ASDR of malaria reduced by 77.08%, 87.84%, and 82.21%, respectively, in 2019 as compared to 1990. No significant differences in disease burden were found between males and females between 2005 and 2019. Children who were under 5 years old showed a relatively small decrease in the rate of DALYs as compared to other age groups, but remained the group with the highest disease burden of malaria in the country. Conclusions: The disease burden of malaria in STP showed a significant decrease between 1990 and 2019, but it will still be challenging to achieve the goal of eliminating malaria by 2025. The government and relevant authorities should aim to strengthen the prevention and surveillance of malaria and tailor population-specific interventions in order to reduce the disease burden of malaria in STP.

Development of alcohol control law, Sao Tome and Principe.

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO's 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

La Région africaine de l'Organisation mondiale de la Santé (OMS) fait face à une hausse des dégâts causés par l'alcool. Préoccupés par la situation et par la forte prévalence des troubles liés à cette consommation, les législateurs de Sao Tomé-et-Principe ont élaboré un projet de loi détaillé afin d'y remédier. À l'origine de sa conception, plusieurs entretiens avec différentes parties prenantes. Le processus s'est divisé en cinq phases: (i) définir l'étendue du problème pour évaluer le fardeau que les dégâts provoqués par l'alcool font peser sur la société; (ii) actualiser les données probantes relatives aux politiques en matière d'alcool et identifier les domaines nécessitant une intervention législative; (iii) rédiger le projet de loi; (iv) aligner le cadre législatif du projet de loi; et enfin, (v) initier la procédure parlementaire. Le nouveau projet de loi a obtenu un score de 92/100 sur une échelle d'évaluation standard des mesures de lutte contre l'alcool. Il couvre tous les thèmes repris dans la Stratégie mondiale de l'OMS visant à réduire l'usage nocif de l'alcool, publiée en 2010. Il prévoit également les trois interventions les plus rentables en termes de diminution de la consommation d'alcool: l'augmentation des taxes d'accise sur l'alcool; l'interdiction ou l'instauration de conditions strictes en matière d'exposition à la publicité pour l'alcool; et une disponibilité restreinte des boissons alcoolisées dans le commerce en limitant les heures de vente. L'Assemblée nationale a soutenu le projet de loi en séance plénière. Il est désormais en cours d'évaluation au sein de la première Commission spécialisée en affaires politiques, juridiques, constitutionnelles et éthiques. Pour être adopté, le projet de loi doit revenir à l'Assemblée nationale pour un vote final, puis être promulgué par le président. Une loi globale de lutte contre l'alcool, élaborée par le pays lui-même, fondée sur des faits et n'ayant subi aucune ingérence de la part de l'industrie de l'alcool contribue à faire passer les objectifs de santé publique avant d'autres intérêts.

La Región de África de la Organización Mundial de la Salud (OMS) está tratando de hacer frente a los crecientes daños derivados del consumo de alcohol. Los legisladores de Santo Tomé y Príncipe, preocupados por estos daños y por la alta prevalencia de los trastornos por consumo de alcohol, diseñaron un proyecto de ley integral para el control del alcohol con el fin de solucionar esta situación. Las contribuciones al diseño del proyecto de ley se obtuvieron a través de entrevistas en las que participaron muchas partes interesadas. El proceso constó de cinco fases: (i) la delimitación del problema para comprender la carga social de los daños causados por el consumo de alcohol; (ii) la actualización de los datos sobre las políticas de alcohol y la identificación de las áreas de intervención legislativa; (iii) la redacción del proyecto de ley; (iv) la adaptación del marco legislativo del proyecto de ley; y (v) el inicio del procedimiento parlamentario. El nuevo proyecto de ley obtuvo una puntuación de 92/100 según una escala estandarizada de políticas para el control del alcohol. El proyecto de ley abarca todos los ámbitos de la estrategia mundial que la OMS puso en marcha en 2010 para reducir el uso nocivo del alcohol, e incluye las tres intervenciones más rentables para reducir el consumo de alcohol: el aumento de los impuestos especiales sobre el alcohol; la prohibición o la restricción general de la exposición a la publicidad del alcohol; y la restricción de la disponibilidad del alcohol al por menor mediante la reducción del horario de venta. La sesión plenaria de la Asamblea Nacional respaldó el proyecto de ley, que ahora está bajo evaluación de la Comisión Primera especializada en Asuntos Políticos, Jurídicos, Constitucionales y Éticos. La aprobación del proyecto de ley requiere la votación final una vez que regrese a la Asamblea Nacional y que el Presidente lo promulgue. La elaboración de un proyecto de ley para el control del alcohol que sea liderado por el país, inclusivo, basado en la evidencia y libre de interferencias por parte de la industria del alcohol ayuda a priorizar los objetivos de salud pública sobre otros intereses.

Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?

BACKGROUND: Adolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP. METHODS: An institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran's and Mantel-Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant. RESULTS: The adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18-3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07-5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89-12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes. CONCLUSION: Adolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study.

BACKGROUND: Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents' characteristics and factors associated to early childbearing in STP. METHODS: A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers' clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software. RESULTS: The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2-0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2-0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2-0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn's danger signs (OR 15.7, 95% CI= 9-26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup. CONCLUSIONS: Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents' partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns' danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl's empowerment and awareness and, at the same time, reinforce boy's role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn't, simultaneously, improve educational and economic opportunities for girls.

Dynamic changes in genetic diversity, drug resistance mutations, and treatment outcomes of falciparum malaria from the low-transmission to the pre-elimination phase on the islands of São Tomé and Príncipe.

BACKGROUND: With effective vector control and case management, substantial progress has been made towards eliminating malaria on the islands of São Tomé and Príncipe (STP). This study assessed the dynamic changes in the genetic diversity of Plasmodium falciparum, the anti-malarial drug resistance mutations, and malaria treatment outcomes between 2010 and 2016 to provide insights for the prevention of malaria rebounding. METHODS: Polymorphic regions of merozoite surface proteins 1 and 2 (msp1 and msp2) were sequenced in 118 dried blood spots (DBSs) collected from malaria patients who had visited the Central Hospital in 2010-2016. Mutations in the multi-drug resistance I (pfmdr1), chloroquine resistance transporter (pfcrt), and kelch 13 (pfk13) genes were analysed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing in 111 DBSs. A total of 7482 cases that completed a 28-day follow-up were evaluated for treatment outcomes based on the microscopic results. Regression models were used to characterize factors associated with levels of parasite density and treatment failures. RESULTS: Parasite strains in STP showed significant changes during and after the peak incidence in 2012. The prevalent allelic type in msp1 changed from K1 to MAD20, and that in msp2 changed from 3D7/IC to FC27. The dominant alleles of drug-resistance markers were pfmdr1 86Y, 184F, D1246, and pfcrt 76 T (Y-F-D-T, 51.4%). The average parasite density in malaria cases declined threefold from low-transmission (2010-2013) to pre-elimination period (2014-2016). Logistic regression models showed that patients with younger age (OR for age = 0.97-0.98, p < 0.001), higher initial parasite density (log10-transformed, OR = 1.44, p < 0.001), and receiving quinine treatment (compared to artemisinin-based combination therapy, OR = 1.91-1.96, p < 0.001) were more likely to experience treatment failures during follow-up. CONCLUSIONS: Plasmodium falciparum in STP had experienced changes in prevalent strains, and increased mutation frequencies in drug-resistance genes from the low-transmission to the pre-elimination settings. Notably, patients with younger age and receiving quinine treatment were more likely to show parasitological treatment failure during follow-up. Therapeutic efficacy should be carefully monitored to inform future treatment policy in STP.

Presence of L1014F Knockdown-Resistance Mutation in Anopheles gambiae s.s. From São Tomé and Príncipe.

Malaria, one of the most serious parasitic diseases, kills thousands of people every year, especially in Africa. São Tomé and Príncipe are known to have stable transmission of malaria. Indoor residual spraying (IRS) of insecticides and long-lasting insecticidal nets (LLIN) are considered as an effective malaria control interventions in these places. The resistance status of Anopheles gambiae s.s. from Agua Grande, Caue, and Lemba of São Tomé and Príncipe to insecticides, such as dichlorodiphenyltrichloroethane (DDT) (4.0%), deltamethrin (0.05%), permethrin (0.75%), fenitrothion (1.0%), and malathion (5.0%), were tested according to the WHO standard protocol. DNA extraction, species identification, as well as kdr and ace-1R genotyping were done with the surviving and dead mosquitoes post testing. They showed resistance to cypermethrin with mortality rates ranging from 89.06% to 89.66%. Mosquitoes collected from Agua Grande, Caue, and Lemba displayed resistance to DDT and fenitrothion with mortality rates higher than 90%. No other species were detected in these study localities other than Anopheles gambiae s.s. The frequency of L1014F was high in the three investigated sites, which was detected for the first time in São Tomé and Príncipe. No ace-1R mutation was detected in all investigated sites. The high frequency of L1014F showed that kdr L1014F mutation might be related to insecticide resistance to Anopheles gambiae s.s. populations from São Tomé and Príncipe. Insecticide resistance status is alarming and, therefore, future malaria vector management should be seriously considered by the government of São Tomé and Príncipe.

A large epidemic of a necrotic skin infection in the Democratic Republic of São Tomé and Principe: an epidemiological study.

INTRODUCTION: In 2016-18, the Democratic Republic of São Tomé and Príncipe suffered a necrotic skin infection epidemic. METHODS: A surveillance system was established after increased hospitalisations for this infection. Microbiology results were available for samples analysed in December 2016 and March 2017 using whole genome sequencing and metagenomics. Negative binomial regression was used to study the association of weather conditions with monthly case counts in a time-series analysis. RESULTS: From October 2016 to October 2018, the epidemic cumulative attack rate was 1.5%. The first peak lasted 5 months, accounting for one-third of total cases. We could not conclusively identify the aetiological agent(s) due to the country's lack of microbiology capacity. Increased relative humidity was associated with increased monthly cases (incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.09), and higher precipitation in the previous month with a higher number of cases in the following month (months with 0-49 mm rainfall compared with months with 50-149 mm and ≥150 mm: IRR 1.44, 95 % CI 1.13-1.78 and 1.50, 95% CI 1.12-1.99, respectively). DISCUSSION: This epidemic was favoured by increased relative humidity and precipitation, potentially contributing to community-based transmission of ubiquitous bacterial strains superinfecting skin wounds. FUNDING: World Health Organization Regional Office for Africa, Ministry of Health.

Visual Analogue Score for Urinary Symptoms-VASUS, validation of a visual scale for lower urinary tract symptoms (LUTS) in an African country.

PURPOSE: Validate a visual scale to assess LUTS, especially in developing countries, as an alternative to IPSS. VASUS consist of five questions, where Q1 and Q2 assess urinary stream quality, Q3 nocturia, Q4 incomplete emptying and Q5 QoL. METHODS: Between 2014 and 2017, we carried out a study in the male population over 30 years from São Tomé and Príncipe, a Portuguese speaking African Country. A stratified sample (age and district) of subjects completed IPSS, VASUS and a free flowmetry. RESULTS: We obtained 812 valid responses (average age: 50.72, range: 30-95 years old). In the comparison between IPSS and VASUS, we found positive correlations, with p value < 0.0001, for all variables analyzed and negative correlation for all urodynamic variables. Upon verifying the association of VASUS with IPSS, namely when comparing questions with similar objectives such as nocturia (VASUS-Q3 and IPSS-Q7), the stream quality (VASUS-Q1 and Q2 and IPSS-Q5) or the quality of life (VASUS-Q5 and IPSS-Q8), strong positive correlations were found. CONCLUSION: VASUS is a visual alternative to IPSS allowing evaluation of LUTS and having correlation with IPSS and flowmetry. Its use in developing countries with low levels of literacy will be an asset. The authors believe that widespread use of a scale such as VASUS in urology consultations is warranted, to increase daily practice objectification of LUTS.

Temperature-Dependent Competitive Outcomes between the Fruit Flies Drosophila santomea and Drosophila yakuba.

AbstractChanges in temperature associated with climate change can alter species' distributions, drive adaptive evolution, and in some cases cause extinction. Research has tended to focus on the direct effects of temperature, but changes in temperature can also have indirect effects on populations and species. Here, we test whether temperature can indirectly affect the fitness of Drosophila santomea and Drosophila yakuba by altering the nature of interspecific competition. We show that when raised in isolation, both D. santomea and D. yakuba display similar variation in relative fitness across temperatures of 18°, 22°, and 25°C. However, D. santomea has higher fitness than D. yakuba when experiencing interspecific competition at 18°C, while the inverse is true at 25°C. Patterns of fitness across thermal and competitive environments therefore indicate that the outcome of interspecific competition varies with temperature. We then use a coexistence experiment to show that D. santomea is rapidly (within eight generations) extirpated when maintained with D. yakuba at 25°C. By contrast, D. santomea remains as (or more) abundant than D. yakuba over the course of ∼10 generations when maintained at 18°C. Our results provide an example of how the thermal environment can affect interspecific competition and suggest that some species may become more prone to extinction under scenarios of climate change through indirect effects of the thermal environment on competitive advantages between species.

Investigation of Ctenocephalides felis on domestic dogs and Rickettsia felis infection in the Democratic Republic of Sao Tome and Principe.

Rickettsia felis is an obligate intracellular Gram-negative bacterium which causes flea-borne spotted fever in humans. In the past decades, R. felis has been detected worldwide in Ctenocephalides felis fleas and various other arthropods. However, due to its shared symptoms with other common vector-borne diseases, human infection is prone to be underestimated or misdiagnosed, especially in the malaria-endemic areas including sub-Saharan Africa, where confirmatory laboratory diagnoses are not usually available. In this study, a 'One Health' approach was adopted to explore potential vector-borne and zoonotic pathogens in the Democratic Republic of Sao Tome and Principe (DRSTP), an island nation in the Gulf of Guinea. By collaborating with local veterinarians, 1,187 fleas were collected from 95 domestic dogs across the country and later identified as Ct. felis using taxonomic keys. A cytochrome oxidase gene-based phylogenetic analysis revealed that all collected fleas belonged to a single haplotype and were identical to isolates from Ivory Coast and Brazil that clustered into a clade of tropical distribution. Additional samples of 14 chigoe fleas (Tunga penetrans) were collected from the surrounding environment of the dogs' resting spots. Rickettsia felis infection in fleas was examined by molecular methods targeting the citrate synthase (gltA)- and outer membrane protein A (ompA)-coding genes as well as the R. felis-specific pRF plasmid. The bacterial DNA was detected in 21.01% (146/695) of cat fleas but none of the chigoe fleas. Microimmunofluorescence assay was then performed to assess pathogen exposure of the residents. Of 240 dried blood spots from participants with dog contacts, 8 (3.33%) exhibited R. felis antibodies. Our findings demonstrated the presence of R. felis in DRSTP. Further extensive epidemiological studies regarding its prevalence and its role in causing febrile illness while the nation is entering pre-elimination stage of malaria will be carried out.

Association between the spread of COVID-19 and weather-climatic parameters.

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites. CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.

[Prevention Harmful Consumption of Alcohol and Drugs in Sao Tome and Principe Through Public Health Communication: The Scientific Protocol]. / Comunicação em Saúde Pública na Prevenção do Consumo Excessivo de Álcool e Drogas na População Escolar de São Tomé e Príncipe: Protocolo Científico.

INTRODUCTION: Sao Tome and Principe is an African low-and-middle-income country, where extreme poverty causes major health inequalities. No systematic research has been done on the consumption of alcohol and drugs in Sao Tome and Principe, and only overall statistics are available based on the importation of alcoholic drinks and their distribution among the population. There are also no studies on consumption of alcohol and illicit substances in children and youth and no preventive measures being undertaken. Besides that, manual databases present significant limitations, considering the lack of causes associated with mortality rates (0 - 5 years and > 5), and the difficulty to establish a cause/effect relation between diseases, deaths and life expectancy. No relevant data with burden of life was found in the reports of Centro Nacional de Endemias or the non-governmental, organization Instituto Marques de Valle Flor, a facilitator on healthcare clinical specialties selected on a voluntary basis by doctors from Portuguese hospitals. So, we proposed to provide a first overview of family and housing conditions, and above all, the consumption of alcohol and illegal drugs in young people. Thus, a project, the National Survey on Harmful Consumption of Alcohol and Drugs in Schools of Sao Tome and Principe, will be realized in order to better characterize the situation among children and young students and test public health communication strategies and preventive interventions aimed at this target-population. Interventions were designed taking into consideration local sociocultural realities of target audiences. We considered dialect language, single-parent families (matriarchal structure) and polygamy (mostly) in men and a country and governments led by men (patriarchal structure) and, in which the woman's role, as Food and Agriculture Organization of the United Nations reports, remains overlooked. Subsequently, we will collect traditional alcohols samples from the two main islands for analysis (at Laboratório de Estudos Farmacêuticos and Laboratório Nacional de Engenharia Civil - Portugal) and to determine heavy metals in the production process and impact on burden of life. MATERIAL AND METHODS: In order to characterise the country's situation in terms of alcohol and illicit substances consumption a literature review was carried out through a search in several international electronic databases, such as those of the World Health Organization, World Health Organization Africa, United Nation, The Lancet and Lancet Global Health, etc. Available data of the following institutions of Sao Tome and Príncipe was also analyzed: National Institute of Statistics, Ministry of Education, Culture and Training and Ministry of Health and Social Affairs. Several interviews with community and church leaders as well as with members of catholic missions were carried out to better understand the local situation. Following this, a nationwide cross-sectional survey of a sample of 2064 students will be carried out. This will include a questionnaire on socio-demographic characteristics, lifestyles, health behaviors/attitudes, alcohol and illicit substances consumption. Finally, based on the overall diagnosis obtained, some edutainment health communication preventive interventions will be tested in the primary schools of three districts (EDUCA_TURTLE) and on the radio journalists (EDUCA_PRESS). These were evaluated by primary school teachers and by radio journalists.

Introdução: São Tomé e Príncipe é um País Africano de Língua Oficial Portuguesa, de rendimento baixo-médio, onde a extrema pobreza potencia grandes desigualdades em saúde. Pouco se sabe sobre o consumo de álcool e substâncias ilícitas, além dos indicadores de importação e distribuição pela população. Não existem estudos realizados sobre este tema em crianças e adolescentes e são desconhecidas quaisquer medidas preventivas. Além disso, as bases de dados manuais apresentam limitações significativas, perante a inexistência de causas associadas às taxas de mortalidade (0 - 5 anos e > 5), e incapacidade de estabelecer uma relação causa-efeito entre doenças e morte e esperança média de vida. Inexistência de dados relativo às causas de mortalidade nos relatórios do Centro Nacional de Endemias ou nos relatórios da organização não-governamental Instituto Marquês de Valle Flor, entidade facilitadora de cuidados de saúde em especialidades clínicas selecionadas em regime de voluntariado de médicos de hospitais Portugueses. Propusemos assim realizar o primeiro diagnóstico de situação familiar e condições de habitação, e sobretudo, sobre o consumo de álcool e de substâncias ilícitas nos jovens. Neste sentido, foi desenvolvido o Inquérito Nacional sobre o Consumo de Álcool e Drogas em Meio Escolar em São Tomé e Príncipe para melhor caraterização da situação na população escolar, e para testar estratégias de comunicação em saúde e intervenções preventivas adaptadas às realidades socioculturais das populações-alvo. Foram considerados o dialeto, as famílias monoparentais, (estrutura matriarcal) a poligamia (sobretudo nos homens) num país e com governos liderados por homens (estrutura patriarcal), onde o papel da mulher, como refere a Organização das Nações Unidas para a Alimentação e a Agricultura, continua esquecido. Posteriormente procederemos à recolha de amostras de álcoois tradicionais, nas duas principais ilhas, para análise (pelo Laboratório de Estudos Farmacêuticos e Laboratório Nacional de Engenharia Civil) e determinar os metais pesados no processo de produção e impacto na esperança média de vida.Material e Métodos: Revisão da literatura nas bases de dados eletrónicas da Organização Mundial da Saúde, Organização Mundial da Saúde África, Organização das Nações Unidas, SCOPUS, MEDLINE, The Lancet e Lancet Global Health. Também considerámos e analisámos os dados disponíveis no Instituto Nacional de Estatística, Ministério das Finanças, Estatísticas da Educação, Ministério da Educação, Cultura e Formação, Estatística da Saúde, Ministério da Saúde e Assuntos Sociais do XV Governo de Iniciativa Presidencial 2013-14. Serão realizadas algumas entrevistas qualitativas aos líderes de todas as comunidades, à igreja e missões católicas com intervenção humanitária e apoio aos mais desfavorecidos. Posteriormente, aplicação de um questionário biográfico, demográfico e socioeconómico sobre o uso de substâncias lícitas e ilícitas a uma amostra de 2064 estudantes. Foram consideradas as caraterísticasdemográficas, sociais e culturais. Após resultados e conclusões, iremos ensaiar algumas intervenções preventivas de comunicação em saúde como o edutainment nas escolas primárias de três distritos (EDUCA_TARTARUGA) e com os jornalistas de rádio (EDUCA_PRESS), as quais serão avaliadas pelos professores primários e pelos jornalistas de rádio.

Consumption of Alcohol and Drugs in the School Population of Sao Tome and Principe.

INTRODUCTION: In Sao Tome and Principe there are no studies on alcohol and drug use among students, who could be potential allies in preventive interventions. The objectives of the present study are 1) to determine the frequency of alcohol and drug consumption in the school population, and 2) to identify the main characteristics associated with this behaviour. MATERIAL AND METHODS: We applied a biographical, demographic and socioeconomic questionnaire on the use of licit and illicit substances to a sample of 2064 students. Demographic and social characteristics are presented based on observed frequencies and comparisons between groups were made using chi-square tests. Significance was assessed at α = 0.05. RESULTS: More than half of the students reported consumed alcohol at least once in their lifetime, and 32% consumed in the last 30 days. Older students were more likely to consume alcohol (p < 0.0001), but even in students under 16 years, 17% consumed in the last 30 days. We also found that 7% consumed one or more times per week in the last 30 days. The reasons presented for frequent consumption were different for boys ("participation in their group of friends") and girls ("decrease anxiety") (p = 0.005). Less than 1% of respondents admitted to having used marijuana, cocaine, crack or ecstasy. DISCUSSION: Despite some limitations, such as self-reporting, we provide a first overview showing high consumption of alcohol by young people and the existence of illegal drugs circulating in the schools. CONCLUSION: It is urgent to implement preventive interventions, namely in the context of public health communication.

Introdução: Em São Tomé e Príncipe não há estudos sobre o uso de álcool e drogas na população escolar, potencial aliada em intervenções preventivas. Os objetivos do presente estudo são 1) determinar a frequência do consumo de álcool e drogas na população escolar e 2) identificar as principais características associadas a estes comportamentos. Material e Métodos: Foi aplicado um questionário biográfico, demográfico e socioeconómico sobre o uso de substâncias lícitas e ilícitas para uma amostra de 2064 alunos. As características demográficas e sociais apresentadas baseiam-se nas frequências observadas e as comparações entre os grupos foram feitas usando testes de qui-quadrado. A significância foi avaliada em α = 0,05. Resultados: Mais de metade dos alunos referiram consumir álcool pelo menos uma vez na vida, e 32% nos últimos 30 dias. Os alunos mais velhos mostraram-se mais propensos a consumir álcool (p < 0,0001), mas mesmo nos alunos com idade inferior a 16 anos, 17% consumiram nos últimos 30 dias. Constatou-se também que entre todos os alunos, 7% consumiram uma ou mais vezes por semana nos últimos 30 dias. As razões apresentadas para o consumo frequente foram diferentes para os rapazes ("participação no grupo de amigos") e raparigas ("diminuição da ansiedade") (p = 0,005). Menos de 1% dos entrevistados admitiram ter usado maconha, cocaína, crack ou ecstasy. Discussão: Apesar de algumas limitações, como o auto reporte, publica-se um primeiro diagnóstico de situação mostrando um elevado consumo de álcool pelos jovens e ainda a utilização de drogas ilegais nas escolas. Conclusão: É urgente o desenvolvimento de intervenções preventivas, nomeadamente, no âmbito da comunicação em saúde pública.