Leveraging School Health Programs in Africa: Integrated Screening for Rheumatic Heart Disease and Dental Caries.

Background: Rheumatic heart disease (RHD) and dental caries (DC) disproportionately affect children and young adults in sub-Saharan countries, with major impact on schoolchildren's health and education. DC in children with RHD constitutes an important risk for fatal complications. Our study aimed at assessing the feasibility of simultaneous RHD and DC screening in school environment. Methods: March 20-24, 2022, we performed an observational descriptive study of schoolchildren in a public school in Maputo City, Mozambique. RHD screening involved two stages: first, a physical examination (including cardiac auscultation and direct observation of the oral cavity), and second, an abbreviated echocardiography performed by a cardiologist. Rapid testing for group A Streptococcus (GAS) was done to every eighth child in the classroom and for those with signs suggesting recent infection, in accordance with the study protocol developed for screening. A multidisciplinary team collected the data. Data were analyzed using descriptive statistics. Findings: A total of 954 students (median age 9; range 6-15) were screened. One hundred and twenty-five participants were eligible for a rapid antigen test, of which 6 (4.8%) tested positive. On clinical evaluation 52 children (5.3%) presented a heart murmur. Echocardiography on 362 children showed borderline RHD in 35 children and definite RHD in 2 (0.6%); 1 child had a ventricular septal defect. Dental cavities were present in 444 (48.4%), despite 904 out of 917 students reporting brushing of their teeth once to three times daily (98.6%). Conclusion: School-based integrated oral and cardiovascular screenings and use of rapid tests for GAS carriage provide crucial information to create customized preventive strategies for rheumatic fever (RF) and RHD in low- and middle-income countries (LMICs), in addition to detecting children at very high risk of bacterial endocarditis. The sustainability of such interventions and acceptability by health providers needs to be assessed.

Empowering Frontline Primary Healthcare Workers in a Global Health Partnership Training of Trainers Intervention to Strengthen the Prevention and Control of Cardiovascular Disease in Mozambique.

Background: Unpreparedness of health professionals to address non-communicable diseases (NCD) at peripheral health facilities is a critical health system challenge in Mozambique. To address this weakness and decentralize NCD care, training of the primary care workforce is needed. We describe our experience in the design and implementation of a cascade training of trainers (ToT) intervention to strengthen the prevention and control of cardiovascular disease. Methods: Between October 2018 and March 2020 a multidisciplinary global technical partnership was used to train frontline primary care health professionals from a resource-poor suburban setting in Maputo, Mozambique. Following engagement with local policy makers, clinicians, and academics, core training materials were developed, and a ToT cascade was implemented, supported by an on-site pilot clinic. Knowledge and confidence acquisition by participants and new local trainers were assessed using pre- and post-training surveys, while trainees and trainers completed further evaluation surveys at the end of the program. Results: Three ToT workshops trained 60 mixed cadre healthcare workers in assessment, diagnosis and management of hypertension, diabetes, and cardiovascular risk; of these, 11 became new local trainers. Mean pre- and post-test scores improved in all three training workshops (53% to 90%, 59% to 78%, and 58% to 74% respectively). New local trainers were highly rated by their trainees and reported increased confidence as trainers (mean Likert scale 3.0/5 pre-training to 4.8/5 post-training). Conclusion: This global health partnership delivered interprofessional training with good knowledge acquisition and increased self-reported confidence. Intensive local supervision and hands-on training empowered a new cohort of trainers to strengthen the prevention and control of cardiovascular disease and is likely to improve coordination and integration at primary care level as well as support the national scale up of NCD care delivery.

Psicointervenção para manejo da ansiedade e depressão através de plataformas digitais / Psychointervention for managing anxiety and depression through digital platforms

Introdução: A pandemia da COVID-19 colocou desafios ao sistema habitual de atendimento dos doentes em Moçambique, devido ao risco que o atendimento presencial representa para a sua transmissão. Os doentes crónicos que acorrem aos serviços de urgências constituem um grupo de alto risco para infecção por COVID-19, acrescido devido à sua condição de saúde aguda. Tendo em conta este facto, a implementação de intervenções para a educação sobre a COVID-19, bem como o rastreio de doenças mentais comuns (ansiedade e depressão) nesta população, são essenciais. O presente estudo tem como objectivo: (1) determinar a exequibilidade de despiste de ansiedade e depressão e (2) determinar a aplicabilidade de realização de psicointervenção por via remota/telessaúde. Métodos: Foram contactados todos os pacientes adultos com diagnóstico de Doença Não-Transmissível dum estudo de coorte prospectivo sobre padrão de doença em serviços de urgência em Moçambique, realizado pelo Instituto Nacional de Saúde em 2016-2017. Foram efectuadas chamadas telefónicas para 259 participantes elegíveis do Hospital Geral de Mavalane (Cidade de Maputo) de quem se obteve o consentimento informado, tendo sido feita triagem de sintomatologia ansiosa/depressiva usando as escalas General Anxiety Disorder Assessment-7 (GAD-7) e o Patient Health Questionnaire-9 (PHQ-9). Resultados: Dos 259 participantes elegíveis, 30 (11.3%) o contacto não correspondia ao participante, 7.7% (20/259) foram óbitos e 5% (13/259) participantes não estava presente. Onze participantes (5.6%) recusaram o consentimento. Dezasseis (16/185 = 8.6%) doentes tiveram despiste positivo para ansiedade ou depressão. Dez dos onze participantes (90.9%) que beneficiaram da intervenção revelaram dificuldades em aceder aos serviços sociais, tendo sido feita a devida orientação. Um caso (9.1%) foi orientado para o acompanhamento psiquiátrico por parte da equipa. Devido à curta duração do período envolvido não foi feito seguimento dos casos intervencionados. Conclusão: Usando consultas por via remota foi encontrada uma incidência clinicamente relevante de depressão e ansiedade numa coorte de pacientes crónicos durante a fase inicial da pandemia da COVID-19 em Moçambique. A exequibilidade de intervenções de saúde mental por via remota suporta o seu uso precoce em doentes crónicos, em situações de emergência sanitárias com descontinuidade de cuidados presenciais.

Introduction: The COVID-19 pandemic posed challenges to the usual patient care system in Mozambique. Patients who come to the emergency services are a high-risk group for COVID-19 infection, due to their acute health condition, especially if they have a chronic condition. The implementation of education interventions on COVID-19, as well as the screening for common mental illnesses (anxiety and depression) in this population, are essential. This project aims to: (1) determine the feasibility of screening for anxiety and depression and (2) determine the applicability of performing remote / telehealth psychointervention. Methods: All adult patients (over 18 years old), diagnosed with Noncommunicable Disease (DNT) from the MOZART study, conducted by the National Health Institute (INS) in 2016-2017, were contacted. Demographic, clinical, laboratory data and information on hospital treatment and immediate prognosis were collected. Telephone calls were made to 259 participants with DNT who were recruited in 2016 and 2017 at Hospital Geral de Mavalane (Maputo City). They were screened for depression and anxiety symptoms through Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder Assessment-7 (GAD-7). Results: Of the 259 participants, 11.3% (30/259) did not correspond the call, 7.7% (20/259) died and 5% (13/259) participants were not present. Eleven participants (5.6%) refused consent. Sixteen (16/185 = 8.6%) patients scored Revista Moçambicana de Ciências de Saúde, vol.7, no 1, 2021 | ISSN 2311-3308 15 positive for anxiety or depression. Ten of the eleven participants (90.9%) who benefited from the intervention revealed difficulties in accessing social services, having been given the appropriate guidance. One case (9.1%) was oriented for psychiatric monitoring by the team. Due to the short duration of the period involved, the cases were not followed up. Conclusion: The results of this study suggest a considerable incidence of symptoms of depression and anxiety in the cohort of patients seen in the Emergency Department of Hospital Geral de Mavalane, during the initial phase of the COVID-19 pandemic in Mozambique. There is a need to offer mental health interventions at an early stage to patients using emergency services in Maputo City, as well as the expansion of this intervention to the entire country. It justifies the pertinence of the development and evaluation of psychointervention using the telephone.

Pulmonary vascular disease in Africa: Lessons from registries.

The epidemiology of pulmonary vascular disease (PVD) remains unclear in Africa, where health systems do not reach the majority of the population and heath information systems are poorly developed. In this context, registries are particularly important in gathering crucial information on PVD, aiming at improving knowledge of the epidemiology and/or quality of care. While population-based registries are the main tool to identify incident cases, and be a better indicator of pulmonary vascular disease burden, hospital-based registries can give an indication of the demand for specific care services, which is useful for health policy and planning. The only registry for pulmonary hypertension in Africa - the Pan African Pulmonary Hypertension Cohort (PAPUCO) - involved four countries, and was a pragmatic study that revealed a unique pattern of environmental risks, issues related to low access to health care, and ill-equipped health facilities for diagnosis and management of pulmonary hypertension. In addition, disease specific registries for conditions such as congenital heart disease and rheumatic heart disease uncovered high occurrence of PVD that can be managed and/or prevented with improvements in community awareness, surveillance, management and prevention. It is suggested that existing networks of experts and researchers develop regional registries to determine the epidemiology of PVD in Africa, assess geographic, environmental and seasonal differentials, as well as inform policy and care provision in the continent.

SARS-CoV-2 em Grávidas e Puérperas no Início da Transmissão Comunitária na Cidade de Maputo / SARS-CoV-2 in Pregnant and Postpartum Women at the Beginning of Transmission Community in Maputo City

A COVID-19 é causada por coronavírus descri to pela primeira vez em 2019, designado SARS- -CoV-2,1 e afectou até ao momento milhões de pessoas em todo o mundo, resultando em milhares de óbitos.2 O quadro patológico pode cursar com síndrome respiratória aguda grave. Nos casos sin tomáticos, os doentes apresentam geralmente febre, tosse, dispneia e cansaço;3 contudo, a infecção as sintomática ocorre em cerca de 87.9% dos infec tados.4 Indivíduos com doenças crónicas e idosos são mais susceptíveis a COVID-19.5 As grávidas são igualmente susceptíveis a contrair o SARS-CoV-2 devido as alterações fisiológicas do seu estado. As mesmas durante a infecção correm o potencial risco de evoluir com pneumonia,6 mesmo que em alguns casos cursem sem sintomas.7 Até Março de 2020 em Singapura, a análise de 55 gestantes infectadas com a COVID-19 e 46 recém-nascidos, não evidenciou transmissão vertical ou maior susceptibilidade de grávidas ao SARS-CoV-2.8 Mesmo assim, no início da pandemia cerca de 10% das grávidas infectadas tiveram insuficiência respiratória grave, e 5% neces sitaram de ventilação.