Características Sociodemográficas e Risco de Transmissão da COVID-19 em Moçambique / Sociodemographic Characteristics and Transmission Risk of COVID-19 in Mozambique

Objectivo: Mapear o potencial risco de transmissão do novo coronavírus em Moçambique de modo a identificar os distritos cujas características sociodemográficas favorecem a propagação do vírus. Métodos: Usou-se a modelação espacial para determinar o risco relativo de propagação da COVID-19 num distrito em relação ao outro com base nos seguintes factores sociodemográficos: densidade populacional, tamanho médio de agregado familiar, percentagem da população jovem de 15-34 anos e percentagem da população que vive num raio de 2 km de uma estrada classificada. Primeiro, para cada factor foi estimado um risco relativo dividindo os distritos em quintis, e, em segundo lugar, os riscos individuais de cada factor foram somados com igual peso para estimar o risco agregado de transmissão da COVID-19 por distrito. Resultados: Dezanove distritos localizados sobretudo nos principais centros urbanos e no corredor da Beira apresentam alto risco de propagação da COVID-19 em função das suas características sociodemográficas; 24 distritos mostram risco médio-alto e distribuem-se pelas regiões centro e sul do país; 60 distritos localizados nas regiões centro e sul e no interior da região norte apresentam risco médio e; 58 distritos mostram risco médio-baixo ou baixo de transmissão da COVID-19 e encontram-se no litoral centro-norte do país. Conclusão: Os distritos cujo perfil sociodemográfico é favorável à rápida propagação do novo coronavírus são os das grandes cidades e os localizados nas principais rotas de transporte. No entanto, este padrão de risco é susceptível de alterações em função da celeridade, abrangência e níveis de observância das medidas de prevenção e/ou de mitigação da COVID-19. Assim, recomenda-se que as medidas de prevenção e mitigação tenham em conta o risco potencial em cada distrito em função das suas características sociodemográficas.

Objective: To map the potential risk of COVID-19 transmission in Mozambique in order to identify districts with sociodemographic characteristics that favour the spread of coronavirus. Methods: Spatial modelling was used to determine the relative risk of COVID-19 transmission in a certain district in relation to other districts based on the following sociodemographic factors: population density, mean number of household members, the percentage of the young population aged 15-34 and the proportion of a district's population living within two kilometres of a classified road. First, a relative risk due to each factor was estimated grouping the districts into quintiles and, second, the individual risks were added with equal weight to estimate the aggregate relative risk of COVID-19 transmission per district. Results: Nineteen districts located in the main urban centres and along the Beira corridor were found to be at a high relative risk of COVID-19 transmission; 24 districts located mainly in central and southern regions display a medium-high risk category; 60 districts located in the central and southern regions and in the hinterland of the northern region show a medium risk category and; 58 districts exhibit a medium-low or low risk category of COVID-19 transmission and are mainly located at the eastern part of the central-north region. Conclusion: The districts with sociodemographic profile favouring the spread of the new coronavirus are those in the big cities and those located along the main transportation routes. However, the pattern of risk is subject to changes due to the speed, coverage and level of compliance with COVID-19 prevention and mitigation measures. It is recommended that COVID-19 prevention and mitigation measures should take into account the potential risk of each district.

Re-emergence of thiamine deficiency disease in the Pacific islands (2014-15): A case-control study.

BACKGROUND: From late 2014 multiple atolls in Kiribati reported an unusual and sometimes fatal illness. We conducted an investigation to identify the etiology of the outbreak on the most severely affected atoll, Kuria, and identified thiamine deficiency disease as the cause. Thiamine deficiency disease has not been reported in the Pacific islands for >5 decades. We present the epidemiological, clinical, and laboratory findings of the investigation. METHODOLOGY/PRINCIPAL FINDINGS: We initially conducted detailed interviews and examinations on previously identified cases to characterize the unknown illness and develop a case definition. Active and passive surveillance was then conducted to identify additional cases. A questionnaire to identify potential risk factors and blood samples to assay biochemical indices were collected from cases and asymptomatic controls. Thiamine hydrochloride treatment was implemented and the response to treatment was systematically monitored using a five-point visual analogue scale and by assessing resolution of previously abnormal neurological examination findings. Risk factors and biochemical results were assessed by univariate and multivariate analyses. 69 cases were identified on Kuria (7% attack rate) including 34 confirmed and 35 unconfirmed. Most were adults (median age 28 years [range 0-62]) and 83% were male. Seven adult males and two infants died (13% case fatality rate). Resolution of objective clinical signs (78%) or symptoms (94%) were identified within one week of starting treatment. Risk factors included having a friend with thiamine deficiency disease and drinking kava; drinking yeast alcohol reduced the risk of disease. Higher chromium (p<0·001) but not thiamine deficiency (p = 0·66) or other biochemical indices were associated with disease by univariate analyses. Chromium (p<0·001) and thiamine deficiency (p = 0·02) were associated with disease by multivariate analysis. CONCLUSIONS/SIGNIFICANCE: An outbreak of thiamine deficiency disease (beriberi) in Kiribati signals the re-emergence of a classic nutritional disease in the Pacific islands after five decades. Although treatment is safe and effective, the underlying reason for the re-emergence remains unknown. Chromium was highly and positively correlated with disease in this study raising questions about the potential role of factors other than thiamine in the biochemistry and pathophysiology of clinical disease.