Emotional contagion behavior in a group of young girls in a secondary school in Maputo, Mozambique.

BACKGROUND: Emotional Contagion Behavior (ECB), the synchronized expression of emotional symptoms among members of a group, has been observed globally. In Mozambique, there have been numerous reports of ECB in recent years. Since 2010 several girls from a secondary school in Maputo City, Mozambique exhibited ECB which involved repeated fainting spells, sometimes including verbal aggression and threats to colleagues and teachers. We conducted a study to analyze sociodemographic and clinical characteristics associated with ECB. METHODS: This cross-sectional study included 154 females aged from 16 to 24 years old. We considered emotional contagion behavior as repeated fainting spells, sometimes including verbal aggression and threats to others (colleagues and teachers). Participants responded to a sociodemographic questionnaire, the Beck Anxiety Scale, and the revised Eysenck Personality Questionnaire (EPQ-R). Bivariate and multivariate logistic regression models analyzed sociodemographic and clinical characteristics associated with EBC. RESULTS: Among study participants, 57 presented ECB and 97 did not. The likelihood of ECB was higher among those with previous history of ECB (OR = 8.28, 95% CI [2.51, 27.30]; p ⩽ .001) and extroverted personality profile (OR = 1.15, 95% CI [1.01, 1.30]; p = .038). Having a romantic relationship was related to lower likelihood of having ECB (OR = 0.04, 95% CI [0.01, 0.19]; p = .001). CONCLUSIONS: These results suggest that ECB may repeat over time and be related to challenges pertaining to personality development, the presence of sexual life, and close relationships with peers faced by adolescent girls.

Does It Matter What Screener We Use? A Comparison of Ultra-brief PHQ-4 and E-mwTool-3 Screeners for Anxiety and Depression Among People With and Without HIV.

The burden of depression and anxiety disorders is high in sub-Saharan Africa, especially for people with HIV (PWH). The Patient Health Questionnaire-4 (PHQ-4) and Electronic Mental Wellness Tool-3 (E-mwTool-3) are ultra-brief screening tools for these disorders. We compared the performance of PHQ-4 and E-mwTool-3 for screening MINI-International Neuropsychiatric Interview diagnoses of depression and anxiety among a sample of individuals with and without HIV in two primary care clinics and one general hospital in Maputo City, Mozambique. Areas-under-the-curve (AUC) were calculated along with sensitivities and specificities at a range of cutoffs. For PWH, at a sum score cutoff of ≥ 1, sensitivities were strong: PHQ-4:Depression = 0.843; PHQ-4:Anxiety = 0.786; E-mwTool-3:Depression = 0.843; E-mwTool-3:Anxiety = 0.929. E-mwTool-3 performance was comparable to PHQ-4 among people with and without HIV.

Community Health Workers' Knowledge, Attitudes, and Practices towards Epilepsy in Sofala, Central Mozambique.

BACKGROUND: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has been task-sharing the identification and care for epilepsy by community health workers (CHWs). The present study aimed to assess the knowledge, attitudes, and practices (KAPs) of CHWs towards epilepsy in Mozambique. METHODS: One hundred and thirty-five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided into six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) across nine districts of Sofala, Mozambique. The internal consistency was examined to evaluate the reliability of the instrument (QKAP-EPI). The association between sociodemographic variables and QKAP-EPI subscales was examined using linear regression models. RESULTS: The internal consistency was moderate for two subscales (causes of epilepsy, α = 0.65; medical treatment, α = 0.694), acceptable for cultural treatment (α = 0.797) and excellent for 2 subscales (safety and risks, α = 0.926; negative attitudes, α = 0.904). Overall, CHWs demonstrated accurate epilepsy knowledge (medical treatment: mean = 1.63, SD = 0.28; safety/risks: mean = 1.62, SD = 0.59). However, CHWs reported inaccurate epilepsy knowledge of the causes, negative attitudes, as well as culturally specific treatments for epilepsy, such as: "if a person with epilepsy burns when set on fire they cannot be treated". Knowledge about how to manage epileptic seizures varied across the different emergency care practices, from the accurate belief that it is not advisable to place objects in the individual's mouth during an epileptic seizure, to the wrong perception of the need to hold the person in seizures to control seizures. Heterogeneity in the level of epilepsy knowledge was observed among CHWs, when considering epilepsy according to the local names as treatable ("Dzumba") and other forms as untreatable ("Nzwiti"). CONCLUSION: CHWs knowledge of medical treatment and epilepsy safety/risks were adequate. However, information on the causes of epilepsy, stigmatizing attitudes, cultural treatment, and some knowledge of epileptic seizure management were low. These areas of poor knowledge should be the focus of educating CHWs in increasing their ability to provide quality care for patients with epilepsy in Mozambique.

Perceptions of Community Health Workers (CHW) on barriers and enablers to care for people with psychosis in rural Mozambique: findings of a focus group discussion study using the Capability, Opportunity, Motivation and Behaviour framework (COM-B framework).

BACKGROUND: Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique. METHODS: A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B). RESULTS: Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care. CONCLUSION: CHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.

Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation.

BACKGROUND: Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. AIMS: This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. METHODS: We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Expert consultation was performed according to Arksey & O'Malley framework and cultural adaptation analysis was performed according to Bernal framework. RESULTS: Out of 14,549 retrieved records, we identified ten peer-reviewed articles conducted in Zimbabwe, Uganda, South Africa and Zambia describing four distinct interventions. Six were randomized controlled trials; none addressed implementation outcomes. Group-based interpersonal therapy (n = 5), trauma-focused cognitive behaviour therapy (n = 1), problem solving therapy (n = 3) and narrative exposure therapy (n = 1) emerged as psychological interventions delivered by LHW for people with depression, anxiety, trauma and suicidal behavior. Psychological interventions delivered by LHW in Africa were all culturally adapted to meet the competence of LHW. All the interventions were associated with symptom improvement, but the quality of this evidence varied widely with study design. CONCLUSION: Task-shifting psychological interventions delivered by LHW after appropriate cultural adaptation show promise for addressing unmet mental health care needs in Africa. More effectiveness and implementation evidence is needed, especially with regard to psychological interventions delivered by LHW for adolescence, older people and those with severe mental disorders and suicidal behaviors.

Brief Screening Tool for Stepped-Care Management of Mental and Substance Use Disorders.

OBJECTIVE: Stepped mental health care requires a rapid method for nonspecialists to detect illness. This study aimed to develop and validate a brief instrument, the Mental Wellness Tool (mwTool), for identification and classification. METHODS: Cross-sectional development and validation samples included adults at six health facilities in Mozambique. Mini International Neuropsychiatric Interview diagnoses were the criterion standard. Candidate items were from nine mental disorder and functioning assessments. Regression modeling and expert consultation determined best items for identifying any mental disorder and classifying positives into disorder categories (severe mental disorder, common mental disorder, substance use disorder, and suicide risk). For validation, sensitivity and specificity were calculated for any mental disorder (index and proxy respondents) and disorder categories (index). RESULTS: From the development sample (911 participants, mean±SD age=32.0±11 years, 63% female), 13 items were selected-three with 0.83 sensitivity (95% confidence interval [CI]=0.79-0.86) for any mental disorder and 10 additional items classifying participants with a specificity that ranged from 0.72 (severe mental disorder) to 0.90 (suicide risk). For validation (453 participants, age 31±11 years, 65% female), sensitivity for any mental disorder was 0.94 (95% CI=0.89-0.97) with index responses and 0.73 (95% CI=0.58-0.85) with family proxy responses. Specificity for categories ranged from 0.47 (severe mental disorder) to 0.93 (suicide risk). Removing one item increased severe mental disorder specificity to 0.63 (95% CI=0.58-0.68). CONCLUSIONS: The mwTool performed well for identification of any mental disorder with index and proxy responses to three items and for classification into treatment categories with index responses to nine additional items.

Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence-Based Practices (PRIDE) in Mozambique.

BACKGROUND: Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs' mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interventions (EBIs). This article discusses the protocol for the first study implementing comprehensive mental health services in LMICs. METHODS: In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial will evaluate implementation, patient, and service outcomes of three task-shifting delivery pathways in 20 Mozambican districts (population 4.7 million). In pathway 1 (usual care), community health workers (CHWs) and primary care providers (PCPs) refer patients to district-level mental health clinics. In pathway 2 (screen, refer, and treat), CHWs screen and refer patients to PCPs for behavioral and pharmacological EBIs in community clinics. In pathway 3 (community mental health stepped care), CHWs screen patients and deliver behavioral EBIs in the community and refer medication management cases to PCPs in clinics. Mixed-methods process evaluation will be used to examine factors affecting pathway implementation, adoption, and sustainability. Clinical activities will occur without research team support. Ministry of Health personnel will coordinate training and supervision. RESULTS: The most cost-effective pathway will be scaled up in all districts for 12 months. NEXT STEPS: This novel study integrating comprehensive mental health services into primary care will inform a toolkit to help the Mozambican Ministry of Health scale up the most cost-effective pathway for mental health services and can be a template for other LMICs.

Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study.

OBJECTIVE: To report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications. DESIGN AND SETTING: The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications. MAIN OUTCOME MEASURES: We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs PARTICIPANTS: Psychiatric technicians and primary care providers trained in the EBPs. RESULTS: PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment. CONCLUSIONS: The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.

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.

Lowering costs for large-scale screening in psychosis: a systematic review and meta-analysis of performance and value of information for speech-based psychiatric evaluation

Objective: Obstacles for computational tools in psychiatry include gathering robust evidence and keeping implementation costs reasonable. We report a systematic review of automated speech evaluation for the psychosis spectrum and analyze the value of information for a screening program in a healthcare system with a limited number of psychiatrists (Maputo, Mozambique). Methods: Original studies on speech analysis for forecasting of conversion in individuals at clinical high risk (CHR) for psychosis, diagnosis of manifested psychotic disorder, and first-episode psychosis (FEP) were included in this review. Studies addressing non-verbal components of speech (e.g., pitch, tone) were excluded. Results: Of 168 works identified, 28 original studies were included. Valuable speech features included direct measures (e.g., relative word counting) and mathematical embeddings (e.g.: word-to-vector, graphs). Accuracy estimates reported for schizophrenia diagnosis and CHR conversion ranged from 71 to 100% across studies. Studies used structured interviews, directed tasks, or prompted free speech. Directed-task protocols were faster while seemingly maintaining performance. The expected value of perfect information is USD 9.34 million. Imperfect tests would nevertheless yield high value. Conclusion: Accuracy for screening and diagnosis was high. Larger studies are needed to enhance precision of classificatory estimates. Automated analysis presents itself as a feasible, low-cost method which should be especially useful for regions in which the physician pool is insufficient to meet demand.

Conhecimentos, Atitudes e Práticas dos Trabalhadores de Saúde em Moçambique sobre a COVID-19: estudo online rápido / Knowledge, Attitudes and Practices of Health Workers in in Mozambique about COVID-19: rapid online study

Os profissionais de saúde (PS), como profissionais da linha de frente, têm maior risco de infecção pela COVID-19. Foram adoptadas várias medidas para controlar a rápida propagação da epidemia da COVID-19 em Moçambique. A adesão dos (PS) a essas medidas é influenciada por seus conhecimentos, atitudes e práticas (CAP) em relação à COVID-19. Neste estudo, analisámos os CAP dos PS em relação à COVID-19 durante o primeiro mês da pandemia em Moçambique. Os PS, foram convidados a participar do estudo, através dos grupos de redes sociais. O questionário de conhecimento é composto por 13 questões referentes às características clínicas e prevenção da COVID-19. As atitudes e práticas em relação à COVID-19 foram avaliadas por meio de perguntas sobre a confiança no controle da COVID-19 e o uso de máscaras quando em locais públicos.Entre os respondentes da pesquisa (n = 431), 53,1% eram mulheres, 57,8% possuíam o grau de licenciatura. A taxa geral de respostas correctas do questionário de conhecimento foi de 87,2%. A maioria dos inquiridos (86,2%) tem confiança de que Moçambique vencerá a luta contra a COVID-19. A maioria dos PS (91,2%) usou máscara quando saiu de casa nos últimos dias. Em geral, os participantes da pesquisa possuem bons conhecimentos sobre a COVID-19 e atitudes positivas em relação à vitória na batalha contra a COVID-19. As acções de educação e treinamento em COVID-19 para profissionais de saúde devem ter em consideração factores como género, experiência de trabalho e nível de diferenciação profissional. No entanto, existem lacunas em aspectos de conhecimento e práticas que devem receber atenção especial pelas autoridades de saúde em futuras iniciativas de educação dos profissionais de saúde sobre a COVID-19.

Health Care Workers (HCW) as a frontline's professional has higher risk of infections and worst outcome by COVID-19. Measures have been adopted to control the rapid spread of the COVID-19 epidemic in Mozambique. HCW adherence to these measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we investigated Mozambican HCW KAP towards COVID-19 during the first month of the pandemic in Mozambique. An online sample of Mozambican HCW was invited to participate via the HCW social media groups. The knowledge questionnaire consisted of 13 questions regarding the clinical characteristics and prevention of COVID-19. Attitudes and practices towards COVID-19 was assessed using questions on confidence in winning the battle against COVID-19 and wearing masks when going out in recent days. Among the survey respondents (n=431), 53.1 % were women, 57.8% held a bachelor degree. The overall correct rate of the knowledge questionnaire was 87.2%. The majority of the respondents (86.2%) had confidence that Mozambique can win the battle against COVID-19. Most HCW (91.2%) wore masks when going out in recent days. In general, HCW who participated in the survey have good knowledge about COVID-19, and positive attitudes towards victory in the battle against COVID-19. Education and training actions on COVID-19 for HCW should take into account factors such as gender, work experience and level of professional differentiation. However, there are gaps in aspects of knowledge and practices that should be given special attention by health authorities in future initiatives to raise awareness and education for health professionals

Lowering costs for large-scale screening in psychosis: a systematic review and meta-analysis of performance and value of information for speech-based psychiatric evaluation.

OBJECTIVE: Obstacles for computational tools in psychiatry include gathering robust evidence and keeping implementation costs reasonable. We report a systematic review of automated speech evaluation for the psychosis spectrum and analyze the value of information for a screening program in a healthcare system with a limited number of psychiatrists (Maputo, Mozambique). METHODS: Original studies on speech analysis for forecasting of conversion in individuals at clinical high risk (CHR) for psychosis, diagnosis of manifested psychotic disorder, and first-episode psychosis (FEP) were included in this review. Studies addressing non-verbal components of speech (e.g., pitch, tone) were excluded. RESULTS: Of 168 works identified, 28 original studies were included. Valuable speech features included direct measures (e.g., relative word counting) and mathematical embeddings (e.g.: word-to-vector, graphs). Accuracy estimates reported for schizophrenia diagnosis and CHR conversion ranged from 71 to 100% across studies. Studies used structured interviews, directed tasks, or prompted free speech. Directed-task protocols were faster while seemingly maintaining performance. The expected value of perfect information is USD 9.34 million. Imperfect tests would nevertheless yield high value. CONCLUSION: Accuracy for screening and diagnosis was high. Larger studies are needed to enhance precision of classificatory estimates. Automated analysis presents itself as a feasible, low-cost method which should be especially useful for regions in which the physician pool is insufficient to meet demand.

Reducing the Number of People with Dementia Through Primary Prevention in Mozambique, Brazil, and Portugal: An Analysis of Population-Based Data.

BACKGROUND: Most people with dementia live in low- and middle-income countries and little is known about the potential for reducing these numbers by reducing key risk factors. OBJECTIVE: To investigate the potential for dementia incidence reduction in Brazil, Mozambique, and Portugal (a culturally related, high-income country). METHODS: We replicated previously published methods and based on the relative risks from previous studies, we estimated the population-attributable risk (PAR) of dementia in Mozambique, Brazil, and Portugal for seven modifiable risk factors associated with dementia (low educational attainment, physical inactivity, midlife hypertension, midlife obesity, depression, smoking, and diabetes mellitus). The combined PAR was calculated and adjusted for associations between risk factors. The potential for risk factor reduction was assessed by examining the effect of relative reductions of 10% and 20% per decade for each of the risk factors on projections for dementia cases for each decade until 2050. RESULTS: After adjusting for non-independence of risk factors, 24.4%, 32.3%, and 40.1% of dementia cases could be related to seven potentially modifiable risk factors in Mozambique, Brazil, and Portugal, respectively. Reducing the prevalence of each risk factor by 20% per decade could, by 2050, potentially reduce the prevalence of dementia in Mozambique, Brazil, and Portugal by 12.9%, 16.2%, and 19.5%, respectively. CONCLUSION: There is a substantial difference between the countries in the percentage of dementia cases that could be attributable to the seven potentially modifiable risk factors. The proportion of cases that could be prevented by 2050 if measures were taken to address these main risk factors was higher in Portugal than in Brazil and Mozambique. Each country or region should consider their unique risk factor profile when developing dementia risk reduction programs.

Family reintegration of homeless in Maputo and Matola: a descriptive study.

BACKGROUND: Homelessness is a global and local social problem with underestimated prevalence. It has been shown to increase the risk of mental illness, raising concerns from mental health providers about the need for effective interventions targeting this population. OBJECTIVES: The aim of this paper is to describe the mental health status of the homeless people in two urban setting in a low-income country, through using standardised clinical and socio-demographic assessments as well assessing potential predictors of family integration versus non-family integration among a group of homeless individuals receiving psychiatric and psychosocial treatment. METHODS: A descriptive study was performed in Maputo and Matola cities between 2008 and 2010. Homeless people with apparent mental illness were mapped and recruited. The participants were referred from community to hospital, using a multidisciplinary treatment model, according to their clinical condition and later entered a family reintegration process. RESULTS: Seventy-one homeless people were recruited (93.0% male; 80.3% unemployed). The most common diagnosis was schizophrenia and other psychosis (46; 64.8%), followed by mental and behaviour disorder related to substance misuse (21; 29.6%), and intellectual disability (4; 5.6%). Family reintegration was achieved for 53.5% (38 patients). Patients with intellectual disability were less reintegrated and those with disorders related to substance use had better reinsertion in their families (Chi square (2)  = 6.1; p = 0.047). CONCLUSIONS: Family reintegration was achieved in more than half of participants after hospitalization. Integration was higher in cases of substance misuse, with those with associated intellectual disability being more difficult to reintegrate. Trial registration Trial Registration Number: NCT02936141, date of registration: 14/10/2016, retrospectively registered.