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1.
Pan Afr Med J ; 33: 52, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448015

RESUMO

Introduction: The use of mass gatherings as spaces to practice health surveillance has been growing in recent years. In Mozambique, the 9th National Festival of Culture in 2016 was selected for this practice. A specific public health surveillance system to facilitate rapid detection of outbreaks and other health-related events was implemented for this event with real time data collection and analysis. Methods: A descriptive epidemiological evaluation of all the health consultations that occurred in fixed posts prepared for the event was conducted. The data were collected through electronic mobile system (tablets) in real time, with the aid of a form designed for this purpose and sent directly to the incident command system (ICS). Results: During the event, a total of 355 patients were assisted, 52.3% were female, 87.0% were from Beira city and the artists were the group that most frequently sought health care at 59.4%. The largest number of visits took place on the third day (36.4%). People over 45 years of age were the age group that most frequently sought health care (30.8%). The main provisional diagnoses of those who were attended to during the festival was arterial hypertension (20.3%), followed by febrile syndrome (19.0%), with falls being the most frequent causes of trauma during the festival (60.0%). Conclusion: The system of monitoring in real time using mobile technologies proved to be efficient for the monitoring of the main health events during the mass gatherings. This profile of health consultations encourages the health sector to plan strategies and actions geared to the reality of care for this type of event.

2.
Curr Environ Health Rep ; 6(3): 116-126, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102183

RESUMO

PURPOSE OF REVIEW: This research aims to summarize evidence on the cardiovascular effects of indoor air pollution (IAP) from solid fuel and identify areas for research and policy for low- and middle-income countries. RECENT FINDINGS: IAP affects people from low socioeconomic status in Latin America, Asia, and Africa, who depend upon biomass as a fuel for cooking, heating, and lighting. In these settings, IAP disproportionately affects women, children, the elderly, and people with cardiopulmonary disease. The health effects of IAP include acute respiratory infections, chronic obstructive pulmonary disease, pneumoconiosis, cataract and blindness, pulmonary tuberculosis, adverse effects to pregnancy, cancer, and cardiovascular and cerebrovascular disease. New methods for assessing individual IAP exposure, exposing pathways of IAP-related cardiovascular disease, and performing qualitative research focusing on population preferences regarding strategies to reduce IAP exposure have been the most important developments in tackling the burden of IAP. Unfortunately, major disparities exist regarding research into the cardiovascular effects of IAP, with only few studies coming from sub-Saharan Africa, despite this region having the highest proportion of households using solid fuels. Premature cardiovascular deaths and disability can be averted in low-middle income countries by addressing biomass fuel usage by the most disadvantaged settings. While research is needed to uncover the mechanisms involved in cardiovascular outcomes linked to IAP, immediate action is needed to educate the most affected populations on IAP health hazards and to reduce their exposure to this environmental risk through promoting improved housing and better ventilation, as well as increasing access to affordable clean cooking energy.

3.
PLoS Med ; 16(4): e1002783, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30978179

RESUMO

BACKGROUND: Most pregnancy hypertension estimates in less-developed countries are from cross-sectional hospital surveys and are considered overestimates. We estimated population-based rates by standardised methods in 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials. METHODS AND FINDINGS: CLIP-eligible pregnant women identified in their homes or local primary health centres (2013-2017). Included here are women who had delivered by trial end and received a visit from a community health worker trained to provide supplementary hypertension-oriented care, including standardised blood pressure (BP) measurement. Hypertension (BP ≥ 140/90 mm Hg) was defined as chronic (first detected at <20 weeks gestation) or gestational (≥20 weeks); pre-eclampsia was gestational hypertension plus proteinuria or a pre-eclampsia-defining complication. A multi-level regression model compared hypertension rates and types between countries (p < 0.05 considered significant). In 28,420 pregnancies studied, women were usually young (median age 23-28 years), parous (53.7%-77.3%), with singletons (≥97.5%), and enrolled at a median gestational age of 10.4 (India) to 25.9 weeks (Mozambique). Basic education varied (22.8% in Pakistan to 57.9% in India). Pregnancy hypertension incidence was lower in Pakistan (9.3%) than India (10.3%), Mozambique (10.9%), or Nigeria (10.2%) (p = 0.001). Most hypertension was diastolic only (46.4% in India, 72.7% in Pakistan, 61.3% in Mozambique, and 63.3% in Nigeria). At first presentation with elevated BP, gestational hypertension was most common diagnosis (particularly in Mozambique [8.4%] versus India [6.9%], Pakistan [6.5%], and Nigeria [7.1%]; p < 0.001), followed by pre-eclampsia (India [3.8%], Nigeria [3.0%], Pakistan [2.4%], and Mozambique [2.3%]; p < 0.001) and chronic hypertension (especially in Mozambique [2.5%] and Nigeria [2.8%], compared with India [1.2%] and Pakistan [1.5%]; p < 0.001). Inclusion of additional diagnoses of hypertension and related complications, from household surveys or facility record review (unavailable in Nigeria), revealed higher hypertension incidence: 14.0% in India, 11.6% in Pakistan, and 16.8% in Mozambique; eclampsia was rare (<0.5%). CONCLUSIONS: Pregnancy hypertension is common in less-developed settings. Most women in this study presented with gestational hypertension amenable to surveillance and timed delivery to improve outcomes. TRIAL REGISTRATION: This study is a secondary analysis of a clinical trial - ClinicalTrials.gov registration number NCT01911494.

4.
Hum Resour Health ; 17(1): 15, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819211

RESUMO

BACKGROUND: Pre-eclampsia is one of the leading causes of maternal death in Mozambique. Limited access to health care facilities and a lack of skilled health professionals contribute to the high maternal morbidity and mortality rates in Mozambique and indicate a need for community-level interventions. The aim of this review was to identify and characterise health policies related to the role of CHWs in the management of pre-eclampsia and eclampsia in Mozambique. METHODS: The policy review was based on three methods: a desk review of relevant documents from the Mozambique Ministry of Health (n = 7), contact with 28 key informants in the field of health policy in Mozambique (n = 5) and literature review (n = 699). Policy documents obtained included peer-reviewed articles, government and institutional policies, reports and action plans. Seven hundred and eleven full-text documents were assessed for eligibility and included based on pre-defined criteria. Qualitative analysis was done to identify main themes using content analysis. RESULTS: A total of 56 papers informed the timeline of key events. Three main themes were identified from the qualitative review: establishment of the community health worker programme and early challenges, revitalization of the CHW programme and the integration of maternal health in the community health tasks. In 1978, following the Alma Alta Declaration, the Mozambique government brought in legislation establishing primary health care and the CHW programme. Between the late 1980s and early 1990s, this programme was scaled down due to several factors including a prolonged civil war; however, the decision to revitalise the programme was made in 1995. In 2010, a revitalised programme was re-launched and expanded to include the management of common childhood illnesses, detection of warning signs of pregnancy complications, referrals for maternal health and basic health promotion. To date, their role has not included management of emergency conditions of pregnancy including pre-eclampsia and eclampsia. CONCLUSION: The role of CHWs has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling. Studies to assess the impact of CHWs in providing services to reduce maternal morbidity and mortality are recommended.


Assuntos
Serviços de Saúde Comunitária , Agentes Comunitários de Saúde , Eclampsia/terapia , Política de Saúde , Serviços de Saúde Materna , Pré-Eclâmpsia/terapia , Papel Profissional , Criança , Eclampsia/mortalidade , Feminino , Acesso aos Serviços de Saúde , Humanos , Morte Materna/prevenção & controle , Saúde Materna , Mortalidade Materna , Moçambique , Pré-Eclâmpsia/mortalidade , Gravidez
5.
BMC Public Health ; 19(1): 147, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717732

RESUMO

BACKGROUND: As Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools. METHODS: Workshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique's capital. RESULTS: Over 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies. CONCLUSION: Changes in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way.


Assuntos
Doenças não Transmissíveis/epidemiologia , Vigilância da População/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Recursos em Saúde/provisão & distribução , Hospitais Urbanos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Estudos Prospectivos , Encaminhamento e Consulta , Adulto Jovem
6.
J Alzheimers Dis ; 70(s1): S283-S291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30664504

RESUMO

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.

7.
PLoS One ; 13(11): e0202186, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30412633

RESUMO

Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with overdispersion and clustered counts when analyzing data on maternal deaths and related risk factors within health facilities in Mozambique. This paper aims at providing additional insights over previous analyses and presents an extension of such models to account for spatial variation in a disease mapping framework of facility-based maternal mortality in Mozambique.

8.
Arq Bras Cardiol ; 110(6): 500-511, 2018 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30226906

RESUMO

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

9.
Nutrients ; 10(8)2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30087242

RESUMO

High salt intake is a major risk factor of hypertension and cardiovascular disease. Improving knowledge, attitudes, and practices (KAP) related to salt intake in the general population is a key component of salt reduction strategies. The objective of this study was to describe and compare the KAP of adults related to salt in urban areas of five countries in sub-Saharan Africa. The survey included 588 participants aged 25 to 65 years who were selected using convenience samples in the urban areas of Benin, Guinea, Kenya, Mozambique, and Seychelles. Socio-demographic and food consumption were assessed using a structured closed-ended questionnaire administered by survey officers. Height, weight, and blood pressure were measured. Food consumption varied largely between countries. Processed foods high in salt, such as processed meat, cheese, pizzas, and savory snacks were consumed rather infrequently in all the countries, but salt-rich foods, such as soups or bread and salty condiments, were consumed frequently in all countries. The majority of the participants knew that high salt intake can cause health problems (85%) and thought that it is important to limit salt intake (91%). However, slightly over half (56%) of the respondents regularly tried to limit their salt intake while only 8% of the respondents thought that they consumed too much salt. Salt and salty condiments were added most of the time during cooking (92% and 64%, respectively) but rarely at the table (11%). These findings support the need for education campaigns to reduce salt added during cooking and for strategies to reduce salt content in selected manufactured foods in the region.


Assuntos
Grupo com Ancestrais do Continente Africano , Ingestão de Alimentos/etnologia , Fast Foods , Comportamento Alimentar/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hipertensão/etnologia , Cloreto de Sódio na Dieta/administração & dosagem , População Urbana , Adulto , África ao Sul do Saara/epidemiologia , Grupo com Ancestrais do Continente Africano/psicologia , Idoso , Culinária , Estudos Transversais , Inquéritos sobre Dietas , Ingestão de Alimentos/psicologia , Fast Foods/efeitos adversos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Fatores de Proteção , Recomendações Nutricionais , Fatores de Risco , Comportamento de Redução do Risco , Cloreto de Sódio na Dieta/efeitos adversos
10.
Arq. bras. cardiol ; 110(6): 500-511, June 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-950178

RESUMO

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


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

11.
Biosensors (Basel) ; 8(2)2018 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-29693557

RESUMO

The appearance, over a decade ago, of continuous glucose monitoring (CGM) devices has triggered a patient-centred revolution in the control and management of diabetes mellitus and other metabolic conditions, improving the patient’s glycaemic control and quality of life. Such devices, the use of which remains typically restricted to high-income countries on account of their elevated costs, at present show very limited implantation in resource-constrained settings, where many other urgent health priorities beyond diabetes prevention and management still need to be resolved. In this commentary, we argue that such devices could have an additional utility in low-income settings, whereby they could be selectively used among severely ill children admitted to hospital for closer monitoring of paediatric hypoglycaemia, a life-threatening condition often complicating severe cases of malaria, malnutrition, and other common paediatric conditions.


Assuntos
Glicemia/química , Hipoglicemia/diagnóstico , Humanos , Hipoglicemia/patologia , Pobreza
12.
Pregnancy Hypertens ; 11: 26-31, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29523269

RESUMO

In well-resourced settings, reduced circulating maternal free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preeclampsia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when pre-eclampsia is suspected. This operational pilot implementation of maternal plasma PlGF in women with suspected preeclampsia was conducted in six antenatal clinics in Maputo, Mozambique (six control clinics for comparison). The primary outcome was transfer to higher levels of care, following the informative PlGF assay. Of antenatal visits, 133/31,993 (0.42%) and 20/33,841 (0.06%) resulted in pre-eclampsia-related transfers of care for women attending intervention and control clinics, respectively (p < .0001). The clinic-to-delivery for women with low PlGF (<100 pg/ml) interval was shorter, (vs normal PlGF (median 10 days [IQR 1-25] vs 36 [11-83], p < .0001)). Low PlGF was associated with younger maternal age, higher blood pressure, earlier delivery, more therapeutic interventions, preterm birth, lower birth weight, and perinatal loss. In addition, one-third of hypertensive women with PlGF < 50 pg/ml suffered a stillbirth. In urban Mozambican women with symptoms and/or signs suggestive of preeclampsia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, especially early delivery and stillbirth. Therefore, introducing PlGF into the clinical care of women with suspected preeclampsia was associated with increased transfers to higher levels of care; low PlGF (<100 pg/ml) was associated with increased maternal and perinatal risks. PlGF < 50 pg/ml is particularly associated with stillbirth in women with suspected preeclampsia.


Assuntos
Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Adulto , Área Sob a Curva , Biomarcadores/sangue , Pressão Sanguínea , Estudos de Casos e Controles , Regulação para Baixo , Diagnóstico Precoce , Feminino , Humanos , Moçambique , Projetos Piloto , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/etiologia , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco , Natimorto , Saúde da População Urbana , Adulto Jovem
13.
Eur J Clin Nutr ; 72(12): 1690-1699, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29588530

RESUMO

BACKGROUND/OBJECTIVES: Health education and regulatory measures may contribute to lower population salt intake. Therefore, we aimed to describe knowledge and behaviors related to salt intake in Mozambique. SUBJECTS/METHODS: A cross-sectional evaluation of a representative sample of the population aged 15-64 years (n = 3116) was conducted in 2014/2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance, including a 12-question module for evaluation of dietary salt. RESULTS: Three dimensions were identified in the questionnaire, named "self-reported salt intake", "knowledge of health effects of salt intake", and "behaviors for control of salt intake". A total of 7.4% of the participants perceived that they consumed too much/far too much salt and 25.9% reported adding salt/salty seasoning often/always to prepared foods. The proportion considering that it was not important to decrease the salt contents of their diet was 8%, and 16.9% were not aware that high salt intake could be deleterious for health. Prevalences of lack of behaviors for reducing salt intake ranged from 74.9% for not limiting consumption of processed foods, to 95% for not buying low salt alternatives. There were few differences according to socio-demographic variables, but awareness of hypertension was, in general, associated with better knowledge and less frequent behaviors likely to contribute to a high salt intake. CONCLUSIONS: Most Mozambicans were aware that high salt intake can cause health problems, but the self-reported salt intake and behaviors for its control show an ample margin for improvement. This study provides evidence to guide population level salt-reducing policies.

14.
Reprod Health ; 15(1): 5, 2018 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-29304812

RESUMO

BACKGROUND: Vital signs measurement can identify pregnant and postpartum women who require urgent treatment or referral. In low-resource settings, healthcare workers have limited access to accurate vital signs measuring devices suitable for their environment and training. The CRADLE Vital Signs Alert (VSA) is a novel device measuring blood pressure and pulse that is accurate in pregnancy and designed for low-resource settings. Its traffic light early warning system alerts healthcare workers to the need for escalation of care for women with hypertension, haemorrhage or sepsis. This study evaluated the usability and acceptability of the CRADLE VSA device. METHODS: Evaluation was conducted in community and primary care settings in India, Mozambique and Nigeria and tertiary hospitals in South Africa. Purposeful sampling was used to convene 155 interviews and six focus groups with healthcare workers using the device (n = 205) and pregnant women and their family members (n = 41). Interviews and focus groups were conducted in the local language and audio-recorded, transcribed and translated into English for analysis. Thematic analysis was undertaken using an a priori thematic framework, as well as an inductive approach. RESULTS: Most healthcare workers perceived the CRADLE device to be easy to use and accurate. The traffic lights early warning system was unanimously reported positively, giving healthcare workers confidence with decision-making and a sense of professionalism. However, a minority in South Africa described manual inflation as tiring, particularly when measuring vital signs in obese and hypertensive women (n = 4) and a few South African healthcare workers distrusted the device's accuracy (n = 7). Unanimously, pregnant women liked the CRADLE device. The traffic light early warning system gave women and their families a better understanding of the importance of vital signs in pregnancy and during the postpartum period. CONCLUSION: The CRADLE device was well accepted by healthcare workers from a range of countries and levels of facility, including those with no previous vital signs measurement experience. The device motivated women to attend primary care and encouraged them to accept treatment and referral.


Assuntos
Equipamentos e Provisões/economia , Serviços de Saúde Materna , Monitorização Fisiológica/instrumentação , Complicações na Gravidez/diagnóstico , Sinais Vitais , Adulto , Serviços de Saúde Comunitária , Agentes Comunitários de Saúde , Diagnóstico Precoce , Desenho de Equipamento/economia , Estudos de Viabilidade , Feminino , Humanos , Índia , Serviços de Saúde Materna/economia , Monitorização Fisiológica/economia , Moçambique , Nigéria , Áreas de Pobreza , Gravidez , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , África do Sul , Recursos Humanos
15.
J Hypertens ; 36(4): 779-784, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29210894

RESUMO

OBJECTIVE: To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25-64 years old population. METHODS: A cross-sectional study of a representative sample of the population aged 15-64 years (n = 2965) was conducted in 2014-2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25-64 years. RESULTS: The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014-2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014-2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15-24 years, in 2014-2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8-16.4). CONCLUSION: Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.

16.
Cogitare enferm ; 23(3): e55216, 2018. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-984253

RESUMO

RESUMO Objetivo: avaliar a presença de fatores de risco cardiovascular em estudantes universitários de países lusófonos. Metodologia: estudo transversal, realizado de janeiro a julho de 2017, com 334 estudantes de uma universidade pública federal no estado do Ceará, com idade igual ou superior a 18 anos, dos seguintes países: Brasil, Angola, Cabo Verde, Guiné-Bissau, Moçambique, São Tomé e Príncipe e Timor-Leste. Efetuou-se a análise estatística dos dados por meio do programa Epi Info versão 7.1.2.0. Resultados: dos 334 participantes, 75,7% encontravam-se na faixa etária entre 18 e 24 anos, 56,9% eram brasileiros, 51,8% do sexo feminino, 47,3% de cor parda e 47,6% solteiros com parceria eventual. Quanto aos fatores de risco para doenças cardiovasculares, destacaram-se a história familiar de doenças cardiovasculares (81,1%), o sedentarismo (44,3%) e o uso do álcool (36,2%). Conclusão: a identificação dos principais fatores de risco modificáveis e hereditários nos estudantes universitários poderão nortear ações voltadas para a promoção da saúde cardiovascular.


RESUMEN Objetivo: evaluar la presencia de factores de riesgo cardiovascular en estudiantes universitarios de países lusófonos. Metodologia: estudio transversal, realizado de enero a julio de 2017, con 334 estudiantes de una universidad pública federal en el estado de Ceará, con edad igual o superior a 18 años, de los siguientes países: Brasil, Angola, Cabo Verde, Guinea-Bissau, Mozambique, San Tomé y Príncipe y Timor-Leste. Se hizo análisis estadístico de los datos por medio del programa Epi Info versión 7.1.2.0. Resultado: de los 334 participantes, 75,7% estaban en edad entre 18 y 24 años, 56,9% eran brasileños, 51,8% del sexo femenino, 47,3% de color pardo y 47,6% solteros con pareja eventual. Acerca de los factores de riesgo para enfermedades cardiovasculares, se destacaron la historia familiar de enfermedades cardiovasculares (81,1%), el sedentarismo (44,3%) y el uso de alcohol (36,2%). Conclusión: la identificación de los principales factores de riesgo modificables y hereditarios en los estudiantes universitarios podrán nortear acciones de promoción de salud cardiovascular.


ABSTRACT Objective: to evaluate the presence of cardiovascular risk factors in university students from Portuguese-speaking countries. Methodology: cross-sectional study, carried out from January to July 2017, with 334 students from a federal public university in the state of Ceará, aged 18 years and over, from the following countries: Brazil, Angola, Cape Verde, Guinea-Bissau, Mozambique, Sao Tome and Principe and East Timor. Data was analyzed with the Epi Info version 7.1.2.0 statistical software. Results: of the 334 participants, 75.7% were aged 18-24 years old, 56.9% were Brazilian, 51.8% were female, 47.3% were brown and 47.6% were single individuals with an occasional partner. Risk factors for cardiovascular diseases included a family history of cardiovascular disease (81.1%), sedentary lifestyle (44.3%) and alcohol use (36.2%). Conclusion: identification of the main modifiable and hereditary risk factors in university students could guide actions aimed at promoting cardiovascular health.


Assuntos
Estudantes , Doenças Cardiovasculares , Risco , Países em Desenvolvimento
17.
Afr Health Sci ; 17(3): 773-779, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29085405

RESUMO

INTRODUCTION: Data regarding the association between diabetes mellitus (DM) and tuberculosis (TB) in Africa are scarce. DM screening among TB patients in Mozambique was carried out. METHODS: The study was implemented from January to August 2016 in three Urban Health Centers in Beira, Mozambique and recruited adult (>18 years) patients newly diagnosed with pulmonary TB. RESULTS: Three hundred and one patients were enrolled (67.4%, males mean age 31.7(SD 11 years). Diabetes was diagnosed in only 3 patients (1%) and impaired glucose tolerance (IGT) in an additional 6 subjects (2%). CONCLUSION: A lower than expected prevalence of DM was observed, which could be explained by the lack of traditional risk factors for DM (overweight, age over 45 years, hypertension and smoking) in Mozambique.


Assuntos
Diabetes Mellitus/epidemiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Idoso , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Prevalência , Fatores de Risco , Serviços Urbanos de Saúde , População Urbana
19.
World J Pediatr Congenit Heart Surg ; 8(4): 495-501, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28696875

RESUMO

The 54 countries in Africa have an estimated total annual congenital heart defect (CHD) birth prevalence of 300,486 cases. More than half (51.4%) of the continental birth prevalence occurs in only seven countries. Congenital heart disease remains primarily a pediatric health issue in Africa because of the deficient health-care systems: the adults with CHD made up just 10% of patients with CHD in Ghana, and 13.7% of patients with CHD presenting for surgery in Mozambique. With Africa's population projected to double in the next 35 years, the already deficient health systems for CHD care will suffer unbearable strain unless determined and courageous action is undertaken by the African leaders.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Acesso aos Serviços de Saúde , Cardiopatias Congênitas/cirurgia , Adulto , África/epidemiologia , Cardiopatias Congênitas/epidemiologia , Humanos , Prevalência , Fatores Socioeconômicos , Taxa de Sobrevida/tendências
20.
Hypertension ; 69(3): 469-474, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28137987

RESUMO

In well-resourced settings, reduced circulating maternal-free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preeclampsia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when preeclampsia is suspected. This blinded, prospective cohort study of maternal plasma PlGF in women with suspected preeclampsia was conducted in antenatal clinics in Maputo, Mozambique. The primary outcome was the clinic-to-delivery interval. Other outcomes included: confirmed diagnosis of preeclampsia, transfer to higher care, mode of delivery, intrauterine fetal death, preterm birth, and low birth weight. Of 696 women, 95 (13.6%) and 601 (86.4%) women had either low (<100 pg/mL) or normal (≥100 pg/mL) plasma PlGF, respectively. The clinic-to-delivery interval was shorter in low PlGF, compared with normal PlGF, women (median 24 days [interquartile range, 10-49] versus 44 [24-81], P=0.0042). Also, low PlGF was associated with a confirmed diagnosis of preeclampsia, higher blood pressure, transfer for higher care, earlier gestational age delivery, delivery within 7 and 14 days, preterm birth, cesarean delivery, lower birth weight, and perinatal loss. In urban Mozambican women with symptoms or signs suggestive of preeclampsia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, whether the diagnosis of preeclampsia is confirmed. Therefore, PlGF should improve the provision of precision medicine to individual women and improve pregnancy outcomes for those with preeclampsia or related placenta-mediated complications.


Assuntos
Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Moçambique/epidemiologia , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
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