Increased peripartum mortality associated with maternal subclinical malaria in Mozambique.

BACKGROUND: Plasmodium falciparum infection in pregnant women in sub-Saharan Africa is often asymptomatic. As these forms of malaria are often submicroscopic and difficult to diagnose by conventional methods (microscopy and/or rapid diagnostic test), diagnosis requires the use of molecular techniques such as polymerase chain reaction (PCR). This study analyses the prevalence of subclinical malaria and its association with adverse maternal and neonatal outcomes, a topic that has been scarcely evaluated in the literature. METHODS: A cross-sectional study was conducted using semi-nested multiplex PCR to assess the presence of P. falciparum in placental and peripheral blood of 232 parturient pregnant women at the Hospital Provincial de Tete, Mozambique between March 2017 and May 2019. Multivariate regressions were performed to assess the associations of maternal subclinical malaria with several maternal and neonatal outcomes after controlling for the presence of preeclampsia/eclampsia (PE/E) and HIV infection, as well as for other maternal and pregnancy characteristics. RESULTS: In total, 17.2% (n = 40) of the women studied had positive PCR for P. falciparum (7 in placental blood only, 3 in peripheral blood only). We found a significant association between subclinical malaria and a higher peripartum mortality risk, which persisted after controlling for maternal comorbidity and maternal and pregnancy characteristics (adjusted odds ratio: 3.50 [1.11-10.97]). In addition, PE/E and HIV infections were also significantly associated with several adverse maternal and neonatal outcomes. CONCLUSION: This study demonstrated the association of subclinical malaria, as well as of PE/E and HIV, in pregnant women with adverse maternal and neonatal outcomes. Therefore, molecular methods may be sensitive tools to identify asymptomatic infections that can reduce the impact on peripartum mortality and their contribution to sustained transmission of the parasite in endemic countries.

Effects of HIV infection and/or malaria on maternal and neonatal health in a high-prevalence setting.

OBJECTIVE: HIV infection and malaria have been associated with different complications during pregnancy and delivery. HIV-positive pregnant women are at increased risk for all adverse outcomes of malaria during pregnancy. The main objective was to analyse the obstetric and perinatal consequences of malaria, HIV infection and HIV/malaria co-infection in pregnant women and newborns, which has been less well evaluated. METHODS: A cross-sectional study was carried out in the Maternity Service of the Provincial Hospital of Tete Mozambique, involving completion of a structured questionnaire that included demographic data, and information on the current pregnancy, delivery and the newborn. In total, 819 women (13-45 years old) in the immediate postpartum period were enrolled between 1 March and 31 October 2016. RESULTS: The overall prevalence of HIV and malaria, considered separately, in pregnant women was ~12% (103 women with HIV and 101 with malaria). Only one-fifth of HIV-infected women knew their HIV status before pregnancy. A significantly higher proportion of women with HIV attended four or more antenatal care visits than women without HIV. Caesarean section was less frequent in HIV patients, and peripartum urinary infection was more frequent than in seronegative women (13/103 [12.6%] vs. 34/716 [4.7%]). HIV/malaria co-infection were 17/819 (2%) and was significantly associated with the development of pre-eclampsia when HIV-infected patients received anti-retroviral treatment, and with an increase in urinary tract infections around delivery. With respect to the newborn, co-infection increased the frequency of early neonatal death, as well as neonatal asphyxia and jaundice. CONCLUSIONS: In Mozambique, the prevalence of malaria and HIV infection in women of childbearing age continues to be high and contributes additively to complications during pregnancy and childbirth, and in the newborn. Therefore, integrating HIV, malaria and reproductive health services is essential if maternal and foetal outcomes are to improve.

Adolescent motherhood in Mozambique. Consequences for pregnant women and newborns.

INTRODUCTION: In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn. AIMS: To identify the factors associated with adolescent motherhood in Tete (Mozambique). METHODS: This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn. RESULTS: The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040-0.110), pregnancy follow-up (OR 0.29; CI 0.173-0.488) and previous abortions (OR 4.419; 95% CI 1.931-10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn. CONCLUSION: Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.

Proyecto ULPGC-UniZambeze. Formación médica universitaria en países en desarrollo / ULPGC-UniZambeze project. Undergraduate medical education in developing countries

Todos los países, cualquiera que sea su grado de desarrollo, se esfuerzan por proporcionar unos cuidados sanitarios adecuados a sus ciudadanos. Gozar de buena salud es una condición básica para el desarrollo y la seguridad de las personas, a pesar de lo cual persisten enormes desigualdades en salud entre los países. Los educadores médicos tienen un papel clave en la reducción de estas desigualdades al abordar uno de los aspectos esenciales del problema: la acusada escasez de médicos que sufren algunas regiones, especialmente en el África subsahariana. Una de las mayores dificultades para afrontar esta cuestión es la falta de profesores cualificados, lo que podría solventarse mediante estancias cortas de graduados procedentes de países desarrollados que voluntariamente quisieran participar en este tipo de iniciativas. Pero el mundo de la educación médica tampoco es un terreno justo, equilibrado y equitativo, y trabajar en países pobres y alejados supone un reto importante. En este artículo, presentamos la experiencia en el diseño y desarrollo de un proyecto de formación de médicos en la Universidad de Zambeze, en Tete (Mozambique), llevada a cabo desde la Universidad de Las Palmas de Gran Canaria (AU)

Every nation-ich or poor and developed or developing-strives hard to deliver optimal healthcare to its citizens. Good health is the necessary condition for development and human security, but inequities in health persist. Medical educators have a key role to play in reducing inequities in global health by addressing the underlying doctor shortages that have reached crisis levels in some regions. The region in which these health inequities and doctor deficiencies are starkest is sub-Saharan Africa. In poor countries, a major constraint to approach this issue is the scarcity of qualified teachers. One of the options is the short-term placement of graduates from rich countries seeking opportunities to contribute in other countries that are severely deficient in faculty. But the world of medical education is not a level playing field and working in developing countries, and in remote areas in particular, can be challenging. In this article we show a recent experience carried out at the University of Las Palmas de Gran Canaria designing and supporting a project on undergraduate medical education at the University of Zambeze, in Tete, Mozambique (AU)