Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis.

INTRODUCTION: Climate change-related extreme weather events have increased in frequency and intensity, threatening people's health, particularly in places with weak health systems. In March 2019, Cyclone Idai devastated Mozambique's central region, causing infrastructure destruction, population displacement, and death. We assessed the impact of Idai on maternal and child health services and recovery in the Sofala and Manica provinces. METHODS: Using monthly district-level routine data from November 2016 to March 2020, we performed an uncontrolled interrupted time series analysis to assess changes in 10 maternal and child health indicators in all 25 districts before and after Idai. We applied a Bayesian hierarchical negative binomial model with district-level random intercepts and slopes to estimate Idai-related service disruptions and recovery. RESULTS: Of the 4.44 million people in Sofala and Manica, 1.83 (41.2%) million were affected. Buzi, Nhamatanda, and Dondo (all in Sofala province) had the highest proportion of people affected. After Idai, all 10 indicators showed an abrupt substantial decrease. First antenatal care visits per 100,000 women of reproductive age decreased by 23% (95% confidence interval [CI]=0.62, 0.96) in March and 11% (95% CI=0.75, 1.07) in April. BCG vaccinations per 1,000 children under age 5 years declined by 21% (95% CI=0.69, 0.90) and measles vaccinations decreased by 25% (95% CI=0.64, 0.87) in March and remained similar in April. Within 3 months post-cyclone, almost all districts recovered to pre-Idai levels, including Buzi, which showed a 22% and 13% relative increase in the number of first antenatal care visits and BCG, respectively. CONCLUSION: We found substantial health service disruptions immediately after Idai, with greater impact in the most affected districts. The findings suggest impressive recovery post-Idai, emphasizing the need to build resilient health systems to ensure quality health care during and after natural disasters.

Plano estrategico Multissectorial de prevenção e controlo de doenças não transmissíveis / Multisectoral strategic plan for the prevention and control of non-communicable diseases

A morte prematura por Doenças Não Transmissíveis (DNTs), continua a ser um dos principais desafios para o desenvolvimento a nível global, ceifando por ano perto de 15 milhões de vidas em idades compreendidas entre 30 e 70 anos. Moçambique não permanece inócuo pois já é notável a transição epidemiológica com o duplo peso das doenças transmissíveis e não transmissíveis. Em África o peso das Doenças Cardiovasculares, Diabetes Mellitus, Doenças Respiratórias Crónicas e o Cancro tem estado a aumentar de forma desproporcional entre os países de baixa e média renda, afetando sobretudo os grupos populacionais mais pobres e vulneráveis, impulsionado por factores como a pobreza, a globalização do mercado, o comércio de produtos prejudiciais à saúde, a crescente urbanização, crescimento e envelhecimento da população. Em Moçambique, à semelhança de muitos países, o desenvolvimento económico está a trazer grandes benefícios, mas também mudanças negativas na dieta e estilos de vida. É estimado que cerca de um terço das mortes no país sejam causadas pelas DNTs, e o risco de mortalidade prematura, ou seja, o risco de morte por DNTs antes dos 70 anos de idade, é de 18%. Este facto é preocupante pois maioria destas mortes prematuras e incapacidade por DNTs, pode ser evitada ou adiada através da redução da exposição aos factores de risco como consumo excessivo de álcool, consumo do tabaco, dieta não saudável e inatividade física.

Spectrum of nutrition-specific and nutrition-sensitive determinants of child undernutrition: a multisectoral cross-sectional study in rural Mozambique.

BACKGROUND: Despite an increasing need for multisectoral interventions and coordinations for addressing malnutrition, evidence-based multisectoral nutrition interventions have been rarely developed and implemented in low-income and middle-income countries. To identify key determinants of undernutrition for effectively designing a multisectoral intervention package, a nutrition survey was conducted, by comprehensively covering a variety of variables across sectors, in Niassa province, Mozambique. METHODS: A cross-sectional household survey was conducted in Niassa province, August-October 2019. Anthropometric measurements, anaemia tests of children under 5 years of age and structured interviews with their mothers were conducted. A total of 1498 children under 5 years of age participated in the survey. We employed 107 background variables related to possible underlying and immediate causes of undernutrition, to examine their associations with being malnourished. Both bivariate (χ2 test and Mann-Whitney's U test) and multivariate analyses (logistic regression) were undertaken, to identify the determinants of being malnourished. RESULTS: Prevalence rates of stunting, underweight and wasting were estimated at 46.2%, 20.0% and 7.1%, respectively. Timely introduction of solid, semi-solid or soft foods to children of 6-8 months of age was detected as a determinant of being not stunted. Mother-child cosleeping and ownership of birth certificate were a protective factor from and a promoting factor for being underweight, respectively. Similarly, availability and consumption of eggs at the household level and cough during the last 2 weeks among children were likely to be a protective factor from and a promoting factor for being wasted, respectively. CONCLUSION: Timely introduction of solid, semi-solid or soft foods could serve as an entry point for the three sectors to start making joint efforts, as it requires the interventions from all health, agriculture and water sectors. To enable us to make meaningful interprovincial, international and inter-seasonal comparisons, it is crucially important to develop a standard set of variables related to being malnourished.

Aplicación del OLEOZÓN en el tratamiento de las pericoronaritis / Usage of Oleozón in the treatment of pericoronaritis

La atención primaria se orienta hacia los principales problemas de salud de la comunidad, entre ellos los de urgencias estomatológicas, donde es atendida la pericoronaritis, siendo el tratamiento indicado la aplicación de sustancias cáusticas (ácido tricloroacético), que pueden ocasionar daños en los tejidos dentarios. Teniendo en cuenta las características de la pericoronaritis, se utilizó la ozonoterapia, realizando un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la evolución microbiológica después de aplicado el OLEOZÓN en el tratamiento de la pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero 2008. El universo de estudio fueron los pacientes con pericoronaritis, y la muestra abarcó 90 pacientes, conformándose dos grupos, uno experimental, tratado con Oleozón, y otro control, donde se empleó el tratamiento convencional. La eficacia del OLEOZÓN resultó ser alta en los pacientes tratados(AU)

Primary care is directed to the main health problems of the community, and among them stomatologic emergencies where pericoronaritis is attended, being the indicated treatment the application of caustic substances (trichloroacetic acid), that may damage dental tissues. Considering the characteristics of pericoronaritis, we used ozone therapy, carrying out a Phase III randomized, controlled and open clinical trial, that allowed studying the microbiologic evolution after applying Oleozón in the treatment of pericoronaritis, at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from January 2003 to January 2008. The universe of study was the patients with pericoronaritis, and the sample covered 90 patients. Two groups were formed, one experimental, treated with Oleozon, and the other control, where we used the conventional treatment. The OLEOZÓN efficacy was high in the treated patients(AU)

Aplicación del OLEOZÓN® en el tratamiento de las pericoronaritis / Usage of Oleozón® in the treatment of pericoronaritis

La atención primaria se orienta hacia los principales problemas de salud de la comunidad, entre ellos los de urgencias estomatológicas, donde es atendida la pericoronaritis, siendo el tratamiento indicado la aplicación de sustancias cáusticas (ácido tricloroacético), que pueden ocasionar daños en los tejidos dentarios. Teniendo en cuenta las características de la pericoronaritis, se utilizó la ozonoterapia, realizando un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la evolución microbiológica después de aplicado el OLEOZÓN® en el tratamiento de la pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero 2008. El universo de estudio fueron los pacientes con pericoronaritis, y la muestra abarcó 90 pacientes, conformándose dos grupos, uno experimental, tratado con Oleozón, y otro control, donde se empleó el tratamiento convencional. La eficacia del OLEOZÓN® resultó ser alta en los pacientes tratados.

Primary care is directed to the main health problems of the community, and among them stomatologic emergencies where pericoronaritis is attended, being the indicated treatment the application of caustic substances (trichloroacetic acid), that may damage dental tissues. Considering the characteristics of pericoronaritis, we used ozone therapy, carrying out a Phase III randomized, controlled and open clinical trial, that allowed studying the microbiologic evolution after applying Oleozón® in the treatment of pericoronaritis, at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from January 2003 to January 2008. The universe of study was the patients with pericoronaritis, and the sample covered 90 patients. Two groups were formed, one experimental, treated with Oleozon, and the other control, where we used the conventional treatment. The OLEOZÓN® efficacy was high in the treated patients.

Os deslocamentos temporais e a aprendizagem da história nos anos iniciais do ensino fundamental / Dislocations in time and history learning in the first years of elementary school

Apresentamos neste artigo a análise da progressão do conhecimento no sentido da complexidade do pensamento histórico, com ênfase nos deslocamentos temporais. Situamos nossa investigação no processo de entendimento do aluno quanto aos deslocamentos temporais, o que nos aproximou do constituído e/ou em constituição pela criança em termos de pensamento histórico perante a história ensinada.

Os deslocamentos temporais e a aprendizagem da história nos anos iniciais do ensino fundamental / Dislocations in time and history learning in the first years of elementary school

Apresentamos neste artigo a análise da progressão do conhecimento no sentido da complexidade do pensamento histórico, com ênfase nos deslocamentos temporais. Situamos nossa investigação no processo de entendimento do aluno quanto aos deslocamentos temporais, o que nos aproximou do constituído e/ou em constituição pela criança em termos de pensamento histórico perante a história ensinada. (AU)

Evolución clínica de las pericoronaritis tratadas con OLEOZON® en urgencias estomatológicas / Clinical evolution of pericoronaritis treated with OLEOZÓN® in stomatologic urgencias

La pericoronaritis es una patología bucal que aparece con frecuencia en consultas de urgencias estomatológicas. Se considera un proceso infeccioso agudo caracterizado por inflamación del tejido blando que rodea el diente retenido, lo cual provoca efectos indeseables en el paciente. El tratamiento indicado es la aplicación de sustancias caústicas que pueden ocasionar daños en los tejidos dentarios, por lo cual se decidió utilizar la ozonoterapia para realizar un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la eficacia del OLEOZON® en el tratamiento de la Pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero de 2008. El universo de estudio fueron los pacientes que en ese período asistieron con Pericoronaritis a la consulta de urgencia, y la muestra abarcó 90 pacientes, conformándose dos grupos: uno experimental, donde se aplicó el OLEOZON®, y otro control, donde se empleó el tratamiento convencional. Se caracterizaron los grupos desde el punto de vista sociodemográfico y clínico, determinándose la eficacia del OLEOZON®, la cual resultó ser alta en los pacientes tratados...(AU)

Pericoronaritis is an oral pathology frequently found in stomatologic urgency consultations. It is considered an acute infectious process characterized by inflammation of the soft tissues surrounding the retained tooth, causing unwanted effects in the patient. The indicated treatment is applying caustic substances that may damage dental tissues, so we decided using ozonotherapy to develop a clinical assay Phase III, randomized, controlled and open, allowing us to study the efficacy of OLEOZÓN® in treating Pericoronaritis at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from january 2003 to january 2008. The universe of study were the patients assisting to the urgency consultation with Pericoronaritis in that period of time, and the sample were 90 patients, divided in two groups, an Experimental one where OLEOZÓN® was applied, and a Control one where the conventional treatment was used. Both groups were characterized from the sociodemographic and clinic points of view, stating the efficacy of OLEOZÓN®, high in treated patients...(AU)

Evolución clínica de las pericoronaritis tratadas con OLEOZON® en urgencias estomatológicas / Clinical evolution of pericoronaritis treated with OLEOZÓN® in stomatologic urgencias

La pericoronaritis es una patología bucal que aparece con frecuencia en consultas de urgencias estomatológicas. Se considera un proceso infeccioso agudo caracterizado por inflamación del tejido blando que rodea el diente retenido, lo cual provoca efectos indeseables en el paciente. El tratamiento indicado es la aplicación de sustancias caústicas que pueden ocasionar daños en los tejidos dentarios, por lo cual se decidió utilizar la ozonoterapia para realizar un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la eficacia del OLEOZON® en el tratamiento de la Pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero de 2008. El universo de estudio fueron los pacientes que en ese período asistieron con Pericoronaritis a la consulta de urgencia, y la muestra abarcó 90 pacientes, conformándose dos grupos: uno experimental, donde se aplicó el OLEOZON®, y otro control, donde se empleó el tratamiento convencional. Se caracterizaron los grupos desde el punto de vista sociodemográfico y clínico, determinándose la eficacia del OLEOZON®, la cual resultó ser alta en los pacientes tratados.

Pericoronaritis is an oral pathology frequently found in stomatologic urgency consultations. It is considered an acute infectious process characterized by inflammation of the soft tissues surrounding the retained tooth, causing unwanted effects in the patient. The indicated treatment is applying caustic substances that may damage dental tissues, so we decided using ozonotherapy to develop a clinical assay Phase III, randomized, controlled and open, allowing us to study the efficacy of OLEOZÓN® in treating Pericoronaritis at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from january 2003 to january 2008. The universe of study were the patients assisting to the urgency consultation with Pericoronaritis in that period of time, and the sample were 90 patients, divided in two groups, an Experimental one where OLEOZÓN® was applied, and a Control one where the conventional treatment was used. Both groups were characterized from the sociodemographic and clinic points of view, stating the efficacy of OLEOZÓN®, high in treated patients.