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1.
Artigo em Inglês | MEDLINE | ID: mdl-33530538

RESUMO

We assessed adherence to government recommendations implemented shortly after the introduction of COVID-19 in Mozambique in March 2020, through two online cross-sectional surveys in April and June 2020. We quantified adherence to preventive measures by a composite score comprising of five measures: physical distancing, face mask use, hand hygiene, cough hygiene, and avoidance of touching the face. 3770 and 1115 persons participated in the first and second round respectively. Wearing face masks, regular handwashing and cough hygiene all reached compliance rates of over 90% while physical distancing and avoiding to touch the face reached a compliance rate of 80-90%. A multivariable model investigating factors associated with adherence found that being older, more educated, and belonging to the healthcare sector increased the odds for higher adherence. Private workers and retired people, respondents receiving COVID-19 information through social media, and those who reported flu-like symptoms were less likely to adhere. 6% of respondents reported flu-like symptoms which aligned with the WHO clinical definition of COVID-19, suggesting low level community transmission. In conclusion, most respondents in this online survey in Mozambique complied well with strategies to prevent COVID-19. Whether the good preventive behaviour explains the low grade COVID-19 transmission requires further study.


Assuntos
Fidelidade a Diretrizes , Guias como Assunto , /epidemiologia , Estudos Transversais , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Moçambique/epidemiologia , Inquéritos e Questionários
2.
PLoS One ; 16(2): e0244924, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33566850

RESUMO

Healthcare workers (HCWs) are at the frontline of the Coronavirus Disease 2019 (COVID-19) pandemic response, yet there is a paucity of literature on their knowledge, attitudes and practices (KAP) in relation to the pandemic. Community Health Workers (CHWs) in Mozambique are known locally as agentes polivalentes elementares (APEs). While technical guidance surrounding COVID-19 is available to support APEs, communicating this information has been challenging due to restrictions on travel, face-to-face group meetings and training, imposed from May to August 2020. A digital health platform, upSCALE, that already supports 1,213 APEs and 299 supervisors across three provinces, is being used to support APEs on effective COVID-19 management by delivering COVID-19 sensitive SMS messages, training modules and a COVID-19 KAP survey. The KAP survey, conducted from June 2020 to August 2020, consisted of 10 questions. Of 1,065 active upSCALE APEs, 28% completed the survey. Results indicate that only a small proportion of APEs listed the correct COVID-19 symptoms, transmission routes and appropriate prevention measures (n = (25%), n = (16%) and n = (39%), respectively) specifically included in national health education materials. Misconceptions were mainly related to transmission routes, high risk individuals and asymptomatic patients. 84% said they followed all government prevention guidelines. The results from the KAP survey were used to support the rapid development and deployment of targeted COVID-19 awareness and education materials for the APEs. A follow-up KAP survey is planned for November 2020. Adapting the existing upSCALE platform enabled a better understanding, in real time, of the KAP of APEs around COVID-19 management. Subsequently, supporting delivery of tailored messages and education, vital for ensuring a successful COVID-19 response.


Assuntos
/epidemiologia , Agentes Comunitários de Saúde/educação , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique , Sistemas On-Line , Pandemias/prevenção & controle , Inquéritos e Questionários , Adulto Jovem
3.
BMC Infect Dis ; 21(1): 16, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407206

RESUMO

BACKGROUND: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum ß-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique. METHODS: A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR. RESULTS: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n = 58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n = 25/75; 33%) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread. CONCLUSION: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major ß-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.


Assuntos
Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Cefotaxima/uso terapêutico , Ceftazidima/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , Plasmídeos/metabolismo , beta-Lactamases/genética , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/urina , Humanos , Testes de Sensibilidade Microbiana , Moçambique/epidemiologia , Fenótipo , Prevalência
4.
BMC Infect Dis ; 21(1): 18, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407207

RESUMO

BACKGROUND: Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. METHODS: The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). RESULTS: Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. CONCLUSIONS: The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Diarreia/epidemiologia , Desnutrição/epidemiologia , Infecções por Rotavirus/epidemiologia , Rotavirus/imunologia , Animais , Aleitamento Materno , Pré-Escolar , Comorbidade , Estudos Transversais , Diarreia/virologia , Características da Família , Fezes/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Prevalência , Fatores de Risco , Infecções por Rotavirus/prevenção & controle , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/uso terapêutico
5.
Mar Pollut Bull ; 163: 111952, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33461077

RESUMO

Liquid natural gas (LNG) exploration has started off the coast of northern Mozambique, in the Rovuma Basin, East Africa. In advance of gas production, we collected in 2018 over 100 samples of surface sediments from 40 locations in the pristine and exploration areas at water depths of 5-2000 m. We have determined the levels of hydrocarbons (total hydrocarbon contents (THC) and 49 individual PAHs), heavy metals, arsenic, grain size and total organic carbon. While sediment composition varied strongly from coarse sediment to high mud contents (<63 µm), background levels of hydrocarbons and metals were found in most samples. We found anthropogenic contamination at one site in Pemba harbor. We observed no petroleum-related contamination, including the Palma area with numerous exploration wells. Elevated concentrations of barium and THC at some locations in this area are attributed to drilling activities but are not considered to be of environmental concern.


Assuntos
Hidrocarbonetos Policíclicos Aromáticos , Poluentes Químicos da Água , África Oriental , Monitoramento Ambiental , Sedimentos Geológicos , Ilhas do Oceano Índico , Moçambique , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Químicos da Água/análise
6.
Artigo em Inglês | MEDLINE | ID: mdl-33466388

RESUMO

Background: Tobacco growing has been considered a mainstay of Mozambique's economy, but there is a dearth of analysis of the tobacco policy landscape in the country. Methods: Review of government and non-government documents and academic papers addressing Mozambique's tobacco-growing history, the changes in the political economy of tobacco, and health policies addressing tobacco use and prevention of noncommunicable diseases. Results: Despite its tobacco growing and exporting history, the contribution of tobacco to the economy has been in steady decline in the past two decades, including in the areas dedicated to growing. At the same time there has been an increase in multinational control of the tobacco economy. In parallel, Mozambique's commitment to addressing the growing burden of noncommunicable disease and accession to the Framework Convention on Tobacco Control indicate a potential for internal government tensions to balance immediate economic interests with long term health goals. Conclusions: With the decline in tobacco share of the overall economy, Mozambique may be well-positioned to explore alternative, sustainable livelihoods for farmers that grow tobacco, but it must overcome inter-sectoral barriers and advocate for a whole of government approach to address the health and economic impact of tobacco.


Assuntos
Política de Saúde , Indústria do Tabaco/economia , Produtos do Tabaco/legislação & jurisprudência , Agricultura , Humanos , Moçambique , Tabaco/crescimento & desenvolvimento , Uso de Tabaco/epidemiologia
8.
Anim Sci J ; 91(1): e13463, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33222395

RESUMO

To effectively utilize crop by-product resources for ruminant feed in semi-arid West Africa, we studied the chemical composition, characteristics concerned with fermentative quality, and microbial population of ensiled pearl millet stover (PMS) and sorghum stover (SS) in Mozambique. After panicle harvest, the PMS and SS were exposed in the field for 7, 21, 35, 49, 63, 77, 91, and 120 days under natural weather conditions. The fresh stover silages were prepared and stored for 120 days. With increased exposure time, the dry matter, neutral detergent fiber, acid detergent lignin, and neutral detergent insoluble nitrogen contents increased, whereas the crude protein, ether extract, gross energy, digestible energy, metabolizable energy, and true protein contents decreased. After 120 days of field exposure, aerobic bacteria dominated both stovers, and lactic acid bacteria (LAB) decreased to below detectable levels. After 120 days of ensiling, LAB dominated the silage of both crops, while the harmful microorganisms as aerobic bacteria, coliform bacteria, yeast, and mold were reduced or below detectable levels. Both silages did not produce more lactic acid to reduce the pH value, but they preserved nutrients well during ensiling. Therefore, PMS and SS can be prepared as silage for ruminant feed in semi-arid West Africa.


Assuntos
Fermentação , Qualidade dos Alimentos , Pennisetum , Silagem , Sorghum , Bactérias Aeróbias , Fibras na Dieta/análise , Concentração de Íons de Hidrogênio , Lactobacillales , Lignina/análise , Moçambique , Nitrogênio/análise , Proteínas de Plantas/análise , Silagem/análise , Silagem/microbiologia , Fatores de Tempo , Tempo (Meteorologia)
9.
PLoS One ; 15(10): e0239782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33091019

RESUMO

The Mozambique Indicators of Immunization, Malaria and HIV/AIDS (IMASIDA) survey was conducted in 2015 and used a two Enzyme Immunoassay (EIA) (Vironostika HIV-1/2 and Murex HIV-1/2) based algorithm to determine the HIV status of the consented participants. The Mozambique Ministry of Health, with support from the US Centers for Disease Control and Prevention (US CDC), added Bio-Rad Geenius™ HIV-1/2 Supplemental Assay to the IMASIDA HIV testing algorithm to confirm all specimens that were found to be reactive on one or both EIAs. In total 11690 specimens were collected to estimate the proportion of HIV positive samples. Results indicate that the proportion of HIV positive samples based on the concordant positive results of two EIA assays was 21.5% (2518/11690). The addition of the Geenius assay to the IMASIDA HIV testing algorithm demonstrated that 792 (31.5%) of 2518 specimens were false-positive and reduced the proportion of HIV positive samples to 14.7% (1722/11690), demonstrating the importance of including a highly specific HIV test to confirm HIV diagnosis. HIV surveys exclusively based on EIA testing algorithm may result in misleading high prevalence results. Our results demonstrate that more specific confirmatory testing should be added to the EIA-based algorithms to ensure accurate HIV diagnosis and correct HIV prevalence estimate in cross-sectional surveys.


Assuntos
Infecções por HIV/diagnóstico , HIV-1/imunologia , HIV-2/imunologia , Técnicas Imunoenzimáticas , Adolescente , Adulto , Algoritmos , Estudos Transversais , Reações Falso-Positivas , Feminino , Anticorpos Anti-HIV , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Moçambique , Sensibilidade e Especificidade , Adulto Jovem
10.
J Infect Dev Ctries ; 14(9): 994-1000, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031087

RESUMO

Mozambique is located on the East Coast of Africa and was one of the last countries affected by COVID-19. The first case was reported on 22 March 2020 and since then the cases have increased gradually as they have in other countries worldwide. Environmental and population characteristics have been analyzed worldwide to understand their possible association with COVID-19. This article seeks to highlight the evolution and the possible contribution of risk factors for COVID-19 severity according to the available data in Mozambique. The available data highlight that COVID-19 severity can be magnified mainly by hypertension, obesity, cancer, asthma, HIV/SIDA and malnutrition conditions, and buffered by age (youthful population). Due to COVID-19 epidemic evolution, particularly in Cabo Delgado, there is the need to increase laboratory diagnosis capacity and monitor compliance of preventive measures. Particular attention should be given to Cabo Delgado, including its isolation from other provinces, to overcome local transmission and the spread of SARS-CoV-2.


Assuntos
Poluição do Ar/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/etiologia , Pneumonia Viral/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prognóstico , Fatores de Proteção , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
11.
Zootaxa ; 4834(4): zootaxa.4834.4.3, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-33056104

RESUMO

The highly diverse goatfish genus Upeneus (Mullidae) requires enhanced attention regarding the possible occurrence of undescribed species in insufficiently explored regions. This study focuses on the South-Western Indian Ocean region (SWIO), and on the so-called japonicus-group, a taxonomic species group of Upeneus. Based on in-situ observations and collections in Sodwana Bay, KwaZulu-Natal, South Africa, the Floros goatfish, U. floros n. sp., is described. Detailed comparative studies of colour patterns and morphological characters of all other 13 japonicus-group species were undertaken as well as COI barcoding. The new species occurs in the coastal area between Angoche, N Mozambique and KwaZulu-Natal and partly overlaps in distribution with two similar species, U. guttatus, widely distributed in the Indo-W Pacific, and U. saiab, assumed to be endemic in a small area off Angoche. Two additional japonicus-group species occurring in the SWIO, U. seychellensis from the Seychelles Bank and U. pori from the Mediterranean Sea (as Lessepsian migrant), Northern Red Sea and Madagascar, were also compared. Because specimens as well as in-situ photographs of U. floros have been erroneously identified as either U. guttatus or U. pori during previous studies, updated taxonomic accounts and diagnoses are provided for these species taking size-related and population differences into account. For U. pori, of which a single preserved specimen from SW Madagascar was known so far, a new record from NE Madagascar is reported based on three specimens and a fresh-colour photo. Upeneus floros can be distinguished from U. guttatus and U. pori by a combination of three characters: head length, first dorsal-fin height and number of gill rakers. Upeneus guttatus can be distinguished from the other two species by disproportionally higher anterior dorsal-fin spines vs. a proportional decrease of dorsal-fin spines in height, barbels mostly yellow vs. white or creamy-white, and slightly fewer pectoral-fin rays. COI barcoding detected a clear distinction between U. guttatus and U. floros and U. pori, respectively, but no significant divergence between the two latter species. COI barcoding also failed to differentiate several other Upeneus species which are clearly distinguished morphologically. Possible interrelationships between species distribution patterns and physical oceanography are discussed. An identification key for the 22 WIO Upeneus species is provided.


Assuntos
Peixes , Animais , Oceano Índico , Moçambique , África do Sul
12.
Zootaxa ; 4802(1): zootaxa.4802.1.2, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-33056630

RESUMO

The genus Meligethinus Grouvelle, 1906 represents a small group of pollen beetles, including some twenty species distributed from southern Palaearctic areas to northern Oriental and Afrotropical regions. All constituent species appear to be strictly associated as larvae and adults to male inflorescences of palms (Monocots: Arecaceae). Two new species of this genus (Meligethinus mondlanei sp. nov. and M. hamerlae sp. nov.) were recently discovered in southern Mozambique, and are described herein. Both are associated as larvae with male inflorescences of the widespread eastern African palm Phoenix reclinata Jacq. The two new species are compared with related taxa from central Africa. Additionally, the presence of additional species of the same genus in southern Mozambique is reported, and the local associations of several Meligethinus species are discussed.


Assuntos
Arecaceae , Besouros , Animais , Larva , Masculino , Moçambique , Pólen
13.
Artigo em Inglês | MEDLINE | ID: mdl-32867019

RESUMO

In 2017, the Government of Mozambique declared localized acute malnutrition crises in a range of districts across Mozambique including Cabo Delgado. This is in spite of intensive efforts by different non-governmental organizations (NGO) and the Government of Mozambique to expand access to information on good nutritional practices as well as promote nutrition-specific interventions, such as cooking demonstrations, home gardens and the distribution of micronutrient powder to children. This paper examines and discusses key nutritional influences on the health of pregnant and breastfeeding mothers in Cabo Delgado province, Mozambique. We conducted 21 key informant interviews (KIIs) with a wide range of stakeholders and 16 in-depth interviews (IDIs) with women. In addition, we conducted four focus group discussions with each of the following groups: (1) pregnant adolescent girls, (2) pregnant women >20 yrs, (3) women >20 yrs with babies <6 mths who were not practicing exclusive breastfeeding, (4) women >20 yrs of children <2 yrs and (5) with fathers of children <2 yrs. Data were analyzed thematically using NVIVO software. There is no single widely held influence on pregnant and breast-feeding women's nutritional decision-making, choices and food consumption. Rather, variables such as social-cultural, environmental, economic, gender, knowledge and information intersect in their roles in nutritional food choices.


Assuntos
Aleitamento Materno , Gestantes , Adolescente , Criança , Saúde da Criança , Feminino , Grupos Focais , Nível de Saúde , Humanos , Lactente , Moçambique/epidemiologia , Gravidez , Pesquisa Qualitativa , Saúde da Mulher
14.
Artigo em Inglês | MEDLINE | ID: mdl-32872524

RESUMO

In developing countries, markets are the main supply of horticultural products to populations, but this can pose a public health challenge due to the risk of the fecal-oral transmission of gut pathogens. This transmission is strongly associated with inadequate public sanitation or low standards of personal and domestic hygiene, and their prevalence can cause gastrointestinal diseases, which are the third leading cause of death in Mozambique. This study aims at assessing the risk for public health of horticultural products supply chain, from the farmers-vendors to the consumers, in municipal markets in Maputo-City, Mozambique. Surveys (75) were conducted on vendors and an observational analysis was performed in the markets under study. The results showed that 62% of the vendors had access to water from boreholes or artisanal sources and the issue "access to water" was significantly different between markets (p = 0.004). Of the vendors who wash their products (53.3%), only 7.5% use tap-water for this purpose, with the difference in attitudes being statistically significant between vendors in the markets (p = 0.035). The majority (60.4%) said that vegetables and fruits can cause diseases due to pesticides and only 31.3% believe that the diseases may be related to poor hygiene. Despite the vendors' low knowledge of Good Hygiene Practices (GHP), we noticed that women have better practical assimilation of GHP when compared to men (p = 0.008). Although Maputo's markets are struggling to achieve quality hygiene standards in a reliable and sustainable manner, their resources are limited and significantly different (p = 0.044) from market to market, and this problem remains a concern for the public-health authorities of the city. In conclusion, the provision of adequate drinking water and sewage disposal systems, together with education for health of vendors, can reduce the risk of contamination of fresh food by the more common organisms causing diarrhea in children, including intestinal parasites.


Assuntos
Manipulação de Alimentos , Saúde Pública , Verduras , Adolescente , Adulto , Cidades , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Higiene , Masculino , Pessoa de Meia-Idade , Moçambique , Adulto Jovem
15.
Clinics (Sao Paulo) ; 75: e1771, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876111

RESUMO

OBJECTIVES: Physical activity (PA) may reduce cardiovascular risk and preserve functional capacity of people living with human immunodeficiency virus (HIV). However, only limited research objectively measured PA in patients with low socioeconomic status (SES) in low-income countries, particularly in South America and sub-Saharan Africa. This study compared the PA assessed by accelerometers in women of low SES living with HIV under common antiretroviral therapy (cART) from two major cities in Brazil (Rio de Janeiro, n=33; 40.1±6.1 years) and Mozambique (Maputo, n=50; 38.8±8.7 years). METHODS: Eligible women wore triaxial accelerometers during seven consecutive days, to estimate their habitual PA and daily energy expenditure. RESULTS: The proportion of participants with overweight/obesity was greater in Rio than Maputo (57% vs. 30%; p=0.021), as well as those classified as sedentary based on steps/day (45% vs. 22%; p=0.02). Sedentary time was prevalent (Median±IQD: Rio-1236±142 vs. Maputo-1192±135 min/day; p=0.15). Time spent in PA was short, but Brazilians exhibited lower amount of light (111±56 vs. 145±51 min/day; p<0.001) and moderate-to-vigorous PA (88±3 vs. 64±36 min/day; p=0.001) vs. Mozambicans. The proportion of patients performing 60 min/day of moderate-to-vigorous PA were 58% (Rio) and 82% (Maputo), respectively. Despite of this, estimated daily energy expenditure was equivalent in both groups (1976±579 vs. 1933±492 kcal; p=0.731). CONCLUSIONS: Women with low SES living with HIV in Maputo were more active vs. patients from Rio de Janeiro. Albeit sedentary behavior was prevalent, the proportion of patients complying with the minimum recommended PA for health was higher than values usually reported in developed countries.


Assuntos
Exercício Físico , Infecções por HIV , Brasil , Cidades , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Moçambique/epidemiologia , Classe Social
16.
BMC Infect Dis ; 20(1): 659, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894092

RESUMO

BACKGROUND: Diarrheagenic Escherichia coli (DEC) are among the leading pathogens associated with endemic diarrhea in low income countries. Yet, few epidemiological studies have focused the contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (DAEC). METHODS: We assessed the contribution of EHEC, EIEC and DAEC isolated from stool samples from a case-control study conducted in children aged < 5 years in Southern Mozambique between December 2007 and November 2012. The isolates were screened by conventional PCR targeting stx1 and stx2 (EHEC), ial and ipaH (EIEC), and daaE (DAEC) genes. RESULTS: We analyzed 297 samples from cases with less-severe diarrhea (LSD) matched to 297 controls, and 89 samples from cases with moderate-to-severe diarrhea (MSD) matched to 222 controls, collected between November 3, 2011 and November 2, 2012. DEC were more common among LSD cases (2.7%, [8/297] of cases vs. 1.3% [4/297] of controls; p = 0.243]) than in MSD cases (0%, [0/89] of cases vs. 0.4%, [1/222] of controls; p = 1.000). Detailed analysis revealed low frequency of EHEC, DAEC or EIEC and no association with diarrhea in all age strata. Although the low frequency, EIEC was predominant in LSD cases aged 24-59 months (4.1% for cases vs. 0% for controls), followed by DAEC in similar frequency for cases and controls in infants (1.9%) and lastly EHEC from one control. Analysis of a subset of samples from previous period (December 10, 2007 and October 31, 2011) showed high frequency of DEC in controls compared to MSD cases (16.2%, [25/154] vs. 11.9%, [14/118], p = 0.383, respectively). Among these, DAEC predominated, being detected in 7.7% of cases vs. 17.6% of controls aged 24-59 months, followed by EIEC in 7.7% of cases vs. 5.9% of controls for the same age category, although no association was observed. EHEC was detected in one sample from cases and two from controls. CONCLUSIONS: Our data suggests that although EHEC, DAEC and EIEC are less frequent in endemic diarrhea in rural Mozambique, attention should be given to their transmission dynamics (e.g. the role on sporadic or epidemic diarrhea) considering that the role of asymptomatic individuals as source of dissemination remains unknown.


Assuntos
Diarreia/epidemiologia , Escherichia coli Êntero-Hemorrágica/genética , Infecções por Escherichia coli/epidemiologia , Saúde da População Rural , Estudos de Casos e Controles , Pré-Escolar , Diarreia/microbiologia , Doenças Endêmicas , Escherichia coli Êntero-Hemorrágica/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , População Rural
17.
Mem Inst Oswaldo Cruz ; 115: e200006, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997000

RESUMO

BACKGROUND: Occult hepatitis B virus (HBV) - characterized by the absence of detectable HBsAg in the presence of HBV DNA - represents a potential threat for blood safety. OBJECTIVES: This study was conducted with the aim to investigate the serological and molecular characterization of occult HBV infection (OBI) among blood donors in Mozambique. METHODS: 1,502 blood donors were tested for HBsAg. All HBsAg-negative individuals were tested for HBV DNA. Antibodies against HBV core, surface and HBe antigen (anti-HBc, anti-HBs, HBeAg) were measured in HBV DNA positive individuals. FINDINGS: 1435 serum samples were HBsAg negative and 16 positive for HBV DNA, 14 confirmed to have OBI, corresponding to a frequency of 0.98%. Of the 14 OBI infections identified, 13/14 (92.8%) were positive for anti-HBc, 4/14 (28.5%) for anti-HBs, and no samples were reactive for HBeAg. Of the 14 OBI cases, nine samples (64.2%) were sequenced for the S/P region. Eight samples (88.9%) belonged to genotype A1 and one (11.1%) to genotype E. One escape mutation (T123A) associated with OBI and various amino acid substitutions for genotype A1 and E were observed. MAIN CONCLUSIONS: Our results show the importance of using nucleic acid amplification test to detect occult hepatitis B infection in blood donors in Mozambique.


Assuntos
Doadores de Sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/genética , Vírus da Hepatite B/isolamento & purificação , Hepatite B/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/métodos , Adulto , Estudos Transversais , DNA Viral , Feminino , Humanos , Masculino , Moçambique , Filogenia , Reação em Cadeia da Polimerase
18.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194195

RESUMO

BACKGROUND: Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance. OBJECTIVE: We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique. METHODS: A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed. RESULTS: Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients' behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians' prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms. CONCLUSIONS: The practices of non-prescribed antibiotic dispensing characterize the 'daily life' of the pharmacists. On the one hand, the patient's demand for antibiotics without valid prescriptions, and pharmacist's wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Prática Profissional , Medicamentos sem Prescrição/normas , Antibacterianos/uso terapêutico , Medicamentos de Venda Assistida/normas , Boas Práticas de Dispensação , Moçambique , Assistência Farmacêutica/normas , Saúde Pública
19.
PLoS One ; 15(8): e0238023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833987

RESUMO

BACKGROUND: Palliative care is an essential part of medical practice but it remains limited, inaccessible, or even absent in low and middle income countries. OBJECTIVES: To evaluate the general knowledge, attitudes, and practices of Mozambican physicians on palliative care. METHODS: A cross-sectional observational study was conducted between August 2018 and January 2019 in the 3 main hospitals of Mozambique, in addition to the only hospital with a standalone palliative care service. Data was collected from a self-administered survey directed to physicians in services with oncology patients. RESULTS: Two hundred and seven out of 306 physicians surveyed answered the questionnaire. The median physician age was 38 years. Fifty-five percent were males, and 49.8% residents. The most common medical specialty was surgery with 26.1%. Eighty percent of physicians answered that palliative care should be provided to patients when no curative treatments are available; 87% believed that early integration of palliative care can improve patients' quality of life; 73% regularly inform patients of a cancer diagnosis; 60% prefer to inform the diagnosis and prognosis to the family/caregivers. Fifty percent knew what a "do-not-resuscitate" order is, and 51% knew what palliative sedation is. Only 25% of the participants answered correctly all questions on palliative care general knowledge, and only 24% of the participants knew all answers about euthanasia. CONCLUSIONS: Mozambican physicians in the main hospitals of Mozambique have cursory knowledge about palliative care. Paternalism and the family-centered model are the most prevalent. More interventions and training of professionals are needed to improve palliative care knowledge and practice in the country.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Cuidados Paliativos/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique , Cuidados Paliativos/estatística & dados numéricos , Inquéritos e Questionários
20.
Lancet ; 396(10250): 553-563, 2020 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-32828187

RESUMO

BACKGROUND: To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries. METHODS: In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014-17. Consenting pregnant women, aged 12-49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of care. The intervention comprised community engagement and existing community health worker-led mobile health-supported early detection, initial treatment, and hospital referral of women with hypertension. For this meta-analysis, as for the original studies, the primary outcome was a composite of maternal or perinatal outcome (either maternal, fetal, or neonatal death, or severe morbidity for the mother or baby), assessed by unmasked trial surveillance personnel. For this analysis, we included all consenting participants who were followed up with completed pregnancies at trial end. We analysed the outcome data with multilevel modelling and present data with the summary statistic of adjusted odds ratios (ORs) with 95% CIs (fixed effects for maternal age, parity, maternal education, and random effects for country and cluster). This meta-analysis is registered with PROSPERO, CRD42018102564. FINDINGS: Overall, 44 clusters (69 330 pregnant women) were randomly assigned to intervention (22 clusters [36 008 pregnancies]) or control (22 clusters [33 322 pregnancies]) groups. 32 290 (89·7%) pregnancies in the intervention group and 29 698 (89·1%) in the control group were followed up successfully. Median maternal age of included women was 26 years (IQR 22-30). In the intervention clusters, 6990 group and 16 691 home-based community engagement sessions and 138 347 community health worker-led visits to 20 819 (57·8%) of 36 008 women (of whom 11 095 [53·3%] had a visit every 4 weeks) occurred. Blood pressure and dipstick proteinuria were assessed per protocol. Few women were eligible for methyldopa for severe hypertension (181 [1%] of 20 819) or intramuscular magnesium sulfate for pre-eclampsia (198 [1%]), of whom most accepted treatment (162 [89·5%] of 181 for severe hypertension and 133 [67·2%] of 198 for pre-eclampsia). 1255 (6%) were referred to a comprehensive emergency obstetric care facility, of whom 864 (82%) accepted the referral. The primary outcome was similar in the intervention (7871 [24%] of 32 290 pregnancies) and control clusters (6516 [22%] of 29 698; adjusted OR 1·17, 95% CI 0·90-1·51; p=0·24). No intervention-related serious adverse events occurred, and few adverse effects occurred after in-community treatment with methyldopa (one [2%] of 51; India only) and none occurred after in-community treatment with magnesium sulfate or during transport to facility. INTERPRETATION: The CLIP intervention did not reduce adverse pregnancy outcomes. Future community-level interventions should expand the community health worker workforce, assess general (rather than condition-specific) messaging, and include health system strengthening. FUNDING: University of British Columbia, a grantee of the Bill & Melinda Gates Foundation.


Assuntos
Pré-Eclâmpsia/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Criança , Serviços de Saúde Comunitária/normas , Feminino , Humanos , Índia/epidemiologia , Morte Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Moçambique/epidemiologia , Paquistão/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
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