A novel angiotensin-converting enzyme (ACE) inhibitory peptide from tilapia skin: Preparation, identification and its potential antihypertensive mechanism.

To obtain food-derived peptides with high ACE inhibitory activity, tilapia skin was pretreated with steam explosion prior to enzymatic hydrolysis. The results showed that steam explosion pretreatment improved the hydrolysis efficiency and ACE inhibitory activity of fish skin hydrolysates. A novel ACE inhibitory peptide VGLFPSRSF (1009.17 Da) was obtained from steam-exploded fish skin hydrolysates. VGLFPSRSF had an IC50 value of 61.43 µM for ACE inhibitory activity, showing a non-competitive binding mode and gastrointestinal enzyme hydrolysis resistance. Molecular docking results showed that VGLFPSRSF interacted with ACE receptor protein through hydrogen bonding and hydrophobic interactions. Based on the results of network pharmacological analysis and molecular docking, VGLFPSRSF might regulate blood pressure through interaction with hypertensive targets such as AKT1, ACE, CD4, REN, and MMP9. Steam-exploded tilapia skin peptides had potential antihypertension activity and might be promising to achieve high-value utilization of fish skin by-products.

Differentiation of protein types extracted from tilapia byproducts by FTIR spectroscopy combined with chemometric analysis and their antioxidant protein hydrolysates.

This research aimed to characterize protein types including sarcoplasmic protein (SP), myofibrillar protein (MP), and alkali-aided protein extract (AP) prepared from tilapia byproducts using water, 0.6 M NaCl, and alkaline solution (pH 11), respectively compared to freeze-dried minced tilapia muscle (CONTROL). Principal component analysis was performed from second derivative FTIR spectra to differentiate protein type. The AP mostly contained ß-sheet structure and had low total sulfhydryl content and surface hydrophobicity. SP can be distinguished from MP by the loading plots of the FTIR bands representing the α-helical structure. While the bands for lipids and ß-sheet of protein were noted for differentiating AP from CONTROL. After being hydrolyzed by Protease G6, the AP hydrolysate disclosed the highest ABTS radical scavenging activity, while the SP hydrolysate revealed the strongest metal chelating ability. Thus, an understanding of how fish processing waste can be utilized in the production of antioxidant protein hydrolysates has been achieved.

Tilapia, a good model for studying reproductive endocrinology.

The Nile tilapia (Oreochromis niloticus), with a system of XX/XY sex determination, is a worldwide farmed fish with a shorter sexual maturation time than that of most cultured fish. Tilapia show a spawning cycle of approximately 14 days and can be artificially propagated in the laboratory all year round to obtain genetically all female (XX) and all male (XY) fry. Its genome sequence has been opened, and a perfect gene editing platform has been established. With a moderate body size, it is convenient for taking enough blood to measure hormone level. In recent years, using tilapia as animal model, we have confirmed that estrogen is crucial for female development because 1) mutation of star2, cyp17a1 or cyp19a1a (encoding aromatase, the key enzyme for estrogen synthesis) results in sex reversal (SR) due to estrogen deficiency in XX tilapia, while mutation of star1, cyp11a1, cyp17a2, cyp19a1b or cyp11c1 affects fertility due to abnormal androgen, cortisol and DHP levels in XY tilapia; 2) when the estrogen receptors (esr2a/esr2b) are mutated, the sex is reversed from female to male, while when the androgen receptors are mutated, the sex cannot be reversed; 3) the differentiated ovary can be transdifferentiated into functional testis by inhibition of estrogen synthesis, and the differentiated testis can be transdifferentiated into ovary by simultaneous addition of exogenous estrogen and androgen synthase inhibitor; 4) loss of male pathway genes amhy, dmrt1, gsdf causes SR with upregulation of cyp19a1a in XY tilapia. Disruption of estrogen synthesis rescues the male to female SR of amhy and gsdf but not dmrt1 mutants; 5) mutation of female pathway genes foxl2 and sf-1 causes SR with downregulation of cyp19a1a in XX tilapia; 6) the germ cell SR of foxl3 mutants fails to be rescued by estrogen treatment, indicating that estrogen determines female germ cell fate through foxl3. This review also summarized the effects of deficiency of other steroid hormones, such as androgen, DHP and cortisol, on fish reproduction. Overall, these studies demonstrate that tilapia is an excellent animal model for studying reproductive endocrinology of fish.

An inventory and analysis of the medicinal plants of Mozambique.

ETHNOPHARMACOLOGICAL RELEVANCE: A comprehensive checklist and analysis of medicinal plant species and their uses in Mozambique, and a comparison with South Africa provided a more profound understanding of the broad concept of Traditional African Medicine as a healing culture and the need for a more informative classification system. AIMS OF THE STUDY: This study was aimed at recording all medicinal plants reported in Mozambique according to literature and answer four main questions. 1. How many medicinal plant species have been recorded for Mozambique? Of those, how many are indigenous to Mozambique, and how many are introduced or cultivated exotics? 2. What are the main medicinal uses in Mozambique and which species are used for which ailments? 3. What are the similarities and differences between the medicinal floras of Mozambique and South Africa - are the same species used for the same ailments and is there evidence of cultural exchange? 4. Do the data provide new insights into Traditional African Medicine as one of the oldest medicine systems in the world? MATERIALS AND METHODS: A literature survey was done to compile the medicinal checklist of Mozambique using 29 available literature sources, which were found from published books, journal articles, reports, unpublished theses, dissertations, and online databases. RESULTS: A total of 731 medicinal plant species and infraspecific taxa from 447 genera and 120 families was recorded for Mozambique. Of these, 590 (81%) are indigenous, and 87 are non-indigenous (50 naturalised and 37 cultivated exotics). Of the 731 medicinal plant species, 494 (68%) are also used medicinally in South Africa and 148 (30%) are used for the same or similar ailments. Many of the shared taxa and uses have been recorded in the adjoining KwaZulu-Natal Province of South Africa, which has similar vegetation types. CONCLUSION: The similarity between Mozambique and South Africa (and especially the KwaZulu-Natal Province) not only suggest an exchange of traditional knowledge but also indicates the existence of a hitherto unnamed medicinal system of the southern and eastern African Bantu-speaking cultures that is in need of detailed comparative studies.

First report on chemometric modeling of tilapia fish aquatic toxicity to organic chemicals: Toxicity data gap filling.

The Toxic Substances Control Act (TSCA) mandates the Environmental Protection Agency (EPA) to document chemicals entering the US. Due to the vast range of toxicity endpoints, experimental toxicological study for all chemicals is impossible to conduct. To address this, in silico methods like QSAR and read-across are strategically used to prioritize testing for chemicals lacking ecotoxicity data. Aquatic toxicity is one of the most critical endpoints directly related to aquatic species, mainly fish, followed by direct to indirect effects on humans through drinking water and fish as food, respectively. Therefore, we have employed the ToxValDB database to curate acute LC50 toxicity data for three Tilapia species covering two different genera, an ideal species for aquatic toxicity testing. Employing the curated dataset, we have developed multiple robust and predictive QSAR and quantitative read-across structure-activity relationship (q-RASAR) models for Tilapia zillii, Oreochromis niloticus, and Oreochromis mossambicus which helped to understand the toxicological mode of action (MoA) of the modeled chemicals and predict the aquatic toxicity of new untested chemicals followed by toxicity data gap filling. The best three QSAR models showed encouraging statistical quality in terms of determination coefficient R2 (0.94, 0.74, and 0.77), cross-validated leave-one-out Q2 (0.90, 0.67 and 0.70), and predictive capability in terms of R2pred (0.95, 0.77, and 0.74) for T. zillii, O. niloticus, and O. mossambicus datasets, respectively. The developed best mathematical models were used for the prediction of aquatic toxicity in terms of pLC50 for 297 untested organic chemicals across three major Tilapia species ranging from 1.841 to 8.561 M in terms of environmental risk assessment.

Monitoring of First-line Drug Resistance Mutations Outside the Scope of Xpert MTB/RIF Ultra is Needed for Successful Control of DR-TB in Southern Mozambique.

Multidrug-resistant(MDR) tuberculosis in Southern Africa is of great concern, exacerbated by the spread of a clone harboring a mutation missed by Xpert Ultra. In Southern Mozambique, the presence of such mutation and rising cases of non-MDR isoniazid resistance highlights the need to ensure accurate detection of antimicrobial-resistance in the country.

Whole genomes from Angola and Mozambique inform about the origins and dispersals of major African migrations.

As the continent of origin for our species, Africa harbours the highest levels of diversity anywhere on Earth. However, many regions of Africa remain under-sampled genetically. Here we present 350 whole genomes from Angola and Mozambique belonging to ten Bantu ethnolinguistic groups, enabling the construction of a reference variation catalogue including 2.9 million novel SNPs. We investigate the emergence of Bantu speaker population structure, admixture involving migrations across sub-Saharan Africa and model the demographic histories of Angolan and Mozambican Bantu speakers. Our results bring together concordant views from genomics, archaeology, and linguistics to paint an updated view of the complexity of the Bantu Expansion. Moreover, we generate reference panels that better represents the diversity of African populations involved in the trans-Atlantic slave trade, improving imputation accuracy in African Americans and Brazilians. We anticipate that our collection of genomes will form the foundation for future African genomic healthcare initiatives.

Knowledge about Cervical Cancer Prevention and Screening in Women with Cervical Cancer Attending Gynecological Services in Southern Mozambique.

BACKGROUND: Mozambique has high rates of cervical cancer and cancer-related deaths among women. A high rate of refusal and low acceptance of treatment is observed among cervical cancer patients. The extent of their knowledge of the disease is unknown. OBJECTIVES: To assess knowledge about this disease (prevention, risk factors, and the possibilities of early diagnosis) in women with cervical cancer attended in gynecological services in Gaza province, Mozambique. MATERIALS AND METHODS: This cross-sectional study took place in the city of Xai-Xai at the Provincial Hospital of Xai-Xai (HPXX) in the southern province of Gaza (Mozambique). Non-probability convenience sampling was used. Eligible patients (women) aged 35-50 years, diagnosed with cervical cancer and followed at the HPXX in the second quarter of 2021 (n = 60), took part in the survey during their scheduled consultations. Descriptive statistics were calculated using SPSS statistical software (version 16). RESULTS: The study included 60 women, 39 (65%) HIV positive. More than half (55.0%) believed that having a single sexual partner was an effective form of prevention; 50.0% reported that excessive alcohol consumption and having many sexual partners could cause the disease, and 46.7% affirmed that having many children increased the risk. Thirty-eight (63.3%) women reported that early diagnosis of cervical cancer was important for receiving prompt treatment, and 54 (90.0%) said regular visits to the gynecologist were important for an early diagnosis. Thirty-five (58.3%) mentioned acetic acid screening as a diagnostic test. CONCLUSIONS: There are significant gaps in awareness of cervical cancer among high-risk groups.

Longitudinal analysis of innate immune system in infants with perinatal HIV infection until 18 months of age.

With the advent of antiretroviral therapy (ART), perinatal HIV infection is declining globally but prevalence in Sub-Saharan Africa is still greater than other nations. The relationship of HIV replication in early infancy and the developing immune system is not well understood. In this study, we investigated cellular components of the innate immune system including Natural Killer (NK) cells, monocytes, and Dendritic Cells (DC) in a cohort of HIV exposed infected (HEI) and age-matched HIV exposed uninfected (HEU) infants from Mozambique. Study entry was at the first visit after delivery at age 1-2 months for HIV diagnosis and initiation of ART. Phenotypic analysis by multi-parameter flow cytometry revealed an expansion of total NK cells and the dysfunctional, CD56 - CD16 + , NK cell subset; increased activation in monocytes and DC; and higher levels of inflammatory homing receptor CCR5 on circulating DC subsets in the HEI infants. NKG2A, an inhibitory receptor for NK cytolytic function, was reduced in HEI compared to HEU and positively correlated with pre-ART viral load (VL) while expression of CCR2, the inflammatory homing receptor, on NK was negatively correlated with VL. Other subsets exhibited positive correlations with VL including the frequency of intermediate monocytes amongst total monocytes. Longitudinal analysis of VL indicated suboptimal ART adherence in HEI. Regardless of level of viral suppression achieved, the frequencies of specific innate immune subsets in HEI were normalized to HEU by 18m. These data support the notion that in early life, NK cells play a role in virus control and should be explored for functional attributes that are effective against HIV at this time during development. Overall, our study provides high resolution overview of the innate immune system during perinatal HIV infection. Author Summary: Vertical transmission of HIV has been reduced globally in recent years, however in utero exposure and acquisition of HIV continues to occur, especially in sub-Saharan Africa. Immediate ART initiation is recommended in infants diagnosed with HIV, but adherence is often suboptimal due to behavioral and sociological challenges. The impacts of perinatal HIV infection and ART on the developing immune system in infants are still unclear. Here, we evaluated a cohort of HIV exposed infected infants, and age-matched HIV exposed uninfected infants from Mozambique at pre-ART (age 1-2m) and post-ART longitudinally (up to 18m) specifically to compare the innate immune cellular components. We found that circulating innate immune cells including Natural Killer (NK) cells, monocytes, and Dendritic Cells (DC) exhibited altered distributions and more activated (inflammatory) phenotypes at pre-ART in infants with HIV suggesting the presence of a virus specific immune response. Despite suboptimal ART adherence in the cohort, differences in innate immune subsets between infected (suppressed and unsuppressed) and uninfected were not observed longitudinally pointing to normalized immune development despite HIV infection. Our study provides new insights into the early innate immune response during perinatal HIV.

Respiratory distress syndrome prediction at birth by optical skin maturity assessment and machine learning models for limited-resource settings: a development and validation study.

Background: A handheld optical device was developed to evaluate a newborn's skin maturity by assessing the photobiological properties of the tissue and processing it with other variables to predict early neonatal prognosis related to prematurity. This study assessed the device's ability to predict respiratory distress syndrome (RDS). Methods: To assess the device's utility we enrolled newborns at childbirth in six urban perinatal centers from two multicenter single-blinded clinical trials. All newborns had inpatient follow-up until 72 h of life. We trained supervised machine learning models with data from 780 newborns in a Brazilian trial and provided external validation with data from 305 low-birth-weight newborns from another trial that assessed Brazilian and Mozambican newborns. The index test measured skin optical reflection with an optical sensor and adjusted acquired values with clinical variables such as birth weight and prenatal corticoid exposition for lung maturity, maternal diabetes, and hypertensive disturbances. The performance of the models was evaluated using intrasample k-parts cross-validation and external validation in an independent sample. Results: Models adjusting three predictors (skin reflection, birth weight, and antenatal corticoid exposure) or five predictors had a similar performance, including or not maternal diabetes and hypertensive diseases. The best global accuracy was 89.7 (95% CI: 87.4 to 91.8, with a high sensitivity of 85.6% (80.2 to 90.0) and specificity of 91.3% (95% CI: 88.7 to 93.5). The test correctly discriminated RDS newborns in external validation, with 82.3% (95% CI: 77.5 to 86.4) accuracy. Our findings demonstrate a new way to assess a newborn's lung maturity, providing potential opportunities for earlier and more effective care. Trial registration: RBR-3f5bm5 (online access: http://www.ensaiosclinicos.gov.br/rg/RBR-3f5bm5/), and RBR-33mjf (online access: https://ensaiosclinicos.gov.br/rg/RBR-33rnjf/).

A probabilistic approach to compare the risk associated with heavy metals and bromine in honey from Dominican Republic, Mexico, Mozambique and Spain.

This study aims to analyse the risk to consumers given the presence of heavy metals and bromine in honey from different countries. A probabilistic approach was applied to assess carcinogenic risk. Concerning exposure, Al in Spain (3.3E-04 mg/kgBw/day), B in Dominican Republic and Mexico (2E-04 mg/kgBw/day in both cases) and Fe in Mexico and Mozambique had the highest values (5E-05 and 4.8E-05 mg/kgBw/day). In risk characterisation, the values were less than 1 for hazard index (HI), meaning that the consumption of honey represents a low level of concern for non-genotoxic effects. A combination of margin of exposure and probability of exceedance results that exposure to Pb pose no threat. The probability of suffering cancer for Br, Cd, Ni and Pb was lower than 1.0E-06 and, therefore, considered safe. However, the risk at the 95th percentile of Br in Dominican Republic was 1.18E-04 in adults and 2.45E-04 in children, exceeding 1.0E-04, and therefore, considered intolerable. Finally, the sensitivity analysis indicated that the most influential factor in the HI was the consumption in adults and the concentration of Ni in children, whereas for cancer risk, were the concentrations of Ni, Cd, Br and Pb, in both cases.

SIG TeleRedeBLH 24 de Março de 2011: Primeira transmissão Brasil-África da Rede Universitária de Telemedicina^

Primeira transmissão Brasil-África da Rede Universitária de Telemedicina. Equipe da Fiocruz no Hospital Central de Maputo, Moçambique.

Emergence of bedaquiline-resistant tuberculosis and of multidrug-resistant and extensively drug-resistant Mycobacterium tuberculosis strains with rpoB Ile491Phe mutation not detected by Xpert MTB/RIF in Mozambique: a retrospective observational study.

BACKGROUND: In 2021, an estimated 4800 people developed rifampicin-resistant tuberculosis in Mozambique, 75% of which went undiagnosed. Detailed molecular data on rifampicin-resistant and multidrug-resistant (MDR) tuberculosis are not available. Here, we aimed at gaining precise data on the determinants of rifampicin-resistant and MDR tuberculosis in Mozambique. METHODS: In this retrospective observational study, we performed whole-genome sequencing of 704 rifampicin-resistant Mycobacterium tuberculosis complex (Mtbc) strains submitted to the National Tuberculosis Reference Laboratory (NTRL) in Maputo, Mozambique, between 2015 and 2021. Phylogenetic strain classification, genomic resistance prediction, and cluster analysis were performed. FINDINGS: Between Jan 1, 2015, and July 31, 2021, 2606 Mtbc isolates with an isoniazid or rifampicin resistance were identified in the NTRL biobank, of which, 1483 (56·9%) were from men, 1114 (42·7%) from women, and nine (0·4%) were unknown. Genome-based drug-resistant prediction classified 704 Mtbc strains as rifampicin resistant. 628 (89%) of the 704 Mtbc strains were classified MDR; of those, 146 (23%) were pre-extensively drug resistant (pre-XDR; additional fluoroquinolone resistance), and 24 (4%) extensively drug resistant (XDR; combined fluoroquinolone and bedaquiline resistance). Overall, 61 (9%) of 704 strains revealed resistance to bedaquiline: five (7%) of 76 rifampicin resistant plus bedaquiline resistant, 32 (7%) of 458 MDR plus bedaquiline resistant, and 24 (100%) of 24 XDR. Prevalence of bedaquiline resistance increased from 3% in 2016 to 14% in 2021. The cluster rate (12 single-nucleotide polymorphism threshold) was 42% for rifampicin-resistant strains, 78% for MDR strains, 94% for pre-XDR strains, and 96% for XDR Mtbc strains. 31 (4%) of 704 Mtbc strains, belonging to a diagnostic escape outbreak strain previously described in Eswatini (group_56), had an rpoB Ile491Phe mutation which is not detected by Xpert MTB/RIF (no other rpoB mutation). Of these, 23 (74%) showed additional resistance to bedaquiline, 13 (42%) had bedaquiline and fluoroquinolone resistance, and two (6%) were bedaquiline, fluoroquinolone, and delamanid resistant. INTERPRETATION: Pre-XDR resistance is highly prevalent among MDR Mtbc strains in Mozambique and so is bedaquiline resistance; and the frequency of bedaquiline resistance quadrupled over time and was found even in Mtbc strains without fluoroquinolone resistance. Importantly, strains with Ile491Phe mutation were frequent, accounting for 31% (n=10) of MDR plus bedaquiline-resistant strains and 54% (n=13) of XDR Mtbc strains. Given the current diagnostic algorithms and treatment regimens, both the emergence of rifampicin resistance due to Ile491Phe and bedaquiline resistance might jeopardise MDR tuberculosis prevention and care unless sequencing-based technology is rolled out. The potential cross border spread of diagnostic escape strains needs further investigation. FUNDING: The German Ministry of Health through the Seq_MDRTB-Net project, the Deutsche Forschungsgemeinschaft under Germany's Excellence Strategy Precision Medicine in Inflammation and the Research Training Group 2501 TransEvo, the Leibniz Science Campus Evolutionary Medicine of the Lung, and the German Ministry of Education and Research via the German Center for Infection Research.

Cervical cancer in Mozambique: Clinical characteristics, treatment and survival of incident cases admitted to the Oncology Service of Maputo Central Hospital in 2016-2018.

In Mozambique, cervical cancer is the most frequent cancer in women. However, studies about cervical cancer treatment and prognosis are scarce. We describe the clinical characteristics, treatment and survival of patients with cervical cancer admitted to Maputo Central Hospital (MCH) in 2016 to 2018. Sociodemographic, clinical and cancer-related data were retrieved from clinical records of patients admitted to the Oncology Service of the MCH with an incident cervical cancer in 2016 to 2018 (n = 407). The Pathology Service database was used to obtain information regarding pathological diagnosis. Survival data was obtained through the MCH Cancer Registry and clinical records. Odds ratios for the association between patients' characteristics and the diagnosis of advanced stage cancer were computed using logistic regression. Survival analyses were performed using the Kaplan-Meier estimator. A total of 91.2% of the patients were diagnosed with advanced disease (stage IIB-IV) and squamous cell carcinoma was the predominant histological subtype. Most of the patients underwent chemotherapy (93.1%) but <7% were submitted to surgery, radiotherapy or brachytherapy. Those living with HIV had 3.4-fold higher odds of advanced disease. Overall survival was 72.7% (95% confidence interval [CI]: 67.9-77.0) at 1-year and 51.0% (95%CI: 45.3-56.3) at 2-years. Those with early stage (IA-IIA) and asymptomatic at diagnosis had a significantly higher 2-year overall survival. In Mozambique, cervical cancer is diagnosed mostly in advanced stages, resulting in poor prognosis. This highlights the importance of HPV vaccination and screening, to decrease the burden of cervical cancer in this context.

Evaluation of the Acute flaccid paralysis surveillance indicators in Zambia from 2015-2021: a retrospective analysis.

BACKGROUND: The resurgence of poliovirus infection in previously polio free regions and countries calls for renewed commitment to the global polio eradication efforts including strengthening of Acute Flaccid Paralysis (AFP) surveillance systems. Zambia is one of the countries substantially at risk for the importation of poliovirus infection from neighbouring countries including Malawi, Mozambique, and Democratic Republic of the Congo (DRC). This study describes a seven-year AFP surveillance, assesses the surveillance indicators, and highlights areas for improvement. METHODS: We conducted retrospective analysis of the routinely collected AFP surveillance data from January 2015 to December 2022. The AFP surveillance indicators performance was assessed using the World Health Organisation's recommended minimum AFP surveillance indicators performance. RESULTS: Cumulatively, a total of 1715 AFP cases were reported over the study period. More than half, 891 (52%) of reported cases were aged < 5 years with 917 (53.5%) of males. More than half, 1186 (69.2%) had fever at onset, 718 (41.9%) had asymmetric paralysis and 1164 (67.9%) had their paralysis progressed within 3 days of onset. The non-polio AFP rate ranges from 3.4 to 6.4 per 100,000 children < 15 years old and stool adequacy ranging from 70.9% to 90.2% indicating sensitive surveillance with late detection of cases. The percentage of cases with early stool collection, timely transportation was above the World Health Organisation (WHO) minimum of 80% but with declining proportion of stools arriving in the laboratory in optimal condition. Completeness of 60-days follow-up evaluation was suboptimal ranging from 0.9% to 28.2%. CONCLUSION: The AFP surveillance system in Zambia is doing well. However, additional efforts are needed to improve early detection of cases; stool sample collection, transportation and monitoring to ensure arrival in good condition in the laboratory; and improve 60-days follow-up evaluation for evidenced-based classification of inadequate AFP cases and proper care.

Evaluation of the Performance of a 3D-Printed Smartphone-Based Retinal Imaging Device as a Screening Tool for Retinal Pathology in Mozambique.

Low-income countries carry approximately 90% of the global burden of visual impairment, and up to 80% of this could be prevented or cured. However, there are only a few studies on the prevalence of retinal disease in these countries. Easier access to retinal information would allow differential diagnosis and promote strategies to improve eye health, which are currently scarce. This pilot study aims to evaluate the functionality and usability of a tele-retinography system for the detection of retinal pathology, based on a low-cost portable retinal scanner, manufactured with 3D printing and controlled by a mobile phone with an application designed ad hoc. The study was conducted at the Manhiça Rural Hospital in Mozambique. General practitioners, with no specific knowledge of ophthalmology or previous use of retinography, performed digital retinographies on 104 hospitalized patients. The retinographies were acquired in video format, uploaded to a web platform, and reviewed centrally by two ophthalmologists, analyzing the image quality and the presence of retinal lesions. In our sample there was a high proportion of exudates and hemorrhages-8% and 4%, respectively. In addition, the presence of lesions was studied in patients with known underlying risk factors for retinal disease, such as HIV, diabetes, and/or hypertension. Our tele-retinography system based on a smartphone coupled with a simple and low-cost 3D printed device is easy to use by healthcare personnel without specialized ophthalmological knowledge and could be applied for the screening and initial diagnosis of retinal pathology.

Knowledge of COVID-19 symptoms, transmission, and prevention: Evidence from health and demographic surveillance in Southern Mozambique.

Understanding community members' knowledge of SARS-CoV-2 transmission and prevention is essential for directing public health interventions to reduce disease spread and improve vaccination coverage. Here, we describe knowledge of COVID-19 transmission, prevention, and symptoms among community residents in Mozambique. We conducted a cross-sectional survey among 33,087 households in a Health and Demographic Surveillance System in Manhiça, Mozambique. Participants were recruited in April 2021 before the Delta variant wave to the peak of Omicron cases in February 2022. Principal components analysis was used to create scores representing knowledge of COVID-19 symptoms, transmission, and prevention. Multiple imputation and quasi-Poisson regression were used to examine associations between demographic characteristics and sources of COVID-19 information, and knowledge of COVID-19 symptoms, transmission, and prevention. We examined whether sources of COVID-19 information mediated the relationship between educational attainment and knowledge of symptoms, transmission, and prevention. Across this rural community, 98.2%, 97.0%, and 85.1% of respondents reported knowing how COVID-19 could be prevented, that SARS-CoV-2 can cause disease, and how SARS-CoV-2 is transmitted, respectively. The most recognized COVID-19 symptoms were cough (51.2%), headaches (44.9%), and fever (44.5%); transmission mechanisms were saliva droplets (50.5%) or aerosol (46.9%) from an infected person; and prevention measures were handwashing (91.9%) and mask-wearing (91.8%). Characteristics associated with greater knowledge of symptoms, transmission, and prevention included having at least primary education, older age, employment, higher wealth, and Christian religion. Respondents who had experienced COVID-19 symptoms were also more likely to possess knowledge of symptoms, transmission, and prevention. Receiving information from television, WhatsApp, radio, and hospital, mediated the relationship between educational attainment and knowledge scores. These findings support the need for outreach and for community-engaged messaging to promote prevention measures, particularly among people with low education.

Family planning decision-making among young males in Southern Africa.

Male partners play a crucial role in reproductive health matters and seem to be identified as the main contributors responsible for the large proportion of poor reproductive health suffered by their female partners. Limited evidence exists, however, on effective strategies to increase male involvement in family planning. Therefore, this study aims to examine the prevalence and factors associated with male involvement in family planning decisions. Using recent data from Demographic and Health Surveys of seven countries in Southern Africa (Lesotho, Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe), age, education, wealth index, religion, occupation, exposure to media, contraceptive knowledge, and sex of household head showed significant associations of male involvement in family planning, and these associations differed by country. By country, the adjusted odds ratio (AOR) showed that education (Malawi (primary) AOR: 1.12; 95% CI: 0.91-1.38; South Africa (secondary/ higher) AOR: 1.44; 95% CI: 0.95-2.19), religion (Lesotho (Muslim) AOR: 2.10; 95% CI: 0.54-8.12; Zambia (Muslim) AOR: 1.01; 95% CI: 0.69-1.49; Zambia (Traditional) AOR: 1.06; 95% CI: 0.77-1.47), marital status (Malawi (widowed) AOR: 1.06; 95% CI: 0.55- 2.05; Lesotho (divorced/separated) AOR: 1.18; 95% CI: 0.84-1.66; Mozambique (divorced/separated) AOR: 1.03; 95% CI: 0.80- 1.33), and sex of household head (South Africa (female) AOR: 1.11; 95% CI: 0.96-1.27) were significant predictors of male involvement in family planning decision-making in Southern African countries. Certain socio-economic factors such as wealth status (Malawi (middle) AOR: 1.04; 95% CI: 0.91-1.19, ρ< 0.05; South Africa (Rich) AOR: 1.06; 95% CI: 0.91-1.23), and occupational status (Mozambique (working) AOR: 1.12; 95% CI: 0.97-1.29) were found to be positively associated with males' participation in family planning decision-making in Malawi, South Africa and Mozambique. Suggested strategies include programmes targeting couples jointly and family planning education for men provided by male outreach workers, especially in communities at the grassroots level. Therefore, to encourage men's involvement and approval of family planning, community - based intervention programmes that openly target men are required to reduce stigma and misconceptions and boost consciousness of the advantages of family planning utilization.

Les partenaires masculins jouent un rôle crucial en matière de santé reproductive et semblent être identifiés comme les principaux contributeurs responsables de la grande proportion de mauvaise santé reproductive subie par leurs partenaires féminines. Cependant, il existe peu de preuves sur les stratégies efficaces pour accroître la participation des hommes à la planification familiale. Par conséquent, cette étude vise à examiner la prévalence et les facteurs associés à l'implication des hommes dans les décisions de planification familiale. En utilisant des données récentes d'enquêtes démographiques et sanitaires de sept pays d'Afrique aus trale (Lesotho, Malawi, Mozambique, Afrique du Sud, Tanzanie, Zambie et Zimbabwe), l'âge, l'éducation, l'indice de richesse, la religion, la profession, l'exposition aux médias, les connaissances en matière de contraception et le sexe du chef de ménage a montré des associations significatives de l'implication des hommes dans la planification familiale, et ces associations différaient selon les pays. Par pays, l'odds ratio (AOR) ajusté a montré que l'éducation (AOR au Malawi (primaire) : 1,12 ; IC à 95 % : 0,91­1,38; AOR en Afrique du Sud (secondaire/ supérieur) : 1,44 ; IC à 95 % : 0,95 ­2,19), religion (RCA du Lesotho (musulman) : 2,10 ; IC à 95 % : 0,54­8,12; RCA de la Zambie (musulmane) : 1,01 ; IC à 95 % : 0,69­1,49; Zambie (traditionnel) AOR : 1,06 ; IC à 95 % : 0,77­1,47), état matrimonial (Malawi (veuve) AOR : 1,06 ; IC à 95 % : 0,55­2,05; Lesotho (divorcé/séparé) AOR : 1,18 ; IC à 95 % : 0,84­1,66; Mozambique (divorcé/séparé) AOR : 1,03 ; IC à 95 % : 0,80­1,33) et le sexe du chef de ménage (Afrique du Sud (fémme) AOR : 1,11 ; IC à 95 % : 0,96-1,27) étaient des prédicteurs significatifs de l'implication des hommes dans la prise de décision en matière de planification familiale dans les pays d'Afrique australe. Certains facteurs socio-économiques tels que le statut de richesse (Malawi (moyen) AOR : 1,04 ; IC à 95 % : 0,91-1,19; Afrique du Sud (riche) AOR : 1,06 ; IC à 95 % : 0,91- 1,23), et le statut professionnel (Mozambique (actif) AOR : 1,12 ; IC à 95 % : 0,97­1,29) se sont révélés positivement associés à la participation des hommes à la prise de décision en matière de planification familiale au Malawi, en Afrique du Sud et au Mozambique. Les stratégies suggérées comprennent des programmes ciblant conjointement les couples et une éducation à la planification familiale pour les hommes dispensée par des agents de proximité masculins, en particulier dans les communautés au niveau local. Par conséquent, pour encourager la participation et l'approbation des hommes à la planification familiale, des programmes d'intervention communautaires qui ciblent ouvertement les hommes sont nécessaires pour réduire la stigmatisation et les idées fausses et renforcer la prise de conscience des avantages de l'utilisation de la planification familiale.

Diagnostic accuracy of a three-gene Mycobacterium tuberculosis host response cartridge using fingerstick blood for childhood tuberculosis: a multicentre prospective study in low-income and middle-income countries.

BACKGROUND: Childhood tuberculosis remains a major cause of morbidity and mortality in part due to missed diagnosis. Diagnostic methods with enhanced sensitivity using easy-to-obtain specimens are needed. We aimed to assess the diagnostic accuracy of the Cepheid Mycobacterium tuberculosis Host Response prototype cartridge (MTB-HR), a candidate test measuring a three-gene transcriptomic signature from fingerstick blood, in children with presumptive tuberculosis disease. METHODS: RaPaed-TB was a prospective diagnostic accuracy study conducted at four sites in African countries (Malawi, Mozambique, South Africa, and Tanzania) and one site in India. Children younger than 15 years with presumptive pulmonary or extrapulmonary tuberculosis were enrolled between Jan 21, 2019, and June 30, 2021. MTB-HR was performed at baseline and at 1 month in all children and was repeated at 3 months and 6 months in children on tuberculosis treatment. Accuracy was compared with tuberculosis status based on standardised microbiological, radiological, and clinical data. FINDINGS: 5313 potentially eligible children were screened, of whom 975 were eligible. 784 children had MTB-HR test results, of whom 639 had a diagnostic classification and were included in the analysis. MTB-HR differentiated children with culture-confirmed tuberculosis from those with unlikely tuberculosis with a sensitivity of 59·8% (95% CI 50·8-68·4). Using any microbiological confirmation (culture, Xpert MTB/RIF Ultra, or both), sensitivity was 41·6% (34·7-48·7), and using a composite clinical reference standard, sensitivity was 29·6% (25·4-34·2). Specificity for all three reference standards was 90·3% (95% CI 85·5-94·0). Performance was similar in different age groups and by malnutrition status. Among children living with HIV, accuracy against the strict reference standard tended to be lower (sensitivity 50·0%, 15·7-84·3) compared with those without HIV (61·0%, 51·6-69·9), although the difference did not reach statistical significance. Combining baseline MTB-HR result with one Ultra result identified 71·2% of children with microbiologically confirmed tuberculosis. INTERPRETATION: MTB-HR showed promising diagnostic accuracy for culture-confirmed tuberculosis in this large, geographically diverse, paediatric cohort and hard-to-diagnose subgroups. FUNDING: European and Developing Countries Clinical Trials Partnership, UK Medical Research Council, Swedish International Development Cooperation Agency, Bundesministerium für Bildung und Forschung; German Center for Infection Research (DZIF).