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1.
Artigo em Inglês | MEDLINE | ID: mdl-34838935

RESUMO

This study was conducted to elucidate the influence of melanin-concentrating hormone (MCH) along the reproductive-axis in the female tilapia Oreochromis mossambicus. Administration of MCH (4 µg / 0.1 ml saline) for 22 days resulted in significantly lower gonadosomatic index compared to controls. Significant reduction in the mean numbers of follicles at different stages of development such as previtellogenic (stages I-III), vitellogenic (stage IV) and preovulatory (stage V) follicles was observed in MCH-treated fish compared with controls. On the other hand, the rate of atresia was significantly higher in follicles at stages II, III and IV in MCH-treated fish. In addition, in the pituitary gland, sparsely labelled gonadotropin releasing hormone (GnRH)-immunoreactive fibres were observed in MCH-treated fish in contrast to their intense labelling in controls. The serum level of luteinizing hormone (LH) showed significant decrease, but the serum cortisol level rose significantly following MCH treatment compared to those of controls. Collectively, these results indicate for the first time, that MCH treatment blocks follicular development during the ovarian cycle, possibly through the suppression of GnRH-LH axis in fish. The results also indicate that MCH may activate the stress-axis pathway in fish.


Assuntos
Hormônios Hipotalâmicos , Tilápia , Animais , Feminino , Hormônio Liberador de Gonadotropina/metabolismo , Gônadas/metabolismo , Hormônios Hipotalâmicos/metabolismo , Melaninas , Hipófise/metabolismo , Hormônios Hipofisários , Tilápia/fisiologia
2.
PLoS Negl Trop Dis ; 16(5): e0010355, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35576233

RESUMO

Global efforts to control Aedes mosquito-transmitted pathogens still rely heavily on insecticides. However, available information on vector resistance is mainly restricted to mosquito populations located in residential and public areas, whereas commercial settings, such as hotels are overlooked. This may obscure the real magnitude of the insecticide resistance problem and lead to ineffective vector control and resistance management. We investigated the profile of insecticide susceptibility of Aedes aegypti mosquitoes occurring at selected hotel compounds on Zanzibar Island. At least 100 adults Ae. aegypti females from larvae collected at four hotel compounds were exposed to papers impregnated with discriminant concentrations of DDT (4%), permethrin (0.75%), 0.05 deltamethrin (0.05%), propoxur (0.1%) and bendiocarb (0.1%) to determine their susceptibility profile. Allele-specific qPCR and sequencing analysis were applied to determine the possible association between observed resistance and presence of single nucleotide polymorphisms (SNPs) in the voltage-gated sodium channel gene (VGSC) linked to DDT/pyrethroid cross-resistance. Additionally, we explored the possible involvement of Glutathione-S-Transferase gene (GSTe2) mutations for the observed resistance profile. In vivo resistance bioassay indicated that Ae. aegypti at studied sites were highly resistant to DDT, mortality rate ranged from 26.3% to 55.3% and, moderately resistant to deltamethrin with a mortality rate between 79% to and 100%. However, genotyping of kdr mutations affecting the voltage-gated sodium channel only showed a low frequency of the V1016G mutation (n = 5; 0.97%). Moreover, for GSTe2, seven non-synonymous SNPs were detected (L111S, C115F, P117S, E132A, I150V, E178A and A198E) across two distinct haplotypes, but none of these were significantly associated with the observed resistance to DDT. Our findings suggest that cross-resistance to DDT/deltamethrin at hotel compounds in Zanzibar is not primarily mediated by mutations in VGSC. Moreover, the role of identified GSTe2 mutations in the resistance against DDT remains inconclusive. We encourage further studies to investigate the role of other potential insecticide resistance markers.

3.
FASEB J ; 36 Suppl 12022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35555589

RESUMO

Sexual dimorphism in body size is a common phenomenon among vertebrates, including teleost fishes. The hormonal underpinnings of this phenomenon, however, have not been fully clarified and may be associated with interactions between the endocrine factors that control growth and reproduction. Given their well-described patterns of sexually dimorphic growth, we used Mozambique tilapia (Oreochromis mossambicus) as a model to examine how the activities of luteinizing hormone (LH) are modulated by growth hormone (GH), and conversely, how LH affects targets of GH. We hypothesized that GH would induce factors within the GH/insulin-like growth factor (GH/IGF) axis that favor growth, while LH would attenuate growth-promoting factors and stimulate factors that favor reproduction. We analyzed gonad morphology and gene expression in hypophysectomized tilapia injected with ovine GH (oGH) and LH (oLH) either alone or in combination. Gonadosomatic index (GSI) was reduced in females following hypophysectomy; the combined administration of oGH and oLH restored GSI to control levels. Hypophysectomy regressed the ovary and the combined treatment of oGH and oLH restored ovarian structure. Gonadal gh receptor (ghr2) and estrogen receptor ß (erß) were higher in females, whereas igf1, igf3, erα, and androgen receptor ß (arß) were higher in males of control fish. The inhibitory effects of hypophysectomy were most pronounced on igf3transcripts, and these levels were restored by both oGH and oLH alone, or in combination, in males. In females, the combination of both hormones was required to recover gonadal igf3 levels. A hypophysectomy-induced decrease in arß was restored by a combination of oGH and oLH in females, while there were no effects of oGH or oLH on arß in males. In muscle, ghr2 was more responsive to oGH in males, while igf2 was more responsive to oLH in females. oGH and oLH both inhibited a hypophysectomy-induced increase in hepatic igf2 in males. Our results indicate that genes associated with growth and reproduction exhibit sexually dimorphic responses to GH and LH in tilapia, and therefore, provide insight into the endocrine bases of sexually dimorphic growth in fishes.

4.
BMC Public Health ; 22(1): 983, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578273

RESUMO

BACKGROUND: Impact evaluation of most water, sanitation and hygiene (WASH) interventions in health are user-centered. However, recent research discussed WASH herd protection - community WASH coverage could protect neighboring households. We evaluated the effect of water and sanitation used in the household and by household neighbors in children's morbidity and mortality using recorded health data. METHODS: We conducted a retrospective cohort including 61,333 children from a district in Mozambique during 2012-2015. We obtained water and sanitation household data and morbidity data from Manhiça Health Research Centre surveillance system. To evaluate herd protection, we estimated the density of household neighbors with improved facilities using a Kernel Density Estimator. We fitted negative binomial adjusted regression models to assess the minimum children-based incidence rates for every morbidity indicator, and Cox regression models for mortality. RESULTS: Household use of unimproved water and sanitation displayed a higher rate of outpatient visit, diarrhea, malaria, and anemia. Households with unimproved water and sanitation surrounded by neighbors with improved water and sanitation high coverage were associated with a lower rate of outpatient visit, malaria, anemia, and malnutrition. CONCLUSION: Household and neighbors' access to improve water and sanitation can affect children's health. Accounting for household WASH and herd protection in interventions' evaluation could foster stakeholders' investment and improve WASH related diseases control. Distribution of main water and sanitation facilities used during study period.

5.
AIDS Care ; : 1-9, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578397

RESUMO

Mozambique introduced guidelines for integrated gender-based violence (GBV) services in 2012. In 2017, we trained providers on empathetic and supportive services to GBV survivors and introduced home-based services for survivors who are loss-to-follow up. Rate ratios of clinic visits were compared before and after intervention initiation, using exact significance tests. Data of 1,806 GBV survivors were reviewed, with a total of 2005 events. The median age was 23 years (IQR 17-30) and 89% were women. Among those reporting violence, 69% reported physical violence, 18% reported sexual violence (SV), and 12% reported psychological violence. Rates of care-seeking behavior were higher in the intervention period (rate ratio 1.31 [95%CI: 1.18-1.46]); p < 0.01. Among those eligible for post-exposure prophylaxis (PEP), 94% initiated PEP. Uptake of HIV retesting improved in percentage points by 34% (14% to 48%), 34% (8% to 42%) and 26% (5% to 31%) at 1-, 3- and 6-months, respectively. The intervention led to an increase in the rate of GBV survivors seeking health care services, and improved rates of follow-up care among SV survivors initiating PEP. Strengthening of PEP adherence counseling remains crucial for improving GBV services.

6.
Artigo em Inglês | MEDLINE | ID: mdl-35579964

RESUMO

Introduction HIV self-testing (HIVST) is a WHO recommended strategy to increase testing, especially among key populations, men, and young adults. Between May - December 2019, a pilot was implemented in Zambézia province, Mozambique, allowing clients to purchase HIV self-tests in 14 public/private pharmacies. The study assessed the strategy's acceptability and uptake. Methods Pharmacy-based exit-surveys were conducted in a random sample of clients, during the first three months of the pilot, independent of HIVST purchase. Another random sample of clients who bought an HIVST completed a survey 1-12 weeks after purchase. Chi-square and Mann-Whitney tests were used for the analysis, comparing clients who purchased an HIVST versus not. Results 1139 adults purchased 1344 tests. Buyers were predominantly male (70%) and younger (52% between 15-34 years of age). Surveys were completed by 280 exiting pharmacy clients and 82 clients who purchased an HIVST. Main advantages were confidentiality and lack of need of a health provider visit, with main disadvantages being absence of nearby counseling and fear of results. No differences between buyers and non-buyers were seen for these factors. Among all undergoing HIVST, the 71 (92%) perceived the instructions to be clear, however, 29 (38%) stated they would have benefitted from additional pre-test information or counseling. Ten (13%) reported following up at a nearby health facility to confirm results and/or receive care. Conclusions Offering HIVST at public/private pharmacies was acceptable among people who traditionally tend to have a lower HIV testing coverage, such as males and young adults. However, additional resources and/or enhanced educational materials to address the lack of counseling, and linkage-to-care systems need to be put into place before scaling up this strategy.

7.
J Clin Tuberc Other Mycobact Dis ; 27: 100316, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35521634

RESUMO

Background: The novel urine-based FujiLAM test identifies tuberculosis in HIV-positive patients but may be challenging to use at point-of-care (POC). Objectives: We assessed the feasibility and acceptability of using the FujiLAM test at point of care in outpatient settings. Methods: We conducted a mixed methods study in four outpatient settings in Kenya, Mozambique, South Africa, and Uganda between November 2020 and September 2021. The test was performed at POC in existing clinic laboratories and consultation spaces. We performed direct observations in the four health facilities, individual questionnaires, proficiency testing evaluations, and individual interviews among healthcare workers performing the FujiLAM test (healthcare workers), and group discussions with programme managers. Results: Overall, 18/19 (95%) healthcare workers and 14/14 (100%) managers agreed to participate in the study. Most assessed healthcare workers, including lay health workers (10/11; 91%), met the minimum required theoretical knowledge and practical skill in performing the FujiLAM test. Most healthcare workers (17/18; 94%) found the FujiLAM test overall "Easy/Very easy" to perform. Some challenges were mentioned: many timed steps (5/18; 28%); ensuring correct incubation period (5/18; 28%); test result readability (4/18; 22%); and difficulties with cartridge buttons (3/18; 17%). Half of the healthcare workers regularly performing the test (4/7; 57%) found it "Easy" to integrate into routine activities. Most healthcare workers and managers believed that any healthcare worker could perform the test after adequate training. Conclusions: Implementing the FujiLAM test in outpatient POC settings is feasible and acceptable to healthcare workers and managers. This test can be performed in various clinic locations by any healthcare worker. The timed, multi-step test procedure is challenging and may affect the workload in resource-constrained health facilities.

8.
PLoS One ; 17(5): e0267949, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35544535

RESUMO

BACKGROUND: Meningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique. METHOD: We performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (≥18 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing. RESULTS: Retrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include Neisseria meningitidis (8.9%; 14/158), Escherichia coli (6.3%; 10/158), Haemophilus influenzae (5.1%; 8/158) and S. aureus (4.4%; 7/158), which represent (24.7%; 39/158) of the total confirmed cases. CONCLUSION: Altogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care.

9.
FASEB J ; 36 Suppl 12022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35552045

RESUMO

Variations in salinity are among the main physical parameters that drive the capacity of fish to survive and thrive in a range of environments. Acclimation to changes in environmental salinity is regulated by the interplay of local osmotically-induced cellular responses and the systemic regulation by the neuroendocrine system, which together, direct ion extrusion or uptake responses via the gill and other osmoregulatory tissues. Many euryhaline teleost fish are native to waters in which salinity varies tidally between that of fresh water (FW) and seawater (SW), such as estuaries. The physiology of salinity acclimation of euryhaline teleosts has been studied extensively in steady-state salinities, and after one-way transfers between steady-state salinities. Fewer studies, however, have addressed salinity regimes that reflect or simulate the continuous dynamic changes by which euryhaline fishes may be subject to in a native environment. Experimentally, the simulation of a changing environment was obtained by rearing fish in salinities that changed between those of FW and SW every six hours, in a tidal regime (TR). An overview of the main differences in the regulation of transcripts involved in ion balance between euryhaline Mozambique tilapia, Oreochromis mossambicus, responding to TR and those acclimating to steady-state salinities is provided. Transcripts analyzed include branchial Na+/K+-ATPase (nka), Na+, Cl- co-transporter (ncc), Na+/H+ antiporter 3 (nhe3), 2Cl- co-transporter (nkcc), cystic fibrosis transmembrane conductance regulator (cftr), and aquaporin 3 (aqp3). In particular, both cftrand aqp3were highly sensitive to changes in salinity in fish acclimated to a TR, indicating indispensable roles in rapidly maintaining hydromineral balance. The pituitary hormones, prolactin and growth hormone, known to play osmoregulatory roles in Mozambique tilapia, were also compared along with their receptors between TR and steady-state salinity paradigms. Specifically, through the dynamic changes in hormone receptor transcription observed in the TR rearing paradigm, the endocrine control of osmoregulatory outcomes appears shifted from systemic to local regulation at the level of target tissues. Together, these studies indicate that fish are able to compensate for broad and frequent changes in external salinity while keeping osmoregulatory parameters within a narrow range.

10.
Lancet Glob Health ; 10(6): e873-e881, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35561722

RESUMO

BACKGROUND: Most malaria burden estimates rely on modelling infection prevalence to case incidence data, with insufficient attention having been paid to the changing clinical presentation of severe disease and its relationship with changing transmission intensity. We present 20 years of longitudinal surveillance data to contribute to the understanding of the relationship between malaria transmission and the burden and clinical presentation of severe malaria and to inform policy. METHODS: This retrospective analysis of clinical surveillance hospital data included all children younger than 15 years admitted with malaria to Manhiça District Hospital (MDH), Mozambique, from July 1, 1997, to June 30, 2017. Case fatality ratios (CFRs) were calculated as the number of patients who died having a specific diagnosis or syndrome divided by the total number of patients with known outcome admitted with that diagnosis or syndrome. FINDINGS: Over the study period, 32 138 children were admitted to MDH with a malaria diagnosis. Malaria accounted for a large proportion of admissions, ranging from 4083 (76·9%) of 5307 admissions in 2000-01 to 706 (27·5%) of 2568 admissions in 2010-11. Since 2000-02, the absolute and relative number of malaria admissions and deaths presented a decreasing trend. The age pattern of patients with malaria shifted to older ages with a median age of 1·7 years (IQR 0·9-3·0) in 1997-2006 and 2·6 years (IQR 1·3-4·4) in 2006-17, although most malaria deaths (60-88% in 2009-17) still occurred in children younger than 5 years. The clinical presentation of severe malaria changed, with an increase in cerebral malaria and a decrease in severe anaemia and respiratory distress, leading to similar yearly cases for the three syndromes. CFRs for severe malaria fluctuated between 1·1% (2 of 186 in 2014-15) and 7·2% (11 of 152 in 2010-11), varying by severe malaria syndrome (3·3% [70 of 2105] for severe anaemia, 5·1% [191 of 3777] for respiratory distress, and 14·8% [72 of 487] for cerebral malaria). Overall malaria CFRs (1·8% [543 of 30 163]) did not vary by age group. INTERPRETATION: Despite the unprecedented scale up of malaria control tools, malaria still represented around 30-40% of paediatric hospital admissions in 2006-17. The age shift towards older children was not accompanied by an increase in severe malaria or deaths; however, control programmes should consider adapting their high-risk target groups to include older children. Malaria remains a leading cause of disease and health-care system use and the massive unfinished malaria control agenda warrants intensified efforts. FUNDING: Spanish Agency for International Cooperation and Development.

11.
Pulmonology ; 2022 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-35568650

RESUMO

OBJECTIVE: To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact. RESULTS: Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution. CONCLUSIONS: Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

12.
Int J Infect Dis ; 2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35489634

RESUMO

OBJECTIVE: Analyse the frequency of Diarrhoeagenic Escherichia coli (DEC) pathotypes and their antimicrobial resistance profiles among children younger than 15 years with diarrhea in four Mozambican provinces. METHODS: A cross-sectional hospital-based surveillance program of diarrhea was implemented in Maputo, Sofala, Zambézia and Nampula. A single stool sample was collected from each child from May-2014 to May-2017. Cultural methods and biochemical characterization were performed to detect E. coli strains. DEC pathotypes were determined by conventional polymerase chain reaction (PCR) targeting specific virulence genes. Antimicrobials susceptibility was assessed by Kirby Bauer method. RESULTS: From 723 specimens analyzed by culture, 262 were positive for E. coli. A total of 208 samples were tested by PCR for DEC identification, from which 101 (48.6%) gave positive result for a DEC pathotype. The predominant pathotypes were enteroaggregative (EAEC) 66.3% (67/101), enteropathogenic 15.8% (16/101), enterotoxigenic 13.9% (14/101), and enteroinvasive E. coli 4.0% (4/101). No Shiga toxin-producing E. coli was identified. Regardless of the province, the most frequent pathotype was EAEC. Isolated diarrheagenic E. coli presented high frequency of resistance to ampicillin (97.8%), tetracycline (68.3%), chloramphenicol (28.4%), nalidixic acid (19.5%) and gentamicin (14.4%). CONCLUSION: Children with diarrhea in Mozambique had DEC and higher resistance to ampicillin and tetracycline.

13.
S Afr Med J ; 112(3): 234-239, 2022 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-35380527

RESUMO

BACKGROUND: Tuberculosis (TB) is a serious public health problem and remains one of the leading causes of death from an infectious agent globally. Mozambique is one of 30 countries considered to have a high TB burden. OBJECTIVES: To describe the clinical characteristics of TB in children and adults in Bilene District in Gaza Province, Mozambique, over 43 months and to assess determinants of unfavourable treatment outcomes. METHODS: This retrospective cohort study took place from 1 January 2016 to 31 July 2019 in Bilene District, Gaza. We included patients in the TB register at the Centro de Saúde de Macia TB unit with available data on final treatment outcome. Predictors of unfavourable outcomes were determined using multivariable logistic regression models. RESULTS: A total of 3 012 TB-infected patients were registered in the TB unit of the Macia health facility during the study period: 358 (11.9%) were children (<14 years), 1 522 (50.5%) were male, and 2 581 (85.7%) were new TB cases. No bacteriological test was performed at diagnosis in 1 250 patients (41.5%). Treatment was successful in 2 863 patients (95.1%), with better outcomes in children than in adults (98.0% v. 94.6%; p=0.005). Although mortality (n=97; 3.2%) was low in both groups, the proportion who died was lower in children compared with adults (1.4% v. 3.5%; p=0.035). Multivariable logistic regression analysis showed that unfavourable outcomes were more likely in men compared with women (adjusted odds ratio (aOR) 1.48; 95% confidence interval (CI) 1.04 - 2.12; p=0.029), in patients with recurrent TB infection compared with newly infected patients (aOR 1.63; 95% CI 1.05 - 2.50; p=0.027), and in patients co-infected with TB and HIV compared with HIV-negative TB-infected patients (aOR 2.17; 95% CI 1.43 - 3.29; p<0.001). The factor conferring the most risk for an unfavourable outcome was positive microbiological sputum results (aOR 5.27; 95% CI 3.25 - 8.54; p<0.001). CONCLUSIONS: Factors independently associated with an unfavourable TB treatment outcome were male sex, recurrent TB infection, having positive microbiology, and co-infection with HIV. It remains crucial to improve data quality and adherence to TB screening and diagnostic algorithms.


Assuntos
Coinfecção , Infecções por HIV , Tuberculose , Adulto , Antituberculosos/uso terapêutico , Criança , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Moçambique/epidemiologia , Estudos Retrospectivos , África do Sul , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia
14.
Pan Afr Med J ; 41: 100, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35465369

RESUMO

Introduction: esophageal cancer is a major public health problem in Mozambique. It is the nineth most common cancer worldwide in terms of incidence (604.000 new cases/year), and sixth in overall mortality (544.076 deaths/year). In Mozambique esophageal cancer was the seventh most common cancer in males and the fifth in females between 1991 and 2008. Methods: it was done a cross-sectional hospital-based epidemiological study, using secondary demographics endoscopic and pathologic features data. A retrospective analysis of the existing information of patients classified as esophageal cancer diagnosed with upper gastrointestinal endoscopy observed from January 1st, 2016 to December 31st, 2018 at the Gastroenterology Service of Maputo Central Hospital. A coding sheet was created a priori, and data analysed in SPSS version 20. Results: of the 205 cases with complete records where included in the analysis, there was a higher frequency of females with 56.6% (116/205). The average age was 59.5 years with standard deviation of ± 12.9 years. Most of the patients were native of southern Mozambique, with 92.7% (190/205), of which Maputo made up 53.2% (109/205). Regarding race, 99.5% (204/205) were black. The most affected endoscopic location was the middle third with 48.8% (100/205), followed by the lower third with 29.8% (61/205) and the upper third with 21.5% (44/205). Squamous cell carcinoma was the most frequent, with 92.7% (190/205), followed by adenocarcinoma with 4.9% (10/205). Conclusion: due to the high number of observed cases of esophageal cancer, a high degree of clinical suspicion is needed for timely diagnosis and more effective treatment. Updated prevalent studies are needed throughout the country to understand the true impact of esophageal cancer on the Mozambican population.


Assuntos
Neoplasias Esofágicas , Gastroenterologia , Estudos Transversais , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/epidemiologia , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Pan Afr Med J ; 41: 119, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35465382

RESUMO

Introduction: the quality of maternity services is an essential factor in reducing maternal and newborn morbidity and mortality, which remains extremely high in Africa. In Mozambique, maternal mortality rate is 451.6 deaths per 100,000 live births (2017). The reasons for this are complex, but one important factor to reduce this burden is to provide effective and efficient care, to improve institutional deliveries. To reduce maternal and newborn mortality rates in Nampula, researchers from Lúrio University and the University of Saskatchewan, carried out an implementation research program, including various interventions such as training activities for health professionals in maternal and child health care. We planned a mid-project evaluation, to assess the trainings´ impact on the quality of services at Marrere Hospital Maternity. Methods: quantitative pre-post study, carrying out two cross-sectional surveys about maternity service quality, one being conducted after five health professionals´ trainings and the other after six more trainings. The two surveys included samples of post-partum women in the maternity, calculated with a 10% margin error and 90% confidence interval for the first survey, and with a 7% margin error and 95% confidence interval for the second. The surveys were entered into REDCap and analysed to assess frequencies, percentages, mean and standard deviations. This research was approved by the Institutional Committees of Bioethics at Lúrio University and at the University of Saskatchewan. Results: one hundred and sixteen post-partum women were surveyed at the maternity, assessing standards of patient centred care during delivery labour. Most areas showed no improvement. Some positive improvements were delivering women were given the option to have a person of their choice accompany them during labour (75%), notably a traditional birth attendant (34%), and they had continuous support from a health professional (68%). But many shortcomings persisted in areas of privacy (33%) and confidentiality (57%). Conclusion: the quality of patient centred care at Marrere Hospital Maternity did not improve much with health professionals´ trainings. Decreasing the large turnover rate of such staff, reviewing their learning styles, and promoting continuous professional capacity building would be the next steps to improve quality of care.


Assuntos
Serviços de Saúde Materna , Tocologia , Criança , Estudos Transversais , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Moçambique , Gravidez
16.
J Int Dev ; 2022 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-35465455

RESUMO

This study assesses the impact of COVID-19 on household consumption poverty. To predict changes in income and the associated effects on poverty, we rely on existing estimated macroeconomic impacts. We assume two main impact channels: direct income/wage and employment losses. Our simulations suggest that consumption decreased by 7.1%-14.4% and that poverty increased by 4.3-9.9 percentage points in 2020. This points to a reversal of the positive poverty reduction trend observed in previous years. Poverty most certainly increased in the pre-COVID period due to other shocks, so Mozambique finds itself in a deepening struggle against poverty.

17.
Artigo em Inglês | MEDLINE | ID: mdl-35438003

RESUMO

Prolactin (PRL) cells within the rostral pars distalis (RPD) of euryhaline and eurythermal Mozambique tilapia, Oreochromis mossambicus, rapidly respond to a hyposmotic stimulus by releasing two distinct PRL isoforms, PRL188 and PRL177. Here, we describe how environmentally relevant temperature changes affected mRNA levels of PRL188 and PRL177 and the release of immunoreactive prolactins from RPDs and dispersed PRL cells. When applied under isosmotic conditions (330 mOsm/kg), a 6 °C rise in temperature stimulated the release of PRL188 and PRL177 from both RPDs and dispersed PRL cells under perifusion. When exposed to this same change in temperature, ~50% of dispersed PRL cells gradually increased in volume by ~8%, a response partially inhibited by the water channel blocker, mercuric chloride. Following their response to increased temperature, PRL cells remained responsive to a hyposmotic stimulus (280 mOsm/kg). The mRNA expression of transient potential vanilloid 4, a Ca2+-channel involved in hyposomotically-induced PRL release, was elevated in response to a rise in temperature in dispersed PRL cells and RPDs at 6 and 24 h, respectively; prl188 and prl177 mRNAs were unaffected. Our findings indicate that thermosensitive PRL release is mediated, at least partially, through a cell-volume dependent pathway similar to how osmoreceptive PRL release is achieved.

18.
BMJ Glob Health ; 7(4)2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443938

RESUMO

INTRODUCTION: Currently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems' exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic's negative impact on tuberculosis case detection. METHODS: Applying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces. RESULTS: A total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually; however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020. CONCLUSION: The most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.


Assuntos
COVID-19 , Tuberculose , Teorema de Bayes , COVID-19/diagnóstico , COVID-19/epidemiologia , Atenção à Saúde , Feminino , Humanos , Masculino , Moçambique/epidemiologia , Pandemias , Tuberculose/diagnóstico , Tuberculose/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-35460301

RESUMO

BACKGROUND: Health information systems (HIS) are meant to support decision-making at all levels of the system, including frontline health workers. In field studies in Côte d'Ivoire, Mozambique and Nigeria, we observed health workers' interactions with the HIS and identified twelve decision-making components of HIS. The objective of this framework synthesis is to portray these components in HIS research, in order to inform the ideation of a paper-based HIS intervention (PHISICC). METHODS: We searched studies in the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Epistemonikos, Medline, in-Process on the Ovid platform, OpenGrey, PDQ  Evidence ("pretty darnd quick" Evidence), the World Health Organization (WHO) Global Health Library and included studies focussing on HIS interventions, data quality, information support tools and data use for decision-making in the context of the governmental health care sector. We assessed the methodological quality of studies using the Critical Appraisal Skills Programme tool. We synthesised the findings based on the decision-making components of HIS and thematic areas. RESULTS: The search identified 6784 studies; 50 were included. Most of the 50 studies had quality concerns. All studies included at least one of the decision-making components: the most prominent were the technical aspects of 'recording' and 'reporting'. Data use for decision-making was much less represented. CONCLUSION: HIS research focuses on the more technical aspects of HIS. Further research on HIS, given the strong push towards HIS digitalisation, should consider putting at the centre the human experience of decision-making and data use, in order to make HIS relevant for quality of care.

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