Epidemiology of Rotavirus Infection in Children from a Rural and Urban Area, in Maputo, Southern Mozambique, before Vaccine Introduction.

This study aimed to describe the epidemiology of rotavirus infections in Mozambique before vaccine introduction. Between February 2012 and September 2013, stool specimens, demographic and clinical data were collected from 384 children <5 years old hospitalized with acute diarrhea in Mavalane General Hospital and Manhiça District Hospital, southern Mozambique. The samples were tested for rotavirus A using enzyme-linked immunosorbent assay. The overall prevalence of rotavirus infection was 42.4% [95% confidence interval (95CI): 37.4-47.6%], and was similar in Manhiça (44.3%; 95CI: 36.2-52.7%) and Mavalane (41.3%; 95CI: 34.9-47.9%). The highest prevalence of rotavirus infection was observed in children between 6 and 11 months old. It was also observed that 162 (43.7%) of the children were underweight (weight-for-age z-score < -2), of which 61 were infected by rotavirus.

Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data.

The World Health Organization's systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.

Norovirus Genetic Diversity in Children under Five Years Old with Acute Diarrhea in Mozambique (2014-2015).

Norovirus (NoV) is the second most important cause of viral diarrheal disease in children worldwide after rotavirus and is estimated to be responsible for 17% of acute diarrhea in low-income countries. This study aimed to identify and report NoV genotypes in Mozambican children under the age of five years with acute diarrhea. Between May 2014 and December 2015, stool specimens were collected within the Mozambique Diarrhea National Surveillance (ViNaDia) and tested for NoV genogroups I (GI) and II (GII) using conventional reverse transcriptase-polymerase chain reaction (RT-PCR). Partial capsid and RNA-dependent RNA polymerase (RdRp) nucleotide sequences were aligned using the Muscle tool, and phylogenetic analyses were performed using MEGA X. A total of 204 stool specimens were tested for NoV. The detection rate of NoV was 14.2% (29/204). The presence of NoV was confirmed, by real-time RT-PCR (RT-qPCR), in 24/29 (82.8%) specimens, and NoV GII predominated (70.8%; 17/24). NoV GII.4 Sydney 2012[P31] was the predominant genotype/P-type combination detected (30.4%; 7/23). This is the first study which highlights the high genetic diversity of NoV in Mozambican children and the need to establish a continuous NoV surveillance system.

40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives.

In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.

Examining comorbidities in children with diarrhea across four provinces of Mozambique: A cross-sectional study (2015 to 2019)

Comorbidities are defined as the simultaneous occurrence of two or more diseases within the same individual. Comorbidities can delay a patient's recovery and increase the costs of treatment. Assessing comorbidities can provide local health care policy-makers with evidence of the most common multi-health impairments in children. This could aid in redirecting and integrating care and treatment services by increasing health facilities the awareness and readiness of health facilities. The present analysis aims to determine the frequency and associated factors of comorbidities in children with diarrhea in Mozambique. A cross-sectional hospital-based analysis was conducted between January 2015 and December 2019 in children up to 59 months of age who were admitted with diarrhea in six reference hospitals in Mozambique. These hospitals are distributed across the country's three regions, with at least one hospital in each province from each region. Sociodemographic and clinical data were obtained through semi-structured interviews and by reviewing the child clinical process. Descriptive statistics, and Mann-Whitney-U tests were used. Crude and adjusted logistics regression models were built. P-values < 0.05 were considered statistically significant. Comorbidities were observed in 55.5% of patients (389/701; 95%CI: 51.8-59.1). Wasting was the most common comorbidity (30.2%; 212/701) and pneumonia was the least common (1.7%; 12/701). Children born with a low birth weight were 2.420 times more likely to have comorbidities, adjusted odds ratio: 2.420 (95% CI: 1.339-4374). The median (interquartile range) duration of hospitalization was significantly higher in children with comorbidities than without comorbidities, 5 days (3-7) and 4 days (3-6), respectively (p-value < 0.001). One in every two children with diarrhea in Mozambique has an additional health impairment, and this increases the length of their hospital stay.

Immunogenicity of Reduced-Dose Monovalent Type 2 Oral Poliovirus Vaccine in Mocuba, Mozambique

The global polio eradication initiative (gpei) has made steady progress toward the eradication target since its inception in 1988 [1]. the number of paralytic cases due to wild poliovirus has declined worldwide by >99.9%, and 2 of the 3 wild poliovirus serotypes have been declared eradicated by an independent global certification commission: serotype 2 in 2015 and serotype 3 in 2019 [2, 3]. the gpei has implemented the endgame strategic plan 2013­2018 to accelerate the eradication of wild poliovirus type 1 from its last endemic zones in pakistan and afghanistan. [4]. in addition, the plan called for the sequential removal of the sabin strains from the oral poliovirus vaccine (opv) and the concomitant addition of ≥1 dose of inactivated poliovirus vaccine (ipv) in routine national immunization programs. the removal was needed because the continuing use of live viral vaccines is incompatible with eradication, since these viruses can mutate and recombine, thus reacquiring the neurovirulence and transmission characteristics of wild poliovirus [5]. the burden of paralytic disease caused by vaccine-related polioviruses would not be accepted as the world approaches eradication of wild poliovirus. for example, sabin type 2 was responsible for approximately 40% of the vaccine-associated paralytic poliomyelitis burden and caused 91% of circulating vaccine-derived poliovirus (cvdpv) cases between 2000 and 2016...

Characterizing Undernourished Children Under-Five Years Old with Diarrhoea in Mozambique: A Hospital Based Cross-Sectional Study, 2015­2019

Diarrhoea is associated with undernutrition and this association is related to increased morbidity and mortality in children under-five. In this analysis we aimed to assess the frequency and associated factors of undernutrition in children under-five with diarrhoea. A hospital-based cross-sectional study was conducted from January 2015 to December 2019 through a surveillance system in five sentinel hospitals in Mozambique. Sociodemographic and clinical information was collected, including anthropometry. A total of 963 children were analysed. The overall undernutrition frequency was 54.1% (95% CI: 50.9­57.2), with 32.5% (95% CI: 29.6­35.5) stunting, 26.6% (95% CI: 23.9­29.6) wasting and 24.7% (95% CI: 22.1­27.5) underweight. Children from Nampula province had 4.7 (p = 0.016) higher odds for stunting compared with children from Maputo. Children whose caregiver was illiterate had higher odds of being underweight 5.24 (p < 0.001), and the wet season was associated with higher odds 1.70 (p = 0.012) of being wasted. Children born under 2500 g of weight had 2.8 (p = 0.001), 2.9 (p < 0.001) and 2.6 (p = 0.010) higher odds for being underweighted, wasted and stunted, respectively. The HIV positive status of the children was associated with higher odds of being underweight 2.6 (p = 0.006), and stunted 3.4 (p = 0.004). The province, caregiver education level, wet season, child's birthweight and HIV status were factors associated with undernutrition in children with diarrhoea. These findings emphasise the need for additional caregiver's education on the child's nutrition and associated infectious diseases. More studies are needed to better understand the social context in which a child with diarrhoea and undernutrition is inserted.

40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives / Quarenta anos de imunização em Moçambique: uma revisão narrativa da literatura, avanços e perspectivas / 40 años de inmunización en Mozambique: una revisión narrativa de la literatura, logros y perspectivas

In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.

Em Moçambique, o Programa Alargado de Vacinação (PAV) foi implementado em 1979 com o compromisso de reduzir a morbimortalidade na população infantil através dos serviços de imunização. O presente estudo tem como objetivo descrever as características do PAV e revisar as informações disponíveis relacionadas aos serviços de imunização em Moçambique, os avanços e perspectivas. Foi realizada uma revisão narrativa da literatura, e as bases de dados acessadas foram BVS, Google Scholar e PubMed, entre 1979 e 2019, usando descritores relacionados ao tema. A revisão acessou um total de 28 artigos científicos, além de outras fontes relevantes. A cobertura nacional de vacinação em Moçambique entre 1997 (47%) e 2015 (66%) aumentou 19 pontos percentuais, e a cobertura de vacinação em crianças abaixo de 12 meses de idade aumentou de 44,3% (1997) para 57% (2015). De acordo com os dados de 2015, das 11 províncias, apenas as do Sul e a de Cabo Delgado atingiram a meta de cobertura recomendada de 80%. As províncias de Zambézia, Nampula e Tete mostraram baixas coberturas ao longo dos anos, enquanto Cabo Delgado mostrou oscilação na cobertura. As vacinas BCG, DPT3, Polio 3 e sarampo atingiram a meta de cobertura de 80% entre 1997 e 2015. Nossa análise mostrou avanços importantes na vacinação nacional, caracterizados por um aumento geral nas coberturas nacional e provinciais e uma queda no número de crianças que não receberam nenhuma vacina. Apesar desses avanços, algumas províncias tiveram coberturas aquém das metas, o que reforça a necessidade de entender os determinantes do abandono da imunização nas crianças, para retê-las e assegurar a imunização oportuna e completa.

En Mozambique, el Programa de Inmunización Expandido (EPI por sus siglas en inglés) fue implementado en 1979, con el compromiso de reducir la mortalidad infantil y la morbilidad a través de la provisión de servicios de inmunización. El objetivo del presente estudio es describir las características del EPI y revisar la información disponible, relacionada con el servicio de inmunización en Mozambique, así como sus logros y perspectivas. Se llevó a cabo una revisión narrativa de la literatura y se accedió a las siguientes bases de datos electrónicas: BVS, Google Scholar y PubMed para el período de 1979 a 2019, usando descriptores relacionados con el tema. Se tuvo acceso a un total de 28 artículos y otras fuentes relevantes para la revisión. La cobertura nacional de inmunización en Mozambique de 1997 (47%) a 2015 (66%) mejoró 19 puntos porcentuales y la cobertura de inmunización de los niños con menos de 12 meses se incrementó de un 44,3% (1997) a un 57% (2015). La encuesta de 2015 mostró que, de las 11 provincias, solamente la provincia del sur y la provincia de Cabo Delgado podrían alcanzar el 80% de la meta recomendada a nivel provincial. Las provincias de Zambézia, Nampula, y Tete han estado informando de baja cobertura a largo de estos años y Cabo Delgado tiene oscilaciones en la cobertura. BCG, DPT3, Polio 3 y sarampión han alcanzado un 80% de la meta de la cobertura de 1997-2015. Nuestro análisis ha mostrado importantes mejoras en la inmunización nacional, caracterizada por un aumento en general en la cobertura nacional y provincial, así como un decremento en el número de niños que no recibieron ninguna vacuna. A pesar de estas mejoras, algunas provincias tienen coberturas más bajas que las esperadas y existe una necesidad para entender los determinantes del abandono en niños para retenerlos y proporcionarles a tiempo una completa inmunización.

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection. Methodology We conducted a cross-sectional study in children aged 0­168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immuneenzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection. Results Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916­34.894; p-value < 0.01); animal contact (children with animal contactinstitute for global health sciences, university of california san francisco, san francisco, california, united states of America had a protective effect OR: 0.627; CI: 0.398­0.986; p-value < 0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310­4.069; p-value < 0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60­168 months (OR: 2.322; CI: 1.000­5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286­3.565, p-value < 0.01).

Diferenças de género e sexo na susceptibilidade às doenças infecciosas / Gender and sex difference susceptibility to infectious diseases

As doenças infecciosas ocorrem de forma desproporcional entre homens e mulheres. Muitas vezes, a severidade e o resultado da doença estão geralmente relacionados ao sexo. Os factores inerentes a estas diferenças ainda estão a ser estudados. Contudo, alguns estudos apontam o sexo como um dos factores principais das difer- enças da resposta imunológica às infecções. As mulheres desenvolvem naturalmente uma imunidade inata, celular e humoral com algumas utuações devido aos níveis hormonais que naturalmente variam durante os ciclos menstruais, gravidez, menopausa ou pelo uso de anticonceptivos hormonais ou o uso de tratamentos hormonais. Entretanto, as hormonas masculinas também têm sido implicadas na imunoregulação. A testesterona por exemplo causa o declínio de certas respostas imunológicas e os indivíduos jovens do sexo masculino são muitas vezes susceptíveis a infecções severas comparados às mulheres ou a homens adultos. Por outro lado, o género joga um papel importante na susceptibilidade às infecções transmitidas por vectores. Outros estudos apontam que o padrão hormonal no seio da família e a química da pele in uenciam na susceptibilidade à picada por mosquitos e outros vectores nos homens e mulheres. As diferenças comportamentais, ocupacionais e culturais também estão relacionadas com a exposição a vectores, assim como o uso de medidas de protecção individual e a procura pelos cuidados de saúde. Tomando em conta estes aspectos, é importante que futuros estudos imunológicos, epidemiológi- cos, comportamentais, de conhecimentos atitudes e práticas tenham em conta o sexo como uma variável, para uma melhor interpretação dos resultados e melhores práticas de saúde, princi- palmente no que tange ao tratamento das doenças infecciosas.

Infectious diseases occur di erently in men and women. Usually the severity and the result of the disease are related to the gender. Although some studies indicate the gender as one of main factor of immunological di erences, the causes of these di erences are still to be revealed. However, Women naturally develop innate immune response, cellular and humoral response with some uctuations due to the level of hormones that varies during the menstrual cycle, pregnancy and menopause, or due to the use of anti-conception pill or the use of hormonal treatments. e hormones from males also are implicated in immunoregulation. Testosterone decreases certain immune responses and young males are more susceptible to severe infections compared to adult males and females. In other hand, the gender was shown to play an important role on the susceptibility to vector transmitted diseases where the hormonal pattern within the family and the chemistry of the skin in uence the susceptibility to mosquito's bite and other vectors in men and women. e behavior, occupational and cultural behaviors in uence the exposure to vectors, but also the use of individual protection measures and the search for health services. Taking together, it's very important that future studies address gender and sex di erences in their designs, in order to conduct better conclusions and heath practices related to infectious diseases treatment or prevention.

Rotavirus a strains obtained from children with acute gastroenteritis in mozambique, 2012-2013: g and p genotypes and phylogenetic analysis of vp7 and partial vp4 genes

In Mozambique rotavirus (RV) was shown to be the greatest cause of acute diarrhoea in infants from 0 to 11 months, and in 2015, national rotavirus vaccination was introduced. As with other developing countries, there is very limited active strain characterisation. Rotavirus positive clinical specimens, collected between 2012 and 2013, have now provided information on the genotypes circulating in southern Mozambique prior to vaccine introduction. Genotypes G2 (32.4%), G12 (28.0%), P[4] (41.4%) and P[6] (22.9%) (n = 157) strains were commonly detected with G2P[4] (42.3%) RVs being predominant, specifically during 2013. Phylogenetic evaluation of the VP7 and VP8* encoding genes showed, for the majority of the Mozambican strains, that they clustered with other African strains based on genotype. RVA/Human-wt/MOZ/0153/2013/G2P[4], RVA/Human-wt/MOZ/0308/2012/G2P[4] and RVA/Human-wt/MOZ/0288/2012/G12P[8] formed separate clusters from the other Mozambican strains with similar genotypes, suggesting possible reassortment. Amino acid substitutions in selected epitope regions also supported phylogenetic clustering. As expected, the VP7 and VP8* genes from the Mozambican strains differed from both the RotaTeq® (SC2-9) G2P[5] and Rotarix® (A41CB052A) G1P[8] genes. This study provides information on the genetic diversity of rotavirus strains prior to vaccine introduction and generates baseline data for future monitoring of any changes in rotavirus strains in response to vaccine pressure.

Microscopia e Ensaio de Imunoabsorção Enzimática: detecção de Cryptosporidium spp. em fezes de crianças moçambicanas / Microscopy and Enzyme-Linked Immunosorbent Assay for Cryptosporidium spp. detection in diarrheic feces of Mozambican children

A diarreia causada por Cryptosporidium spp. é comum em crianças e culmina com elevadas taxas de morbi-mortalidade, sobretudo nos países em desenvolvimento. A técnica convencional para o diagnóstico de Cryptosporidium spp. é a microscopia óptica, contudo, o Ensaio de Imunoabsorção Enzimática (ELISA) também tem sido usado. O objectivo deste estudo foi de comparar a performance do ELISA (ensaio comercial) em relação a microscopia óptica na detecção de Cryptosporidium spp. em fezes diarreicas de crianças admitidas no Hospital Geral de Mavalane (HGM) de Maio de 2014 a Fevereiro de 2015. No total, 130 amostras de fezes foram testadas, primeiramente por microscopia óptica e depois por ELISA. A estatística descritiva, sensibilidade, especi cidade e valores preditivos negativo e positivo foram usados para analisar os dados.A microscopia permitiu a identi cação de Cryptosporidium spp., Entamoeba hystolitica/díspar/moshovskii, Giardia intestinalis, Ascaris lumbricóides, Trichuris trichiura e Balantidium coli. Doze (9.2%) amostras foram positivas para Cryptosporidium spp., contra 22 (16.9%) identi cadas por ELISA. Esta diferença foi estatisticamente signi cativa (p = 0.002). A frequência de detecção deste patógeno por microscopia foi maior em crianças dos 12 aos 23 meses (4.6%), enquanto por ELISA foi maior em crianças dos zero aos 11 meses. A sensibilidade do ELISA na detecção de antígenos de Cryptosporidium spp. foi de 58.3%, enquanto a especi-cidade foi de 81.4%. Os resultados encontrados ressaltam a necessidade de uma ferramenta de diagnóstico complementar tal como o ELISA, para con rmar o diagnóstico em pacientes com sinais clínicos típicos de criptosporidiose mas com resultado negativo por microscopia.

Diarrhea caused by Cryptosporidium spp. is common in children and ends with high morbidity and mortality rates, mostly in developing countries. e conventional technique for the diagnosis of Cryptosporidium spp. is the optical microscopy, however, the Enzyme-linked immunosorbent assay (ELISA) is also being implemented. e aim of this study was to compare the performance of ELISA (commercial immunoassay) in relation to optical microscopy to detect Cryptosporidium spp. in diarrheic feces of children admitted to Mavalane General Hospital from May 2014 to February 2015. Overall 130 stool samples were tested rstly by optical microscopy and then by ELISA. Descriptive statistics, sensitivity, speci city, negative and positive predictive value were used to analyze the data. e microscopy detected 12 (9.2%) Cryptosporidiumspp., positive samples and ELISA identi ed 22 (16.9%). is di erence was statistically signi cant (p = 0.002). e frequency of detection by microscopy was higher in children from 12 to 23 months (4.6%), while by ELISA was higher in those from zero to 11 months. e microscopy enabled the identi cation of other parasites such as Entamoeba hystolitica/díspar/moshovskii, Giardia intestinalis, Ascaris lumbricóides, Trichuris trichiura and Balantidium coli. e sensitivity of the ELISA in detection of Cryptosporidium spp. antigens was 58.3%, while the speci city was 81.4%. Taking all together, our results highlight the need of a complementary diagnostic tool, such as this ELISA, to con rm the diagnosis in patients with typical clinicalsymptoms of cryptosporidiosis but negative results by microscopy.

Políticas de saúde informadas por evidências: relato da cooperação Brasil-Moçambique / Evidence-informed health policy: report of the Brazil-Mozambique cooperation

Neste artigo, descrevem-se os principais elementos da cooperação bilateral entre Brasil e Moçambique na área de desenvolvimento de capacidades em políticas de saúde informadas por evidências. Apresentam-se aspectos relevantes da colaboração multi-institucional, descrevem-se visitas internacionais, incluindo re uniões de trabalho, a oficina sobre as Ferramentas SUPPORT e seus desdobramentos e futuras perspectivas de trabalho. Os principais ganhos da colaboração foram o fortalecimento institucional pela aproximação e o intercâmbio de grupos de pesquisa, a docência e gestão pública de saúde, o aprimoramento metodológi co da oficina e insights sobre as melhores formas de fazer chegar as evidências disponíveis a quem tem o poder de tomar decisões no Ministério da Saúde em Moçambique através da cooperação entre o Instituto Nacional de Saúde e a Faculdade de Medicina da Universidade Eduardo Mondlane.

Evidence-informed health policy: report of the Brazil-Mozambique cooperation Abstract in this article, we describe the main elements of the Brazil-Mozambique bilateral cooperation in the area of capacity building in evidence-informed policy in health. We mapped relevant aspects of multi-institutional collaboration and described international visits, including various meetings, a workshop on the SUPPORT tools and its outputs and perspectives on future jointed work. Key gains from such collaboration were institutional strengthening through gathering and exchange among health research, academics, and policy makers; workshop methodological improvement, and insights on best ways to provide evidence to decision makers in the Ministry of Health of Mozambique through cooperation between the National Institute of Health and the University Eduardo Mondlane's Faculty of Medicine.

Políticas de saúde informadas por evidências: relato da cooperação Brasil-Moçambique / Evidence-informed health policy: report of the Brazil-Mozambique cooperation

Neste artigo, descrevem-se os principais elementos da cooperação bilateral entre Brasil e Moçambique na àrea de desenvolvimento de capacidades em políticas de saúde informadas por evidências. Apresentam-se aspectos relevantes da colaboração multi-institucional, descrevem-se visitas internacionais, incluindo reuniões de trabalho, a oficina sobre as Ferramentas SUPPORT e seus desdobramentos e futuras perspectivas de trabalho. Os principais ganhos da colaboração foram o fortalecimento institucional pela aproximação e o intercâmbio de grupos de pesquisa, a docência e gestão pública de saúde, o aprimoramento metodológico da oficina e insights sobre as melhores formas de fazer chegar as evidências disponíveis a quem tem o poder de tomar decisões no Ministério da Saúde em Moçambique através da cooperação entre o Instituto Nacional de Saúde e a Faculdade de Medicina da Universidade Eduardo Mondlane.

40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives

In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.