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BACKGROUND: The World Health Organization has identified the primary referral hospital as its priority site for improving surgical care in low- and middle-income countries. Little is known about the relative burden surgical patients place on health care facilities at this level. This research estimates the fraction of admissions due to surgical conditions at three hospitals in rural Mozambique. METHODS: Prospective data were collected on all inpatients at three primary referral hospitals in Mozambique during a 12-day period. We compared the number of surgical patients and their length of stay (LOS) to the patients admitted to the medicine, pediatric, and maternity wards. These findings were validated using retrospective data collected from one hospital from January to May 2012. RESULTS: Patients with surgical conditions (i.e., patients admitted to the surgical or maternity ward) accounted for 57.5 % of admissions and 48.0 % of patient-days. The majority of patients were admitted to the maternity ward (32.3 %). The other admissions were evenly distributed to the pediatric (22.5 %), medical (20.0 %), and surgical (25.2 %) wards. Compared to patients from the three other wards, surgical patients had longer average LOS (8.7 vs. 1.9-7.7 days) and a higher number of total patient-days (891 vs. 252-703 days). The most prevalent procedures were cesarean section (33.3 %) and laceration repair/wound care (11.8 %). CONCLUSIONS: Surgical conditions are the most common reason for admissions at three primary referral hospitals in rural Mozambique. These data suggest that surgical care is a major component of health care delivered at primary referral hospitals in Mozambique and likely other sub-Saharan African countries.
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Países em Desenvolvimento/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Moçambique , Estudos Prospectivos , Estudos Retrospectivos , Adulto JovemRESUMO
Introduction: This study aims to determine the baseline seroprevalence of leptospirosis, a zoonotic and neglected disease, in people living with HIV (PWH) in Maputo, Mozambique, and to evaluate the relationship between selected HIV-related factors that might influence risk of coinfection with leptospirosis, such as degree of immunosuppression, as assessed by CD4 cell count, World Health Organization (WHO) HIV/AIDS clinical stage and antiretroviral therapy (ART) intake. Methods: This was a descriptive cross-sectional analysis of 157 PWH, aged over 18 years old, admitted to the Maputo Central Hospital, in Maputo, Mozambique, between March 2020 and October 2021. The study participants were recruited as a convenience sample regardless of the reasons for their admission. We collected sociodemographic and clinical data, including ART and WHO HIV/AIDS clinical stage, and blood for CD4 cell count and detection of Leptospira IgG antibodies using a commercial Kit ab247199 Leptospira IgG ELISA (www.abcam.com/ab247199) with sensitivity and specificity of 100% and 97.3%, respectively. Laboratory testing was performed at the Faculty of Medicine, Eduardo Mondlane University and Laboratory of Clinical Analysis, in Maputo. Results: Participants were aged 18 to 72 years (median age 39 years; SD ± 10.5), the majority were female 100 (63.7%), from urban areas 138 (87.9%), with secondary-level education 80 (51%). The overall seroprevalence of Leptospira IgG antibodies was 40.1%. The median CD4 cell count was 385 cells/µl (02 to 2297; SD ± 378.47). Higher seroprevalence of Leptospira antibodies was found among participants with CD4 cell counts <250 cells/µl (54.8%), WHO HIV/AIDS stage IV (70.2%) and those on ART (92%), though there were no statistically significant differences between groups with and without Leptospira antibodies. Conclusion: Our study confirmed that Leptospira antibodies are highly prevalent in PWH in Maputo; however, Leptospira infection was not associated with the degree of immunosuppression, WHO HIV/AIDS clinical stage, or the use of ART. Our data support the need for routine screening for leptospirosis in PWH in Mozambique. Future studies are warranted to characterize the incidence and outcomes of symptomatic leptospirosis in this patient population and to identify circulating serovars and species in the country and region, as well as the implicated reservoirs.
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BACKGROUND: Since Mozambique's independence, the major emphasis of its higher educational institutions has been on didactic education. Because of fiscal and human resource constraints, basic and applied research activities have been relatively modest in scope, and priorities have often been set primarily by external collaborators. These factors have compromised the scope and the relevance of locally conducted research and have limited the impact of Mozambique's universities as major catalysts for national development. CASE DESCRIPTION: We developed a multi-institutional partnership to undertake a comprehensive analysis of the research environment at Mozambique's major public universities to identify factors that have served as barriers to the development of a robust research enterprise. Based on this analysis, we developed a multifaceted plan to reduce the impact of these barriers and to enhance research capacity within Mozambique. INTERVENTIONS: On the basis of our needs assessment, we have implemented a number of major initiatives within participating institutions to facilitate basic and applied research activities. These have included specialized training programmes, a reorganization of the research administration infrastructure, the development of multiple collaborative research projects that have emphasized local research priorities and a substantial investment in bioinformatics. We have established a research support centre that provides grant development and management services to Mozambique's public universities and have developed an independent Institutional Review Board for the review of research involving human research subjects. Multiple research projects involving both communicable and non-communicable diseases have been developed and substantial external research support has been obtained to undertake these projects. A sizable investment in biomedical informatics has enhanced both connectivity and access to digital reference material. Active engagement with relevant entities within the Government of Mozambique has aligned institutional development with national priorities. CONCLUSIONS: Although multiple challenges remain, over the past 3 years significant progress has been made towards establishing conditions within which a broad range of basic, translational and clinical and public health research can be undertaken. Ongoing development of this research enterprise will enhance capacity to address critical locally relevant research questions and will leverage resources to accelerate the development of Mozambique's national universities.
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Pesquisa Biomédica/organização & administração , Comportamento Cooperativo , Educação Médica/organização & administração , Fortalecimento Institucional , Programas Governamentais , Humanos , Moçambique , Apoio à Pesquisa como Assunto , UniversidadesRESUMO
Commercial antigens used to diagnose human neurocysticercosis are obtained from either a soluble parasite extract or a parasite-derived glycoprotein fraction. The aim of the present study was to identify antigenic proteins as potential diagnostic candidates in Mozambique. Soluble proteins from Taenia solium cysticerci were separated by two-dimensional electrophoresis and blotted onto nitrocellulose membranes. Subtracted hybridization was performed with serum samples obtained from patients with neurocysticercosis (NCC) and from a NCC-negative control group. Six antigenic proteins were identified and sequenced by liquid chromatography-mass spectrometry. Among these we found Tsol-p27, which was previously identified as a diagnostic candidate in a study conducted in Nicaragua, Central America. Here, we evaluated Tsol-p27 and the antigen cC1 as potential recombinant diagnostic reagents, and also investigated the localization and partial function of Tsol-p27. Immunoblotting demonstrated that Tsol-p27 was recognized by all 10 serum samples from NCC-positive individuals, whereas cC1 was identified by only five of the 10 positive sera. None of the antigens were recognized by negative control sera. Despite the limited number of serum samples evaluated in this study, the results suggest that Tsol-p27 can be a suitable candidate for diagnosis of human NCC, not only in Central America but also in sub-Saharan Africa.
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Antígenos de Helmintos , Proteínas de Helminto , Neurocisticercose/diagnóstico , Taenia solium/imunologia , Sequência de Aminoácidos , Animais , Anticorpos Anti-Helmínticos/sangue , Especificidade de Anticorpos , Antígenos de Helmintos/química , Antígenos de Helmintos/imunologia , Antígenos de Helmintos/isolamento & purificação , Western Blotting , Estudos de Casos e Controles , Cromatografia Líquida , Eletroforese em Gel Bidimensional , Eletroforese em Gel de Poliacrilamida , Proteínas de Helminto/química , Proteínas de Helminto/imunologia , Proteínas de Helminto/isolamento & purificação , Humanos , Soros Imunes/imunologia , Masculino , Espectrometria de Massas , Dados de Sequência Molecular , Moçambique , Neurocisticercose/imunologia , Coelhos , Suínos , Taenia solium/isolamento & purificaçãoRESUMO
Diarrhea is an important cause of hospitalizations in Mozambique. However, little attention has been paid to the impact HIV infection on the prevalence or clinical manifestations of enteric bacterial infections. This study aimed to determine the prevalence of Salmonella spp., Shigella spp. and Campylobacter spp. in HIV-infected and HIV-uninfected patients with diarrhea, identify risk factors for infection, and explore the association between HIV status, viral load, and bacterial prevalence. We conducted a case-control study at the Centro de Saúde de Mavalane and Centro de Saúde 1° de Maio in Maputo, Mozambique, from November 2021 to May 2022. We recruited 300 patients, including 150 HIV-infected (cases) and 150 HIV-uninfected patients (controls), aged between 0-88 years, presenting with diarrhea. Stool samples were collected for bacterial isolation through culture, and for each HIV-infected patient, 4 ml of venous blood were obtained for viral load detection through PCR. A total of 129 patients (43.0%) had at least one bacterial infection. The prevalence of Salmonella spp., Shigella spp. and Campylobacter spp. was 33.0% (n = 99), 15.0% (n = 45) and 4.3% (n = 13), respectively. The prevalence of any bacterial infection did not differ significantly between HIV-infected (45.3%, n = 68) and HIV-uninfected patients (40.7%, = 61) (p = 0.414). Overall, having 2-3 symptoms of enteric disease (p = 0.008) and a basic education (p = 0.030) were factors associated with bacterial infection. Of the 148 patients for whom HIV-1 RNA levels were available, 115 had copy numbers ≤ 75. Another 13 had levels between 76 and 1,000 and the remaining 20 had an average of 327,218.45 copies/ml. Bivariate logistic regression found that Shigella spp. were associated with HIV (p = 0.038), although no association was found in the multivariate analysis. Enteric infections are common in both HIV-infected and -uninfected patients. Low schooling influences the occurrence of enteric infections, which highlights the need to raise awareness about their prevention.
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IMPORTANCE: Malaria is a devastating disease caused by Plasmodium parasites. The evolution of parasite drug resistance continues to hamper progress toward malaria elimination, and despite extensive efforts to control malaria, it remains a leading cause of death in Mozambique and other countries in the region. The development of successful vaccines and identification of molecular markers to track drug efficacy are essential for managing the disease burden. We present an analysis of the parasite genome in Mozambique, a country with one of the highest malaria burdens globally and limited available genomic data, revealing current selection pressure. We contribute additional evidence to limited prior studies supporting the effectiveness of SWGA in producing reliable genomic data from complex clinical samples. Our results provide the identity of genomic loci that may be associated with current antimalarial drug use, including artemisinin and lumefantrine, and reveal selection pressure predicted to compromise the efficacy of current vaccine candidates.
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Antimaláricos , Malária Falciparum , Malária , Parasitos , Animais , Humanos , Plasmodium falciparum/genética , Moçambique , Antimaláricos/farmacologia , Malária/tratamento farmacológico , Genômica , Resistência a Medicamentos/genética , Malária Falciparum/tratamento farmacológicoRESUMO
BACKGROUND: Leptospirosis is an occupational, neglected febrile disease of bacterial origin transmitted between humans and animals. In this manuscript we summarize available data on Leptospira infection in HIV uninfected and in people living with HIV from the Southern African Development Community (SADC) countries, identifying gaps in knowledge and recommend future research priorities. METHODOLOGY: Articles published between 1990 and 2021 were accessed by an online search of Google Scholar and Medline/PubMed performed between February 2020 and July 2022. The STATA program was used for the Meta-analysis. Pooled prevalence values with 95% confidence intervals and heterogeneity were determined. RESULTS: Thirty studies from eight SADC countries, reporting the prevalence on Leptospira were reviewed. A pooled prevalence of 19% (CI: 13-25%), a heterogeneity level of 96% and index score ranging from 2 to 9 was determined. Only four (4) studies reported HIV co-infection status. Three species of Leptospira (Leptospira interrogans (4), L. kirschneri (3), Leptospira borgpetersenii (1) and 23 serogroups were identified. The most frequently reported serogroups were Icterohaemorrhagiae (13), Grippotyphosa and Australis (10) followed by Sejroe (8). CONCLUSION: Studies on human leptospirosis in the SADC region are scarce, especially in people living with HIV. Additional studies aimed at determining the prevalence and the role of the pathogen in people living with HIV, including detailed clinical, molecular and demographic data are recommended.
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Infecções por HIV , Leptospira interrogans , Leptospira , Leptospirose , Animais , Humanos , Leptospirose/epidemiologia , Leptospirose/microbiologia , Sorogrupo , Prevalência , Doenças Negligenciadas , Infecções por HIV/complicações , Infecções por HIV/epidemiologiaRESUMO
Background: The further development of research capacity in low- and middle-income countries is critical to the delivery of evidence-based healthcare, the design of sound health policy and effective resource allocation. Research capacity is also critical for the retention of highly skilled faculty and staff and for institutional internationalization. Objectives: We summarize the accomplishments, challenges and legacy of a five-year program to train biomedical researchers entitled "Enhanced Advanced Biomedical Research Training for Mozambique (EABRTM)". Methods: A program conducted from 2015-2021 built upon the Medical Education Partnership Initiative to develop research capacity at Eduardo Mondlane University (UEM) and allied institutions. The project included design and implementation of postgraduate training programs and bolstered physical and human research infrastructure. Findings: The program supported development and implementation of UEM's first doctoral (Bioscience and Public Health) and master (Biosciences) programs with 31 and 23 students enrolled to date, respectively. Three master programs were established at Lúrio University from which 176/202 (87.1%) and 107/202 (53.0%) students obtained a Postgraduate Diploma or master's degree, respectively. Scholarships were awarded to 39 biomedical researchers; 13 completed master degrees, one completed a PhD and five remain in doctoral studies. Thirteen administrative staff and four biomedical researchers were trained in research administration and in biostatistics, respectively. A total of 119 courses and seminars benefited 2,142 participants. Thirty-five manuscripts have been published to date in peer-reviewed international journals of which 77% are first-authored by Mozambicans and 44% last-authored by Africans. Sustainability was achieved through 59 research projects awarded by international agencies, totaling $16,363,656.42 and funds ($ 7,319,366.11) secured through 2025. Conclusions: The EABRTM program substantially increased research and mentorship capacity and trained a new generation of biostatisticians and research administrators. These programmatic outcomes significantly increased the confidence of early stage Mozambican researchers in their ability to successfully pursue their career goals.
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Pesquisa Biomédica , Educação Médica , Pesquisa Biomédica/educação , Fortalecimento Institucional , Humanos , Moçambique , Pesquisadores/educaçãoRESUMO
BACKGROUND: Taenia solium (neuro-)cysticercosis, a neglected tropical disease, can be associated with epileptic seizures and other neuropsychiatric (= neurological and psychiatric) disorders. This study aimed to evaluate the association of T. solium cysticercosis with selected neuropsychiatric disorders and/or symptoms (chronic headache, epileptic seizures/epilepsy and psychosis) in Mocuba district, Mozambique. METHODOLOGY: Between March and May 2018, a cross-sectional study was conducted among 1,086 participants aged 2 years or above in Mocuba district, Zambézia province, central Mozambique, to assess the seroprevalence of human cysticercosis and risk factors for infection, as well as to explore its relation to selected neuropsychiatric disorders. Socio-demographic and clinical data were collected from each participant using a modified questionnaire designed by the Cysticercosis Working Group for Eastern and Southern Africa. Additionally, neuropsychiatric disorders, such as chronic headache, epileptic seizures/epilepsy and psychosis were assessed using four vignettes. T. solium antigen and cysticercosis IgG in serum were detected using both T. solium antigen B158/B60 enzyme linked immunosorbent assay (ELISA) and LDBIO Cysticercosis Western Blot, respectively. PRINCIPAL FINDINGS: Overall, 112/1,086 participants (10.3%) were sero-positive for T. solium antigen or antibodies. Prevalence of antibodies (6.6%; n = 72) was higher than of antigens (4.9%; n = 54). In the questionnaires, 530 (49.5%) of participants reported chronic headache, 293 (27%) had generalized epileptic seizures, 188 (18%) focal seizures and 183 (18.3%) psychosis. We found a statistically significant association between seropositivity for T. solium and chronic headache (p = 0.013). Additionally, increasing age (p = 0.03) was associated with Ag-ELISA seropositivity. CONCLUSIONS: Our study revealed that in Mocuba, T. solium cysticercosis is prevalent and associated with self-reported chronic headache. Additionally, in the study setting, the seroprevalence of cysticercosis increased with age. However, it is not associated with other neuropsychiatric disorders such epileptic seizures/epilepsy and psychosis. Future studies are needed to confirm the high burden of neuropsychiatric disorders and their possible etiology, including neurocysticercosis, using additional serological, molecular biological and radiological diagnostic tools, as well as in-depth clinical examinations.
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Cisticercose , Epilepsia , Transtornos da Cefaleia , Doenças dos Suínos , Taenia solium , Animais , Estudos Transversais , Cisticercose/diagnóstico , Ensaio de Imunoadsorção Enzimática , Epilepsia/epidemiologia , Epilepsia/etiologia , Humanos , Moçambique/epidemiologia , Prevalência , Convulsões/epidemiologia , Estudos Soroepidemiológicos , Suínos , Doenças dos Suínos/epidemiologiaRESUMO
Background: In Mozambique, vegetables are the main source of nutrients and they are consumed raw or cooked. Their consumption, especially in their raw form, might be a source of contamination, which may take place during production and/or transportation as well as in the markets. In this study we aimed to assess the profile and frequency of parasites in lettuces and cabbages sold in some selected markets in Maputo city, the capital of Mozambique. Methods: A cross sectional study was conducted between February and March 2018, in 10 selected markets from Maputo City. A total of 100 combined samples of lettuces and cabbages were analyzed using a spontaneous sedimentation method. Data such as gender and age of the vendors and about handling of vegetables at the point of sale were also collected. Results: Out of the samples, 84 (84%) were contaminated with parasites (86% of lettuces and 82% of cabbages). The analyses performed revealed the presence of E. coli (66%), S. stercoralis (40%), E. histolytica (20%), A. duodenalis (6%), S. haematobium (4%), A. lumbricoides (2%), S. mansoni (2%) and T. trichiura (1%). Two markets, Janete and Fajardo showed contamination in all samples. A Chi square analysis revealed a significant association between the contaminated cabbages and the market where they were obtained. The majority of vendors (57%) do not wash their hands before handling vegetables. Most of the vendors had tables to place vegetables (72%) and those tables are cleaned before display (86%). None of the differences observed in each risk factor studied were statistically significant. Conclusion: The present study highlights that contamination of raw vegetables with pathogenic parasites in markets might represent a vector for transmission of intestinal and water- borne parasites to consumers. Future studies should investigate the extent of vegetable contamination at each stage of the supply chain from the farm to consumers, as well as its relationship to human parasitic infection and its consequences. Good hygienic practices of farmers, vendors and consumers should be enforced to break the contamination chain. Whenever possible, hydroponic cultivation should be encouraged to avoid the influence of highly contaminated soils.
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Background: It is hypothesized that schistosomiasis and intestinal parasites increase susceptibility to HIV-1 infection and enhance AIDS progression by immunomodulation. This study aims to compare the prevalence and risk factors for schistosomiasis and intestinal parasites in HIV-1 infected and uninfected persons and to evaluate the association between HIV-1 induced immunosuppression and risk factors for parasite infection. Methods: This was a cross-sectional study conducted at Boane Health Center in Boane village, Maputo Province from April to June 2017 in 280 patients aged over 5 years. From each of 140 HIV-1 infected or 140 HIV-1 uninfected persons, demographic and clinical data were collected as well as one stool and urine sample for parasitological analysis. All stool samples were processed using direct wet mount and Ritchie method for detection of common parasites, and modified Ziehl-Neelsen staining techniques to identify Cryptosporidium spp., Cystoisospora belli and Cyclospora spp. oocysts from children stools. The urine was sedimented and analyzed for S. haematobium eggs detection. Results: The overall prevalence of parasitism in the study population was 46.8% (131/280). Fifty six percent of the HIV-1 infected persons (78/140) were infected by at least one parasite compared to 38% (53/140 of the HIV-1 uninfected persons (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.2-3.3).Further, HIV-1 infected persons were more likely to be infected by S. mansoni (OR 5.6, 95% CI 1.8-15.8) when compared to HIV-1 uninfected person and HIV-1 infected women were more likely to be infected by S. mansoni (OR 6.7 CI 95% 1.8-22.8%) when compared to HIV-1 uninfected women (p< 0.001). HIV-1 serostatus (OR 7.0, 95% CI 1.5-31.2). Multivariate logistic regression revealed that HIV-1 infected status (OR=1.813575), the use of river or lake as water sources either for drinking (OR=7.289245) or domestic chores (OR=9.16205) were significant risk factor for parasitic infection. Partcipants with secondary and higher school (OR=0.379) were less likely to have a parasitic infection compared with primary school or illiterate participants. Conclusions: It is possible that the a high prevalence of schistosomiais and intestinal parasites in this region plays an important role on the transmission and pathogenesis of HIV.
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Previous studies suggest that neurocysticercosis (NCC), the most common cause of acute symptomatic seizures (ASS), epilepsy and other neuropsychiatric disorders, typically presents with a solitary lesion and focal seizures in children from places where cysticercosis is endemic. We report a series of 3 patients, aged 7 to 11 years, with a history of epilepsy and or recurrent headache referred from Mocuba to the Quaternary Central Hospital in Quelimane, Zambeze Province, Mozambique, an area endemic for cysticercosis. Clinical history and examination, blood chemistry and hemogram screening, serological testing for Cysticercus antigens and antibodies detection, and a computerized tomography (CT) scan, were performed. NCC was confirmed in all 3 patients, based on criteria defined by Del Bruto. Two confirmed cases tested positive for antigen (Ag) by enzyme-linked immunosorbent assay (ELISA) with CT lesions in different stages of parasite evolution. Headache/encephalopathy was present in all patients. This case series of children with epilepsy confirms for the first time the presence of NCC in children from Zambezia province, an east-central region of Mozambique. Further, NCC should be included in the differential diagnosis of children with ASS, epilepsy and other neuropsychiatric disorders. Future studies should be targeted to the identification of biomarkers to support the diagnosis of NCC, given the limited availability of imaging tools and limited value of serological assays for the diagnosis and management of NCC.
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PURPOSE: To describe the strategies used to design and implement three postgraduate programs at Lúrio University (UniLúrio), a resource-limited setting, in northern Mozambique. METHODS: We conducted a longitudinal, descriptive case study from 2011 to 2018 in two phases: 1) needs assessment (2011-2012), 2) implementation strategies (2013-2018), taking into account innovations whenever necessary. RESULTS: Several obstacles and barriers to the establishment of postgraduate programs were identified. These included a lack of a core curricula aimed at postgraduate programs, shortage of human resources for teaching and mentorship, limited teaching and research infrastructures, limited financial resources, and lack of administrative capacity. With the support of the Medical Education Partnership Initiative (MEPI), three Master degree programs were designed and implemented. During the period of 2013-2018, UniLúrio enrolled 202 students, distributed as follows: Master degree in Tropical Medicine and Global Health (55), Master degree in Health Professional Education (99), and Master degree in Nutrition and Food Security (48). Of those, 152 (75.2%) obtained a Postgraduate Diploma as they did not present a master dissertation, 89 (44.0%) obtained their Master degree, 30 (14.8%) dropped out, and 20 (9.9%) are awaiting decision. UniLurio's staff trained a Master's degree or a Postgraduate Diploma in 34 (16.8%) and 15 (7.4%), respectively. Our strategies allowed us to improve research capacity building, and set the basis for long-term sustainability by allowing for the establishment of other postgraduate programs, and offered UniLurio a strong role in its internationalization. CONCLUSION: By sharing multiple resources, long-lasting partnerships were established with multiple institutions, and competency-based training and postgraduate studies management were developed. Research and eLearning were leveraged, retention and faculty development was enhanced, and some inequalities within the country were reduced. These strategies and innovations can be applied to other resource-limited settings, allowing the scaleup of health professional's training and research capacity building.
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Objective: We assessed the knowledge, preparedness, and attitude of health profession students towards COVID-19 outbreak in Sub-Saharan Africa. Methods: This cross-sectional study used convenience sampling to recruit participants from institutions under African Forum for Research and Education in Health (AFREhealth). The survey was developed in QuestionPro software covering the participants' socio-demographic characteristics, knowledge, attitude, and preparedness towards the COVID-19 outbreak. Data were analysed and the association between variables was tested. Results: The mean age of the 336 students was 25â¢75 (±7â¢88) years. Most (99â¢7%) knew the cause of COVID-19 which could be transmitted via droplets (97â¢3%). Several participants vowed to adhere to preventive measures (92â¢3%) and claimed their curriculum equipped them with skills addressing infectious disease outbreaks (63â¢6%). Nursing students were better prepared than other students (p=0â¢001). Students from West African regions were more prepared (p=0â¢001) and aware they could contract COVID-19 if they cared for infected persons (p=0â¢001). Conclusion: Students are knowledgeable about COVID-19, adequately prepared to handle epidemics, have a positive attitude towards infection prevention, and their training institutions and government have taken adequate measures to address the COVID-19 outbreak. Funding: AFREhealth.
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INTRODUCTION: Malaria is an important parasitic disease that affects mostly the African continent. Traditional medicine is very important in Mozambique and traditional healers play a key role in the primary health care services, particularly in rural areas. We aim to report the results of an ethnobotanical survey undertaken in Mogovolas district, northern region of Mozambique. We recorded and identified the medicinal plants used by traditional healers for treatment of malaria, as well as the mode of preparation and administration. METHODS: The study was conducted in 14 villages from Mogovolas between June and August 2015. Sixteen traditional healers were interviewed using semi-structured questionnaires. Under their guidance, we collected medicinal plants and prepared herbarium specimens that were sent and kept at Eduardo Mondlane University Herbarium for scientific identification. We searched for information on the in vitro and in vivo studies of the cited plants for antiplasmodial activity. RESULTS: Traditional healers from Mogovolas district reported the use of 37 plants to treat malaria, belonging to 22 families. The most used species are Ochna kirkii Oliv. (5 citations), Ehretia amoena Klotzsch and Pteleopsis myrtifolia (M.A.Lawson) Engl. & Diels (both with 3 citations). These plants belong to Ochnaceae, Boraginaceae and Combretaceae families, respectively. The herbal remedies are prepared using leaves (22/37), roots (18/37), stem barks (16/37) and stems (3/37). The administration of the herbal remedies was made essentially by oral route and bathing. CONCLUSION: The ethnobotanical data resulted from this study can be the starting point for further chemical and pharmacological studies aiming to identify medicinal species with antimalarial activity, thus, open the insights for the discovery of new antimalarial substances, as well as better integration of the traditional medicine into the national health systems, particularly in developing countries, as the health system coverage is limited.
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Urbanization in low-income countries represents an important inflection point in the epidemiology of disease, with rural populations experiencing high rates of chronic and recurrent infections and urban populations displaying a profile of noncommunicable diseases. To investigate if urbanization alters the expression of genes encoding mitochondrial proteins, we queried gene microarray data from rural and urban populations living in Morocco (GSE17065). The R Bioconductor packages edgeR and limma were used to identify genes with different expression. The experimental design was modeled upon location and sex. Nuclear genes encoding mitochondrial proteins were identified from the MitoCarta2.0 database. Of the 1158 genes listed in the MitoCarta2.0 database, 847 genes (73%) were available for analysis in the Moroccan dataset. The urban-rural comparison with the greatest environmental differences showed that 76.5% of the MitoCarta2.0 genes were differentially expressed, with 97% of the genes having an increased expression in the urban area. Enrichment analysis revealed 367 significantly enriched pathways (adjusted p value < 0.05), with oxidative phosphorylation, insulin secretion and glucose regulations (adj.p values = 6.93E-16) being the top three. Four significantly perturbed KEGG disease pathways were associated with urbanization-three degenerative neurological diseases (Huntington's, Alzheimer's, and Parkinson's diseases) and herpes simplex infection (false discover rate corrected p value (PGFdr) < 0.2). Mitochondrial RNA metabolic processing and translational elongation were the biological processes that had the greatest enrichment (enrichment ratios 14.0 and 14.8, respectively, FDR < 0.5). Our study links urbanization in Morocco with changes in the expression of the nuclear genes encoding mitochondrial proteins.
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Núcleo Celular/genética , Regulação da Expressão Gênica , Proteínas Mitocondriais/genética , População Rural , População Urbana , Perfilação da Expressão Gênica , Geografia , Humanos , Proteínas Mitocondriais/metabolismo , Marrocos , Transdução de Sinais/genéticaRESUMO
INTRODUCTION: Onchocerciasis, remains an unfamiliar condition for health professionals in Mozambique leading to its misdiagnosis as leprosy or scabies as noted in previous studies. Meta-analyses conducted in some African countries, have concluded that onchocerciasis is associated with epilepsy and nodding syndrome. Epilepsy affects at least 3% of the Mozambican population. AIM: We aim to discuss the possible misdiagnosis of scabies and/or leprosy in cases of onchocerciasis as well as insights into a putative role for onchocerciasis in the etiology of epilepsy. Based on these issues, we also highlight some priorities for future onchocerciasis research. METHODS: We carried out a literature review of the epidemiology of onchocerciasis in Mozambique and other parts of the world where the disease exists, its clinical features, and information on the prevalence of epilepsy, scabies and leprosy in Mozambique. RESULTS AND CONCLUSIONS: A number of studies (1997 - 2007) revealed that onchocerciasis is present in at least five provinces of Mozambique, comprising 47% of the country's population, and at least three provinces of Mozambique where onchocerciasis has been reported are those where the incidence of leprosy is also high. This increases the possibility that onchocerciasis cases could be misdiagnosed as leprosy or scabies, as seen in previous studies by Noormahomed., et al. In addition, onchocerciasis may contribute to the development of epilepsy at an early age, as has been found in some other African countries such as Tanzania and the Democratic Republic of Congo.Mozambique is not included in many epidemiological maps of onchocerciasis prevalence, while Tanzania and Malawi are listed as endemic countries and have well established community drug treatment with ivermectin, probably because the disease was considered hypoendemic in previous studies. Research should be carried out in focal areas to determine the burden and clinical features of onchocercal disease in Mozambique, as well as, the socio and economic impact of disease in the affected patients and communities. With these data in hand, it will also be possible to assess the possible association of onchocerciasis with epilepsy in Mozambique. It will be equally important to train health professionals in the diagnosis and management of this neglected and poverty-related disease.
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Background: Medical training in developing countries has continuously faced challenges to produce the needed number of cadres and maintain the needed quality standards. Mozambique, a low-income country in Southern Africa, has a major disparity in distribution of medical doctors in the country and only a small proportion are trained as specialists and/or retained as faculty. In this context, we thought that Information and Communication Technologies (ICT) are an attractive tool to support expansion of medical training and residency programs and designed a strategy for its use to promote changes in the learning environment of a university teaching hospital in this country. Approach: Beginning in 2010-under the Medical Education Partnership Initiative between Universidad Eduardo Mondlane, Mozambique, and University of California San Diego, United States of America - we conducted extensive interviews to 21 UEM faculty and medical trainees to assess barriers to education and medical care at the major referral hospital in Mozambique. Then, changes were made to address the issues raised mainly through building an ICT infrastructure to improve connectivity, improving access to medical information, distributing communication and mobile medical devices, as well as fostering exchange between students, residents and faculty members. These changes were tracked years after to evaluate adoption. Main Findings & Discussion: Internet access with large bandwidth and devices such as tablets and computers were distributed to increase access to medical information. The students: resident ratio improved from 13:1 to 5:1 at the end of the project. Additional 25 new faculty members were involved in clinical training, mainly through incentives such as faculty development courses and research training. Teleconferences and other exchanges using ICT have evolved from being used as a platform for weekly clinical rounds and case discussions, to become a day-to-day tool for implementation of quality improvement processes and research projects. New exchange programs between local and foreign institutions were fostered to create a growing network with over 20 institutions at the end of the program. Importantly, these changes persisted beyond the project, and constituted a driver for transformative education and distance learning. Conclusion: Context-tailored use of ICT and mobile medical devices transformed medical education by improving the learning environment, addressing scarcity and low quality of trained doctors in a low-income setting of Africa. This strategy has the potential to reduce health disparities and contribute to achieving universal health coverage. Efforts to guaranty sustainability and health professional's retention are warranted.
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Several studies suggest that neurocysticercosis might be one of the main reasons for onset of seizures in adolescents and young adults in Mozambique, however, no studies have evaluated the burden and impact of the disease in women of childbearing age. This is also true for other parasitic diseases such as toxoplasmosis, toxocariasis and onchocerciasis, although the latter has been reported in some regions in central and northern Mozambique. We describe herein an 18 year old female who was admitted to Hospital Central de Quelimane, Zambézia Province in Mozambique, 8 days after delivery with a misdiagnosis of eclampsia that turned out to be neurocysticercosis. We discuss challenges in the diagnosis of neurocysticercosis in women of childbearing age and the potential for missed diagnosis in those who present with eclampsia and other conditions associated with seizures.
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INTRODUCTION: Leptospirosis is a neglected zoonotic disease caused by a bacteria of the genus Leptospira. In Africa it is frequently mistaken for frequently occurring conditions such as malaria. The aim of this study was to identify rodent species involved in the transmission of the disease, the prevalence of pathogenic Leptospira spp. in selected rodent species and risk factors for human leptospirosis. MATERIAL AND METHODS: We conducted a descriptive and exploratory epidemiological and molecular study in Mozambique Island city in 2015. Six neighborhoods, comprising 30 households each were randomly selected. People from the selected 180 households were interviewed regarding their awareness of the disease, the presence of rodents in their houses, chemicals used to eliminate them, sewage disposal, water supply system, and other key issues related to the disease. In each neighborhood we trapped 10 rodents for morphometric study to identify their species and for molecular isolation of Leptospira DNA. We extracted kidneys from 57/60 of rodents trapped, and performed nested polymerase chain reaction targeting rrs 16S ribosomal DNA and lipL32 genes for identification of Leptospira genus and pathogenic Leptospira spp. respectively. RESULTS: Of the 180 participants 92 (51%) reported having heard of leptospirosis; 107 (59%) have had the disease; 151 (83%) reported the existence of rats in their house; 100 (56%) had latrines; 118 (66%) used chemicals to kill the rats; 102 (57%) used well water and 114 (63%) used trash containers. The most prevalent rodent species captured was Rattus norvegicus 36/60 (60%), followed by Rattus rattus 19/60 (31.67%) and Mus musculus 3/60 (5%). rrs 16S ribosomal DNA was identified in 20/57 (35.%) rodents. Out these two were positive for lipL32 gene, giving an overall pathogenic Leptospira infection of 3.5% (2/57). The rodent species identified as carriers of pathogenic Leptospira were Rattus norvegicus (1) and R. rattus (1). CONCLUSION: This is the first study in Mozambique to identify the presence of pathogenic species of Leptospira using molecular tools. Leptospirosis risk factors in Mozambique Island city are rodent's infestation, limited disease awareness, lack of access to clean water, insufficient resources for waste collection, greater clustering of households, poor sanitation environment and degradation of living conditions. Pathogenic Leptospira spp. are present in the area studied and at least two species of rodents, the R. rattus and R. norvegi-cus are potentially involved in the transmission of the causal agents of the disease.