Measuring preparedness to infectious diseases among people exposed to climate disasters in Cabo Delgado, Mozambique: a cross-sectional study.

INTRODUCTION: Climate change is contributing to increase the frequency and severity of climate disasters in Mozambique, leading, since 2019, to extensive damage to infrastructure and displacement 1.3 million people. Aim of this study is to evaluate baseline preparedness to vector-borne and water-borne infections among households and internally displaced people exposed to climate disasters in Mozambique. METHODS: This was a cross-sectional, community-based survey assessing the preparedness to infectious diseases outbreaks among people exposed to climate disasters in six districts in Mozambique. Structured form was delivered via face-to-face between October 15th and November 7th, 2022. Study outcome was defined as a seven-point score of preparedness to infectious disease outbreaks. Multivariable analysis of the score was conducted using Conway-Maxwell-Poisson regression. RESULTS: This study included 2,140 households and 11,239 people, with IDPs accounting for 30% of them. Overall, 1,186 (55.4%) households were overcrowded. Median score of preparedness was 3 points (IQR 2-4). At multivariable analyses, districts with low preparedness were Montepuez and Mueda. Higher preparedness was associated with family planning (p < 0.0001), access to primary education for all children living in the household (p < 0.001) and possession of a birth certificate for all children aged < 5y (p < 0.0001), while preparedness was heterogeneous among the districts (p < 0.05). Households composed by IDPs were not associated with a lower preparedness score. CONCLUSIONS: In climate-vulnerable communities in Mozambique, households practicing family planning, providing access to primary education and birth certificate for all children were less vulnerable to water-borne and vector-borne infectious disease outbreaks. Being family planning and childcare primarily performed by women, our findings can inform policymakers and practitioners on the importance of addressing women to mitigate the impact of climate disasters and reduce the risk of infectious disease outbreaks.

Knowledge, Attitudes and Practices on Cholera and Water, Sanitation, and Hygiene among Internally Displaced Persons in Cabo Delgado Province, Mozambique.

In disaster situations, cholera outbreaks represent a public health emergency due to their high fatality rates and high spreading risk through camps for refugees and internally displaced persons (IDPs). The aim of this study is to examine water, sanitation, and hygiene attitudes and cholera knowledge, attitude, and practice (KAP) among people living in resettlement sites in Cabo Delgado, the northernmost province of Mozambique. Between January 1 and March 31, 2022, a cross-sectional survey was conducted by administering a face-to-face interview to IDPs and residents in six relocation sites in Cabo Delgado Province. A total of 440 people were enrolled in the study. Overall, 77.8% (N = 342) were female, 61% (N = 268) were younger than 35 years old, and 60.5% (N = 266) reported primary school to be the highest education level. Seventy-five percent (N = 334) of participants lived with children under 5 years old. Thirty-one percent (N = 140) and 11.8% (N = 52) of the respondents reported, respectively, at least one cholera case and at least one diarrheal-related death among their family members in the previous 2 years. In multivariate analysis, being female, being younger than 35 years old, having attained a higher education level, owning a phone, or having soap at home were factors significantly associated with improved cholera KAP. In severely deconstructed social contexts, continuous education and community sensitization are crucial to achieve and maintain positive cholera prevention attitudes.

Effectiveness of a prevention of mother-to-child HIV transmission programme in an urban hospital in Angola.

BACKGROUND: Antiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007-2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa. RESULTS: Data for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07-1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31-20.15, p = 0.019). CONCLUSIONS: Among the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV.