Primeira Conferência Científica sobre COVID-19 em Moçambique com Uso Combinado de Plataformas de Informação e Comunicação / First Scientific Conference on COVID-19 in Mozambique with Combined Use of Information and Communication Platforms

O Instituto Nacional de Saúde (INS) organi zou, entre os dias 17 e 18 de Junho do presen te ano, a primeira Conferência Científica sobre a COVID-19 no país. O evento teve lugar nas instalações do INS, em Marracuene, tendo sido transmitida em directo por várias plataformas de comunicação e informação, uma vez que, pelo contexto da pandemia, não era possível realizar um evento presencial abrangente. Em cada um dos dias, houve uma sessão plenária seguida de painéis, com um orador e três comentadores. As sim, a conferência ligou entre si investigadores, académicos e público em geral através de várias plataformas de comunicação e informação (televi são, rádio, jornal e plataformas digitais: facebook, youtube e zoom) num evento que visava promo ver o debate científico sobre a COVID-19, e os desafios que ela coloca à sociedade moçambicana. Pretendia também analisar a resposta à pandemia em Moçambique e no mundo, nos planos eco nómico, social, cultural e, particularmente, no campo das ciências biomédicas. O modelo virtual desta conferência, permitiu a interacção com os participantes, tendo estes gozado da possibilidade de colocar questões aos membros do painel.

The National Institute of Health (INS) organized, between the 17th and 18th of June of this year, the first Scientific Conference on COVID-19 in the country. The event took place at the INS premises, in Marracuene, and was broadcast live by various communication and information platforms, since, due to the context of the pandemic, it was not possible to hold a comprehensive face-to-face event. On each day, there was a plenary session followed by panels, with one speaker and three commentators. Thus, the conference connected researchers, academics and the general public through various communication and information platforms (television, radio, newspaper and digital platforms: facebook, youtube and zoom) in an event that aimed to promote the scientific debate on COVID-19, and the challenges it poses to Mozambican society. It also intended to analyze the response to the pandemic in Mozambique and in the world, at the economic, social, cultural levels and, particularly, in the field of biomedical sciences. The virtual model of this conference allowed interaction with the participants, who enjoyed the possibility of asking questions to the panel members.

Air pollution and other risk factors might buffer COVID-19 severity in Mozambique

Mozambique is located on the East Coast of Africa and was one of the last countries affected by COVID-19. The first case was reported on 22 March 2020 and since then the cases have increased gradually as they have in other countries worldwide. Environmental and population characteristics have been analyzed worldwide to understand their possible association with COVID-19. This article seeks to highlight the evolution and the possible contribution of risk factors for COVID-19 severity according to the available data in Mozambique. The available data highlight that COVID-19 severity can be magnified mainly by hypertension, obesity, cancer, asthma, HIV/SIDA and malnutrition conditions, and buffered by age (youthful population). Due to COVID-19 epidemic evolution, particularly in Cabo Delgado, there is the need to increase laboratory diagnosis capacity and monitor compliance of preventive measures. Particular attention should be given to Cabo Delgado, including its isolation from other provinces, to overcome local transmission and the spread of SARS-CoV-2

Potential impact of temperature and atmospheric pressure on the number of cases of COVID-19 in Mozambique, Southern Africa

The potential reasons why COVID-19 is not spreading rapidly in Sub-Saharan Africa include sociopolitical, biological and environmental variables. Among the latter, some studies indicate temperature and atmospheric pressure as significantly influential. Could they have impact on the number of COVID-19 cases in Mozambique? The aim of this study is to analyze the relationships between weather and the frequency of confirmed COVID-19 cases in Mozambique, Southern Africa. The study was conducted in Mozambique, Maputo area (Province and City) and Nampula Province. Daily history of weather variables ­ daily maximum and minimum temperatures and atmospheric pressure ­ was obtained from three online databases (AccuWeather, Time and Date AS and WeatherSpark) and the number of COVID-19 cases from official Government's daily Bulletins. The main statistical analyses were Pearson correlations between the variables. The first case was observed in the Maputo area on 22 March, 2020 and the cases in Mozambique increased exponentially up to 769 by 24 June, 2020. The first three cases in Nampula province were observed on 24 May 2020 but its frequency surpassed Maputo area's within one month. Temperatures showed negative correlations with the number of cases in all areas and pressure showed positive correlations in Maputo area and Nampula Province. A bubble chart allowed the visualization of the combined relationship of both weather variables and the number of cases, suggesting that the number of cases increases as temperature decreases and pressure increases. Temperature and atmospheric pressure seems to be correlated with the number of confirmed cases of COVID-19 in Mozambique. Thus, decision-makers should consider weather as a predictor of the rate at which the pandemic is spreading in the country

Avaliação das práticas de higiene nos serviços de restauração da Universidade Eduardo Mondlane / Evaluation of hygiene practices in the food services of the Eduardo Mondlane University Mondlane University (UEM)

O presente trabalho tinha como objectivo avaliar as práticas de higiene associadas aos factores de riscos de doenças bacterianas de origem alimentar nos serviços de restauração da Universidade Eduardo Mondlane. O estudo foi realizado nos serviços de restauração da UEM de Maputo e Inhambane. Foram inqueridos, através de um questionário de perguntas semi-estruturadas, 37 trabalhadores com a categoria de cozinheiros e auxiliares de cozinha, foram visitadas as instalações e tiraram-se algumas fotografias por meio de uma máquina fotográfica digital da marca SAMSUNG. 80% dos inquiridos tinha escolaridade básica; 48% eram do sexo feminino e 52% masculino, a idade dos inquiridos variava de 22 a 57 anos e o tempo de serviço de 3 a 31 anos. Segundo os resultados do estudo os inquiridos têm consciência da necessidade de implementação das práticas correctas de higiene no decurso das suas actividades de modo a prevenir as doenças de origem alimentar. Contudo, foram observadas práticas que constituem factores de risco para a ocorrência de doenças bacterianas de origem alimentar. Os factores de risco observados estavam relacionados a prática incorrectas de armazenamento, higiene pessoal e geral, manipulação das sobras de alimentos, acondicionamento de lixo e controle de pragas. Conclui-se que a falta de observância de práticas correctas de higiene nos serviços de restauração concorre para o surgimento de doenças bacterianas de origem alimentar. Recomenda-se a implementação de programas educativos integrados regulares no sector, supervisão permanente e encorajamento de mudanças de comportamento na manipulação de alimentos.

The objective of the present study was to assess the practices of hygiene associated to the risks of foodborne diseases at restauration services of Eduardo Mondlane University (UEM). The study took place at services of restauration of UEM of Maputo and Inhambane; the data was collated using a questionnaire, with semi-structure questions. The questionnaire was submitted to 37 works namely cookers and auxiliaries of cookers, the installations were visited and some photography was taken using a SUMSUNG digital camera. 80% of the enquired has basic education; 48% were female and 52 were male; the age of the enquired varied from 22 to 57 years and the period of time of work varied from 3 to 31 years. According to the results of the study the inquired was aware about the need of the implementation of correct practices of hygiene during the work in order to avoid the foodborne diseases. However, was observed practices which constitute risk factor to the occurrence of foodborne diseases. The risk factors observed were related to storage, general and personal hygiene and handle of leftover, waste and pest control. It was concluded that the lack of correct practices of hygiene in the service of restauration constitute risk factor for the occurrence of foodborne diseases. It recommends the implementation of regular program of education, permanent supervision and encouraging of change of behaver in the handle of food.

Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique

Introduction The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results : 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for 'green'/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for 'red'/urgent (IQR 2­40 min). Conclusion : In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings

Sexual and physical intimate partner violence among women using antenatal care in Nampula, Mozambique

The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women

Teenage pregnancies in Mozambique: the experience of "Servicios Amigos dos Adolescentes" clinics in Beira

The purpose of this article is to provide insights into the demand for pregnancy-related health services by adolescent girls and young women in Mozambique. We analysed the patient registers for the first year of operation (2014) of the Servicios Amigos dos Adolescentes (SAAJ) [Friendly Services for Adolescents] clinics in Beira, Mozambique. These registers provide details of the service demands of, and services provided to the 8 290 adolescent girls and young women who accessed the 6 SAAJ clinics in 2014. Analysis of that record, with disaggregation of the patients according to age (9 years or less; 10­14; 15­19; 20­24; 25 and older), show that 3 021 (36%) were pregnant or had previously been pregnant; most being girls in the 15­19 age band (59%). Being pregnant or having been pregnant previously was associated with dropping out of school. Of all the girls and women, 60% agreed to HIV testing and counselling; the HIV prevalence rate amongst this group was 4­5% amongst adolescents and 25% amongst women 25 years and older. A minority of the girls and women who were pregnant or had been pregnant previously agreed to HIV testing and counselling. Notwithstanding the limitations for analysis, the results were alarming: substantially high HIV prevalence rates were indicated (2% amongst 10­14 year old girls; 8% amongst 15­19 year olds; 10% amongst 20­24 year olds; and 28% amongst >24 year olds). The data from the SAAJ clinics and results pertain only to conditions in Beira. However, as the first empirical assessment of pregnancy-related service demand amongst adolescent girls and young women in the country and involving a relatively large sample, we contend that this study affirms the need for expansion of sexual and reproductive health (SRH) services, including HIV services, for adolescent girls and young women in Mozambique

Family environment, socioeconomic conditions and childhood health and wellbeing in informal settlements in Mozambique

Background. A possible relationship between slum residence and children's health and wellbeing in sub-Saharan Africa has been relatively under-researched.Objective. To investigate the relationship between the type of area of residence and children's and adolescents' health and wellbeing in urban Mozambique.Methods. Descriptive and logistic regression techniques were employed on data from 1 913 children and 798 adolescents, to analyse several key outcomes.Results. The descriptive findings indicate that children in slum areas are the most disadvantaged, followed by those in quasi-slum areas,in terms of school enrolment, health and the type of care received in the home. Similar descriptive results were found for the adolescents'outcomes. Multivariate analyses showed that compared with children in slum areas, those in non-slum areas were more likely to be attending school (odds ratio (OR) 4.22; confidence interval (CI) 1.73 - 10.31), less likely to be typically sick (OR 0.26; CI 0.14 - 0.47) and less likely to be left alone in the household (OR 0.29; CI 0.18 - 0.48). Adolescents in non-slum areas tended to have completed ≥6 years of education (OR 3.01; CI 1.78 - 5.07), to be aware of HIV/AIDS programmes (OR 4.29; CI 2.43 - 7.55), to believe that HIV/AIDS may be transmitted through unprotected sex (OR 13.01; CI 3.76 - 45.02) and to have parents or caregivers who had ever talked to them about matters related to sex (OR 3.15; CI 1.76 - 5.65). Family structure and sowcioeconomic characteristics, together, account for most of the differences between slum and quasi-slum areasparticularlchildren's outcomes.Conclusion. The health and the wellbeing of children and adolescents in slums is negatively affected, compared with other urban places in Mozambique. However, for children, family structure and other socioeconomic factors remove most slum/quasi-slum effects

The multidimensional nature of HIV stigma: evidence from Mozambique

HIV stigma continues to be a major challenge to addressing HIV/AIDS in various countries in sub-Saharan Africa, including Mozambique. This paper explores the multidimensional nature of HIV stigma through the thematic analysis of five qualitative studies conducted in high HIV prevalence provinces in Mozambique between 2009 and 2012. These studies included 23 interviews with people living with HIV (PLHIV) (10 women and 13 men); 6 focus groups with 32 peer educators (24 women and 8 men) working for community-based organisations (CBOs) providing services to PLHIV; 17 focus groups with community members (72 men and 70 women); 6 interviews (4 women and 2 men) with people who had family members living with HIV/AIDS; 24 focus groups (12 with men and 12 with women) and 6 interviews with couples. Our findings indicate that HIV stigma is a barrier to HIV testing and counselling, status disclosure, partner notification, and antiretroviral therapy (ART) access and adherence, and that moral stigma seems to be more common than physical stigma. Additionally, the findings highlight that HIV stigma is a dynamic social process that is conceptualised as being tied to personal responsibility. To effectively diminish HIV stigma in Mozambique, future interventions should address moral stigma and re-conceptualise HIV as a chronic disease

Determinants of antibiotic prescription in paediatric patients: The case of two hospitals in Maputo, Mozambique

Background. The need for healthcare in paediatric patients is often due to respiratory diseases, acute diarrhoea and viral fever, which suggests a limited need for the use of antibiotics.Objectives. To identify the determinants of antibiotic prescription in hospitalised paediatric patients in Mozambique.Methods. A cross-sectional study was conducted between January and June 2015. A total of 454 medical prescriptions and clinical records of children aged 0 - 14 years from Hospital Central de Maputo (HCM) and Hospital Geral de Mavalane (HGM) were analysed.Results. Antibiotics were used in 97.6% of the patients, with no significant differences (p>0.05) in the prescription rates of the hospitals. The most commonly used antibiotics were beta-lactams (57.3%), aminoglycosides (28.3%) and co-trimoxazole(9.4%). Antibiotics were prescribed in all cases of bronchopneumonia, fever, sepsis and acute gastroenteritis. For malaria and undefined diagnoses, antibiotics were prescribed 97.8% and 99.3% of cases, respectively. It was clear that most severe clinical conditions (odds ratio (OR) 9.06; 1.13 - 12.14) and age <5 years (OR 5.47;1.54 - 7.60) were treated with antibiotics.Conclusion. The prescription of antibiotics for paediatric patients at both HCM and HGM was largely influenced by patients' clinical condition and age. It showed that physicians used an empirical approach, in the absence of laboratory tests, often leading to unnecessary antibiotic treatments with negative causative effects. Physicians should be encouraged to use an evidence-based approach for managing the cases correctly

Saúde, estilo de vida e urbanização em Moçambique: problemas e perspectivas / Health, Lifestyle and urbanization in Mozambique: problems and perspectives

A irreversibilidade do processo de urbanização da população mundial está a atingir Moçambique de uma forma abrupta com múltiplas consequências para a saúde e bem, estar. Entre outros, o aumento da mecanização, o tempo de televisão, o uso do automóvel e o recurso a alimentação artificial, está a transformar, em poucos anos, uma população activa em pessoas sedentárias sujeitas à poluição e níveis de ansiedade até então desconhecidos. Os estudos disponíveis demonstram de forma clara uma enorme redução dos espaços para a recreação activa e uma concomitante redução do dispêndio energético por actividade física habitual. Como consequência, os dados epidemiológicos indicam um aumento, nas cidades, da obesidade, hipertensão e diabetes em adultos. Por seu turno, as crianças em idade escolar estão a conhecer um crescimento em todos os factores de risco de doença cardiovascular e uma redução do seu nível de desenvolvimento motor. A falta de planeamento no crescimento urbano está a ter consequências catastróficas na saúde da população urbana. Neste quadro, a denominada transição epidemiológica acontece sob a forma de acumulação, dado que a população continua muito permissiva a doenças transmissíveis e sofre agora a acumulação de um grupo de patologias associadas ao sedentarismo e desiquilíbrio nutricional.

The process of urbanization of the world population is reaching Mozambique rather abruptly with multiple consequences for the health and well-being. Increased mechanization, screen time, car use and use of fast food are causing, in a short time period, a dramatic changing in lifestyle. Population is reducing their activity levels, that used to be high, the stress levels are increasing as well as the environmental pollution. The available studies demonstrate a huge reduction of spaces for active recreation and a concomitant reduction of energy expenditure for physical activity. As a consequence, epidemiological data indicate an increase in the prevalence of obesity, hypertension and diabetes in adults. In turn, studies are demonstrating that the school aged children are increasing prevalence in all risk factors for cardiovascular disease and a reduction in their level of motor development. Lack of urban planning on urban growth seems to cause disastrous consequences on the health of the urban population. Thus, the so-called epidemiological transition are happening in the form of accumulation since the population remains very permissive to transmissible diseases adding to them an increased in the sedentary lifestyle and nutritional imbalance related diseases.

Willingness to participate in future HIV prevention trials in Beira, Mozambique

In preparation for trials of new HIV prevention methods; willingness to participate (WTP) was assessed in Beira; Mozambique. A totla of 1 019 women participating in an HIV incidence study; and 97 men participating in a separate WTP survey; were interviewed. When comparing the answers to questions that were identical in the two studies; WTP was higher among women than men for all prevention methods. Among women; WTP was highest for trials evaluating daily oral pre-exposure prophylaxis (PrEP; 84.4 reporting very likely to participate); followed by vaccination (77.8); daily vaginal gel use (67.7); coital vaginal gel use (67.1) and monthly vaginal ring use (47.7). Among men; WTP was highest for trials evaluating vaccination (57.6); followed by daily vaginal gel use for female sexual partners (52.5); daily oral PrEP (49.5); coital vaginal gel use for female sexual partners (46.4) and monthly vaginal ring use for female sexual partners (39.4). Among men; the most important motivators for trial participation were social benefits; whereas personal risks (most notably receiving injections and/or blood draws) were deterrents; this was not assessed in women. Other important lessons learnt are that male circumcision and antiretroviral drugs were not generally recognised as ways to prevent HIV; that having to use hormonal contraception during trial participation will likely reduce WTP; and that evening clinics are not likely to be popular. The barriers reported in this and other studies may be challenging but are not impossible to overcome

Revenue-raising potential for universal health coverage in Benin, Mali, Mozambique and Togo

Increasing overall fiscal space is important for the health sector due to the centrality of public financing to make progress towards universal health coverage. One strategy is to mobilize additional government revenues through new taxes or increased tax rates on goods and services. We illustrate how countries can assess the feasibility and quantitative potential of different revenue-raising mechanisms. We review and synthesize the processes and results from country assessments in Benin, Mali, Mozambique and Togo. The studies analysed new taxes or increased taxes on airplane tickets, phone calls, alcoholic drinks, tourism services, financial transactions, lottery tickets, vehicles and the extractive industries. Study teams in each country assessed the feasibility of new revenue-raising mechanisms using six qualitative criteria. The quantitative potential of these mechanisms was estimated by defining different scenarios and setting assumptions. Consultations with stakeholders at the start of the process served to select the revenue-raising mechanisms to study and later to discuss findings and options. Exploring feasibility was essential, as this helped rule out options that appeared promising from the quantitative assessment. Stakeholders rated stability and sustainability positive for most mechanisms, but political feasibility was a key issue throughout. The estimated additional revenues through new revenue-raising mechanisms ranged from 0.47­1.62% as a share of general government expenditure in the four countries. Overall, the revenue raised through these mechanisms was small. Countries are advised to consider multiple strategies to expand fiscal space for health

The use of evaluation to improve the expanded programme on immunization in Mozambique

Reported are the results of an evaluation of process indicators and outputs for the Expanded Programme on Immunization (EPI) in Mozambique which were used to modify immunization strategies from 1985 to 1987. In 1986 according to cluster sample surveys, 84% of children in Maputo, the capital, were fully vaccinated. In other cities in the country, vaccination coverage increased from an average of 36% in 1985 to 55% in 1987. The major determinants of low vaccination coverage were provision of vaccination services at health centres on less than 3 days per week; missed opportunities; and vaccinating too early or with too short an interval between doses. The results of sentinel site surveillance in Maputo indicated that EPI had a marked impact on neonatal tetanus and to a lesser extent on poliomyelitis and measles. Evaluation led to changes in EPI policy in Mozambique (e.g., adoption of a uniform national vaccination schedule and discontinuation of the use of expired vaccine) and strategies (elaboration of different strategies for urban areas, rural areas, and displaced people). Also, performance was improved by involving programme managers and implementors in evaluation, and by providing timely and widespread feedback of results to policy-makers, peripheral health workers, and the community