Trends and Determinants of Full Immunisation among Children Aged 12-23 Months: Analysis of Pooled Data from Mozambican Household Surveys between 1997 and 2015.

The 1974 Expanded Program on Immunisation has saved millions of children worldwide by promoting full immunisation coverage (FIC). However, forty years later, many sub-Saharan African countries remain well below its target of 90% FIC. This study analysed the level, trends and determinants of FIC in 4322 Mozambican children aged 12-23 months from pooled data from four national surveys between 1997 and 2015. Descriptive statistics and multivariable logistic regression models were performed to analyse the factors associated with full immunisation coverage. Overall, the coverage of fully immunised children increased from 47.9% in 1997 to 66.5% in 2015, corresponding to a 1.8% yearly increase. The needed FIC growth rate post-2015 was 4.3 times higher. Increased maternal education and a higher household wealth index were associated with higher odds of FIS. Furthermore, attending antenatal care (ANC) visits, institutional delivery and living in southern provinces were also associated with increased odds of FIS. Between 1997 and 2015, FIC among 12-23-month-old children made modest annual gains but remained well below international targets. Factors related to access to healthcare, educational level, socioeconomic status and geographical location were associated with improved FIC. Targeted interventions to expand these factors will improve immunisation coverage among Mozambican children.

Infodemic Preparedness and COVID-19: Searching about Public Health and Social Measures Is Associated with Digital Health Literacy in University Students.

We aimed to evaluate the associations between information searching about public health and social measures (PHSM) and university students' digital health literacy (DHL) related to the new coronavirus (SARS-CoV-2) and COVID-19. METHODS: This cross-sectional study included 3,084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5). Sociodemographic data, DHL questionnaire and online information concerning PHSM were gathered. Cox proportional hazards models were performed. RESULTS: Students who searched for personal protective measures achieved in shorter time sufficient "evaluating reliability" (HR = 1.4; 95% CI = 1.1; 1.7) and "determining relevance" (HR = 1.5; 95% CI = 1.2; 1.8). Searching for surveillance and response measures was associated with sufficient "determining relevance" (HR = 1.4; 95% CI = 1.1; 1.9). Finally, those students who searched for environmental, economic and psychosocial measures achieved in shorter time "determining relevance" (HR = 1.2; 95% CI = 1.0; 1.4). CONCLUSIONS: Searching for PHSM was significantly associated with an increased likelihood of achieving sufficient DHL subscales in a shorter time. Further studies are needed, including developing strategies to increase the availability of high-quality information concerning public health and social measures and to improve (digital) health literacy.

Adaptation and validation of the Digital Health Literacy Instrument for Portuguese university students.

BACKGROUND: Health literacy is an important skill to deal with information and positively influences individual and community health. Information concerning health is available from a plethora of online resources. The concept of digital health literacy has gained prominence with the pandemic. The absence of valid tools to analyse digital literacy levels are scant. This study aims to translate, adapt and validate the Portuguese version of the Digital Health Literacy Instrument (DHLI) as used in the global COVID-HL Network. METHODS: Participants were mostly students from social sciences, psychology, education and health sciences. The Portuguese version of the DHLI contained five dimensions each consisting of three items. An online survey with university students (n = 1815, 75.1% female, average age: 24.15 years) was administered to test the validity of the Portuguese version of the DHLI. Data were analysed using exploratory and confirmatory factor analysis. Pearson correlations were also studied. RESULTS: Two items revealed symmetry and kurtosis problems. We chose to eliminate them from the analysis. Different exploratory factor analysis attempts were made, obtaining two possible models to be tested in the confirmatory factor analysis: a three-factor model and a four-factor model. A four-factor structure of the instrument (information searching, adding self-generated content, evaluating reliability, determining relevance) was supported by confirmatory factor analysis and had good internal consistency. CONCLUSIONS: The Portuguese version of the Digital Health Literacy Instrument met adequate psychometric criteria. Therefore, it can be confidently used in Portuguese students' assessment of digital health literacy. Representative studies are needed to shed light on different target groups and their COVID-19-related DHLI.

Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students.

We aim to evaluate the associations between digital health literacy (DHL) related to COVID-19 and online information-seeking behavior among university students. METHODS: A total of 3.084 students (75.7% women), with an average age of 24.2 (SD = 7.5) participated in this cross-sectional study, most of whom (36.5%) were from social sciences and pursued a bachelor's degree (50.7%). Data on COVID-19-related DHL and online information-seeking behavior were collected using an online questionnaire. Logistic regression models were performed. RESULTS: As the pandemic progressed, participants showed a lower chance of achieving a sufficient DHL (OR = 0.7; 95% CI = 0.6; 0.9). Using search engines more often (e.g., Google) (OR = 0.7; 95% CI = 0.5; 0.9), Wikipedia (OR = 0.7; 95% CI = 0.6; 0.9) and social media (e.g., Facebook) (OR = 0.7; 95% CI = 0.6; 0.9) decreased the likelihood of achieving sufficient DHL related to COVID-19. More frequent use of websites of public bodies (OR = 1.7; 95% CI = 1.1; 2.5) increased the odds of reporting sufficient DHL. CONCLUSION: DHL is associated with university students' online information-seeking behavior in the time of COVID-19. From a community and public health perspective, programs aiming at improving DHL should be highlighted.

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.

High Mobility and STIs/HIV among Women Informal Cross Border Traders in Southern Mozambique: Exploring Knowledge, Risk Perception, and Sexual Behaviors.

High circular mobility creates vulnerability and elevates risk for sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV). We aim to explore knowledge, perceptions of risk, and sexual behaviors in relation to STIs/HIV, in Mozambican women involved in an informal cross border trade (ICBT) and residing in South Mozambique. A cross-sectional quantitative study, in 200 women cross border traders (WICBT), affiliated to the Mukhero Association, using a structured, face-to-face questionnaire, was conducted. Descriptive statistics and Pearson's Chi-square test were used. The median age of participants was 37.0 years (interquartile range (IQR): 31.0-43.0), 100% were literate, travelled on average six times a month. WICBT with a high education level were more likely to have awareness of Gonorrhea, Syphilis, and Candidiasis; to self-perceive being at risk of getting HIV, Syphilis, and Human Papilloma Virus (HPV); and to test for HIV and Syphilis. Those with a low education level were more likely to have misconceptions about HIV and ever have sex in exchange for money/goods/services. Married participants were more likely to know how to prevent HIV. Participants with a high income were more likely to know about HPV; to self-perceive being at risk of getting Syphilis; to point sex workers as being at higher risk of getting HPV; and to ever test for HIV. WICBT with a low income were more likely to have sex in exchange for money/goods/services. Low and inconsistent knowledge and misconceptions of STIs/HIV, high sexual risky behavior, low perception of risk of getting STIs/HIV among this neglected and key population suggests their increased vulnerability to the STIs/HIV.

High Mobility and STIs/HIV among Women Informal Cross Border Traders in Southern Mozambique: Exploring Knowledge, Risk Perception, and Sexual Behaviors

High circular mobility creates vulnerability and elevates risk for sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV). We aim to explore knowledge, perceptions of risk, and sexual behaviors in relation to STIs/HIV, in Mozambican women involved in an informal cross border trade (ICBT) and residing in South Mozambique. A cross-sectional quantitative study, in 200 women cross border traders (WICBT), affiliated to the Mukhero Association, using a structured, face-to-face questionnaire, was conducted. Descriptive statistics and Pearson's Chi-square test were used. The median age of participants was 37.0 years (interquartile range (IQR): 31.0-43.0), 100% were literate, travelled on average six times a month. WICBT with a high education level were more likely to have awareness of Gonorrhea, Syphilis, and Candidiasis; to self-perceive being at risk of getting HIV, Syphilis, and Human Papilloma Virus (HPV); and to test for HIV and Syphilis. Those with a low education level were more likely to have misconceptions about HIV and ever have sex in exchange for money/goods/services. Married participants were more likely to know how to prevent HIV. Participants with a high income were more likely to know about HPV; to self-perceive being at risk of getting Syphilis; to point sex workers as being at higher risk of getting HPV; and to ever test for HIV. WICBT with a low income were more likely to have sex in exchange for money/goods/services. Low and inconsistent knowledge and misconceptions of STIs/HIV, high sexual risky behavior, low perception of risk of getting STIs/HIV among this neglected and key population suggests their increased vulnerability to the STIs/HIV.

HIV prevention and treatment in Southern Europe in the aftermath of bailout programmes.

BACKGROUND: The global financial crisis impacted public health in Europe, and had a particularly critical detriment to health systems in Southern Europe. We aim to describe HIV response and progress towards the current global HIV targets in specific Southern European countries, which received financial adjustment programmes. METHODS: We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain. The indicators included: (i) HIV epidemiology; (ii) adoption of WHO's 'Treat All' recommendation; (iii) progress towards the UNAIDS global targets of 90-90-90; (iv) adoption/implementation of pre-exposure prophylaxis (PrEP); and (v) adoption/implementation of WHO's HIV self-testing (HIVST) recommendation. RESULTS: HIV incidence varied across countries since 2010, with sustained declines in Portugal and Spain, and marked increases in Greece and Cyprus. By 2016, all four countries have adopted WHO's 'Treat All' recommendation, leading to a marked increase in people receiving ART. Improvements were seen in all 90-90-90 targets, with Portugal achieving those in 2017, but Greece lagging somewhat behind, as of 2016. Portugal and Spain have also started implementing PrEP, and Greece has completed a pilot with no additional access to PrEP for pilot participants and no national programme in place. Cyprus has been the slowest in terms of adopting PrEP and HIVST. CONCLUSIONS: Countries need to focus on prioritizing effective and comprehensive prevention measures, including HIVST and PrEP, and scale-up access to quality treatment and care for those diagnosed, in order to accelerate the reduction of new HIVs infections and successfully meet the global targets for HIV treatment.

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.

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.

HIV/AIDS length of stay in Portugal under financial constraints: a longitudinal study for public hospitals, 2009-2014.

BACKGROUND: The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS: Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS: For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION: Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.

Estimating risk factors for HIV infection among women in Mozambique using population-based survey data.

The use of population-based survey data together with sound statistical methods can enhance better estimation of HIV risk factors and explain variations across subgroups of the population. The distribution and determinants of HIV infection in populations must be taken into consideration. We analysed data from the HIV Prevalence and Behaviour Survey in Mozambique aiming to find risk factors associated with HIV infection among Mozambican women. The paper provides a complex survey logistic regression model to explain the variation in HIV seropositivity using demographic, socio-economic and behavioural factors. Results show that women aged 25-29 years, living in female-headed households, living in richer households and those widowed, divorced or not living with a partner have higher odds of being HIV-positive. Findings from our study provide a unique and integrated perspective on risk factors for being HIV-positive among Mozambican women and could support the implementation of programmes aiming to reduce HIV infection in Mozambique.

Estimating risk factors for HIV infection among women in Mozambique using population-based survey data

The use of population-based survey data together with sound statistical methods can enhance better estimation of HIV risk factors and explain variations across subgroups of the population. The distribution and determinants of HIV infection in populations must be taken into consideration. We analysed data from the HIV Prevalence and Behaviour Survey in Mozambique aiming to find risk factors associated with HIV infection among Mozambican women. The paper provides a complex survey logistic regression model to explain the variation in HIV seropositivity using demographic, socio-economic and behavioural factors. Results show that women aged 25-29 years, living in female-headed households, living in richer households and those widowed, divorced or not living with a partner have higher odds of being HIV-positive. Findings from our study provide a unique and integrated perspective on risk factors for being HIV-positive among Mozambican women and could support the implementation of programmes aiming to reduce HIV infection in Mozambique.

Spatiotemporal analysis of the relationship between socioeconomic factors and stroke in the Portuguese mainland population under 65 years old.

Stroke risk has been shown to display varying patterns of geographic distribution amongst countries but also between regions of the same country. Traditionally a disease of older persons, a global 25% increase in incidence instead was noticed between 1990 and 2010 in persons aged 20-≤64 years, particularly in low- and medium-income countries. Understanding spatial disparities in the association between socioeconomic factors and stroke is critical to target public health initiatives aiming to mitigate or prevent this disease, including in younger persons. We aimed to identify socioeconomic determinants of geographic disparities of stroke risk in people <65 years old, in municipalities of mainland Portugal, and the spatiotemporal variation of the association between these determinants and stroke risk during two study periods (1992-1996 and 2002-2006). Poisson and negative binomial global regression models were used to explore determinants of disease risk. Geographically weighted regression (GWR) represents a distinctive approach, allowing estimation of local regression coefficients. Models for both study periods were identified. Significant variables included education attainment, work hours per week and unemployment. Local Poisson GWR models achieved the best fit and evidenced spatially varying regression coefficients. Spatiotemporal inequalities were observed in significant variables, with dissimilarities between men and women. This study contributes to a better understanding of the relationship between stroke and socioeconomic factors in the population <65 years of age, one age group seldom analysed separately. It can thus help to improve the targeting of public health initiatives, even more in a context of economic crisis.