ABSTRACT
BACKGROUND: Undiagnosed and untreated hypertension is a main driver of cardiovascular disease and disproportionately affects persons living with HIV (PLHIV) in low- and middle-income countries. Across sub-Saharan Africa, guideline application to screen and manage hypertension among PLHIV is inconsistent due to poor service readiness, low health worker motivation, and limited integration of hypertension screening and management within HIV care services. In Mozambique, where the adult HIV prevalence is over 13%, an estimated 39% of adults have hypertension. As the only scaled chronic care service in the county, the HIV treatment platform presents an opportunity to standardize and scale hypertension care services. Low-cost, multi-component systems-level strategies such as the Systems Analysis and Improvement Approach (SAIA) have been found effective at integrating hypertension and HIV services to improve the effectiveness of hypertension care delivery for PLHIV, reduce drop-offs in care, and improve service quality. To build off lessons learned from a recently completed cluster randomized trial (SAIA-HTN) and establish a robust evidence base on the effectiveness of SAIA at scale, we evaluated a scaled-delivery model of SAIA (SCALE SAIA-HTN) using existing district health management structures to facilitate SAIA across six districts of Maputo Province, Mozambique. METHODS: This study employs a stepped-wedge design with randomization at the district level. The SAIA strategy will be "scaled up" with delivery by district health supervisors (rather than research staff) and will be "scaled out" via expansion to Southern Mozambique, to 18 facilities across six districts in Maputo Province. SCALE SAIA-HTN will be introduced over three, 9-month waves of intensive intervention, where technical support will be provided to facilities and district managers by study team members from the Mozambican National Institute of Health. Our evaluation of SCALE SAIA-HTN will be guided by the RE-AIM framework and will seek to estimate the budget impact from the payer's perspective. DISCUSSION: SAIA packages user-friendly systems engineering tools to support decision-making by frontline health workers and to identify low-cost, contextually relevant improvement strategies. By integrating SAIA delivery into routine management structures, this pragmatic trial will determine an effective strategy for national scale-up and inform program planning. TRIAL REGISTRATION: ClinicalTrials.gov NCT05002322 (registered 02/15/2023).
ABSTRACT
BACKGROUND: Irrational use of antibiotics is a major driver of antimicrobial resistance (AMR) worldwide. Sub-Saharan Africa, where the risk of spread of AMR is highest, lacks data on the knowledge, attitudes and practices regarding antibiotic prescription and use. This is the first study in Mozambique to address this gap. METHODS: A cross-sectional study was conducted in 2016 in 1091 adults (age ≥18 years) living in five districts in peri-urban areas of Maputo City. Three stage cluster sampling was used to select the households. A semi-structured questionnaire was used to collect information on the knowledge, attitudes and practices regarding antibiotics and their use and socio-demographic data. RESULTS: Of the 1091 participants, 20.9% (228/1091) had used non-prescribed antibiotics. Most of the non-prescribed antibiotics were purchased in pharmacies (199/228; 87.3%). The proportion of use of non-prescribed antibiotics was higher in those who purchased from informal markets (82.6%; 14/17) and home stores (66.7%; 12/18), compared to pharmacies (24.6%; 199/810) (p = 0.000). Variables significantly associated with use of non-prescribed antibiotics were male gender (p = 0.004), living in the Central A (p<0.001), Aeroporto B (p<0.001) or 25 de Junho (p<0.001) neighborhoods, purchase of antibiotics in informal markets (p<0.002) or obtaining from home stores (p = 0.026), not completing the course (p<0.001) and having poor knowledge on the use of antibiotics (p<0.001). Main reasons for use of non-prescribed antibiotics were a perception that there was no need to attend a health facility (26.8%), followed by someone else's advice (7.7%), symptoms similar to a previous episode (6.2%) and poor quality of care in health facilities (6.7%). CONCLUSIONS: Our study shows for the first time that knowledge regarding antibiotics is poor in Maputo City. Purchase of non-prescribed antibiotics is a common practice and most are sold in pharmacies, indicating deficient inspection. Interventions to reinforce adherence by pharmacies to current legislation for dispensing antibiotics, combined with community education are urgently needed.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Health Knowledge, Attitudes, Practice , Adolescent , Adult , Female , Humans , Logistic Models , Male , Middle Aged , Mozambique , Nonprescription Drugs/therapeutic use , Young AdultABSTRACT
Background Irrational use of antibiotics is a major driver of antimicrobial resistance (AMR) worldwide. Sub-Saharan Africa, where the risk of spread of AMR is highest, lacks data on the knowledge, attitudes and practices regarding antibiotic prescription and use. This is the first study in Mozambique toaddress this gap. Methods Across-sectional study was conducted in 2016 in 1091 adults (age �18 years) living in five districts in peri-urban areas of Maputo City. Three stage cluster sampling was used to select the households. A semi-structured questionnaire was used to collect information on the knowledge, attitudes and practices regarding antibiotics and their use and socio-demographic data. Results Of the 1091participants, 20.9% (228/1091) had used non-prescribed antibiotics. Most of the non-prescribed antibiotics were purchased in pharmacies (199/228; 87.3%). The proportion of use of non-prescribed antibiotics was higher in those who purchased from informal markets (82.6%; 14/17) and home stores (66.7%; 12/18), compared to pharmacies (24.6%; 199/810) (p = 0.000). Variables significantly associated with use of non-prescribed antibiotics were male gender (p =0.004), living in the Central A (p<0.001), Aeroporto B (p<0.001) or 25 deJunho(p<0.001) neighborhoods, purchase of antibiotics in informal markets (p<0.002) or obtaining from home stores (p = 0.026), not completing the course (p<0.001) andhaving poor knowledge on the use ofantibiotics (p<0.001). Main reasons for use of non-prescribed antibiotics were a perception that there was no need to attend a health facility (26.8%), followed by someone else's advice (7.7%), symptoms similar to a previous episode (6.2%) and poor quality of care in health facilities (6.7%). PLOSONE|https://doi.org/10.1371/journal.pone.0221452 August 22, 2019 1/ 15Knowledge, attitudes and practices regarding antibiotic use in Maputo, Mozambique Conclusions Ourstudy shows for the first time that knowledge regarding antibiotics is poor in Maputo City. Purchase of non-prescribed antibiotics is a common practice and most are sold in pharmacies, indicating deficient inspection. Interventions to reinforce adherence by pharmacies to current legislation for dispensing antibiotics, combined with community education are urgently needed.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Health Knowledge, Attitudes, Practice , Anti-Bacterial Agents/therapeutic use , Logistic Models , Nonprescription Drugs/therapeutic use , MozambiqueABSTRACT
Os antibióticos são substâncias que inibem o crescimento dos microrganismos ou causam sua destruição. A falta de conhecimentos e as práticas deficientes de uso dos antibióticos constituem uma ameaça à saúde, podendo causar falência terapêutica e resistência antibiótica. Em Moçambique estudos sobre uso de antibióticos são raros. O estudo avaliou os conhecimentos e as práticas de uso de antibióticos na Cidade de Maputo, em 2016. Métodos: Um estudo descritivo transversal, com participação de 1091 indivíduos com idade igual ou superior a 18 anos, entre Agosto e Novembro de 2016. Foi feita uma amostragem em três etapas e os dados foram colhidos através de entrevista, com recurso a um questionário semiestruturado. Resultados: De 1222 indivíduos contactados, 1091 foram entrevistados, e destes 73.1% (797) eram do sexo feminino. A mediana de idade foi de 33 anos, com IQR: 25-47. Dos 1091 participantes, 20.9% (228) adquiriram antibióticos sem prescrição com uma frequência significativa para sexo masculino (26.2%). A principal razão para o uso de antibióticos sem prescrição foi a de que não há necessidade de ir ao hospital (26.8%). A maior proporção de indivíduos que obtiveram antibióticos sem prescrição foi observada nos que os obtiveram no mercado informal (82.6%; 14/17). Ser do sexo feminino (OR=0.53; IC95%=0.34-0.82), residir nos bairros de Polana Caniço A (OR=0.21; IC95%=0.10-0.43) e Mahotas (OR: 0.12; IC95%=0.06- 0.24), obter antibióticos na farmácia (OR=0.22; IC95%=0.05-0.80) e completar a dose de antibióticos (OR=0.09; IC95%=0.06-014) não estão associados ao uso de antibióticos sem prescrição. O conhecimento pobre sobre o uso de antibióticos está relacionado com o aumento do uso de antibióticos sem prescrição (OR=2.72; IC95%=1.57-4.78). Conclusões: O uso de antibióticos sem prescrição é comum na cidade de Maputo . A maior proporção dos antibióticos não prescritos foram obtidos nos mercados informais o que denota uma fraca inspeção a estes locais bem como a falta de conhecimento sobre os antibióticos por parte das comunidades. Intervenções junto ao mercados informais e farmácias, bem como educação das comunidades sobre antibióticos e seu uso, são necessárias e urgentes.
Irrational use of antibiotics is a major driver of antimicrobial resistance (AMR) worldwide, however, in Sub Saharan Africa, where the risk of spread of AMR is the highest worldwide, lacks data on the knowledge, attitudes and practices regarding antibiotics prescription and use. This is the first study being conducted in Mozambique to address this matter. Methods: A cross-sectional study was conducted to recruit a total of 1091 adults 18 years or older living in five districts in the peri-urban area of Maputo city between August and November 2016. A cluster sampling stratified into three steps was used to select the households and a semi-structured questionnaire was used for data collection. The aim of this study was to evaluate the knowledge and practices of antibiotics use in Maputo City in 2016. Results: Of the 1091 participants, 20.9% (228/1091) used non-prescribed antibiotics. Most of used antibiotics were purchased in pharmacies (199/228; 87.3%), but the proportion of use of non-prescribed antibiotics was higher in those who obtained from the informal market (82.6%; 14/17). Female gender (OR=0.53; IC95%=0.34-0.82), living in Polana Caniço A (OR=0.21; IC95%=0.10-0.43) and Mahotas (OR: 0.12; IC95%=0.06- 0.24) neighbourhoods, obtein antibiotics in pharmacy (OR=0.22; IC95%=0.05-0.80) e completing the full dosage (OR=0.09; IC95%=0.06-014) were not associated to the use of non prescribed antibiotics. The poor knowledge about antibiotics was associated to the use of non prescribed antibiotics. (OR=2.72; IC95%=1.57-4.78). Conclusion: Data from our study shows for the first time that knowledge towards antibiotics is poor in Maputo city. Moreover, purchase of non-prescribed antibiotics is significant and most are sold in informal markets, which denotes poor inspection in this places in Maputo city. Interventions in the informal markets and pharmacies to apply for the current legislations for dispensing antibiotics, combined with education of communities are urgently needed.
Subject(s)
Pharmacology , Therapeutics , Pharmaceutical Preparations , Anti-Bacterial Agents , Health , Public Health , Prescriptions , MozambiqueABSTRACT
Since the first reported epidemic of dengue in Pemba, the capital of Cabo Delgado province, in 1984-1985, no further cases have been reported in Mozambique. In March 2014, the Provincial Health Directorate of Cabo Delgado reported a suspected dengue outbreak in Pemba, associated with a recent increase in the frequency of patients with nonmalarial febrile illness. An investigation conducted between March and June detected a total of 193 clinically suspected dengue patients in Pemba and Nampula, the capital of neighboring Nampula Province. Dengue virus-type 2 (DENV-2) was detected by reverse transcriptase polymerase chain reaction in sera from three patients, and 97 others were classified as probable cases based on the presence of DENV nonstructural protein 1 antigen or anti-DENV immunoglobulin M antibody. Entomological investigations demonstrated the presence of Aedes aegypti mosquitos in both Pemba and Nampula cities.
