RESUMEN
INTRODUCTION: Leprosy and lymphatic filariasis (LF) are among the most disabling neglected tropical diseases (NTDs) that affect the citizens of Mozambique, especially in the Northern provinces. The irreversible impairments caused by these NTDs often lead to psychosocial consequences, including poor mental wellbeing, stigma and reduced social participation. Limited data on these consequences are available for Mozambique, which are urgently needed to better understand the true disease burden and support advocacy for scaling up interventions. METHODS: A cross-sectional mixed-methods study was conducted. Mental distress was assessed with the Self Reporting Questionnaire (SRQ-20), participation restriction was assessed with the Participation Scale Short (PSS) and perceived stigma was assessed with the Explanatory Model Interview Catalogue affected persons stigma scale (EMIC-AP). Additionally, semi-structured interviews were conducted with persons affected by leprosy or LF. RESULTS: In total, 127 persons affected by leprosy and 184 persons affected by LF were included in the quantitative portion of the study. For the qualitative portion, eight semi-structured interviews were conducted. In both disease groups, mental distress was found in 70% of participants. Moreover, 80% of persons affected by leprosy and 90% of persons affected by LF perceived stigma. Moderate to extreme participation restriction was found in approximately 43% of persons affected by leprosy and in 26% of the persons affected by LF. Persons affected by leprosy and LF felt excluded from society and experienced financial problems. More severe disabilities were associated with more severe outcomes for mental wellbeing, participation restriction and stigma. By contrast, participation in a self-care group was suggested to have a positive impact on these outcomes. CONCLUSION: The findings provide evidence that persons affected by leprosy and LF must not only confront physical impairments but also experience significant disability in the psychosocial domain, including mental distress, participation restriction and stigma. These challenges must be urgently addressed by NTD programmes to promote the inclusion and wellbeing of persons affected by NTDs.
Asunto(s)
Personas con Discapacidad , Filariasis Linfática , Lepra , Estigma Social , Humanos , Lepra/psicología , Lepra/epidemiología , Masculino , Femenino , Filariasis Linfática/psicología , Filariasis Linfática/epidemiología , Adulto , Estudios Transversales , Persona de Mediana Edad , Mozambique/epidemiología , Personas con Discapacidad/psicología , Adulto Joven , Anciano , Adolescente , Encuestas y Cuestionarios , Costo de Enfermedad , Enfermedades Desatendidas/psicología , Enfermedades Desatendidas/epidemiologíaRESUMEN
Konzo is a toxico-nutritional upper motor neuron disease causing a spastic paraparesis in schoolchildren and childbearing women in some African countries. Almost a century since the first description of konzo, its underlying etiopathogenic mechanisms and causative agent remain unknown. This paper aims at refreshing the current knowledge of konzo determinants and pathogenesis in order to enlighten potential new research and management perspectives. Literature research was performed in PubMed and Web of Science databases according to the PRISMA methodology. Available data show that cassava-derived cyanide poisoning and protein malnutrition constitute two well-documented risk factors of konzo. However, observational studies have failed to demonstrate the causal relationship between konzo and cyanide poisoning. Thiocyanate, the current marker of choice of cyanide exposure, may underestimate the actual level of cyanide poisoning in konzo patients as a larger amount of cyanide is detoxified via other unusual pathways in the context of protein malnutrition characterizing these patients. Furthermore, the appearance of konzo may be the consequence of the interplay of several factors including cyanide metabolites, nutritional deficiencies, psycho-emotional and geo-environmental factors, resulting in pathophysiologic phenomena such as excitotoxicity or oxidative stress, responsible for neuronal damage that takes place at sparse cellular and/or subcellular levels.
Asunto(s)
Cianuros/envenenamiento , Desnutrición/epidemiología , Manihot/efectos adversos , Enfermedad de la Neurona Motora/inducido químicamente , Enfermedad de la Neurona Motora/epidemiología , Deficiencia de Proteína/epidemiología , África/epidemiología , Proteínas en la Dieta , Humanos , Desnutrición/metabolismo , Enfermedad de la Neurona Motora/metabolismo , Deficiencia de Proteína/metabolismo , Factores de Riesgo , Tiocianatos/metabolismoRESUMEN
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.
Asunto(s)
Antibacterianos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mozambique , Medicamentos sin Prescripción/uso terapéutico , Adulto JovenRESUMEN
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.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Antibacterianos/uso terapéutico , Modelos Logísticos , Medicamentos sin Prescripción/uso terapéutico , MozambiqueRESUMEN
Mozambique is a tropical country situated in the Southern part of Africa, a region where data on the burden and epidemiology of arbovirus is presently quite scarce although the frequency of outbreaks caused by arboviruses is rapidly increasing. Outbreaks of dengue fever have been reported in Mozambique, Angola and Tanzania and a recent unprecedented outbreak of Yellow fever has been recorded in Angola. These new outbreaks collectively suggest that arboviruses, and specifically flavivirus infections, are endemic in Mozambique.Although recent data on arbovirus activity is scarce, the work of Kokernot et al. [R.H. Kokernot, K.C. Smithburn, A.F. Gandara, B.M. Mc'Intosh and C.S. Heymann Anais Inst Med Trop (1960), 17:201-230] describes seroepidemiological and entomological studies carried out in several parts of Mozambique during the 1950s. Complementary seroepidemiological investigations on arboviruses that were conducted in the early 1980s also found serological evidence of several arboviruses which included Dengue, Chikungunya, Zika, Rift Valey Fever, Sinbdis virus, Wesselsbron, Bunyamwera, Pongola and Bawamba Fever and Yellow Fever.Notably the first description of Chikungunya virus in 1952-1953 in Tanzania also included reported cases in northern Mozambique. Furthermore, DENV serotype 3 was for the first time described in northern Mozambique in 1984 and 1985. Since several arboviral infections result in acute self limiting fever they have remained unsuspected for several decades. However, it is well known that during the 1980's intensive malaria control initiatives which included massive distribution of bed nets, community education and indoor and outdoor spraying campaigns were implemented. It is possible that these measures may have influenced the epidemiology of arboviruses. However, the impact of these interventions in controlling the spread of arboviruses is not known.In conclusion, the old literature on arboviruses in Mozambique is relevant for assessing the gaps and current risk of occurrence of these pathogens at the region, particularly in a time in which they are spreading worldwide.
Asunto(s)
Infecciones por Arbovirus/virología , Arbovirus/fisiología , Animales , Infecciones por Arbovirus/diagnóstico , Infecciones por Arbovirus/epidemiología , Infecciones por Arbovirus/historia , Arbovirus/clasificación , Arbovirus/genética , Arbovirus/aislamiento & purificación , Brotes de Enfermedades/historia , Epidemias/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Mozambique/epidemiologíaRESUMEN
BACKGROUND: Communication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective. It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities. Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership. METHODS: We conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey. RESULTS: Collectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust". CONCLUSION: This Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention - it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly.
Asunto(s)
Comunicación en Salud/métodos , Evaluación de Procesos, Atención de Salud , Vacunación/psicología , Niño , Técnica Delphi , Empleados de Gobierno , Educación en Salud/métodos , Personal de Salud , Humanos , Internet/estadística & datos numéricos , Organizaciones , Padres/psicología , Investigadores , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricosRESUMEN
BACKGROUND: Effective vaccination communication with parents is critical in efforts to overcome barriers to childhood vaccination, tackle vaccine hesitancy and improve vaccination coverage. Health workers should be able to provide information to parents and other caregivers and support them in reaching decisions about vaccinating their children. Limited information exists regarding the perceptions of caregivers and health workers on the vaccination communication strategies employed in Nigeria. This study, which forms part of the 'Communicate to vaccinate' (COMMVAC) project, aims to explore the perceptions and experiences of caregivers and health workers in Nigeria on vaccination communication strategies implemented in their settings. METHODOLOGY: We conducted the study in two States: Bauchi in Northern Nigeria and Cross River in the south. We carried out observations (n = 40), in-depth interviews (n = 14) and focus group discussions (FGDs) (n = 12) amongst 14 purposively selected health workers, two community leaders and 84 caregivers in the two states. We transcribed data verbatim and analysed the data using a framework analysis approach. RESULTS: Caregivers were informed about vaccination activities through three main sources: health facilities (during health education sessions conducted at antenatal or immunization clinics); media outlets; and announcements (in churches/mosques, communities and markets). Caregivers reported that the information received was very useful. Their preferred sources of information included phone text messages, town announcers, media and church/mosque announcements. Some caregivers perceived the clinic environment, long waiting times and health worker attitudes as barriers to receiving vaccination information.When delivering communication interventions, health workers described issues tied to poor communication skills; poor motivation; and attitudes of community members, including vaccine resistance. CONCLUSION: Communication about vaccination involves more than the message but is also influenced by the environment and the attitudes of the deliverer and receiver. It is pertinent for health policy makers and programme managers to understand these factors so as to effectively implement communication approaches.
Asunto(s)
Cuidadores/psicología , Educación en Salud , Vacunación/psicología , Adulto , Niño , Femenino , Comunicación en Salud , Personal de Salud/psicología , Humanos , Masculino , Nigeria , Padres/psicología , Adulto JovenRESUMEN
BACKGROUND: Understanding stakeholders' (parents', communities' and health workers') perspectives of communication about childhood vaccination, including their preferences for its format, delivery and content, is an important step towards designing better communication strategies and ensuring more informed parents. Our objectives were to explore stakeholders' views, experiences and preferences for childhood vaccination communication in Cameroon. METHODS: In 2014, in the Central and North West Regions of Cameron, we gathered qualitative data for our case study using the following methods: semi structured interviews; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; document analysis of reports and mass media communications about vaccination; and a survey of parents. We conducted a thematic analysis of the qualitative data to identify themes relating to views, experiences and perceptions of vaccination information and its delivery. Survey data were analysed using simple descriptive statistics. RESULTS: All of the parents interviewed felt that vaccinating their child was important, and trusted the information provided by health workers. However, many parents wanted more information. Parents did not always feel that they could ask questions during vaccination appointments. All participants felt that health workers and vaccination clinics were important sources of information. Social mobilisation activities such as door-to-door visits and announcements during religious services were important and accepted ways of communicating information, especially during vaccination campaigns. Information communicated through mass media and text messages was also seen as important. In general, stakeholders believed that more consistent messaging about routine vaccination through community channels would be helpful to remind parents of the importance of routine vaccination during ongoing rounds of vaccination campaigns against polio. CONCLUSIONS: This study confirms that parents regard information about childhood vaccination as important, but that health services need to be organized in ways that prioritize and facilitate communication, particularly about routine vaccination.
Asunto(s)
Poliomielitis/epidemiología , Vacunación/psicología , Camerún , Niño , Femenino , Comunicación en Salud , Personal de Salud/psicología , Humanos , Masculino , Padres/psicología , Percepción , Poliomielitis/prevención & control , Poliomielitis/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age <15 years (p = 0.05), bite by stray dog (p = 0.002), deep wound (p = 0.02), bite in the head (p = 0.001), bite by unimmunized dog (p = 0.01), no use of soap and water (p = 0.001), and no post-exposure prophylaxis (p = 0.01). CONCLUSIONS/SIGNIFICANCE: Implementation of control measures for rabies is poor in Maputo and Matola cities, where cases of human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures.
Asunto(s)
Mordeduras y Picaduras/epidemiología , Brotes de Enfermedades/prevención & control , Enfermedades de los Perros/prevención & control , Profilaxis Posexposición/métodos , Rabia/mortalidad , Rabia/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Estudios de Casos y Controles , Niño , Preescolar , Demografía , Enfermedades de los Perros/virología , Perros , Femenino , Humanos , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mozambique , Salud Pública , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Vacunación , Adulto JovenRESUMEN
This case study is based on a real-life outbreak investigation undertaken in Mozambique in 1981. This case study describes and promotes one particular approach to unknown disease outbreak investigation. Investigational procedures, however, may vary depending on location and outbreak. It is anticipated that the epidemiologist investigating an unknown disease outbreak will work within the framework of a "multidisciplinary investigation team". It is through the collaborative efforts of this team, with each member playing a critical role, that outbreak investigations are successfully completed. Some aspects of the original outbreak and investigation have, however, been altered to assist in meeting the desired teaching objectives and to allow completion of the case study in less than 3 hours.
Asunto(s)
Brotes de Enfermedades , Epidemiología/educación , Paraparesia Espástica/epidemiología , Conducta Cooperativa , Métodos Epidemiológicos , Humanos , Comunicación Interdisciplinaria , Mozambique/epidemiología , Paraparesia Espástica/etiología , Salud Pública/métodosRESUMEN
BACKGROUND: Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation. OBJECTIVES: Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps. METHODS: We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions. RESULTS: We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members. CONCLUSIONS: We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers.
Asunto(s)
Comunicación en Salud/métodos , Educación en Salud/métodos , Promoción de la Salud/métodos , Padres/educación , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mozambique , Pobreza , Investigación CualitativaRESUMEN
BACKGROUND: Communication can be used to generate demand for vaccination or address vaccine hesitancy, and is crucial to successful childhood vaccination programmes. Research efforts have primarily focused on communication for routine vaccination. However, vaccination campaigns, particularly in low- or middle-income countries (LMICs), also use communication in diverse ways. Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice. In this paper, we broaden the scope of our existing taxonomy of communication interventions for routine vaccination to include communication used in campaigns, and integrate these into a comprehensive taxonomy of vaccination communication interventions. METHODS: Building on our taxonomy of communication for routine vaccination, we identified communication interventions used in vaccination campaigns through a targeted literature search; observation of vaccination activities in Cameroon, Mozambique and Nigeria; and stakeholder consultations. We added these interventions to descriptions of routine vaccination communication and categorised the interventions according to their intended purposes, building from an earlier taxonomy of communication related to routine vaccination. RESULTS: The comprehensive taxonomy groups communication used in campaigns and routine childhood vaccination into seven purpose categories: 'Inform or Educate'; 'Remind or Recall'; 'Enhance Community Ownership'; 'Teach Skills'; 'Provide Support'; 'Facilitate Decision Making' and 'Enable Communication'. Consultations with LMIC stakeholders and experts informed the taxonomy's definitions and structure and established its potential uses. CONCLUSIONS: This taxonomy provides a standardised way to think and speak about vaccination communication. It is categorised by purpose to help conceptualise communication interventions as potential solutions to address needs or problems. It can be utilised by programme planners, implementers, researchers and funders to see the range of communication interventions used in practice, facilitate evidence synthesis and identify evidence gaps.
Asunto(s)
Comunicación en Salud/métodos , Vacunación , Camerún , Países en Desarrollo , Humanos , Mozambique , Nigeria , PobrezaRESUMEN
BACKGROUND: Although Chikungunya virus has rapidly expanded to several countries in sub-Saharan Africa, little attention has been paid to its control and management. Until recently, Chikungunya has been regarded as a benign and self-limiting disease. In this report we describe the first case of severe Chikungunya disease in an adult patient in Pemba, Mozambique. CASE PRESENTATION: A previously healthy 40 year old male of Makonde ethnicity with no known past medical history and resident in Pemba for the past 11 years presented with a severe febrile illness. Despite administration of broad spectrum intravenous antibiotics the patient rapidly deteriorated and became comatose while developing anaemia, thrombocytopenia and later, melaena. Laboratory testing revealed IgM antibodies against Chikungunya virus. Malaria tests were consistently negative. CONCLUSIONS: This report suggests that Chikungunya might cause unsuspected severe disease in febrile patients in Mozambique and provides insights for the improvement of national protocols for management of febrile patients in Mozambique. We recommend that clinicians should consider Chikungunya in the differential diagnosis of febrile illness in locations where Aedes aegypti mosquitos are abundant.
Asunto(s)
Fiebre Chikungunya/diagnóstico , Virus Chikungunya/patogenicidad , Fiebre/diagnóstico , Leucocitosis/diagnóstico , Melena/diagnóstico , Adulto , Animales , Antibacterianos/uso terapéutico , Anticuerpos Antivirales/sangre , Recuento de Células Sanguíneas , Fiebre Chikungunya/tratamiento farmacológico , Fiebre Chikungunya/patología , Fiebre Chikungunya/virología , Virus Chikungunya/fisiología , Diagnóstico Diferencial , Fiebre/tratamiento farmacológico , Fiebre/patología , Fiebre/virología , Humanos , Inmunoglobulina M/sangre , Islas del Oceano Índico , Leucocitosis/tratamiento farmacológico , Leucocitosis/patología , Leucocitosis/virología , Masculino , Melena/tratamiento farmacológico , Melena/patología , Melena/virología , Mozambique , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria. METHODS: We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis. RESULTS: We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees. CONCLUSIONS: Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.
Asunto(s)
Comunicación en Salud/métodos , Vacunación , Actitud del Personal de Salud , Cuidadores , Fuerza Laboral en Salud , Humanos , Nigeria , Padres , Política , Investigación CualitativaRESUMEN
OBJECTIVES: We present a comprehensive taxonomy of outcomes for childhood vaccination communication interventions. Adding to our earlier map of trial outcomes, we aimed to (1) identify relevant outcomes not measured in trials, (2) identify outcomes from stakeholder focus groups, and (3) organize outcomes into a taxonomy. STUDY DESIGN AND SETTING: We identified additional outcomes from nonvaccination health communication literature and through parent and health care professional focus groups. We organized outcomes into the taxonomy through iterative discussion and informed by organizational principles established by leaders in core outcome research. RESULTS: The taxonomy includes three overarching core areas, divided into eight domains and then into outcomes. Core area one is psychosocial impact, including the domains "knowledge or understanding," "attitudes or beliefs," and "decision-making." Core area two is health impact, covering "vaccination status and behaviors" and "health status and well-being." Core area three is community, social, or health system impact, containing "intervention design and implementation," "community participation," and "resource use." CONCLUSION: To our knowledge, this taxonomy is the first attempt to conceptualize the range of potential outcomes for vaccination communication. It can be used by researchers selecting outcomes for complex communication interventions. We will also present the taxonomy to stakeholders to establish core outcome domains.
Asunto(s)
Comunicación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Comunicación Interdisciplinaria , Evaluación de Resultado en la Atención de Salud/métodos , Vacunación , Preescolar , Grupos Focales , Personal de Salud , Humanos , Lactante , PadresRESUMEN
Background: Although Chikungunya virus has rapidly expanded to several countries in sub-Saharan Africa, little attention has been paid to its control and management. Until recently, Chikungunya has been regarded as a benign and self-limiting disease. In this report we describe the first case of severe Chikungunya disease in an adult patient in Pemba, Mozambique. Case presentation: A previously healthy 40 year old male of Makonde ethnicity with no known past medical history and resident in Pemba for the past 11 years presented with a severe febrile illness. Despite administration of broad spectrum intravenous antibiotics the patient rapidly deteriorated and became comatose while developing anaemia, thrombocytopenia and later, melaena. Laboratory testing revealed IgM antibodies against Chikungunya virus. Malaria tests were consistently negative. Conclusions: This report suggests that Chikungunya might cause unsuspected severe disease in febrile patients in Mozambique and provides insights for the improvement of national protocols for management of febrile patients in Mozambique. We recommend that clinicians should consider Chikungunya in the differential diagnosis of febrile illness in locations where Aedes aegypti mosquitos are abundant...
Asunto(s)
Animales , Adolescente , Índice de Severidad de la Enfermedad , Melena/diagnóstico , Fiebre/diagnóstico , Fiebre Chikungunya/diagnóstico , Leucocitosis/diagnóstico , Antibacterianos , Inmunoglobulina M/sangre , Melena/patología , Melena/terapia , Melena/virología , Fiebre/parasitología , Fiebre/terapia , Fiebre/virología , Fiebre Chikungunya , Fiebre Chikungunya/parasitología , Fiebre Chikungunya/terapia , Fiebre Chikungunya/virología , Leucocitosis/terapia , Leucocitosis/virología , MozambiqueRESUMEN
OBJECTIVES: To describe causes of death among young women and estimate the role of HIV/AIDS as a cause in Maputo City, based on the civil death register. METHODS: Death data of 17-49 year-old women were abstracted from January 2007-March 2010 from the civil death register in Maputo City, registering overall about 15 000 deaths per-year. Causes of death in the register were either based on physicians' diagnoses on death certificates or determined by asking questions to deceased relatives. Causes of death were written in Portuguese; we translated them into English and classified them into 106 codes using ICD-9; these codes were then categorized into 10 groups. Estimated populations from the 2007 census were used to calculate annual mortality rates. An earlier study was used to compare deaths in 2001. FINDINGS: A total of 9640 deaths (6510 for residents of Maputo City) were registered and 77% had a specified cause of death reported. HIV-deaths represented 36% of all deaths and 40% among 25-39 year-olds. The death rate did not increase linearly by age, as there was a peak among women aged 30-34 years. The overall annual death rate was 6.7 deaths per 1000 population, with a notable decline by year. Death rates for HIV slightly declined by year. HIV-deaths explained most of the peak in death rate among 30-34-year-olds. The share of HIV-deaths among all deaths increased from 18% in 2001 to 35% in 2007-2010. Sixty-eight percent of all and 92% of HIV-related deaths occurred in hospital, with no increase over time. CONCLUSIONS: Routine death register was useful to study death rates, distribution of deaths, and change over time in the urban setting of Maputo during late 2000s. Over time, the death rate among 17-49 years old women seemed to have declined, but the relative contribution of HIV increased.
Asunto(s)
Causas de Muerte/tendencias , Adolescente , Adulto , Ciudades , Femenino , Infecciones por VIH/mortalidad , Humanos , Persona de Mediana Edad , Mozambique/epidemiología , Sistema de Registros , Adulto JovenAsunto(s)
Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/historia , Aedes/virología , Animales , Historia del Siglo XX , Humanos , Control de Mosquitos/historia , Mosquitos Vectores/virología , Mozambique/epidemiología , Factores de Riesgo , Infección por el Virus Zika/prevención & controlRESUMEN
Although Kokernot et al. found neutralizing antibodies against ZIKV in Mozambique in 1957 [20], the country has repeatedly been excluded from the list of countries with a past history of ZIKV. The current Centers for Disease Control and Prevention map, the recent World Health Organization Risk Assessment map on ZIKV in the Africa region, and most of the recent literature mapping countries with a current and past history of ZIKV have consistently excluded Mozambique [10, 21, 22] from the list of countries with past serological evidence of ZIKV. This might result in errors in the calculation and interpretation of the risk of Zika in Mozambique as well as in the region. In this regard, in this manuscript we revisit findings of the study conducted by Kokernot et al. in an attempt to discuss the current risk of Zika in the country. The survey, conducted in 1957, was published in Portuguese in 1960 [20]. This study was part of a larger study on arboviruses, in which blood samples were screened for antibodies against 13 arboviruses, including ZIKV, chikungunya, Rift Valley fever, Sindbis, Middleburg, and Wesselsbron. Samples were collected in 29 localities situated widely apart from each other throughout the country between July and August 1957. In each locality, they selected an average of 30 local residents who had been born in the area with no history of travel outside in their lifetime. The samples were analyzed in South Africa, using confirmatory neutralization testing (NT). NT was performed using an in vivo system. For this purpose, previously titrated virus strains for each arbovirus being tested were incubated with each participant's serum and inoculated into Swiss mice to assess the neutralization profile of each serum against each virus strain. For ZIKV, the prototype ZIKV strain was used [18], and both adult and newborn mice were used for inoculation. An amount of 0.03 mL of the preparation virus and serum was inoculated intracerebrally, as previously described [18], and each mouse was observed daily between 10 17 days to assess the viral effect. The authors found neutralizing antibodies to all of the viruses and concluded that the whole length of Mozambique was a "tropical corridor" of arbovirus activity. The viruses with highest prevalence rates of neutralizing antibodies were chikungunya (21.0%), Wesselsbron (15.9%), Bunyamwera (24.1%), Pongola (23.2%) and Bwamba fever (24.7%)...