Covid-19: produto interno bruto, número de testes e de casos confirmados em 13 países africanos / Covid-19: Gross Domestic Product, Number of Tests and Confirmed Cases in 13 African Countries

Introdução: Nos países africanos, a capacidade financeira de aquisição de testes, representada pelo produto interno bruto (PIB) per capita pode-se reflectir na aquisição e num consequente aumento de registo de casos positivos, criando uma falsa impressão de que quanto mais rico o país maior a frequência de casos de COVID-19. Pretende-se através deste estudo correlacionar o PIB per capita, o número de testes e de casos confirmados de COVID-19 em 13 países africanos. Métodos: Estudo Transversal, quantitativo e de correlação. Com dados secundários referentes a África do Sul, Costa do Marfim, Gana, Quénia, Etiópia, Marrocos, Moçambique, Nigéria, Ruanda, Senegal, Togo, Tunísia e Zimbabué. Feito a uma população de 622.132.603 habitantes, correspondentes à combinação da população dos países abrangidos. Os dados do presente estudo (PIB per capita, número de testes e casos confirmados de COVID-19 a 19 de Julho de 2020) foram obtidos da base de dados Data on COVID-19 (coronavirus) (plataforma GitHub). As análises estatísticas foram realizadas no Microsoft Excel 2016 ™, IBM SPSS 21 ™ e JASP 0.13.0.0. Estas incluíram testes Kolmogorov-Smirnov de cada variável (a = 0,05), comparações dos seus valores entre os países e uma matriz de correlações de Pearson. Resultados: O PIB per capita, número de testes e de casos confirmados de COVID-19 apresentaram correlações de Pearson significativas, aceitáveis e positivas (p < 0,05 e r > 0,5), isto é, a capacidade de compra de testes do país parece afectar a sua aquisição e o registo de casos. Há um ciclo de retroalimentação positiva entre as quantidades de testes e o número de casos confirmados e o PIB per capita revela que o poder financeiro do país funciona como catalisador deste fenómeno. Como consequência deste cenário, os países com maior número de testes também apresentaram maior número de casos confirmados. Conclusões: As evidências observadas nos 13 países em estudo sugerem que em África o poder económico determina o volume de testagem e este por sua vez pode estar a afectar o padrão de diferenças entre os números de casos confirmados entre as nações.

Introduction: In African countries, the financial capacity to acquire tests, represented by the gross domestic product (GDP) per capita, can be reflected in the acquisition and in a consequent increase in the registration of positive cases, creating a false impression that the richer the country, the greater the frequency of COVID-19 cases. This study intends to analyse the relationship between GDP per capita, number of tests and confirmed cases of COVID-19 in 13 African countries. Methods: Cross-sectional, quantitative, and correlational. Secondary data related to South Africa, Ivory Coast, Ghana, Kenya, Ethiopia, Morocco, Mozambique, Nigeria, Rwanda, Senegal, Togo, Tunisia, and Zimbabwe. To a population of 622.132.603 inhabitants, corresponding to the combined population of all countries included in this study. Data (GDP per capita, number of tests and confirmed cases of COVID-19 on 19 July 2020) were obtained on the database Data on COVID-19 (coronavirus) (GitHub platform). Statistical analyses were performed on Microsoft Excel 2016 ™, IBM SPSS 21 ™ and JASP 0.13.0.0. The variables were subjected to Kolmogorov-Smirnov test (a = 0.05), comparisons of their values considering the countries and a Pearson's correlation matrix. Results: GDP per capita, the number of tests and confirmed cases of COVID-19 presented significant, acceptable, and positive Pearson's correlations (p < 0,05 e r > 0,5), i.e., the countries' capacities to purchase tests seem to affect their acquisition and the record of cases. There is a cycle of positive feedback between the quantity of tests and number of cases and the GDP per capita reveals that the purchase power works as a catalyst of such phenomenon. As consequence, countries with the highest number of tests also present the highest numbers 20 Revista Moçambicana de Ciências de Saúde, vol.7, no 1, 2021 | ISSN 2311-3308 of confirmed cases. Conclusions: The evidence from these 13 countries suggests that, in Africa, the economic power determines the volume of testing and such fact might be affecting the differences between the numbers of confirmed cases in these nations.

A narrative review on Rotavirus A in Mozambique

Introduction: Rotavirus A (RVA) is a leading cause of acute infant gastroenteritis in Mozambique, responsible for approximately 13,000 annual infant deaths in peri-urban and other areas. Aim: the present review aimed summarize the most relevant and recent literature regarding RVA infection in Mozambique. Methods: the documents were obtained from electronic databases such as PubMed, Google Scholar, Scinapse, Scilit, and Microsoft Academicto find the leading scientific publications related to Mozambique's RVA.Findings: The search allowed us to find 20 peer-reviewed journal articles, three official reports, eight abstracts from national conferences, one thesis, and other documents to supplement the information. Rotavirus frequency ranged between 24 to 42.4%, 34.8% attributable to Mozambique. Most data are hospital-based from Maputo, Sofala, Zambézia, and Nampula provinces. Nampula province shows the highest number of cases. Thus, there might be some bias on the geographical distribution of the virus. The prevalence is high in children less than one year. Regarding the control, the Expanded Program on Immunization (EPI) introduced a monovalent vaccine in September 2015 (Rotarix), which positively impacted the reduction of RVA cases. After vaccine introduction, a high diversity of RVA genotypes was observed, with the predominance ofG1P[8] and the emergence of G9P[4],G9P[6], G3P[4]. However, only the whole genome sequence can confirm if it is due to the natural genotypes fluctuation. RVA infection was detected in swine, and a recent analysis reported an RVA strain from children clustered with different animal strains.Conclusion: The scarceyethighly reliable research resourcesallowed scientists to detect RVA G1P[8] and other genotypes, potential animal reservoirs, and to find that RVA is more prevalent during the transition dry-rainy season, and thevirus becomes more frequent when children approach the 11thmonth, to then decline as they age.It is essential to develop studies providing a broad view of RVA reservoirs as part of the strategy to control its dissemination

Influence of population density and access to sanitation on Covid-19 in Mozambique

In 2020, as COVID-19 spread worldwide, prestigious entities published faulty predictions about the level of dissemination, especially when describing African countries and others with "weak healthcare systems." How could the best fall so short, even when using well-known epidemiological variables to predict the behavior of a hygiene-related malady? It might have been due to insufficient data since COVID-19 was a novelty, still poorly understood. The current study aimed to analyze how two variables ­population density and percentage of people with access to improved sanitation ­affected the number of confirmed COVID-19 cases in Mozambique by February 2021, almost one year since the first case in the country. All data were publicly available: population density in Census 2017, access to sanitation in the Mozambique Public Expenditure Review 2014, and the number of COVID-19 cases in the Ministry of Health's COVID-19 daily bulletin (no. 332). JASP 0.13.1.0 allowed correlating all variables, and MicrosoftExcel™ was chosen to perform fitting analysis to model the algebraic relationship between the number of cases and the other variables. The cases showed a positive correlation (r = 0.663) with density, and their relationship was consistent with a cubic function. Sanitation coverage also showed a positive correlation (r = 0.679), but the most straightforward algebraic representation was a quadratic function. The impact of population density on the number of COVID-19 cases was intuitive, but the logic points towards the highest number of cases where sanitation facilities lacked the most. Thus, the influence of other factors outweighed the effect of sanitation, or people tend to be careless before the sense of security where the sanitation is better. Nevertheless, these findings can support predictions and decision-making, and the population needs to abide by the Government's recommendations.

Relevância das Condições Meteorológicas para a Ocorrência da COVID-19 / Relevance of Meteorological Conditions for the Occurrence of COVID-19

Desde a declaração da COVID-19 como Emergência Internacional de Saúde Pública (PHEIC) pela Organização Mundial da Saúde (OMS), tem-se tentado identificar factores que afectam o comportamento da pandemia para garantir melhor controlo. Dos diversos factores, os meteorológicos estão entre os mais importantes. Objectivo: Analisar a relação estatística entre duas variáveis meteorológicas ­ temperatura e pressão atmosférica ­ e a frequência de casos confirmados de COVID-19 em Moçambique. Tipo de estudo: observacional e longitudinal e estatístico. Local: Moçambique, área de Maputo (Província e Cidade) e Província de Nampula. População: De acordo com o Censo 2017, Moçambique tem 27 909 798 habitantes, área de Maputo tem 3 595 547 e a Província de Nampula tem 6 102 867. Métodos: Os dados meteorológicos foram obtidos diariamente nas bases de dados AccuWeather, Time and Date AS e Weather Spark, e o número de casos confirmados de COVID-19 a partir da informação diária dos órgãos oficiais de comunicação do Governo de Moçambique.

Since the declaration of COVID-19 as an International Public Health Emergency (PHEIC) by the World Health Organization (WHO), efforts have been made to identify factors that affect the behavior of the pandemic to ensure better control. Of the various factors, meteorological ones are among the most important. Objective: To analyze the statistical relationship between two meteorological variables ­ temperature and atmospheric pressure ­ and the frequency of confirmed cases of COVID-19 in Mozambique. Type of study: observational and longitudinal and statistical. Location: Mozambique, Maputo area (Province and City) and Nampula Province. Population: According to the 2017 Census, Mozambique has 27,909,798 inhabitants, Maputo area has 3,595,547 and Nampula Province has 6,102,867. Methods: Meteorological data were obtained daily from AccuWeather, Time and Date databases. AS and Weather Spark, and the number of confirmed cases of COVID-19 from daily information from the official communication bodies of the Government of Mozambique.

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

Esophageal cancer in Mozambique: should mycotoxins be a concern?

Fumonisin B1 (FB1) is a mycotoxin frequently found in agricultural commodities. The toxin poses a considerable risk for human and animal health. FB1 is among several mycotoxins produced by Fusarium spp. contaminating virtually any cereal and other Poaceae. Their intracellular action includes the promotion of oxidative stress through the generation of reactive oxygen species (ROS) that damage biomolecules such as DNA. These toxic effects were observed in vivo and in vitro. However, the association between esophageal lesions and oxidative stress induced by FB1. Studies in China, Iran and South Africa showed higher exposure to fumonisins in areas with higher risk of esophageal cancer (EC). Exposure to mycotoxins may be inevitable in Mozambique. How mycotoxins, particularly fumonisins from the contaminated food, can be associated with the emergence of EC in Mozambique? Herein, we revise the literature and present some pieces of evidence in order to highlight the burden of mycotoxins and to provide evidence-based considerations for the stakeholders involved in the management of the EC agenda in Mozambique. The information presented herein supports the need to implement novel and/or to revisit the existent detoxification methods to reduce the global burden of mycotoxins and its outcomes in health management.

Outbreak of Cholera Due to Cyclone Kenneth in Northern Mozambique, 2019.

Cyclone Kenneth was the strongest in the recorded history of the African continent. It landed in the Cabo Delgado province in northern Mozambique on 25 April 2019, causing 45 deaths, destroying approximately 40,000 houses, and leaving 374,000 people in need for assistance, most at risk of acquiring waterborne diseases such as cholera. This short article aims to explain how the resulting cholera outbreak occurred and the response by the government and partner organizations. The outbreak was declared on 2 May 2019, after 14 cases were recorded in Pemba city (11 cases) and the Mecúfi district (3 cases). The disease spread to Metuge, and by the 12th of May 2019, there were 149 cases. Aware of the risk of an outbreak of cholera, the government and partners took immediate action as the cyclone ended, adapting the Cholera Response Plan for Beira, revised after the experience with cyclone Idai (4-21 March 2019). The response relevant to cholera epidemics consisted of social mobilization campaigns for prevention, establishment of treatment centers and units, coordination to improve of water, sanitation and hygiene, and surveillance. By 26 May 2019, 252,448 people were immunized in the area affected by cyclone Kenneth. The recovery process is ongoing but the number of new cases has been reducing, seemingly due to an efficient response, support of several organizations and collaboration of the civil society. Future interventions shall follow the same model of response but the government of Mozambique shall keep a contingency fund to manage disasters such as cyclone Idai and Kenneth. The unlikeliness of two cyclones (Idai and Kenneth) within two months after decades without such kind of phenomena points towards the problem of climate change, and Mozambique needs to prepare effective, proven response plans to combat outbreaks of waterborne diseases due to cyclones.

Esophageal cancer in Mozambique: should mycotoxins be a concern?

Fumonisin B1 (FB1) is a mycotoxin frequently found in agricultural commodities. The toxin poses a considerable risk for human and animal health. FB1 is among several mycotoxins produced by Fusarium spp. contaminating virtually any cereal and other Poaceae. Their intracellular action includes the promotion of oxidative stress through the generation of reactive oxygen species (ROS) that damage biomolecules such as DNA. These toxic effects were observed in vivo and in vitro. However, the association between esophageal lesions and oxidative stress induced by FB1. Studies in China, Iran and South Africa showed higher exposure to fumonisins in areas with higher risk of esophageal cancer (EC). Exposure to mycotoxins may be inevitable in Mozambique. How mycotoxins, particularly fumonisins from the contaminated food, can be associated with the emergence of EC in Mozambique? Herein, we revise the literature and present some pieces of evidence in order to highlight the burden of my cotoxins and to provide evidence-based considerations for the stakeholders involved in the management of the EC agenda in Mozambique. The information presented herein supports the need to implement novel and/or to revisit the existent detoxification methods to reduce the global burden of mycotoxins and its outcomes in health management.

Why RGB Imaging Should be Used to Analyze Fusarium Graminearum Growth and Estimate Deoxynivalenol Contamination.

Size-based fungal growth studies are limited because they do not provide information about the mold's state of maturity, and measurements such as radius and diameter are not practical if the fungus grows irregularly. Furthermore, the current methods used to detect diseases such as Fusarium head blight (FHB) or mycotoxin contamination are labor-intensive and time consuming. FHB is frequently detected through visual examination and the results can be subjective, depending on the skills and experience of the analyzer. For toxin determination (e.g., deoxynivalenol (DON), the best methods are expensive, not practical for routine. RGB (red, green and blue) imaging analysis is a viable alternative that is inexpensive, easy to use and seemingly better if enhanced with statistical methods. This short communication explains why RGB imaging analysis should be used instead of size-based variables as a tool to measure growth of Fusarium graminearum and DON concentration.

Stress tolerance of Staphylococcus aureus with different antibiotic resistance profiles.

Staphylococcus aureus (S. aureus) is a zoonotic bacterium and is among the most important pathogens causing bacterial foodborne diseases. In recent years, disease caused by antibiotic-resistant S. aureus is a serious clinical problem that poses a great threat to public health. In this study, we examined the drug-resistance phenotypes and genotypes of 9 S. aureus strains. One strain was obtained from the China Center for Type Culture Collection (CCTCC), and the remaining eight strains were isolated from food. Two common methods (the Kirby-Bauer disk diffusion and broth microdilution methods) were used to detect bacterial drug resistance. Then, we analysed the relationship between the bacterial drug resistance phenotypes and genotypes. We found that some S. aureus strains isolated from food were drug-resistant or even multi-drug resistant and that there was not a perfect match between resistance phenotypes and genotypes. The viabilities of the drug-sensitive (DS), drug-resistant (DR), and multi-drug resistant (MDR) S. aureus strains were also compared when they were exposed to conditions of acid (HCl, pH = 1.5), heat (63 °C), and osmotic pressure (30% NaCl). The results showed that the DR and MDR bacterial strains had survival rates similar to or higher than those of the DS strains under environmental stress.

Fusarium graminearum Colors and Deoxynivalenol Synthesis at Different Water Activity.

Deoxynivalenol (DON) is a well-known mycotoxin, responsible for outbreaks of gastrointestinal disorders in Japan. Fusarium graminearum, a parasite of cereal crops, produces this toxin and this is one of the reasons why it is important to understand its metabolism. It is possible to predict the mold's color change and the quantity of DON synthesized throughout its lifecycle. Furthermore, aw has been found to affect the amount of DON. This study aimed to analyze the potential of F. graminearum surface color as a predictor of DON concentration at aw = 0.94, 0.97, and 0.99. Thus, 36 specimens were incubated at 25 °C, 12 at each aw. After 4, 8, 12, and 16 days, three specimens from each aw were collected for color analysis and DON quantification. For color analysis, photos were taken and red, green and blue (RGB) channels were measured on ImageJ software. DON was quantified through liquid chromatography (HPLC). Color changes were only observed at aw = 0.99 because at lower aw the molds presented high growth of white mycelium. Yet, DON increased in all cases. It was only possible to relate the colors with DON concentration at aw = 0.99, where they presented inverse proportionality.

Comprehensive Description of Fusarium graminearum Pigments and Related Compounds.

Several studies have explored in depth the biochemistry and genetics of the pigments present in Fusarium graminearum, but there is a need to discuss their relationship with the mold's observable surface color pattern variation throughout its lifecycle. Furthermore, they require basic cataloguing, including a description of their major features known so far. Colors are a viable alternative to size measurement in growth studies. When grown on yeast extract agar (YEA) at 25 °C, F. graminearum initially exhibits a whitish mycelium, developing into a yellow-orange mold by the sixth day and then turning into wine-red. The colors are likely due to accumulation of the golden yellow polyketide aurofusarin and the red rubrofusarin, but the carotenoid neurosporaxanthin also possibly plays a major role in the yellow or orange coloration. Torulene might contribute to red tones, but it perhaps ends up being converted into neurosporaxanthin. Culmorin is also present, but it does not contribute to the color, though it was initially isolated in pigment studies. Additionally, there is the 5-deoxybostrycoidin-based melanin, but it mostly occurs in the teleomorph's perithecium. There is still a need to chemically quantify the pigments throughout the lifecycle, and analyze their relationships and how much each impacts F. graminearum's surface color.

A Glance at Aflatoxin Research in Mozambique.

In Mozambique, aflatoxin research started in the 1960's and has been carried through apparently unrelated efforts according to opportunities. However, they can be grouped in two sets: early epidemiological studies and recent agricultural research. Early investigators found a strong correlation between aflatoxin contamination and primary liver cancer. Since then, there have been efforts to examine the extent of contamination, especially in groundnuts and maize. More recent investigations and interventions aimed mostly to reduce the level of contamination, enough to allow such commodities to gain acceptance in the international market. The current status of knowledge is still marginal but the increasing involvement of local authorities, academia, and international organizations seems promising.

The Use of Colors as an Alternative to Size in Fusarium graminearum Growth Studies.

Size-based fungal growth studies have limitations. For example, the growth in size stops in closed systems once it reaches the borders and poorly describes metabolic status, especially in the stationary phase. This might lead mycotoxin studies to unrealistic results. Color change could be a viable alternative, as pigments result from a mold’s metabolic activity. This study aimed to verify the possibility of using gray values and the RGB system to analyze the growth of Fusarium graminearum. It consisted of color and area measurements using ImageJ software for specimens grown in yeast extract agar (YEA). The results suggest the utility of color and gray values as reliable tools to analyze the growth of F. graminearum.