Engaging Men and Boys in Maternal Health: Results from a Participatory Film Project in Maputo Province.

BACKGROUND: Research has demonstrated that men often play a critical role in increasing access to and use of maternal health services. Improving male involvement in maternal health can contribute to better health outcomes for the mother, the newborn, and the father. OBJECTIVES: Assess barriers and facilitators for male involvement in maternal health in a local community in Mozambique and analyze perceived benefits and challenges of using a participatory approach. METHODS: Participants engaged in a participatory video project involving different components: a workshop around gender norms, a video workshop, a filming phase, a feedback screening, and a dissemination phase of the final film. Qualitative data were gathered throughout the participatory process and analyzed thematically by an inductive approach. In addition, the participatory video framework was used to analyze the participatory process. RESULTS: Our research project showed that participants faced several barriers for their involvement in maternal health, including strong patriarchal gender norms in the community, unwelcoming health care facilities, and economic challenges. Facilitators for their engagement included a strong sense of responsibility for taking care of the family, the willingness to generate change among the younger generation and the valorization of women as equal partners. Our findings suggest that the project empowered the participants to take up a more active and supporting role in maternal health and inspire other men's involvement. CONCLUSIONS: The participatory approach used in our study helped to identify and tackle barriers for male involvement in maternal health at community level, and dissemination of findings. Community campaigns should consider both barriers and facilitators for more male involvement in maternal health. In addition, governments and program planners should invest on male-friendliness of health facilities and to minimize the incidence of bribery and other illegal practices for health services.

Antimicrobial Resistance of Campylobacter spp. Isolates from Broiler Chicken Meat Supply Chain in Maputo, Mozambique.

The transfer of antimicrobial-resistant bacterial strains from poultry products to humans has become a public health issue, a possible cause being the indiscriminate antibiotics use in poultry production. Therefore, in this study we examined the susceptibility of 24 Campylobacter isolates from broiler chicken carcasses from supermarkets, informal markets, and a slaughterhouse in Maputo, Mozambique, to 13 antibiotics. The results of the study showed that the isolates were resistant to at least six antibiotics in four classes. Isolates from supermarkets were resistant to tetracycline, doxycycline, erythromycin, streptomycin, and cotrimoxazole (100%); penicillin (87.5%); and gentamycin and sulfamethoxazole (75%). Isolates from informal markets were resistant to tetracycline (100%); doxycycline and penicillin (87.5%); and erythromycin (75%), whereas isolates from the slaughterhouse were resistant to tetracycline, doxycycline, penicillin, and colistin (100%); erythromycin (87.5%); and streptomycin (75%). Overall, isolates from supermarkets showed higher resistance profiles (37.9%) than those from informal markets (31.5%) and slaughterhouses (30.6%); however, the difference was not significant (p > 0.05). The findings of the study showed that there is a high circulation of antimicrobial-resistant Campylobacter in the broiler meat supply chain of Maputo, Mozambique, representing sources for human infections and highlighting the need for measures regulating antibiotics use in livestock production.

Antiplasmodial Mode of Action of Pantothenamides: Pantothenate Kinase Serves as a Metabolic Activator Not as a Target.

N-Substituted pantothenamides (PanAms) are pantothenate analogues with up to nanomolar potency against blood-stage Plasmodium falciparum (the most virulent species responsible for malaria). Although these compounds are known to target coenzyme A (CoA) biosynthesis and/or utilization, their exact mode of action (MoA) is still unknown. Importantly, PanAms that retain the natural ß-alanine moiety are more potent than other variants, consistent with the involvement of processes that are selective for pantothenate (the precursor of CoA) or its derivatives. The transport of pantothenate and its phosphorylation by P. falciparum pantothenate kinase (PfPanK, the first enzyme of CoA biosynthesis) are two such processes previously highlighted as potential targets for the PanAms' antiplasmodial action. In this study, we investigated the effect of PanAms on these processes using their radiolabeled versions (synthesized here for the first time), which made possible the direct measurement of PanAm uptake by isolated blood-stage parasites and PanAm phosphorylation by PfPanK present in parasite lysates. We found that the MoA of PanAms does not involve interference with pantothenate transport and that inhibition of PfPanK-mediated pantothenate phosphorylation does not correlate with PanAm antiplasmodial activity. Instead, PanAms that retain the ß-alanine moiety were found to be metabolically activated by PfPanK in a selective manner, forming phosphorylated products that likely inhibit other steps in CoA biosynthesis or are transformed into CoA antimetabolites that can interfere with CoA utilization. These findings provide direction for the ongoing development of CoA-targeted inhibitors as antiplasmodial agents with clinical potential.

A pantetheinase-resistant pantothenamide with potent, on-target, and selective antiplasmodial activity.

Pantothenamides inhibit blood-stage Plasmodium falciparum with potencies (50% inhibitory concentration [IC50], ∼20 nM) similar to that of chloroquine. They target processes dependent on pantothenate, a precursor of the essential metabolic cofactor coenzyme A. However, their antiplasmodial activity is reduced due to degradation by serum pantetheinase. Minor modification of the pantothenamide structure led to the identification of α-methyl-N-phenethyl-pantothenamide, a pantothenamide resistant to degradation, with excellent antiplasmodial activity (IC50, 52 ± 6 nM), target specificity, and low toxicity.

Efficacy of albendazole against Taenia multiceps larvae in experimentally infected goats.

A controlled trial was conducted to evaluate the efficacy of three therapeutics regimes of albendazole (ABZ) against Taenia multiceps larvae in experimental infected goats. Forty-nine goats experimentally infected with 3000 T. multiceps eggs were selected and randomly divided into treatment or control groups. Treatment with 10mg/kg for 3 days for group 1 (G1), 10mg/kg for group 2 (G2) and 20mg/kg/day for group 3 (G3) was applied 2 months after infection; group 4 (G4) served as a control group. A treatment with doses of 10mg/kg/day for 3 days on group 5 (G5) and group 6 (G6) was used as control, 5 months after the infection. The efficacy of ABZ was assessed as percentage of non-viable cysts which were determined by morphologic characteristics, movement and methyl blue staining technique. The efficacy of ABZ against 2 months old cysts was significantly different from the control and were 90.3% (28/31), 72.7% (8/11) and 73.9% (14/19) for G1, G2 and G3, respectively. No differences were observed in cyst viability between treated and control groups for 5-month old cysts. The results in this study indicate that ABZ is effective in goats against 2-month-old cysts of T. multiceps larva located in tissues outside the brain.

Pantothenamides are potent, on-target inhibitors of Plasmodium falciparum growth when serum pantetheinase is inactivated.

Growth of the virulent human malaria parasite Plasmodium falciparum is dependent on an extracellular supply of pantothenate (vitamin B(5)) and is susceptible to inhibition by pantothenate analogues that hinder pantothenate utilization. In this study, on the hunt for pantothenate analogues with increased potency relative to those reported previously, we screened a series of pantothenamides (amide analogues of pantothenate) against P. falciparum and show for the first time that analogues of this type possess antiplasmodial activity. Although the active pantothenamides in this series exhibit only modest potency under standard in vitro culture conditions, we show that the potency of pantothenamides is selectively enhanced when the parasite culture medium is pre-incubated at 37°C for a prolonged period. We present evidence that this finding is linked to the presence in Albumax II (a serum-substitute routinely used for in vitro cultivation of P. falciparum) of pantetheinase activity: the activity of an enzyme that hydrolyzes the pantothenate metabolite pantetheine, for which pantothenamides also serve as substrates. Pantetheinase activity, and thereby pantothenamide degradation, is reduced following incubation of Albumax II-containing culture medium for a prolonged period at 37°C, revealing the true, sub-micromolar potency of pantothenamides. Importantly we show that the potent antiplasmodial effect of pantothenamides is attenuated with pantothenate, consistent with the compounds inhibiting parasite proliferation specifically by inhibiting pantothenate and/or CoA utilization. Additionally, we show that the pantothenamides interact with P. falciparum pantothenate kinase, the first enzyme involved in converting pantothenate to coenzyme A. This is the first demonstration of on-target antiplasmodial pantothenate analogues with sub-micromolar potency, and highlights the potential of pantetheinase-resistant pantothenamides as antimalarial agents.

Structural modification of pantothenamides counteracts degradation by pantetheinase and improves antiplasmodial activity.

Pantothenamides are secondary or tertiary amides of pantothenic acid, the vitamin precursor of the essential cofactor and universal acyl carrier coenzyme A. A recent study has demonstrated that pantothenamides inhibit the growth of blood-stage Plasmodium falciparum with submicromolar potency by exerting an effect on pantothenic acid utilization, but only when the pantetheinase present in the growth medium has been inactivated. Here, we demonstrate that small modifications of the pantothenamide core structure are sufficient to counteract pantetheinase-mediated degradation and that the resulting pantothenamide analogues still inhibit the in vitro proliferation of P. falciparum by targeting a pantothenic acid-dependent process (or processes). Finally, we investigated the toxicity of the most potent analogues to human cells and show that the selectivity ratio exceeds 100 in one case. Taken together, these results provide further support for pantothenic acid utilization being a viable target for antimalarial drug discovery.

Os homens e o HIV em Mocambique: papel; riscos e responsabilidades

Desde que foi diagnosticado o primeiro caso de HIV em Mocambique em 1986; o numero de individuos infectados pelo HIV; das quais cerca de 600.000 sao mulheres; 450.000 homens e mais de 100.000 criancas-menos de 15 anos. De acordo com o grupo de trabalho sobre o impacto Demografico do HIV/SIDA em Mocambique; durante o ano de 2001; cerca de 500 novas infeccoes eram registadas por dia; com cerca de metade (44;2 por cento) ocorrendo na zona centro do pais (provincias de Sofala; Manica; Tete e Zambezia). A provincia de Manica apresenta a taxa mais alta de prevalencia da infeccao pelo HIV em adultos (15 a 49 anos); com 21;1 por cento-uma em cada cinco pessoas; seguida das provincias de Tete e Sofala onde 19;8 por cento e 18;7 por cento da populacao adulta respectivamente; esta infectada. A zona Norte (provincias de Nampula; Cabo Delgado e Niassa) apresenta a taxa de prevalencia mais baixa do pais; com 5;7 por cento da populacao infectada e a zona sul (provincias de Maputo; Gaza e Inhambane) apresenta taxas de prevalencia intermedias; com 13;2 por cento da populacao adulta infectada