Etiology-specific incidence and mortality of diarrheal diseases in the African region: a systematic review and meta-analysis.

BACKGROUND: Diarrheal diseases substantially affect public health impact in low- and middle-income countries (LMIC), particularly in Africa, where previous studies have indicated a lack of comprehensive data. With a growing number of primary studies on enteric infections in Africa, this study aimed to estimate the incidence and mortality of diarrheal pathogens across all ages in Africa in the year 2020. We also explored different methodological assumptions to allow comparison with other approaches. METHODS: Through a systematic review and meta-analysis of data from African LMICs, we estimated the etiology proportions for diarrheal diseases and deaths. We combined the etiology proportions with incidence data collected from a population survey in Africa from 2020 and mortality data from the Global Health Observatory of WHO. RESULTS: We estimated 1,008 billion diarrhea cases (95% UI 447 million-1,4 billion) and 515,031 diarrhea deaths (95% UI 248,983-1,007,641) in the African region in 2020. In children under five, enteroaggregative E. coli (EAEC) (44,073 cases per 100,000 people, 95% UI 18,818 - 60,922) and G. lamblia (36,116 cases per 100,000 people, 95% UI 15,245 - 49,961) were the leading causes of illness. Enteroinvasive E. coli (EIEC) (155 deaths per 100,000 people, 95% UI 106.5-252.9) and rotavirus (61.5 deaths per 100,000 people, 95% UI 42.3-100.3) were the primary causes of deaths. For children over five and adults, Salmonella spp. caused the largest number of diarrheal cases in the population of children ≥ 5 and adults (122,090 cases per 100,000 people, 95% UI 51,833 - 168,822), while rotavirus (16.4 deaths per 100,000 people, 95% UI 4.2-36.7) and enteroaggregative E. coli (EAEC) (14.6 deaths per 100,000 people, 95% UI 3.9-32.9) causing the most deaths. Geographically, the highest incidence of diarrhea was in Eastern Africa for children under five (114,389 cases per 100,000 people, 95% UI 34,771 - 172,884) and Central Africa for children over five and adults (117,820 cases per 100,000 people, 95% UI 75,111-157,584). Diarrheal mortality was highest in Western Africa for both children below five and above (children < 5: 194.5 deaths per 100,000 people, 95% UI 120-325.4; children ≥ 5 and above: 33.5 deaths per 100,000 people, 95% UI 12.9-75.1). CONCLUSION: These findings provide new information on the incidence and mortality of sixteen pathogens and highlight the need for surveillance and control of diarrheal infectious diseases in Africa. The cause-specific estimates are crucial for prioritizing diarrheal disease prevention in the region.

Understanding male circumcision: insights from a peri-urban community in Maputo City, Mozambique.

BACKGROUND: Circumcision is a protective measure against sexually transmitted infections (STIs), reducing the risk of HIV infection. This study reported coverage of male circumcision and assessed the factors associated with male uncircumcision in a peri-urban area in Maputo City, Mozambique. METHODS: This cross-sectional study of the Health Demographic Surveillance System in the Polana Caniço neighborhood investigated the sociodemographic and behavioral factors associated with uncircumcised males aged 15-49 y from October 2019 to June 2021. Data were collected from an HIV risk factors questionnaire and descriptive analyses conducted comparing self-reported male circumcision status by sociodemographic factors and sexual behaviors. The association was assessed via χ2 tests, and a multivariable logistic regression model was constructed. Adjusted ORs and 95% CIs were reported for factors associated with uncircumcised status. RESULTS: Of the 3481 males aged 15-49 y who responded to the questionnaire, 79.5% (2766) self-reported being circumcised. The percentage of uncircumcised men steadily increased with age, ranging from 12.4% (95) among males aged 15-19 y to 34.5% (148) of men aged 40-49 y. Men without education or with primary education, as well as those not practicing Islam, were 3-4 times more likely to be uncircumcised. Uncircumcised men were more likely to self-report an STI and a lack of condom use. CONCLUSIONS: Being uncircumcised was associated with not using condoms and having STIs, highlighting the need to further emphasize combination HIV-prevention programs and regular HIV/STI screening. Targeting males with lower education and across religions can help reach those with lower coverage of this effective prevention intervention.

Experiences and perceptions of urine sampling for tuberculosis testing among HIV patients: a multisite qualitative descriptive study.

OBJECTIVES: Evidence on the acceptability of urine-based assays for tuberculosis (TB) diagnosis among patients remains limited. We sought to describe patients' experiences and perceptions of urine sampling for TB testing at point of care. SETTING: Study sites in Kenya, Uganda, Mozambique and South Africa. PARTICIPANTS: Adult ambulatory HIV patients enrolled in a TB diagnostic study were selected purposively. INTERVENTION: For this qualitative descriptive study, audiorecorded individual interviews conducted with consenting participants were translated, transcribed and analysed using content analysis. Ethical agreement was obtained from relevant ethical review committees. RESULTS: Fifty-eight participants were interviewed. Three domains were identified. Overall, participants described urine sampling as easy, rapid and painless, with the main challenge being lacking the urge. Urine was preferred to sputum sampling in terms of simplicity, comfort, stigma reduction, convenience and practicality. While perceptions regarding its trustworthiness for TB diagnosis differed, urine sampling was viewed as an additional mean to detect TB and beneficial for early diagnosis. Participants were willing to wait for several hours for same-day results to allay the emotional, physical and financial burden of having to return to collect results, and would rather not pay for the test. Facilitators of urine sampling included cleanliness and perceived privacy of sampling environments, comprehensive sampling instructions and test information, as well as supplies such as toilet paper and envelopes ensuring confort and privacy when producing and returning samples. Participants motivation for accepting urine-based TB testing stemmed from their perceived susceptibility to TB, the value they attributed to their health, especially when experiencing symptoms, and their positive interactions with the medical team. CONCLUSIONS: This study suggests that urine sampling is well accepted as a TB diagnostic method and provides insights on how to promote patients' uptake of urine-based testing and improve their sampling experiences. These results encourage the future broad use of urine-based assays at point of care.

Countrywide Mortality Surveillance for Action in Mozambique: Results from a National Sample-Based Vital Statistics System for Mortality and Cause of Death.

Sub-Saharan Africa lacks timely, reliable, and accurate national data on mortality and causes of death (CODs). In 2018 Mozambique launched a sample registration system (Countrywide Mortality Surveillance for Action [COMSA]-Mozambique), which collects continuous birth, death, and COD data from 700 randomly selected clusters, a nationally representative population of 828,663 persons. Verbal and social autopsy interviews are conducted for COD determination. We analyzed data collected in 2019-2020 to report mortality rates and cause-specific fractions. Cause-specific results were generated using computer-coded verbal autopsy (CCVA) algorithms for deaths among those age 5 years and older. For under-five deaths, the accuracy of CCVA results was increased through calibration with data from minimally invasive tissue sampling. Neonatal and under-five mortality rates were, respectively, 23 (95% CI: 18-28) and 80 (95% CI: 69-91) deaths per 1,000 live births. Mortality rates per 1,000 were 18 (95% CI: 14-21) among age 5-14 years, 26 (95% CI: 20-31) among age 15-24 years, 258 (95% CI: 230-287) among age 25-59 years, and 531 (95% CI: 490-572) among age 60+ years. Urban areas had lower mortality rates than rural areas among children under 15 but not among adults. Deaths due to infections were substantial across all ages. Other predominant causes by age group were prematurity and intrapartum-related events among neonates; diarrhea, malaria, and lower respiratory infections among children 1-59 months; injury, malaria, and diarrhea among children 5-14 years; HIV, injury, and cancer among those age 15-59 years; and cancer and cardiovascular disease at age 60+ years. The COMSA-Mozambique platform offers a rich and unique system for mortality and COD determination and monitoring and an opportunity to build a comprehensive surveillance system.

Causas e Determinantes Sociais de Mortalidade em Mulheres Adultas em Moçambique / Causes and Social Determinants of Mortality in Adult Women in Mozambique

Introdução: As mortes em mulheres são consideradas um dos grandes desafios da saúde pública mundial, emespecial em países em desenvolvimento, uma vez que a maioria das mortes são por causas evitáveis. Pretende-secom este estudo identificar as principais causas biológicas e sociais das mortes de mulheres ocorridas em Mo-çambique no período de 2019 à 2020. Métodos: Neste estudo foram analisados registos de mortes de mulheres com idade igual ou superior a 18 anos ocorridas em 700 conglomerados, notificadas por agentes comunitários através de um telemóvel. Para a identificação da causa da morte foi administrado aos familiares das falecidas umquestionário de autópsia verbal e social desenvolvido pela OMS. A análise de dados foi feita usando o software STATA 17 e aplicados os testes qui-quadrado de Pearson a um nível de significância de 5%. As causas de morte foram atribuídas usando o algorítmo InSilicoVA. A procura de cuidados foi analisada em diferentes grupos para determinar se os cuidados foram procurados por provedores formais (médico, enfermeira/parteira e agente comunitário de saúde treinado) ou outros provedores (provedor tradicional, familiar e farmacêutico). Resultados: Do total demortes notificadas de 2019 a 2020, 2019 mortes foram de mulheres com idade >/= 18 anos. Sendo, as principais causas de morte foram HIV (25%), cancro (17%), doenças cardiovasculares (9%), trauma (7%) e causas maternas (7%). A maioria das mortes por HIV, cancro e doenças cardiovasculares ocorreram fora da unidade sanitária. Conclusão: A procura de cuidados antes da morte é observada nas mulheres cuja causa da morte foi cancro quando comparada a procura de cuidados por mulheres cuja causa da morte foi o HIV ou doenças cardiovasculares. Conhecer os determinantes de mortalidade por causas evitáveis permite orientar a tomada de decisões políticas para melhoria de programas e intervenções na área de saúde da mulher.

Background: Deaths in women are considered one of the great challenges of public health worldwide, especially in developing countries, since most deaths are from preventable causes. Objective: The aim of this study is to identify the main biological and social causes of deaths of women that occurred in Mozambique in the period from 2019 to 2020. Methods: In this study, records of deaths of women aged 18 years and over that occurred in 700 conglome rates, notified by, community agents through a mobile phone. To identify the cause of death, a verbal and social autopsy questionnaire developed by the WHO was administered to the relatives of the deceased. Data analysis was performed using STATA 17 software and Pearson's chi-square tests were applied at a significance level of 5%. Causes of death were assigned using the InSilicoVA algorithm. Care-seeking was analyzed across different groups to determine whether care was sought by formal providers (physician, nurse/midwife, and trained community health worker) or other providers (traditional provider, family member, and pharmacist). Results: Out of a total ofreported deaths from 2019 to 2020, 2019 deaths were in women aged 18 or over. The main causes of death were HIV (25%), cancer (17%), cardiovascular disease (9%), trauma (7%) and maternal causes (7%). Most deaths from HIV, cancer and cardiovascular disease occurred outside the health facility. Conclusion: The search for care before death is observed in women whose cause of death was cancer when compared to the search for care by women whose cause of death was HIV or cardiovascular diseases. Knowing the determinants of mortality from preventable causes allows guiding political decision-making to improve programs and interventions around women's health.