Malaria prevention knowledge, attitudes, and practices in Zambezia Province, Mozambique.

BACKGROUND: In Mozambique, socio-economic and cultural factors influence the wide adoption of disease preventive measures that are relevant for malaria control strategies to promote early recognition of disease, prompt seeking of medical care, sleeping under insecticide-treated nets (ITNs), and taking intermittent preventive treatment for pregnant women. However, there is a critical information gap regarding previous and ongoing malaria social and behavioural change (SBC) interventions. The aim of this study is to assess the knowledge, attitudes, practices of beneficiaries of SBC interventions. METHODS: A descriptive cross-sectional survey was undertaken in 2018 in two rural districts of Zambezia Province, Mozambique. A structured questionnaire was administered to 773 randomly selected households. Respondents were the adult heads of the households. Descriptive statistics were done. RESULTS: The main results show that 96.4% of respondents recalled hearing about malaria in the previous 6 months, 90.0% had knowledge of malaria prevention, and 70.0% of preventive measures. Of the 97.7% respondents that had received ITNs through a mass ITN distribution campaign, 81.7% had slept under an ITN the night before the survey. In terms of source of health information, 70.5% mentioned the role of community volunteers in dissemination of malaria prevention messages, 76.1% of respondents considered worship places (churches and mosques) to be the main places where they heard key malaria prevention messages, and 79.1% asserted that community dialogue sessions helped them better understand how to prevent malaria. CONCLUSIONS: Results show that volunteers/activists/teachers played an important role in dissemination of key malaria prevention messages, which brought the following successes: community actors are recognized and people have knowledge of malaria transmission, signs and symptoms, preventive measures, and where to get treatment. There is, however, room for improvement on SBC messaging regarding some malaria symptoms (anaemia and convulsions) and operational research is needed to ascertain the drivers of malaria prevalence and inform the SBC approach.

Malaria prevention knowledge, attitudes, and practices in Zambezia Province, Mozambique

Background: In Mozambique, socio-economic and cultural factors influence the wide adoption of disease preventive measures that are relevant for malaria control strategies to promote early recognition of disease, prompt seeking of medical care, sleeping under insecticide-treated nets (ITNs), and taking intermittent preventive treatment for pregnant women. However, there is a critical information gap regarding previous and ongoing malaria social and behavioural change (SBC) interventions. The aim of this study is to assess the knowledge, attitudes, practices of beneficiaries of SBC interventions. Methods: A descriptive cross-sectional survey was undertaken in 2018 in two rural districts of Zambezia Province, Mozambique. A structured questionnaire was administered to 773 randomly selected households. Respondents were the adult heads of the households. Descriptive statistics were done. Results: The main results show that 96.4% of respondents recalled hearing about malaria in the previous 6 months, 90.0% had knowledge of malaria prevention, and 70.0% of preventive measures. Of the 97.7% respondents that had received ITNs through a mass ITN distribution campaign, 81.7% had slept under an ITN the night before the survey. In terms of source of health information, 70.5% mentioned the role of community volunteers in dissemination of malaria prevention messages, 76.1% of respondents considered worship places (churches and mosques) to be the main places where they heard key malaria prevention messages, and 79.1% asserted that community dialogue sessions helped them better understand how to prevent malaria. Conclusions: Results show that volunteers/activists/teachers played an important role in dissemination of key malaria prevention messages, which brought the following successes: community actors are recognized and people have knowledge of malaria transmission, signs and symptoms, preventive measures, and where to get treatment. There is, however, room for improvement on SBC messaging regarding some malaria symptoms (anaemia and convulsions) and operational research is needed to ascertain the drivers of malaria prevalence and inform the SBC approach.

"We have this, with my husband, we live in harmony": exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique.

BACKGROUND: Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. METHODS: A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. RESULTS: Participants (n = 106) took part in six FGDs and five IDIs in each district. Those exposed to TTSM commonly stated that the programme influenced more equalitarian gender roles, attitudes and uptake of protective malaria-related practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women's domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and making nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fishing) was men's prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, influential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers first. This inward-facing treatment decision was within their control, in contrast to the frequently transport-dependent, outward-facing decision to attend a health facility. Sharing decisions was described as a feature of a "harmonious household," something that was said to be encouraged by the TTSM intervention and that was both lived and aspirational. CONCLUSIONS: TTSM community dialogues helped communication on both interpersonal (couple) and community levels, ultimately encouraging malaria-related behaviours. Leveraging ways of bringing men and women together to share decision making will improve malaria intervention success.

"We have this, with my husband, we live in harmony": exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique

Background: Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. Methods: A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. Results: Participants (n=106) took part in six FGDs and fve IDIs in each district. Those exposed to TTSM commonly stated that the programme infuenced more equalitarian gender roles, attitudes and uptake of protective malariarelated practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women's domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and mak ing nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fshing) was men's prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, infuential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers frst. This inward-facing treatment decision was within their control, in contrast to the frequently transport-dependent, outward-facing decision to attend a health facility. Sharing decisions was described as a feature of a "harmonious household," something that was said to be encouraged by the TTSM intervention and that was both lived and aspirational.

A cross-sectional exploratory study of knowledge, attitudes, and practices of emergency health care providers in the assessment of child maltreatment in Maputo, Mozambique.

BACKGROUND: In Mozambique, and other low-income countries (LICs), there is little information on the burden of child maltreatment (CM). Emergency care services (ECS) play an important role in recognizing, treating, and intervening in situations of CM. We aim to identify knowledge, attitudes, and practices regarding CM among health care providers in ECS at Mavalane General Hospital in Maputo, Mozambique. METHODS: This exploratory cross-sectional study evaluates the knowledge, attitudes, and practices of health care providers to diagnose and treat cases of CM. A 25 min, pilot-tested verbal interview questionnaire was administered to 49 physicians and nurses working in ECS at Mavalane General Hospital. Interviews were completed between October-November 2010. Data were managed and analyzed in SPSS 14.0 and descriptive statistics were generated. RESULTS: Of 49 health care providers, 83.6% reporting receiving no, or very little CM education or training. Only 61.2% had knowledge of physical abuse as a main form of child maltreatment and 38.8% were able to identify corresponding symptoms of physical abuse. Sexual abuse as a main form of CM was mentioned by 26.5 and 2% cited its symptoms. While 87.7% of health care providers strongly agreed or agreed that they hold an important role in preventing CM, 51.1% also strongly disagreed or disagreed that they feel confident diagnosing and treating CM cases. In regards to follow-up, 14.3% strongly disagreed or disagreed that they know where to refer victims for further follow-up and an additional 14.3% did not know whether they agreed or disagreed. CONCLUSION: This study revealed knowledge gaps in emergency health care provider knowledge of the main forms of CM and their symptoms. The fact that a majority of health care providers in our sample did not receive information specific to CM in their medical education and training could explain this gap, as well as their unawareness of where to refer victims. Given that health care providers believe they play an important role in identifying and treating CM, future research should focus on raising physician awareness of CM and developing education and training materials grounded in cultural contexts to build response capacity in Mozambique and other LICs.

Implementation strategies to increase access and demand of long-lasting insecticidal nets: a before-and-after study and scale-up process in Mozambique.

BACKGROUND: The universal coverage bed nets campaign is a proven health intervention promoting increased access, ownership, and use of bed nets to reduce malaria burden. This article describes the intervention and implementation strategies that Mozambique carried out recently in order to improve access and increase demand for long-lasting insecticidal nets (LLINs). METHODS: A before-and-after study with a control group was used during Stage I of the implementation process. The following strategies were tested in Stage I: (1) use of coupons during household registration; (2) use of stickers to identify the registered households; (3) new LLIN ascription formula (one LLIN for every two people). In Stage II, the following additional strategies were implemented: (4) mapping and micro-planning; (5) training; and (6) supervision. Odds ratio (OR) and 95% confidence interval (CI) were used to compare and establish differences between intervened and control districts in Stage I. Main outcomes were: percentage of LLINs distributed, percentage of target households benefited. RESULTS: In Stage I, 87.8% (302,648) of planned LLINs were distributed in the intervention districts compared to 77.1% (219,613) in the control districts [OR: 2.14 (95% CI 2.11-2.16)]. Stage I results also showed that 80.6% (110,453) of households received at least one LLIN in the intervention districts compared to 72.8% (87,636) in the control districts [OR: 1.56 (95% CI 1.53-1.59)]. In Stage II, 98.4% (3,536,839) of the allocated LLINs were delivered, covering 98.6% (1,353,827) of the registered households. CONCLUSIONS: Stage I results achieved better LLINs and household coverage in districts with the newly implemented strategies. The results of stage II were also encouraging. Additional strategies adaptation is required for a wide-country LLIN campaign.

Superoxide reduction by a superoxide reductase lacking the highly conserved lysine residue.

Superoxide reductases (SORs) are the most recently identified superoxide detoxification systems, being found in microorganisms from the three domains of life. These enzymes are characterized by a catalytic mononuclear iron site, with one cysteine and four histidine ligands of the ferrous active form. A lysine residue in the -EKHVP- motif, located close to the active site, has been considered to be essential for the enzyme function, by contributing to the positive surface patch that attracts the superoxide anion and by controlling the chemistry of the catalytic mechanism through a hydrogen bond network. However, we show here that this residue is substituted by non-equivalent amino acids in several putative SORs from Archaea and unicellular Eukarya. In this work, we focus on mechanistic and spectroscopic studies of one of these less common enzymes, the SOR from the hyperthermophilic Crenarchaeon Ignicoccus hospitalis. We employ pulse radiolysis fast kinetics and spectroscopic approaches to study the wild-type enzyme (-E23T24HVP-), and two mutants, T24K and E23A, the later mimicking enzymes lacking both the lysine and glutamate (a ferric ion ligand) of the motif. The efficiency of the wild-type protein and mutants in reducing superoxide is comparable to other SORs, revealing the robustness of these enzymes to single mutations.

Flavodiiron oxygen reductase from Entamoeba histolytica: modulation of substrate preference by tyrosine 271 and lysine 53.

Flavodiiron proteins (FDPs) are a family of enzymes endowed with bona fide oxygen- and/or nitric-oxide reductase activity, although their substrate specificity determinants remain elusive. After a comprehensive comparison of available three-dimensional structures, particularly of FDPs with a clear preference toward either O2 or NO, two main differences were identified near the diiron active site, which led to the construction of site-directed mutants of Tyr(271) and Lys(53) in the oxygen reducing Entamoeba histolytica EhFdp1. The biochemical and biophysical properties of these mutants were studied by UV-visible and electron paramagnetic resonance (EPR) spectroscopies coupled to potentiometry. Their reactivity with O2 and NO was analyzed by stopped-flow absorption spectroscopy and amperometric methods. These mutations, whereas keeping the overall properties of the redox cofactors, resulted in increased NO reductase activity and faster inactivation of the enzyme in the reaction with O2, pointing to a role of the mutated residues in substrate selectivity.

Complicaciones postoperatorias de la apendicectomía laparoscópica en niños menores de 10 años con apendicitis aguda complicada en el Hospital Nacional Alberto Sabogal sologuren - EsSalud de Enero 2010 a Enero 2012 / Postoperative complications of laparoscopic appendectomy in children under 10 years with complicated acute appendicitis in National Hospital Alberto Sabogal Sologuren-EsSalud January 2010 January 2012

Objetivo: Describir las Complicaciones de la apendicetomía laparoscópica en niños menores de 10 años con Apendicitis Aguda Complicada, atendidos en la Unidad de Cirugía Pediátrica en el Hospital Nacional Alberto Sabogal Sologuren-Es Salud desde el 1 de enero 2010 al 1 de enero 2012. Diseño y Métodos: Se realizó un estudio descriptivo, retrospectivo, transversal de las complicaciones post-operatorias de la apendicetomía laparoscópica en niños menores de 10 años con apendicitis aguda complicada en la Unidad de Cirugía Pediátrica del Hospital Nacional Alberto Sabogal Sologuren en el periodo comprendido enero del 2010 a enero 2012, tornando en cuenta: los datos epidemiológicos, los días de estancia hospitalaria, las complicaciones postoperatorias más frecuentes, el tiempo operatorio según tipo de apendicitis aguda complicada, y el restablecimiento de la dieta sólida postoperatoria. Con el fin de contar con una información, exacta y clara, se utilizaron datos recolectados de 104 historias clínicas, y fueron tabulados con el programa Excel. Resultados: Se realizó el análisis encontrándose un predominio en la edad de entre 6 a 10 años en un 73.07 por ciento en un rango de 0 a 10 años, siendo el de menor frecuencia el del grupo de entre 0-2 años de edad. La incidencia de niños con diagnóstico de apendicitis aguda complicada en nuestra institución, ha sido de 32.37 por ciento. Las complicaciones post operatorias se encuentran en el orden del 29 por ciento, encontrándose en primer lugar la infección de la herida operatoria que representan el 39.39 por ciento del total de complicaciones seguida los abscesos intra abdominales que representa el 30.30 por ciento del total de complicaciones. Se analizaron los días de estancia hospitalaria de los pacientes en estudio siendo la estancia de mayor frecuencia entre 4 y 6 días, con un promedio de 5.1 días de permanencia. Conclusiones: La incidencia de apendicitis aguda complicada en niños menores de 10 años fue de 32.37...

Objective: To describe the complications of laparoscopic appendectomy in children under 10 years with Complicated Acute Appendicitis treated at the Pediatric Surgery Unit at the National Hospital Alberto Sabogal Sologuren from January 2010 to January 2012. Design and Methods: A descriptive, retrospective, cross about postoperative complications of laparoscopic appendectomy in children under 10 years with acute appendicitis complicated at the Pediatric Surgery Unit at the National Hospital Alberto Sabogal Sologuren in the period January 2010 to January 2012, taking into account: the epidemiological data, the hospital stay, more frequent postoperative complications, operative time by type of complicated acute appendicitis, and the restoration of postoperative solid diet. In order to have information, accurate and clear, we used data collected from 104 clinical records, and were tabulated with Excel. Results: Analysis was performed on the finding of predominant age between 6-10 years in a 73.07 per cent in the range of 0-10 years, with the lower frequency group between 0-2 years old. Incidence of children with complicated acute appendicitis in our institution has been of 32.37 per cent. Postoperative complications are on the order of 29 per cent. Finding firstly wound infection accounting for 39.39 per cent of all complications followed by intra-abdominal abscesses, representing 30.30 per cent of all complications. We analyzed the hospital stay of patients in the study still stay most often between 4 and 6 days, with an average stay of 5.1 days. Conclusions: The incidence of complicated appendicitis in children under 10 years was 32.37 per cent, the age group most often between 6 and 10 years. Complicated acute appendicitis in children younger than 10 years, was more common in males. The average postoperative hospital stay was 5.1 days for acute appendicitis cases necrotic, 6.2 days for cases of acute appendicitis with localized peritonitis, and 9.4 days for...

A detoxifying oxygen reductase in the anaerobic protozoan Entamoeba histolytica.

We report the characterization of a bacterial-type oxygen reductase abundant in the cytoplasm of the anaerobic protozoan parasite Entamoeba histolytica. Upon host infection, E. histolytica is confronted with various oxygen tensions in the host intestine, as well as increased reactive oxygen and nitrogen species at the site of local tissue inflammation. Resistance to oxygen-derived stress thus plays an important role in the pathogenic potential of E. histolytica. The genome of E. histolytica has four genes that encode flavodiiron proteins, which are bacterial-type oxygen or nitric oxide reductases and were likely acquired by lateral gene transfer from prokaryotes. The EhFdp1 gene has higher expression in virulent than in nonvirulent Entamoeba strains and species, hinting that the response to oxidative stress may be one correlate of virulence potential. We demonstrate that EhFdp1 is abundantly expressed in the cytoplasm of E. histolytica and that the protein levels are markedly increased (up to ~5-fold) upon oxygen exposure. Additionally, we produced fully functional recombinant EhFdp1 and demonstrated that this enzyme is a specific and robust oxygen reductase but has poor nitric oxide reductase activity. This observation represents a new mechanism of oxygen resistance in the anaerobic protozoan pathogen E. histolytica.

Superoxide reductase from Nanoarchaeum equitans: expression, purification, crystallization and preliminary X-ray crystallographic analysis.

Superoxide reductases (SORs) are the most recent oxygen-detoxification system to be identified in anaerobic and microaerobic bacteria and archaea. SORs are metalloproteins that are characterized by their possession of a catalytic nonhaem iron centre in the ferrous form coordinated by four histidine ligands and one cysteine ligand. Ignicoccus hospitalis, a hyperthermophilic crenarchaeon, is the only organism known to date to serve as a host for Nanoarchaeum equitans, a nanosized hyperthermophilic archaeon isolated from a submarine hot vent which completely depends on the presence of and contact with I. hospitalis cells for growth to occur. Similarly to I. hospitalis, N. equitans has a neelaredoxin (a 1Fe-type SOR) that keeps toxic oxygen species under control, catalysing the one-electron reduction of superoxide to hydrogen peroxide. Blue crystals of recombinant N. equitans SOR in the oxidized form (12.7 kDa, 109 residues) were obtained using polyethylene glycol (PEG 2000 MME) as precipitant. These crystals diffracted to 1.9 Å resolution at 100 K and belonged to the orthorhombic space group P2(1)2(1)2(1), with unit-cell parameters a = 51.88, b = 82.01, c = 91.30 Å. Cell-content analysis suggested the presence of four monomers in the asymmetric unit. The Matthews coefficient (V(M)) was determined to be 1.9 Å(3) Da(-1), corresponding to an estimated solvent content of 36%. Self-rotation function and native Patterson calculations suggested a tetramer with 222 point-group symmetry, similar to other 1Fe-SORs. The three-dimensional structure will be determined by the molecular-replacement method.

Evaluación psicodiagnóstica y social de la vivencia de desamparo en el adolescente disocial / Psychological and social diagnosis in the assessment of hopelessness feelings in the asocial adolescent

El presente artículo encara la comparación del perfil psicológico y del apoyo social entre adolescentes disociales y adolescentes no disociales. Partimos de la hipótesis que ambos perfiles están asociados. La violencia se establece en contextos interaccionales y se consolida intrapsíquicamente a través de la subjetivización de modelos de relación característicos. Interrogantes: ¿Cuáles son las condiciones sociales para que aparezcan conductas violentas en la adolescencia? ¿Cuál es la relación entre la conducta transgresora del varón y su estructura familiar? ¿Cuál es la estructura de las redes sociales en situaciones de desamparo? ¿Cómo se inscribe el desamparo en la subjetividad del adolescente violento? Se presentan planteos teóricos de P. Blos; J, Bowlby; F. Dolto; D. Winnicott. En una muestra de 32 sujetos de cada grupo se aplicó el Cuestionario Desiderativo (J. Bernstein, Argentina, 1957), el Test de Apercepción Temática (Murray, 1955) y el MISS - Mannheim Interview on Social Support (Veiel, 1987). Se analizaron cualitativa y cuantitativamente variables relacionadas con la problemática del desamparo

Evaluación psicodiagnóstica y social de la vivencia de desamparo en el adolescente disocial / Psychological and social diagnosis in the assessment of hopelessness feelings in the asocial adolescent

El presente artículo encara la comparación del perfil psicológico y del apoyo social entre adolescentes disociales y adolescentes no disociales. Partimos de la hipótesis que ambos perfiles están asociados. La violencia se establece en contextos interaccionales y se consolida intrapsíquicamente a través de la subjetivización de modelos de relación característicos. Interrogantes: ¿Cuáles son las condiciones sociales para que aparezcan conductas violentas en la adolescencia? ¿Cuál es la relación entre la conducta transgresora del varón y su estructura familiar? ¿Cuál es la estructura de las redes sociales en situaciones de desamparo? ¿Cómo se inscribe el desamparo en la subjetividad del adolescente violento? Se presentan planteos teóricos de P. Blos; J, Bowlby; F. Dolto; D. Winnicott. En una muestra de 32 sujetos de cada grupo se aplicó el Cuestionario Desiderativo (J. Bernstein, Argentina, 1957), el Test de Apercepción Temática (Murray, 1955) y el MISS - Mannheim Interview on Social Support (Veiel, 1987). Se analizaron cualitativa y cuantitativamente variables relacionadas con la problemática del desamparo(AU)