Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge.

INTRODUCTION: Cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. METHODS: To identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. RESULTS: The study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. CONCLUSION: In Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.

Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique.

PURPOSE: The aim of this study was to assess the surgical resources and surgical oncology team skills at the Surgical Department of Maputo Central Hospital (MCH) in Mozambique in order to define an educational program to support surgical oncology practice. METHODS: From January 2017 to December 2017, a general evaluation of the resources of MCH was carried out, as well as its offerings in oncological care in different services. Data were obtained by reviewing documents, visiting surgical services and interviewing key-informants and others informally. In addition, a group of seven surgeons of the Surgical Department of MCH answered a questionnaire about the quality of the cancer units (The Cancer Units Assessment Checklist for low- or middle-income African countries). Subsequently, surgical, anaesthesiology and intensive care facilities were evaluated according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery). All the data were triangulated in order to identify gaps, develop an action plan and define an educational program. RESULTS: Breast, oesophagus and colorectal cancers were the most commonly treated neoplasms in MCH. A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognised the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons to improve the practice of surgical oncology. It was evident that all these interventions needed to be formalised, appropriately certified and count for professional career progression. Based on the local epidemiological data and on these study findings, oncology education programs were developed for surgeons. CONCLUSIONS: The findings of this study contributed to the development of an educational program in surgical oncology, considered essential to the training of surgeons at MCH. The cancer educational programs and the mobilisation of adequate resources will ensure the provision of adequate surgical oncology treatments for MCH. The training requirements should be tailored to suit the local needs based on the most prevalent malignancies diagnosed in the region. In our view, this methodology may apply to other countries with similar realities in the formation of surgical oncologists.

Clinical and epidemiological characterization of influenza virus infections in children with severe acute respiratory infection in Maputo, Mozambique: Results from the implementation of sentinel surveillance, 2014 - 2016.

In Sub-Saharan Africa, where burden, impact, and incidence of acute respiratory infections (ARI) are the highest in the world, conversely, the epidemiology of influenza-associated severe acute respiratory infections (SARI) is incompletely known. The aim of this study was to describe the clinical and epidemiological features of influenza-associated SARI in hospitalized children in Maputo city, Mozambique. Nasopharyngeal and oropharyngeal swabs were collected from children aged 0-14 years old who met the case definition for SARI in two hospitals in Maputo city after their parents or legal representative consented to participate. A structured questionnaire was used to collect clinical and demographic data. Typing and subtyping of influenza were performed by real-time PCR. From January 2014 to December 2016, a total of 2,007 eligible children were recruited, of whom 1,997 (99.5%) were screened for influenza by real-time PCR. The median age of participants was 16.9 months (IQR: 7.0-38.9 months) and 53.9% (1076/1991) were male. A total of 77 were positive for influenza, yielding a frequency of 3.9% (77/1,991), with the highest frequency being reported in the age group 1-5 years old. Cases of influenza peaked twice each year, during which, its frequency reached up to 60%-80%. Among all influenza confirmed cases, 33.7% (26/77), 35.1% (27/77) and 28.6% (22/77) were typed as influenza A/H3N2, A/H1N1pdm09, and B, respectively. This represents the first report of influenza in urban/sub urban setting in Mozambique and the first evidence of distribution of strains of influenza in the country. Our data showed that frequency of influenza was lower than reported in a rural setting in Mozambique and the frequency of seasonal (A/H1N1pdm09) and (A/H3N2) subtypes were similar in children with SARI.

Respiratory syncytial and influenza viruses in children under 2 years old with severe acute respiratory infection (SARI) in Maputo, 2015.

INTRODUCTION: Although respiratory syncytial virus (RSV) and influenza virus (influenza) infections are one of the leading causes of Severe Acute Respiratory Infections (SARI) and death in young children worldwide, little is known about the burden of these pathogens in Mozambique. MATERIAL AND METHODS: From January 2015 to January 2016, nasopharyngeal swabs from 450 children, aged ≤2 years, who had been admitted to the Pediatric Department of the Maputo Central Hospital (HCM) in Mozambique, suffering with SARI were enrolled and tested for influenza and RSV using a real-time PCR assay. RESULTS: Influenza and RSV were detected in 2.4% (11/450) and 26.7% (113/424) of the participants. Children with influenza were slightly older than those infected with RSV (10 months in influenza-infected children compared to 3 months in RSV-infected children); male children were predominant in both groups (63.6% versus 54.9% in children with influenza and RSV, respectively). There was a trend towards a higher frequency of influenza (72.7%) and RSV (93.8%) cases in the dry season. Bronchopneumonia, bronchitis and respiratory distress were the most common diagnoses at admission. Antibiotics were administered to 27,3% and 15,9% of the children with influenza and RSV, respectively. Two children, of whom, one was positive for RSV (aged 6 months) and another was positive for Influenza (aged 3 months) died; both were children of HIV seropositive mothers and had bronchopneumonia. CONCLUSIONS: Our data demonstrated that RSV, and less frequently influenza, occurs in children with SARI in urban/sub-urban settings from southern Mozambique. The occurrence of deaths in small children suspected of being HIV-infected, suggests that particular attention should be given to this vulnerable population. Our data also provide evidence of antibiotics prescription in children with respiratory viral infection, which represents an important public health problem and calls for urgent interventions.

Análise das políticas de controlo da tuberculose e do perfil epidemiológico da infecção em Moçambique (2009-2017) / Analysing tuberculosis control policies and the epidemiological profile of the infection in Mozambique (2009-2017)

A epidemia da tuberculose em Moçambique tem sido influenciada consideravelmente por factores como as condições económicas, incluindo a pobreza e o desemprego, as condições ambientais, incluindo bairros urbanos superlotados, a epidemia de VIH, as condições sociais, incluindo as migrações por trabalho, e as infraestruturas de saúde deficientes, bem como pela ocorrência de novas infecções por tuberculose, que têm aumentado de forma dramática nos últimos 10 a15 anos. A análise das políticas do Programa Nacional de Controlo da Tuberculose é de extrema importância, pois permite avaliar as suas operações e resultados, tornando-as mais efectivas na consecução da cobertura universal dos cuidados de saúde. Estas políticas, adoptadas na área da tuberculose influenciam o perfil epidemiológico da doença, pelo que a análise desse perfil é fundamental para avaliar o desempenho do programa ao longo dos tempos. Por outro lado, a análise do perfil epidemiológico da tuberculose permite, também, ajustar os objectivos e as respectivas intervenções do programa, contribuindo, desta forma, para a melhoria da resposta e dos indicadores de saúde. A maioria dos estudos realizados em Moçambique sobre as políticas de saúde e, mais especificamente, sobre aquelas relacionadas com a tuberculose, analisam as políticas e o perfil dos indicadores do programa de forma independente, desconhecendo-se, até ao presente momento, estudos que adoptem uma abordagem integrada destas duas vertentes ­ políticas e perfil da infecção. A presente investigação teve como objetivo geral compreender as políticas de controlo de tuberculose e a forma como estas se reflectiram no perfil epidemiológico da doença entre 2009 e 2017. Realizaram-se dois estudos: um qualitativo e outro quantitativo. No primeiro estudo, qualitativo, analisaram-se as políticas do Programa Nacional de Controlo da Tuberculose em Moçambique. Para tal utilizou-se a análise documental para identificar as políticas relevantes e a análise de conteúdo para discernir sobre as mesmas. No segundo estudo, quantitativo, o perfil epidemiológico da tuberculose entre 2009 e 2017 foi analisado utilizando um desenho ecológico descritivo, recorrendo a dados secundários de notificação e de avaliação dos casos, colhidos nos programas provinciais de controlo da tuberculose de Nampula, Sofala e Maputo. Para caracterizar clínica e epidemiológicamente a tuberculose, foram calculados indicadores anuais e a variação 7 percentual ao longo dos anos. De seguida, relacionaram-se as políticas, nomeadamente os seus principais marcos, com o perfil epidemiológico da doença, relacionando-os qualitativamente com os resultados dos indicadores...

he tuberculosis epidemic in Mozambique has been considerably influenced by factors such as economic conditions, including poverty and unemployment, environmental conditions, including overcrowded urban neighborhoods, the HIV epidemic, social conditions, including migrations by work, and poor health infrastructure; as well as the occurrence of new tuberculosis infections that have increased dramatically in the last 10 to 15 years. The analysis of the policies of the National Tuberculosis Control Program is extremely important, as it allows to evaluate its operations and results, making them more effective in achieving universal health care coverage. These policies adopted in the area of tuberculosis influence the epidemiological profile of the disease, so the analysis of this profile is essential to assess the performance of the program over time. On the other hand, the analysis of the epidemiological profile of tuberculosis also allows to adjust the objectives and respective interventions of the program, thus contributing to the improvement of the response and health indicators. Most of the studies carried out in Mozambique on health policies and, more specifically, on those related to tuberculosis, analyze the policies and the profile of the program indicators independently, and at the moment, studies that adopt an integrated analyze of these two policy approaches and infection profile are unknown. This research aimed to understand the tuberculosis control policies and the way they were reflected in the epidemiological profile of the disease between 2009 and 2017. Two studies were carried out: one qualitative and other quantitative. In the qualitative study, the policies of the National Tuberculosis Control Program in Mozambique were analyzed. To this end, document analysis was used to identify relevant policies and content analysis to discern them. In the seconda, quantitative study, the epidemiological profile of tuberculosis between 2009 and 2017 was analyzed using a descriptive ecological design, using secondary data for notification and case assessment, collected in the provincial tuberculosis control programs of Nampula, Sofala and Maputo. In order to clinically and epidemiologically characterize tuberculosis, annual indicators and percentage change over the years were calculated. Then, the policies, namely their main milestones, were related to the epidemiological profile of the disease, qualitatively relating them to the results of the indicators...

Determinants of stillbirths occurred in health facilities in Zambezia province, Mozambique (2013-2014) / Determinantes da natimortalidade ocorrida nas unidades sanitárias da província da Zambézia, Moçambique (2013-2014)

Abstract Objectives: to identify the determinants of stillbirths in Zambezia province, Mozambique. Methods: a retrospective cross-sectional ecological study was carried out in 2013-2014 by using perinatal indicators captured by the health information system in Zambezia. Sequentially perinatal care indicators, bivariate analysis and multiple adjusted regression at a 5% significance level with possible explainable variables of stillbirths were described. Results: a median proportion of stillbirths was 1.6%, low birth weight and preterm birth and obstetric complications were 4.9%, 1.9% and 4.1%, respectively. The bivariate analysis demonstrated association of stillbirths with anemia (p=0.043), antepartum hemorrhage (p=0.009), dystocic delivery (p<0.001), obstructed labor (p=0.004). In the analysis of multiple adjusted regression, the obstructed labor were a predictor (ß=0.435; p=0.03) to stillbirths Conclusions: the most important factor associated to stillbirths in health facilities in Zambezia province in 2013-2014 was the obstructed labor. The strengthening of diagnostic analysis and the attempt to handle obstetric complications is still a priority in Zambezia, in being able to decrease the avoidable perinatal deaths.

Resumo Objetivos: identificar os determinantes dos natimortos na província da Zambézia, Moçambique. Métodos: foi feito um estudo ecológico transversal retrospetivo, do período de 2013-2014, com base em indicadores perinatais captados pelo sistema de informação sanitário da Zambézia. Sequencialmente foi feita estatística descritiva dos indicadores de cuidados perinatais, análise bivariada e regressão múltipla ajustada a um nível de significância de 5%, com possíveis variáveis explicativas de natimortos. Resultados: a proporção mediana de natimortos foi de 1,6%, e a de baixo peso ao nascer, de nascimento pré-termo e de complicações obstétricas foram, respectivamente, 4,9%, 1,9% e 4,1%. A análise bivariada mostrou associação, de natimortalidade com índice de anemia (p=0,043), hemorragia pré-parto (p=0,009), parto distócico (p<0,001) e trabalho de parto obstruído (p=0,004). Na análise de regressão múltipla ajustada, partos obstruídos manteve-se como preditor (ß=0,435; p=0,03) de natimortalidade. Conclusões: o mais importante fator associado com natimortos nas unidades sanitárias da província da Zambézia, nos anos 2013-2014, foi partos obstruídos. O fortalecimento das capacidades de diagnóstico e manejo atempado de complicações obstétricas é ainda uma prioridade na Zambézia, podendo concorrer para redução de mortes perinatais evitáveis.

Mycobacterium tuberculosis resistance to antituberculosis drugs in Mozambique.

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in Mozambique. METHODS: We analyzed secondary data from the National Tuberculosis Referral Laboratory, in the city of Maputo, Mozambique, and from the Beira Regional Tuberculosis Referral Laboratory, in the city of Beira, Mozambique. The data were based on culture-positive samples submitted to first-line drug susceptibility testing (DST) between January and December of 2011. We attempted to determine whether the frequency of DST positivity was associated with patient type or provenance. RESULTS: During the study period, 641 strains were isolated in culture and submitted to DST. We found that 374 (58.3%) were resistant to at least one antituberculosis drug and 280 (43.7%) were resistant to multiple antituberculosis drugs. Of the 280 multidrug-resistant tuberculosis cases, 184 (65.7%) were in previously treated patients, most of whom were from southern Mozambique. Two (0.71%) of the cases of multidrug-resistant tuberculosis were confirmed to be cases of extensively drug-resistant tuberculosis. Multidrug-resistant tuberculosis was most common in males, particularly those in the 21-40 year age bracket. CONCLUSIONS: M. tuberculosis resistance to antituberculosis drugs is high in Mozambique, especially in previously treated patients. The frequency of M. tuberculosis strains that were resistant to isoniazid, rifampin, and streptomycin in combination was found to be high, particularly in samples from previously treated patients.

Mycobacterium tuberculosis resistance to antituberculosis drugs in Mozambique / Resistência de Mycobacterium tuberculosis aos tuberculostáticos em Moçambique

OBJECTIVE: To determine the drug resistance profile of Mycobacterium tuberculosis in Mozambique. METHODS: We analyzed secondary data from the National Tuberculosis Referral Laboratory, in the city of Maputo, Mozambique, and from the Beira Regional Tuberculosis Referral Laboratory, in the city of Beira, Mozambique. The data were based on culture-positive samples submitted to first-line drug susceptibility testing (DST) between January and December of 2011. We attempted to determine whether the frequency of DST positivity was associated with patient type or provenance. RESULTS: During the study period, 641 strains were isolated in culture and submitted to DST. We found that 374 (58.3%) were resistant to at least one antituberculosis drug and 280 (43.7%) were resistant to multiple antituberculosis drugs. Of the 280 multidrug-resistant tuberculosis cases, 184 (65.7%) were in previously treated patients, most of whom were from southern Mozambique. Two (0.71%) of the cases of multidrug-resistant tuberculosis were confirmed to be cases of extensively drug-resistant tuberculosis. Multidrug-resistant tuberculosis was most common in males, particularly those in the 21-40 year age bracket. CONCLUSIONS: M. tuberculosis resistance to antituberculosis drugs is high in Mozambique, especially in previously treated patients. The frequency of M. tuberculosis strains that were resistant to isoniazid, rifampin, and streptomycin in combination was found to be high, particularly in samples from previously treated patients. .

OBJETIVO: Avaliar o perfil de resistência de Mycobacterium tuberculosis aos tuberculostáticos em Moçambique. MÉTODOS: Foram analisados dados secundários do Laboratório Nacional de Referência da Tuberculose, em Maputo, Moçambique, e do Laboratório Regional de Referência da Tuberculose, na Beira, Moçambique. Os dados foram relativos a amostras positivas à cultura e submetidas ao teste de sensibilidade aos tuberculostáticos de primeira linha durante o período de janeiro a dezembro de 2011. Os resultados do teste de sensibilidade foram analisados, e sua frequência foi comparada com o tipo de paciente e sua proveniência. RESULTADOS: Foram analisadas 641 cepas, isoladas em cultura e submetidas ao teste de sensibilidade. Das 641 cepas, 374 (58,3%) foram resistentes a pelo menos um tuberculostático e 280 (43,7%) revelaram-se multirresistentes. Dos 280 casos de tuberculose multirresistente, 184 (65,7%) eram pacientes com tratamento prévio, a maioria dos quais era oriunda da zona sul do país. Confirmou-se que 2 (0,71%) dos casos de tuberculose multirresistente eram casos de tuberculose extensivamente resistente a drogas. O sexo masculino foi o mais afetado, particularmente na faixa etária de 21 a 40 anos. CONCLUSÕES: A resistência de M. tuberculosis aos tuberculostáticos é elevada em Moçambique, especialmente em indivíduos com tratamento prévio. A resistência de M. tuberculosis à combinação de isoniazida, rifampicina e estreptomicina foi elevada, especialmente em amostras provenientes de indivíduos com tratamento prévio. .