a narrative review of literature, accomplishments, and perspectives

Funding Information: We would like to thank the Calouste Gulbenkian Foundation and the Flandres Government (Building Institutional Capacity at the Mozambique INS – BICMINS) from where M. Cassocera has a PhD scholarship; Fundo Nacional de Investigação-Moçambique and German Research Foundation (DFG) from where A. Chissaque has scholarship. Sousa Ribe and Orvalho Augusto for the inputs and clarifications regarding the Expanded Program on Immunization. Publisher Copyright: © 2020 Fundacao Oswaldo Cruz. All rights reserved.In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.publishersversionpublishe

Impact of elevated maternal HIV viral load at delivery on T-cell populations in HIV exposed uninfected infants in Mozambique

Background: HIV-uninfected infants born to HIV-infected mothers (HIV-exposed uninfected, HEU) have been described to have immune alterations as compared to unexposed infants. This study sought to characterize T-cell populations after birth in HEU infants and unexposed infants living in a semirural area in southern Mozambique. Methods: Between August 2008 and June 2009 mother-infant pairs were enrolled at the Manhiça District Hospital at delivery into a prospective observational analysis of immunological and health outcomes in HEU infants. Infants were invited to return at one month of age for a clinical examination, HIV DNA-PCR, and immunophenotypic analyses. The primary analysis sought to assess immunological differences between HEU and unexposed groups, whereas the secondary analysis assessed the impact of maternal HIV RNA viral load in the HEU group. Infants who had a positive HIV DNA-PCR test were not included in the analysis. Results: At one month of age, the 74 HEU and the 56 unexposed infants had similar median levels of naïve, memory and activated CD8 and CD4 T-cells. Infant naïve and activated CD8 T-cells were found to be associated with maternal HIV-RNA load at delivery. HEU infants born to women with HIV-RNA loads above 5 log10 copies/mL had lower median levels of naïve CD8 T-cells (p = 0.04), and higher median levels of memory CD8 T-cells, (p = 0.014). Conclusions: This study suggests that exposure to elevated maternal HIV-RNA puts the infant at higher risk of having early T-cell abnormalities. Improving prophylaxis of mother to child HIV programs such that more women have undetectable viral load is crucial to decrease vertical transmission of HIV, but may also be important to reduce the consequences of HIV virus exposure in HEU infants

GESTOS DE SILENCIAMENTO E AUTORIA NO LIVRO DIDÁTICO DO ENSINO MÉDIO DA ÁREA DE LINGUAGENS: UMA LEITURA DE ARQUIVO

In this article, we aim to analyze how news arising from journalistic discursive training was rearranged within the scope of pedagogical discursive training, focusing on 0the Secondary School textbook in the area of Languages. We point out that the (re)formulation of this text in the pedagogical discursive domain is instituted from the erasure of certain textual clippings in the intradiscursive thread. Anchored theoretically and methodologically in the Pecheuxtian materialist Discourse Analysis, we emphasize that this deletion is not contingent. Therefore, we consider it pertinent to approach a specificity of the operation of authorship: the production of the constitutive archive of the textbook, taking into account its inscription within the Ideological Apparatuses. We base and produce our interpretation gestures, taking our analytical corpus in the form of discursive clippings, and then examining the discursive sequences that help us understand how the discursive processes of erasure instituted in the formulation axis cause the silencing of meanings that are possible, but which, due to the relationship of forces, are prohibited. The analyzes show that in the passage from one discursive formation to the other, the effects of meaning produced are different, and, from the erasure mechanisms, discursiveness not affiliated to the pedagogical discursive formation is prohibited.Neste artigo, temos por propósito analisar o modo como uma notícia oriunda da formação discursiva jornalística foi reacomodada no âmbito da formação discursiva pedagógica, tendo por enfoque o livro didático do Ensino Médio da área da Linguagens. Salientamos que a (re)formulação desse texto no domínio discursivo pedagógico é instituída a partir do apagamento de determinados recortes textuais no fio intradiscursivo. Ancorados teórica e metodologicamente na Análise de Discurso materialista de base pecheuxtiana, ressaltamos que esse apagamento não é contingente. Portanto, consideramos pertinente abordar uma especificidade do funcionamento da autoria: a produção do arquivo constitutivo do livro didático, levando em conta a sua inscrição no interior dos Aparelhos Ideológicos. Fundamentamos e produzimos nossos gestos de interpretação, tomando o nosso corpus analítico na forma de recortes discursivos para, em seguida, examinarmos as sequências discursivas que nos ajudam a compreender o modo como os processos discursivos de apagamento instituídos no eixo da formulação provoca o silenciamento de sentidos que são possíveis, mas que, pela relação de forças, estão interditados. As análises evidenciam que na passagem de uma formação discursiva para a outra os efeitos de sentido produzidos são distintos, e, a partir dos mecanismos de apagamento, interditam-se as discursividades não filiadas à formação discursiva pedagógica

AS DISCURSIVIDADES SOBRE A BNCC NO ESPAÇO DIGITAL: : MEMÓRIA METÁLICA E EFEITOS DE SENTIDOS

In this work, we address the discourses about the National Common Core Curriculum (BNCC) circulating in the digital space and their effects of meaning. We aim to shed light on digital materialities and highlight how the specificities of the digital space impact the formulation of discourses. The process of production and approval of the BNCC was marked by political and ideological conflicts, leading to reverberations in the digital space. Therefore, it is important to reflect on how the implementation of the BNCC (re)produces discourses that circulate in the social body through the digital space, extending beyond the institutionalized realm. In this way, our focus is on the discourses produced by two social categories linked to the archive, namely: the Ministry of Education (MEC); and representatives of secondary student groups (UBES). Theoretically and methodologically, we align ourselves with the French Discourse Analysis formulated by Pêcheux in France and disseminated by Orlandi in Brazil. We emphasize the contributions of Dias (2018) and Paveau (2021) for reflections on Digital Discourse Analysis. The analyzes point out that the effects of meaning produced by UBES contradict the discourses of MEC, given that this category (UBES) expresses opposition to the approval of the BNCC. Through its official discursive formation, MEC seeks to produce effects of unity in its posts. Keywords: Discourse Analysis. BNCC. digital space. Metal Memory. social network.Neste trabalho, abordamos as discursividades sobre a Base Nacional Comum Curricular (BNCC) em circulação no espaço digital e seus efeitos de sentido. Buscamos lançar luz às materialidades digitais e destacar como as especificidades do espaço digital afetam a formulação de discursividades. O processo de produção e homologação da BNCC foi marcado por embates políticos e ideológicos, fomentando reverberações no espaço digital. Portanto, é importante refletir como a implementação da BNCC (re)produz discursividades que circulam no corpo social, por meio do espaço digital, indo além do institucionalizado. Dessa forma, temos como foco as discursividades produzida por duas categorias sociais que estão atreladas ao arquivo, a saber: Ministério da Educação (MEC); e, representantes dos estudantes secundaristas (UBES). Nos filiamos teoricamente e metodologicamente à Análise de Discurso Francesa, formulada por Pêcheux, na França, difundida por Orlandi, no Brasil. Acentuamos as contribuições de Dias (2018) e de Paveau (2021) para reflexões acerca da Análise do Discurso Digital. As análises apontam para os efeitos de sentidos produzidos pela UBES vão de encontro às discursividades do MEC, uma vez que essa categoria (UBES) se manifestam contraria à aprovação da BNCC. O MEC, por meio da formação discursiva oficial, busca em suas postagens produzir efeitos de unidades. Palavras-chaves: Análise do Discurso. BNCC. Espaço digital. Memória Metálica. Rede social

Recent HIV-1 Infection: Identification of Individuals with High Viral Load Setpoint in a Voluntary Counselling and Testing Centre in Rural Mozambique

Background: Identification of recent HIV-infections is important for describing the HIV epidemic and compiling HIV-RNA-setpoint data for future HIV intervention trials. We conducted a study to characterize recent infections, and HIV-RNA-setpoint within the adult population presenting at a voluntary counselling and testing centre (VCT) in southern Mozambique. Methods: All adults attending the Manhiça District-Hospital VCT between April and October 2009 were recruited if they had at least one positive rapid HIV-serology test. Patients were screened for recent HIV-1 infection by BED-CEIA HIV-incidence test. Clinical examination, assessment of HIV-RNA and CD4 cell counts were performed at enrollment, 4 and 10 months. Results: Of the 492 participants included in this study, the prevalence of recent infections as defined by BED-CEIA test, CD4 counts >200 cells/µl and HIV-RNA >400 copies/mL, was 11.58% (57/492; 95% CI 8.89-14.74). Due to heterogeneity in HIV-RNA levels in recently infected patients, individuals were categorized as having "high" HIV-RNA load if their HIV-RNA level was above the median (4.98 log10 copies/mL) at diagnosis. The "high" HIV-RNA group sustained a significantly higher HIV-viral load at all visits with a median HIV-RNA setpoint of 5.22 log10 copies/mL (IQR 5.18-5.47) as compared to the median of 4.15 log10 copies/ml (IQR 3.37-4.43) for the other patients (p = 0.0001). Conclusion: The low proportion of recent HIV-infections among HIV-seropositive VCT clients suggests that most of this population attends the VCT at later stages of HIV/AIDS. Characterization of HIV-RNA-setpoint may serve to identify recently infected individuals maintaining HIV viral load>5 log10 copies/mL as candidates for antiretroviral treatment as prevention interventions

Intestinal parasites in children up to 14 years old hospitalized with diarrhea in Mozambique, 2014–2019

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Diarrhea remains a public health problem in Mozambique, even with control strategies being implemented. This analysis aimed to determine the proportion and factors associated with intestinal parasitic infection (IPI) in children up to 14 years old with diarrheal disease, in the southern, central and northern regions of Mozambique. A single diarrheal sample of 1424 children was collected in hospitals and examined using the formol-ether concentration and modified Ziehl-Neelsen techniques to identify intestinal parasites using optical microscopy. Sociodemographic characteristics were obtained by questionnaires. Descriptive statistics and cross-tabulation were performed, and p-values <0.05 were considered statistically significant. A single IPI was detected in 19.2% (273/1424) of the children. Cryptosporidium spp. was the most common parasite (8.1%; 115/1424). Polyparasitism was seen in 26.0% (71/273), with the co-infection of Ascaris lumbricoides and Trichuris trichiura (26.8%; 19/71) being the most common. Age and province were related to IPI (p-value < 0.05). The highest occurrence of IPI was observed in the wet period (October to March), with 21.9% (140/640), compared to the dry period (April to September), with 16.9% (131/776) (p-value = 0.017). Cryptosporidium spp. and the combination of A. lumbricoides/T. trichiura were the main intestinal parasites observed in children hospitalized with diarrhea in Mozambique.This work was supported by funds from the European Foundation Initiative for African Research into Neglected Tropical Diseases (EFINTD, grant number 98539), the World Health Organization, Deutsche Forschungsgemeinschaft (DFG, grant number JO369/5-1) and The Global Vaccine Alliance Initiative through Health System Strengthening. O.N., PhD, is supported by Camões—Instituto da Cooperação e da Língua.info:eu-repo/semantics/publishedVersio

Risk factors, genotypes distribution by vaccination status and age of children in Nampula Province, Northern Mozambique (2015-2019)

Publisher Copyright: © 2021 Chissaque et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Mozambique introduced the monovalent rotavirus vaccine (Rotarix®, GSK Biologicals, Rixensart, Belgium) in September 2015. Previous analysis, showed that Nampula province continues reporting a high frequency of Rotavirus A (RVA) infection and the emergence of G9P[6], G9P[4] and G3P[4] genotypes. This analysis aimed to determine the RVA frequency; risk factors; genotype distribution by vaccination status and age between pre- and post-vaccine periods in children under-five years old with diarrhea in Nampula. A cross-sectional, hospital-based surveillance study was conducted in the Hospital Central de Nampula in Mozambique. Socio-demographic and clinical data were collected to assess factors related to RVA infection in both periods. Stool specimens were screened to detect RVA by ELISA, and positive samples were genotyped. Between 2015 (pre-vaccine period) and 2016-2019 (post-vaccine period), 614 stool specimens were collected and tested for RVA in which 34.9% (67/192) were positive in pre-vaccine period and 21.8% (92/422) in post-vaccine (p = 0.001). In the post-vaccine period, age, year, and contact with different animal species (chicken, duck, or multiple animals) were associated with RVA infection. RVA infection was higher in children partially vaccinated (40.7%, 11/27) followed by the fully vaccinated (29.3%, 56/191) and the unvaccinated (15.3%, 21/137) (p = 0.002). G1P[8] and G9P[4] were common in vaccinated children less than 12 months. The present analysis showed that RVA infection reduced slightly in the post-vaccine period, with a high proportion of infection and genotype diversity in children, under 12 months of age, vaccinated. Further research on factors associated with RVA infection on vaccinated compared to unvaccinated children and vaccination optimization should be done.publishersversionpublishe

A cross-sectional study in four provinces of Mozambique: Diarrheagenic Escherichia coli in Mozambique

Funding Information: The National Surveillance of Diarrhea was supported by a Senior Fellowship awarded to Nilsa de Deus by the European Foundations Initiative for African Research into Neglected Tropical Diseases (EFINTD, grant number 98539), the World Health Organization, a Master Fellowship funded by the Italian Agency for Development Cooperation (AICS) project AID10524, Deutsche Forschungsgemeinschaft (DFG, grant number JO369/5–1)—where Adilson Fernando Loforte Bauhofer and Assucênio Chissaque are fellows, GAVI (Global Alliance for Vaccines and Immunization) through Health System Strengthening (HSS), and Fundo Nacional de Investigação (FNI). The protocol was approved by the National Bioethics Committee for Health of Mozambique (IRB00002657, reference number: 348/CNBS/13), and each caregiver gave written informed consent to authorize their child's participation. The authors want to thank the parents or guardians who consented to their children's enrollment in the surveillance program. The authors acknowledge Dr. Octávio Jossai, the National Reference Laboratory of Microbiology team, all the focal points, and the provincial field teams who helped to conduct this study. Funding Information: The National Surveillance of Diarrhea was supported by a Senior Fellowship awarded to Nilsa de Deus by the European Foundations Initiative for African Research into Neglected Tropical Diseases (EFINTD, grant number 98539), the World Health Organization, a Master Fellowship funded by the Italian Agency for Development Cooperation (AICS) project AID10524, Deutsche Forschungsgemeinschaft (DFG, grant number JO369/5–1)—where Adilson Fernando Loforte Bauhofer and Assucênio Chissaque are fellows, GAVI (Global Alliance for Vaccines and Immunization) through Health System Strengthening (HSS), and Fundo Nacional de Investigação (FNI). Publisher Copyright: © 2022Objectives: Analyze the frequency of diarrheagenic Escherichia coli (DEC) pathotypes and their antimicrobial resistance profiles among children aged <15 years with diarrhea in four Mozambican provinces. Methods: A cross-sectional hospital-based surveillance program of diarrhea was implemented in Maputo, Sofala, Zambézia, and Nampula. A single stool sample was collected from each child from May 2014 to May 2017. Culture methods and biochemical characterization were performed to detect E. coli strains. DEC pathotypes were determined by conventional polymerase chain reaction targeting specific virulence genes. Antimicrobial susceptibility was assessed by the Kirby–Bauer method. Results: From 723 specimens analyzed by culture, 262 were positive for E. coli. A total of 208 samples were tested by polymerase chain reaction for DEC identification, of which 101 (48.6%) were positive for a DEC pathotype. The predominant pathotypes were enteroaggregative (66.3%, 67/101), enteropathogenic (15.8%, 16/101), enterotoxigenic (13.9%, 14/101), and enteroinvasive E. coli (4.0%, 4/101). No Shiga toxin–producing E. coli was identified. Regardless of the province, the most frequent pathotype was enteroaggregative E. coli. Isolated DEC presented high frequency of resistance to ampicillin (97.8%), tetracycline (68.3%), chloramphenicol (28.4%), nalidixic acid (19.5%), and gentamicin (14.4%). Conclusion: Children with diarrhea in Mozambique had DEC and higher resistance to ampicillin and tetracycline.publishersversionpublishe