Incidence Of Endemic Burkitt Lymphoma In Three Regions Of Mozambique

Data on the burden and incidence of endemic Burkitt lymphoma (eBL) across Mozambique are scarce. We retrospectively retrieved information on eBL cases from reports of the three main hospitals of Mozambique: Maputo Central Hospital (MCH), Beira Central Hospital (BCH), and Nampula Central Hospital (NCH) between 2004 and 2014. For 2015, we prospectively collected information of new eBL cases attending these hospitals. A total of 512 eBL cases were reported between 2004 and 2015: 153 eBL cases were reported in MCH, 195 in BCH, and 164 in NCH. Mean age of cases was 6.9 years (standard deviation = 2.8); 63% (319/504) of cases were males. For 2015, the estimated incidence rate of eBL was 2.0, 1.7, and 3.9 per 10(6) person-year at risk in MCH, BCH, and NCH, respectively. Incidence was higher in NCH (northern Mozambique), where intensity of malaria transmission is higher. Data presented show that eBL is a common pediatric malignancy in Mozambique, as observed in neighboring countries

Extremely high prevalence of multi-resistance among uropathogens from hospitalised children in Beira, Mozambique

Objectives. A prospective surveillance study was conducted to investigate the epidemiology and patterns of antibiotic resistance among uropathogens from hospitalised children in Beira, Mozambique. Additionally, information regarding determinants of a urinary tract infection (UTI) was obtained. Methods. Bacterial species identification, antimicrobial susceptibility testing and extended-spectrum beta-lactamase testing were performed for relevant bacterial isolates. Results. Analysis of 170 urine samples from 148 children yielded 34 bacterial isolates, predominantly Escherichia coli and Klebsiella spp., causative of a urinary tract infection in 29 children; 30/34 isolates (88.2%) from 26/29 children (89.7%) were considered highly resistant micro-organisms (HRMOs). No significant determinants of urinary tract infection with HRMOs were detected when analysing gender, antibiotic use during hospital admission and HIV status. Conclusion. This study shows, for the first time in Mozambique, an extremely high prevalence of HRMOs among uropathogens from hospitalised children with a urinary tract infection

Impact of different mass drug administration strategies for gaining and sustaining control of <i>Schistosoma mansoni</i> and <i>Schistosoma haematobium</i> infection in Africa

This report summarizes the design and outcomes of randomized controlled operational research trials performed by the Bill & Melinda Gates Foundation-funded Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) from 2009 to 2019. Their goal was to define the effectiveness and test the limitations of current WHO-recommended schistosomiasis control protocols by performing large-scale pragmatic trials to compare the impact of different schedules and coverage regimens of praziquantel mass drug administration (MDA). Although there were limitations to study designs and performance, analysis of their primary outcomes confirmed that all tested regimens of praziquantel MDA significantly reduced local; Schistosoma; infection prevalence and intensity among school-age children. Secondary analysis suggested that outcomes in locations receiving four annual rounds of MDA were better than those in communities that had treatment holiday years, in which no praziquantel MDA was given. Statistical significance of differences was obscured by a wider-than-expected variation in community-level responses to MDA, defining a persistent hot spot obstacle to MDA success. No MDA schedule led to elimination of infection, even in those communities that started at low prevalence of infection, and it is likely that programs aiming for elimination of transmission will need to add supplemental interventions (e.g., snail control, improvement in water, sanitation and hygiene, and behavior change interventions) to achieve that next stage of control. Recommendations for future implementation research, including exploration of the value of earlier program impact assessment combined with intensification of intervention in hot spot locations, are discussed

Medical schools in sub-Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85361/1/MedicalSchoolsinSubSaharaAfrica.pd

Częstość występowania i profil nowotworów kobiecych narządów płciowych w latach 2010–2014 w mieście Beira w Mozambiku

Objective: Gynecologic cancers represent a large health, social and economic burden worldwide. In low-income countries, particularly in Mozambique, little data is available and no effective policies are implemented to fight these diseases. Our objective was to trace the epidemiological profile of gynecologic cancers from 2010 to 2014 in Beira, Mozambique. Methods: We retrospectively reviewed the registers of the Department of Pathology of Central Hospital of Beira to identify all cases of gynecologic malignancies recorded from January 2010 to December 2014. Results: Most of the diagnosed female cancers (43.4%) were gynecologic and, among these, cervical cancer was definitely the most commonly reported cancer every year, ranging from 86.7% in 2013 to 93.3% in 2014. Conclusion: As in many low-income countries, the access to screening programs for gynecologic cancer is not effective in Mozambique; therefore urgent preventive policies are crucial to address this emergent issue.Cel: Nowotwory kobiecych narządów płciowych stanowią istotne obciążenie zdrowotne, społeczne i ekonomiczne na całym świecie. W krajach o niskich dochodach, w szczególności w Mozambiku, brak jest zarówno dostępnych danych, jak i skutecznych strategii walki z tymi chorobami. Celem badania było prześledzenie profilu epidemiologicznego nowotworów ginekologicznych w latach 2010–2014 w mieście Beira w Mozambiku. Metoda: Autorzy dokonali retrospektywnego przeglądu rejestrów medycznych Oddziału Patologii Szpitala Centralnego w Beirze w celu wyodrębnienia wszystkich przypadków nowotworów kobiecych narządów płciowych odnotowanych w okresie od stycznia 2010 do grudnia 2014 roku. Wyniki: W większości przypadków (43,4%) rozpoznane u kobiet nowotwory dotyczyły narządów rodnych, przy czym rak szyjki macicy był zdecydowanie najczęściej odnotowywanym nowotworem w  każdym roku (od 86,7% w  2013 do 93,3% w 2014 roku). Wniosek: Podobnie jak w wielu krajach o niskich dochodach, również w Mozambiku dostęp do programów przesiewowych nowotworów narządów rodnych jest ograniczony – niezbędne jest pilne podjęcie działań prewencyjnych

Urogenital schistosomiasis in Cabo Delgado, northern Mozambique: baseline findings from the SCORE study

Abstract Background The results presented here are part of a five-year cluster-randomised intervention trial that was implemented to understand how best to gain and sustain control of schistosomiasis through different preventive chemotherapy strategies. This paper presents baseline data that were collected in ten districts of Cabo Delgado province, northern Mozambique, before treatment. Methods A cross-sectional study of 19,039 individuals was sampled from 144 villages from May to September 2011. In each village prevalence and intensity of S. haematobium were investigated in 100 children first-year students (aged 5–8 years), 100 school children aged 9–12 years (from classes 2 to 7) and 50 adults (20–55 years). Prevalence and intensity of S. haematobium infection were evaluated microscopically by two filtrations, each of 10 ml, from a single urine specimen. Given that individual and community perceptions of schistosomiasis influence control efforts, community knowledge and environmental risk factors were collected using a face-to-face interview. Data were entered onto mobile phones using EpiCollect. Data summary was made using descriptive statistics. Chi-square and logistic regression were used to determine the association between dependent and independent variables. Results The overall prevalence of urogenital schistosomiasis was 60.4% with an arithmetic mean intensity of infection of 55.8 eggs/10 ml of urine. Heavy infections were detected in 17.7%, of which 235 individuals (6.97%) had an egg count of 1000 eggs/10 ml or more. There was a significantly higher likelihood of males being infected than females across all ages (62% vs 58%; P < 0.0005). Adolescents aged 9–12 years had a higher prevalence (66.6%) and mean infection intensity (71.9 eggs/10 ml) than first-year students (63.1%; 58.2 eggs/10 ml). This is the first study in Mozambique looking at infection rates among adults. Although children had higher levels of infection, it was found here that adults had a high average prevalence and intensity of infection (44.5%; 23.9 eggs/10 ml). Awareness of schistosomiasis was relatively high (68.6%); however, correct knowledge of how schistosomiasis is acquired was low (23.2%) among those who had heard of the disease. Schistosomiasis risk behaviour such as washing (91.3%) and bathing (86.7%) in open water sources likely to be infested with host snails was high. Conclusions Urogenital schistosomiasis is widespread in Cabo Delgado. In addition, poor community knowledge about the causes of schistosomiasis and how to prevent it increases the significant public health challenge for the national control program. This was the first study in Mozambique that examined infection levels among adults, where results showed that S. haematobium infection was also extremely high. Given that this controlled trial aims to understand the impact of different combinations of schistosomiasis control through treatment of communities, schools, and treatment holidays over a five-year period, these findings highlight the importance of examining the impact of different treatment approaches also in adults. Trial registration The trials have been registered with the International Standard Randomised Controlled Trial registry under ISRCT 14117624 Mozambique (14 December 2015)

Determinants of prevalent HIV infection and late HIV diagnosis among young women with two or more sexual partners in Beira, Mozambique

Background: The prevalence and determinants of HIV and late diagnosis of HIV in young women in Beira, Mozambique, were estimated in preparation for HIV prevention trials.Methods: An HIV prevalence survey was conducted between December 2009 and October 2012 among 1,018 women aged 18-35 with two or more sexual partners in the last month. Participants were recruited in places thought by recruitment officers to be frequented by women at higher-risk, such as kiosks, markets, night schools, and bars. Women attended the research center and underwent a face-to-face interview, HIV counseling and testing, pregnancy testing, and blood sample collection.Results: HIV prevalence was 32.6% (95% confidence interval (CI) 29.7%-35.5%). Factors associated with being HIV infected in the multivariable analysis were older age (p < 0.001), lower educational level (p < 0.001), self-reported genital symptoms in the last 3 months (adjusted odds ratio (aOR) = 1.4; CI 1.1-2.0), more than one lifetime HIV test (aOR = 0.4; CI 0.3-0.6), and not knowing whether the primary partner has ever been tested for HIV (aOR = 1.7; CI 1.1-2.5). About a third (32.3%) of participants who tested HIV-positive had a CD4 lymphocyte count o

Accuracy of the WHO praziquantel dose pole for large-scale community treatment of urogenital schistosomiasis in northern Mozambique: Is it time for an update?

BackgroundA pioneering strategy developed by the World Health Organization (WHO) for the control of schistosomiasis was the concept of a height-based dose pole to determine praziquantel (PZQ) dosing in large-scale treatment campaigns. However, some recent studies have shown variable accuracy for the dose pole in terms of predicting correct mg/Kg dosing, particularly for treatment of adults. According to the WHO, 91 million adults in 52 countries are targeted to be treated by 2020.Methods/principal findingsThe present study aimed to test the accuracy of the dose pole in determining PZQ dosage by comparing the number of tablets determined by the dose pole with the number of tablets determined according to total body weight. The analysis included height-for-weight data from 9,827 school-aged children (SAC) and adults from 42 villages in the province of Cabo Delgado in Mozambique. The results revealed that of the 7,596 SAC, 91.8% has received an appropriate dose (30-60mg/Kg), 6% received an insufficient dose ( 60mg/Kg). On the other hand, 13.7% out of 2,231 adults were treated inaccurately with 13.5% receiving an insufficient dose and 0.2% an excessive dose. When the percentage of insufficient dosing was disaggregated by gender, the frequency of adult females who were underdosed reached 18.3% versus 10.8% of adult males. Of note, Adult females aged 21-55 years were found to have an underdose frequency of 21.3%, compared to 11.8% of adult males in the same age range. The performance of a proposed modified dose pole was compared using the same dataset of adult Mozambicans. The results showed that the modified dose pole reduced the underdose frequency among adults from 13.5% to 10.4%, and subsequently increased the percentage of optimal dosing from 33.7% to 45.3%.ConclusionsOur findings highlight the need to update the WHO-dose pole to avoid administration of insufficient PZQ doses to adults and therefore minimize the potential emergence of PZQ-resistant strains.Trial registrationInternational Standard Randomized Controlled Trial registry under ISRTC number 14117624