Social determinants and exposure to risk factors for chronic non-communicable diseases in a peri-urban setting of Maputo City, Mozambique

Background: Chronic non-communicable diseases (NCDs) are responsible for almost three quarters of all deaths globally. The prevalence of NCDs and its behavioral and metabolic risk factors are increasing rapidly in African urban areas. Identifying the behavioral and metabolic risk factors for NCDs present in the Mozambican capital and its associated social determinants may guide health policies for the prevention and control of NCDs. Methods: A cross-sectional study where quantitative data regarding socioeconomic status and risk factors for NCDs was collected in individuals aged 15-64 years was conducted in the Health and Demographic Surveillance System (HDSS) in Maputo city. STEPwise Approach-based procedures were used to collect physical measures (weight, height, abdominal circumference and blood pressure). Capillary blood samples were collected to measure glucose and lipid profile. Physical activity was measured using pedometers. Results: Overall, 963 individuals from 367 households consented to participate in the study. The percentage of sedentary subjects was 20.8% while the percentage who were physically inactive was 64.8%. The prevalence of overweight (BMI ≥25 kg/m²) and obesity (BMI≥30 kg/m²) was 30.9% (95% CI: 28.0, 33.9) and 12.6% (95% CI: 10.4, 14.7), respectively. The overall prevalence of metabolic syndrome (MS) was 5.6% (95%CI: 4.1, 7.1). In general, women were more sedentary and inactive and showed a significantly higher prevalence of overweight, obesity and MS compared to men. Social determinants such as wealth, education and occupation were not associated with measured behavioral and metabolic risk factors for NCDs. Conclusion: Both behavioral and metabolic risk factors for NCDs are highly prevalent in this peri-urban part of the Mozambican capital where underweight and infectious diseases are also present, which confirms that the country is facing a double burden of disease. The fact that behavioral and metabolic risk factors for NCDs are not associated with specific socioeconomic and environmental factors may relate to the homogenicity of the evaluated cohort. However, this finding also indicates that prevention programs should not be restricted to certain population subgroups but should target the general population

Young at risk-people in Maputo City, Mozambique, present a high willingness to participate in HIV trials: Results from an HIV vaccine preparedness cohort study

Introduction: Vaccine efficacy testing requires engagement of willing volunteers with high disease incidence. We evaluated factors associated with willingness to participate in potential future HIV vaccine trials in Maputo, Mozambique. Methods: Adults aged 18–35 years without HIV and who reported at least two sexual partners in the 3 months prior to screening were enrolled into a 24-month observational study. They were asked at screening and exit if they would be willing to participate in a theoretical HIV vaccine study. Bivariate and multivariate logistic regression analyses were done between willingness to participate, demographic, sexual behavior, and motivational factors for screening visit data. Logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors potentially associated with willingness to participate for data from both visits. Results: A total of 577 participants without HIV were eligible, including 275 (48%) women. The mean age was 22.2 (SD ± 3.9) years. At screening 529 (92%) expressed willingness to participate and the proportion remained stable at 378 (88%) of the 430 participants retained through the exit visit (p = 0.209). Helping the country (n = 556) and fear of needles (n = 26) were the top motive and barrier for willingness to participate, respectively. Results from the GEE binary logistic regression (screening visit and exit visit) showed that wanting to learn how to avoid risk behaviors (aOR 3.33, 95% CI: 1.61–6.86) and feeling protected against HIV infection (aOR 2.24, 95% CI: 1.07–4.7) were associated with willingness to participate in HIV vaccine studies. Conclusion: The majority of our study population in Mozambique expressed willingness to participate in a theoretical HIV vaccine trial. Participation in a HIV vaccine trial was seen as a way to contribute to the fight against HIV but was associated with some unrealistic expectations such as protection against HIV. This reinforces the need for continuous mobilization and awareness of potential participants to HIV vaccine trial

The collaborative framework for the management of tuberculosis and type 2 diabetes syndemic in low- and middle-income countries: a rapid review

Abstract Introduction Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC). Methods A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022. Results A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services. Conclusions This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening

Social determinants and behaviors associated with overweight and obesity among youth and adults in a peri-urban area of Maputo City, Mozambique

Background Overweight and obesity are important risk factors for non-communicable diseases (NCDs) such as cardiovascular diseases (CVD), type 2 diabetes and certain cancers. NCDs are responsible for an increased number of deaths worldwide, including in developing countries. We aimed to determine the prevalence of overweight and obesity among youth and adults in a peri-urban area of Maputo city, Mozambique, and to assess their social and behavioral determinants. Methods A cross-sectional study was conducted in a Health and Demographic Surveillance System (HDSS) area in Maputo city. We measured BMI and interviewed 15-64-year-old inhabitants to assess sociodemographic and behavioral characteristics using the STEPwise Approach methodology. A household wealth index was derived through Principal Component Analysis of various household assets and physical activity (PA) was measured using pedometers and accelerometers. Univariable and multivariable analyses were conducted to determine associations between overweight/obesity and social and behavioral determinants. Results Among a total of 931 participants, the prevalence of overweight (BMI\geq25 kg/m2) and obesity (BMI\geq30 kg/m2) was 30.9% (95% confidence interval (CI) = 28.0, 33.9) and 12.6% (95% CI = 10.4, 14.7), respectively; one in every 10 youths and adults were underweight. Being female, older and living in a wealthier household were found to be significantly associated with overweight and obesity. Those with higher levels of education were found to have a reduced risk of being obese compared to those with no or lower levels of education. Behavioral risk factors (diet, alcohol and tobacco consumption and physical activity) did not significantly increase the risk of overweight and obesity. Conclusions Overweight and obesity are highly prevalent in this peri-urban part of the Mozambican capital, where underweight is still present in youth and adults, confirming that the country is facing a double burden of malnutrition. Social determinants of health should be taken into consideration in the design and implementation of NCD prevention programs

Compliance and impact of mozambican state of emergency on COVID-19 containment measures: a cross-sectional study in an urban setting

The study aimed to describe responses to changes in behaviour associated with the Coronavirus containment measures, to assess the impact on behaviour related to physical activity and family incomes and to determine the association between compliance with the containment measures and social demographic variables. A cross-sectional study design was applied. Adults (n=1054) from two main cities of Mozambique were interviewed. Virtually everyone goes out frequently (99.4%), mostly to work, selling and shopping. Masks were always used (75.9%) and 91.7% declared to have increased washing hands frequently. Among those who exercise, 54.7% exercised outdoors in groups. More than half (54.9%) declared that their income was affected and physical activity was reduced for 30.1% of the subjects. From the logistic regression analysis, Males (OR=1.42), vendors (OR=2.09) and students (OR=1.97) tend to stay at home less. Predictors for not staying at home were informal business (OR=11.54), working (OR=8.83), hanging out (OR=4.76), shopping (OR=2.75) and physical activities (OR=2.73). Informal vending is the occupation more likely to lose income (OR=9.05). The strategy for preventing the spread of the coronavirus proposed worldwide found severe constraints in its application in the urban context of Mozambique

Compliance and impact of Mozambican State of Emergency on COVID-19 containment measures: a cross-sectional study in an urban setting

The study aimed to describe responses to changes in behaviour associated with the Coronavirus containment measures, to assess the impact on behaviour related to physical activity and family incomes and to determine the association between compliance with the containment measures and social demographic variables. A cross-sectional study design was applied. Adults (n=1054) from two main cities of Mozambique were interviewed. Virtually everyone goes out frequently (99.4%), mostly to work, selling and shopping. Masks were always used (75.9%) and 91.7% declared to have increased washing hands frequently. Among those who exercise, 54.7% exercised outdoors in groups. More than half (54.9%) declared that their income was affected and physical activity was reduced for 30.1% of the subjects. From the logistic regression analysis, Males (OR=1.42), vendors (OR=2.09) and students (OR=1.97) tend to stay at home less. Predictors for not staying at home were informal business (OR=11.54), working (OR=8.83), hanging out (OR=4.76), shopping (OR=2.75) and physical activities (OR=2.73). Informal vending is the occupation more likely to lose income (OR=9.05). The strategy for preventing the spread of the coronavirus proposed worldwide found severe constraints in its application in the urban context of Mozambique

Comprehensive profiling of social mixing patterns in resource poor countries: A mixed methods research protocol

Background: Low-and-middle-income countries (LMICs) bear a disproportionate burden of communicable diseases. Social interaction data inform infectious disease models and disease prevention strategies. The variations in demographics and contact patterns across ages, cultures, and locations significantly impact infectious disease dynamics and pathogen transmission. LMICs lack sufficient social interaction data for infectious disease modeling.Methods: To address this gap, we will collect qualitative and quantitative data from eight study sites (encompassing both rural and urban settings) across Guatemala, India, Pakistan, and Mozambique. We will conduct focus group discussions and cognitive interviews to assess the feasibility and acceptability of our data collection tools at each site. Thematic and rapid analyses will help to identify key themes and categories through coding, guiding the design of quantitative data collection tools (enrollment survey, contact diaries, exit survey, and wearable proximity sensors) and the implementation of study procedures.We will create three age-specific contact matrices (physical, nonphysical, and both) at each study site using data from standardized contact diaries to characterize the patterns of social mixing. Regression analysis will be conducted to identify key drivers of contacts. We will comprehensively profile the frequency, duration, and intensity of infants\u27 interactions with household members using high resolution data from the proximity sensors and calculating infants\u27 proximity score (fraction of time spent by each household member in proximity with the infant, over the total infant contact time) for each household member.Discussion: Our qualitative data yielded insights into the perceptions and acceptability of contact diaries and wearable proximity sensors for collecting social mixing data in LMICs. The quantitative data will allow a more accurate representation of human interactions that lead to the transmission of pathogens through close contact in LMICs. Our findings will provide more appropriate social mixing data for parameterizing mathematical models of LMIC populations. Our study tools could be adapted for other studies

Helios expressing regulatory T cells are correlated with decreased IL-2 producing CD8 T cells and antibody diversity in Mozambican individuals living chronically with HIV-1

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1) causes impairment of T and B cell responses, which begins during the acute phase of infection and is not completely restored by antiretroviral treatment. Regulatory T cell (Tregs) can improve overall disease outcome by controlling chronic inflammation but may also suppress beneficial HIV-1 specific immune responses. We aimed to analyze the profile of Tregs and their correlation with the status of T cells activation, the expression of IL-2 and IFNγ and the profile of HIV-1 specific antibodies response in Mozambican people living chronically with HIV-1 (PLWH-C). RESULTS: In PLWH-C, the proportion of total Tregs was positively correlated with the proportion of IL-2(+)CD4 T cells (r = 0.647; p = 0.032) and IL-2(+)IFNγ(+)CD8 T cells (r = 0.551; p = 0.014), while the proportions of Helios(+)Tregs correlated inversely with levels of IL-2(+)CD8 T cells (r = − 0.541; p = 0.017). Overall, PLWH-C, with (82%) or without virologic suppression (64%), were seronegative for at least HIV-1 p31, gp160 or p24, and the breadth of antibody responses was positively correlated with proportions of CD38(+)HLA-DR(+)CD8 T cells (r = 0.620; p = 0.012), viral load (r = 0.452; p = 0.040) and inversely with absolute CD4 T cells count (r = − 0.481; p = 0.027). Analysis of all individuals living HIV-1 showed that the breadth of HIV-1 antibody responses was inversely correlated with the proportion of Helios(+)Tregs (r = − 0.45; p = 0.02). CONCLUSION: Among Mozambican people living with HIV-1, seronegativity to some HIV-1 proteins is common, particularly in virologically suppressed individuals. Furthermore, lower diversity of HIV-specific antibodies is correlated to lower immune activation, lower viral replication and higher CD4 counts, in PLWH-C. Elevation in the proportion of Helios(+)Tregs is related to a reduction of CD8 T expressing intracellular IL-2, in PLWH-C, but may contribute to impairment of B cell function. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12865-022-00487-3

L'Avenir de Luchon : journal scientifique, littéraire, annonces et réclames : guide général des baigneurs et des touristes aux eaux thermales, bains de mer de la France et de l'étranger

08 janvier 19331933/01/08 (N573)-1933/01/08.Appartient à l’ensemble documentaire : MidiPyren

HIV prevalence and risk behavior among male and female adults screened for enrolment into a vaccine preparedness study in Maputo, Mozambique.

IntroductionMozambique continues to have a significant burden of HIV. Developing strategies to control the HIV epidemic remains a key priority for the Mozambican public health community. The primary aim of this study was to determine HIV prevalence and risk behavior among males and females screened for a HIV vaccine preparedness study in Maputo, Mozambique.MethodsMale and female participants between 18-35 years old were recruited from the general community and from female sex worker (FSW) and lesbian, gay, bisexual, and transgender (LGBT) associations in Maputo. All participants were screened for HIV and a questionnaire was administered to each participant to assess HIV risk behavior.ResultsA total of 1125 adults were screened for HIV infection, among whom 506 (45%) were male. Among men, 5.7% reported having had sex with men (MSM) and 12% of female participants reported having exchanged sex for money, goods or favors in the past 3 months. The overall HIV prevalence was 10.4%; 10.7% of women, and 10.1% of men were HIV infected; 41.4% of MSM were seropositive. HIV infection was associated with older age (25-35 years old) (OR: 6.13, 95% CI: 3.01, 12.5), MSM (OR: 9.07, 95% CI: 3.85, 21.4), self-perception of being at high-risk for HIV (OR: 3.99, 95% CI: 1.27, 12.5) and self-report of a history of a diagnosis of sexually transmitted infection (OR: 3.75, 95% CI: 1.57, 8.98).ConclusionIn our cohort, HIV prevalence was much higher among MSM compared to the overall prevalence. Behavioral factors were found to be more associated with HIV prevalence than demographic factors. The study findings demonstrate the critical importance of directing services to minority communities, such as MSM, when prevention strategies are being devised for the general population