Microbiological contamination of improved water sources, Mozambique

Objective To assess if water from improved sources are microbiologically safe in Niassa province, Mozambique, by examining the presence of total coliforms in different types of water sources. Methods We conducted a cross-sectional household survey in two rural districts of Niassa province during the dry season, from 21 August to 4 October 2019. We observed water sources and conducted microbiological water quality tests and structured household interviews. Findings We included 1313 households, of which 812 (61.8%) used water from an improved source. There was no significant difference in presence of total coliforms between water sampled at improved and unimproved water sources, 62.7% (509 samples) and 65.7% (329 samples), respectively (P-value = 0.267). Households using improved water sources spent significantly longer time collecting water (59.1 minutes; standard deviation, SD: 55.2) than households using unimproved sources (49.8 minutes; SD: 58.0; P-value < 0.001). A smaller proportion of households using improved sources had access to water sources available 24 hours per day than that of households using unimproved sources, 71.7% (582 households) versus 94.2% (472 households; P-value < 0.001). Of the 240 households treating water collected from improved sources, 204 (85.4%) had total coliforms in their water, while treated water from 77 of 107 (72.0%) households collecting water from an unimproved source were contaminated. Conclusion Current access to an improved water source does not ensure microbiological safety of water and thereby using access as the proxy indicator for safe drinking and cooking water is questionable. Poor quality of water calls for the need for integration of water quality assessment into regular monitoring programmes

Evolution of primary HIV drug resistance in a subtype C dominated epidemic in Mozambique.

In Mozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralization and expansion, resulting in a more than 20-fold increase in coverage by 2009. Implementation of HIV drug resistance threshold surveys (HIVDR-TS) is crucial in order to monitor the emergence of transmitted viral resistance, and to produce evidence-based recommendations to support antiretroviral (ARV) policy in Mozambique.World Health Organization (WHO) methodology was used to evaluate transmitted drug resistance (TDR) in newly diagnosed HIV-1 infected pregnant women attending ante-natal clinics in Maputo and Beira to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI). Subtypes were assigned using REGA HIV-1 subtyping tool and phylogenetic trees constructed using MEGA version 5.Although mutations associated with resistance to all three drug were detected in these surveys, transmitted resistance was analyzed and classified as <5% in Maputo in both surveys for all three drug classes. Transmitted resistance to NNRTI in Beira in 2009 was classified between 5-15%, an increase from 2007 when no NNRTI mutations were found. All sequences clustered with subtype C.Our results show that the epidemic is dominated by subtype C, where the first-line option based on two NRTI and one NNRTI is still effective for treatment of HIV infection, but intermediate levels of TDR found in Beira reinforce the need for constant evaluation with continuing treatment expansion in Mozambique

Phylogenetic tree depicting HIV sequences from Maputo analyzed in 2009 TDR threshold survey.

<p>Tree was constructed bases on complete sequences of protease and part of RT gene (1.317 bp), using Kimura 2-parameter (K2P) model of base substitution with bootstrap analysis (100 replications) in MEGA 5.05. Nomenclature of samples herein characterized is as follows: MZ (country) and year of sequencing-patient code-region of isolation [CID: Jose Macamo Health Center and 1° de Junho Health Center]. Tree includes sequences of the HIV-1 subtypes inferred through REGA (empty circles) along with previously described subtype C in the region, India and Brazil (full circles), other subtypes (other full shapes) and outlier group CPZ, obtained from Los Alamos HIV Sequence Database Subtype Reference Alignments (http: //<a href="http://www.hiv.lanl.gov/content/index" target="_blank">www.hiv.lanl.gov/content/index</a>).</p

HAART service coverage at included antenatal care sites in Mozambique.

<p>HAART service coverage at included antenatal care sites in Mozambique.</p

Distribution of PI secondary mutations in 112 specimens collected in Maputo and Beira in 2009.

<p>Distribution of PI secondary mutations in 112 specimens collected in Maputo and Beira in 2009.</p

Distribution of NNRTI (etravirine) secondary mutations in 112 specimens collected in Maputo and Beira in 2009.

<p>Distribution of NNRTI (etravirine) secondary mutations in 112 specimens collected in Maputo and Beira in 2009.</p

Transmitted drug resistance (TDR) classification and subtype assignment from two threshold surveys conducted in Mozambique in 2007 and 2009.

<p>(a) A total of 77+25 = 102 samples were eligible in 2007 and 76+56 = 132 samples were eligible in 2009.</p><p>(b) Subtype assigned by REGA HIV-1 subtyping tool version 2.0 and confirmed by phylogenetic analysis.</p><p>(c) Discordant results as per subtype assigned by Stanford Drug Resistance Database.</p