A Cross-Sectional Analytical Study

Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients’ files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had “high obstetric-risk” and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8; 95% Confidence Interval (95%CI) = 1.3–2.6], preeclampsia [aOR (95%CI) = 2.0 (1.2–3.3)], age [aOR (95%CI) = 0.96 (0.93– 0.99)] and “high obstetric-risk” [aOR (95%CI) = 0.54 (0.37–0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8–2.6)], “high obstetric-risk” [aOR (95%CI) = 1.6 (1.3–1.96)], preeclampsia [aOR (95%CI) = 1.5 (1.2–1.8), mother’s age [aOR (95%CI) = −2% (−3%, −0.1%)] and gestational age [aOR (95%CI) = −8% (−13%, −6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals’ performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads.publishersversionpublishe

Analysis of the 2015 National Health Survey

Funding Information: Funding: This research received no external funding. S.C. was a doctoral scholar partially funded by Canada Aid through the International Development Research Center grant number 102278-001 to the Mozambique’s Instituto Nacional de Saúde. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal con-sultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65; 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1; 95% CI = 1.2–3.7), rural residency (AOR = 1.5; 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5; 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9; 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.publishersversionpublishe

Conceptualizing sexual and gender-based violence in European asylum reception centers

Background: Sexual and gender based violence (SGBV) is a major public health problem and a violation of human rights. Refugees, asylum seekers and migrants are exposed to a constant risk for both victimization and perpetration. Yet, in the context of European asylum reception centers (EARF) professionals are also considered to be at risk. Our study explores the conceptualization of SGBV that residents and professionals have in this specific context. Further, we intent to identify key socio-demographic characteristics that are associated with SGBV conceptualization for both groups. Methods: We developed a cross-sectional study using the Senperforto project database. Semi-structured interviews were conducted with residents (n=398) and professionals (n=202) at EARF. A principal component analysis (PCA) was conducted to variables related with knowledge on SGBV. Chi-square test and Fisher's exact test were applied to understand if significant statistical association exists with socio-demographic characteristics (significant level 0.5%). Results: The majority of residents were male (64.6%), aged from 19 to 29years (41.4%) and single (66.8%); for professionals the majority were women (56.2%), aged from 30 to 39years (42.3%) and married (56.8%). PCA for residents resulted in 14 dimensions of SGBV representing 83.56% of the total variance of the data, while for professionals it resulted in 17 dimensions that represent 86.92% of the total variance of the data. For both groups differences in SGBV conceptualization were found according to host country, sex, age and marital status. Specific for residents we found differences according to the time of arrival to Europe/host country and type of accommodation, while for professionals differences were found according to legal status and education skills. Conclusion: Residents and professionals described different conceptualization of SGBV, with specific types of SGBV not being recognized as a violent act. Primary preventive strategies in EARF should focus on reducing SGBV conceptualization discrepancies, taking into account socio-demographic characteristics

Literature review of information technology adoption models at firm level

Today, information technology (IT) is universally regarded as an essential tool in enhancing the competitiveness of the economy of a country. There is consensus that IT has significant effects on the productivity of firms. These effects will only be realized if, and when, IT are widely spread and used. It is essential to understand the determinants of IT adoption. Consequently it is necessary to know the theoretical models. There are few reviews in the literature about the comparison of IT adoption models at the individual level, and to the best of our knowledge there are even fewer at the firm level. This review will fill this gap. In this study, we review theories for adoption models at the firm level used in information systems literature and discuss two prominent models: diffusion on innovation (DOI) theory, and the technology, organization, and environment (TOE) framework. The DOI found that individual characteristics, internal characteristics of organizational structure, and external characteristics of the organization are important antecedents to organizational innovativeness. The TOE framework identifies three aspects of an enterprise's context that influence the process by which it adopts and implements a technological innovation: technological context, organizational context, and environmental context. We made a thorough analysis of the TOE framework, analysing the studies that used only this theory and the studies that combine the TOE framework with other theories such as: DOI, institutional theory, and the Iacovou, Benbasat, and Dexter model. The institutional theory helps us to understand the factors that influence the adoption of interorganizational systems (IOSs); it postulates that mimetic, coercive, and normative institutional pressures existing in an institutionalized environment may influence the organization’s predisposition toward an IT-based interorganizational system. The Iacovou, Benbasat, and Dexter model, analyses IOSs characteristics that influence firms to adopt IT innovations. It is based on three contexts: perceived benefits, organizational readiness, and external pressure. The analysis of these models takes into account the empirical literature, and the difference between independent and dependent variables. The paper also makes recommendations for future research. (17) (PDF) Literature Review of Information Technology Adoption Models at Firm Level. Available from: https://www.researchgate.net/publication/258821009_Literature_Review_of_Information_Technology_Adoption_Models_at_Firm_Level [accessed Aug 26 2020].publishersversionpublishe

Intestinal parasitic infections in children under five in the Central Hospital of Nampula, Northern Mozambique

Introduction: Intestinal parasites are known to cause infection in humans worldwide, with higher prevalence in low- and middle- incoming countries. Children are greatly affected leading to malnutrition and subsequently to physical and cognitive development impairment. Despite the scale and importance of this issue, there are few studies conducted in Mozambique concerning parasitic intestinal infections in hospitalized children. To our knowledge this is the first published report with data on this subject from Northern Mozambique. Methodology: A cross-sectional study was conducted in 2012 and 2013 in 831 children, attending the Central Hospital of Nampula in Northern Mozambique. One single stool sample was obtained from each child. Socio-demographic and clinical data were also obtained. Parasitological analysis of feces was performed through direct examination and Ritchie concentration technique and Giardia duodenalis antigen detection by rapid immunochromatographic test. Modified Ziehl-Neelsen staining was used for coccidia detection. Results: The global prevalence of pathogenic intestinal parasites was 31.6%. G. duodenalis (23.9%) was by far the most prevalent parasite followed by Strongyloides stercoralis (4.1%) and Cryptosporidium sp. (3.4%). Intestinal parasites were more frequent in older children (p = 0.005; aOR = 1.025). Conclusions: This work is one of the few published studies reporting intestinal parasites infection in hospitalized children. The percentage of children affected with G. duodenalis is higher than found in other studies in the African region. This highlights the need of particular attention being given to this intestinal protozoan and its resistance to water treatment, as well as to environmental health and personal hygiene.publishersversionpublishe

Predicting dengue importation into Europe, using machine learning and model-agnostic methods

The geographical spread of dengue is a global public health concern. This is largely mediated by the importation of dengue from endemic to non-endemic areas via the increasing connectivity of the global air transport network. The dynamic nature and intrinsic heterogeneity of the air transport network make it challenging to predict dengue importation. Here, we explore the capabilities of state-of-the-art machine learning algorithms to predict dengue importation. We trained four machine learning classifiers algorithms, using a 6-year historical dengue importation data for 21 countries in Europe and connectivity indices mediating importation and air transport network centrality measures. Predictive performance for the classifiers was evaluated using the area under the receiving operating characteristic curve, sensitivity, and specificity measures. Finally, we applied practical model-agnostic methods, to provide an in-depth explanation of our optimal model’s predictions on a global and local scale. Our best performing model achieved high predictive accuracy, with an area under the receiver operating characteristic score of 0.94 and a maximized sensitivity score of 0.88. The predictor variables identified as most important were the source country’s dengue incidence rate, population size, and volume of air passengers. Network centrality measures, describing the positioning of European countries within the air travel network, were also influential to the predictions. We demonstrated the high predictive performance of a machine learning model in predicting dengue importation and the utility of the model-agnostic methods to offer a comprehensive understanding of the reasons behind the predictions. Similar approaches can be utilized in the development of an operational early warning surveillance system for dengue importation.publishersversionpublishe

Accounting for Sampling Weights in the Analysis of Spatial Distributions of Disease Using Health Survey Data, with an Application to Mapping Child Health in Malawi and Mozambique

Funding Information: Acknowledgments: Support from a doctoral Calouste Gulbenkian Foundation grant (135422 to S.R.C.) is acknowledged. Support from the Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) (through the project UIDB/00297/2020 (Centro de Matemática e Aplicações) to S.R.C. and F.M.) is acknowledged. Support from the South Africa Medical Research Council (SAMRC) with funds from the National Treasury in terms of the SAMRC’s competitive Intramural Research Fund (SAMRC-RFA-IFF-02-2016 to S.M.) is acknowledged. We also extend thanks to DHS Measure for allowing us to use the 2015-16 MDHS and 2015 IMASIDA datasets for this study. Funding Information: Funding: This work was partially supported through the project of the Centro de Matemática e Aplicações, UID/MAT/00297/2020, financed by the Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology). The APC was by supported the New University of Lisbon through the PhD program in Statistics and Risk Management of the FCT Nova Faculty. Funding Information: This work was partially supported through the project of the Centro de Matemática e Aplicações, UID/MAT/00297/2020, financed by the Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology). The APC was by supported the New University of Lisbon through the PhD program in Statistics and Risk Management of the FCT Nova Faculty. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Most analyses of spatial patterns of disease risk using health survey data fail to adequately account for the complex survey designs. Particularly, the survey sampling weights are often ignored in the analyses. Thus, the estimated spatial distribution of disease risk could be biased and may lead to erroneous policy decisions. This paper aimed to present recent statistical advances in disease-mapping methods that incorporate survey sampling in the estimation of the spatial distribution of disease risk. The methods were then applied to the estimation of the geographical distribution of child malnutrition in Malawi, and child fever and diarrhoea in Mozambique. The estimation of the spatial distributions of the child disease risk was done by Bayesian methods. Accounting for sampling weights resulted in smaller standard errors for the estimated spatial disease risk, which increased the confidence in the conclusions from the findings. The estimated geographical distributions of the child disease risk were similar between the methods. However, the fits of the models to the data, as measured by the deviance information criteria (DIC), were different.publishersversionpublishe

Desenvolvimento e validação do índice de vulnerabilidade de famílias a incapacidades e dependência (IVF-ID)

This exploratory, descriptive, cross-sectional, and quantitative study aimed to develop and validate an index of family vulnerability to disability and dependence (FVI-DD). This study was adapted from the Family Development Index, with the addition of social and health indicators of disability and dependence. The instrument was applied to 248 families in the city of Sao Paulo, followed by exploratory factor analysis. Factor validation was performed using the concurrent and discriminant validity of the Lawton scale and Katz Index. The descriptive level adopted for the study was p < 0.05. The final vulnerability index comprised 50 questions classified into seven factors contemplating social and health dimensions, and this index exhibited good internal consistency (Cronbach’s alpha = 0.82). FVI-DD was validated using both the Lawton scale and Katz Index. We conclude that FVI-DD can accurately and reliably assess family vulnerability to disability and dependence.Pesquisa exploratória, descritiva, transversal, de abordagem quantitativa, cujo objetivo foi desenvolver e validar um índice de vulnerabilidade de famílias a incapacidades e dependência (IVF-ID). Adaptou-se o Índice de Desenvolvimento da Família (IDF), acrescentando indicadores de relações sociais e de saúde relacionados a incapacidades e dependência. Aplicou-se o instrumento a 248 famílias de uma região do município de São Paulo e realizou-se a análise fatorial exploratória. A validação dos fatores foi feita por meio das validades discriminante e concorrente, utilizando a escala de Lawton e o índice de Katz. O nível descritivo adotado para o estudo foi pInvestigación cuantitativa, exploratoria, descriptiva y transversal, con objetivo de desarrollar y validar un índice de vulnerabilidad de la familia a la discapacidad y la dependencia (IVF-ID). El Índice de Desarrollo de la Familia (IDF) fue adaptado, añadiendo indicadores de relaciones sociales e de salud relacionados a discapacidad y dependencia. Se aplicó el instrumento a 248 familias de una región de São Paulo y ae realizó un análisis factorial exploratoria. La validación fue hecha a través de la validez discriminante y la validez concurrente, con la utilización de las escalas de Lawton y Katz. Se adoptó el nivel descriptivo de

Africa Rising, a Narrative for Life Expectancy Gains? Evidence from a Health Production Function

Background: The narrative of Africa Rising has increasingly been called into scrutiny, not just as a debate for economic growth and development, but also as a possible link to the surge in life expectancy on the continent. Theoretically, an increase in economic development tends to result in an increase in public health spending and subsequent better health outcomes. Objective: This paper examines the contribution of economic development and other social determinants to the health status of the African continent and to provide evidence on whether the increase in life expectancy of the past two decades can be largely attributed to the Africa Rising narrative. Methods: We estimated an empirical health production function, with life expectancy gains as the output of the health care system, and various socio-economic, environmental and lifestyle factors as contributory factors. We fitted a generalized least squares model, using panel data from 52 African countries for the period 1995–2014. Findings: The estimation shows that while increases in health care spending contributed to life expectancy gains, urbanization rates and improved water access were the major drivers of life expectancy gains with substantially larger impacts in the past two decades. Conclusions: Overall, the results provide an evidence base for iterating the need to prioritize increasing funding and examine more critically how to improve the efficiency of health spending. It also illustrates potential gains that can be achieved from an inclusive health policy agenda with a broader range of social and economic development issues

Evaluating vertical transmission of sexually transmitted infections to newborns

Funding Information: The authors are grateful to the parturients who participated in the study. We also want to thank the staff of the INM, particularly the nurses’ team. The study was supported by the Calouste Gulbenkian Foundation (Portugal) through a scholarship assigned to the corresponding author (grant number 135499). Publisher Copyright: Copyright © 2021 Oliveira et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Introduction: Sexually transmitted infections are among the most frequent infections affecting pregnant women. We assessed the transmission of hepatitis B virus, human immunodeficiency virus type 1 and Treponema pallidum to newborns from infected parturients. Methodology: An observational, cross-sectional, analytical facility-based survey was conducted among 57 newborns in Irene Neto Maternity, Lubango city, Huíla province, Angola. Hepatitis B virus DNA molecular identification was done through nested PCR. Human immunodeficiency virus type 1 proviral DNA detection was carried out by two successive nested PCRs. Real-time PCR was performed to examine the presence of T. pallidum DNA. Amplicons from PCR positive samples were sequenced for identity search and genotype assignment. Results: Hepatitis B virus DNA genotype E was detected in 3/41 (7.3%) newborns from HBsAg (hepatitis B surface antigen) positive mothers. To analyse the association between mothers HBeAg (hepatitis B e antigen) positivity and hepatitis B virus vertical transmission to newborns, a Fisher's exact test was performed, showing a highly significant association (p = 0.006). Human immunodeficiency virus type 1 provirus or T. pallidum DNA was not detected in any newborn. Conclusions: To prevent hepatitis B virus vertical transmission in Angola it is important to promote universal antenatal screening, expanding hepatitis B virus markers (viral load and/or HBeAg), risk-based infected mothers' antiviral therapy and newborn passive immunoprophylaxis.publishersversionpublishe