Konzo and continuing cyanide intoxication from cassava in Mozambique

In Mozambique, epidemics of the cassava-associated paralytic disease, konzo, have been reported in association with drought or war: over 1100 cases in 1981, over 600 cases in 1992-1993, and over 100 cases in 2005. Smaller epidemics and sporadic cases have also been reported.Large epidemics have occurred at times of agricultural crisis, during the cassava harvest, when the population has been dependent on a diet of insufficiently processed bitter cassava. Konzo mostly affects women of child-bearing age and children over 2. years of age.When measured, serum or urinary thiocyanate concentrations, indicative of cyanide poisoning, have been high in konzo patients during epidemics and in succeeding years. Monitoring of urinary thiocyanate concentrations in schoolchildren in konzo areas has shown persistently high concentrations at the time of the cassava harvest. Inorganic sulphate concentrations have been low during and soon after epidemics.Programmes to prevent konzo have focused on distributing less toxic varieties of cassava and disseminating new processing methods, such as grating and the flour wetting method. Attention should be given to the wider question of agricultural development and food security in the regions of Africa where dependence on bitter cassava results in chronic cyanide intoxication and persistent and emerging konzo

Rising African cassava production, diseases due to high cyanide intake and control measures

Cassava is the staple food of tropical Africa and its production, averaged over 24 countries, has increased more than threefold from 1980 to 2005, and the population has more than doubled over that time compared with a 1.5 times increase worldwide. Agriculturally, cassava performs very well but the roots and leaves contain cyanogenic glucosides that are dangerous to human health. These cyanogens sometimes produce acute intoxication leading to death, they exacerbate goitre and cretinism in iodine-deficient regions, cause konzo and are implicated in the occurrence of tropical ataxic neuropathy and stunting of children. Konzo is an irreversible paralysis of the legs with many thousands of cases, mainly amongst children, in Mozambique, Tanzania, Democratic Republic of Congo, Cameroon, Central African Republic and probably other tropical African countries. Attempts to alleviate cassava cyanide toxicity have included the development of an information network and distribution in developing countries of picrate kits, which measure total cyanide in cassava and urinary thiocyanate. A simple wetting method that reduces total cyanide in cassava flour three- to sixfold has been successfully field tested and is being introduced in Mozambique. Transgenic technology shows promise in increasing the rate of loss of cyanide from roots during processing. World health and agricultural bodies should pay more attention to emerging health problems associated with toxicity of cyanogens in cassava

Depicting the healthcare landscape around a community for a m-health Intervention: a look into maternal health in KaTembe, Mozambique

This work-in-progress is part of a larger project that aims at developing methods for information systems developers to support local communities in Africa to develop their life situations in the way they decide. The focus is on maternal and newborn health – how can the maternal and newborn healthcare services available to communities be improved by means of appropriate information and communication processes, particularly using mobile phone technology and computerbased information systems. To that end, information technology (IT) analysts and developers must first learn about the communities in question and the setting around them. The purpose of this study is to test and further develop an existing method for analysing the “healthcare landscape” around a given geographic community. The results of the analysis should be useful as a basis for the community, their healthcare providers, local authorities, and IT analysts to identify relevant stakeholders for a collaborative needs analysis and solutions development project. The main focus is on maternal health and mobile technology but within a holistic view

Measuring the burden of SARS-CoV-2 infection among persons living with HIV and healthcare workers and its impact on service delivery in Mozambique: protocol of a prospective cohort study

Introduction As COVID-19 continues to spread globally and within Mozambique, its impact among immunosuppressed persons, specifically persons living with HIV (PLHIV), and on the health system is unknown in the country. The ‘COVid and hIV’ (COVIV) study aims to investigate: (1) the seroprevalence and seroincidence of SARS-CoV-2 among PLHIV and healthcare workers providing HIV services; (2) knowledge, attitudes, practices and perceptions regarding SARS-CoV-2 infection; (3) the pandemic’s impact on HIV care continuum outcomes and (4) facility level compliance with national COVID-19 guidelines.Methods and analysis A multimethod study will be conducted in a maximum of 11 health facilities across Mozambique, comprising four components: (1) a cohort study among PLHIV and healthcare workers providing HIV services to determine the seroprevalence and seroincidence of SARS-CoV-2, (2) a structured survey to assess knowledge, attitudes, perceptions and practices regarding COVID-19 disease, (3) analysis of aggregated patient data to evaluate retention in HIV services among PLHIV, (4) an assessment of facility implementation of infection prevention and control measures.Ethics and dissemination Ethical approval was obtained from the National Health Bioethics Committee, and institutional review boards of implementing partners. Study findings will be discussed with local and national health authorities and key stakeholders and will be disseminated in clinical and scientific forums.Trial registration number NCT05022407

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

For the poorest of our world, non-communicable diseases and injuries (NCDIs) account for more than a third of their burden of disease; this burden includes almost 800000 deaths annually among those aged younger than 40 years, more than HIV, tuberculosis, and maternal deaths combined. • Despite already living in abject poverty, between 19 million and 50 million of the poorest billion spend a catastrophic amount of money each year in direct out-of-pocket costs on health care as a result of NCDIs. • Progressive implementation of affordable, cost-effective, and equitable NCDI interventions between 2020 and 2030 could save the lives of more than 4·6 million of the world’s poorest, including 1·3 million who would otherwise die before the age of 40 years. • To avoid needless death and suffering, and to reduce the risk of catastrophic health spending, essential NCDI services must be financed through pooled, public resources, either from increased domestic funding or external funds. • National governments should set and adjust priorities based on the best available local data on NCDIs and the specific needs of the worst off. • International development assistance for health should be augmented and targeted to ensure that the poorest families affected by NCDIs are included in progress towards universal health care

Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries

Introduction The Package of Essential Noncommunicable Disease Interventions—Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up.Methods and analysis Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews.Ethics and dissemination This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project’s course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals