14 research outputs found
Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhica district
Background: In Mozambique most of demographic data are obtained using census or sample survey including indirect estimations. A method of collecting longitudinal demographic data was introduced in southern Mozambique since 1996 (DSS -Demographic Surveillance System in Manhiça district, Maputo province), but the extent to which it yields demographic measures that are typical of southern rural Mozambique has not been evaluated yet. Methods: Data from the DSS were used to estimate the levels and trends of fertility, mortality and migration in Manhiça, between 1998 and 2005. The estimates from Manhiça were compared with estimates from Maputo province using the 1997 National census and 1997 Demographic and Health Survey (DHS). The DHS data were used to estimate levels and trends of adult mortality using the siblings' histories and the orphanhood methods. Results: The populations in Manhiça and in Maputo province are young (44% <15 years in Manhiça and 42% in Maputo); with reduced adult males when compared to females (all ages sex ratio of 78.7 in Manhiça and 89 in Maputo). Fertility in Manhiça is at a similar level as in Maputo province and has remained around 5 children per woman, during the eight years of surveillance in Manhiça. Although the infant mortality rate (IMR) in Mozambique has decreased during the last two decades (from 148 deaths per 1000 live births in 1980 to 101 in 2003), it has remained stable around 80 in Manhiça during the surveillance period. Adult mortality has increased both in Manhiça (probability of dying from ages 15 to 60 increased from 0.4 in 1998 to 0.6 in 2005 in Manhiça, from 0.3 in 1992 to 0.4 in 1997 in Maputo province and from 0.1 in 1980 to 0.6 in 2000 in Mozambique). Consequently, the life expectancy decreased from 53 to 46 in Manhiça and from 42 years in 1997 to 38 in 2004 in Mozambique. Migration is high in Manhiça but tends to stabilise after the movements of resettlement that followed the end of the civil war in 1992. Conclusion: The population under demographic surveillance in Manhiça district presents characteristics that are typical of southern rural Mozambique, with predominance of young people and reduction of adult males. Labour migration and excess adult male mortality are the major factors for the reduction of adult males. Mortality is high and only infant mortality has started to stabilise while adult mortality has increased, and as consequence, life expectancy has decreased. The Manhiça DSS is an adequate tool to report demographic measures for southern rural Mozambique
Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhiça district
BACKGROUND: In Mozambique most of demographic data are obtained using census or sample survey including indirect estimations. A method of collecting longitudinal demographic data was introduced in southern Mozambique since 1996 (DSS -Demographic Surveillance System in Manhiça district, Maputo province), but the extent to which it yields demographic measures that are typical of southern rural Mozambique has not been evaluated yet. METHODS: Data from the DSS were used to estimate the levels and trends of fertility, mortality and migration in Manhiça, between 1998 and 2005. The estimates from Manhiça were compared with estimates from Maputo province using the 1997 National census and 1997 Demographic and Health Survey (DHS). The DHS data were used to estimate levels and trends of adult mortality using the siblings' histories and the orphanhood methods. RESULTS: The populations in Manhiça and in Maputo province are young (44% <15 years in Manhiça and 42% in Maputo); with reduced adult males when compared to females (all ages sex ratio of 78.7 in Manhiça and 89 in Maputo). Fertility in Manhiça is at a similar level as in Maputo province and has remained around 5 children per woman, during the eight years of surveillance in Manhiça. Although the infant mortality rate (IMR) in Mozambique has decreased during the last two decades (from 148 deaths per 1000 live births in 1980 to 101 in 2003), it has remained stable around 80 in Manhiça during the surveillance period. Adult mortality has increased both in Manhiça (probability of dying from ages 15 to 60 increased from 0.4 in 1998 to 0.6 in 2005 in Manhiça, from 0.3 in 1992 to 0.4 in 1997 in Maputo province and from 0.1 in 1980 to 0.6 in 2000 in Mozambique). Consequently, the life expectancy decreased from 53 to 46 in Manhiça and from 42 years in 1997 to 38 in 2004 in Mozambique. Migration is high in Manhiça but tends to stabilise after the movements of resettlement that followed the end of the civil war in 1992. CONCLUSION: The population under demographic surveillance in Manhiça district presents characteristics that are typical of southern rural Mozambique, with predominance of young people and reduction of adult males. Labour migration and excess adult male mortality are the major factors for the reduction of adult males. Mortality is high and only infant mortality has started to stabilise while adult mortality has increased, and as consequence, life expectancy has decreased. The Manhiça DSS is an adequate tool to report demographic measures for southern rural Mozambique
Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention
INTRODUCTION: Context-specific improvements in the continuum of
HIV care are needed in order to achieve the UNAIDS target of
90-90-90. This study aimed to assess the linkage to and
retention in HIV care according to different testing modalities
in rural southern Mozambique. METHODS: Adults newly diagnosed
with HIV from voluntary counseling and testing (VCT),
provider-initiated (PICT) and home-based HIV testing (HBT)
services were prospectively enrolled between 2014- 2015 at the
Manhica District. Patients were passively followed-up through
chart examination .Tracing was performed at 12-months to
ascertain causes of loss to follow-up. Fine and Grey competing
risk analysis was performed to determine factors associated with
the each step of the cascade. RESULTS: Overall linkage to care
as defined by having a CD4 count at 3 months, was 43.7% (95CI%
40.8-46.6) and 25.2% of all participants initiated ART. Factors
associated with increased linkage in multivariable analysis
included testing at VCT, older age, having been previously
tested for HIV, owning a cell phone, presenting with WHO
clinical stages III/IV, self-reported illness-associated
disability in the previous month , and later calendar month of
participant recruitment. Ascertaining deaths and transfers
allowed adjustment of the rate of 12-month retention in
treatment from 75.6% (95% CI 70.2-80.5) to 84.2% (95% CI
79.2-88.5). CONCLUSIONS: HBT reached a socio-demographically
distinct population from that of clinic based testing modalities
but low linkage to care points to a need for facilitated linkage
interventions. Distinguishing between true treatment defaulting
and other causes of loss-to-follow-up can significantly change
indicators of retention in care
Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study.
"Patients lost to follow-up (LTFU) over the human
immunodeficiency virus (HIV) cascade have poor clinical outcomes
and contribute to onward HIV transmission. We assessed true care
outcomes and factors associated with successful reengagement in
patients LTFU in southern Mozambique.Newly diagnosed
HIV-positive adults were consecutively recruited in the
Manhi\xC3\xA7a District. Patients LTFU within 12 months after
HIV diagnosis were visited at home from June 2015 to July 2016
and interviewed for ascertainment of outcomes and reasons for
LTFU. Factors associated with reengagement in care within 90
days after the home visit were analyzed by Cox proportional
hazards model.Among 1122 newly HIV-diagnosed adults, 691 (61.6%)
were identified as LTFU. Of those, 557 (80.6%) were approached
at their homes and 321 (57.6%) found at home. Over 50% had died
or migrated, 10% had been misclassified as LTFU, and 252 (78.5%)
were interviewed. Following the visit, 79 (31.3%) reengaged in
care. Having registered in care and a shorter time between LTFU
and visit were associated with reengagement in multivariate
analyses: adjusted hazards ratio of 3.54 [95% confidence
interval (CI): 1.81-6.92; P\xE2\x80\x8A<\xE2\x80\x8A.001] and
0.93 (95% CI: 0.87-1.00; P\xE2\x80\x8A=\xE2\x80\x8A.045),
respectively. The most frequently reported barriers were the
lack of trust in the HIV-diagnosis, the perception of being in
good health, and fear of being badly treated by health personnel
and differed by type of LTFU.Estimates of LTFU in rural areas of
sub-Saharan Africa are likely to be overestimated in the absence
of active tracing strategies. Home visits are resource-intensive
but useful strategies for reengagement for at least one-third of
LTFU patients when applied in the context of differentiated care
for those LTFU individuals who had already enrolled in HIV care
at some point.
Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015
BACKGROUND: Maternal group B streptococcal (GBS) vaccines under
development hold promise to prevent GBS disease in young
infants. Sub-Saharan Africa has the highest estimated disease
burden, although data on incidence and circulating strains are
limited. We described invasive bacterial disease (IBD) trends
among infants <90 days in rural Mozambique during 2001-2015,
with a focus on GBS epidemiology and strain characteristics.
METHODS: Community-level birth and mortality data were obtained
from Manhica's demographic surveillance system. IBD cases were
captured through ongoing surveillance at Manhica district
hospital. Stored GBS isolates from cases underwent serotyping by
multiplex PCR, antimicrobial susceptibility testing, and whole
genome sequencing. RESULTS: There were 437 IBD cases, including
57 GBS cases. Significant declines in overall IBD, neonatal
mortality, and stillbirth rates were observed (P<0.0001), but
not for GBS (P = 0.17). In 2015, GBS was the leading cause of
young infant IBD (2.7 per 1,000 live births). Among 35 GBS
isolates available for testing, 31 (88.6%) were highly related
serotype III isolates within multilocus sequence types (STs) 17
(68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had
elevated minimum inhibitory concentration (MIC) to penicillin
(>/=0.12 mug/mL) associated with penicillin-binding protein
(PBP) 2x substitution G398A. Epidemiologic and molecular data
suggest this is a well-established clone. CONCLUSION: A notable
young infant GBS disease burden persisted despite improvements
in overall maternal and neonatal health. We report an
established strain with pbp2x point mutation, a first-step
mutation associated with reduced penicillin susceptibility
within a well-known virulent lineage in rural Mozambique. Our
findings further underscores the need for non-antibiotic GBS
prevention strategies
Demographic and health community-based surveys to inform a malaria elimination project in Magude district, southern Mozambique
--- - Label: OBJECTIVES NlmCategory: OBJECTIVE content: A
Demographic and Health Platform was established in Magude in
2015, prior to the deployment of a project aiming to evaluate
the feasibility of malaria elimination in southern Mozambique,
named the Magude project. This platform aimed to inform the
design, implementation and evaluation of the Magude project,
through the identification of households and population; and the
collection of demographic, health and malaria information. -
Label: SETTING NlmCategory: METHODS content: Magude is a rural
district of southern Mozambique which borders South Africa. It
has nine peripheral health facilities and one referral health
centre with an inpatient ward. - Label: INTERVENTION
NlmCategory: METHODS content: "A baseline census enumerated and
geolocated all the households, and their resident and
non-resident members, collecting demographic and socio-economic
information, and data on the coverage and usage of malaria
control tools. Inpatient and outpatient data during the
5\xE2\x80\x89years (2010 to 2014) before the survey were
obtained from the district health authorities. The demographic
platform was updated in 2016." - Label: RESULTS NlmCategory:
RESULTS content: "The baseline census conducted in 2015 reported
48\xE2\x80\x89448 (92.1%) residents and 4133 (7.9%)
non-residents, and 10\xE2\x80\x89965 households. Magude's
population is predominantly young, half of the population has no
formal education and the main economic activities are
agriculture and fishing. Houses are mainly built with
traditional non-durable materials and have poor sanitation
facilities. Between 2010 and 2014, malaria was the most common
cause of all-age inpatient discharges (representing 20% to 40%
of all discharges), followed by HIV (12% to 22%) and anaemia
(12% to 15%). In early 2015, all-age bed-net usage was between
21.8% and 27.1%\xE2\x80\x89and the reported coverage of indoor
residual spraying varied across the district between 30.7% and
79%." - Label: CONCLUSION NlmCategory: CONCLUSIONS content: This
study revealed that Magude has limited socio-economic
conditions, poor access to healthcare services and low coverage
of malaria vector control interventions. Thus, Magude
represented an area where it is most pressing to demonstrate the
feasibility of malaria elimination. - Label: TRIAL REGISTRATION
NUMBER NlmCategory: BACKGROUND content: NCT02914145;
Pre-results
Setting the scene and generating evidence for malaria elimination in Southern Mozambique
Mozambique has historically been one of the countries
with the highest malaria burden in the world. Starting in the
1960s, malaria control efforts were intensified in the southern
region of the country, especially in Maputo city and Maputo
province, to aid regional initiatives aimed to eliminate malaria
in South Africa and eSwatini. Despite significant reductions in
malaria prevalence, elimination was never achieved. Following
the World Health Organization's renewed vision of a
malaria-free-world, and considering the achievements from the
past, the Mozambican National Malaria Control Programme (NMCP)
embarked on the development and implementation of a strategic
plan to accelerate from malaria control to malaria elimination
in southern Mozambique. An initial partnership, supported by the
Bill and Melinda Gates Foundation and the La Caixa Foundation,
led to the creation of the Mozambican Alliance Towards the
Elimination of Malaria (MALTEM) and the Malaria Technical and
Advisory Committee (MTAC) to promote national ownership and
partner coordination to work towards the goal of malaria
elimination in local and cross-border initiatives. Surveillance
systems to generate epidemiological and entomological
intelligence to inform the malaria control strategies were
strengthened, and an impact and feasibility assessment of
various interventions aimed to interrupt malaria transmission
were conducted in Magude district (Maputo Province) through the
"Magude Project". The primary aim of this project was to
generate evidence to inform malaria elimination strategies for
southern Mozambique. The goal of malaria elimination in areas of
low transmission intensity is now included in the national
malaria strategic plan for 2017-22 and the NMCP and its partners
have started to work towards this goal while evidence continues
to be generated to move the national elimination agenda forward
Escherichia coli ST131 clones harbouring AggR and AAF/V fimbriae causing bacteremia in Mozambican children: Emergence of new variant of fimH27subclone
Multidrug-resistant Escherichia coli ST131 fimH30 responsible for extra-intestinal pathogenic (ExPEC) infections is globally distributed. However, the occurrence of a subclone fimH27 of ST131 harboring both ExPEC and enteroaggregative E. coli (EAEC) related genes and belonging to commonly reported O25:H4 and other serotypes causing bacteremia in African children remain unknown. We characterized 325 E. coli isolates causing bacteremia in Mozambican children between 2001 and 2014 by conventional multiplex polymerase chain reaction and whole genome sequencing. Incidence rate of EAEC bacteremia was calculated among cases from the demographic surveillance study area. Approximately 17.5% (57/325) of isolates were EAEC, yielding an incidence rate of 45.3 episodes/105 children-years-at-risk among infants; and 44 of isolates were sequenced. 72.7% (32/44) of sequenced strains contained simultaneously genes associated with ExPEC (iutA, fyuA and traT); 88.6% (39/44) harbored the aggregative adherence fimbriae type V variant (AAF/V). Sequence type ST-131 accounted for 84.1% (37/44), predominantly belonging to serotype O25:H4 (59% of the 37); 95.6% (35/44) harbored fimH27. Approximately 15% (6/41) of the children died, and five of the six yielded ST131 strains (83.3%) mostly (60%; 3/5) due to serotypes other than O25:H4. We report the emergence of a new subclone of ST-131 E. coli strains belonging to O25:H4 and other serotypes harboring both ExPEC and EAEC virulence genes, including agg5A, associated with poor outcome in bacteremic Mozambican children, suggesting the need for prompt recognition for appropriate management
Malaria in rural Mozambique. Part I: Children attending the outpatient clinic
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens
A 10 year study of the cause of death in children under 15 years in Manhiça, Mozambique
<p>Abstract</p> <p>Background</p> <p>Approximately 46 million of the estimated 60 million deaths that occur in the world each year take place in developing countries. Further, this mortality is highest in Sub-Saharan Africa, although causes of mortality in this region are not well documented. The objective of this study is to describe the most frequent causes of mortality in children under 15 years of age in the demographic surveillance area of the Manhiça Health Research Centre, between 1997 and 2006, using the verbal autopsy tool.</p> <p>Methods</p> <p>Verbal autopsy interviews for causes of death in children began in 1997. Each questionnaire was reviewed independently by three physicians with experience in tropical paediatrics, who assigned the cause of death according to the International Classification of Diseases (ICD-10). Each medical doctor attributed a minimum of one and a maximum of 2 causes. A final diagnosis is reached when at least two physicians agreed on the cause of death.</p> <p>Results</p> <p>From January 1997 to December 2006, 568499 person-year at risk (pyrs) and 10037 deaths were recorded in the Manhiça DSS. 3730 deaths with 246658 pyrs were recorded for children under 15 years of age. Verbal autopsy interviews were conducted on 3002 (80.4%) of these deaths. 73.6% of deaths were attributed to communicable diseases, non-communicable diseases accounted for 9.5% of the defined causes of death, and injuries for 3.9% of causes of deaths. Malaria was the single largest cause, accounting for 21.8% of cases. Pneumonia with 9.8% was the second leading cause of death, followed by HIV/AIDS (8.3%) and diarrhoeal diseases with 8%.</p> <p>Conclusion</p> <p>The results of this study stand out the big challenges that lie ahead in the fight against infectious diseases in the study area. The pattern of childhood mortality in Manhiça area is typical of developing countries where malaria, pneumonia and HIV/AIDS are important causes of death.</p