Capitalismo africano dependente: estudo histórico-estrutural da economia moçambicana entre o período de 1985-2015

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Sócio Econômico, Programa de Pós-Graduação em Economia, Florianópolis, 2017.O trabalho tem por objetivo estudar o paradigma da dependência no processo de desenvolvimento econômico de Moçambique, através da análise da evolução dos indicadores socioeconômicos. Esta pesquisa compreende a análise estrutural da economia nacional no período de 1985?2015, com um enfoque estrutural nas dependências, produtiva, comercial, financeira. A abordagem teórica encontra-se embasada na teoria Latino-americana da ?dependência?. Os principais resultados apontam que desde que a economia foi liberalizada entre 1984?1985, tornou-se mais dependente da dinâmica do capitalismo produtivo e financeiro mundial. Os principais setores industriais do país (têxtil, caju, borracha, etc.) que detinham na década de 1980 uma participação significativa na divisão internacional e regional (SADC) do trabalho fora encerada ou privatizada na década de 1990. No campo produtivo, os dados mostraram que em 2015, cerca de 80% das exportações do país estavam sobre o controle das empresas multinacionais. E, apesar de Moçambique ter sido ao longo século XXI (2000-2015), o segundo maior destino preferencial do Investimento Direto Externo (IDE) na África Subsaariana, à contribuição média anual dos megaprojetos não superou 2% do Produto Interno Bruto (PIB). O Estado Moçambicano tornou-se um ao longo do período em estudo um ?Estado-empresário?, reflexionando nos níveis de endividamento público interno e externo e na própria dinâmica empresarial nacional. A burguesia nacional que também controla e/ou tem seus interesses entrelaçadas no Estado, para comparticipar financeiramente nos megaprojetos de capital externo vê?se obrigada a contrair empréstimos em mercados internacionais. O nível de endividamento público impacta nos níveis de sustentabilidade da dívida, agudizando as contradições econômicas e sociais, tais como pobreza e desigualdades sociais.Abstract : The objective of this study is to study the dependency paradigma in Mozambique's economic development process, by analyzing the evolution of socioeconomic indicators. This research comprises the structural analysis of the national economy in the period 1985-2015, with a structural focus on dependencies, productive, commercial and financial. The theoretical approach is based on the Latin American theory of "dependence". The main results indicate that since the economy was liberalized between 1984 and 1985, it became more dependent on the dynamics of world productive and financial capitalism. The major industrial sectors of the country (textile, cashew, rubber, etc.) that had significant participation in the international and regional division of the 1980s had been waxed or privatized in the 1990s. In the productive field, the data showed that in 2015, about 80% of the country's exports were over the control of multinational companies. And although Mozambique has been the second destination of Foreign Direct Investment (FDI) in sub-Saharan Africa during the XXI century (2000-2015), the average annual contribution of megaprojects did not exceed 2% of Gross Domestic Product (GDP). The Mozambican State became during the period under study as a "business-state", reflecting the levels of internal and external public indebtedness and in the national business dynamics itself. The local bourgeoisie, which also controls and/or has its interests intertwined in the state to participate financially in the megaprojects of foreign capital is obliged to borrow in international markets. The level of public debt impacts on levels of debt sustainability, exacerbating economic and social contradictions such as poverty and social inequalities

Estratégia de desenvolvimento socioeconômico de Moçambique na concepção da teoria da dependência

O artigo tem por objetivo trazer à análise as estratégias de desenvolvimento socioeconômico adotado por Moçambique nas últimas duas décadas na perspectiva dialética substanciada na teoria de dependência. Neste plano analítico, far-se-á um cruzamento teórico entrelaçado nas várias correntes da teoria da dependência, como forma elucidativa de buscar enquadramento das economias periféricas no sistema capitalista mundial. Finda a parte do enquadramento teórico, procura-se apresentar o quadro metodológico histórico-estrutural, instrumento chave no estudo das trajetórias de desenvolvimento. Depois procuramos avançar na caracterização geral das dinâmicas estruturais ocorridas na implementação da estratégia de desenvolvimento socioeconômico optado por Moçambique. O resultado da liberalização da economia, que possibilitaram à atração massiva de Investimento Direto Estrangeiro, com efeitos positivos na perspectiva macroeconômica, porém atrelado à dependência financeira, tecnológica e econômica externa, marginalizando os setores tradicionais da indústria, que tem capacidade de criar fatores de encadeamento com outros sectores produtivos, possibilitando reais transformações estruturais na economia. Neste quesito, a estratégia de desenvolvimento socioeconômico de Moçambique é ambígua, não tendo uma substanciação viável quando vista e avaliada numa perspectiva de longo prazo.Palavras-chave: Estratégia Nacional, Desenvolvimento Econômico, Moçambique

Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique

Hypoglycemia is a life-threatening complication of several diseases in childhood. We describe the prevalence and incidence of hypoglycemia among admitted Mozambican children, establishing its associated risk factors. We retrospectively reviewed clinical data of 13 years collected through an ongoing systematic morbidity surveillance in Manhica District Hospital in rural Mozambique. Logistic regression was used to identify risk factors for hypoglycemia and death. Minimum community-based incidence rates (MCBIRs) for hypoglycemia were calculated using data from the demographic surveillance system. Of 49,089 children < 15 years hospitalized in Manhica District Hospital, 45,573 (92.8%) had a glycemia assessment on admission. A total of 1,478 children (3.2%) presented hypoglycemia (< 3 mmol/L), of which about two-thirds (972) were with levels < 2.5 mmol/L. Independent risk factors for hypoglycemia on admission and death among hypoglycemic children included prostration, unconsciousness, edema, malnutrition, and bacteremia. Hypoglycemic children were significantly more likely to die (odds ratio [OR] = 7.11; P < 0.001), with an associated case fatality rate (CFR) of 19.3% (245/1,267). Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child years at risk (CYAR), significantly decreasing throughout the study period. Newborns showed the highest incidences (9.47 episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a hazardous condition for African children. Symptoms and signs associated to hypoglycemia should trigger the verification of glycemia and the implementation of life-saving corrective measures

Molecular Characterization of Community Acquired Staphylococcus aureus Bacteremia in Young Children in Southern Mozambique, 2001–2009

Background: The emergence of community-acquired Staphylococcus aureus infections is increasingly recognized as life threating problem worldwide. In Manhiça district, southern Mozambique, S. aureus is the leading cause of community-acquired bacteremia in neonates.Methods: Eighty-four S. aureus isolates from children less than 5 years admitted to Manhiça District Hospital from 2001 to 2009 were randomly selected and genetically characterized by DNA microarray and spa typing. Antimicrobial susceptibility was determined by VITEK 2.Results: Thirty-eight different spa types and 14 clonal complexes (CC) were identified. Spa-type t084 (n = 10; 12%) was the most predominant while CC8 (n = 18; 21%) and CC15 (n = 14; 16%) were the most frequent CCs. Mortality tended to be higher among children infected with CC45 (33.3%, 1/3) and CC8 (27.8%, 5/18). The majority of isolates possessed the accessory gene regulator I (45%) and belonged to either capsule type 8 (52%) or 5 (47%). Panton valentine leukocidin (PVL) encoding genes were detected in 30%. Antibiotic resistance was high for penicillin (89%), tetracycline (59%) and Trimethoprim Sulfamethoxazole (36%) while MRSA was uncommon (8%).Conclusions: Although MRSA were uncommon, we found high genetic diversity of methicillin susceptible S. aureus causing bacteremia in Mozambican children, associated with high resistance to the most available antibiotics in this community. Some CCs are likely to be more lethal indicating the need for prompt recognition and appropriate treatment

Group B Streptococcus and HIV Infection in Pregnant Women, Malawi, 2008–2010

To determine whether an association exists between group B streptococcus carriage and HIV infection, we recruited 1,857 pregnant women (21.7% HIV positive) from Queen Elizabeth Central Hospital, Blantyre, Malawi. Overall, group B streptococcus carriage was 21.2% and did not differ by HIV status. However, carriage was increased among HIV-positive women with higher CD4 counts

Epidemiology and molecular characterization of multidrug-resistant Escherichia coli isolates harboring blaCTX-M group 1 extended-spectrum β-lactamases causing bacteremia and urinary tract infection in Manhiça, Mozambique

Background: The emergence and spread of extended-spectrum β-lactamases (ESBLs), especially CTX-M, is an important public health problem with serious implications for low-income countries where second-line treatment is often unavailable. Knowledge of the local prevalence of ESBL is critical to define appropriate empirical therapeutic strategies for multidrug-resistant (MDR) organisms. This study aimed to assess and characterize the presence of ESBL and especially CTX-M-producing Escherichia coli MDR isolates from patients with urinary tract infections (UTIs) and bacteremia in a rural hospital in Mozambique. Materials and methods: One hundred and fifty-one E. coli isolates from bacteremia and UTI in children were screened for CTX-M, TEM, SHV and OXA β-lactamases by polymerase chain reaction and sequencing. Isolates carrying CTX-M group 1 β-lactamases were further studied. The resistance to other antibiotic families was determined by phenotypic and genotypic methods, the location of the blaCTX-M gene and the epidemiology of the isolates were studied, and extensive plasmid characterization was performed. Results: Approximately 11% (17/151) of E. coli isolates causing bacteremia and UTI were ESBL producers. CTX-M-15 was the most frequently detected ESBL, accounting for 75% of the total isolates characterized. The blaCTX-M gene is located in different plasmids belonging to different incompatibility groups and can be found in non-epidemiologically related isolates, indicating the high capacity of this resistance determinant to spread widely. Conclusion: Our data suggest the presence of a co-selection of third-generation cephalosporin-resistant determinants in the study area despite limited access to these antibiotics. This highlights the importance of continuous surveillance of antimicrobial resistance of both genetic elements of resistance and resistant isolates in order to monitor the emergence and trends of ESBL-producing isolates to promote adequate therapeutic strategies for the management of MDR bacterial infections

Under treatment of pneumonia among children under 5 years of age in a malaria-endemic area: population-based surveillance study conducted in Manhica district- rural, Mozambique

BACKGROUND: Integrated Management of Childhood Illness (IMCI) guidelines were developed to decrease morbidity and mortality, yet implementation varies across settings. Factors associated with poor adherence are not well understood. METHODS: We used data from Manhica District Hospital outpatient department and five peripheral health centers to examine pneumonia management for children <5 years old from January 2008 to June 2011. Episodes of IMCI-defined pneumonia (cough or difficult breathing plus tachypnea), severe pneumonia (pneumonia plus chest wall in-drawing), and/or clinician-diagnosed pneumonia (based on discharge diagnosis) were included. RESULTS: Among severe pneumonia episodes, 96.2% (2,918/3,032) attended in the outpatient department and 70.0% (291/416) attended in health centers were appropriately referred to the emergency department. Age<1 year, malnutrition and various physical exam findings were associated with referral. For non-severe pneumonia episodes, antibiotics were prescribed in 45.7% (16,094/35,224). Factors associated with antibiotic prescription included age <1 year, abnormal auscultatory findings, and clinical diagnosis of pneumonia; diagnosis of malaria or gastroenteritis and pallor were negatively associated with antibiotic prescription. CONCLUSION: Adherence to recommended management of severe pneumonia was high in a hospital outpatient department, but suboptimal in health centers. Antibiotics were prescribed in fewer than half of non-severe pneumonia episodes, and diagnosis of malaria was the strongest risk factor for incorrect management

Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study

BACKGROUND: Preterm and small for gestational age (SGA) births have been associated with adverse outcomes during the first stages of life. We evaluated the morbidity and mortality associated with preterm and SGA births during the first year of life in a rural area of Southern Mozambique. METHODS: This is a retrospective cohort study using previously collected data from children born at the Manhica District Hospital in two different periods (2003-2005 and 2010-2012). Newborns were classified as being preterm and/or SGA or as babies not fulfilling any of the previous conditions (term non-SGA). All children were followed up for a year for morbidity and mortality outcomes. RESULTS: A total of 5574 live babies were included in the analysis. The prevalence of preterm delivery was 6.2% (345/5574); the prevalence of SGA was 14.0% (776/5542) and 2.2% (114/5542) of the children presented both conditions. During the neonatal period, preterm delivery and SGA were associated with 13 (HR: 13.0, 95% CI 4.0-42.2) and 5 times (HR: 4.5, 95% CI: 1.6-12.6) higher mortality compared to term non SGA babies. Risk of hospitalization was only increased when both conditions were present (IRR: 3.5, 95%CI: 1.5-8.1). Mortality is also increased during the entire first year, although at a lower rate. CONCLUSIONS: Neonatal and infant mortality rates are remarkably high among preterm and SGA babies in southern Mozambique. These increased rates are concentrated within the neonatal period. Prompt identification of these conditions is needed to implement interventions aimed at increasing survival of these high-risk newborns

Malaria in rural Mozambique. Part II: children admitted to hospital

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Characterisation of extended-spectrum b-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique

The aim of this study was to determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from urinary tract and bloodstream infections in a rural hospital in Manhiça, Mozambique. ESBLs were investigated among ceftriaxone-non-susceptible K. pneumoniae clinical isolates recovered between 2004 and 2009. Characterisation of blaCTX-M, blaSHV, blaOXA and blaTEM genes was performed by PCR and sequencing. Epidemiological relationships were established by phylogenetic analysis, repetitive extragenic palindromic PCR (REP-PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), whilst plasmid transferability was evaluated by conjugation. In addition, the presence of class 1 and 2 integrons was studied. A total of 19 K. pneumoniae were analysed. The blaCTX-M-15 gene was found in all strains. Other ESBL genes were found concomitantly, including blaSHV-5, blaSHV-2, blaSHV-2A, blaSHV-12 and blaSHV-38. In addition, other β-lactamases such as blaTEM-1 and blaOXA-30 were also detected. REP-PCR identified 15 different epidemiological profiles. MLST analysis also showed great variability of sequence types. The blaCTX-M-15 gene showed a high transfer capacity. The presence of class 1 integrons was high. High levels of multidrug resistance were also found. In conclusion, these data show the dominance of the CTX-M-type ESBL, particularly CTX-M-15, supporting its worldwide dissemination, including in areas with limited access to third-generation cephalosporins. This finding is a matter of concern for clinical management as third-generation cephalosporins are an alternative for treating severe cases of multidrug-resistant infections in this community