Is ALT control really necessary for routine ART monitoring in resource poor settings?

2006 AIDS Conference in Toront

Workers’ compensation, minimum wages, and moral hazard scope. Stylized considerations on a South African case

Viewing issues from the perspective of workers’ compensation, the article highlights how for some South African sectors the simultaneous provision of a minimum wage and a permanent disablement coverage increases moral hazard scope. From an economy-wide perspective this increasing scope means that employers (and society) not only pay too much to provide workers’ compensation, but are doing so at a mounting pace. The article considers some policy options that are overall not too drastic as regards the elimination of the increasing scope, and in so doing it also reminds us about the crucial importance of careful institutional design

A survey on the occurrence of resistance to anthelmintics of gastrointestinal nematodes of goats in Mozambique

A survey to study the extent of anthelmintic resistance was conducted in Maputo and Gaza, two of the ten provinces of Mozambique, during February and March 1999. A total of 12 flocks, six in Maputo and six in Gaza, was surveyed. The faecal egg count reduction test was used to assess the efficacy of three anthelmintics most often used in Mozambique, namely albendazole fenbendazole and levamisole. The degree of resistance was calculated using two different methods, and varied according to the method used. Using the formula of Coles, Bauer, Borgsteede, Geerts, Klei, Taylor and Waller (1992), resistance to the benzimidazoles was detected in one flock in Maputo and one in Gaza, and to levamisole in three flocks in Maputo and one in Gaza. When the formula of Dash, Hall and Barger (1988) was used, however, resistance to the benzimidazoles was detected in only one flock in Maputo, and no resistance to levamisole was detected. The 12 farms surveyed were too few for conclusions to be made on the prevalence of anthelmintic resistance in goats in Mozambique as a whole. Therefore, an extensive survey at national level is needed. This study gives evidence, however, that anthelmintic resistance in nematode parasites of goats is an emerging problem, to which special attention should be paid.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Swedish International Development and Cooperation Agency (SIDA).mn201

The Impact of Charcoal Production on Forest Degradation: a Case Study in Tete, Mozambique

Charcoal production for urban energy consumption is a main driver of forest degradation in sub-Saharan Africa. Urban growth projections for the continent suggest that the relevance of this process will increase in the coming decades. Forest degradation associated to charcoal production is difficult to monitor and commonly overlooked and underrepresented in forest cover change and carbon emission estimates. We use a multi-temporal dataset of very high-resolution remote sensing images to map kiln locations in a representative study area of tropical woodlands in central Mozambique. The resulting maps provided a characterization of the spatial extent and temporal dynamics of charcoal production. Using an indirect approach we combine kiln maps and field information on charcoal making to describe the magnitude and intensity of forest degradation linked to charcoal production, including aboveground biomass and carbon emissions. Our findings reveal that forest degradation associated to charcoal production in the study area is largely independent from deforestation driven by agricultural expansion and that its impact on forest cover change is in the same order of magnitude as deforestation. Our work illustrates the feasibility of using estimates of urban charcoal consumption to establish a link between urban energy demands and forest degradation. This kind of approach has potential to reduce uncertainties in forest cover change and carbon emission assessments in sub-Saharan Africa

What drives policy change for REDD+? : A qualitative comparative analysis of the interplay between institutional and policy arena factors

Reducing Emissions from Deforestation and forest Degradation (REDD+) has emerged as a promising climate change mitigation mechanism in developing countries. In order to identify the enabling conditions for achieving progress in the implementation of an effective, efficient and equitable REDD+, this paper examines national policy settings in a comparative analysis across 13 countries with a focus on both institutional context and the actual setting of the policy arena. The evaluation of REDD+ revealed that countries across Africa, Asia and Latin America are showing some progress, but some face backlashes in realizing the necessary transformational change to tackle deforestation and forest degradation. A Qualitative Comparative Analysis (QCA) undertaken as part of the research project showed two enabling institutional configurations facilitating progress: (1) the presence of already initiated policy change; and (2) scarcity of forest resources combined with an absence of any effective forestry framework and policies. When these were analysed alongside policy arena conditions, the paper finds that the presence of powerful transformational coalitions combined with strong ownership and leadership, and performance-based funding, can both work as a strong incentive for achieving REDD+ goals. Key policy insights The positive push of already existing policy change, or the negative stress of resource scarcity together with lack of effective policies, represents institutional conditions that can support REDD+ progress. Progress also requires the presence of powerful transformational coalitions and strong ownership and leadership. In the absence of these internal drivers, performance-based funding can work as a strong incentive. When comparing three assessments (2012, 2014, 2016) of REDD+ enabling conditions, some progress in establishing processes of change can be observed over time; however, the overall fluctuation in progress of most countries reveals the difficulty in changing the deforestation trajectory away from business as usual.Peer reviewe

Risk factors, genotypes distribution by vaccination status and age of children in Nampula Province, Northern Mozambique (2015-2019)

Publisher Copyright: © 2021 Chissaque et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Mozambique introduced the monovalent rotavirus vaccine (Rotarix®, GSK Biologicals, Rixensart, Belgium) in September 2015. Previous analysis, showed that Nampula province continues reporting a high frequency of Rotavirus A (RVA) infection and the emergence of G9P[6], G9P[4] and G3P[4] genotypes. This analysis aimed to determine the RVA frequency; risk factors; genotype distribution by vaccination status and age between pre- and post-vaccine periods in children under-five years old with diarrhea in Nampula. A cross-sectional, hospital-based surveillance study was conducted in the Hospital Central de Nampula in Mozambique. Socio-demographic and clinical data were collected to assess factors related to RVA infection in both periods. Stool specimens were screened to detect RVA by ELISA, and positive samples were genotyped. Between 2015 (pre-vaccine period) and 2016-2019 (post-vaccine period), 614 stool specimens were collected and tested for RVA in which 34.9% (67/192) were positive in pre-vaccine period and 21.8% (92/422) in post-vaccine (p = 0.001). In the post-vaccine period, age, year, and contact with different animal species (chicken, duck, or multiple animals) were associated with RVA infection. RVA infection was higher in children partially vaccinated (40.7%, 11/27) followed by the fully vaccinated (29.3%, 56/191) and the unvaccinated (15.3%, 21/137) (p = 0.002). G1P[8] and G9P[4] were common in vaccinated children less than 12 months. The present analysis showed that RVA infection reduced slightly in the post-vaccine period, with a high proportion of infection and genotype diversity in children, under 12 months of age, vaccinated. Further research on factors associated with RVA infection on vaccinated compared to unvaccinated children and vaccination optimization should be done.publishersversionpublishe

Causes of death among infants and children in the Child Health and Mortality Prevention Surveillance (CHAMPS) network

Importance The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. Objective To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. Design, Setting, and Participants The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021. Main Outcomes and Measures The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies. Results In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions. Conclusions and Relevance In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death