Addressing health care disruption in rural Mozambique due to extreme climate events: mobile units tackling cyclones, vaccine-preventable diseases, and beyond

Floods, and cyclones are occurring with increasing frequency and intensity worldwide due to global warming. Mozambique is very susceptible to these extreme events due to its geographical location. In the last ten years, four of the most severe extreme climatic events have been observed in this country, leading to widespread destruction of infrastructure and the displacement of inhabitants. Cyclones Dineo in 2017, Idai and Kenneth in 2019 and recently Freddy in 2023 affected in total over two million people impacting food and water security, causing cholera outbreaks and damage to health facilities. The mobile health units, known as Brigadas Móveis (BM), are crucial to the Mozambican health system as they provide people in the most remote areas with vaccinations, and antimalarials, and other interventions. The BM activities in five districts of Inhambane province in the south of Mozambique are run by the NGO Medicus Mundi Italia in collaboration with the local health authorities. Cyclone Freddy flooded the province of Inhambane, affecting road accessibility and the BM’s planned operations in all five districts with a loss of 37.8% of BM outreach activities. The temporary absence of the BM service resulted in rural communities having no access to health care, including routine vaccine administration. Adaptation strategies need to be implemented to address the healthcare challenges associated with extreme climate events. As described in our experience in Inhambane, BM restored outreach activities immediately after the cyclone, improving access to care after challenging situations

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs

The cascade of care of HIV after one year of follow-up in a cohort of HIV-positive adult patients in three health settings of Morrumbene in rural Mozambique

Objective: To assess the state of the retention in care of HIV patients in three health settings in Morrumbene, a rural district of Inhambane Province, Mozambique. We evaluated potential factors associated with early loss to follow-up (LTFU), retention in care and ART adherence during the first year of follow-up. Material and methods: Retrospective, cross-sectional, observational study. We collected data on patients diagnosed with HIV infection in 2017 in two permanent clinics and one mobile clinic. Demographic, clinical, immunological and therapeutic data were retrieved up to December 31st, 2018. Data on follow-up were collected at 6 and 12 months for medical visits and for ART adherence and analysed for factors associated with LTFU, retention in care and adherence to ART by Stata Version 14 and univariate and stepwise multiple unconditional logistic regression models. Results: In 2017, 960 patients were diagnosed with HIV infection. At 6-month follow-up, 49% attended the medical visit and 157 (25%) adhered to ART. After one year, 34% of patients were available for follow-up, and only 72 patients adhered to ART. In multivariate analysis, factors associated with early LTFU were male sex (p = 0.036) and immediate prescription of ART (p = 0.064). Older age (p < 0.001) and being followed in the mobile clinic (p = 0.001) favoured retention in care. Advanced WHO status (p = 0.005) and being pregnant or breastfeeding showed a negative correlation with adherence to treatment (p = 0.068). Conclusions: Only one-third of patients were available for follow-up after one year, and only 13% adhered to ART. Young individuals, men and pregnant/breastfeeding women seem to be particularly at risk for LTFU and non-adherence to treatment

Female Genital Schistosomiasis: A Neglected among the Neglected Tropical Diseases

Schistosomiasis is a neglected parasitic disease linked to water, posing a global public health concern with a significant burden in sub-Saharan Africa. It is transmitted by Schistosoma spp., causing both acute and chronic effects affecting the urogenital or the hepato-intestinal system. Through granuloma formation, chronic schistosomiasis weakens host immunity, heightening susceptibility to coinfections. Notably, female genital schistosomiasis (FGS), a disregarded gynecological condition, adversely affects girls' and women's reproductive health and increases vulnerability to HIV. This review explores the intricate interplay between schistosomiasis and HIV, considering their geographical overlap. We delve into the clinical features of this coinfection, underlying mutual influences on transmission, diagnostic challenges, and therapeutic approaches. Understanding the dynamics of FGS and HIV coinfection is pivotal for integrated healthcare strategies in regions with co-endemicity, aiming to mitigate the impact of the two infections on vulnerable populations

Monkeypox, a Literature Review: What Is New and Where Does This concerning Virus Come From?

Among the Poxviridae family, orthopoxvirus is the most notorious genus. Several DNA viruses belonging to this group are known to produce human disease from the life-threatening variola virus (VARV) (the causative agent of smallpox), monkeypox virus (MPXV), cowpox virus (CPXV), and vaccinia virus (VACV). These orthopoxviruses still remain a public health concern as VACV or CPXV still cause emerging endemic threads, especially in developing countries. MPXV is able to cause sporadic human outbreaks of a smallpox-like zoonotic disease and, in May 2022, hundreds of cases related to MPXV have been reported from more than 30 countries around the globe. At the end of July, monkeypox (MPX) outbreak was even declared a global health emergency by the World Health Organization (WHO). Many aspects remain unclear regarding this outbreak and a deep understanding of orthopoxvirus might have crucial and evident implications. During the era in which people under 45 years old are not protected against VACV, the potential use of orthopoxviruses as a biological weapon raises global concern considering the rapid spreading of the current MPX outbreak in vulnerable populations. Hence, we review the most recent evidence about phylogenesis, pathogenesis, prevention, and treatment for this concerning disease

Impact of the SARS Coronavirus 2 epidemic on tuberculosis treatment outcome, Northern Italy

It is important to recognise the impact of COVID-19 on TB care to mitigate its consequences. TB services have an urgent need to identify novel strategies to ensure the continuum of TB care at the time of the coronavirus pandemic

Amoebic colitis and liver abscess: A rare case of autochthonous invasive infection due to Entamoeba histolytica

We report an unusual and confirmed case of invasive amebiasis in a non-endemic area where the source of infection remains unknown. During her admission, the patient developed amebic colitis and extraintestinal liver abscess with a favorable outcome following the antiparasitic therapy

Perception and Awareness about Monkeypox and Vaccination Acceptance in an At-Risk Population in Brescia, Italy: An Investigative Survey

Before 2022, monkeypox virus (Mpox) infection in humans was seldom reported outside Africa. During the May 2022 outbreak, most cases were detected among men who have sex with men (MSM). Since Mpox is largely unknown to the general population, through a self-completion questionnaire, we investigated the behaviours and knowledge of our at-risk population belonging to the sexually transmitted infection (STI) outpatient clinic of the Infectious Diseases Unit of the ASST Spedali Civili of Brescia, Italy, between August and October 2022. Most patients that took part in the compilation are HIV positive MSM. The other participants were HIV-seronegative patients with other STIs. Overall, 144 questionnaires were compiled. Most of the participants were Italians (130;90%) and males (139;96.5%) between 30 and 60 years (118;82%). Almost all (136;94%) reported having heard about Mpox and more than half (80;56%) received information about the transmission. Twenty-four respondents (16%) received information from health professionals and 14 (10%) believed that the information received was complete. Although 41% of respondents thought they were at risk of getting the infection and 62% were afraid to get it, the majority (56%) did not increase the precautions taken. When asked if they would accept a vaccine to prevent the disease, more than a third (32%) of respondents expressed hesitation or complete refusal to be vaccinated. Based on our results, what emerges is that there is still a lack of knowledge and awareness about Mpox. To address this issue, targeted health promotion and education strategies that provide the necessary resources to reduce risk behaviours and enhance connections with healthcare professionals are needed

Imported malaria in northern italy: Epidemiology and clinical features observed over 18 years in the teaching hospital of Brescia

Background: Even though malaria incidence is decreasing worldwide, travel-related cases reported in Europe have remained stable in recent years. In Italy, incidence had increased in the 1990s, reaching a peak in 1999; a slow decline was then reported over the subsequent decade. To our knowledge, few published data are available on imported malaria in Italy since 2010. In this article we aimed to analyse trends in imported malaria in the teaching hospital of Brescia, northern Italy, over the last 18 years. Methods: All malaria cases diagnosed from 1999 to 2016 in Spedali Civili Hospital, Brescia, were retrospectively identified. Demographic, clinical and travel-related data were described. Results: A total of 1200 cases of imported malaria were diagnosed in Brescia during the study period. Among them, 225 were children. A trend of increasing paediatric cases was identified over the study period, while cases in adults were stable. Most cases were diagnosed between August and October. Patients were most likely exposed in sub-Saharan Africa (87.2%). The main reported travel reason was travelling to visit friends and relatives (66.0%). A significantly higher risk of severe malaria was observed in non-immune patients and children visiting friend and relatives (P < 0.001 and P = 0.006, respectively). Conclusions: Our study reveals a relatively stable incidence in imported malaria cases with a peak during the summertime. A large and increasing paediatric burden of disease was identified. Imported malaria requires attention since in Italy a potential reappearance of autochthonous Plasmodium vivax malaria transmission cannot be excluded. Preventive action and physician awareness should be especially directed to children visiting friends and relatives in endemic countries and to non-immune patients since they both represent high-risk groups for severe malaria