City Of Luanda Research Articles

Molecular Patterns and Antimicrobial Resistance Characterization of Salmonella enterica Non-Typhoidal from Human, Food, and Environment Samples Isolated in Luanda, Angola

The aim of this study was to characterize the antimicrobial resistance phenotype and genotype of non-typhoidal Salmonella spp. isolated in Luanda, Angola. Between 2013 and 2015, human clinical samples, food, and environmental samples (n = 290) were collected at different regions of Luanda city and screened for the presence of Salmonella spp. Bacterial isolates were preliminarily identified using the API 20E Kit, and their identification was confirmed using PCR and serotyping. All Salmonella spp. isolates were tested by minimum inhibitory concentration against 19 antimicrobials. The isolates were also screened using PCR for the presence of resistance genes (blaOXA-1, blaSHV, blaTEM, sul1, sul2, sul3, qnrA, qnrB, qnrS, qnrC, qnrD, aac(6′)-Ib, dfrIa [targeting dfrA1, dfrA5, dfrA15, dfrA15b, dfrA16, dfrA16b] and dfrA12, cmlA, and floR) and typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Salmonella enterica non-typhoidal was detected in 21.3% of the clinical samples (n = 32/150), 11.1% of the food samples (n = 10/90), and 26% of the environmental samples (n = 13/50). Serotyping revealed that the monophasic variant of Salmonella Typhimurium (Salmonella enterica serovar 4,[5],12:i:-) was detected in 38.1% of the samples. Moreover, serovar Salmonella Enteritidis was the second most frequent. Only 7.3% of the isolates were resistant to at least one antimicrobial. Furthermore, isolates from different origins (clinical, environmental, and food) were associated with the same lineages, Salmonella Enteritidis ST11 and S. enterica ser. Typhimurium ST313. The detection of S. enterica serovar 4,[5],12:i:- in different settings reinforces the need for a One Health approach to control this zoonosis in Angola.

Kuduro, Digital Music and Lifestyle in Diaspora

Abstract Kuduro is a style of dance and electronic music that emerged in Angola in the nineties, in a peculiar social context. Initially consumed and produced by young people from the periphery of the city of Luanda, it became a means of expression, entertainment, socialization and subsistence, through which they became autonomous and symbolically transformed their realities of scarcity. With access to communication technologies and movements of global dispersion of people and information, kuduro also spread to other countries and gained other meanings. Here, I analyze the characteristics of its context of origin, the conditions and implications of such dispersal, and disputes over the meanings of style.

Selection and Justification of a Digital System Broadcasting for the Republic of Angola

In this work we seek to approach the choice of the Republic of Angola for the ISDB-T telebroadcasting system. The experimental results of the ISDB-T digital transmission system in the Republic of Angola are Execelente. Currently, the Japanese terrestrial digital broadcasting system (ISDB-T) is used in 14 countries around the world (Argentina, Bolivia, Brazil, Chile, Costa Rica, Japan, Peru, Paraguay, El Salvador, Uruguay, Honduras, Venezuela, Philippines, Botswana) and 6 more countries (Angola, Maldives, Sri Lanka, Guatemala, Ecuador, Nicaragua) have adopted this system. The study shows that ISDB-T is a system applicable in our country, as even with the transmitter operating at 50% of its maximum power, the signal is received in a large part of the city of Luanda, with failures only in regions far from the center urban. The implementation of a fully digital transmitter that is foreseen, the increase of the transmitter's power, among other changes, may provide better advantages in implementing the ISDBT in the Republic of Angola. The commitment comes at a time when Angola plans to cover the entire national territory, starting in 2023.

Design of air quality monitoring network of Luanda, Angola: Urban air pollution assessment

The World Health Organization has been making recommendations on assessing and monitoring air quality for human health protection. Its implementation implies a spatial distribution plan for air quality monitoring sites, especially in populated cities where high emissions of air pollutants with anthropogenic origin are observed. Therefore, the present study aimed: (i) to propose the spatial distribution of air quality monitoring sites in the city of Luanda (capital of Angola); and (ii) to determine the PM2.5, PM10, NO2, SO2 and CO concentrations at two monitoring sites (Avenida Deolinda Rodrigues, ADR, and Condomínio Vale do Talatona, CVT), during four weeks for each site. Due to the absence of national legislation, air quality measurements were then compared to the limits defined by the European Union through Directive, 2008/50/EC. At ADR site, the average concentrations for PM10, PM2.5 and SO2 exceeded the limits recommended for human health. At CVT site, CO, NO2, PM10, PM2.5 and SO2 concentrations were lower than the values measured at ADR site, due to the relative location of important fixed air pollutant emission sources: airport, thermoelectric plants, refinery, cement plants and the Port of Luanda. The weekend effect was also assessed at both sites. At ADR site, NO2, SO2, PM2.5 and PM10 concentrations were higher at weekends than on weekdays. At CVT site, NO2, SO2 and PM2.5 concentrations were higher on weekdays compared to weekends. The present research will contribute to the decision-making process by the environmental health regulator in Luanda.

Practices of Protest in Luanda, Angola: A Chronology of Recent Urban Change in Chicala

ABSTRACT At the heart of this article is an investigation of the reciprocal relationship between the city of Luanda and one of its informal neighbourhoods, Chicala. The study situates Chicala among conflicts that have arisen in its urban densification process. It aims to understand the ‘slow’ and ‘small’ practices of protest acting in and around the case. These practices help to complexify the discourse on the city, bringing the local dwellers closer to the rest of the population – everyone reacts to change. Actions of protest are in themselves an expression of citizenship, they present alternative visions for Luanda’s future development.

“Os Transparentes”de Ondjaki: Luanda como metáfora de Angola

Este artigo analisa a obra “Os transparentes” do escritor angolano Ondjaki, a partir dos conceitos de memória, nostalgia e ficção, no cenário da cidade de Luanda, entendida como metáfora de Angola. Recorrendo aos trabalhos de Baccega sobre “Mayombe” de Pepetela, inicia-se a exposição traçando o contexto em que se inscreve o romance de Ondjaki. Assinala-se, a partir de excertos da obra, como o autor ficciona personagens e interesses da cidade de Luanda, nomeadamente os de uma elite afeta ao ex-presidente, que governou o país por cerca de quarenta anos. Em seguida, evocando mais uma vez Baccega, analisa-se como são construídas as personagens, numa dicotomia ganhadores/perdedores, e num cenário urbano progressivamente caótico e corrumpido, onde a memória e a nostalgia são âncora da resiliência dos despossuídos. Por fim, são mapeadas as referências e o papel das mídias, com principal relevância para o Jornalismo em Angola e a influência das telenovelas brasileiras.

ONFALITE: UM REALIDADE DE SAÚDE PÚBLICA EM ANGOLA

O presente estudo apresenta uma questão de saúde pública em Luanda, Angola, relacionada com situações de internamento e morte de recém-nascidos por onfalite, permitindo alertar para um grave problema de saúde pública que o país enfrenta. Objetivo Geral:descrever este problema de saúde pública associado a situações de onfalite em Luanda. Objectivos específicos: descrever a realidade de um hospital público geral na cidade de Luanda, relativamente a este problema; identificar as principais causas de onfalites no contexto Angolano; descrever os cuidados corretos com o coto umbilical; evidenciar as implicações sociais, culturais e de saúde nos cuidados ao recém-nascido. Método:estudo descritivo, exploratório e transversal. ,Foram analisados os processos de internamento de um serviço de pediatria de um hospital público da cidade de Luanda, com situações de internamento por onfalite, entre janeiro de 2017 e junho de 2018. Resultados:no período em estudo, foram analisados 182 processos de internamento neste hospital com registos de onfalites no recém-nascido. Destes internamentos, 26 culminaram em óbito do recém-nascido. Dos 156 recém-nascidos internados, 153 tiveram alta para o domicílio, 2 tiveram transferência para o hospital pediátrico e houve um registo de uma fuga. Conclusão:os resultados obtidos demonstram que as mães e os recém-nascidos angolanos permanecem vulneráveis no que se refere aos cuidados ao coto umbilical do recém-nascido, o que se traduz pelo elevado número de onfalites registadas. Torna-se, assim, prioritária a formação dos profissionais de saúde nesse domínio, de modo a que as intervenções sejam efetivas e de qualidade, no sentido de diminuir este flagelo de saúde pública neste país, em particular na cidade de Luanda.
 PALAVRAS CHAVE : Cordão umbilical;Recém-nascido; Mortalidade infantil;Cuidados infantis; Cultura.

A Heritage-Based Method to Urban Regeneration in Developing Countries: The Case Study of Luanda

In developing countries, where political instability, former conflicts and social breakdown take place, heritage can be included in urban regeneration processes as a driver for economic development but also for social cohesion and cultural identity. This paper presents a heritage-based method for urban regeneration, developed for the city of Luanda (Angola), within the elaboration of its Metropolitan Plan (2016). Actions focus on the rehabilitation of buildings and public spaces, creating the conditions to implement effective financial mechanisms able to cover the costs of urban regeneration by results. Here, rehabilitation measures are combined with the implementation of mixed-use development models, addressing one of the key issues of urban regeneration: attracting private investments. From a practical perspective, the proposed approach focusses on the elaboration of heritage preservation, valorization and requalification strategies, moving from a geographical urban delimitation of Heritage Sets to a regeneration process based on a radius of influence that goes beyond the single building. From the regeneration of the built environment and public spaces in these Heritage Sets, the surrounding area is naturally affected. Strategic actions applied to Heritage Sets aim to produce a domino effect of regeneration that involves multiple spatial scales: from buildings and public spaces to neighbourhoods and, consequently, to the entire city. The implementation of this approach to several Heritage Sets delimited across the city, would, in the long-term, create a connected heritage network that results in an integrated urban regeneration process. Criteria for the delimitation of Heritage Sets are proposed, dealing with the concept of diversity, namely: time, historical, symbolic and functional diversity. The results from this study aim to support decision-makers in integrating heritage-based urban regeneration approaches into public policies and local planning practice.

Serological and molecular evidence of Bartonella henselae in cats from Luanda city, Angola

A total of 100 domestic cats from Luanda (Angola) were tested for the presence of antibodies against Bartonella henselae and spotted fever group of Rickettsia (SFGR) using indirect immunofluorescence assay (IFA). Molecular screening targeting the riboflavin synthase (ribC) gene for Bartonella and outer membrane protein B (ompB) gene for Rickettsia, using conventional PCR and sequencing was also performed in cat´s blood samples.Sixty-six percent of the cats from Luanda had IgG antibodies against Bartonella species but none of them had antibodies against SFGR. Of the total seroreactive cats for Bartonella henselae, 4.5% had an IgG titre of 64 (cut-off), 60.6% a titre of 128, 28.8% a titre of 256 and 6.1% a titre of 512. A statistically significant association was observed between seropositivity for Bartonella henselae and the lack of access to prophylaxis against ectoparasites (p = 0.018).Molecular detection and further sequence analysis of the positive amplicons allowed identification of Bartonella henselae in a 2-year old male cat.To the best of our knowledge this study confirms for the first time, the presence of Bartonela henselae circulating in domestic cats from Luanda. This fact call the attention for the possible cases of cat-scratch disease in humans.

A study of skin disease spectrum occurring in Angola phototype V-VI population in Luanda.

Prevalence of skin diseases in Luanda (Angola) is unknown, and publications are barely found in the literature. We aim to describe, for the first time, the frequency of skin disease spectrum in phototype V-VI Angolan population in Luanda City. We included Fitzpatrick phototype V-VI Angolan patients who consulted the Dermatology Unit in Luanda Medical Center during a 1-year period. Medical information was recovered from the electronic database, and diagnoses were based on ICD-10. Only the main complaint was registered, and the results were classified according to age and sex. Criteria exclusion consisted of incomplete clinical records, Fitzpatrick phototype I-IV Angolan, or foreign patients from the study. From a total of 3938 patients, 3554 met the inclusion criteria, of which 2742 were adults 13 years or older. In this group, acne (23.6%), dermatophytosis (11.0%), and pityriasis versicolor (8.6%) were the main complaints. On the other hand, in the pediatric population (n = 812), atopic dermatitis (29.4%), tinea capitis (13.7%), and molluscum contagiosum (12.5%) were the most frequent disorders. In adult females, acne (31.3%) was the main condition, while in adult males, dermatophytosis (13.5%). In children, the frequency of atopic dermatitis was comparable: 29.1% and 28.6% in girls and boys, respectively. We published for the first time the frequency of the skin disease spectrum in Fitzpatrick phototype V-VI Angolan population in Luanda City, highlighting the prevalence of acne, dermatophytosis, and atopic dermatitis.

Malaria deaths and associated factors in children under 5 in a pediatric hospital in Angola

Introduction: malaria is the main cause of morbidity and mortality in Angola, with more than 3 million cases being reported in 2015, amongst which 5714 died, mostly children at younger ages. This study aimed to identify the factors associated with mortality by malaria in children under 5-year old that were admitted to a tertiary pediatric hospital in the city of Luanda, Angola during the first quarter of 2016.

Prevalence and factors associated with cryptococcosis infection in patients with HIV and AIDS, Esperanza Hospital, Luanda, 2016

Introduction: cryptococcosis is an infectious, systemic and opportunistic mycosis in HIV and AIDS patients. To date, few studies on Cryptococcosis and HIV and AIDS have been done in Angola. Thus, this study was carried out to determine the prevalence and factors associated with cryptococcosis infection in patients with HIV and AIDS at Hospital Esperana, a tertiary hospital, in Luanda, Angola. Methods: a cross-sectional study was carried out from March 1 to June 30, 2016. The data was obtained through a semi-structured questionnaire administered to participants, and a review of clinical processes and laboratory tests. For the associated factors were using the odds ratio, Chi square test (nominal variables) or Z test (numerical variables) with 95% confidence level. Results: of the 165 samples (55%) were processed, of which 33% were positive for cryptococcus and 75% were from female patients. The median age of these patients was 38 years, and 38% of the patients were from the city of Luanda. The factors associated with cryptococcal infection were: Cough (OR = 4.00; 95% CI: 2.01-7.93; p 50 mg / dL (OR = 1.08, 95% CI: 1-175, p<0.001); Anemia (OR = 6.72, 95% CI: 1.72-25.16, p = 0.004); Pneumonia (OR = 4.21, 95% CI: 1.55-11.44, p = 0.004); Tuberculosis (OR = 3.99, 95% CI: 1.74-9.17, p = 0.001) and Malaria (OR = 6.73, 95% CI: 2.73-20.84, p < 0.001). Conclusion: the present study showed a 33% prevalence of cryptococcosis infection among the HIV and AIDS patients under follow-up in Hospital Esperana, Luanda, which might be indicative of patients presenting to care at a late stage of disease and with low CD4 cell counts. To our knowledge this is the first study that evaluated the prevalence of cryptococcosis in HIV patients in Angola and this data should inform future HIV and AIDS policies and public health strategies.

Travessias literárias: novas viagens à cidade de Luanda ressignificada

&lt;p class="Pa5"&gt;Durante o período de lutas pela libertação de Angola, a cidade de Luanda tornou-se um dos espaços simbólicos privilegiados dos textos literários, sendo referência para o processo de construção da identidade nacional. Depois de conquistada a independência, autores angolanos passaram a abordar a consequente onda de desilusão e decepções e os novos desa­fios que se colocaram para o país. Nesse processo, Luanda também sofreu ressignificações, tornando-se o ponto de partida para novas e necessárias caminhadas. O objetivo deste trabalho é abordar tais alterações de senti­dos referentes a esse espaço simbólico, a partir de uma breve análise de textos de José Luandino Vieira produzidos durante o período colonial e dois romances angolanos escritos no pós-independência: &lt;em&gt;A casa velha das margens &lt;/em&gt;(1999), de Arnaldo Santos, e &lt;em&gt;Mãe, materno mar &lt;/em&gt;(2001), de Boa­ventura Cardoso. Nessas obras, Luanda deixa de ser o palco privilegiado dos acontecimentos, dando lugar ao protagonismo do deslocamento dos personagens-guias de ambos os textos e às descobertas de si e do país que suas viagens proporcionam.&lt;/p&gt;

Cartografias da memória

Ondjaki carrega a pena sob o peso de memórias íntimas, vividas e inventadas no tempo e espaço do “antigamente”. Nessas memórias, escapam retratos de uma Luanda em sua eterna busca identitária. Num tom irônico mescla a crítica ácida e o deboche pueril, mas sua escrita permite, sobretudo, sonhar a Angola do futuro, através de uma literatura utópica e geoficcional. A escrita da ironia em Ondjaki desvela múltiplos desdobramentos do eu e do outro. O eu nas revelações e percepções do narrador sobre esta cidade e o outro a própria cidade “multiperspectivada”. Luanda é geográfica, cultural, ancestral, cordão umbilical e, também, lugar inventado. Este artigo tenciona discorrer sobre as múltiplas faces que a cidade de Luanda apresenta, a partir do olhar do narrador de Ondjaki, percorrendo para isso suas cartografias da memória.

Mutuality from above: urban crisis, the state and the work of Comissões de Moradores in Luanda

My paper discusses the emergence of new regimes of mutuality in the context of a crisis in the built environment of Luanda. By 1991, Luanda's city centre had suffered years of neglect and talk of an urban crisis abounded. The Angolan government decided that the only way out of the crisis was through the sale of state property. However, privatisation did not simply imply a transfer of ownership from the state to former long-term lessees willing to purchase their homes; the process also had a number of unintended consequences. This paper argues that the Angolan government's property privatisation process ended up constituting mutuality from above, by forcing residents of apartment blocks into formal associations. It has not prevented buildings in downtown Luanda from further decay and has brought about new sites of property litigation.

Perceptions and practices of Angolan health care professionals concerning intimate partner violence against women.

This was a qualitative exploratory study with the objective of identifying perceptions and practices among health professionals in Angola concerning intimate partner violence against women. Semi-structured interviews were held with a senior health administrator, head nurses, medical directors, psychologists, and nurse technicians in three national hospitals in the capital city of Luanda. The perceptions of Angolan health professionals towards violence against women are marked by the cultural construction of woman's social role in the family and the belief in male superiority and female weakness. Despite their familiarity with the types of violence and the consequences for physical and mental health, the health professionals' practices in providing care for women in situations of violence focus on the treatment of physical injuries, overlooking the subjectivity and complexity of these situations. Recent inclusion of the issue in public policies is reflected in health professionals' practices and raises challenges for the health sector in caring for women in situations of violence.

Another Day of Life: Spatial Practices and Arbitrary Detentions in Luanda, Angola

In March 2013, the Angolan National Police arbitrarily and illegally detained four people in the capital city of Luanda during the course of an eviction and demolition. Two of them were Angolan nationals and the other two were foreign researchers duly authorized to remain in Angolan territory. Putting to use an unpublished report made for local media outlets, this article contextualizes and describes these events in order to provide an explicitly non-scholarly account of the risks, perils and hazards faced by spatial research practitioners in such a context, with the aim of allowing for reflection on the articulations between architecture, activism and urban politics.

Successful Outcomes Of An Infant Sickle Cell Clinic In Luanda, Angola

BackgroundSickle cell anemia (SCA) is a significant, under recognized contributor to global childhood mortality, especially in sub-Saharan Africa. Early diagnosis is critical to enable timely access to care and education, before severe and life-threatening complications develop in the first year of life. Unfortunately, such early and comprehensive care remains largely unavailable for many infants across Africa. In an attempt to reduce the high early mortality associated with SCA, an infant SCA clinic was developed and implemented in the capital city of Luanda, Angola. We describe the early experiences and successful outcomes for infants enrolled in this clinic. MethodsInfants were enrolled in the clinic if the diagnosis of SCA was made in the first year of life. The clinic was established in the major public pediatric hospital in Angola, Hospital Pediátrico David Bernardino (HPDB). The vast majority of enrolled infants were diagnosed by newborn screening at local maternity hospitals, while some were diagnosed due to clinical suspicion or known family history. Initial clinic visit included intake of demographics such as contact information, family history, and details of basic housing conditions. A dried bloodspot was collected and the diagnosis of SCA was confirmed by isoelectric focusing. All families received sickle cell education and confirmed infants received penicillin prophylaxis (125 mg by mouth twice per day), pneumococcal vaccination series (Prevnar-13), and an insecticide-treated mosquito net for malaria prophylaxis. ResultsIn the first twenty months of the HPDP Infant SCA clinic, 301 infants were enrolled. Eighty-one percent (244/301) were identified through the associated newborn screening program, while the remaining fifty-seven infants presented due to clinical symptoms or known family history. Families live in the urban and poverty-stricken Luanda. The average household has 6.4 people with 2.8 people per bedroom. Only 34.2% of families reported access to water within their household. Despite poverty and difficult housing situations, continued follow-up was extraordinarily high at 97.3%. After the initial visit, only eight families (2.7%) chose not to follow-up – four preferred faith or traditional healing techniques, and four chose follow-up care at a private clinic. With a concentrated effort to track and enable timely follow-up care, there were zero babies truly “lost to follow-up.” For the 167 babies who are now at least one year of age, the calculated infant mortality rate (under 1 year of age) is 6.6%, which compares favorably to the nationally reported infant mortality rate for all children (9.8%). Upon reviewing the 11 deaths, in nearly all cases the families sought appropriate medical care as instructed, and most deaths were likely preventable if appropriate and timely emergency care were available in the community. ConclusionsEarly mortality associated with SCA can be significantly reduced through early diagnosis and access to care and education, even in countries with few health resources such as Angola. These experiences with a newborn clinic in the urban city of Luanda demonstrate that simple, lifesaving care is feasible and that follow-up and survival is excellent. Although the survival in this Angolan cohort was even better than the national infant mortality rate, the few deaths illustrate gaps in the understanding of emergency SCA care among the healthcare community. It is critical to include education and training of healthcare professionals at all levels of care in any national strategy, so that children with SCA can be promptly triaged and adequately treated for emergent and life-threatening complications. Disclosures:No relevant conflicts of interest to declare.

Cost-Effectiveness Of Neonatal Screening For Sickle Cell Disease In The Republic Of Angola

IntroductionSickle cell disease (SCD) is a tremendous global health problem with over 400,000 babies born every year worldwide. Early diagnosis by newborn screening (NBS) reduces mortality, by allowing timely access to lifesaving interventions such as parental education, penicillin prophylaxis, and pneumococcal vaccination. Without early diagnosis and treatment, it has been estimated that 50-90% of babies with SCD in sub-Saharan Africa will die before they reach five years of age. In the United States, a universal NBS approach has been implemented. Despite the relatively low incidence of SCD in the United States (1 in 2,500 per live births) compared to Angola (1 in 66 live births), universal NBS in the US has been demonstrated to be cost-effective. A pilot NBS and treatment program has been ongoing in the capital city of Luanda, Angola since July 2011. Using data from the first two years of this program, we have now performed a cost-effective analysis (CEA) of NBS and treatment for SCD in Angola. Cost Analysis Methods and AssumptionsModified WHO-CHOICE methodology was used. Cost and follow-up data from the first two years of the pilot NBS and treatment program in Luanda, Angola were used for this CEA analysis. Based upon our experiences in this pilot NBS program, just over 50% of those testing positive for SCD have been contacted and successfully brought to medical care. Although we anticipate this “find rate” to improve over time with increased overall sickle cell awareness and dedication of national health resources, we have used actual numbers of patients brought to care through this pilot program for these analyses. Estimated costs were calculated for providing routine clinical care, insecticide-treated mosquito nets, and prophylactic penicillin through 5 years of age. The costs of pneumococcal immunization were not included, since these are now available to most sub-Saharan countries (including Angola) through the GAVI Alliance. Cost-effectiveness analysisIn the first two years of the pilot program in Luanda, a total of 36,453 patients were screened with 550 (1.51%) diagnosed as having SCA (hemoglobin SS disease) and 245 received clinical care. Infants are brought to care by 8 weeks of age; this number represents 50% of age-eligible infants. Up-front investment in laboratory equipment to perform NBS by isoelectric focusing, including delivery, installation and training, was US$53,608. Cost per test, including all materials required for heel stick testing and for laboratory processing by IEF was $4.94. The cost of treating one patient for five years, including prophylactic penicillin and clinical costs for every 3 month visits was $332. The cost to treat 236 patients for five years is $81,340. Total costs for screening all infants and treating those found is $315,026. Assuming that screening and treatment reduces mortality from 80% to the baseline under-5 mortality rate of 15.8%, we estimate that 157 lives will be saved by NBS. The expectation of life at age 5 years in Angola is 55.9 years, or 20 discounted life-years using a 3% discount rate. The cost per life saved is $2,007. If the life expectancy for an Angolan with SCA at age 5 is 60-75% that of other Angolans, 1884 to 2355 discounted life-years are saved and the cost per life-year saved is approximately $134 to $167. Assuming an average disability weight of 0.1 for survivors with SCA, the cost per DALY averted is $150 to $190. ConclusionsInterventions are defined as “very cost-effective” if the cost per DALY is less than the per capita. This analysis demonstrates that the cost per DALY for NBS and treatment in Luanda appears to be 30 to 40 times lower than the annual per-capita GDP in Angola ($5,475). These data demonstrate that newborn screening and simple preventative treatments are extremely cost effective. With an increasing global burden of SCD, it is essential for governmental and Ministry of Health leaders to recognize and take action in order to reduce the morbidity and mortality of SCD. NBS that is linked to treatment is a logical, cost-effective and high-impact program that should be incorporated into national sickle cell strategies. Disclosures:No relevant conflicts of interest to declare.

A Prospective Pilot Newborn Screening and Treatment Program for Sickle Cell Anemia in the Republic of Angola

AbstractAbstract 480 Background:Sickle cell anemia (SCA) is a significant global health problem with >300,000 affected infants born each year in sub-Saharan Africa. Up to 80–90% of all children with SCA in Africa die before five years of age, due to infection or anemia, and usually without the proper diagnosis of SCA. Early identification by newborn screening (NBS), followed by interventions such as pneumococcal immunization and prophylactic penicillin, have dramatically reduced the mortality of children with SCA in the US, but this strategy not yet been established in Africa. A novel public-private partnership involving the Republic of Angola, Chevron Corporation, and Baylor College of Medicine/Texas Children’s Hospital was created to develop a pilot NBS and treatment program for SCA, focusing on capacity building and local ownership. Methods:Two large maternity hospitals in the capital city of Luanda, Angola were initially selected for dried blood spot (DBS) collection and analysis, and a third local health center was soon added. Maternity nurses were taught DBS collection and laboratory technicians learned isoelectric focusing (IEF) and capillary electrophoresis (CE) techniques. Identifiers including cell phone numbers are collected onto the Whatman NBS card to facilitate retrieval of affected babies. After collection, DBS were transported to the central NBS laboratory at Hospital Pediátrico David Bernardino (HPDB) for hemoglobin identification by IEF and CE. Demographic data and test results were entered into a unique internet-based electronic data capture system designed with secure password-protection and servers located in Houston, Texas. Results:Since initiation of NBS in July 2011, 17,055 babies have DBS collection and laboratory results: 3,588 (21%) with FAS pattern (sickle cell trait), and 264 (1.55%) with FS (consistent with SCA). Twenty-one samples produced a result other than FA, FAS, or FS, including 10 FAC and 1 FSC. Families of infants with an FS screening result are notified by phone to initiate care and treatment, ideally by age 8 weeks. In the new infant SCA clinic at HPDB, infants receive penicillin prophylaxis and PCV-13 pneumococcal immunization, while parents receive sickle cell education and insecticide-treated bed nets for malaria protection. In the first 6 months, 67.8% of DBS cards had phone numbers documented, but with education and reinforcement, 81.4% of cards had phone numbers in the past 6 months. To date, 220 FS babies are age-eligible for contact and 110 (50%) families have been reached: 104 (47%) have come to the infant SCA clinic, 6 (2.7%) had already died within the first month of life, and 0 refused care. A total of 201 doses of PCV-13 have been provided as per routine vaccination scheduling. After initial visit, the return rate for second immunization is 94% with only 3 babies lost to follow-up including 2 deaths. The calculated first-year mortality rate for all contacted FS babies (6.9%) compares favorably to the national infant mortality rate (9.8%). Conclusions:This prospective pilot study documents that newborn screening for SCA is feasible in a developing country such as Angola. Capacity building and teaching provide local healthcare workers with skills necessary to have a functional NBS program and infant SCA clinic. The sickle cell burden is extremely high in Angola, and contact and retrieval of all affected FS infants remains an ongoing challenge, but families are compliant with clinic appointments and treatment. Early mortality data suggest comprehensive SCA care can save lives, suggesting that expansion of the pilot program is warranted with an eventual national strategy for the diagnosis, care, and treatment of children with SCA in Angola. Disclosures:No relevant conflicts of interest to declare.