Maputo City Research Articles

Cancer incidence in Mozambique in 2015-2016: data from the Maputo Central Hospital Cancer Registry.

There is scarce information on cancer incidence in Mozambique. We aimed to describe cancer incidence data from the Cancer Registry of the Maputo Central Hospital (MCH) in 2015-2016, for Maputo City dwellers, and to compare the incidence rates with those observed in 1956-1961. Cancers with incidence data in 2015-2016 were identified by the Cancer Registry of the MCH. Crude and age-standardized incident rates (ASIR, per 100 000) - direct method, world standard population - were computed for Maputo City, under the assumption that most cancer cases among this population were identified at the MCH. A total of 1707 incident cases in Maputo City dwellers were registered (76.6% confirmed histologically). Prostate cancer, Kaposi sarcoma, and liver cancer were the most frequent in men (ASIR: 24.5, 19.8, and 13.3, respectively). Cervical and breast cancers, and Kaposi sarcoma were the most common among women (ASIR: 32.4, 11.8, and 9.5, respectively). Compared with the data from 1956 to 1961, the most pronounced declines in ASIR were for bladder and liver cancers, in both sexes, and increases were greater for prostate cancer among men (172.2%) and breast cancer (237.1%) among women. Our study highlights the high frequency of infection-related cancers in Maputo, but also of those related to the ongoing demographic and socioeconomic transition.

Occurrence of feline immunodeficiency virus and feline leukaemia virus in Maputo city and province, Mozambique: a pilot study.

ObjectivesFeline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) are immunosuppressive viruses in cats that increase their susceptibility to zoonotic pathogens. This study aimed to determine the occurrence of one or both viruses, the risk factors associated with infection, and to develop further recommendations.MethodsThis was a cross-sectional study conducted at the Veterinary Faculty of Eduardo Mondlane University, Mozambique, between March and December 2017, in 145 cats. From each of 145 cats, we took 1.5 ml of blood by jugular puncture for detection of antibodies to FIV and FeLV antigens in whole blood using a commercial test kit, DFV Test FeLV/FIV.ResultsWe found an overall prevalence of 11.0% and 14.5% for FIV antibodies and FeLV antigens, respectively, with four (2.8%) cats coinfected by both pathogens. Male cats were more likely to be infected with FIV (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.3–4.0) compared with female cats. Clinically ill cats were more likely to have a positive result for FeLV antigen infection (OR 18.8, 95% CI 5.2–68.3). Moreover, cats living in suburban areas have a greater chance of a positive result for FeLV infection (OR 3.7, 95% CI 1.4–9.6) compared with cats living in urban areas.Conclusions and relevanceFIV and FeLV occur in cats from Maputo and possibly all over the country. Further studies should be conducted in Mozambique and other African countries to define the burden of both pathogens in cats, coinfection with other zoonotic pathogens and the possible role played by the cats on the transmission of zoonotic and opportunistic diseases to humans.

Cervical cancer screening uptake in women aged between 15 and 64 years in Mozambique.

Cervical cancer is the most common cancer in Mozambique, reflecting the high prevalence of both human papillomavirus and HIV infections. A national screening program for cervical cancer was started in 2009, using the visual inspection with acetic acid and cryotherapy, targeting women aged 30-55 years. We aimed to estimate the self-reported prevalence and determinants of cervical cancer screening uptake in Mozambique. A cross-sectional study of a representative sample of the women aged 15-64 years (n=1888) was carried out in 2014/2015 following the WHO-Stepwise Approach to Chronic Disease Risk Factor Surveillance. The prevalence of screening uptake using visual inspection with acetic acid or cervical cytology, at least once in a lifetime, was 3.0% [95% confidence interval (CI): 2.2-4.1]; the prevalence was the lowest in the center region (1.4%) and the highest in the capital city of Maputo (11.1%). Among women aged 30-55 years, the prevalence was 3.4% (95% CI: 2.3-5.2) and the factors independently associated with a greater frequency of screening uptake were education (≥8 schooling years vs. none: prevalence ratio=5.57, 95% CI: 1.34-23.16) and use of oral contraceptives (prevalence ratio=2.33, 95% CI: 1.05-5.15). This was the first national Mozambican survey on cervical cancer screening uptake ever carried out and it showed a very low prevalence of screening, even in the more urban and affluent areas. There is an urgent need to raise public awareness of cervical cancer screening and to increase the number of screening units and trained personnel throughout the country.

The Inclusion of Young Entrepreneurs in the City of Maputo’s Food Markets

The City of Maputo’s food system comprises a diversity of retailers providing access to food from both domestic and international suppliers. Food markets, whether formal and informal, are the most commonly accessed food source within the city and provide an important source of employment for city residents. As urban labour markets continue to catalyze the growth of national economies in the Global South, the inclusion of young entrepreneurs in the food retail sector in Maputo has become an important but largely unstudied phenomenon. This paper assesses the demographic and entrepreneurial characteristics of this population through a vendor survey of 504 young entrepreneurs (those aged 35 years and younger), drawn from a survey of 1022 entrepreneurs, operating small-scale food enterprises in Maputo. The sampled young food vendors identified survival, family financial security, personal desire, learning and self-determination as the most common reasons for starting their businesses. The sampled young food vendors also identified competition, insufficient sales and few customers along with unaffordable suppliers as the most common business challenges. This paper highlights the aspirations of this population and the formidable economic challenges in their path to business success.

Quantitative COBAS AmpliPrep/ COBAS TaqMan test shows good performance for HIV screening among blood donors in Maputo, Mozambique

Quantitative <scp>COBAS</scp> AmpliPrep/ <scp>COBAS</scp> TaqMan test shows good performance for <scp>HIV</scp> screening among blood donors in Maputo, Mozambique

Shackled Orange: Biofortified Varieties in the Sweetpotato Commodity Chain in Mozambique

Biofortified, orange-fleshed sweetpotato (OFSP) varieties are being promoted as a part of a strategy to reduce Vitamin A Deficiency among rural and urban populations in Sub-Saharan Africa. This paper uses the commodity chain approach to understand whether markets may stimulate or not the production of the new orange sweetpotato varieties on Mozambique’s main consumer market, Maputo, its capital and largest city. It shows that the chain linking rural producers to the city’s consumers is operated by private actors; the government provides basic infrastructures and price information. International donors are involved through the dissemination of planting material and nutrition information in support the marketing of OFSP. The commodity chains of white and orange-fleshed varieties are entwined with no clear price differences. The annual marketed volume is estimated at 8,000 tonnes, mostly produced by smallholders and sold to consumers by sidewalk and open-air market retailers. This market segment is dominated by women. A small group of specialized - male and female - commercial OFSP producers supplies about 0.5% to 1% of this market selling directly to a specific group of clients who either buy at farm gate or through home delivery. The conclusion is that the existing commodity chain fails to stimulate the production of OFSP and the expansion of its benefits to wider sections of the population suggesting that the emphasis should be on having biofortified varieties that can compete successfully with the conventional ones at the farm-level.

The potential of urban agriculture towards a more sustainable urban food system in food-insecure neighbourhoods in Cape Town and Maputo

Sub-Saharan Africa is one of the most rapidly urbanising regions in the world. Achieving food and nutrition security is not only a rural challenge; the access to adequate (in terms of quantity and quality), healthy, nutritious and affordable food is also a growing concern for cities. The latest food crisis (2007/08) put food security back onto the political agenda as food prices increased significantly within just a few weeks and showed the world how vulnerable food systems are, particularly in cities. Food systems describe the ‘farm-to-fork’ processes, pathways and dynamics between interlinked actors and are embedded in a spatial context. The global discourse on food security happens without considering the urban context, just as the global discourse on the urban context happens without considering food security (Battersby 2016: 3). The controversial debate on the contribution of urban agriculture to food and nutrition security frames this study. Based on the perspective of a food systems approach this research seeks to understand the two case areas, City of Cape Town (South Africa) and City of Maputo (Mozambique), through local food production, pathways, dynamics and challenges. This paper shows early results of two baseline surveys amongst urban farmers in both cities, as well as in-depth interviews with urban farmers. Both case studies show similar challenges but different opportunities to increase the potential of urban agriculture to contribute towards a more sustainable food system.

Need for active cardiovascular screening in HIV-infected children under antiretroviral therapy in Africa.

Unacceptably high incidence of pediatric HIV despite worldwide increased access to antiretroviral therapy. The routine management of these children includes provision of antiretroviral therapy, and periodic assessment of its results and complications. However, no systematic assessment of the nutritional status, lipid profile or screening for cardiovascular disease is done. Our study aimed at describing the occurrence of cardiovascular abnormalities in HIV-infected children under antiretroviral therapy, and at determining the vital outcomes 5 years after. A prospective observational study was implemented at a dedicated HIV center in Maputo City, where we gathered detailed socio-demographic data and performed full cardiovascular evaluation, including transthoracic cardiac ultrasound. A total of 47 children were examined (24 male) of which 10 had abnormal cardiac ultrasound: impaired systolic function (5 children); three had congenital heart defects; one had severe rheumatic aortic regurgitation and one had tuberculous pericarditis. Heart failure was present in five children. The study also uncovered the presence of malnutrition (36 patients; 80% had BMI below 18.5 kg/m2) and anemia in a considerable proportion of children. On 5 year follow up there was one death due to malária; three new cases of left ventricular dysfunction occurred among children who had normal ultrasound on recruitment. Our results support systematic cardiovascular risk profiling and disease screening in HIV-infected children on antiretroviral therapy, using cardiac ultrasound wherever possible.

Detection and molecular characterization of rotavirus a antigen in fecal samples from diarrheic and non-diarrheic pigs in Maputo city and province, Southern of Mozambique

Detection and molecular characterization of rotavirus a antigen in fecal samples from diarrheic and non-diarrheic pigs in Maputo city and province, Southern of Mozambique

Whole genome analyses of DS-1-like Rotavirus A strains detected in children with acute diarrhoea in southern Mozambique suggest several reassortment events

We report the first whole genome constellations of Mozambican rotavirus A strains detected between 2012 and 2013 in the Mavalane General Hospital in Maputo city and Manhiça District Hospital in the Manhiça district. Consensus sequences for ten DS-1-like strains (G2P[4] and G8P[4]) were identified with an Illumina Miseq platform using cDNA prepared from dsRNA extracted from stool samples, without genome amplification or prior adaptation to cell culture. Comparison of previously reported genotyping results and the consensus sequences described in this study, indicated that the genotype primers specific for G12 and P[4] might require revision. Phylogenetic analyses indicated diversity among the G2P[4] Mozambican strains and suggested reassortment between G2P[4] and G8P[4] Mozambican strains, as well as the intragenogroup reassortment of all the genome segments encoding VP1, 2, 3 and 6 for strain RVA/Human-wt/MOZ/0045/2012G8P[4]. These results highlight the necessity to determine whole genome constellations to confirm surveillance data in Africa and to monitor the growing diversity in DS-1-like strains.

The Role of Microcredit Activities as an Instrument for Poverty Reduction: An Analysis from Mozambique

This article comes about with the objective of analyzing the role of microcredit activities as a tool for poverty reduction in Mozambique, and specifically to sellers of the Xipamanine Market in Maputo City. The central thesis to be defended is that: microcredit if is well managed contributes to improve the socioeconomic conditions of populations that do not have access to credit in traditional banks. The research was carried out in Xipamanine Market in Maputo City and the data collection on the survey was carried out based on interviews with the sellers of this market. In general, about 90% of the respondents indicated that, in fact, whenever banks grant microcredit to borrowers and they manage it well, there is a change in their initial situation. According to the respondents, the traditional financial system leads to exclusion of certain categories such as low-income populations and especially the poorest people. Therefore, this article draws the conclusion that microcredit has a significant impact on the Mozambican economy, since, in addition to being able to generate individual wealth, it contributes significantly as an instrument to fight against poverty.

Understanding groundwater salinization mechanisms to secure freshwater resources in the water-scarce city of Maputo, Mozambique

In this study hydrochemical, isotopic and multivariate statistical tools are combined with a recharge analysis and existing geophysical data to improve understanding of major factors controlling freshwater occurrence and the origins of high salinities in the multi-layered coastal aquifer system of the Great Maputo area in Mozambique. Access to freshwater in this semi-arid area is limited by an inefficient public supply network, scarce surface waters, long droughts and an increasing population growth. Groundwater has a large potential to enhance water security, but its exploitation is threatened by both coastal and inland salinization mechanisms that are poorly understood. A GIS approach is utilized to classify potential recharge zones based on hydrogeological properties and land use/cover, whereas potential recharge rates are estimated through a root zone water balance method. In combination with water stable isotope data results reveal that extreme rainfall events provide the most relevant contributions to recharge, and interception and evaporation play an important role in the low recharge areas. Hierarchical clustering of hydrochemical and isotopic data allows the classification of six water groups, varying from fresh to brackish/salt waters. Corresponding scatter plots and PHREEQC modelling show evaporation and mixing with seawater (up to 5%) as major processes affecting salinity in the area. The co-occurrence of high alkalinity and Cl concentrations, in combination with piezometric and geo-electrical data, suggests that: 1) inland brackish/salt groundwater is caused by mixing with seawater trapped within clay layers; and 2) brackish/salt surface waters result from seepage of brackish groundwater into rivers and wetlands, followed by evaporation, hence increasing salinity and δ18O values. Mixing with small fractions of trapped seawater as main salinity source, rather than halite dissolution, is further corroborated by Br/Cl ratios of brackish/salt water samples near the ocean ratio. Cation exchange upon salinization is mainly observed in the semi-confined aquifer, while freshening takes place in the phreatic aquifer, particularly in areas presenting high recharge rates.

Carbon Storage in Secondary Mangroves along the West Coastline of Maputo City, Mozambique

Mangroves are often excluded when estimating carbon (C) from global and tropical forests. Therefore, C estimates of global and tropical forests are likely to be underestimated. On the other hand, allometric biomass models and C stocks estimates are lacking for juvenile mangrove trees (seedling and sapling), yet required for increasing of young successional mangrove forests as result of disturbances. In this study, allometric biomass models were fitted and ecosystem C stock estimated for a juvenile secondary mangrove forest, using a non-destructive biomass sampling. Besides the advantage of enforcing additivity and being least biased, the models fitted simultaneously using nonlinear seemingly unrelated regression (NSUR) with parameter restriction were superior with regard to predictive accuracy and ability compared to those fitted independently. The surface soil accounted for the majority of the ecosystem C stock (90%). Aboveground biomass ranked next with 9.6% of the ecosystem C stock.

PO376 Measuring Access to Essential CVD Medicines and Diagnostics in Maputo City, Mozambique

PO376 Measuring Access to Essential CVD Medicines and Diagnostics in Maputo City, Mozambique

Survey of local impacts of biofuel crop production and adoption of ethanol stoves in southern Africa

The two datasets outlined in this paper contain information related to (a) the local impacts of biofuel feedstock production, and (b) the factors that influence the adoption and/or sustained use of ethanol stoves in southern Africa. The first dataset was generated through extensive household surveys around four operational jatropha and sugarcane production sites in Malawi, Mozambique, and Swaziland. This project aimed to examine the local impacts of the most prominent modes of existing or intended biofuel feedstock production in southern Africa. The resulting dataset contains information about impacts on rural livelihoods, ecosystem services, food security and poverty alleviation. The second dataset is the outcome of research into factors that influence the adoption and sustained use of ethanol stoves. This dataset was collected through a household survey in Maputo city where the only large-scale ethanol stove dissemination programme in Africa has been implemented.

Cartografia da migração interna em Moçambique entre 1997 e 2007

Resumo O texto “Cartografia da migração interna em Moçambique entre 1997 e 2007” resulta de uma análise exploratória da informação referente à migração interna das bases de dados dos censos demográficos de 1997 e 2007, respectivamente o segundo e o terceiro de Moçambique, após a independência nacional em 1975. A análise é feita em torno da migração de toda a vida ou acumulada, observada entre as províncias, em 1997 e 2007, e também da migração registada no quinquénio anterior ao censo demográfico de 2007 (isto é, o quinquénio 2002-2007). Como resultados da análise, o texto apresenta fluxos migratórios entre as províncias e, também, os volumes da migração acumulada por sexo e província, em 1997 e 2007, bem como volumes da migração interprovincial do quinquénio 2002-2007. Ainda, a análise permitiu agrupar as províncias em três categorias, de acordo com as suas tendências migratórias: a primeira, composta por províncias de imigração (Niassa, Manica e Maputo); a segunda, por províncias de emigração (Zambézia, Tete, Inhambane e Gaza); e a terceira, por províncias que, de um período para outro, mudaram de uma tendência migratória para outra (Sofala, Cabo Delgado, Nampula e Cidade de Maputo). Por último, os resultados indicam que, nas províncias do Sul de Moçambique, a proporção de mulheres no volume total de migrantes supera à dos homens.

Antigenic and genetic characterization of influenza viruses isolated in Mozambique during the 2015 season.

BackgroundDue to the high rate of antigenic variation of influenza virus, seasonal characterization of the virus is crucial to assess and monitor the emergence of new pathogenic variants and hence formulate effective control measures. However, no study has yet been conducted in Mozambique to assess genetic, antigenic and antiviral susceptibility profile of influenza virus.MethodsA subset of samples (n = 20) from influenza positive children detected in two hospitals in Maputo city during 2015 season as part of the implementation of influenza surveillance system, were selected. The following assays were performed on these samples: antigenic characterization by hemagglutination inhibition assay, genetic characterization by Sanger sequencing of hemagglutinin (HA) and neuraminidase (NA) and susceptibility to oseltamivir and zanamivir (NA inhibitors) by enzymatic assay.ResultsThe A(H1N1)pdm09 subtype viruses remained closely related antigenically and genetically to the 2016 vaccine virus A/California/7/2009 and other widely distributed viruses belonging to genetic group 6B. The majority of influenza A(H3N2) viruses studied were antigenically similar to the 2016–2017 vaccine virus, A/Hong Kong/4801/2014, and their HA and NA gene sequences fell into genetic subclade 3C.2a being closely related to viruses circulating in southern Africa. The influenza B viruses were antigenically similar to the 2016 season vaccine virus and HA sequences of all three fell into the B/Yamagata-lineage, clade 3, but contained NA genes of the B/Victoria-lineage. All tested viruses were sensitive to oseltamivir and zanamivir.ConclusionOverall, all Mozambican influenza A and B viruses were most closely related to Southern African viruses and all were sensitive to oseltamivir and zanamivir. These findings suggest the existence of an ecological niche of influenza viruses within the region and hence highlighting the need for joint epidemiologic and virologic surveillance to monitor the evolution of influenza viruses.

Clinical and epidemiological characterization of influenza virus infections in children with severe acute respiratory infection in Maputo, Mozambique: Results from the implementation of sentinel surveillance, 2014 - 2016.

In Sub-Saharan Africa, where burden, impact, and incidence of acute respiratory infections (ARI) are the highest in the world, conversely, the epidemiology of influenza-associated severe acute respiratory infections (SARI) is incompletely known. The aim of this study was to describe the clinical and epidemiological features of influenza-associated SARI in hospitalized children in Maputo city, Mozambique. Nasopharyngeal and oropharyngeal swabs were collected from children aged 0–14 years old who met the case definition for SARI in two hospitals in Maputo city after their parents or legal representative consented to participate. A structured questionnaire was used to collect clinical and demographic data. Typing and subtyping of influenza were performed by real-time PCR. From January 2014 to December 2016, a total of 2,007 eligible children were recruited, of whom 1,997 (99.5%) were screened for influenza by real-time PCR. The median age of participants was 16.9 months (IQR: 7.0–38.9 months) and 53.9% (1076/1991) were male. A total of 77 were positive for influenza, yielding a frequency of 3.9% (77/1,991), with the highest frequency being reported in the age group 1–5 years old. Cases of influenza peaked twice each year, during which, its frequency reached up to 60%-80%. Among all influenza confirmed cases, 33.7% (26/77), 35.1% (27/77) and 28.6% (22/77) were typed as influenza A/H3N2, A/H1N1pdm09, and B, respectively. This represents the first report of influenza in urban/sub urban setting in Mozambique and the first evidence of distribution of strains of influenza in the country. Our data showed that frequency of influenza was lower than reported in a rural setting in Mozambique and the frequency of seasonal (A/H1N1pdm09) and (A/H3N2) subtypes were similar in children with SARI.

First report of occult hepatitis B infection among ART naïve HIV seropositive individuals in Maputo, Mozambique.

BackgroundThe prevalence of hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection in Mozambique is one of the highest in the world, though in spite of this the prevalence of occult hepatitis B infection (OBI) is unknown.ObjectivesThis study was conducted with the aim to investigate the prevalence of OBI and frequency of isolated hepatitis B core antibody (anti-HBc alone) among antiretroviral (ART) naïve HIV-positive patients in Mozambique.MethodsA cross-sectional study was conducted in two health facilities within Maputo city. All ART-naive HIV seropositive patients attending outpatient clinics between June and October 2012 were consecutively enrolled. Blood samples were drawn from each participant and used for serological measurement of HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs) and antibodies against core antigen (anti-HBc) using ELISA. Quantification of HBV DNA was performed by real time PCR. A questionnaire was used to obtain demographics and clinical data.ResultsOf the 518 ART-naive HIV-positive subjects enrolled in the study, 90.9% (471/518) were HBsAg negative. Among HBsAg negative, 45.2% (213/471) had isolated anti-HBc antibodies, and the frequency of OBI among patients with anti-HBc alone was 8.3% (17/206). OBI was not correlated either with CD4+ T cells count or transaminases levels. A total of 11.8% of patients with OBI presented elevated HBV DNA level. Frequency of individuals with APRI score > 2 and FIB-4 score > 3.25 was higher in patients with OBI as compared not exposed, immune and anti-HBc alone patients.ConclusionOur data demonstrate for the first time that OBI is prevalent among HIV patients in Mozambique, and will be missed using the commonly available serological assays that measures HBsAg.

Causes of death among women aged 17-49 years between 2007 and 2010 in Maputo, Mozambique.

ObjectivesTo describe causes of death among young women and estimate the role of HIV/AIDS as a cause in Maputo City, based on the civil death register.MethodsDeath data of 17–49 year–old women were abstracted from January 2007–March 2010 from the civil death register in Maputo City, registering overall about 15 000 deaths per–year. Causes of death in the register were either based on physicians’ diagnoses on death certificates or determined by asking questions to deceased relatives. Causes of death were written in Portuguese; we translated them into English and classified them into 106 codes using ICD–9; these codes were then categorized into 10 groups. Estimated populations from the 2007 census were used to calculate annual mortality rates. An earlier study was used to compare deaths in 2001.FindingsA total of 9640 deaths (6510 for residents of Maputo City) were registered and 77% had a specified cause of death reported. HIV–deaths represented 36% of all deaths and 40% among 25–39 year–olds. The death rate did not increase linearly by age, as there was a peak among women aged 30–34 years. The overall annual death rate was 6.7 deaths per 1000 population, with a notable decline by year. Death rates for HIV slightly declined by year. HIV–deaths explained most of the peak in death rate among 30–34–year–olds. The share of HIV–deaths among all deaths increased from 18% in 2001 to 35% in 2007–2010. Sixty–eight percent of all and 92% of HIV–related deaths occurred in hospital, with no increase over time.ConclusionsRoutine death register was useful to study death rates, distribution of deaths, and change over time in the urban setting of Maputo during late 2000s. Over time, the death rate among 17–49 years old women seemed to have declined, but the relative contribution of HIV increased.