São Tomé And Príncipe Research Articles

Regional variation in incidence and mortality due to hypertension in Sao Tome and Principe

Abstract Background The analysis of incidence and mortality due to hypertension (HT) provides statistical data for addressing public health programs, particularly in low-income countries where poor health systems impose constraints to address non-communicable diseases (NCDs). This study aims to assess the geographic pattern of incidence and mortality due to HT in Sao Tome and Principe (STP). Methods This is a descriptive ecological study. Aggregated data on new cases of and deaths due to HT by gender, age-group and district (2022-2023) were extracted from the Health National Database (STP Ministry of Health). Age-standardized incidence and mortality rates (ASIR and ASMR) and respective 95% confidence interval (95%CI) were obtained. Mortality-to-incidence ratio (MIR) was computed by district (lower values indicate better quality of care). Comparison between districts was done through standardized incidence ratios (SIR) and respective p-value. Analyses were stratified by gender. Results ASIR and ASMR per 100,000 were, respectively, 1168.9 (95%CI:1103.3-1237.6) and 76.8 (95%CI:62.0-96.2) among men and 2460.6 (95%CI:2365.0-2559.0) and 99.7 (95%CI:81.4-121.6) among women. Incidence of HT was significantly higher than expected (p < 0.001) in Agua Grande, Caue and Lemba with SIR varying from 122.8% (Agua Grande) to 201.1% (Caue) in men and from 125.1% (Lemba) to 224.1% (Caue) in women. Instead, Mé-Zochi presented much lower incidence than expected for both, men (SIR=43.1%;p<0.001) and women (SIR=38.4%;p<0.001). Large differences between districts were observed in MIR, varying from 0% (Caue and Lobata) to 84% (Mé-Zochi) in men and from 0% (Lobata) to 57% (Mé-Zochi) in women. Conclusions According to our findings there is, not only, a high incidence rate of HT, but also regional variation in this rate, deserving particular attention from policy-makers. Regional variation in hypertension incidence could be partially explained by differences in the quality of healthcare services. Key messages • Awareness should be given to the high incidence of hypertension demanding preventive strategies in the field of public health. • Public health strategies should address the quality of care in regards to the prevention, diagnosis and monitoring of hypertension.

Vector Competence of Aedes aegypti from São Tomé and Príncipe for West Nile Virus Transmission.

The global distribution of Aedes aegypti mosquitoes, particularly in tropical regions, poses a significant public health risk due to their apparent ability to transmit arboviruses such as West Nile virus (WNV). This study aimed to evaluate the vector competence of Ae. aegypti from São Tomé and Príncipe (STP) for the transmission of the WNV PT6.39 strain, considering its potential role as a bridge vector in a region where Culex quinquefasciatus would be the main vector. Aedes aegypti mosquitoes were collected, reared, and experimentally infected with WNV, with viral dissemination and transmission potential assessed 7, 14, and 21 days post infection (dpi). The results showed an increasing trend in infection rates, from 5% at 7 dpi to 35% at 21 dpi, with corresponding dissemination rates of 0%, 100%, and 43%. The transmission rates also increased from 0% at 7 dpi to 67% at 21 dpi, with a maximum transmission efficiency of 10% observed at the final time point. Although Ae. aegypti from STP demonstrated the potential to transmit WNV, the overall transmission efficiency remained relatively low. These findings provide necessary insights into the vector competence of Ae. aegypti in this region, highlighting the importance of continued monitoring and targeted vector control measures to mitigate the risk of potential WNV outbreaks.

Food Insecurity and Nutritional Inadequacy in Children and Adolescents of Basic Education Schools of Cantagalo District in São Tomé and Príncipe, Central Africa.

Food insecurity (FI) is a critical socioeconomic and public health problem globally, particularly affecting children's nutritional status and development. This cross-sectional study aimed to assess the prevalence of nutritional inadequacy among children and adolescents in the Cantagalo district of São Tomé and Príncipe (STP), in Central Africa. It also assessed their households' FI situation and examined sociodemographic, anthropometric, and nutritional characteristics associated with severe FI. Data included 546 children/adolescents (51.8% males, aged 9-15 years) from the eight public basic education schools. A structured questionnaire provided sociodemographic data, while anthropometric measurements assessed nutritional status. Dietary intake data were gathered using a single 24 h dietary recall, and the adjusted prevalences of nutritional inadequacy were obtained using version 2.0 of the PC-Software for Intake Distribution Estimation (PC-SIDE®). The Household Food Insecurity Access Scale was used to assess FI, and households were classified as severely or non-severely food insecure. Multivariable binary logistic regression models adjusted for potential confounders identified factors related to FI. Children's/adolescents' thinness was exhibited in 34.1% of participants, and over 95% had inadequate intake of essential micronutrients, including iron. Notably, 73.7% were severely food insecure. A higher severity of FI was positively associated with a lower intake of iron and certain household head characteristics, such as being female or older, and negatively associated with having a home garden.

Genetic surveillance reveals low, sustained malaria transmission with clonal replacement in Sao Tome and Principe.

Despite efforts to eliminate malaria in Sao Tome and Principe (STP), cases have recently increased. Understanding residual transmission structure is crucial for developing effective elimination strategies. This study collected surveillance data and generated amplicon sequencing data from 980 samples between 2010 and 2016 to examine the genetic structure of the parasite population. The mean multiplicity of infection (MOI) was 1.3, with 11% polyclonal infections, indicating low transmission intensity. Temporal trends of these genetic metrics did not align with incidence rates, suggesting that changes in genetic metrics may not straightforwardly reflect changes in transmission intensity, particularly in low transmission settings where genetic drift and importation have a substantial impact. While 88% of samples were genetically linked, continuous turnover in genetic clusters and changes in drug-resistance haplotypes were observed. Principal component analysis revealed some STP samples were genetically similar to those from Central and West Africa, indicating possible importation. These findings highlight the need to prioritize several interventions such as targeted interventions against transmission hotspots, reactive case detection, and strategies to reduce the introduction of new parasites into this island nation as it approaches elimination. This study also serves as a case study for implementing genetic surveillance in a low transmission setting.

Fisher’s perceptions on shark fisheries in Sao Tome Island (Gulf of Guinea, West Africa)

Sao Tome and Principe (STP) is a small island developing state in the Gulf of Guinea (West Africa) and is considered a global hotspot of marine biodiversity. Still, detailed information on sharks’ diversity, abundance, and respective fisheries is mainly absent. Here, we interviewed fishers from different local communities of the island of Sao Tome to characterize: i) local knowledge on shark fisheries, ii) those reliant upon these resources, and iii) their perceptions about shark populations and their importance on Sao Tome Island. A total of 111 semi-structured interviews were conducted between May 6 and June 15, 2019, in 11 fishing communities. Ninety-seven percent of fishers mentioned that sharks are present in their fishing grounds, and 98 % reported that they catch sharks. The species most identified by fishers (77 %) was the scalloped hammerhead shark (Sphyrna lewini), followed by the bluntnose sixgill shark (Hexanchus griseus; 33 %), white shark (Carcharodon carcharias; 31 %), longfin mako shark (Isurus paucus; 29 %), pigeye shark (Carcharhinus amboinensis; 27 %), and other six species (under 20 % each). Sixty-two percent of interviewees perceived sharks as a threat to their safety and livelihoods. When asked if sharks should be protected, 59 % of fishers agreed, while 40 % did not consider it necessary. Common reasons in support of protection were that sharks were disappearing (23 %), important for ocean health (9 %), and overfished (5 %). Most fishers (89 %) noticed shark abundance changes, decreasing over the past 15 years. Regarding the underlying causes, the most common response was the increase in the fishing pressure from international fishing fleets (72 %). We argue that raising awareness and building capacity close to local communities on sharks' essential role and importance will be fundamental to supporting future conservation measures, as misinformation and prejudice against sharks are widespread.

Organic cocoa farmer’s strategies and sustainability

São Tomé and Príncipe (STP) is one of the world’s smallest organic cocoa exporting countries, whose product has a positive socio-cultural and economic impact. Small producers who ensure it, are associated into two cooperatives that experience several difficulties and dilemmas including climate changes and poverty. Diversification of livelihood strategies could lead to wellbeing, poverty and climate mitigation. The aim of this study was to analyse producers’ perception of sustainability related to the organic cocoa production in STP and to explain the influence of different factors on their livelihood strategies (LS). An ordered probit model for disaggregation of factor categories was used for the 2021 period. The results showed that gender, age, family size, members on-farm and off-farm work and professional training courses do not influence livelihood strategies. The important variables for them are education level, perception of social class, insurances and loans and access to services.

Digitally managed larviciding as a cost-effective intervention for urban malaria: operational lessons from a pilot in São Tomé and Príncipe guided by the Zzapp system

BackgroundOnce a mainstay of malaria elimination operations, larval source management (LSM)—namely, the treatment of mosquito breeding habitats–has been marginalized in Africa in favour of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). However, the development of new technologies, and mosquitoes' growing resistance to insecticides used in LLINs and IRS raise renewed interest in LSM.MethodsA digitally managed larviciding (DML) operation in three of the seven districts of São Tomé and Príncipe (STP) was launched by the Ministry of Health (MOH) and ZzappMalaria LTD. The operation was guided by the Zzapp system, consisting of a designated GPS-based mobile application and an online dashboard, which facilitates the detection, sampling and treatment of mosquito breeding sites. During the operation, quality assurance (QA) procedures and field management methods were developed and implemented.Results12,788 water bodies were located and treated a total of 128,864 times. The reduction impact on mosquito population and on malaria incidence was 74.90% and 52.5%, respectively. The overall cost per person protected (PPP) was US$ 0.86. The cost varied between areas: US$ 0.44 PPP in the urban area, and US$ 1.41 PPP in the rural area. The main cost drivers were labour, transportation and larvicide material.ConclusionDML can yield highly cost-effective results, especially in urban areas. Digital tools facilitate standardization of operations, implementation of QA procedures and monitoring of fieldworkers’ performance. Digitally generated spatial data also have the potential to assist integrated vector management (IVM) operations. A randomized controlled trial (RCT) with a larger sample is needed to further substantiate findings.

Acculturation Experiences of International Students from Sao Tome and Principe in China

While many studies are focused on international students from the main source countries in China, few studies have addressed how minority groups experience acculturation. Therefore, an interpretive phenomenology was used to explore the acculturation experiences of international students from Sao Tome and Principe (STP) studying in China. Semi-structured interviews were conducted with eight STP students, while analyzing the interview data using the Colaizzi method. Finally, the data yielded a total of four themes that were emerged as follows: 1. surprising explorers, 2. temporary mutes, 3. confused newcomers, and 4. elite pioneers. The findings provide insights into how the acculturation process is experienced and the strategies STP students in China followed toward it and are even consistent with existing theories and literature. International students from STP and other minority groups may benefit a lot from this study and enrich their experience of the acculturation process in a more targeted way.

Aplicação da VECM para Medir o Impacto Econômico do Turismo em São Tomé e Príncipe Integrando Variáveis Macroeconômicas

This quantitative research aims to analyze the long-run relationship and causality between economic development, tourism, and other macroeconomic variables in the context of Sao Tome and Principe (STP). First, the Augmented Dickey and Fuller (ADF) and Phillips and Perron (PP) unit root test is applied, followed by the Johansen cointegration test and the Vector Error Correction Model (VECM). Gross domestic product (GDP), tourism receipts (TR), foreign direct investment (FDI), Unemployment rate (UR), and Inflation (INF) are the variables used in the econometric model from 1993 to 2019. The findings indicate a positive long-run relationship between GDP and the explanatory variables TR and FDI. It also indicates a negative long-run relationship between GDP and the variables INF and UR. In terms of short-run causality, the results reveal a unidirectional causality running from GDP to FDI and INF and bidirectional causality between TR and INF. Furthermore, it suggests a long-run unidirectional causality from all independent variables to GDP. This is the first quantitative study that presents a new perspective of tourism in the context of STP by applying the VECM and integrating several macroeconomic variables.

Aplicação da VECM para Medir o Impacto Econômico do Turismo em São Tomé e Príncipe Integrando Variáveis Macroeconômicas

This quantitative research aims to analyze the long-run relationship and causality between economic development, tourism, and other macroeconomic variables in the context of Sao Tome and Principe (STP). First, the Augmented Dickey and Fuller (ADF) and Phillips and Perron (PP) unit root test is applied, followed by the Johansen cointegration test and the Vector Error Correction Model (VECM). Gross domestic product (GDP), tourism receipts (TR), foreign direct investment (FDI), Unemployment rate (UR), and Inflation (INF) are the variables used in the econometric model from 1993 to 2019. The findings indicate a positive long-run relationship between GDP and the explanatory variables TR and FDI. It also indicates a negative long-run relationship between GDP and the variables INF and UR. In terms of short-run causality, the results reveal a unidirectional causality running from GDP to FDI and INF and bidirectional causality between TR and INF. Furthermore, it suggests a long-run unidirectional causality from all independent variables to GDP. This is the first quantitative study that presents a new perspective of tourism in the context of STP by applying the VECM and integrating several macroeconomic variables.

Intestinal Parasitic Infections, Treatment and Associated Factors among Pregnant Women in Sao Tome and Principe: A Cross-Sectional Study.

Intestinal parasitic infections (IPIs) are a public health problem in developing countries such as Sao Tome and Principe (STP) although the pregnancy burden of IPIs is unknown in this endemic country. Thus, the aim of this study was to determine the prevalence of IPIs, prescribed anthelmintics, and associated factors among pregnant women admitted to Hospital Dr. Ayres de Menezes (HAM). A hospital-based cross-sectional study was conducted among pregnant women admitted to the HAM who had undergone antenatal copro-parasitological screening. Data were abstracted from antenatal care (ANC) cards regarding parasitological results and anthelmintic prescriptions. A structured questionnaire face-to-face interview was also applied. Pregnant women with an IPI (210) were compared to noninfected women (151). Data analysis was performed using SPSS version 25.0. Odds ratios (ORs) with 95% confidence intervals (CIs) for factors associated with IPIs were estimated using multiple logistic regression models. A p value <0.05 was considered statistically significant. A total of 361 participants (210 IPI and 151 no-IPI) with a mean age of 26.96 (SD: 7.00) were included. The overall prevalence of IPI was 58.2% (95% CI 52.9 to 63.3), mainly due to helminthiasis, with a 55.9% (95% CI 50.7-61.2%) rate. Ascaris lumbricoides (90.9%) was the most predominant parasite species identified followed by Trichuris trichiura (13.8%). Polyparasitism was observed in 25 cases (11.9%). Anthelmintics were prescribed to 23% of pregnant women. S intercalatum (11) and E histolytica (7) infections were not adequately treated. IPI was significantly associated with primary education (AOR 1.73 (95% CI: 1.10-2.71)), unemployment (AOR 1.94 (95% CI: 1.20-3.13)), and parity of five or above (AOR 3.82 (95% CI: 1.32-11.08)). This study highlights the IPI burden, associated factors, and missing treatment opportunities among pregnant women with STP. This study is a useful tool for policymakers in STP to enhance the health of women and their unborn babies.

Burden of Malaria in Sao Tome and Principe, 1990-2019: Findings from the Global Burden of Disease Study 2019.

Background: Malaria is a parasitic infection transmitted by mosquito vectors, commonly found in tropical regions, and characterized by high morbidity and mortality. It causes a heavy disease burden in Sao Tome and Principe (STP), an island country in West Africa which at one time had a high incidence of malaria. Objective: This study aims to analyze the trend of disease burden of malaria in STP. Methods: The crude and age-standardized incidence, mortality, and disability-adjusted life years (DALYs) rate data of malaria were extracted from GBD 2019. Joinpoint 4.9 software was used to calculate the annual percentage change (APC) and the average annual percentage change (AAPC), which were also used to indicate the change in disease burden by different stages. Results: In general, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) of malaria presented a decreasing trend between 1990 and 2019, with an average annual decrease of 5.6%, 6.2%, and 10.7%, respectively, in STP. Specifically, all indicators first presented an increasing trend from 1990 to about 2000, followed by a decreasing trend until 2019, although the incidence rebounded slightly after 2015. Overall, the ASIR, ASMR, and ASDR of malaria reduced by 77.08%, 87.84%, and 82.21%, respectively, in 2019 as compared to 1990. No significant differences in disease burden were found between males and females between 2005 and 2019. Children who were under 5 years old showed a relatively small decrease in the rate of DALYs as compared to other age groups, but remained the group with the highest disease burden of malaria in the country. Conclusions: The disease burden of malaria in STP showed a significant decrease between 1990 and 2019, but it will still be challenging to achieve the goal of eliminating malaria by 2025. The government and relevant authorities should aim to strengthen the prevention and surveillance of malaria and tailor population-specific interventions in order to reduce the disease burden of malaria in STP.

Analysis of Fishery Resource Management Practices in São Tomé and Príncipe: Perception of the Dynamics of Catches from 1950–2020, Recommendations and Strategies for Future Research

Fisheries play an important role in the socio-economic development of São Tomé and Príncipe (STP), although the exploited fishery resources have remained largely unknown due to extreme data limitation conditions, which have hindered their sustainable utilization and effective management. Fish has traditionally been seen as a crucial element in the population’s dietary and nutritional security, playing a significant role as a source of 85% of animal protein. However, the sustainable management of these resources has recently been facing some challenges. Fishermen control the patterns of fishing exploitation by modifying their methods in response to shifting socioeconomic situations and the management of their resources. In the present study, we assess the dynamics and trends of catches of artisanal, semi-industrial, and industrial fleets in São Tomé and Príncipe marine waters, as well as aspects related to fishing effort, using catch data collected from 1950 to 2020. The observed results show the dynamics and importance that the fishing sectors of São Tomé and Príncipe have for the country’s economic growth. According to the indices of abundance of fishery resources, the levels of exploitation during this study’s period revealed a reduction in recent years of artisanal catches. Furthermore, this study also identified major problems faced in the fishing sector of São Tomé and Príncipe and makes some recommendations to address them. These recommendations would allow future studies to define the status of stocks threatened or overexploited and control fishing efforts, ensuring the legitimacy and sustainability of fishing activity in São Tomé and Príncipe.

Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?

BackgroundAdolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP.MethodsAn institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran’s and Mantel–Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant.ResultsThe adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18–3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07–5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89–12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes.ConclusionAdolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

Mitogenome Analyses Reveal Limited Introduction of Anopheles coluzzii Into the Central African Islands of São Tomé and Príncipe

Islands possess physical characteristics that make them uniquely well-suited for initial field trials of new genetic-based technologies applied to African malaria vectors. This has led to efforts to characterize the degree of isolation of island mosquito populations. São Tomé and Príncipe (STP) is a country composed of two small islands in the Gulf of Guinea (Central Africa) where Anopheles coluzzii is the primary malaria vector. Several studies have shown a relatively high degree of genetic isolation between A. coluzzii populations in STP and the mainland compared with pairs of mainland populations separated by equivalent distances. Here, we analyzed complete mitochondrial genomes of individual A. coluzzii specimens from STP and neighboring mainland countries. The objectives are to describe the history of A. coluzzii establishment in STP, specifically to address several questions germane to their suitability as sites for a field trial release of genetically engineered mosquitoes (GEMs). These questions include: (i) What are the origins of A. coluzzii populations in STP?; (ii) How many introductions occurred?; (iii) When was A. coluzzii introduced into STP? and (iv) Is there ongoing, contemporary gene flow into STP from mainland populations? Phylogenetic analysis and haplotype networks were constructed from sequences of 345 A. coluzzii from STP, and 107 individuals from 10 countries on or near the west coast of Africa. Analysis of these data suggest that there have been two introductions of A. coluzzii onto the island of São Tomé that occurred roughly 500 years ago and that these originated from mainland West Africa. It appears that A. coluzzii has never been introduced into Príncipe Island directly from mainland Africa, but there have been at least four introductions originating from São Tomé. Our findings provide further support for the notion that contemporary populations of A. coluzzii on São Tomé and Príncipe are genetically isolated from mainland populations of this mosquito species.

Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study

BackgroundPregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents’ characteristics and factors associated to early childbearing in STP.MethodsA cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers’ clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software.ResultsThe study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2–0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2–0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2–0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn’s danger signs (OR 15.7, 95% CI= 9–26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup.ConclusionsUnfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents’ partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns’ danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl’s empowerment and awareness and, at the same time, reinforce boy’s role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn’t, simultaneously, improve educational and economic opportunities for girls.

Acute Hemorrhagic Fever: Clinical, Epidemiological and Laboratory Aspects in S&amp;#227;o Tom&amp;#233; and Pr&amp;#237;ncipe

Background: In the last 6 months, cases of acute hemorrhagic fever (AHF) have been recorded in Sao Tome and Principe (STP). Objective: To identify the clinical, epidemiological and laboratory parameters associated with AHF cases found in patients hospitalized in STP. Methods: Descriptive and quantitative analysis of AHF cases hospitalized in STP in the period December 2021 to May 19, 2022 through the variables: demographic data; clinical data; laboratory data and clinical outcome. Results: Analyzed 18 of 22 AHF cases, 50% of them male, mean age 33.7 years, 85.7% residing in the 2 largest districts of the country, 66.7% rural workers, administrative near maritime areas, sailors and domestics. 66.7% were healthy individuals. ≥50% had a fever, asthenia/weakness, myalgia, headache, lethargy, nausea, vomiting, and diarrhea. 22.2% to 33.3% had retro-orbital pain, abdominal pain, decreased consciousness, dyspnea/hypoxia, and cough. In a smaller register (5.6% - 11.1%), exanthema, convulsion, arthralgia, low back pain, chills, and chest pain. Bleeding from the digestive tract was found in 72.2%, followed by vaginal (33.3%), urethral (27.8%), nasal (22.2%), and oral (16.7%). 50% had laboratory confirmation for dengue, and another 50% with suspected clinical diagnosis without laboratory confirmation of the etiologic agent. Despite hemorrhage, 66.7% of confirmed cases were hemodynamically non-severe, and 88.9% of suspected cases were severe. Coinfection with malaria is evidenced in 11.1% of cases. 72.2% recovered and 27.8% died (deaths in 55.5% of suspected cases). Case deaths were male (100%), resident foreigners (40%), tool store employees, sailors and students, healthy (80%), and residing in the largest district in the country (60%). All deaths were hospitalized in serious condition, 80% were hospitalized for hemorrhage and shock, with bleeding arising between day 4 - 5 of illness in 60% and hospitalization on day 5 of illness. 60% died within ≤24 hours of hospitalization. 80% died from shock and multi-organ dysfunction and 20% from respiratory failure. Deaths had thrombocytopenia (100%), renal dysfunction (100%) and significantly increased transaminases (100%), anemia (75%) and leukocytosis (66.7%). 20% had a radiological change of pulmonary infiltrates. Conclusion: Our data reveal the complexity of the pathogens causing AHF and suggest the possible presence of other human pathogens usually unknown in the Santomean geographical territory.

Organic Cocoa Value Chain Sustainability: The Perception of São Tomé and Príncipe’s Stakeholders

Cocoa farming in São Tomé and Príncipe (STP) faces several challenges due to its poor socioeconomic context, the adverse impact of climate changes, the complex and limited access to global value chains, and worldwide demand pressure for higher cocoa quality and productivity. This exploratory research investigates potential pathways to a more sustainable organic cocoa (OC) production in STP by mapping the perceptions of the stakeholders involved in its value chain. Qualitative interviews, field observation, and focus group discussions were applied to understand how sustainability dimensions, drivers, impacts, and challenges of OC are perceived and how these three dimensions can be improved and balanced. The gathered perceptions are rather diverse, reflecting the stakeholders’ position and knowledge of the specific contexts and processes. Producers do not perceive how governance is adopting new organizational structures or practices that allow for an effective sustainability improvement. Most stakeholders recognize that market-related factors drive the sustainability adoption and that financing-related constraints challenge their wide implementation. There are trade-offs and power asymmetries in the OC value chain, which manifest differently, due to the governance approaches, processes, overall regulations, and training of producers. An alignment of perceptions and activities as well as a stronger cooperation between cooperatives, private firms, and public institutions is strongly recommended.

São Tomé and Príncipe’s toponymy

gabrielaraujo@um.edu.mo&#x0D; ABSTRACT. This study describes the toponymic profile of the Democratic Republic of São Tomé and Príncipe (STP), a former Portuguese colony. Here, we consider (i) its linguistic contact situation, reflected in the toponyms of non-Portuguese etyma (mainly from national languages), and (ii) the structure of the toponymic syntagma in Portuguese. Toponyms are created according to a place's geographic, social, historical, and linguistic reality. Therefore, STP's toponyms are the locus of the Santomean linguistic ecology and memory. Due to its linguistic diversity, the study of Santomean toponymy is transdisciplinary. It contributes to understanding different languages that share São Tomé and Príncipe's ethnicity and linguistic heritage, including multilingual synchronic and/or diachronic conjunctures and the political importance of Portuguese. STP's toponymy expresses a multilingual conjuncture common to the country since the arrival of the Portuguese and (mainly) enslaved Africans from different regions of Africa. Although the Portuguese language and culture have influenced most local toponymy, the Santomean toponymic profile contains endemic linguistic and cultural specificities. Thus, natural phenomena, along with political and historical events, among others, play a role in forming toponyms and characterizing the local toponymy as unique.

Leveraging technology to reach global health: The case of telemedicine in São Tomé and Príncipe health system

Background: Many African healthcare systems are seeking innovative solutions to improve access to specialized care. Accordingly, Sao Tome and Principe (STP) has adopted telemedicine to overcome the shortage of healthcare professionals, since 2011, and to support daily connections with Portuguese specialists, through a teleconsultation platform. This study presents a comprehensive assessment of the telemedicine service development, evolution, and impact in global health in the context of a low and middle-income country (LMIC). Methods: A case study approach was used and combined with the Momentum framework's critical success factors to successfully launch telemedicine services analysis, in order to help understand implementation and scale-up processes, as well as the role of strategic partnership in leveraging healthcare services with technology. Results: From 2011 to 2019, the telemedicine service in STP performed a total of 4,966, real-time teleconsultations, 137,976 exams, and clinical files introduced in the telemedicine platform. At present, fourteen medical specialities are providing remote access to care from Portugal. The most frequent specialties were teleradiology (72%), teleophthalmology (13%), teleotorhinolaryngology (9%), and telepediatric (4%). Moreover, behind this platform local human resources were trained to perform teleconsultations with autonomy. Additionally, the Marquês Valle Flor Institute's leadership has been a successful factor. Conclusion: These results suggest a consistent evolution of the service established through the system's integration into the daily routine and with the Portuguese health service. This sustainable telemedicine service is therefore an excellent example of the contribution that information technologies can make to LMIC, especially in the context of universal healthcare coverage.