São Tomé And Príncipe Research Articles

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.

Nasality triggered by /ɲ/ in two portuguese varieties of Sao Tome and Principe

This study describes and analyzes the nasality triggered by /ɲ/ in the Portuguese spoken in São Tomé (PST) and in the Portuguese spoken in Príncipe (PP). PST and PP are Portuguese varieties from São Tomé and Príncipe (STP) that present particular linguistic characteristics. Considering the context of linguistic contact into which PST and PP are inserted, we aim to (i) propose a phonological analysis of nasality triggered by /ɲ/ in PST and PP, and (ii) investigate the presence of ambisyllabic structures. Based on Autosegmental Phonology (Goldsmith 1976; 1990) as the phonological theory and laboratory phonology (Ohala, 1995) as the methodology and considering the phonotactic analysis of vowels, we observed that nasality can be triggered by /ɲ/, a nasal consonant that occupies an ambisyllabic structure. Thus, the palatal nasal nasalizes left contiguous vowels in stressed and unstressed syllables. This nasalization process is possible because /ɲ/ is in coda, resulting in a CVN syllable structure and triggering tautosyllabic nasality. Even though it is optional, the nasality triggered by /ɲ/ occurs independently of the vowel quality and the word stress, as described for BP (Wetzels, 1997).

Repensar a Cadeia de Valor do cacau biológico de São Tomé e Príncipe

Cocoa is an important commodity in the economy of Sao Tome and Principe (STP) for ensuring subsistence, creating employment, developing local microeconomics and contributing to the GDP and image of the country. Thus, due to the monopoly/concentration of power in the international cocoa value chains as well as the overall price decay, the STP cocoa has been losing space in the international markets. As a result, as the country is unable to compete in quantitative terms or to invest in other economies of scale and production and producer income have been declining. This paper aims to characterize and rethink the value chain of organic cocoa in STP, identifying its weaknesses and potentialities while proposing ways to create value and improve its sustainability and international image. The results suggest that rethinking the value chain involves the creation of a PGI with effective official control and a collective promotion component that will enable it to gain efficiency or scale, in a strategic and operational articulation with tourism, coffee. and gastronomy, among other key sectors.

Estudo de Mercado de Café Biológico de STP

The Monte Cafe region, once a prominent place in coffee production, declined with the country's independence in 1975. As a result of the structuring and grouping of 6 smallholder associations, CECAFEB (Organic Coffee Export Cooperative) was created in order to relaunch 510 organic coffee-growing farmers. Despite the strategy of financial self-sufficiency and the commitment to high value-added products, CECAFEB faces problems of low volume production and difficulties in supply and market knowledge. This study aims to make a market study of organic coffee, including its selling and non-selling establishments, in Sao Tome and Principe (STP). The adopted methodology, of mixed nature (qualitative and quantitative), was developed in two stages: The first being exploratory research and the second a conclusive-descriptive research (based on observation and data collection by interview and the survey method, through a structured questionnaire built for the purpose, applied to the universe of current and potential customers of the STP cooperative). The results, in addition to identifying the links in the organic coffee value chain and potential customer establishments of this product, revealed a lack of knowledge of organic coffee, the brand and CECAFEB. The certification of coffee as organic, is a valued attribute in the purchase and consumption.

The Discursive Politics of Adaptation to Climate Change

Adaptation to climate change is a policy objective of rapidly growing importance for development programming across the Global South. This article offers an interrogation of the discursive politics surrounding the term based on insights from postcolonial theory. By employing a theoretical framework rooted in the concepts of imaginative geographies and discursive violence, this contribution seeks to deconstruct how adaptation is being imagined and promoted by development actors in a Global South context. The underlying study adopts a multisited, institutional ethnography to critically analyze an adaptation project in São Tomé and Príncipe (STP) implemented jointly by the United Nations Development Program (UNDP) and the national government. The article presents evidence for how agents of development (re)produce an imaginative geography of the country’s vulnerability and engage in a discursive violence that renders project beneficiaries vulnerable on the one hand, and seeks to transform them into model adaptation subjects on the other. It discusses how local residents have been effectively excluded from the project based on their perceived vulnerabilities and points to critical political theory and “imaginative countergeographies” as ways in which the disempowering representations of the Global South as vulnerable and the discursive violence committed against its residents can be counteracted.

Living excluded from the world: essentialism in development discourse and its percolation into Santomean self-perceptions

Using an analysis of development discourse in and about São Tomé and Príncipe (STP), this article aims to trace the relationship between sociocultural constructions of difference and socio-economic structures of exclusion in the global development project. Using ethnographic data from a rural fishing village and from development professionals, I show how development discourse constructs STP as a place that is perpetually marginal and assigns essentialist traits to the islands and their people. In response, Santomeans imagine their society as one that is isolated and insular from global processes, even though they have historically always been incorporated into global networks of capital, labour, culture and commodities. I argue that this process, whereby Santomeans imagine and reproduce their own marginality, has an under-appreciated impact not only on their collective identity but also on their action and potentiality. I reflect on how the construction of marginality serves the global political, economic and social inequalities upon which the development project depends.

Selective Hepatitis B Birth-Dose Vaccination in São Tomé and Príncipe: A Program Assessment and Cost-Effectiveness Study.

São Tomé and Príncipe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.

Seroepidemiological and molecular investigation of spotted fever group rickettsiae and Coxiella burnetii in Sao Tome Island: A One Health approach.

Spotted fever group rickettsiae (SFGR) and Coxiella burnetii are intracellular bacteria that cause potentially life-threatening tick-borne rickettsioses and Q fever respectively. Sao Tome and Principe (STP), small islands located in the Gulf of Guinea, recently experienced a dramatic reduction in the incidence of malaria owing to international collaborative efforts. However, unexplained febrile illnesses persist. A One Health approach was adopted to investigate exposure to SFGR and C. burnetii in humans and examine the diversity of these bacteria in ticks parasitizing domestic ruminants. A cross-sectional human serological study was conducted in Agua Grande district in Sao Tome Island from January to March 2016, and ticks were collected from farmed domestic ruminants in 2012 and 2016. In total, 240 individuals varying in age were randomly screened for exposure to SFGR and C. burnetii by indirect immunofluorescence assay. Twenty of 240 individuals (8.3%) were seropositive for SFGR (4 for Rickettsia africae and 16 for R. conorii) and 16 (6.7%) were seropositive for C. burnetii. Amblyomma astrion were collected exclusively in 2012, as were A. variegatum in 2016 and Rickettsia spp. were detected in 22/42 (52.4%) and 49/60 (81.7%) respectively. Sequence analysis of multiple gene targets from Rickettsia spp. detected in ticks suggests the presence of a single divergent R. africae strain (Sao Tome). While no ticks were found positive for C. burnetii, Coxiella-like endosymbionts were detected in nearly all ticks. This is the first study in STP to provide serological evidence in humans of SFGR and C. burnetii and additional molecular evidence in ticks for SFGR, which may be responsible for some of the unexplained febrile illnesses that persist despite the control of malaria. Future epidemiological studies are needed to confirm the occurrence and risk factors associated with SFG rickettsioses and Q fever in both humans and animals.

FDI in small states and unattractive markets: the case of São Tomé and Príncipe

ABSTRACTStudies on Small States, ‘unattractive’ markets, namely those from Africa, are very scarce. São Tomé and Príncipe (STP), a Small State, insular economy, has had considerable momentum in attracting FDI in the last decade albeit its geographical and demographic constraints and relative weak economic growth. The current study uncovers the potential determinants of FDI in unattractive markets using STP as a case study. Based on (robust) logistic estimations on a sample of 56 Portuguese companies that have trade relations with African countries, we show that in the case of Small States economies and unattractive markets, the relevance of institutional factors and resource seeking strategies surpass internalisation and location factors related to market size and dynamics. We further uncovered that foreign companies’ characteristics, namely size and (general) human capital, are critical in explaining companies’ likelihood to invest in an ‘unattractive’ market.

Implementing a Birth Dose of Hepatitis B Vaccine in Africa: Findings from Assessments in 5 Countries

Few African countries have introduced a birth dose of hepatitis B vaccine (HepB-BD) despite a World Health Organization (WHO) recommendation. HepB-BD given within 24 hours of birth, followed by at least two subsequent doses, is 90% effective in preventing perinatal transmission of hepatitis B virus. This article describes findings from assessments conducted to document the knowledge, attitudes, and practices surrounding HepB-BD implementation among healthcare workers in five African countries. Between August 2015 and November 2016, a series of knowledge, attitude and practices assessments were conducted in a convenience sample of public and private health facilities in Botswana, the Gambia, Namibia, Nigeria, and São Tomé and Príncipe (STP). Data were collected from immunization and maternity staff through interviewer-administered questionnaires focusing on HepB-BD vaccination knowledge, practices and barriers, including those related to home births. HepB-BD coverage was calculated for each visited facility. A total of 78 health facilities were visited: STP 5 (6%), Nigeria 23 (29%), Gambia 9 (12%), Botswana 16 (21%), and Namibia 25 (32%). Facilities in the Gambia attained high total coverage of 84% (range: 60-100%) but low timely estimates 7% (16-28%) with the median days to receiving HepB-BD of 11 days (IQR: 6-16 days). Nigeria had low total (23% [range: 12-40%]), and timely (13% [range: 2-21%]) HepB-BD estimates. Facilities in Botswana had high total (94% [range: 80-100%]), and timely (74% [range: 57-88%]) HepB-BD coverage. Coverage rates were not calculated for STP because the maternal Hepatitis B virus (HBV) status was not recorded in the delivery registers. The study in Namibia did not include a coverage assessment component. Barriers to timely HepB-BD included absence of standard operating procedures delineating staff responsible for HepB-BD, not integrating HepB-BD into essential newborn packages, administering HepB-BD at the point of maternal discharge from facilities, lack of daily vaccination services, sub-optimal staff knowledge about HepB-BD contraindications and age-limits, lack of outreach programs to reach babies born outside facilities, and reporting tools that did not allow for recording the timeliness of HepB-BD doses. These assessments demonstrate how staff perceptions and lack of outreach programs to reach babies born outside health facilities with essential services are barriers for implementing timely delivery of HepB-BD vaccine. Addressing these challenges may accelerate HepB-BD implementation in Africa.

Línguas Nacionais de São Tomé e Príncipe e Ortografia Unificada

Em São Tomé e Príncipe (STP), são faladas três línguas autóctones (santome, lung’Ie e angolar) além do português, língua oficial desde 1975. Neste ambiente multilíngue, contudo, não havia, até o início dos anos 2000, tentativas oficiais de normalização ortográfica dessas línguas nacionais. Em 2010, o Alfabeto Unificado para as Línguas Nativas de São Tomé e Príncipe (ALUSTP), a fim de se representar alfabeticamente as línguas santome, angolar e lung’Ie, foi sancionado. Além disso, desde 2009, o lung’Ie vem sendo ensinado nas escolas do Príncipe, devido, sobretudo, ao incentivo do Governo Regional do Príncipe à difusão da cultura principense. Nessa perspectiva, o presente capítulo tem como objetivo discutir as duas práticas linguísticas mencionadas, tendo em vista que ambas fazem parte de uma importante etapa para a efetivação de ações políticas em cenários multilíngues. Ademais, abordaremos as línguas crioulas de STP sob a perspectiva histórica e linguística em conjunto com sua ortografia unificada.

Teenage pregnancy - a study in São Tomé and Príncipe.

Introduction The increasing number of pregnant teenagers in São Tomé and Príncipe (STP) represents a serious public health issue. The aim of this study was to characterize the population of pregnant adolescents followed in a health facility dedicated to maternal health in STP. Methods A cross-sectional survey was conducted among pregnant teenagers that attended the Mother and Child Protection Center during the first quarter of 2017. The survey contained questions on sociodemographic characteristics, sexual and risk behaviors, family, partners and health support. Results The mean age of the 51 pregnant teenagers included was 16.37 ± 0.8 years. Eight girls reported that they had planned to fall pregnant. Teenagers whose pregnancy was unplanned usually present with a previous family history of adolescent pregnancy. About 59% of girls engaged in sexual activity before 16 years of age with a mean number of sexual partners of 1.84 ± 0.88. In this study, 51% of the girls do not use any contraceptive method, usually because their partner refuses to do so. The preferred contraceptive method are condoms. Information on contraception is given mainly at school. Pregnant girls' first medical consultation was at a mean gestational age of 6 weeks. Abortion was considered by 51% of girls after pregnancy was confirmed. Conclusion Teenage pregnancy imposes health problems for the mother and child and contributes to educational and socioeconomic disadvantages. The collaboration of healthcare providers, teachers and parents is needed to enhance sexual health education. This is the first study in STP on teenage pregnancy; although the sample is small, the authors believe that the results are representative of the general population.

Integration and Socialization of New Employees in the Bank Sector

The objective of this research was to investigate the growing importance of integration and socialization of new employees, to determine the benefit that the integration and socialization model has brought to the commercial banks at an African State - Sao Tome and Principe (STP), and also to assess the appreciation of employees on the model of integration of new employees. The empirical research is based on an interview and a survey. The target of the interview are the 8 human resources managers of the all commercial banks that operate in the African State - Sao Tome and Principe (STP). The survey sample are 82 employees of the 8 commercial banks. The main results show that employees and managers of commercial banks of STP agree with the integration plan, and older employees are collaborative in the integration and socialization of their new colleagues. This work is innovative in STP, since the authors did not find any research concerning this theme. This work allows to understand the importance to have an initial program of integration and socialization for new collaborators in STP banks, which will contribute, from the beginning, for increasing the motivation, satisfaction and performance of the employees resulting in productivity improvement and cost savings.

A doubtful hope: resource affect in a future oil economy

In global debates about natural resource extraction, affect has played an increasingly prominent, if somewhat nameless, role. This paper proposes a theorization of resource affect both as an intrinsic element of capitalist dynamics and as an object problematized by corporate, government, and third‐sector practice. Drawing on ethnographic research in São Tomé and Príncipe (STP), I explore the affective horizons generated by the prospect of hydrocarbon exploration: a doubtful hope comprised of visions of material betterment, personal and collective transformation, as well as anticipations of failure, friction, and discontent. I also examine the multitude of oil‐related campaigns, activities, and programmes initiated by non‐governmental organizations and global governance institutions in STP, animated by the specific conundrums presented by oil's futurity. In light of this, I argue that what we see emerging is a new resource politics that revolves around not simply the democratic and technical aspects of resource exploitation but increasingly their associated affective dissonances and inconsistencies.

Geology, Potentiality, Speculation: On the Indeterminacy of First Oil

This article uses what the petroleum industry calls first oil to examine the uneven process of resource making on the margins of global zones of extraction. It explores how the double obscurity of hydrocarbon prospects—both geologically obscured and their worth not yet revealed by the market—generates particular material constraints, pauses, and setbacks characteristic of petroleum production. The article draws on ethnographic and archival material from São Tomé and Príncipe (STP), where repeated attempts to explore offshore oil have yet to transform geological potential into an economic asset. It highlights the incongruous effects of certain epistemic practices and devices (contract, zone, and well) aimed at facilitating first oil by managing uncertainty. As a result, they work as gestures of an indeterminate matter whose existence continues to be doubted.

Countering a corrupt oil boom: Energy justice, Natural Resource Funds, and São Tomé e Príncipe's Oil Revenue Management Law

The world's fossil fuels took more than two billion years to accumulate, yet face depletion at a rate that could have them exhausted within one to two centuries. Moreover, their production, extraction, and processing have often occurred with at times devastating consequences for national governments and local communities. After summarizing these concerns, this study presents the notion of prudence, the idea that energy resources ought to be maximized for future use, and utilized to better the communities living near them. It then introduces Natural Resource Funds, a mechanism to both moderate the production and extraction of energy resources and to ensure that energy-related revenues serve the public good rather than merely consolidate corporate profit. São Tomé e Príncipe (STP) offers an excellent case study of how to achieve this balance in practice. STP's Natural Resource Fund moderates oil and gas production and ensure that revenues flow democratically to public projects. Although the country continues to face an array of challenges, these policies have generated much needed government revenue, helped diversify the economy, lowered inflation and rates of poverty, and minimized corruption and the exploitation often associated with oil exploration and production.

Frequent occurrence of oxacillin-susceptible mecA-positive Staphylococcus aureus (OS-MRSA) strains in two African countries.

Oxacillin-susceptible mecA-positive Staphylococcus aureus (OS-MRSA) isolates have been increasingly reported worldwide, but data regarding the African continent have not been available. Between 2010 and 2014, 1462 inpatients and healthcare workers were screened for MRSA nasal carriage in São Tomé and Príncipe (STP) and Angola, two Portuguese-speaking African countries (PALOP countries). We determined the presence of the mecA gene and the antimicrobial susceptibility profiles of the isolates. OS-MRSA clonal lineages were identified as well as the presence of virulence determinants, including Panton-Valentine leucocidin (PVL). Out of 164 S. aureus hospital isolates tested, 29 (17.7%) were mecA positive, but susceptible to oxacillin, showing oxacillin MICs ≤3 mg/L. All OS-MRSA isolates were resistant to cefoxitin and most of them were also resistant to at least two antimicrobials other than β-lactams. The 29 OS-MRSA were distributed into two major clonal lineages: (i) PFGE type B-ST88-SCCmec IVa, associated with spa types t186/t325/t786/t1814/t1951, detected in Angola (n = 5) and STP (n = 10); and (ii) PFGE type C-t451/t648-ST8-SCCmec V, exclusively found in STP (n = 9). OS-MRSA showed at least two virulence determinants. PVL was detected in an isolate recovered in STP. We describe a high prevalence of OS-MRSA among S. aureus strains recovered in two African countries. OS-MRSA in PALOP countries were mainly associated with ST88 and ST8, two prevalent MRSA clonal types in these countries. If direct testing for mecA is not available, cefoxitin susceptibility testing is highly recommended to avoid the misidentification of OS-MRSA.

Staphylococcus aureus in former Portuguese colonies from Africa and the Far East: missing data to help fill the world map

The aim of the present study was to determine the prevalence and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among patients and healthcare workers in Angola (ANG), São Tomé and Príncipe (STP), Cape Verde (CV) and East Timor (ET), and to characterize the antimicrobial susceptibility, virulence content and population structure of all S. aureus. Despite the importance of MRSA as a major human pathogen, data from these former Portuguese colonies in Africa and Asia are scarce. A total of 2065 nasal swabs recovered between 2010–14 were included in the study. Antimicrobial susceptibility testing and molecular characterization of S. aureus showed: (i) a very high MRSA prevalence in ANG (61.6%), moderate in STP (25.5%), low in CV (5.6%) and null in ET; (ii) a high prevalence of Panton–Valentine leukocidin in STP (36.8%), ET (29.2%) and CV (28.3%) contrasting with ANG (7.9%); (iii) ST5-SCCmecIVa, ST8-IV/V and ST5-VI were the major MRSA clones in ANG (65.2%), STP (44.8%) and CV (50%), respectively; (iv) a high resistance to trimethoprim-sulfamethoxazole in ANG (66.5%) and STP (50.9%), to rifampin in ANG (77.3%), and to tetracycline in STP (26.3%) and ET (20.8%); (v) three major methicillin-susceptible S. aureus clones (ST15, ST508, ST152) were present in all four countries. Age <18 years (OR 2.03, 95% CI 1.24–3.31), previous surgery (OR 2.45, 95% CI 1.24–4.83), no smoking (OR 4.04, 95% CI 1.05–15.50), and longer hospitalization (OR 2.53, 95% CI 1.49–4.28) were risk factors for MRSA carriage. This study provided the first comprehensive overview on MRSA in former Portuguese colonies in Africa and Asia, missing data in the world map.

High rate of detection of G8P[6] rotavirus in children with acute gastroenteritis in São Tomé and Príncipe.

The burden of rotavirus infections greatly affects the low-income African countries. In the absence of epidemiological data on pediatric diarrhea in São Tomé and Príncipe (STP), a study was conducted from August to December 2011. Rotavirus antigen was detected in 36.7% of the collected fecal samples (87/237). G8P[6] was identified as the predominant genotype (71.1% detection rate), while G1P[8] represented only 8.4%. Phylogenetic analysis of VP7 G8 strains showed clustering within lineage G8d, while VP4 P[6] strains clustered within lineage 1a. Our results represent the first report on rotavirus from STP and show one of the highest detection rates of G8 rotaviruses worldwide.

Aleitamento materno e caracterização dos hábitos alimentares na primeira infância: experiência de São Tomé e Príncipe

Objetivos: avaliação da amamentação, da diversificação e frequência alimentar, em crianças de São Tomé e Príncipe (STP). Métodos: trata-se de uma amostra constituída por 1285 crianças. O protocolo incluiu a prevalência do aleitamento materno exclusivo (AME) e Total (AMT), início da diversificação alimentar (DA) e um questionário de frequência alimentar. O tratamento estatístico foi efetuado no SPSS®. Os resultados foram apresentados de acordo com o total da amostra. Resultados: 45,5% são do sexo feminino e a média de idades 26±18 meses. 46,6% fez AME até aos 6 meses (média 5±2). A média de AMT foi 12±7 meses e o início da DA aos 6±3 meses (mediana=6), sendo as farinhas e a canja de peixe os primeiros alimentos oferecidos. 42% das crianças são incluídas na dieta familiar aos 7±3 meses (mediana=6). Elevada porcentagem de crianças nunca ingere: leite de vaca (74%) ou iogurte (40%), contrariamente ao elevado consumo de óleo alimentar (34%) e açúcar (33%). A idade média de iniciação da cerveja é aos 18±12 meses e vinho de palma 13±10 meses. Conclusões: observa-se uma elevada prevalência de AME e uma precoce introdução da DA. Embora existam recursos alimentares disponíveis, não há informação/ formação adequada para elaborar um plano alimentar saudável durante a infância.