The TB diagnostic process in this Mozambican hospital remained largely incomplete according to WHO recommendations and few patients with presumptive TB were identified as TB patients. Deficiencies as described should prompt reconsideration of WHO guideline content and feasibility.
BackgroundStreptococcus pneumoniae is the leading cause of community–acquired pneumonia in Africa. Antimicrobial resistance of S. pneumoniae to penicillin and other commonly used antibiotics has increased worldwide. However, prevalence data from the African region are sparse, especially with regard to adults.FindingsIn this study, adult patients presenting at an urban referral hospital in central Mozambique were screened for pneumococcal pneumonia during an 8-week period in 2010: Patients with a respiratory syndrome underwent chest radiography and a sputum sample was collected for pneumococcal culture and antimicrobial susceptibility testing. A urine sample was tested for the presence of pneumococcal antigen.177 patients with a respiratory syndrome were included. Overall, 41/177 (23%) patients fulfilled criteria for definite or probable pneumococcal pneumonia and in the group of patients with a positive chest x-ray this concerned 35/86 (41%) patients. 166 sputum cultures yielded 16 pneumococcal strains. One mg oxacillin disc testing identified potential penicillin resistance in 7/16 (44%) strains. Penicillin minimal inhibitory concentrations (MICs) were measured for 15 of these strains and ranged from <0.016-0.75 mg/L. No MICs >2 mg/L were found, but 3/15 (20%) pneumococcal strains had MICs >0.5 mg/L. All pneumococci were sensitive to erythromycin as measured by disc diffusion testing, whereas 44% was resistant to trimethoprim-sulfametoxazole.ConclusionsThe proportion of pneumonia cases attributable to pneumococcus appeared to be high. Whilst none of the S. pneumoniae strains tested were penicillin resistant, standard penicillin dosing for pneumonia may be insufficient given the observed range of pneumococcal penicillin MICs.
BackgroundExisting literature suggest frequent gaps in the quality of care (QoC) provided to children with malnutrition in low-income and middle-income countries. Beira is the second largest city in Mozambique. This study included two phases: phase 1 was a systematic assessment of the QoC provided to malnourished children in Beira; phase 2 aimed at using findings of the assessment to develop recommendations, with a participatory approach, to improve QoC.MethodsIn phase 1, all facilities offering nutritional care to children in Beira were included, and exit health outcomes were reviewed against international SPHERE standards. A sample of four (66%) facilities was randomly selected for a comprehensive assessment of all areas contributing to QoC using an adapted WHO tool. In phase 2, key stakeholders were identified, and using a participatory approach, a list of actions for improving the QoC for malnourished children was agreed.ResultsIn phase 1, outcomes of 1428 children with either severe acute malnutrition or moderate acute malnutrition (MAM) were reviewed. In-hospital recovery rate (70.1%) was almost in line with the SPHERE standard (75%), while at outpatient level, it was significantly lower (48.2%, risk ratio (RR) 0.68, p<0.0001). Recovery rate was significantly lower in HIV seropositive compared with seronegative (39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneity in MAM recovery rate was detected among facilities (range 32.5%–61.0%). Overall, out of all domains contributing to QoC in the sample, 28/46 (60.8%) indicated suboptimal care with significant health hazards and 13/46 (28.2%) indicated totally inadequate care with severe health hazards. In phase 2, a list of 38 actions to improve QoC for malnourished children was agreed among 33 local and national stakeholders.ConclusionsLarge heterogeneity in QoC for malnourished children in Beria was detected. The study documents a concrete example of using data proactively, for agreeing actions to improve QoC.
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