Background There is a paucity of primary data to understand the overall pattern of disease and injuries as well as related health-service utilization in resource-poor countries in Africa. Objective To generate reliable and robust data describing the pattern of emergency presentations attributable to communicable disease (CD), non-communicable disease (NCD) and injuries in three different regions of Mozambique. Methods We undertook a pragmatic, prospective, multicentre surveillance study of individuals (all ages) presenting to the emergency departments of three hospitals in Southern (Maputo), Central (Beira) and Northern (Nampula) Mozambique. During 24-hour surveillance in the seasonally distinct months of April and October 2016/2017, we recorded data on 7,809 participants randomly selected from 39,124 emergency presentations to the three participating hospitals. Applying a pragmatic surveillance protocol, data were prospectively collected on the demography, clinical history, medical profile and treatment of study participants. Findings A total of 4,021 males and 3,788 (48.5%) females comprising 630 infants (8.1%), 2,070 children (26.5%), 1,009 adolescents (12.9%) and, 4,100 adults (52.5%) were studied. CD was the most common presentation (3,914 cases/50.1%) followed by NCD (1,963/25.1%) and injuries (1,932/24.7%). On an adjusted basis, CD was more prevalent in younger individuals (17.9±17.7 versus 26.6±19.2 years;p<0.001), females (51.7% versus 48.7%—OR 1.137, 95%CI 1.036–1.247;p = 0.007), the capital city of Maputo (59.6%) versus the more remote cities of Beira (42.8%—OR 0.532, 95%CI 0.476–0.594) and Nampula (45.8%—OR 0.538, 95%CI 0.480–0.603) and, during April (51.1% versus 49.3% for October—OR 1.142, 95%CI 1.041–1.253;p = 0.005). Conversely, NCD was progressively more prevalent in older individuals, females and in the regional city of Beira, whilst injuries were more prevalent in males (particularly adolescent/young men) and the northern city of Nampula. On a 24-hour basis, presentation patterns were unique to each hospital. Interpretation Applying highly pragmatic surveillance methods suited to the low-resource setting of Mozambique, these unique data provide critical insights into the differential pattern of CD, NCD and injury. Consequently, they highlight specific health priorities across different regions and seasons in Southern 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/m 2) 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.
Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short‐term outcomes of patients referred to a first referral urban hospital in a low‐income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients’ risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6‐month follow‐up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high‐risk profile, low hypertension control, and high occurrence of complications during short‐term follow‐up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.
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