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Background: In 2020, the WHO-approved Molbio Truenat platform and MTB assays to detect Mycobacterium tuberculosis complex (MTB) and resistance to rifampicin directly on sputum specimens. This primary health care center-based trial in Mozambique and Tanzania investigates the effect of Truenat platform/MTB assays (intervention arm) combined with rapid communication of results compared to standard of care on TB diagnosis and treatment initiation for microbiologically confirmed TB at 7 days from enrolment. Methods: The Tuberculosis Close the Gap, Increase Access, and Provide Adequate Therapy (TB-CAPT) CORE trial employs a pragmatic cluster randomized controlled design to evaluate the impact of a streamlined strategy for delivery of Truenat platform/MTB assays testing at primary health centers. Twenty-nine centers equipped with TB microscopy units were selected to participate in the trial. Among them, fifteen health centers were randomized to the intervention arm (which involves onsite molecular testing using Truenat platform/MTB assays, process process optimization to enable same-day TB diagnosis and treatment initiation, and feedback on Molbio platform performance) or the control arm (which follows routine care, including on-site sputum smear microscopy and the referral of sputum samples to off-site Xpert testing sites). The primary outcome of the study is the absolute number and proportion of participants with TB microbiological confirmation starting TB treatment within 7 days of their first visit. Secondary outcomes include time to bacteriological confirmation, health outcomes up to 60 days from first visit, as well as user preferences, direct cost, and productivity analyses. Ethics and dissemination: TB-CAPT CORE trial has been approved by regulatory and ethical committees in Mozambique and Tanzania, as well as by each partner organization. Consent is informed and voluntary, and confidentiality of participants is maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals. Trial Registration: US National Institutes of Health's ClinicalTrials.gov, NCT04568954. Registered 23 September 2020. [ABSTRACT FROM AUTHOR]

This article seeks to use logistic regression and GIS techniques as a way to understand the influence of forest policy on the dynamics of forest cover in the study area. For this, we chose the following variables: Dynamics of forest cover as the dependent variable; precipitation, temperature, simple license, forest concession, volume of charcoal exploited, agricultural areas, villages, and population dynamics as independent variables. From the correlation, the variables that showed significance in the model are simple license, temperature, and volume of charcoal exploited. But the logistic regression model showed that the simple license and temperature variants are significantly important for the model. This does not rule out the existence of other variables that may explain the phenomenon. Thus, the constructed logistic regression model points out that the simple license predictor is statistically more significant in explaining the variation in forest cover compared with temperature. Simple licensing is one of the modalities that forestry policy in Mozambique has adopted for forest licensing. And many of the operators prefer this type of license. Temperature inversely influences the dynamics of forest cover, causing water stress in plants. While the variable volume of coal explored, its influence is significantly smaller. [ABSTRACT FROM AUTHOR]

Background: Mozambique is among the highest tuberculosis, tuberculosis–HIV and multidrug-resistant-tuberculosis burden countries. Although molecular technologies are available in-country, mycobacterial isolation through culture remains an important tool for tuberculosis diagnostics and drug susceptibility testing. Objective: We evaluated the use of the Ogawa-Kudoh (OK) mycobacterial culture, a simple technique, to isolate Mycobacterium tuberculosis in two health units, in Maputo City, Mozambique. Methods: From May to December 2014, 122 patient samples were collected in Chamanculo General Hospital and Polana Caniço General Hospital. The specimens were first tested in the health units using the OK method and afterwards shipped to the National Tuberculosis Reference Laboratory for mycobacterial culture using the NALC-NaOH-Citrate (NALC) decontamination method followed by inoculation in Lowenstein Jensen (LJ) solid media as the reference standard. Results: Among 107 samples with valid results, 98 (91.6%) had concordant results in both methods; 9 (8.4%) had discordant results. The contamination rate was 4.1% (5/122) for the OK and 9.0% (11/122) for the NALC/LJ methods. The sensitivity of OK was 80% (95% confident interval [CI]: 51.4–94.7) and the specificity was 94% (95% CI: 85.8–97.3). The degree of agreement between both methods was moderate (Kappa: 0.68; 95% CI: 0.48–0.89). Conclusion: The OK method showed satisfactory sensitivity and specificity. The method also had a lower contamination rate when compared to the NALC/LJ. Similar to other studies in resource-limited settings, our findings showed that the OK method can effectively be implemented in settings with limited laboratory capacity to isolate tuberculosis bacteria by culture for further testing. [ABSTRACT FROM AUTHOR]

Background: Internationally-accredited laboratories are recognised for their superior test reliability, operational performance, quality management and competence. In a bid to meet international quality standards, the Mozambique National Institute of Health enrolled the National Tuberculosis Reference Laboratory (NTRL) in a continuous quality improvement process towards ISO 15189 accreditation. Here, we describe the road map taken by the NTRL to achieve international accreditation. Methods: The NTRL adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a strategy to implement a quality management system. After SLMTA, the Mozambique National Institute of Health committed to accelerate the NTRL's process toward accreditation. An action plan was designed to streamline the process. Quality indicators were defined to benchmark progress. Staff were trained to improve performance. Mentorship from an experienced assessor was provided. Fulfilment of accreditation standards was assessed by the Portuguese Accreditation Board. Results: Of the eight laboratories participating in SLMTA, the NTRL was the best-performing laboratory, achieving a 53.6% improvement over the SLMTA baseline conducted in February 2011 to the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) assessment in June 2013. During the accreditation assessment in September 2014, 25 minor nonconformities were identified and addressed. In March 2015, the NTRL received Portuguese Accreditation Board recognition of technical competency for fluorescence smear microscopy, and solid and liquid culture. The NTRL is the first laboratory in Mozambique to achieve ISO 15189 accreditation. Conclusions: From our experience, accreditation was made possible by institutional commitment, strong laboratory leadership, staff motivation, adequate infrastructure and a comprehensive action plan. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study are to examine differences in cardiometabolic risk indicators, as well as their prevalences, in Portuguese and Mozambican youth, and to investigate the associations between weight status and cardiorespiratory fitness levels with cardiometabolic risk.Methods: The sample comprises 721 adolescents (323 Mozambican and 398 Portuguese), aged 10-15 years. Anthropometry (height, sitting height, weight and waist circumference), blood pressure, serum-fasting triglycerides, high-density lipoprotein cholesterol and glucose, and cardiorespiratory fitness were measured. Maturity offset was estimated and a cardiometabolic risk score adjusted for sex, age and biological maturity was computed. Adolescents were classified as normal weight and overweight/obese as well as fit or unfit (cardiorespiratory fitness).Results: Portuguese youth have better cardiometabolic and cardiorespiratory fitness profiles. About 32% and 30% of Portuguese boys and girls, respectively, are overweight/obese; in Mozambicans, these prevalences are 7.5% for boys and 21% for girls; in addition, 81.6% of Portuguese boys and 77.7% of Portuguese girls were classified as cardiorespiratory fit, against 54% and 44.4% of Mozambican boys and girls, respectively. No statistically significant differences (P>0.05) were found between Mozambicans and Portuguese for the cluster of three or more cardiometabolic risk indicators. A positive relationship (P<0.001) was found between weight status and cardiometabolic risk in adolescents from both countries; however, a negative association (P<0.001) between cardiorespiratory fitness and cardiometabolic risk was only found among Portuguese youth.Conclusions: Portuguese and Mozambican youth differ in their cardiometabolic risk profiles, body weight and cardiorespiratory fitness, favoring Portuguese. Overweight/obesity and low cardiorespiratory fitness levels are related to a worse cardiometabolic risk profile, being relevant to design public health intervention strategies to reduce excess weight and increase cardiorespiratory fitness. [ABSTRACT FROM AUTHOR]

Background Streptococcus 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. Findings In 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. Conclusions The 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. [ABSTRACT FROM AUTHOR]

In 2021, an estimated 4800 people developed rifampicin-resistant tuberculosis in Mozambique, 75% of which went undiagnosed. Detailed molecular data on rifampicin-resistant and multidrug-resistant (MDR) tuberculosis are not available. Here, we aimed at gaining precise data on the determinants of rifampicin-resistant and MDR tuberculosis in Mozambique. In this retrospective observational study, we performed whole-genome sequencing of 704 rifampicin-resistant Mycobacterium tuberculosis complex (Mtbc) strains submitted to the National Tuberculosis Reference Laboratory (NTRL) in Maputo, Mozambique, between 2015 and 2021. Phylogenetic strain classification, genomic resistance prediction, and cluster analysis were performed. Between Jan 1, 2015, and July 31, 2021, 2606 Mtbc isolates with an isoniazid or rifampicin resistance were identified in the NTRL biobank, of which, 1483 (56·9%) were from men, 1114 (42·7%) from women, and nine (0·4%) were unknown. Genome-based drug-resistant prediction classified 704 Mtbc strains as rifampicin resistant. 628 (89%) of the 704 Mtbc strains were classified MDR; of those, 146 (23%) were pre-extensively drug resistant (pre-XDR; additional fluoroquinolone resistance), and 24 (4%) extensively drug resistant (XDR; combined fluoroquinolone and bedaquiline resistance). Overall, 61 (9%) of 704 strains revealed resistance to bedaquiline: five (7%) of 76 rifampicin resistant plus bedaquiline resistant, 32 (7%) of 458 MDR plus bedaquiline resistant, and 24 (100%) of 24 XDR. Prevalence of bedaquiline resistance increased from 3% in 2016 to 14% in 2021. The cluster rate (12 single-nucleotide polymorphism threshold) was 42% for rifampicin-resistant strains, 78% for MDR strains, 94% for pre-XDR strains, and 96% for XDR Mtbc strains. 31 (4%) of 704 Mtbc strains, belonging to a diagnostic escape outbreak strain previously described in Eswatini (group_56), had an rpoB Ile491Phe mutation which is not detected by Xpert MTB/RIF (no other rpoB mutation). Of these, 23 (74%) showed additional resistance to bedaquiline, 13 (42%) had bedaquiline and fluoroquinolone resistance, and two (6%) were bedaquiline, fluoroquinolone, and delamanid resistant. Pre-XDR resistance is highly prevalent among MDR Mtbc strains in Mozambique and so is bedaquiline resistance; and the frequency of bedaquiline resistance quadrupled over time and was found even in Mtbc strains without fluoroquinolone resistance. Importantly, strains with Ile491Phe mutation were frequent, accounting for 31% (n=10) of MDR plus bedaquiline-resistant strains and 54% (n=13) of XDR Mtbc strains. Given the current diagnostic algorithms and treatment regimens, both the emergence of rifampicin resistance due to Ile491Phe and bedaquiline resistance might jeopardise MDR tuberculosis prevention and care unless sequencing-based technology is rolled out. The potential cross border spread of diagnostic escape strains needs further investigation. The German Ministry of Health through the Seq_MDRTB-Net project, the Deutsche Forschungsgemeinschaft under Germany's Excellence Strategy Precision Medicine in Inflammation and the Research Training Group 2501 TransEvo, the Leibniz Science Campus Evolutionary Medicine of the Lung, and the German Ministry of Education and Research via the German Center for Infection Research. [ABSTRACT FROM AUTHOR]

Objective: This study presents information about secular trends in physical fitness (PF) levels among Mozambican youth., Methods: The sample comprises 3,851 subjects (1,791 boys; 2,060 girls) aged 8-15 years who were evaluated at three time points (1992, 1999, 2012). PF tests included handgrip strength, 10 m × 5 m shuttle-run, sit-and-reach, and 1-mile run/walk. Biological maturity was assessed by sexual characteristics, and percentage body fat was predicted using triceps and subscapular skinfolds. ANCOVA (controlling for age, maturity status, and percentage body fat) was used to compare mean differences in PF tests among the three time points, by sex., Results: Children in 1992 were more flexible than those from 2012; boys handgrip strength increased from 1992 to 2012, while girls decreased their handgrip strength; youth in 1992 were faster and more agile than their 2012 peers; and a decrease was observed in cardiorespiratory fitness between 1992 and 1999 and between 1992 and 2012 for both sexes., Conclusions: A negative secular trend among Mozambican children's PF was observed over the last two decades, suggesting that socio-political, educational, and economical changes occurring during this period had a relevant effect on their PF. This negative trend suggests that development of intervention programs/strategies to improve PF among youth is warranted., (© 2014 Wiley Periodicals, Inc.)

Objectives: The purpose of this study was to examine secular changes in growth and nutritional status of Mozambican children and adolescents between 1992, 1999 and 2012., Methods: 3374 subjects (1600 boys, 1774 girls), distributed across the three time points (523 subjects in 1992; 1565 in 1999; and 1286 in 2012), were studied. Height and weight were measured, BMI was computed, and WHO cut-points were used to define nutritional status. ANCOVA models were used to compare height, weight and BMI across study years; chi-square was used to determine differences in the nutritional status prevalence across the years., Results: Significant differences for boys were found for height and weight (p<0.05) across the three time points, where those from 2012 were the heaviest, but those in 1999 were the tallest, and for BMI the highest value was observed in 2012 (1992<2012, 1999<2012). Among girls, those from 1999 were the tallest (1992<1999, 1999>2012), and those from 2012 had the highest BMI (1999<2012). In general, similar patterns were observed when mean values were analyzed by age. A positive trend was observed for overweight and obesity prevalences, whereas a negative trend emerged for wasting, stunting-wasting (in boys), and normal-weight (in girls); no clear trend was evident for stunting., Conclusion: Significant positive changes in growth and nutritional status were observed among Mozambican youth from 1992 to 2012, which are associated with economic, social and cultural transitional processes, expressing a dual burden in this population, with reduction in malnourished youth in association with an increase in the prevalence of overweight and obesity.

Social and economic changes occurring in the last two decades in Mozambique may have induced lifestyle changes among youth. This study aimed to document secular changes in habitual physical activities of Mozambican youth between 1992, 1999 and 2012. A total of 3393 youth (eight-15 years), were measured in three different time periods (1992, 1999, 2012). Habitual physical activity (PA) was estimated with a questionnaire, including items related to household chores, sport participation, traditional games and walking activities. Biological maturation was assessed. Analysis of Covariance (ANCOVA) was used to compare mean differences in PA across the years. Significant decreases between 1992-1999 and 1992-2012 were observed for boys in household chores, games and walking, and a significant decline between 1999 and 2012 was found in sport participation. Among girls, a significant and consistent decline (1992 > 1999 > 2012) was observed for household chores, a decline between 1992-1999 and 1992-2012 for games and walking, and a significant increase between 1992 and 1999 in sport participation. In general, a negative secular trend was found in habitual PA among Mozambican youth. Interventions aimed at increasing PA represent important educational and public health opportunities.