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Background Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. Methods In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. Result Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. Conclusions PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

Background Burn injuries are common in low- and middle-income countries (LMICs) and their associated disability is tragic. This study is the first to explore burn scars in rural communities in Mozambique. This work also validated an innovate burn assessment tool, the Morphological African Scar Contractures Classification (MASCC), used to determine surgical need. Methods Using a stratified, population-weighted survey, the team interviewed randomly selected households from September 2012 to June 2013. Three rural districts (Chókwè, Nhamatanda, and Ribáuè) were selected to represent the southern, central and northern regions of the country. Injuries were recorded, documented with photographs, and approach to care was gathered. A panel of residents and surgeons reviewed the burn scar images using both the Vancouver Scar Scale and the MASCC, a validated visual scale that categorizes patients into four categories corresponding to levels of surgical intervention. Results Of the 6104 survey participants, 6% (n = 370) reported one or more burn injuries. Burn injuries were more common in females (57%) and most often occurred on the extremities. Individuals less than 25 years old had a significantly higher odds of reporting a burn scar compared to people older than 45 years. Based on the MASCC, 12% (n = 42) would benefit from surgery to treat contractures. Conclusion Untreated burn injuries are prevalent in rural Mozambique. Our study reveals a lack of access to surgical care in rural communities and demonstrates how the MASCC scale can be used to extend the reach of surgical assessment beyond the hospital through community health workers.

Background Fine needle aspiration cytology (FNAC) is an important diagnostic tool in a range of medical settings. It is fast, quick and a highly accurate diagnostic method and can be used, in settings with minimal laboratory infrastructures. Methods In this report, we describe the experience in the use of FNAC since it is introduction in 1996 in the Anatomical Pathology Service of the Maputo Central Hospital (MCH), along with more detailed data referring to 2009-2010. Results The number of FNAC analyses increased gradually from 269 (4.1% of all pathologic tests of the Service) in 1996, when it was introduced in Mozambique, to 3234 (17% of all tests) in 2010. Lymph nodes were the organs most frequently biopsied, followed by breast and soft tissues. Inflammatory conditions, especially tuberculosis, were the most frequent diagnoses (22.2% of the cases), followed by hyperplastic conditions (20.6%), benign tumors (13.4%) and malignant tumors (12.3%). Conclusion Our results clearly demonstrate that even in an environment with poor laboratory resources, it is possible to establish a FNAC clinic that can provide a quick and precise diagnosis for clinicians to aid in early treatment interventions, especially in inflammatory diseases which were the majority of our cases.

Mozambique, a country in sub-Saharan Africa, has experienced a severe physician shortage for many years, with patients having particularly limited access to surgical care. Medical education and surgical research partnerships formed in 2010 between Universidade Eduardo Mondlane (UEM) in Mozambique and the University of California, San Diego (UCSD), is developing potential solutions to the nation’s surgical care crisis. The findings that have emerged from this initiative, which are aimed at scaling up surgical services, will likely have important implications for improving surgical care in Mozambique and other underserved nations.

BACKGROUND Surgical care is increasingly recognised as an important component of global health delivery. However, there are still major gaps in knowledge related to access to surgical care in low-income countries. In this study, we compare distances travelled by surgical patients with patients seeking other medical services at a first-level hospital in rural Mozambique. METHODS Data were collected on all inpatients at Hospital Rural de Chokwe in rural Mozambique between 20 June 2012 and 3 August 2012. Euclidean distances travelled by surgical versus non-surgical patients using coordinates of each patient's city of residence were compared. Data were analysed using ArcGIS 10 and STATA. RESULTS In total, 500 patients were included. Almost one-half (47.6%) lived in the city where the hospital is based. By hospital ward, the majority (62.0%) of maternity patients came from within the hospital's city compared with only 35.2% of surgical patients. The average distance travelled was longest for surgical patients (42 km) compared with an average of 17 km for patients on all other wards. CONCLUSIONS Patients seeking surgical care at this first-level hospital travel farther than patients seeking other services. While other patients may have access to at community clinics, surgical patients depend more heavily on the services available at first-level hospitals.

With approximately four physicians per 100,000 inhabitants, Mozambique has a critical shortage of medical doctors.1 As in other African countries, only a small proportion of the medical doctors are trained as specialists.2,3,4 This physician shortage goes back at least four decades, when most doctors left Mozambique shortly after the country’s independence (in 1975) and the Ministry of Health (MOH) hired physicians from other countries to work in public hospitals. At the time, the government merged the University of Lourenco Marques—now Eduardo Mondlane University (UEM) teaching hospital—with the Hospital Miguel Bombarda to form the Maputo Central Hospital (MCH).5 Since then, doctors at MCH have been required to provide pre-clinical and clinical instruction to medical students at UEM Faculty of Medicine (UEM-FoM). A major contributor to the shortage of physician specialists is the universal requirement for two or more years of primary care service following medical school graduation, which delays entry into postgraduate specialty training. Although this requirement has increased the availability of health care outside larger cities, it also has contributed to the lack of investment in postgraduate training, which has severely limited UEM-FoM’s faculty development and hindered its enrollment expansion. Simultaneously, the expansion of Mozambique’s health care workforce has been challenged by an internal and external “brain drain”—25% of Mozambique’s medical school graduates between 1980 and 2006 had left the country by 2010, and 62% of the remainder had moved into private practice within Mozambique.6 The MOH initiated in-country specialist training in 1984 without having a cadre of trained specialists. Therefore, UEM-FoM specialists hired for undergraduate medical education were also required to conduct postgraduate training. With the creation of the Mozambican Medical Council (MMC) in 2008, the responsibility for training specialists was transferred to the National Committee for Postgraduate Studies (NCPS).7 This body included specialists who were members of the MMC, the MOH, and the UEM-FoM faculty, and they supervised training programs in their areas of expertise. In 2010, the U.S. government launched the Medical Education Partnership Initiative (MEPI) to develop transformative models in medical education in 12 Sub-Saharan African countries, including Mozambique. The MEPI program for Mozambique is a partnership between UEM and the University of California, San Diego (UCSD), and is aimed at increasing the number and quality of postgraduate medical specialists in Mozambique, with the longer-term goal of expanding undergraduate and postgraduate medical training for the three major public universities—UEM, Universidade Lurio (Unilurio), and Universidade Zambeze (Unizambeze).

Background: Helminthic infections are highly endemic in Mozambique, due to limited access to healthcare and resources for disease prevention. Data on the subclinical prevalence of these diseases are scarce due to the fact that an immunological and imaging diagnosis is not often available in endemic areas. We conducted a cross-sectional study on HIV1+ patients from Beira city in order to determine the seroprevalence of cysticercosis, schistosomiasis, toxocariasis and echinoccocosis and its possible interaction with HIV infection. Methodology/Principal Findings: Patients (601) were voluntarily recruited at the Ponta Gea Health Center and their demographic and clinical data were recorded (including CD4+ cell count and antiretroviral regimen). Mean age was 39.7 years, 378 (62.9%) were women and 223 (37.1%) were men. Four hundred seventy-five (475) patients (79%) were already on highly active antiretroviral therapy (HAART), and 90 started therapy after being enrolled in the study. For serological testing we used a Multiplex Western Blot IgG from LDBIO Diagnostics. The overall seroprevalence was 10.2% for cysticercosis, 23% for schistosomiasis, 7.3% for toxocariasis and 17.3% for echinococcosis. Conclusions/Significance: Neither age nor the CD4+ count were significantly associated with the seroprevalence of the helminths studied. However, patients with CD4+ between 200–500/µl had a higher seroprevalence to all helminths than those with less than 200/µl cells/and those with more than 500 cells/µl. Female gender was significantly associated with cysticercosis and schistosomiasis, and being in HAART with toxocariasis. Headache was significantly associated with cysticercosis and toxocariasis. There was no association between epilepsy and seropositivity to any of the parasites. The study concluded that a clear understanding of the prevalence and manifestations of these coinfections, how best to diagnose subclinical cases, and how to manage diseases with concomitant antiretroviral therapy is needed., The study was funded by the US National Institutes of Health through an International Pilot Grant from the UCSD Center for AIDS Research ((http://cfar.ucsd.edu/), grant number NIAID 5 P30 AI 036214. The Parasitology laboratory was renovated and equipped with support from the Gilead Foundation (Foster City, CA, USA (http://www.gilead.com/)). The manuscript writting was sponsored by Grant Number R24TW008908 from the Fogarty International Center (http://www.nih.gov/), to whom we express our gratitude. The content is solely the responsibility of the authors and does not necessarily represent the official views of the “Fogarty International Center or the National Institutes of Health.” This award is supported by funds provided to the NIH and HRSA under the “Tom Lantos and Henry Hyde United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008,” Public Law 110–293, which is more commonly known as the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR). Co-funding is also provided by the NIH Office of Research on Women's Health and the Office of AIDS Research.

The World Health Organization has identified the primary referral hospital as its priority site for improving surgical care in low- and middle-income countries. Little is known about the relative burden surgical patients place on health care facilities at this level. This research estimates the fraction of admissions due to surgical conditions at three hospitals in rural Mozambique.Prospective data were collected on all inpatients at three primary referral hospitals in Mozambique during a 12-day period. We compared the number of surgical patients and their length of stay (LOS) to the patients admitted to the medicine, pediatric, and maternity wards. These findings were validated using retrospective data collected from one hospital from January to May 2012.Patients with surgical conditions (i.e., patients admitted to the surgical or maternity ward) accounted for 57.5 % of admissions and 48.0 % of patient-days. The majority of patients were admitted to the maternity ward (32.3 %). The other admissions were evenly distributed to the pediatric (22.5 %), medical (20.0 %), and surgical (25.2 %) wards. Compared to patients from the three other wards, surgical patients had longer average LOS (8.7 vs. 1.9-7.7 days) and a higher number of total patient-days (891 vs. 252-703 days). The most prevalent procedures were cesarean section (33.3 %) and laceration repair/wound care (11.8 %).Surgical conditions are the most common reason for admissions at three primary referral hospitals in rural Mozambique. These data suggest that surgical care is a major component of health care delivered at primary referral hospitals in Mozambique and likely other sub-Saharan African countries.

p. 1-10 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-03-20T13:50:24Z No. of bitstreams: 1 1478-4491-11-62.pdf: 821183 bytes, checksum: 1157045d2f4d32225041499f9126c728 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2014-09-09T14:51:25Z (GMT) No. of bitstreams: 1 1478-4491-11-62.pdf: 821183 bytes, checksum: 1157045d2f4d32225041499f9126c728 (MD5) Made available in DSpace on 2014-09-09T14:51:25Z (GMT). No. of bitstreams: 1 1478-4491-11-62.pdf: 821183 bytes, checksum: 1157045d2f4d32225041499f9126c728 (MD5) Previous issue date: 2013 Background: Since Mozambique's independence, the major emphasis of its higher educational institutions has been on didactic education. Because of fiscal and human resource constraints, basic and applied research activities have been relatively modest in scope, and priorities have often been set primarily by external collaborators. These factors have compromised the scope and the relevance of locally conducted research and have limited the impact of Mozambique's universities as major catalysts for national development. Case description: We developed a multi-institutional partnership to undertake a comprehensive analysis of the research environment at Mozambique's major public universities to identify factors that have served as barriers to the development of a robust research enterprise. Based on this analysis, we developed a multifaceted plan to reduce the impact of these barriers and to enhance research capacity within Mozambique. Interventions: On the basis of our needs assessment, we have implemented a number of major initiatives within participating institutions to facilitate basic and applied research activities. These have included specialized training programmes, a reorganization of the research administration infrastructure, the development of multiple collaborative research projects that have emphasized local research priorities and a substantial investment in bioinformatics. We have established a research support centre that provides grant development and management services to Mozambique's public universities and have developed an independent Institutional Review Board for the review of research involving human research subjects. Multiple research projects involving both communicable and non-communicable diseases have been developed and substantial external research support has been obtained to undertake these projects. A sizable investment in biomedical informatics has enhanced both connectivity and access to digital reference material. Active engagement with relevant entities within the Government of Mozambique has aligned institutional development with national priorities. Conclusions: Although multiple challenges remain, over the past 3 years significant progress has been made towards establishing conditions within which a broad range of basic, translational and clinical and public health research can be undertaken. Ongoing development of this research enterprise will enhance capacity to address critical locally relevant research questions and will leverage resources to accelerate the development of Mozambique's national universities. © 2013 Noormahomed et al.; licensee BioMed Central Ltd.