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Harding-Esch EM, Burgert-Brucker CR, Jimenez C, Bakhtiari A, Willis R, Dejene Bejiga M, Mpyet C, Ngondi J, Boyd S, Abdala M, Abdou A, Adamu Y, Alemayehu A, Alemayehu W, Al-Khatib T, Apadinuwe SC, Awaca N, Awoussi MS, Baayendag G, Badiane Mouctar D, Bailey RL, Batcho W, Bay Z, Bella A, Beido N, Bol YY, Bougouma C, Brady CJ, Bucumi V, Butcher R, Cakacaka R, Cama A, Camara M, Cassama E, Chaora SG, Chebbi AC, Chisambi AB, Chu B, Conteh A, Coulibaly SM, Courtright P, Dalmar A, Dat TM, Davids T, DJAKER MEA, de Fátima Costa Lopes M, Dézoumbé D, Dodson S, Downs P, Eckman S, Elshafie BE, Elmezoghi M, Elvis AA, Emerson P, Epée EEE, Faktaufon D, Fall M, Fassinou A, Fleming F, Flueckiger R, Gamael KK, Garae M, Garap J, Gass K, Gebru G, Gichangi MM, Giorgi E, Goépogui A, Gómez DVF, Gómez Forero DP, Gower EW, Harte A, Henry R, Honorio-Morales HA, Ilako DR, Issifou AAB, Jones E, Kabona G, Kabore M, Kadri B, Kalua K, Kanyi SK, Kebede S, Kebede F, Keenan JD, Kello AB, Khan AA, KHELIFI H, Kilangalanga J, KIM SH, Ko R, Lewallen S, Lietman T, Logora MSY, Lopez YA, MacArthur C, Macleod C, Makangila F, Mariko B, Martin DL, Masika M, Massae P, Massangaie M, Matendechero HS, Mathewos T, McCullagh S, Meite A, Mendes EP, Abdi HM, Miller H, Minnih A, Mishra SK, Molefi T, Mosher A, M’Po N, Mugume F, Mukwiza R, Mwale C, Mwatha S, Mwingira U, Nash SD, NASSA C, Negussu N, Nieba C, Noah Noah JC, Nwosu CO, Olobio N, Opon R, Pavluck A, Phiri I, Rainima-Qaniuci M, Renneker KK, Saboyá-Díaz MI, Sakho F, Sanha S, Sarah V, Sarr B, Szwarcwald CL, Shah Salam A, Sharma S, Seife F, Serrano Chavez GM, Sissoko M, Sitoe HM, Sokana O, Tadesse F, Taleo F, Talero SL, Tarfani Y, Tefera A, Tekeraoi R, Tesfazion A, Traina A, Traoré L, Trujillo-Trujillo J, Tukahebwa EM, Vashist P, Wanyama EB, WARUSAVITHANA SD, Watitu TK, West S, Win Y, Woods G, YAJIMA A, Yaya G, Zecarias A, Zewengiel S, Zoumanigui A, Hooper PJ, Millar T, Rotondo L, Solomon AW. Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys. Ophthalmic Epidemiol 2023; 30:544-560. [PMID: 38085791 PMCID: PMC10751062 DOI: 10.1080/09286586.2023.2249546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amza Abdou
- Programme National de Santé Oculaire, Niger
| | | | | | | | | | | | - Naomie Awaca
- Ministère de la Santé Publique, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | - Clarisse Bougouma
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Victor Bucumi
- National Integrated Programme for the Control of Neglected Tropical Diseases and Blindness (PNIMTNC), Burundi
| | | | | | | | | | | | | | | | | | - Brian Chu
- International Trachoma Initiative, USA
| | | | | | - Paul Courtright
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | - Abdi Dalmar
- Ministry of Human Development and Public Services, Somalia
| | | | | | | | | | | | | | | | | | | | | | - Ange Aba Elvis
- Programme National de la Santé Oculaire et de la lutte contre l’Onchocercose, Côte d’Ivoire
| | | | | | | | | | | | | | | | | | | | - Jambi Garap
- Port Moresby General Hospital, Papua New Guinea
| | | | | | | | | | | | | | | | | | - Anna Harte
- London School of Hygiene & Tropical Medicine, UK
| | - Rob Henry
- U.S. Agency for International Development, USA
| | | | | | | | | | | | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | | | | | | | | | | | | | | | | | - Robert Ko
- Port Moresby General Hospital, Papua New Guinea
| | - Susan Lewallen
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa, South Africa
| | | | | | - Yuri A Lopez
- SACAICET / MINISTERIO DEL PODER POPULAR PARA LA SALUD, Venezuela
| | | | | | | | | | | | | | | | | | | | | | | | - Aboulaye Meite
- Ministère de la Santé et de l’Hygiène Publique, Cote d’Ivoire
| | | | | | | | | | | | | | - Aryc Mosher
- U.S. Agency for International Development, USA
| | | | | | | | | | | | | | | | | | | | - Cece Nieba
- Ministère de la Santé et de l’Hygiene Publique, Guinea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Solomon Islands
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ul Hassan E, Kelly M, Waititu T, Olobio N, Kabona G, Mkocha H, Kivumbi P, Mwale C, Mubangizi A, Mugume F, Baayenda G, Mayeku R, Massangaie M, Mbofana MA, Cumaio M, Sisay A, Mersha T, Courtright P. OUP accepted manuscript. Int Health 2022; 14:i24-i28. [PMID: 35385863 PMCID: PMC8986360 DOI: 10.1093/inthealth/ihab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Michaela Kelly
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
| | | | - Nicholas Olobio
- National Trachoma Project Manager, Federal Ministry of Health, Nigeria
| | - George Kabona
- Ministry of Health and Social Welfare, Dar es salaam, Tanzania
| | | | - Peter Kivumbi
- Sightsavers, Tanzania Office, Kinondoni District, Dar es Salaam
| | | | | | | | | | | | - Marilia Massangaie
- Department for Diseases Control and Prevention, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Tolossa Mersha
- Neglected Tropical Disease Specialist, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Paul Courtright
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BZ, UK
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
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Grau-Pujol B, Massangaie M, Cano J, Maroto C, Ndeve A, Saute F, Muñoz J. Frequency and distribution of neglected tropical diseases in Mozambique: a systematic review. Infect Dis Poverty 2019; 8:103. [PMID: 31836025 PMCID: PMC6909500 DOI: 10.1186/s40249-019-0613-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/20/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) affect more than one billion people living in vulnerable conditions. In spite of initiatives recently contributing to fill NTDs gaps on national and local prevalence and distribution, more epidemiological data are still needed for effective control and elimination interventions. MAIN TEXT Mozambique is considered one of the countries with highest NTDs burden although available data is scarce. This study aims to conduct a systematic review on published available data about the burden and distribution of the different NTDs across Mozambique since January 1950 until December 2018. We identified manuscripts from electronic databases (Pubmed, EmBase and Global Health) and paper publications and grey literature from Mozambique Ministry of Health. Manuscripts fulfilling inclusion criteria were: cross-sectional studies, ecological studies, cohorts, reports, systematic reviews, and narrative reviews capturing epidemiological information of endemic NTDs in Mozambique. Case-control studies, letters to editor, case reports and case series of imported cases were excluded. A total of 466 manuscripts were initially identified and 98 were finally included after the revision following PRISMA guidelines. Eleven NTDs were reported in Mozambique during the study span. Northern provinces (Nampula, Cabo Delgado, Niassa, Tete and Zambezia) and Maputo province had the higher number of NTDs detected. Every disease had their own report profile: while schistosomiasis have been continuously reported since 1952 until nowadays, onchocerciasis and cysticercosis last available data is from 2007 and Echinococcosis have never been evaluated in the country. Thus, both space and time gaps on NTDs epidemiology have been identified. CONCLUSIONS This review assembles NTDs burden and distribution in Mozambique. Thus, contributes to the understanding of NTDs epidemiology in Mozambique and highlights knowledge gaps. Hence, the study provides key elements to progress towards the control and interruption of transmission of these diseases in the country.
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Affiliation(s)
- Berta Grau-Pujol
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
- Mundo Sano Foundation, Buenos Aires, Argentina.
| | - Marilia Massangaie
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Maputo, Mozambique
| | - Jorge Cano
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen Maroto
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Francisco Saute
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Jose Muñoz
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Flueckiger RM, Courtright P, Abdala M, Abdou A, Abdulnafea Z, Al-Khatib TK, Amer K, Amiel ON, Awoussi S, Bakhtiari A, Batcho W, Bella AL, Bennawi KH, Brooker SJ, Chu BK, Dejene M, Dezoumbe D, Elshafie BE, Elvis AA, Fabrice DN, Omar FJ, François M, François D, Garap J, Gichangi M, Goepogui A, Hammou J, Kadri B, Kabona G, Kabore M, Kalua K, Kamugisha M, Kebede B, Keita K, Khan AA, Kiflu G, Yibi M, Mackline G, Macleod C, Manangazira P, Masika MP, Massangaie M, Mduluza T, Meno N, Midzi N, Minnih AO, Mishra S, Mpyet C, Muraguri N, Mwingira U, Nassirou B, Ndjemba J, Nieba C, Ngondi J, Olobio N, Pavluck A, Phiri I, Pullan R, Qureshi B, Sarr B, Seiha D, Chávez GMS, Sharma S, Sisaleumsak S, Southisombath K, Stevens G, Woldendrias AT, Traoré L, Turyaguma P, Willis R, Yaya G, Yeo S, Zambroni F, Zhao J, Solomon AW. The global burden of trichiasis in 2016. PLoS Negl Trop Dis 2019; 13:e0007835. [PMID: 31765415 PMCID: PMC6901231 DOI: 10.1371/journal.pntd.0007835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 12/09/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation. Methods We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available. Findings Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand–1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03–2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283–557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand–1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1–5.2 million). Interpretation The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence. As an individual with trichiasis blinks, the eyelashes abrade the cornea, which can lead to corneal opacity and blindness. Through high quality surgery, which involves altering the position of the eyelid margin, it is possible to reduce the number of people with trichiasis. Accurate estimates of the number of persons with trichiasis and their geographical distribution are needed in order to effectively align resources for surgery and other necessary services. We obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used the most recently available data and expert assessments to estimate the global burden of trichiasis. We estimated that in 2016 the global burden was 2.8 million cases (95% CI 1.1–5.2 million). The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.
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Affiliation(s)
- Rebecca M. Flueckiger
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Mariamo Abdala
- Ministerio da Saude, National Ophthalmology Program, Maputo, Mozambique
| | - Amza Abdou
- Ministère de la Santé et de la population, Niamey, Niger
| | | | - Tawfik K. Al-Khatib
- National Eye Health Programme, Ministry of Public Health and Population, Sana’a, Yemen
| | | | | | | | | | | | | | | | - Simon J. Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Global Health, Neglected Tropical Diseases, Bill & Melinda Gates Foundation, Seattle, USA
| | - Brian K. Chu
- The Task Force for Global Health, Atlanta, GA, USA
| | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | | | - Missamou François
- Bureau des Maladies Oculaires, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Drabo François
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Ouagadougou, Burkina Faso
| | - Jambi Garap
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - André Goepogui
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | | | - Boubacar Kadri
- Ministère de la Santé et de la population, Niamey, Niger
| | - George Kabona
- Ministry of Health, Dar es Salaam, United Republic of Tanzania
| | - Martin Kabore
- l'unité d'élimination du trachome, PNMTN, Ouagadougou, Burkina Faso
| | - Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Mathias Kamugisha
- National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
| | | | - Kaba Keita
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Colin Macleod
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Portia Manangazira
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | | | - Marilia Massangaie
- Ministerio da Saude, Department of Neglected Tropical Diseases, Maputo, Mozambique
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | | | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria & Department of Ophthalmology, Jos University, Jos, Nigeria
| | | | - Upendo Mwingira
- Ministry of Health, Dar es Salaam, United Republic of Tanzania
| | - Beido Nassirou
- Ministère de la Santé et de la population, Niamey, Niger
| | - Jean Ndjemba
- Bureau des Maladies Oculaires, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Cece Nieba
- Programme National de Lutte Contre l’Onchocercose et la Cécité et les Maladies Tropicales Négligées, Conakry, Guinea
| | - Jeremiah Ngondi
- RTI International, Dar es Salaam, United Republic of Tanzania
| | | | | | - Isaac Phiri
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Boubacar Sarr
- Ministère de la santé et de l’Action Sociale, Dakar, Senegal
| | - Do Seiha
- Prevention of Blindness Programme, Ministry of Health, Phnom Penh, Cambodia
| | | | | | | | - Khamphoua Southisombath
- National Program for the Prevention of Blindness, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Gretchen Stevens
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Georges Yaya
- Ministère de la Santé Publique, Bangui, Central African Republic
| | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical Colllege Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Cohn DA, Kelly MP, Bhandari K, Zoerhoff KL, Batcho WE, Drabo F, Negussu N, Marfo B, Goepogui A, Lemoine JF, Ganefa S, Massangaie M, Rimal P, Gnandou I, Anagbogu IN, Ndiaye M, Bah YM, Mwingira UJ, Awoussi MS, Tukahebwa EM, Stelmach RD, Mingkwan PC, Pou B, Koroma JB, Rotondo LA, Kraemer JD, Baker MC. Gender equity in mass drug administration for neglected tropical diseases: data from 16 countries. Int Health 2019; 11:370-378. [PMID: 30845318 PMCID: PMC6748770 DOI: 10.1093/inthealth/ihz012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/25/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gender equity in global health is a target of the Sustainable Development Goals and a requirement of just societies. Substantial progress has been made towards control and elimination of neglected tropical diseases (NTDs) via mass drug administration (MDA). However, little is known about whether MDA coverage is equitable. This study assesses the availability of gender-disaggregated data and whether systematic gender differences in MDA coverage exist. METHODS Coverage data were analyzed for 4784 district-years in 16 countries from 2012 through 2016. The percentage of districts reporting gender-disaggregated data was calculated and male-female coverage compared. RESULTS Reporting of gender-disaggregated coverage data improved from 32% of districts in 2012 to 90% in 2016. In 2016, median female coverage was 85.5% compared with 79.3% for males. Female coverage was higher than male coverage for all diseases. However, within-country differences exist, with 64 (3.3%) districts reporting male coverage >10 percentage points higher than female coverage. CONCLUSIONS Reporting of gender-disaggregated data is feasible. And NTD programs consistently achieve at least equal levels of coverage for women. Understanding gendered barriers to MDA for men and women remains a priority.
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Affiliation(s)
- Daniel A Cohn
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Maureen P Kelly
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Kalpana Bhandari
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | | | - Wilfrid E Batcho
- National Communicable Disease Control Program, Ministry of Health, 01 BP 882, Cotonou, Republic of Benin
| | - François Drabo
- National Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health, Ouagadougou, Burkina Faso
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Federal Democratic Republic of Ethiopia
| | - Benjamin Marfo
- National NTD Program, Ghana Health Service, Accra, Republic of Ghana
| | - André Goepogui
- National Onchocerciasis and Blindness and Neglected Tropical Disease Control Program, National Prevention and Community Health Directorate, Ministry of Health, BP 585, Conakry, Republic of Guinea
| | - Jean-Frantz Lemoine
- National Malaria Control Program, Ministry of Public Health and Population, 30 Rue Mercier Laham, Delmas 60, Republic of Haiti
| | - Sitti Ganefa
- Sub-Directorate of Filariasis & Helminthiasis Control, Directorate of Vector Borne Disease Control, Directorate General of Communicable Disease and Environmental Health, Ministry of Health, Jl. Percetakan Negara No. 29, Jakarta, Republic of Indonesia
| | - Marilia Massangaie
- Department of Other Infectious Diseases, Ministry of Health, AV. Eduardo Mondlane e Salvador Allende, Maputo, Republic of Mozambique
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health, Teku, Kathmandu, Federal Democratic Republic of Nepal
| | - Issa Gnandou
- National Bilharzia and Soil-Transmitted Helminths Control Program, Ministry of Public Health, Niamey, Republic of Niger
| | - Ifeoma N Anagbogu
- Department of Public Health, Neglected Tropical Diseases Division, Federal Ministry of Health, Federal Secretariat Complex Phase 3, Ahmadu Bello Way, CBD, Abuja, Federal Republic of Nigeria
| | - Mamadou Ndiaye
- Neglected Tropical Disease Control Program, Disease Control Directorate, Ministry of Health and Social Work, Dakar, Republic of Senegal
| | - Yakuba Madina Bah
- NTD Programme, Ministry of Health and Sanitation, Freetown, Republic of Sierra Leone
| | - Upendo J Mwingira
- Neglected Tropical Diseases Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, United Republic of Tanzania
- National Institute for Medical Research, 2448 Barack Obama Dr, Box 9653, Dar es Salaam, United Republic of Tanzania
| | - Marcel S Awoussi
- National Neglected Tropical Disease Control Program, General Directorate of Health, Ministry of Health and Social Welfare, Lomé, Republic of Togo
| | | | | | - Pia C Mingkwan
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - Bolivar Pou
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC, USA
| | - Joseph B Koroma
- FHI 360, 1st Floor, Marvel House, 148A Giffard Road, East Cantonments, Accra, Ghana
| | - Lisa A Rotondo
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
| | - John D Kraemer
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
- Department of Health Systems Administration, Georgetown University, 3700 Reservoir Road NW, Washington, DC, USA
| | - Margaret C Baker
- RTI International, 701 13th St NW, Suite 750, Washington, DC USA
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6
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Maroto-Camino C, Hernandez-Pastor P, Awaca N, Safari L, Hemingway J, Massangaie M, Whitson D, Jeffery C, Valadez JJ. Improved assessment of mass drug administration and health district management performance to eliminate lymphatic filariasis. PLoS Negl Trop Dis 2019; 13:e0007337. [PMID: 31276494 PMCID: PMC6636779 DOI: 10.1371/journal.pntd.0007337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 07/17/2019] [Accepted: 03/27/2019] [Indexed: 11/20/2022] Open
Abstract
Lymphatic filariasis (LF) elimination as a public health problem requires the interruption of transmission by administration of preventive mass drug administration (MDA) to the eligible population living in endemic districts. Suboptimal MDA coverage leads to persistent parasite transmission with consequential infection, disease and disability, and the need for continuing MDA rounds, requiring considerable investment. Routine coverage reports must be verified in each MDA implementation unit (IU) due to incorrect denominators and numerators used to calculate coverage estimates with administrative data. IU are usually the health districts. Coverage is verified so IU teams can evaluate their outreach and take appropriate action to improve performance. Mozambique and the Democratic Republic of Congo (DRC) have conducted MDA campaigns for LF since 2009 and 2014, respectively. To verify district reports and assess the declared achievement using administrative data of the minimum 80% coverage of eligible people (or 65% of the total population), both countries conducted rapid probability surveys using Lot Quality Assurance Sampling (LQAS)(n = 1102) in 2015 and 2016 in 58 IU in 49 districts. The surveys identified IU with suboptimal coverage, reasons residents did not take the medication, place where the medication was received, information sources, and knowledge about diseases prevented by the MDA. LQAS identified four inadequately covered IU triggering district team performance reviews with provincial and national teams and district retreatment. Provincial estimates using probability samples (weighted by populations sizes) were 10 and 17 percentage points lower than reported coverage in DRC and Mozambique. The surveys identified: absence from home during annual MDA rounds as the main reason for low performance and provided valuable information about pre-campaign and campaign activities resulting in improved strategies and continued progress towards elimination of LF and co-endemic Neglected Tropical Diseases. Global elimination of lymphatic filariasis (LF) is achieved through treatment of at-risk populations with annual or bi-annual mass drug administration campaigns. In Africa campaigns need to be completed in 32 countries with 343 million people at risk. The World Health Organisation recommends verification of the campaign’s administrative records using household cluster surveys at least once every 5-years. However, cluster surveys are expensive and usually completed in a few districts only or at sub-national levels. Together with National Programmes in Mozambique and the Democratic Republic of the Congo (DRC) we adapted Lot Quality Assurance Sampling (LQAS) methods to verify campaign coverage because it is relatively inexpensive in comparison to other survey approaches, provides information and facilitates actions at the Implementation Unit (IU) level, which is usually the district. LQAS signals IU whose performance is likely to need improvement because MDA coverage is below the coverage target. Our results show consistently that administrative records over-estimated campaign coverage and did not detect implementation and coverage problems due to errors in numerators and denominators, incorrect reporting, and/or incorrect aggregation of tally sheets. The LQAS verification approach prompted immediate action to remedy coverage shortfalls averting persistent LF transmission and disease, and the costs associated with failed campaigns. Our study demonstrates that a rapid probability sample to verify coverage provides district teams with information after each campaign which can be used for action, and that one coverage survey every 5-years is insufficient for infectious disease elimination in highly endemic settings where achievement of optimal coverage is essential. It also demonstrates that LQAS provides a decentralised assessment, sensitive for detecting and ameliorating programme bottlenecks and can be used to verify MDA in other countries.
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Affiliation(s)
- Carmen Maroto-Camino
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Pilar Hernandez-Pastor
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Naomi Awaca
- National NTD Programme, Democratic Republic of Congo, Ministère de la Sante Publique, Gombe, Kinshasa
| | - Lebon Safari
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Janet Hemingway
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marilia Massangaie
- National NTD Programme, Direção Nacional da Saúde Publica, Ministério da Saúde, Eduardo Modliane, Maputo, Mozambique
| | - Donald Whitson
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Caroline Jeffery
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joseph J. Valadez
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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7
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Flueckiger RM, Giorgi E, Cano J, Abdala M, Amiel ON, Baayenda G, Bakhtiari A, Batcho W, Bennawi KH, Dejene M, Elshafie BE, Elvis AA, François M, Goepogui A, Kalua K, Kebede B, Kiflu G, Masika MP, Massangaie M, Mpyet C, Ndjemba J, Ngondi JM, Olobio N, Turyaguma P, Willis R, Yeo S, Solomon AW, Pullan RL. Understanding the spatial distribution of trichiasis and its association with trachomatous inflammation-follicular. BMC Infect Dis 2019; 19:364. [PMID: 31039737 PMCID: PMC6492377 DOI: 10.1186/s12879-019-3935-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst previous work has identified clustering of the active trachoma sign "trachomatous inflammation-follicular" (TF), there is limited understanding of the spatial structure of trachomatous trichiasis (TT), the rarer, end-stage, blinding form of disease. Here we use community-level TF prevalence, information on access to water and sanitation, and large-scale environmental and socio-economic indicators to model the spatial variation in community-level TT prevalence in Benin, Cote d'Ivoire, DRC, Guinea, Ethiopia, Malawi, Mozambique, Nigeria, Sudan and Uganda. METHODS We fit binomial mixed models, with community-level random effects, separately for each country. In countries where spatial correlation was detected through a semi-variogram diagnostic check we then fitted a geostatistical model to the TT prevalence data including TF prevalence as an explanatory variable. RESULTS The estimated regression relationship between community-level TF and TT was significant in eight countries. We estimate that a 10% increase in community-level TF prevalence leads to an increase in the odds for TT ranging from 20 to 86% when accounting for additional covariates. CONCLUSION We find evidence of an association between TF and TT in some parts of Africa. However, our results also suggest the presence of additional, country-specific, spatial risk factors which modulate the variation in TT risk.
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Affiliation(s)
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Jorge Cano
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mariamo Abdala
- Ophthalmology Department, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | | | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | - Missamou François
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | - André Goepogui
- Programmes National de Lutte contre l'Onchocercoses et les autres Maladies Tropicales Négligées, Ministère de la Sante, Conakry, Guinea
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria.,Department of Ophthalmology, Jos University, Jos, Nigeria
| | - Jean Ndjemba
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | | | - Nicholas Olobio
- Nigeria Trachoma Elimination Program, Federal Ministry of Health, Abuja, Nigeria
| | | | | | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
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8
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Rassi C, Martin S, Graham K, de Cola MA, Christiansen-Jucht C, Smith LE, Jive E, Phillips AE, Newell JN, Massangaie M. Knowledge, attitudes and practices with regard to schistosomiasis prevention and control: Two cross-sectional household surveys before and after a Community Dialogue intervention in Nampula province, Mozambique. PLoS Negl Trop Dis 2019; 13:e0007138. [PMID: 30730881 PMCID: PMC6382216 DOI: 10.1371/journal.pntd.0007138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/20/2019] [Accepted: 01/07/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour. To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015. Methodology/Principal findings Cross-sectional household surveys were conducted before (N = 791) and after (N = 792) implementation of the intervention to assess its impact on knowledge, attitudes and practices at population level. At both baseline and endline, awareness of schistosomiasis was high at over 90%. After the intervention, respondents were almost twice as likely to correctly name a risk behaviour associated with schistosomiasis (baseline: 18.02%; endline: 30.11%; adjusted odds ratio: 1.91; 95% confidence interval: 1.14–2.58). Increases were also seen in the proportion of people who knew that schistosomiasis can be spread by infected persons and who could name at least one correct transmission route (baseline: 25.74%; endline: 32.20%; adjusted odds ratio: 1.36; 95% confidence interval: 1.01–1.84), those who knew that there is a drug that treats the disease (baseline: 29.20%, endline: 47.55%; adjusted odds ratio: 2.19; 95% confidence interval: 1.67–2.87) and those who stated that they actively protect themselves from the disease and cited an effective behaviour (baseline: 40.09%, endline: 59.30%; adjusted odds ratio: 2.14; 95% confidence interval: 1.40–3.28). The intervention did not appear to lead to a reduction in misconceptions. In particular, the belief that the disease is sexually transmitted continued to be widespread. Conclusions/Significance Given its overall positive impact on knowledge and behaviour at population level, Community Dialogue can play an important role in schistosomiasis prevention and control. The intervention could be further strengthened by better enabling communities to take suitable action and linking more closely with community governance structures and health system programmes. Schistosomiasis is a parasitic neglected tropical disease that affects around 190 million people worldwide, causing chronic ill health and disability. Central to its prevention and control are the acceptance of health interventions such as the distribution of drugs on a mass scale and the adoption of good hygiene and sanitation practices in communities where the disease thrives. One promising method for promoting such behaviours is the Community Dialogue Approach, which involves training volunteers to host regular community meetings, where local health concerns are discussed and culturally appropriate solutions are agreed upon. In 2014/15, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, to improve knowledge, attitudes and practices with regard to schistosomiasis prevention and control. To assess the effectiveness of the approach, two household surveys were conducted. Results show that before the intervention, knowledge of how schistosomiasis is acquired, transmitted, prevented and treated was low. After the intervention, knowledge and self-reported adoption of positive behaviours had improved substantially, demonstrating that Community Dialogue can play a central role in strengthening disease prevention and control. The approach could be strengthened by further empowering communities to take action and reducing deeply-held misconceptions.
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Affiliation(s)
| | | | | | | | | | | | - Ercílio Jive
- Direcção Provincial de Saúde, Nampula, Mozambique
| | - Anna E. Phillips
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - James N. Newell
- The Nuffield Centre for International Health & Development, University of Leeds, Leeds, United Kingdom
| | - Marilia Massangaie
- Departamento das Doenças Tropicais Negligenciadas, Ministério de Saúde, Maputo, Mozambique
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Muianga A, Pinto G, Massangaie M, Ali S, Oludele J, Tivane A, Falk KI, Lagerqvist N, Gudo ES. Antibodies Against Chikungunya in Northern Mozambique During Dengue Outbreak, 2014. Vector Borne Zoonotic Dis 2018; 18:445-449. [PMID: 29733254 DOI: 10.1089/vbz.2017.2261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
An outbreak of dengue and high densities of Aedes aegypti were reported in 2014 in northern Mozambique, suggesting an increased risk for other arboviruses such as chikungunya virus (CHIKV) in this region. The aim of this study was to investigate the occurrence of CHIKV during an outbreak of dengue virus (DENV) in Pemba city in northern Mozambique in 2014. Febrile patients (n = 146) seeking medical attention at the Pemba Provincial Hospital between March and April 2014 were enrolled in this study. Blood samples from each participant were tested for chikungunya and DENV RNA, IgM and IgG antibodies using PCR and ELISA, respectively. The median age of the patients was 26 years (interquartile range: 20-34 years), and 52.7% (77/146) were female. We found that 7.0% (8/114) of the patients were positive for CHIKV IgM and 31.5% (46/146) presented with CHIKV IgG antibodies. DENV IgM and IgG antibodies were detected in 38.3% (46/120) and 28.2% (33/117) of the patients, respectively. This study is the first investigation regarding the occurrence of CHIKV in the north of Mozambique over the last 60 years and our data suggest that Mozambicans had been silently exposed to the virus in this part of the country, indicating that not only DENV but also CHIKV is an arbovirus to consider in febrile patients seeking medical attention in northern Mozambique.
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Affiliation(s)
- Argentina Muianga
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
| | - Gabriela Pinto
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
| | - Marilia Massangaie
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
| | - Sadia Ali
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
| | - John Oludele
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
| | - Almiro Tivane
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
| | - Kerstin I Falk
- 2 Department of Microbiology, The Public Health Agency of Sweden , Stockholm, Sweden
- 3 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet , Stockholm, Sweden
| | - Nina Lagerqvist
- 2 Department of Microbiology, The Public Health Agency of Sweden , Stockholm, Sweden
| | - Eduardo S Gudo
- 1 Virus Isolation Laboratory, National Institute of Health , Ministry of Health, Maputo, Mozambique
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10
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Massangaie M, Pinto G, Padama F, Chambe G, da Silva M, Mate I, Chirindza C, Ali S, Agostinho S, Chilaule D, Weyer J, le Roux C, Abilio AP, Baltazar C, Doyle TJ, Cliff J, Paweska J, Gudo ES. Clinical and Epidemiological Characterization of the First Recognized Outbreak of Dengue Virus-Type 2 in Mozambique, 2014. Am J Trop Med Hyg 2015; 94:413-6. [PMID: 26643534 DOI: 10.4269/ajtmh.15-0543] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
Since the first reported epidemic of dengue in Pemba, the capital of Cabo Delgado province, in 1984-1985, no further cases have been reported in Mozambique. In March 2014, the Provincial Health Directorate of Cabo Delgado reported a suspected dengue outbreak in Pemba, associated with a recent increase in the frequency of patients with nonmalarial febrile illness. An investigation conducted between March and June detected a total of 193 clinically suspected dengue patients in Pemba and Nampula, the capital of neighboring Nampula Province. Dengue virus-type 2 (DENV-2) was detected by reverse transcriptase polymerase chain reaction in sera from three patients, and 97 others were classified as probable cases based on the presence of DENV nonstructural protein 1 antigen or anti-DENV immunoglobulin M antibody. Entomological investigations demonstrated the presence of Aedes aegypti mosquitos in both Pemba and Nampula cities.
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Affiliation(s)
- Marilia Massangaie
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Gabriela Pinto
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fernando Padama
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Geraldo Chambe
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mariana da Silva
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Inocêncio Mate
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Celia Chirindza
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sadia Ali
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sãozinha Agostinho
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Daniel Chilaule
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Jacqueline Weyer
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Chantel le Roux
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ana Paula Abilio
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cynthia Baltazar
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Timothy J Doyle
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Julie Cliff
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Janusz Paweska
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Eduardo Samo Gudo
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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