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Cuboia N, Reis-Pardal J, Pfumo-Cuboia I, Manhiça I, Mutaquiha C, Nitrogénio L, Zindoga P, Azevedo L. Spatial distribution and determinants of tuberculosis incidence in Mozambique: A nationwide Bayesian disease mapping study. Spat Spatiotemporal Epidemiol 2024; 48:100632. [PMID: 38355255 DOI: 10.1016/j.sste.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 11/26/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Mozambique is a high-burden country for tuberculosis (TB). International studies show that TB is a disease that tends to cluster in specific regions, and different risk factors (HIV prevalence, migration, overcrowding, poverty, house condition, temperature, altitude, undernutrition, urbanization, and inadequate access to TB diagnosis and treatment) are reported in the literature to be associated with TB incidence. Although Mozambique has a higher burden of TB, the spatial distribution, and determinants of TB incidence at the sub-national level have not been studied yet for the whole country. Therefore, we aimed to analyze the spatial distribution and determinants of tuberculosis incidence across all 154 districts of Mozambique and identify the hotspot areas. METHOD We conducted an ecological study with the district as our unit of analysis, where we included all cases of tuberculosis diagnosed in Mozambique between 2016 and 2020. We obtained the data from the Mozambique Ministry of Health and other publicly available open sources. The predictor variables were selected based on the literature review and data availability at the district level in Mozambique. The parameters were estimated through Bayesian hierarchical Poisson regression models using Markov Chain Monte Carlo simulation. RESULTS A total of 512 877 people were diagnosed with tuberculosis in Mozambique during our five-year study period. We found high variability in the spatial distribution of tuberculosis incidence across the country. Sixty-two districts out of 154 were identified as hotspot areas. The districts with the highest incidence rate were concentrated in the south and the country's central regions. In contrast, those with lower incidence rates were mainly in the north. In the multivariate analysis, we found that TB incidence was positively associated with the prevalence of HIV (RR: 1.23; 95 % CrI 1.13 to 1.34) and negatively associated with the annual average temperature (RR: 0.83; 95 % CrI 0.74 to 0.94). CONCLUSION The incidence of tuberculosis is unevenly distributed across the country. Lower average temperature and high HIV prevalence seem to increase TB incidence. Targeting interventions in higher-risk areas and strengthening collaboration between HIV and TB programs is paramount to ending tuberculosis in Mozambique, as established by the WHO's End TB strategy and the Sustainable Development Goals.
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Affiliation(s)
- Nelson Cuboia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal; Hospital Rural de Chicumbane, Limpopo, Mozambique.
| | - Joana Reis-Pardal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
| | | | - Ivan Manhiça
- Ministry of Health, National Tuberculosis Program, Maputo, Mozambique
| | - Cláudia Mutaquiha
- Ministry of Health, National Tuberculosis Program, Maputo, Mozambique
| | - Luis Nitrogénio
- Gaza Provincial Health Directorate, Tuberculosis Program, Xai-Xai, Mozambique
| | - Pereira Zindoga
- Ministry of Health, National Tuberculosis Program, Maputo, Mozambique
| | - Luís Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
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Bastard M, Molfino L, Mutaquiha C, Galindo MA, Zindoga P, Vaz D, Mahinça I, DuCros P, Rusch B, Telnov A. Treatment Outcomes of Patients Switching From an Injectable Drug to Bedaquiline During Short Standardized Treatment for Multidrug-resistant Tuberculosis in Mozambique. Clin Infect Dis 2020; 69:1809-1811. [PMID: 30901021 DOI: 10.1093/cid/ciz196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/04/2019] [Indexed: 11/12/2022] Open
Abstract
Bedaquiline was recommended by the World Health Organization as the preferred option in treatment of multidrug-resistant tuberculosis (MDR-TB) with long regimens. However, no recommendation was given for the short MDR-TB regimen. Data from our small cohort of patients who switched from injectable drug to bedaquiline suggest that a bedaquiline-based short regimen is effective and safe.
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Affiliation(s)
| | | | | | | | | | - Deise Vaz
- Médecins Sans Frontières, Geneva, Switzerland
| | | | | | | | - Alex Telnov
- Médecins Sans Frontières, Geneva, Switzerland
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José B, Manhiça I, Jones J, Mutaquiha C, Zindoga P, Eduardo I, Creswell J, Qin ZZ, Ramis O, Ramiro I, Chidacua M, Cowan J. Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique. PLoS One 2020; 15:e0236262. [PMID: 32702073 PMCID: PMC7377411 DOI: 10.1371/journal.pone.0236262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/11/2019] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mozambique has one of the highest incidence rates of both TB and HIV in the world and an estimated tuberculosis (TB) treatment coverage of only 57% in 2018. Numerous approaches are being tested to reduce existing gaps in coverage and the estimated number of missing cases. METHODS Thirty Community Healthcare Workers (CHWs) were tasked with increasing TB notifications by performing verbal facility-based TB screening of all people presenting for care and TB contact tracing in the community. Using routine National TB Program data, we analyzed trends in TB notifications in five intervention districts and seven control districts in Manica province the year before this project and during a one-year intervention period. RESULTS In the four quarters before the study, the intervention districts notified 5,219 individuals with all forms of TB, and the control districts notified 2,248 TB cases. During the study 5,982 all forms of people with TB were notified in the intervention area, an increase of 763 (14.6%) over the baseline, whereas the control districts notified 1,877 persons with TB, a decrease of -371 (-16.5%). The CHW screening activities yielded 1,502 notified and treated individuals with TB. CONCLUSIONS Employing CHWs to promote facility-based TB screening and household contact tracing may lead to an overall increase in TB notification.
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Affiliation(s)
- B. José
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - I. Manhiça
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - J. Jones
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - C. Mutaquiha
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - P. Zindoga
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - I. Eduardo
- Provincial TB Program, Mozambique Ministry of Health, Manica, Mozambique
| | - J. Creswell
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - Z. Z. Qin
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - O. Ramis
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - I. Ramiro
- Health Alliance International, Beira, Mozambique
| | - M. Chidacua
- Health Alliance International, Beira, Mozambique
| | - J. Cowan
- Health Alliance International, Beira, Mozambique
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Graves SK, Augusto O, Viegas SO, Lederer P, David C, Lee K, Hassane A, Cossa A, Amade S, Peleve S, Zindoga P, Massawo L, Torriani FJ, Nunes EA. Tuberculosis infection risk, preventive therapy care cascade and incidence of tuberculosis disease in healthcare workers at Maputo Central Hospital. BMC Infect Dis 2019; 19:346. [PMID: 31023260 PMCID: PMC6485058 DOI: 10.1186/s12879-019-3966-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established. METHODS This study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated. RESULTS Of 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35-49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p < 0.05). Sex, Bacillus Calmette-Guerin vaccination, HIV, outside tuberculosis contacts, and professional category were not. Three new cases of active tuberculosis developed during the follow-up period, two while on preventive therapy. Among 333 participants offered isoniazid preventive therapy, five stopped due to gastrointestinal side effects and 181 completed treatment. For HIV seropositive individuals, the agreement of interferon gamma release assay positivity with positive tuberculin skin testing was 50% among those with a quantitative skin test result of 5-10 mm, and among those with a skin test result ≥10 mm it was 87.5%. For HIV seronegative individuals, the agreement of interferon gamma release assay positivity with a tuberculin skin test result of 10-14 mm was 63.6%, and for those with a quantitative skin test result ≥15 mm it was 82.2%. CONCLUSIONS There is a high prevalence of tuberculosis infected healthcare workers at Maputo Central Hospital. The surgery department was most heavily affected, suggesting occupational risk. Isoniazid preventive therapy initiation was high and just over half completed therapy. An interferon gamma release assay was useful to discern LTBI from false positives among those with lower quantitative tuberculin skin test results.
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Affiliation(s)
- Susannah K. Graves
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Diego, 9500 Gilman Drive MC 0711, La Jolla, CA 92093-0711 USA
| | - Orvalho Augusto
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Sofia Omar Viegas
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Philip Lederer
- Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Catarina David
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Kristen Lee
- Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Anila Hassane
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Anilsa Cossa
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Salma Amade
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Susete Peleve
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Pereira Zindoga
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
| | - Leguesse Massawo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Francesca J. Torriani
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Diego, 9500 Gilman Drive MC 0711, La Jolla, CA 92093-0711 USA
- UC San Diego Infection Prevention and Clinical Epidemiology and TB Control Units at UC San Diego Health, 200 W Arbor Drive MC 8951, San Diego, California 92103 USA
| | - Elizabete A. Nunes
- Department of Internal Medicine, Maputo Central Hospital, Av Agostinho Neto-364, Maputo, Mozambique
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Zindoga P. Mortality of Patients With Sensitive Tuberculosis in the Tuberculosis Department of the Machava General Hospital, Maputo, Mozambique. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pereira Zindoga
- Pulmonary Medicine, Maputo Central Hospital, Maputo, Mozambique
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Zindoga P. Challenges in Laboratory Diagnosis Tuberculosis in the Bacilloscopy Laboratory at the Maputo Central Hospital. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pereira Zindoga
- Pulmonary Medicine, Maputo Central Hospital, Maputo, Mozambique
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