Ilha de Moçambique, Mozambique
Ilha de Moçambique, Mozambique

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Padrao P.,University of Porto | Silva-Matos C.,Mozambique Ministry of Health | Damasceno A.,Eduardo Mondlane University | Lunet N.,University of Porto
Journal of Epidemiology and Community Health | Year: 2011

Background: Smoking, alcohol consumption and unhealthy diet are known to cluster, but evidence from developing countries at the early phases of the tobacco epidemics and with markedly different cultures, lifestyles and forms of tobacco use is scarce. The objective of this study was to quantify the association between tobacco consumption (manufactured cigarettes, hand-rolled cigarettes and smokeless tobacco) and alcohol, fruit and vegetable intake in Mozambique according to place of residence (urban/rural). Methods: A representative sample of 12 902 Mozambicans aged 25-64 years was evaluated in a national household survey conducted in 2003 using a structured questionnaire. Age- and education-adjusted ORs were computed to estimate the association between tobacco consumption and alcohol, fruit and vegetable intake. Results: Tobacco use and overall alcohol drinking were positively associated, regardless of type of tobacco consumed, but smoking of hand-rolled cigarettes and consumption of smokeless tobacco was negatively associated with beer drinking. Smokers of manufactured cigarettes had a less frequent intake of fruit, but smokeless tobacco consumption and hand-rolled cigarette smoking were not inversely related with intake of fruit or vegetables. This pattern was relatively consistent across genders and urban/rural areas, with the observed differences likely to be explained either by random variation or heterogeneity in tobacco consumption patterns across genders or places of residence. Conclusion: Strong associations between tobacco consumption and the intake of alcoholic beverages, vegetable and fruit intake are found, but not consistently for all forms of tobacco use.


Gomes A.,University of Porto | Damasceno A.,Eduardo Mondlane University | Azevedo A.,University of Porto | Prista A.,University Pedagogica | And 3 more authors.
Obesity Reviews | Year: 2010

In 2005 we evaluated a nationally representative sample of the Mozambican adult population (n = 2913; 25-64 years old) following the STEPwise approach to chronic disease risk factor surveillance to estimate urban-rural differences in overweight and obesity and waist circumferences. The prevalences of obesity and overweight were, respectively, 6.8% (95% CI: 5.1-8.6) and 11.8% (95% CI: 8.4-15.4) among women, and 2.3% (95% CI: 1.1-3.6) and 9.4% (95% CI: 5.7-13.1) among men. Overweight/obesity was more frequent in urban settings (age-, income- and education-adjusted prevalence ratios; women, 2.76, 95% CI: 1.82-4.18; men, 1.76, 95% CI: 0.80-3.85). The average waist circumference in Mozambique was 75.2 cm (95% CI: 74.3-76.0) in women, significantly higher in urban than rural areas (age-, income- and education-adjusted β = 3.6 cm, 95% CI: 1.6-5.5) and 76.1 cm (95% CI: 75.0-77.3) in men, with no urban-rural differences (adjusted β = 1.3 cm, 95% CI: -0.9 to 3.5). Our results show urban-rural differences, as expected in a country under epidemiological transition, with urban areas presenting a higher prevalence of overweight/obesity, but age- and education-specific estimates suggesting a trend towards smaller divergences. The development and implementation of strategies to manage the foreseeable obesity-related healthcare demands are needed. © 2010 International Association for the Study of Obesity.


Padrao P.,University of Porto | Damasceno A.,Eduardo Mondlane University | Silva-Matos C.,Mozambique Ministry of Health | Prista A.,University Pedagogica | Lunet N.,University of Porto
Preventive Medicine | Year: 2012

Objective: To assess the socio-demographic determinants of physical activity, by intensity and domain, across urban and rural areas in Mozambican adults. Method: A national representative sample (n=3323) of subjects aged 25-64. years was evaluated in 2005 following the World Health Organization (WHO) Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which includes the Global Physical Activity Questionnaire. We computed prevalences, and age- and education-adjusted prevalence ratios (PR), with 95% confidence intervals (95%CI). Results: Most of the Mozambicans reported a high physical activity level, according to the WHO criteria (urban women: 83.2%, 95%CI 77.4, 89.0; rural women: 93.2%, 95%CI 89.0, 97.3; urban men: 78.9%, 95%CI 74.7, 83.1; rural men: 91.6%, 95%CI 85.5, 97.6). The prevalences of <75. min/week of vigorous activities were higher in urban settings (women: PR=2.21; men: PR=2.28) and increased with education, regardless of place of residence (PR ranging between 1.75 and 5.72 for more vs. less educated subjects). Work activities were the most important contributor to the overall physical activity, followed by transport. Conclusion: Most of the Mozambicans reported to be physically active. Vigorous activities were less common in urban areas and among the more educated subjects, depicting an ongoing shift to more sedentary behaviours in this setting. © 2012 Elsevier Inc.


Padrao P.,University of Porto | Laszczynska O.,University of Porto | Silva-Matos C.,Mozambique Ministry of Health | Damasceno A.,Eduardo Mondlane University | Lunet N.,University of Porto
British Journal of Nutrition | Year: 2012

Monitoring food consumption and its determinants over time is essential for defining and implementing health promotion strategies, but surveillance is scarce in Africa. The present study aimed to describe fruit and vegetable consumption in Mozambique according to socio-demographic characteristics and place of residence (urban/rural). A national representative sample (n 3323) of subjects aged 25-64 years was evaluated in 2005 following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance, which included an assessment of usual fruit and vegetable consumption (frequency and quantity). Crude prevalence and age-, education-and family income-adjusted prevalence ratios (PR) with 95% CI were computed. Less than 5% of the subjects reported an intake of five or more daily servings of fruits/vegetables. Both fruits and vegetables were more often consumed by women and in rural settings. In urban areas, the prevalence of fruit intake (≥ 2 servings/d) increased with education (≥ 6 years v. < 1 year: women, adjusted PR = 3•11, 95% CI 1•27, 7•58; men, adjusted PR = 3•63, 95% CI 1•22, 10•81), but not with income. Conversely, vegetable consumption (≥ 2 servings/d) was less frequent in more educated urban men (≥ 6 years v. < 1 year: adjusted PR = 0•30, 95% CI 0•10, 0•94) and more affluent rural women (≥ $801 US dollars (USD) v. $0-64: adjusted PR = 0•32, 95% CI 0•13, 0•81). The very low intake of these foods in this setting supports the need for fruit and vegetable promotion programmes that target the whole population, despite the different socio-demographic determinants of fruit and vegetable intake. © 2011 The Authors.


Rawlins B.,Health Integrated | Drake M.,Health Integrated | dos Anjos M.,Health Integrated | Cantor D.,Health Integrated | And 4 more authors.
PLoS ONE | Year: 2013

Background:As low-income countries strive to meet targets for Millennium Development Goals 4 and 5, there is growing need to track coverage and quality of high-impact peripartum interventions. At present, nationally representative household surveys conducted in low-income settings primarily measure contact with the health system, shedding little light on content or quality of care. The objective of this study is to validate the ability of women in Mozambique to report on facility-based care they and their newborns received during labor and one hour postpartum.Methods and Findings:The study involved household interviews with women in Mozambique whose births were observed eight to ten months previously as part of a survey of the quality of maternal and newborn care at government health facilities. Of 487 women whose births were observed and who agreed to a follow-up interview, 304 were interviewed (62.4%). The validity of 34 indicators was tested using two measures: area under receiver operator characteristic curve (AUC) and inflation factor (IF); 27 indicators had sufficient numbers for robust analysis, of which four met acceptability criteria for both (AUC >0.6 and 0.75


Sherr K.,University of Washington | Mussa A.,Mozambique Ministry of Health | Chilundo B.,Eduardo Mondlane University | Gimbel S.,University of Washington | And 3 more authors.
PLoS ONE | Year: 2012

Introduction: Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector. Methods: An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980-2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties. Results: Of 723 qualifying physicians between 1980-2006, 95.9% (693) were working full-time, including 71.1% (493) as clinicians, 20.5% (142) as health system managers, and 6.9% (48) as researchers/professors. 25.5% (181) of the sample had left the public sector, of which 62.4% (113) continued working in-country and 37.6% (68) emigrated from Mozambique. Of those cases of internal migration, 66.4% (75) worked for NGOs, 21.2% (24) for donor agencies, and 12.4% (14) in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113) of internal migration cases had previously held senior-level management positions in the public sector. Discussion: Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek to strengthen. © 2012 Sherr et al.


Silva-Matos C.,Mozambique Ministry of Health | Gomes A.,University of Porto | Azevedo A.,University of Porto | Damasceno A.,Eduardo Mondlane University | And 2 more authors.
Diabetes and Metabolism | Year: 2011

Aim: The growing trend towards and deficient management of diabetes in Africa are important public-health challenges requiring surveillance. For this reason, this study aimed to assess the prevalence and awareness of diabetes in urban and rural Mozambique, and to describe its management. Methods: In 2005, a representative sample of the national Mozambican adult population (n=2343) was evaluated, according to the STEPwise approach to chronic disease risk factor surveillance (STEPS). Twelve-hour fasting blood glucose (FBG) was measured, using fingertip capillary whole blood, to estimate the prevalence of impaired fasting glucose (IFG; FBG ≥ 5.6. mmol/L and less than 6.1. mmol/L) and diabetes (FBG ≥ 6.1. mmol/L, or treatment with insulin and/or oral blood glucose-lowering drugs). Patients' awareness and management of diabetes were assessed by questionnaire. Results: The prevalence of diabetes and IFG was 2.9% [95% confidence interval (95%CI): 1.8-4.0] and 2.5% (95%CI: 1.3-3.7), respectively. Diabetes was more frequent among urban dwellers (OR = 2.92, 95%CI: 1.45-5.86), mostly due to urban-rural differences in age, education, body mass index (BMI) and waist circumference (adjusted OR = 2.27, 95%CI: 0.83-6.26). In all, 13% of those with diabetes were aware of their condition, 10.9% had undergone glycaemia determination during the previous year, and 9% were being treated with oral blood glucose-lowering drugs and 3% with insulin. Conclusion: Diabetes prevalence is low in Mozambique, but most diabetic patients were neither aware of their condition nor being treated pharmacologically, thus posing serious challenges to the provision of adequate care in an already disadvantageous context. © 2010 Elsevier Masson SAS.


Padrao P.,University of Porto | Damasceno A.,Eduardo Mondlane University | Silva-Matos C.,Mozambique Ministry of Health | Carreira H.,University of Porto | Lunet N.,University of Porto
Nicotine and Tobacco Research | Year: 2013

Introduction: Monitoring tobacco consumption patterns is essential to define and evaluate strategies to control the tobacco epidemic. We aimed to quantify the use of smoked (manufactured/hand-rolled cigarettes) and smokeless (snuff/ chew) tobacco, according to sociodemographic characteristics, in adult Mozambicans. Methods: A national representative sample (n = 3,323) of subjects aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which included the assessment of tobacco consumption with the quantification of each type of tobacco used daily. We computed prevalences, and age- and education-adjusted prevalence ratios (PR s), with 95% CI s. Results: Daily smoking was reported by 9.1% (95% CI = 5.0- 13.1) of women (manufactured, 3.4%; hand-rolled, 5.6%) and 33.6% (95% CI = 29.3-38.0) of men (manufactured, 18.7%; handrolled, 14.8%). Daily manufactured cigarette smoking was significantly more frequent in men (urban: PR = 14.62, 95% CI = 7.59-28.55; rural: PR = 4.32, 95% CI = 2.42- 7.71). Daily hand-rolled cigarette smoking was three- to fourfold more frequent among men and nearly 80% less frequent in urban areas, regardless of sex. The prevalence of daily smokeless tobacco use was 7.4% (95% CI = 4.6-10.2) in women (chew, 6.4%; snuff, 1.0%) and 3.4% (95% CI = 1.7-5.2) in men (chew, 1.6%; snuff, 1.8%). Daily smokeless tobacco consumption was significantly less frequent in urban areas only among men (PR = 0.05, 95% CI = 0.01- 0.33). Conclusions: Despite the relatively low levels of manufactured cigarette smoking, traditional forms of tobacco consumption are frequent, especially among women and in rural settings, showing the need for control measures to target specifically different patterns of consumption. © The Author 2012. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.


Padrao P.,University of Porto | Damasceno A.,Eduardo Mondlane University | Silva-Matos C.,Mozambique Ministry of Health | Laszczynska O.,University of Porto | And 2 more authors.
Drug and Alcohol Dependence | Year: 2011

This study aimed to describe alcohol consumption in Mozambique, discriminating binge drinking behaviour and the weekday variation in drinking patterns, and to quantify the association between socio-demographic characteristics and alcohol intake.A representative sample of 3265 Mozambicans aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise approach to Chronic Disease Risk Factor Surveillance (STEPS). The consumption of any type of alcoholic beverage, during life and in the previous year, was recorded. Current drinkers were also asked about the number of standard drinks consumed in each day of the previous week.The overall prevalence of current dinking was 28.9% [95% confidence interval (95% CI): 22.6-35.2] in women and 57.7% (95% CI: 49.8-65.7) in men. Forty percent of the current drinkers reported to have had at least one binge drinking occasion in the previous week. The prevalence of current drinking increased with age and education among women and with income among men. No consistent pattern was observed in binge drinking by education in both genders and by annual income among men, but it was significantly less frequent among the more affluent women. Both drinking and binge drinking peaked at the weekend.Knowing the drinking patterns in Mozambique enables the planning of interventions according to the local needs. Future surveys should also include non-adult populations as risk factors for chronic diseases occurs as early as childhood and adolescence, and are associated with increased risk of disease later in life. © 2010 Elsevier Ireland Ltd.


Sherr K.H.,University of Washington | Micek M.A.,University of Washington | Gimbel S.O.,University of Washington | Gloyd S.S.,University of Washington | And 5 more authors.
AIDS | Year: 2010

OBJECTIVES: To compare HIV care quality provided by non-physician clinicians (NPC) and physicians. DESIGN: Retrospective cohort study assessing the relationship between provider cadre and HIV care quality among non-pregnant adult patients initiating antiretroviral therapy (ART) in the national HIV care programme. METHODS: Computerized medical records from patients initiating ART between July 2004 and October 2007 at two HIV public HIV clinics in central Mozambique were used to develop multivariate analyses evaluating differences in process and care continuity measures for patients whose initial provider was a NPC or physician. RESULTS: A total of 5892 patients was included in the study, including 4093 (69.5%) with NPC and 1799 (30.5%) with physicians as initial providers. Those whose initial provider was a NPC were more likely to have a CD4 cell count 90-210 days [risk ratio (RR) 1.13, 1.04

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