MANHIÇA HDSS, MOZAMBIQUE

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Brief Introduction to Manhiça HDSS

The Manhiça Health Research Center is a collaborative program between the National Institute of Health of the Ministry of Health of Mozambique, the Spanish Agency for International Cooperation, the Fundació Clinic of Barcelona and the University of Barcelona in Spain. The mission is to develop a center of excellence in rural Mozambique, which contributes to improve health and development through provision of health care, scientific and technical capacity strengthening and research in priority health problems. After almost 12 years of sharp growth the two governments have agreed to move from a “collaborative program” to a “Trust” in February 2008 (The Manhiça Foundation).

The Manhiça Health Research Center (CISM) is located in the district of Manhiça (Maputo Province) in southern Mozambique, 80 kms north of Maputo City, the capital of Mozambique. CISM runs a Demographic and Health Surveillance System (HDSS) since 1996. This surveillance started with a baseline census carried out in late 1996, which covered an area of 100 km2 and registered a total of 32500 inhabitants. In 2002 the DSA was extended to include Mantchiana, Palmeira and Ilha Josina in the North of the older area. In January 2005, the locality of Taninga (north of Palmeira and south of Ilha Josina) was incorporated into the DSA, increasing the area for 500 km2, with a total population of 80000 inhabitants. In mid 2007, the population under HDSS was 82567 inhabitants.

The HDSS was set up in the area immediately after the first enumeration and was based on the household-registration system (HRS), with some modifications. During the demographic surveillance every household is visited at least twice a year and all vital events including births, deaths and migration are recorded. Other data such as pregnancies, abortions, stillbirths and level of education are also collected during these visits. The semestral visits are complemented by weekly updates by the key informants in the community and daily hospital visits, to avoid possible omissions of some events if only semestral visits are used. All the vital events are linked to the individual by the Permanent Identification Number, which is issued for every resident. This allows for an accurate follow-up avoiding duplication of individuals in the database and, most importantly, allows for estimates of accurate rates by dividing the number of events by the number of person-years of observation.

A 24-hour passive case detection in the health facilities within the DSA ensures a morbidity surveillance of children less than 15 years, for which Identification Cards are issued from the HDSS databases and attached to the child’s vaccination card, which is taken to the clinic whenever a kid requires assistance. The ID cards with Permanent ID ensure a linkage between the demographic surveillance and the morbidity surveillance. Verbal autopsies are carried out in a routine basis, which widens and strengthens the usefulness and potentials of the ManhiçaHealthResearchCenter.

The DSA lies at an average altitude of 50m above sea level. The district has two distinct zones: the fertile lowlands, which comprise the floodplains of the IncomatiRiver, are sparsely inhabited, and are subject to intensive sugar cane and fruit farming; and an escarpment of moderate height, which gives rise to a flat plateau on which virtually the entire DSA is situated. The population is peri-urban and rural. People of the area are mainly Ronga and Changana, and their languages are often termed Xironga and Xichangana.

Objectives

  • To describe the health profile of a rural population in southern Mozambique and thereby help identify priority research issues and inform policy;
  • To describe in detail the epidemiology and burden of disease associated with malaria and acute respiratory infections; and
  • To create a platform to help implement and evaluate new control strategies.

Priority Research Areas

  • Malaria
  • Acute respiratory infections.
  • HIV/AIDS
  • Tuberculosis

Completed Key Projects (Up to 10)

Project Name / Funder / Grant Period
  1. Eficacy of chloroquine, Amodiaquine, Sulphadoxine-pyrimethamine and combination therapy with artesunate in Mozambique children with non-complicated malaria
/ FCRB / AECI / 2000-2001
  1. Human papillomavirus genotypes in rural Mozambique
/ FIS / FCRB / 2002-2003
  1. Epidemiology and clinical presentation of respiratory syncytial virus infection in a rural area of southern Mozambique
/ FCRB / AECI / 2000-2001
  1. Aphase I, double-blind, randomised, controlled, study to evaluate the safety, reactogenicity and immunogenicity byRTS,S/AS02 candidate malaria vaccine, administered IM according to a 0,1,2-month vaccination schedule in children aged 1 through 4 years inMozambique, a malaria endemic region.
/ MVI/PATH/GSK / 2002-2003
  1. A double-blindrandomised controlled phase IIb study to evaluate the safety, immunogenicity and efficacy the candidate malaria vaccine RTS,S/AS02A, administered IM according to a 0, 1 and 2 month vaccination schedule in toddlers and children aged 1 to 4 years in a malaria-endemic region of Mozambique
/ MVI/PATH/GSK / 2003-2004

Ongoing Key Projects (Up to 10)

Project Name / Funder / Grant Period
  1. Evaluation of 4 artemisinin-based combinations for treating uncomplicated malaria in African children
/ EDCTP
  1. Study of asexual blood-stage imuno markers associated with sustained protection in children vaccinated with candidate malaria vaccine RTS,S/AS02A
/ MVI / 2008 – 200…
  1. Adverse drug reactions attributable to anti-malarias and or ARV drugs in pregnancy
/ EDCTP / 2006 – 200…
  1. Diarrhea disease in infants and young children in developing countries
/ BMGF / 2007 -200..
  1. Study on causes of death using the method of verbal Autopsies in a rural area of South of Mozambique
/ FCRB / 1997-200…
  1. Identification of biomarkers suitable for develop rapid test to distinguish pneumonia bacteria, viral and malaria
/ BMGF
  1. Feasibility and acceptability studies for trials of new microbicides
/ ECDTP

Human Resource at the site (Grouped by Major Categories)*

STAFF NAME / QUALIFICATION / POSITION
Pedro Alonso / MD, MSc, PhD / Scientific Director
Clara Menéndez / MD, MSc / Clinical Research
John Aponte / MD, MSc / Head - Medical Statistics Unit
Betuel Sigauque / MD, MSc / Clinical Research
Eusébio Macete / MD, MSc, PhD / Clinical Research
Jahit Sacarlal / MD, MSc / Clinical Research
Anna Roca / MSc. PhD Epidemiology / Clinical Research
Pedro Aide / MD / Clinical Research
Tacilta Nhampossa / MD / Clinical Research
Sonia Machevo / MD / Clinical Research
Montse Renom / MD / Clinical Research
Nayra Gutierez / MD / Clinical Research
Jose Munoz / MD / Clinical Research
Ariel Nhacolo / MSc. Demography / Demography research
Delino Nhalungo / MSc Demography/GIS / Demography research
Charfudin Sacoor / BA Demography / Demography research
Leonildo Matsinhe / BA Demography / Demography research
Khatia Munguambe / PhD Antrophology / Social science research
Carlos Bavo / MSc Social Sciences / Social science research
Arnaldo Nhabanga / BA IT Manager / IT Mananger
Inácio Mandomando / MVet / Microbiology Research
Luís Morais / Mvet / Microbiology Research
Jose Machado / BA Biology / Microbiology Research
Maria Nelia / Mvet / Microbiology Research
Diana Quelhas / BA Biology / Microbiology Research
Augusto Nhabomba / Mvet / Microbiology Research
Lucinda Araujo / Mvet / Microbiology Research
Dinis Jantilal / Mvet / Microbiology Research
Teresa Matchai / Engineer / Training & Communication

* The total number of employees in Manhiça is 270, distributed in seven departments: Clinical department, Laboratory, Demography, Anthropology, Data Management and Administration. The table above presents only the senior staff. Other categories such as nurses, medical and lab technicians, fieldworkers and other are not presented.

FUNDERS

Core funding:

  • Ministry of Health, Mozambique
  • Spanish Agency for International Cooperation
  • Fundació Clinic - University of Barcelona

Other funding bodies:

  • Malaria Vaccine Initiative (MVI)
  • Center for Vaccine Delevopment (CVP)
  • BBVA Foundation
  • La Caixa Foundation
  • Bill and Melinda Gates Foundation (BMGF)
  • Generalitat de Catalunya (ACCD)
  • Medicines for Malaria Venture (MMV)
  • European Development Clinical Trials Partnership (Eaciasajos
    19:00, Rosellen word...
    DCTP)
  • Fondo de Investigaciones Sanitarias – Ministerio Sanidad y Consumo (FIS)
  • Fundació Africa Viva, Barcelona,
  • European Union (DG Research)
  • World Health Organization ( WHO)
  • John Hopkings Bloomberg School of Public Health
  • Prince Leopold Institute on Tropical Medicine
  • Global Alliance Vaccine Initiative (GAVI)
  • Program for Apropriated Technologies on Health

COLLABORATORS

  • Africa: INDEPTH Network, WHO, UNICEF
  • Europe: STI, LSHTM, ICO, IHMT, GSK, PLITM
  • US: CVD/UM, JHSPH, CDC
  • Asia: ICGEB (Delhi)
  • Australia: U. of Perth, U. of Melbourne

KEY PUBLICATIONS (up to 10 recent publications)

  1. Safety and immunogenicity of the RTS,S/AS02A candidate malaria vaccine in children aged 1–4 in Mozambique. E. Macete, J. Aponte, C. Guinovart, J. Sacarlal, O. Ofori-Anyinam, I. Mandomando, M. Espasa, C. Bevilacqua, A. Leach, M. C. Dubois, D. G. Heppner, L. Tello, J. Milman, J. Cohen, F. Dubovsky, N. Tornieporth, R. Thompson and P. L. Alonso. Tropical Medicine and International Health volume 12 no 1 pp 37–46 january 2007
  1. Luis Morais, Maria da Glo´ ria Carvalho, Anna Roca, Brendan Flannery, Inacio Mandomando, Montserrat Soriano-Gabarro, Betuel Sigauque, Pedro Alonso and Bernard Beall. Sequential multiplex PCR for identifying pneumococcal capsular serotypes from south-Saharan African clinical isolates. Journal of Medical Microbiology (2007), 56, 1181–1184
  1. John Aponte, Clara Menendez, David Schellenberg, Elizeus Kahigwa, Hassan Mshinda, Penelope Vountasou, Marcel Tanner, Pedro L. Alonso. Age Interactions in the Development of Naturally Acquired Immunity to Plasmodium falciparum and Its Clinical Presentation. PLoS Medicine, July 2007, Volume 4, Issue 1260 7, e242
  1. Inacio M. Mandomando, Eusebio V. Macete, Joaquim Ruiz, Sergi Sanz, Fatima Abacassamo, Xavier Vallès, Jahit Sacarlal, Margarita M. Navia, Jordi Vila, Pedro L. Alonso, And Joaquim Gascon. Etiology of diarrhea in children younger than 5 years of age admitted in a rural hospital of southern Mozambique. Am. J. Trop. Med. Hyg., 76(3), 2007, pp. 522–527 Copyright © 2007 by The American Society of Tropical Medicine and Hygiene.
  1. Inacio Mandomando, Mateu Espasa, Xavier Valles, Jahit Sacarlal, Betuel Sigauque, Joaquim Ruiz and Pedro Alonso. Antimicrobial resistance of Vibrio cholerae O1 serotype Ogawa isolated in ManhicaDistrictHospital, southern Mozambique. Journal of Antimicrobial Chemotherapy (2007) 60, 662–664.
  1. Alfredo Mayor, John J Aponte, Carole Fogg, Francisco Saúte, Brian Greenwood, Martinho Dgedge, Clara Menendez, and Pedro L Alonso. The epidemiology of malaria in adults in a rural area of southern Mozambique. Malaria Journal 2007, 6:3 doi:10.1186/1475-2875-6-3
  1. Cleofe´ Romagosa, Jaume Ordi, Francisco Saute, Llorenc¸ Quinto, Fernanda Machungo, Mamudo R. Ismail, Carla Carrilho, Nafissa Osman Pedro L. Alonso and Clara Menendez. Seasonal variations in maternal mortality in Maputo, Mozambique: the role of malaria. volume 12 no 1 pp 62–67 january 2007
  1. B. Sigauque, A. Rocaa, S. Sanz, I. Oliveiras, M. Martinez, I. Mandomando, X. Valles, M. Espasa, F. Abacassamo, J. Sacarlal, E. Macete, A. Nhacolo, J. Aponte, M.M. Levine, P.L. Alonso. Acute bacterial meningitis among children, in Manhica a rural area in Southern Mozambique. Acta Trop. (2007), doi:10.1016/j.actatropica.2007.01.006

Minimum Datasets

Mortality
Person Years / Deaths / Basic vital statistics
Age / Both sexes / Male / Female / Both sexes / Male / Female / Rates
<1 / 3332.8 / 1658.1 / 1674.7 / 243 / 126 / 117 / Crude birth rate / 41.5 / Total births during 2006 divided by total mid-year population
1-4 / 11429 / 5754.4 / 5674.6 / 209 / 121 / 88 / Total fertility rate / 4.9 / Calculated according to the general information
5-9 / 12738.5 / 6416 / 6322.5 / 34 / 22 / 12 / Crude death rate / 18.2 / Total deaths during 2006 divided by total mid-year population
10-14 / 10070.3 / 4964.1 / 5106.2 / 24 / 15 / 9 / Neonatal mortality rate / 25.7 / Deaths<28 days of life divided by total births
15-19 / 8136.5 / 3902.5 / 4234 / 24 / 7 / 17 / Post neonatal mortality rate / 46.2 / Deaths 4-52 weeks of life divided by total births
20-24 / 6957.5 / 2791.1 / 4166.4 / 44 / 18 / 26 / Infant mortality / 71.9 / Conventional IMR
25-29 / 6034 / 2190.5 / 3843.5 / 95 / 47 / 48 / Child mortality rate(1-4) / 18.3
30-34 / 4547.1 / 1583.3 / 2963.8 / 111 / 55 / 56 / Underfive mortality / 123.6
35-39 / 3278.3 / 1142.9 / 2135.4 / 86 / 51 / 35 / Crude rate of natural increase / 23.4 / ????
40-44 / 2903.6 / 1002.4 / 1901.2 / 83 / 36 / 47 / In-migration rate / 85.6
45-49 / 2710.4 / 973.1 / 1737.3 / 74 / 33 / 41 / Outmigration rate / 108
50-54 / 2104.5 / 787 / 1317.5 / 47 / 21 / 26 / Growth rate / 3.8% / Between 1997 and 2001(Nhacolo et al,2006)
55-59 / 1957.1 / 677 / 1280.1 / 75 / 42 / 33
60-64 / 1573.4 / 558.6 / 1014.8 / 58 / 26 / 32
65-69 / 1553.6 / 543.7 / 1010 / 66 / 31 / 35
70-74 / 994 / 353.8 / 640.3 / 61 / 33 / 28
75-79 / 829.7 / 250.9 / 578.8 / 58 / 24 / 34
80-84 / 354.5 / 82.7 / 271.7 / 28 / 8 / 20
85-89 / 306.4 / 63 / 243.4 / 35 / 12 / 23
90+ / 113.6 / 33.5 / 80 / 24 / 8 / 16
1479

Cause of death by broad age groups

Age group
Cause / <1 / 1-4 / 5-14 / 15-44 / 45-64 / 65-84 / 85+
Malaria
Infectious diseases
Maternal causes
.
.
etc
Fertility
Age / Women / Births (both) / Male / Female
15-19 / 4169 / 738 / 363 / 375
20-24 / 4091 / 995 / 475 / 520
25-29 / 3815 / 763 / 384 / 379
30-34 / 2986 / 503 / 236 / 267
35-39 / 2090 / 222 / 121 / 101
40-44 / 1922 / 96 / 48 / 48
45-49 / 1686 / 25 / 16 / 9

SITE CONTACT DETAILS

Ariel Nhacolo

Instituto Nacional de Saude (INS)

Ministero Da Saude

P.O. Box 1929

Maputo, Mozambique

Tel: +258 1 810002

Email:

Website: