Ramígio Pololo

Background: Empiric antibiotic prescribing is frequently used in low- and middle-income countries because microbiological diagnostic capacity is often limited, highlighting the need for locally generated microbiological data to support evidence-informed empiric antibiotic selection. However, data on pediatric antibiotic prescribing practices in Mozambique remain scarce. This study aimed to characterize empiric antibiotic prescribing among hospitalized pediatric patients at Maputo Central Hospital prior to the implementation of a syndromic antibiogram intervention. Methods: An exploratory, retrospective, descriptive baseline analysis was conducted among pediatric patients aged 1 month to 14 years admitted with suspected bacterial infections between January and December 2023, prior to the implementation of a syndromic antibiogram intervention. Sociodemographic, clinical, microbiological, and antibiotic prescribing data were extracted from clinical records. Antibiotics were classified according to the WHO AWaRe framework, and associations between patient characteristics, treatment strategies, and outcomes were analyzed using R software version 4.6.0. Results: A total of 358 pediatric patients were included, with a median age of 14 months (IQR: 6–48), and 57% were male. Lower respiratory tract infections were the most frequent diagnosis. Empiric treatment predominated, accounting for 89% of cases, whereas microbiologically guided therapy was observed in only 11%. Urinary tract infections showed significantly higher proportions of microbiologically guided treatment compared with respiratory infections (p < 0.001). Monotherapy predominated, while Watch antibiotics accounted for 64.7% of prescriptions. Prolonged hospitalization was associated with respiratory distress, decreased skin turgor, referral status, infection type, and anemia. Conclusions: Pediatric antibiotic prescribing was characterized by extensive empiric therapy and high Watch antibiotic use, highlighting important antimicrobial stewardship challenges in Mozambique.

Introduction: The global rise in antimicrobial resistance poses a growing threat to public health, particularly in low- and middle-income countries where diagnostic capacity and surveillance systems remain limited. In these settings, optimizing empiric antibiotic prescribing is critical, and syndromic antibiograms offer a promising approach to support evidence-based decision-making. This study examines anticipated barriers and facilitators to the adoption of syndromic antibiograms from the perspectives of pediatric clinicians and laboratory professionals at Maputo Central Hospital in Mozambique. Methods: Guided by the Dynamic Adaptation Process (DAP) framework, this qualitative study used semi-structured interviews with eighteen healthcare professionals to explore empiric antibiotic prescribing practices, perceptions of syndromic antibiograms, and system-level barriers and facilitators. Data were analyzed thematically using deductive codes derived from the DAP framework alongside inductive codes generated from participants’ narratives. Results: Barriers were identified at individual, organizational, and systems levels. Individual barriers included limited awareness, reliance on traditional practices, and resistance to change. Organizational barriers included weak leadership support, insufficient training, poor communication between clinicians and laboratory staff, suboptimal sample collection, heavy workloads, and staff shortages. Systems-level barriers comprised shortages of laboratory supplies and medicines, delays in laboratory results, and weak monitoring mechanisms. Facilitators included health worker motivation for evidence-based practice, organizational collaboration, peer and team support, and the presence of influential champions. Systems-level enablers included functional laboratory services, supportive institutional environments, alignment with clinical guidelines, and recognition of clinical utility. Conclusions: Successful implementation of syndromic antibiograms in LMIC will require addressing systemic and organizational barriers while fostering professional motivation, collaboration, and institutional support. Sustainable integration will depend on coordinated strategies—including resource strengthening, continuous training, supportive leadership, and structured monitoring—that collectively strengthen antimicrobial stewardship and inform health policy.

Antimicrobial resistance (AMR) is a major public health challenge, particularly in low- and middle-income countries (LMICs), where antimicrobial stewardship (AMS) is often lacking. This study assessed the knowledge, attitudes, and practices of healthcare professionals in pediatric settings regarding AMR and AMS at Maputo Central Hospital, Mozambique. Methods: A cross-sectional survey was conducted among pediatric healthcare professionals using a self-administered questionnaire. Descriptive and inferential statistical analyses were performed to assess knowledge, attitudes, and practices, and their associated factors for inappropriate prescribing. Results: Of 108 eligible participants, 82 (76%) responded to the questionnaire. Overall, 53 (66%) correctly identified that antimicrobials do not treat viral infections, and 79 (99%) recognized factors contributing to AMR. However, only 28 (34%) were familiar with the concept of AMS programs, and participant knowledge related to empiric antibiotic selection was suboptimal. Physicians had significantly higher knowledge scores than laboratory technicians (p = 0.036). Prior AMS training was strongly associated with improved knowledge (p < 0.001) and better prescribing practices (p = 0.005). Despite 71 (92%) participants acknowledging AMR as a major issue, only 30 (37%) recognized their personal role in its emergence. A majority, 77 (94%), expressed interest in further AMS training. Conclusion: Pediatric healthcare professionals at Maputo Central Hospital are generally aware of AMR and exhibit positive attitudes toward AMS. However, notable gaps exist in their knowledge and practices. Strengthening AMS education, increasing access to treatment guidelines, and integrating AMS training into routine professional development are recommended to improve appropriate antimicrobial prescribing. These findings support interventions that are aligned with Mozambique’s National Action Plan on AMR.

Background: To reduce the spread and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), schools implemented a series of non-pharmacological interventions such as handwashing stations and cleaning protocols. A baseline assessment of the available interventions and readiness scores for SARS-CoV-2 prevention was conducted in primary schools in Maputo City, Mozambique. Methods: A cross-sectional study was conducted between August and October 2023. Data were collected using a semi-structured questionnaire that assessed the availability of preventive measures. Readiness scores were calculated, based on the relative frequency of available preventive measures against SARS-CoV-2, recommended by the government. Schools with readiness scores of 100% were considered ready. Results: Of the enrolled schools, 60.6% (66/109) were from the public sector. The median readiness score for preventive measures against SARS-CoV-2 implemented in schools was 70%. Water was the most frequent available measure, with 98.2% (107/109). Ash/soap for handwashing (47.7% [52/109]) and functioning thermometers (31.2% [34/109]) were the least available measures. Private schools showed significantly higher readiness scores compared with public schools (p<0.001). Conclusions: Private compared with public schools had higher readiness scores for preventive measures against SARS-CoV-2 in Maputo City, Mozambique. These findings suggest a need for targeted interventions to improve readiness in public schools.

The epidemiology and characteristics of SARS-CoV-2 in the hospitalized Mozambican pediatric population are scarce. We aimed to assess the burden of COVID-19 in the pediatric population at Hospital Central de Maputo and identify comorbidities and factors associated with death among hospitalized COVID-19 cases. A cross-sectional study was conducted from October 2020 to October 2022. Available records were retrieved from admission books. Univariate and bivariate analyses were reported to describe the sample characteristics. The frequency of pediatric cases admitted with COVID-19 was 0.6% (95% confidence interval (CI): 0.5–0.6; 364/63,753), and the frequency of pediatric cases hospitalized with COVID-19 was 2.5% (95% CI: 2.2–2.9; 173/6807). The monthly frequency of pediatric cases admitted and hospitalized with COVID-19 ranged from 0.1% to 5.4% and from 0.2% to 42.1%, respectively. In children hospitalized with COVID-19, underweight was the most observed comorbidity (17.4%; 19/109); death was observed in 30% (95% CI: 22.2–39.1; 33/110), and it was significantly higher in underweight children than in non-underweight children (61.5% [8/13] vs. 21.3% [16/75]; p-value = 0.005). Given the heightened risk of mortality among undernourished children compared to non-undernourished children, vaccination for COVID-19 should be prioritized for undernourished children.