Reducing under-five mortality is a crucial indicator of overall development in a country. However, in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in sub-Saharan Africa, Angola faces significant challenges such as malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, which are the leading causes of death among children. This study aimed to identify factors associated with hospital deaths among children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Using a hospital-based case-control design, the study included 1020 children, among whom 340 experienced hospital deaths. Distal and intermediate determinants emerged as primary predictors of hospital mortality, showing significant associations with: mother without schooling (OR [95%CI] 4.3 [1.2-15.7], p < 0.027); frequent alcohol consumption during pregnancy (OR [95%CI] 3.8 [2.5-5.9], p < 0.001); hospital stay ≤24 h (OR [95%CI] 13.8 [6.2-30.8], p < 0.001); poor nutritional status (OR [95%CI] 2.1 [1.4-3.2], p < 0.001); short interbirth interval (OR [95%CI] 1.7 [1.1-2.5], p < 0.014); maternal age ≤19 years (OR [95%CI] 5.6 [3.0-10.8], p < 0.001); and maternal age ≥35 years (OR [95%CI] 2.1 [1.2-3.7], p < 0.006). These findings highlight the preventable nature of most under-five hospital deaths and underscore the urgent need to address social inequities and improve the quality of primary healthcare services to effectively reduce child mortality in Angola.

BACKGROUND: Urogenital schistosomiasis caused by Schistosoma haematobium is highly endemic in the municipality of Cubal in Angola. Currently, diagnosis is based on the observation of S. haematobium eggs in urine samples by microscopy but this method has low sensitivity. Few studies have been performed using molecular techniques in high-prevalence areas for the detection of S. haematobium. The objective of this study is to evaluate the usefulness of real-time PCR as a diagnostic technique for urogenital schistosomiasis among preschool-age children and its correlation with morbidity data.
METHODS: A cross-sectional study was conducted in Cubal, Angola, involving 97 urine samples from preschool-age children analyzed by the dipstick test, microscopic examination of filtered urine, and real-time PCR. The diagnosis of urogenital schistosomiasis was based on microscopy and/or real-time PCR results. Clinical and ultrasonography evaluation was performed to rule out complications of schistosomiasis.
RESULTS: We detected a total of 64.95% of samples positive by real-time PCR and 37.11% by microscopy. The sensitivity of parasitological diagnosis of urogenital schistosomiasis by real-time PCR and microscopy was 95.45% and 54.55%, respectively, and the sensitivity of real-time PCR compared with microscopy was 91.67%. A positive real-time PCR result was significantly related to older age (mean = 3.22 years), detection of eggs by microscopy, and abnormal urine dipstick results (18.56% with proteinuria, 31.96% with leukocyturia, and 31.96% with microhematuria) (p-value<0.05). Ultrasound analysis showed that 23.94% of children had urinary tract abnormalities, and it was significantly related to the real-time PCR diagnosis (p-value<0.05).
CONCLUSIONS: Real-time PCR is a more sensitive technique than microscopy for urinary schistosomiasis diagnosis in preschool-age children in Cubal. This increase in sensitivity would allow earlier diagnosis and treatment, thus reducing the morbidity associated with schistosomiasis in its early stages.

UNASSIGNED: Hepatitis B virus (HBV) remains a public health concern. Blood donors screened for HBV surface antigen (HBsAg) along with aspartate transaminase (AST)/alanine aminotransferase (ALT) could play a key in providing safe blood products. We investigated the features related to HBV infection among rejected blood donors in Luanda, Angola.
UNASSIGNED: This was a cross-sectional study conducted with 164 rejected donors. Donors were screened for HBsAg from March to May 2022. Overall, 63.4% tested positive for HBV.
UNASSIGNED: The mean age of the HBV-positive (29.2 ± 8.02) was lower than the HBV-negative (33.9 ± 10.0) (p < 0.001). Donors between 20 and 40 years (odds ratio [OR]: 2.34, p = 0.045), females (OR: 1.40, p = 0.516), residents in urbanized areas (OR: 1.23, p = 0.530), low educational (OR: 1.54, p = 0.458), unemployed (OR: 1.65, p = 0.271), and unmarried (OR:1.41, p = 0.616) might be likely to contract HBV. AST/ALT ratio was higher in HBV-infected (2.07 ± 1.42) than in HBV-uninfected (1.90 ± 1.14). About 20% of HBV-positive were classified as having acute liver disease, while 80% with chronic liver disease, based on AST/ALT ratio. Age ranged from 20 to 40 years (OR: 1.97, p = 0.305), females (OR: 1.61, p = 0.557), donors from non-urbanized (OR: 1.69, p = 0.557), a low educational (OR: 1.64, p = 0.571), and unemployed donors (OR: 1.81, p = 0.289) were likely to develop chronic liver disease.
UNASSIGNED: Our findings indicated the failure of viral hepatitis control measures. Authorities should consider including HBV nucleic acid testing to ensure early identification of HBV in Angola.

The dissemination of multidrug-resistant (MDR) bacterial isolates in low- and middle-income countries, including several African countries, is a major concern. The poor sanitary conditions of rural and urban families observed in certain regions may favor the transmission of bacterial infections between animals and humans, including those promoted by strains resistant to practically all available antibiotics. In Angola, in particular, the presence of these strains in human hospitals has already been described. Nevertheless, the information on antimicrobial resistance (AMR) prevalence in Angola is still scarce, especially regarding veterinary isolates. This review aimed to synthesize data on antimicrobial resistance in African countries, with a special focus on Angola, from a One Health perspective. The main goals were to identify research gaps that may require further analysis, and to draw attention to the importance of the conscious use of antimicrobials and the establishment of preventive strategies, aiming to guarantee the safeguarding of public health. To understand these issues, the available literature on AMR in Africa was reviewed. We searched PubMed for articles pertinent to AMR in relevant pathogens in Angola and other African countries. In this review, we focused on AMR rates and surveillance capacity. The principal findings were that, in Africa, especially in sub-Saharan countries, AMR incidence is high due to the lack of legislation on antibiotics, to the close interaction of humans with animals and the environment, and to poverty. The information about current resistance patterns of common pathogenic bacteria is sparse, and the number of quality studies is limited in Angola and in some other Sub-Saharan African countries. Also, studies on the \"One Health Approach\" focusing on the environment, animals, and humans, are scarce in Africa. The surveillance capacity is minimal, and only a low number of AMR surveillance programs and national health programs are implemented. Most international and cooperative surveillance programs, when implemented, are not properly followed, concluded, nor reported. In Angola, the national health plan does not include AMR control, and there is a consistent omission of data submitted to international surveillance programs. By identifying One Health strengths of each country, AMR can be controlled with a multisectoral approach and governmental commitment.

The surveillance of drug resistance in the HIV-1 naïve population remains critical to optimizing the effectiveness of antiretroviral therapy (ART), mainly in the era of integrase strand transfer inhibitor (INSTI) regimens. Currently, there is no data regarding resistance to INSTI in Angola since Dolutegravir-DTG was included in the first-line ART regimen. Herein, we investigated the HIV-1 genetic diversity and pretreatment drug resistance (PDR) profile against nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and INSTIs, using a next-generation sequencing (NGS) approach with MinION, established to track and survey DRMs in Angola. This was a cross-sectional study comprising 48 newly HIV-diagnosed patients from Luanda, Angola, screened between March 2022 and May 2023. PR, RT, and IN fragments were sequenced for drug resistance and molecular transmission cluster analysis. A total of 45 out of the 48 plasma samples were successfully sequenced. Of these, 10/45 (22.2%) presented PDR to PIs/NRTIs/NNRTIs. Major mutations for NRTIs (2.2%), NNRTIs (20%), PIs (2.2%), and accessory mutations against INSTIs (13.3%) were detected. No major mutations against INSTIs were detected. M41L (2%) and I85V (2%) mutations were detected for NRTI and PI, respectively. K103N (7%), Y181C (7%), and K101E (7%) mutations were frequently observed in NNRTI. The L74M (9%) accessory mutation was frequently observed in the INSTI class. HIV-1 pure subtypes C (33%), F1 (17%), G (15%), A1 (10%), H (6%), and D (4%), CRF01_AG (4%) were observed, while about 10% were recombinant strains. About 31% of detected HIV-1C sequences were in clusters, suggesting small-scale local transmission chains. No major mutations against integrase inhibitors were detected, supporting the continued use of INSTI in the country. Further studies assessing the HIV-1 epidemiology in the era of INSTI-based ART regimens are needed in Angola.

UNASSIGNED: The impact of SARS-CoV-2 infection in Africa is still unclear. In comparison to Europe and North America, morbidity and death rates are lower. Several factors have been proposed, including geographical variation in virus impact, environmental factors, differences in age distribution, and the impact of infectious diseases such as malaria, HIV infection and tuberculosis.
UNASSIGNED: We investigated the clinical characteristics and putative determinants linked with COVID-19 in Angolan patients.
UNASSIGNED: Cross-sectional study undertaken at Military Hospital, Luanda, from March 2020 to March 2021. The survey collected sociodemographic and clinical information.
UNASSIGNED: The sample included 1,683 patients aged ≥18 years, 64% men, with mean age of 46.3 years. SARS-CoV-2 was positive in 39% of the cases with RT-PCR. Patients ≥46 years with a level of education of ≥12 years had a considerably higher likelihood of testing positive. About 58% of positive patients had at least one comorbidity, of which hypertension and Diabetes were associated with SARS-CoV-2 infection. HIV and pulmonary TB were putative protective factors. About 14% of positive patients died. Most deaths occurred in patients ≥46 years, with less education and unemployed. Working as a healthcare practitioner was linked to a protective effect. Malignant diseases were the most common comorbidities associated with death.
UNASSIGNED: We identified putative factors related to SARS-CoV-2 infection and mortality. HIV and TB were protective and not associated with mortality. Further study with a broader scope should be conducted to explain the main features related to COVID-19 mortality in Angola.

BACKGROUND: Angola has an extraordinary plant diversity and a great ethnobotanical potential. However, there is a general lack of information about the first botanical explorations in the country and their contribution to the knowledge of the medicinal flora.
OBJECTIVE: The main aim of this study was to unveil the ethnobotanical legacy of José Maria Antunes and Eugène Dekindt, priests of the first Catholic mission in Huíla (Angola) and shed light on their contribution to the knowledge of medicinal wild plants of the country, including information on the uses, plant parts used, and preparation methods documented in the late 19th century. The findings are discussed considering recent ethnobotanical studies to offer a more comprehensive understanding of the historical and traditional uses of plants in Angola over the last two centuries.
METHODS: Based on the information available in manuscripts and on the study of botanical collections preserved in herbaria of Portugal and Angola, we extracted relevant information about the species used in traditional medicine by the rural population of Huíla, the health conditions treated, and the mode of preparation and application.
RESULTS: Our results revealed that Antunes and Dekindt conducted the first ethnobotanical study in Huíla, and documented a large number of medicinal wild plants. From these, we report 191 medicinal species, including 25 endemic and four introduced species, belonging to 56 plant families and 146 genera. Fabaceae family presents the highest richness of medicinal plants (39 taxa), followed by Rubiaceae (13), Asteraceae (10), and Apocynaceae (9). The illnesses reported were classified into 15 different categories, with the highest number of species (49) corresponding to unspecific conditions, such as general pains, chills, and fever. Thirty-seven species were reported for respiratory diseases, 31 for musculoskeletal problems, and 30 for digestive issues. Leaves were the most used plant part for medicinal purposes (84 species). Infusion was the most frequently described preparation method (40 species), followed by maceration (24 species), and powdering (36 species).
CONCLUSIONS: The legacy of Antunes and Dekindt\'s work improves our understanding of Angola\'s botanical richness and traditional uses of plant resources. Our findings highlight the presence of unique medicinal resources in Angola, especially among endemic species, which hold the potential to improve the quality of life of rural communities. Moreover, our research underscores the lack of knowledge of medicinal species, emphasizing the risk of losing valuable historical information.

In southern African countries most of the population uses groundwater collected in dug wells for domestic consumption instead of water from public distribution systems. To investigate the impact of natural and human factors on urban groundwater quality, 276 samples were collected in the Lubango region (Angola) in water distribution systems and dug wells ranging from a few meters to almost one hundred meters in depth. Radon concentrations (RC) were determined by liquid scintillation counting according to ISO 13164-4:2015. Geology is the main source of the variability of RC, with median values higher than 100 Bq/L in granitoid units and lower values in mafic and sedimentary units (ranging from 5 to 38 Bq/L). On average, RC was higher in dug wells compared to public water distribution systems. The annual effective dose due to ingestion of radon in water is, on average, ten times lower in the later compared to dug wells. Therefore, from a public exposure perspective, water distribution systems are preferred as means for water distribution. A severe multi-year meteorological drought over the past decade affecting 76-94 % of the population in southern Angola has been linked with climate change. Consequently, a regional lowering of the water table was observed, as well as a reduction in the productivity of shallower wells, leading to a search for water at greater depths. This work demonstrates an increase in median RC from 66 Bq/L in wells shallower than 30 m to values over 100 Bq/L with increasing depth of water extraction and for the same geological unit. The highest RC observed were also observed at the deepest wells. The dose ingested is proportional to RC, being also higher at deeper water extraction depths. The increase in public radiation exposure from radon ingestion due to water extraction at greater depths is attributed to the underlying issue of climate change. Monitoring water quality in terms of radionuclide concentration is advised to ensure the exposure to ionizing radiation remains at acceptable levels in the future.

BACKGROUND: Human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS) infection has been a serious health problem in pediatric age groups globally, and especially in African countries such as Angola. Our aim was to determine the prevalence rate, accumulate incidence rate, and mortality rate of HIV/AIDS infection in children under 14 years of age residing in four municipalities of Malanje (Malanje, Cacuso, Calandula, and Caculama), from 2010 to 2021.
METHODS: This was a documentary research study, with data from 2010 to 2021, developed from a sample size of 10,984 children.
RESULTS: The prevalence rate data showed a certain level of dispersion, and no relationship was identified in its behavior over the years (R2 = 0.0036). On the other hand, the accumulate incidence rate presented a tendency to decrease, indicating a moderate level of correlation in its behavior over the years (R2 = 0.4278). Finally, the mortality rate has been decreasing and presented a high correlation in its association with the years under analysis (R2 = 0.8142). Primary schooling and low purchasing power were frequent (60% and 82%, respectively) among the families of HIV-infected children under study.
CONCLUSIONS: Despite the temporal variation of HIV in children under 14 years of age living in the different municipalities, there was a tendency of its diminishing in the later part of the period, from 2010 to 2021. Nevertheless, the key players should focus on strengthening community strategies for prevention, investigation, and diagnosis of HIV infections in this population.

The Serra da Neve inselberg in Namibe Province, southwestern Angola is the second highest peak of Angola with an elevation of 2489 m. It remains one of the least explored regions in the country, despite several endemic species having been recently described from this inselberg. Here we provide an inventory of the amphibian and reptile species ocurring in Serra da Neve and compare its fauna with that of the surrounding habitats at lower elevations. We also examine the phylogenetic affinities of the inselberg taxa. A total of 59 herpetological taxa were recorded for the Serra da Neve inselberg and its immediate surroundings. These include 11 species of amphibians, belonging to nine genera and seven different families, and 48 species of reptiles, belonging to 32 genera and 12 families. Of these, one amphibian and seven reptiles from seven different genera are strictly endemic, making the inselberg the richest region in southwestern Africa with respect to strict endemics, with one endemic reptile taxa per 127 km2. Not surprisingly, most of the recorded taxa belong to clades that are endemic, or at least strongly associated, with southern Africa, but two are representatives of central African clades, and another two are more closely related to eastern African highland taxa. We also provide comments on the threats to the conservation of this endemic-rich inselberg.