To Detect Disease Threats, Mozambique Finds Answers in Wastewater

By The Global Fund

October 4^th, 2023

Health researcher Dr. Diocreciano Matias Bero leads the Wastewater Environmental Monitoring Program at Mozambique’s National Institute of Health.

He recognizes that most people are turned off by what goes down the toilet – but studying that waste is his passion.

“No one wanted to know about smelly samples,” he says. “But that's where we have the most precious information.”

In countries around the world, wastewater testing is used to determine whether a virus or bacteria is spreading in a community before a widescale outbreak occurs. The idea is that by locating where a pathogen is circulating before people start to get sick, decision-makers can act fast to contain a disease and prevent it from spreading.

During the COVID-19 pandemic, countries used wastewater testing to detect high levels of the SARS-CoV-2 virus and monitor its evolution.

In six countries across East and Southern Africa, the Global Fund supports wastewater testing programs for early disease detection, including in Mozambique.

Health Researcher Dr. Diocreaciano Matias Bero

To Detect Disease Threats, Mozambique Finds Answers in Wastewater

Dr. Bero and his team established the Wastewater Environmental Monitoring Program last year and now collect and test wastewater samples four times every week as an early surveillance system to detect disease outbreaks.

The team adheres to a number of safety measures during sampling, including the use of personal protective equipment to keep themselves safe and ensure that they do not contaminate the samples they are collecting.

The team of four includes (from left to right) lab technicians Delfa Nhiuane and Loira Machalele, laboratory technical manager Helder Simeao Chaigue, and Dr. Bero.

One of the first steps in wastewater testing is deciding where samples should be collected.

The team currently collects samples from four locations across Mozambique’s capital city, Maputo. The locations are places with a large flow of sewage water as well as specific sites of interest, including those close to a wastewater treatment plant and locations near a busy market and sports stadium.

With the locations determined, Dr. Bero and his team set up “traps” to collect the samples. The traps are made of a special gauze material that the wastewater sticks to. The team sets the traps in the four designated locations and leaves them for 24 hours.

A day later, the team returns and collects the samples and transports them to a laboratory at the National Institute of Health in Marracuene, a city about 30 kilometers north of Maputo.

The samples must be refrigerated while transported and stored between 4 and 8 degrees Celsius to maintain their integrity.

At the laboratory, the samples are tested for SARS-CoV-2, the virus that causes COVID-19, as well as certain strains of influenza. Some results are received in as little as 24 hours.

Dr. Bero explains: “Before cases start circulating in the community, we already know that it is agent “X” that is circulating... and we can easily take preventative measures.”

Beginning next year, the program will expand to 15 additional sites.

Dr. Bero says expanding the program is vital, particularly because Mozambique faces increased risks of climate change-related disease outbreaks.

“[We] are vulnerable to climate change, and when it rains, there are floods,” he says. “If we have the program already established, we can detect if there is cholera or rotavirus or norovirus, or which one is circulating in the community, and which is causing diarrhea. It is extremely important for the country to expand this program.”

Every year the Global Fund invests approximately US$1.5 billion to build resilient and sustainable health systems, which includes investments in early warning systems to help prepare and identify future health threats.