Linked transmission chains of imported SARS-CoV-2 variant B.1.351 across mainland France, January 2021.

Two cases of confirmed SARS-CoV-2 infection with the B.1.351 variant were reported in France in mid-January, 2020. These cases attended a gathering in Mozambique in mid-December 2020. Investigations led to the identification of five imported cases responsible for 14 transmission chains and a total 36 cases. Epidemiological characteristics seemed comparable to those described before the emergence of the South African variant B.1.351. The lack of tertiary transmission outside of the personal sphere suggests that distancing and barrier measures were effective.

Therapeutic Borderlands: Austerity, Maternal HIV Treatment, and the Elusive End of AIDS in Mozambique.

"End of AIDS" requires ambitious testing, treatment, and adherence benchmarks, like UNAIDS' "90-90-90 by 2020." Mozambique's efforts to improve essential maternal/infant antiretroviral treatment (ART) exposes how austerity-related health system short-falls impede public HIV/AIDS service-delivery and hinder effective maternal ART and adherence. In therapeutic borderlands-where household impoverishment intersects with health-system impoverishment-HIV+ women and over-worked care-providers circumnavigate scarcity and stigma. Worrisome patterns of precarious use emerge-perinatal ART under-utilization, delayed initiation, intermittent adherence, and low retention. Ending HIV/AIDS requires ending austerity and reinvesting in a public sector health workforce to ensure universal health coverage as household and community safety nets.

HIV-positive Mozambican migrants in South Africa: loneliness, secrecy and disclosure.

South Africa continues to bear a heavy burden of HIV and a significant proportion of the nation's population consists of immigrants from other severely afflicted African nations. Yet little is known about how migrant populations respond to HIV in shifting cultural and clinical landscapes. Analysing 21 ethnographic life history interviews, this paper explores the social complexities of living with antiretroviral therapy and disclosure of serostatus among HIV-positive Mozambican migrants in Johannesburg. It focuses on (i) conceptualising the 'biosocial ambiance of illness'; (ii) how transformations occur in perceptions of disease; and (iii) how stigma produces an ambit of loneliness and secrecy, which inflects disclosure unevenly in different life-spaces and health-worlds. The net effect of these three processes is a silence which is detrimental to the social normalisation of HIV, treatment-seeking and clinical drug adherence, which in turn may increase rates of morbidity and mortality and contribute to drug resistance.

Along the Indian Ocean Coast: Genomic Variation in Mozambique Provides New Insights into the Bantu Expansion.

The Bantu expansion, which started in West Central Africa around 5,000 BP, constitutes a major migratory movement involving the joint spread of peoples and languages across sub-Saharan Africa. Despite the rich linguistic and archaeological evidence available, the genetic relationships between different Bantu-speaking populations and the migratory routes they followed during various phases of the expansion remain poorly understood. Here, we analyze the genetic profiles of southwestern and southeastern Bantu-speaking peoples located at the edges of the Bantu expansion by generating genome-wide data for 200 individuals from 12 Mozambican and 3 Angolan populations using ∼1.9 million autosomal single nucleotide polymorphisms. Incorporating a wide range of available genetic data, our analyses confirm previous results favoring a "late split" between West and East Bantu speakers, following a joint passage through the rainforest. In addition, we find that Bantu speakers from eastern Africa display genetic substructure, with Mozambican populations forming a gradient of relatedness along a North-South cline stretching from the coastal border between Kenya and Tanzania to South Africa. This gradient is further associated with a southward increase in genetic homogeneity, and involved minimum admixture with resident populations. Together, our results provide the first genetic evidence in support of a rapid North-South dispersal of Bantu peoples along the Indian Ocean Coast, as inferred from the distribution and antiquity of Early Iron Age assemblages associated with the Kwale archaeological tradition.

Patients and Personhood: Perceptions of HIV in Mozambican Immigrants in South Africa.

Foreign-born immigrants residing in South Africa largely come from sub-Saharan countries with the highest HIV prevalence rates worldwide. These migrants may manage HIV medically, despite precarious conditions, but little is known about how they manage socially in shifting cultural and clinical landscapes. In this article, I explore the complexities of stigma by juxtaposing perceptions of illness between HIV-positive Mozambican migrants in care and members of their communities unware of their own serostatus. I argue that stigma is tied to location through social networks. Sharp perceptual contrasts between patients and community members result in equally contrasting social positionalities and othering in sprawling migrant communities, where secrecy and gossip become strategies of social survival. Due to its social lethality, stigma continues to cause distress.

Travessias entre litorais: proposições para a saúde mental em moçambique / Travesías entre costas: proposiciones para la salud mental en mozambique / Crossing between coastlines: proposals for mental health in mozambique

Resumo O presente artigo se constrói a partir de reflexões baseadas numa psicanálise brasileira com interface na psicologia social, com o objetivo de dialogar com a Saúde Mental de Moçambique, um país que se subjetiva numa lógica não-ocidentalizada, cujo sistema de cuidado existente há séculos provém do curandeirismo, (re)conhecido no país como Medicina Tradicional. Sendo as políticas públicas de saúde mental regidas a partir de uma visão ocidental, este estudo questionou as reformulações teóricas necessárias para a inserção de novos dispositivos clínicos no país que incluíssem o saber tradicional. Como se trata de uma travessia, optou-se pelo método de escrita de cartas para melhor contemplar o encontro entre estas duas realidades tão diferentes e ao mesmo tempo tão semelhantes.

Resumen El presente artículo se construye desde reflexiones basadas en un psicoanálisis brasileño con interfaz en la psicología social, con el objetivo de dialogar con la Salud Mental de Mozambique, un país que se subjetiva en una lógica no occidentalizada, cuyo sistema de cuidado existente desde hace siglos se deriva del curanderismo, (re)conocido en el país como Medicina Tradicional. Siendo las políticas públicas de salud mental regidas dentro de una lógica occidental, se cuestionó las reformulaciones teóricas necesarias para la inserción de nuevos dispositivos clínicos en el país que incluyeran el saber tradicional. Como se trata de una travesía, se optó por el método de escritura de cartas para mejor contemplar el encuentro entre estas dos realidades tan diferentes y al mismo tiempo tan semejantes.

Abstract This article is built on reflections based on a Brazilian psychoanalysis with an interface in social psychology, aiming to integrate it into the Mozambican Mental Health. Mozambique is a country that operates in a non-westernized logic; with a care system that for centuries has come from healing practices, known in the country as Traditional Medicine. As public mental health policies are governed by a Western perspective, a question was raised about the theoretical reformulations that might be necessary for the insertion of new clinical devices in the country, including traditional knowledge. Being a traverse, the method of writing letters was chosen to better contemplate the encounter between these two realities, so different and yet so similar.

Therapeutic Navigations and Social Networking: Mozambican Women's Quests for Fertility.

In Mozambique, involuntary childlessness triggers immediate treatment seeking, especially on the woman's side. Treatment processes involve the activation and/or creation of situational social networks that provide emotional, instrumental, and informational support. These are formed through careful processes of disclosure management, and are embedded in social relations and local moral configurations of family making, reproduction, and healing. In this article I explore social networks involving friends, family, religion, and emerging biosocial relations, some or all of which are involved in Mozambican women's and couples' therapeutic navigations in the quest for fertility.

Understanding intra-vaginal and labia minora elongation practices among women heads-of-households in Zambézia Province, Mozambique.

Intra-vaginal drying and tightening and labia minora elongation are commonly practised in some parts of southern Africa. We sought to capture data on these practices among women living in Zambézia province, Mozambique. Information was gathered from 3543 female heads of household on > 500 variables, including vaginal practices, in 2014. Women who planned to use intra-vaginal tightening substances had 1.84 times higher odds of ever receiving an HIV test (p < 0.001) and 1.40 times higher odds of at least one antenatal care visit attended during last pregnancy (p = 0.015). Women who had or planned to undergo labia minora elongation had 2.61 times higher odds of receiving an HIV test in the past (p < 0.001) and 1.60 times higher odds of attending at least one antenatal care visit during their last pregnancy (p < 0.001). There was little evidence for a relationship between self-reported HIV status and anticipated use of intra-vaginal tightening substances (p = 0.21). Current or anticipated participation in labia elongation showed a protective effect on HIV infection (p = 0.028). Given documented associations between intra-vaginal substance use, vaginal infections and HIV acquisition, understanding the prevalence of vaginal practices is an essential component to addressing the epidemic.

Epidemia da AIDS e a Sociedade Moçambicana de Medicamentos: análise da cooperação brasileira / The AIDS Epidemic and the Mozambican Society of Medicines: an analysis of Brazilian cooperation

Com base na literatura sobre Cooperação para o Desenvolvimento e Saúde Global, o artigo à luz do conceito de Cooperação Estruturante em Saúde, analisa a cooperação sul-sul do governo brasileiro no campo da saúde em Moçambique, mais especificamente o combate ao HIV através da Fábrica de Antirretrovirais. O artigo se divide em (i) revisão histórico-bibliográfica da Saúde como um tema de Relações Internacionais; (ii) um panorama geral sobre a saúde em Moçambique; (iii) um debate histórico-político-conceitual sobre as duas vertentes da Cooperação Internacional para o Desenvolvimento: a Cooperação Norte-Sul e a Cooperação Sul-Sul (iv) um estudo sobre a fábrica de medicamentos antirretrovirais HIV-AIDS, conhecida como Sociedade Moçambicana de Medicamentos. O objetivo do trabalho é, através de um estudo de caso, verificar se as ações brasileiras em Moçambique seguem os conceitos defendidos pela Cooperação Estruturante em Saúde e gerar novos questionamentos para o debate acadêmico.

Percepções e experiências dos homens sobre o planejamento familiar no sul de Moçambique / Perceptions and experiences of men on family planning in southern Mozambique

Resumo O estudo explora as percepções e experiências dos homens sobre o planejamento familiar (PF) em dois contextos do sul de Moçambique: na localidade de Macarretane (província de Gaza) e no bairro da Mafalala (cidade capital, de Maputo). Combinando métodos qualitativos, exploram-se os conhecimentos e práticas dos homens sobre o PF, bem como percebem seu papel (e envolvimento) na saúde sexual reprodutiva e as formas de diálogo e negociação com suas parceiras sobre o PF. O PF foi definido apenas como barreira às gravidezes indesejadas. Os conhecimentos dos homens sobre o PF do ponto de vista biomédico são fracos. Existe a percepção de que os contraceptivos modernos criam efeitos secundários no corpo da mulher, colocando em risco sua capacidade reprodutiva e o prazer sexual. A capacidade ou incapacidade de negociar o uso do PF pelas mulheres é influenciada pelas normas de gênero e pelas masculinidades vigentes. Os homens consideram que o seu papel no PF é de consentir que as parceiras façam planejamento. O diálogo e a articulação em torno do uso dos serviços de PF também são influenciados pelas normas de gênero e padrões de masculinidade.

Abstract The study explores the perceptions and experiences of men about family planning (FP) in two contexts of southern Mozambique: in the locality of Macarretane (Gaza province) and in the Mafalala neighborhood (capital city of Maputo). Combining qualitative methods, men's knowledge and practices about FP are explored, as well as perceiving their role (and involvement) in reproductive sexual health and the forms of dialogue and negotiation with their partners about FP. PF was only defined as a barrier to unwanted pregnancies. Men's knowledge about FP from a biomedical point of view is weak. There is a perception that modern contraceptives create side effects on a woman's body, putting her reproductive capacity and sexual pleasure at risk. The capacity or inability to negotiate the use of FP by women is influenced by gender norms and masculinities in force. Men feel that their role in FP is to allow their partners to plan. Dialogue and articulation around the use of FP services are also influenced by gender norms and patterns of masculinity.

Saúde e desenvolvimento na África Subsaariana: uma reflexão com enfoque em Moçambique / Health and development in Sub-Saharan Africa: a reflection focusing on Mozambique

Resumo O reconhecimento de que a melhoria da saúde da população depende do avanço das condições socioeconômicas é cada vez mais visível nos últimos anos, incentivando mudanças nas políticas nacionais e internacionais. Contudo, em vários países da África Subsaariana, se não todos, essa relação é inversamente proporcional. Assim, com este texto pretende-se refletir sobre a conexão existente entre saúde e desenvolvimento em Moçambique. Esta reflexão oferece uma compreensão sobre o crescimento econômico que se registra no país, porém com maior parte da população a viver em precárias condições e com uma multiplicidade de doenças evitáveis, demonstrando, também, que as políticas adotadas pelo país ainda não favorecem um caminhar conjunto da saúde e desenvolvimento. Essa situação requer que o país aplique políticas de redistribuição de renda e de atenção à saúde em populações mais carentes.

Abstract The recognition that population health improvement is linked to the advancement of socioeconomic conditions is visible in the last years, stimulating changes in national and international policies. However, in several countries from Sub-Saharan Africa, if not in all of them, this relationship is inversely proportional. This article aims at reflecting about the connection between health and development in Mozambique. This reflection offers a comprehension about the economic growth registered in the country, with the great majority of the population living in precarious conditions and with a multiplicity of evitable diseases, demonstrating that the adopted policies do not favor an improvement of health and development. This situation requires the country to apply policies of income redistribution and health care to the most needed population.

Perceptions of Men on Puxa-Puxa, or Labia Minora Elongation, in Tete, Mozambique.

Labia minora elongation has been documented as being practiced by 98.6% of the women in Tete province, Mozambique. Women engage in this procedure before the first menstruation. In this article we report on the findings from the male respondents from Tete province that participated in the qualitative component of the World Health Organization-supported multicountry Gender, Sexuality, and Vaginal Practices study. The men reported that the main motivation behind labia minora elongation is to enhance the sexual pleasure for both female and male partners. Researching what men know and perceive of labia minora elongation is crucial to understanding the contribution of this practice for sexual health. This knowledge is helpful to inform the development of new human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention technologies and culturally appropriate information, education, and communication interventions.

HIV prevalence and risk behaviors among Mozambicans working in South African mines.

Mineworkers are considered a population at risk for HIV due to risk behaviors associated with migratory work patterns. This was the first study in Mozambique to determine the prevalence of HIV and associated demographic and risk behaviors, and assess use and access to prevention and healthcare services among Mozambicans working in South African mines. Men who had worked in a South African mine in the past 12 months were recruited between February and May 2012 using time location sampling (TLS) at the Ressano Garcia border between Mozambique and South Africa. Demographic and behavioral data were collected through a standardized questionnaire, and HIV prevalence was estimated by testing dried blood spots (DBS) with two enzyme immunoassays. In total, 432 eligible mine workers were recruited. Mean age was 43 years. Most were married or cohabitating; among them, 12.6 % had two or more wives/marital partners in Mozambique. In the 12 months preceding the survey, 24.7 % had an occasional sexual partner, and 6.6 % had at least one partner who was a female sex worker. Only one in five (18.5 %) used a condom during last sex. HIV prevalence among mineworkers was 22.3 %, and 74.6 % of those who tested positive as part of the survey did not know their status. HIV prevalence was significantly higher (p = 0.018) among those that were uncircumcised (31.2 %) than those who were circumcised (18.5 %). Multiple partners (multiple spouses, cross-border relations, and multiple occasional partnerships), inconsistent condom use, and a high proportion of infected mineworkers who do not know their HIV status increases the risk of HIV transmission in this population. Combination strategies involving the promotion of condom use, HIV testing, and male circumcision should be strengthened among mineworkers.

Ambulatory blood pressure monitoring profile in urban African black and European white untreated hypertensive patients matched for age and sex.

INTRODUCTION: The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. PATIENTS AND METHODS: ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. RESULTS: Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (P<0.02). Black hypertensive patients versus white hypertensive patients showed higher casual blood pressure (BP) 160/104 ± 19/14 versus 149/97 ± 18/12 mmHg, 24-h ABP 146/92 ± 16/13 versus 139/85 ± 11/10 mmHg, daytime ABP 150/95 ± 16/13 versus 143/88 ± 13/11 mmHg, night-time BP 139/84 ± 17/13 versus 130/78 ± 13/10 mmHg (all P<0.001) and lower night-time BP fall 8.3 ± 6.9 versus 10.1 ± 8.7% (P<0.02) and higher BP variability. Differences were still significant in all decades above 30 years of age and when calculations were carried out separately for both men and women. The average 24-h heart rate did not differ between groups. CONCLUSION: Our data suggest that untreated black hypertensive patients systematically present higher clinic and ABP values and a lower night-time BP fall than untreated white hypertensive patients for all spectra of age distribution. This might be the reason for the worse cardiovascular prognosis described in black hypertensive patients compared with white hypertensive patients.

The practice of puxa-puxa among Mozambican women: a systematic inventory of motives.

Puxa-puxa is the elongation of the labia minora of the genital organs. It is one of the most widespread genital practices among women in Mozambique, and the practice seems to be specific to this country. The motives underlying this practice and its abandonment were examined in a theory-driven way. A total of 616 women currently living in the provinces of Maputo, Zambezia, and Nampula, aged 18 to 62, were presented with one of two questionnaires that contained items about possible motives for practicing puxa-puxa or possible motives for not practicing it. Seven separable motives for practicing puxa-puxa were found, and the most highly rated were "Having a satisfying sexual life"; "Satisfying my sexual partner"; and "Gaining self-control." Five separable motives for not practicing puxa-puxa were found, and the most highly rated were "Disliking a painful practice"; "Affirming one's value as a person"; and "Avoiding contamination." The main findings of the study are that the practice of puxa-puxa is associated with deep psychological motives common to most women in most cultures, namely having a satisfying sexual life with a reliable partner, creating the conditions for having children, and being able to care for them. The abandonment of this practice is largely the result of personal decisions, which are not taken under constraint and which are not exclusively taken from fear of illness.

Convergence in fertility of South Africans and Mozambicans in rural South Africa, 1993-2009.

BACKGROUND: Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war (1977-1992) settled in many neighbouring countries, including South Africa. A large number of Mozambican refugees settled within the Agincourt sub-district, underpinned by a Health and Socio-demographic Surveillance Site (AHDSS), established in 1992, and have remained there. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa. OBJECTIVES: To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans. METHODS: Prospective data from the AHDSS on births from 1993 to 2009 were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change. RESULTS: There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors. CONCLUSION: The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains. There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women.

The epidemiology of 'bewitchment' as a lay-reported cause of death in rural South Africa.

BACKGROUND: Cases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to 'bewitchment' by VA respondents. METHODS: Using 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated. RESULTS: The odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be. CONCLUSIONS: Understanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.

Bridges to nowhere: hosts, migrants, and the chimera of social capital in three African cities.

Interest in migrant social networks and social capital has grown substantially over the past several decades. The relationship between "host" and "migrant" communities remains central to these scholarly debates. Recently urbanized cities in Africa, which include large numbers of "native-born" or internal migrants, challenge basic presumptions about host/migrant distinctions informing many of these discussions. Using comparable survey data from Johannesburg, Maputo, and Nairobi, we examine 1) the nature of social connectedness in terms of residence and nativity characteristics; and 2) the relationship between residence and nativity characteristics and three measures of trust within and across communities. Our findings suggest that the host/migrant distinction may not be particularly revealing in African cities where domestic mobility, social fragmentation and the absence of bridging institutions result in relatively low levels of trust both within and across communities. These findings underscore the need for new concepts to study "communities of strangers" and how people strategize their social mobility in urban contexts.

Spatio-temporal analysis of mortality among children under the age of five in Manhiça (Mozambique) during the period 1997-2005.

BACKGROUND: Reducing childhood mortality is the fourth goal of the Millennium Development Goals agreed at the United Nations Millennium Summit in September 2000. However, childhood mortality in developing countries remains high. Providing an accurate picture of space and time-trend variations in child mortality in a region might generate further ideas for health planning actions to achieve such a reduction. The purpose of this study was to examine the spatio-temporal variation for child mortality rates in Manhiça, a district within the Maputo province of southern rural Mozambique during the period 1997-2005 using a proper generalized linear mixed model. RESULTS: The results showed that childhood mortality in all the area was modified from year to year describing a convex time-trend but the spatial pattern described by the neighbourhood-specific underlying mortality rates did not change during the entire period from 1997 to 2005, where neighbourhoods with highest risks are situated in the peripheral side of the district. The spatial distribution, though more blurred here, was similar to the spatial distribution of child malaria incidence in the same area. The peak in mortality rates observed in 2001 could have been caused by the precipitation system that started in early February 2000, following which heavy rains flooded parts of Mozambique's southern provinces. However, the mortality rates at the end of the period returned to initial values. CONCLUSIONS: The results of this study suggest that the health intervention programmes established in Manhiça to alleviate the effects of flooding on child mortality should cover a period of around five years and that special attention might be focused on eradicating malaria transmission. These outcomes also suggest the utility of suitably modelling space-time trend variations in a region when a point effect of an environmental factor affects all the study area.