Investigating the Feasibility of Child Mortality Surveillance With Postmortem Tissue Sampling: Generating Constructs and Variables to Strengthen Validity and Reliability in Qualitative Research.

BACKGROUND: The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS. METHODS: Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting. RESULTS: Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability. CONCLUSIONS: These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS.

Knowledge and experiences of adolescent girls and young women in the use of sexual reproductive health and HIV services at health facilities in Maputo City, Mozambique.

Background: Knowledge and use of sexual reproductive health and human immunodeficiency virus (SRH and HIV) services are crucial for the prevention of pregnancy and sexually transmitted infections (STIs) among adolescent girls and young women (AGYW). This study aims to assess the knowledge and perceptions of AGYW about the SRH and HIV services offered in health facilities in Maputo, Mozambique. Material and methods: A cross-sectional descriptive study was conducted based on exit surveys with AGYW held at Zimpeto and 1° de Junho Health Facilities in Maputo City, between May 1, and June 9, 2023. Data were analyzed through descriptive statistics, t-test and ANOVA, using SPSS version 20. Results: 590 AGYW, aged 15-24 years of age, were included in the study. In general, knowledge of SRH and HIV services was fairly high, with knowledge of each specific service offered ranging between 38% and 97%. Knowledge about SRH and HIV services differed depending on the health facility where the AGYW sought SRH and HIV services; the participant's age; their occupation; their religion, and who they lived with. Counseling services were the most commonly reported services attended, with >90% of participants reporting having received counseling for each of the following: STI and HIV and pregnancy prevention, sexuality, and safer sex practices. The quality of SRH and HIV services, and attitudes of the providers were considered good by >90% of AGYW. Roughly 95% of AGYW at Zimpeto Health Facility were either "satisfied" or "very satisfied". Whereas at 1° de Junho Health Facility, only roughly 75% of AGYW were either "satisfied" or "very satisfied", and roughly 20% of AGYW were "little satisfied that their needs had been met that day. Conclusions: Among AGYW there is high levels of knowledge about counseling services in contrast to diagnostics, treatment and clinical care. Specific attention should be given to ensuring appropriate physical infrastructure, such as dedicated adolescent friendly spaces and comfortable seating, and targeted interventions designed and implemented for those health facilities's identified. Targeted interventions should be designed and implemented for those HF's identified with lower AGYW perceived quality of service delivery.