Perceptions on use of insecticide-treated bed nets to prevent malaria: a qualitative assessment in two rural districts of Zambézia province in Mozambique.

Background: Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. The insecticide-treated bed nets (ITNs) are one of the malaria control strategies that, due to their cost effectiveness, are largely used in the country. Data on the actual coverage and usage of bed nets is unreliable, as it is based only on administrative data from distributed ITNs. Objective: This study assesses knowledge about malaria and bed net use in two areas of high malaria transmission. Methods: A qualitative study was conducted in 6 (six) rural communities in two malaria high-burden districts in Zambézia province. About 96 adults were recruited from the communities and enrolled to participate in focus group discussions. Data were transcribed verbatim, coded, and thematically analyzed using Nvivo11.0. Results: Participants mentioned the mosquito as the only cause of malaria and that the use of bed nets was highlighted as the most proficient protection against mosquito bites and malaria. Children and pregnant women were described as being the priority groups to sleep under a bed net protection in the household. The use of bed nets was common among households, although not sufficient for the number of household members. In addition, the preservation of the nets was considered inadequate. Conclusions: The findings of this study highlight the need to increase public knowledge about malaria and nets and to strengthen the communication and logistics component of the net distribution campaign to ensure that households have enough nets for their members and use them appropriately.

The Use of Research for Health Systems Policy Development and Implementation in Mozambique: A Descriptive Study.

Health policy and systems research (HPSR) is generating an increasing amount of evidence in Mozambique, where implementation of a wide range of public health policies and interventions, and innovative technologies and solutions, is underway. We used qualitative methods to explore the relationship between HPSR and policy development and implementation in Mozambique. We conducted a literature review and in-depth interviews with researchers, experts, and policy makers. Through our analysis, we assessed barriers to the use of research evidence in the development and implementation of national health policies and identified potential opportunities to improve evidence use in this context.We found an increasing number of research institutions producing solid scientific evidence in the country, with activities in health in general and health systems specifically. There is also a growing trend for decision makers and policy makers to use the results of research during the design, formulation, and implementation of health policies. Most HPSR conducted in Mozambique is funded by international donors and focused on research questions of international interest. Therefore, research generated in Mozambique does not always address questions that are relevant to the local health system development agenda.While Mozambique has a lot of "gray literature" outlets, few of its publications support the translation of research evidence into policy. Much of the evidence generated in country is disseminated through project reports and briefings, not peer-reviewed literature. Furthermore, when the research evidence generated is not locally relevant, results may be published only in English and in scientific articles, instead of in formats useful to Mozambican policy makers-to the detriment of national-level understanding and use. We recommend that research institutions and policy makers in Mozambique collaborate on developing a platform that consolidates HPSR, making it more accessible and useful to policy makers.

Uso de máscaras para prevenção da covid-19 em lugares públicos na cidade de maputo / Use of masks to prevent covid-19 in public places in the city of Maputo

As máscaras faciais são efectivas para prevenção de infecções respiratórias, e o seu uso constitui uma medida eficaz para prevenção da disseminação de agentes transmitidos por via respiratória. Foi desenhado um estudo observacional quanti-qualitativo em alguns supermercados, mercados e paragens de transportes semi-colecivo de passageiros na cidade de Maputo, com o objectivo de caracterizar o uso de máscaras em lugares públicos, bem como o conhecimento e compreensão da importância do uso das mesmas para a prevenção da COVID-19. A amostragem foi por conveniência, os dados foram colhidos por observação e através de entrevistas em profundidade. Nos primeiros dois dias do estudo, foram observados 4,150 indivíduos, 48.9% dos quais em mercados. Dentre os indivíduos observados 90.2% usavam máscara, mas 27.5% não as usavam correctamente. As máscaras eram maioritariamente de fabrico caseiro (85.3%) - apenas 8.2% usavam máscaras cirúrgicas. Os indivíduos entrevistados que não usavam correctamente as máscaras alegaram que estas causavam alergia ou sensação de asfixia, principalmente em pessoas com doença respiratória. Estes resultados mostram a necessidade de maior difusão de informação sobre o uso de máscaras e divulgação de informação sobre mecanismos de prevenção da COVID-19

Relatório preliminar do estudo de avaliação de uso de máscaras no âmbito da prevenção da COVID-19 em lugares públicos - O caso da Cidade de Maputo / reliminary report of the study to evaluate the use of masks as part of the prevention of COVID-19 in public places - The case of Maputo City

As máscaras faciais são efectivas para prevenção de infecções respiratórias. O uso destas durante epidemias ou surtos de doenças virais de vias respiratórias constitui uma medida eficaz para prevenção da disseminação do vírus. Com objectivo de avaliar o nível de cumprimento das medidas de prevenção da COVID-19, a luz do decreto presidencial 12/2020, O INS realizou o presente estudo com o propósito de analisar até que ponto as pessoas estão usando máscaras apropriadas e correctamente e, se sabem da importância do uso das mesmas. Trata-se de um estudo observacional quanti-qualitativo, que decorreu no período de 26 de Abril a 03 de Junho de 2020, em alguns supermercados, mercados e paragens de transporte de passageiros na cidade de Maputo. A amostragem foi por conveniência e a duração das observações por cada local selecionado foi de duas horas. Para além das observações, foram também realizadas algumas entrevistas em profundidade com objectivo de avaliar aspectos ligados a conhecimentos, atitudes e práticas sobre o uso de máscaras no âmbito da prevenção da COVID- 19. Durante os primeiros dois dias do estudo, foram observados um total de 4,150 indivíduos dos quais quase metade (48.9%) foram observados nos mercados. Dos indivíduos observados, mais da metade (55.4%) eram adultos e na sua maioria de sexo masculino (50.6%). Do total destes indivíduos observados, mais de três quartos (90.2%) usavam algum tipo de máscara como meio de prevenção da COVID-19, apesar de cerca de um em cada dez indivíduo observado (27.5%) não apresentarem-se com as máscaras correctamente usadas. Em ralação ao tipo de máscaras, a maioria dos indivíduos observados usavam máscaras de fábrico caseiro (85.3%) seguido de máscaras cirurgicas (8.2%). Os resultados do estudo mostram que quase todos os indivíduos que se fazem aos mercados e supermercados e paragens de transporte de passageiros, tem conhecimento da utilidade e importância do uso da máscara na prevenção da COVID-19. Contudo muitos o usam por causa da obrigatoriedade exigida em locais públicos de grandes aglomerados. Persistem ainda casos de indivíduos que não usam correctamente as máscaras, alegando que o uso da máscara causa alergia ou sensassão de asfixia, principalmente para pessoas com problemas de índole respiratória. O estudo mostra qua há necessidade de maior difusão de forma didáctica e pedagógica do uso de máscaras, responsabilização de algumas estruturas governativas na fiscalização do cumprimento das normas de prevenção da COVID-19 e disponibilidade de mais espaços de antena nos órgãos de comunicação social, para mais divulgação de informação sobre mecanismos de prevenção da COVID-19.

HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: The need for increasing awareness and knowledge.

BACKGROUND: As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. METHODS: A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. RESULTS: A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6-27.0) and was higher in the rural community (31.6%; 95% CI: 27.0-35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. CONCLUSION: The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.

HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: the need for increasing awareness and knowledge

As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. Methods A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. Results A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6­27.0) and was higher in the rural community (31.6%; 95% CI: 27.0­35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. Conclusion The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.

Community knowledge and acceptance of indoor residual spraying for malaria prevention in Mozambique: a qualitative study.

BACKGROUND: Malaria control remains a leading health challenge in Mozambique. Indoor residual spraying (IRS) is an effective strategy to control malaria transmission, but there are often barriers to reaching the coverage necessary for attaining maximum community protective effect of IRS. Mozambique recorded a high number of household refusals during the 2016 IRS campaign. This study sought to evaluate household and community factors related to the acceptability of IRS to inform strategies for future campaigns in Mozambique and the region. METHODS: A cross-sectional, qualitative study was conducted in eight urban and rural communities in two high malaria burden provinces in Mozambique. Data were collected through in-depth interviews with community members, leaders, sprayers, and representatives of district health directorates; focus group discussions with community members who accepted and who refused IRS during the 2016 campaign; systematic field observations; and informal conversations. Data were systematically coded and analysed using NVIVO-11®. RESULTS: A total of 61 interviews and 12 discussions were conducted. Community participants predominantly described IRS as safe, but many felt that it had limited efficacy. The main factors that participants mentioned as having influenced their IRS acceptance or refusal were: understanding of IRS; community leader level of support; characteristics of IRS programmatic implementation; environmental, political and historical factors. Specifically, IRS acceptance was higher when there was perceived community solidarity through IRS acceptance, desire to reduce the insect population in homes, trust in government and community satisfaction with past IRS campaign effectiveness. Participants who refused were mainly from urban districts and were more educated. The main barriers to acceptance were associated with selection and performance of spray operators, negative experiences from previous campaigns, political-partisan conflicts, difficulty in removing heavy or numerous household assets, and preference for insecticide-treated nets over IRS. CONCLUSIONS: Acceptance of IRS was influenced by diverse operational and contextual factors. As such, future IRS communications in targeted communities should emphasize the importance of high IRS coverage for promoting both familial and community health. Additionally, clear communications and engagement with community leaders during spray operator selection and spray implementation may help reduce barriers to IRS acceptance.

A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique.

INTRODUCTION: While planning an immunization campaign in settings where public health interventions are subject to politically motivated resistance, designing context-based social mobilization strategies is critical to ensure community acceptability. In preparation for an Oral Cholera Vaccine campaign implemented in Nampula, Mozambique, in November 2016, we assessed potential barriers and levers for vaccine acceptability. METHODS: Questionnaires, in-depth interviews, and focus group discussions, as well as observations, were conducted before the campaign. The participants included central and district level government informants (national immunization program, logistics officers, public health directors, and others), community leaders and representatives, and community members. RESULTS: During previous well chlorination interventions, some government representatives and health agents were attacked, because they were believed to be responsible for spreading cholera instead of purifying the wells. Politically motivated resistance to cholera interventions resurfaced when an OCV campaign was considered. Respondents also reported vaccine hesitancy related to experiences of problems during school-based vaccine introduction, rumors related to vaccine safety, and negative experiences following routine childhood immunization. Despite major suspicions associated with the OCV campaign, respondents' perceived vulnerability to cholera and its perceived severity seem to override potential anticipated OCV vaccine hesitancy. DISCUSSION: Potential hesitancy towards the OCV campaign is grounded in global insecurity, social disequilibrium, and perceived institutional negligence, which reinforces a representation of estrangement from the central government, triggering suspicions on its intentions in implementing the OCV campaign. Recommendations include a strong involvement of community leaders, which is important for successful social mobilization; representatives of different political parties should be equally involved in social mobilization efforts, before and during campaigns; and public health officials should promote other planned interventions to mitigate the lack of trust associated with perceived institutional negligence. Successful past initiatives include public intake of purified water or newly introduced medication by social mobilizers, teachers or credible leaders.

Prevalence of HIV and Associated Risk Factors Among Long Distance Truck Drivers in Inchope, Mozambique, 2012.

This is the first integrated biological and behavioral surveillance survey among long-distance truck drivers (LDTD) in Mozambique. Using modified time-location sampling in 2012 at a key transportation junction (Inchope), we enrolled 327 male LDTD. HIV prevalence was 15.4 % (95 % confidence interval : 11.4-19.4 %, n = 318 tested). Among HIV-positive LDTD, 83.7 % did not know their status. One-third of LDTD had never tested for HIV and three-quarters had not received free condoms, lubricants or HIV literature in the past 12 months. In that same period, 61.4 % of LDTD had at least four sexual partners and 27.1 % paid for sex. Among sexually-active LDTD, 76.5 % did not use a condom at last sex. HIV was associated (p < 0.05) with primary education or lower (AOR 2.1), residence in Mozambique (AOR 2.3) and never having tested for HIV (AOR 2.2). Our findings reveal that broader coverage of HIV prevention and comprehensive care services for LDTD are urgently needed.

High Burden of HIV Infection and Risk Behaviors Among Female Sex Workers in Three Main Urban Areas of Mozambique.

This is the first integrated biological and behavioral survey among female sex workers (FSW) in Mozambique. Using respondent-driven sampling, 400, 411 and 429 FSW were enrolled respectively in Maputo, Beira and Nampula in 2011-2012. Estimates were produced using RDSAT 7.1. HIV prevalence was 31.2, 23.6, and 17.8 % in each location respectively. Among HIV-positive FSW, 48.1, 79.8 and 89.6 % in each city, were unaware of their serostatus. Condom use at last sex with a client was 85.8, 73.4 and 62.8 % among FSW, respectively. HIV was associated with current age, age of first sex for money, low educational level, and having had a genital ulcer in the last 6 months. Results suggest the urgent need to increase behavioral and structural interventions in this key population.

Avaliação da tendência da utilização dos serviços de saúde amigos de adolescentes e jovens (saaj) e seus determinantes no hospital central de maputo e cantos de aconselhamento pelos adolescentes e jovens da cidade de maputo, moçambique (2008 a 2010) / Evaluation of the trend of utilization of adolescent and youth friendly health services (saaj) and its determinants at maputo central hospital and counseling corners by adolescents and youth in maputo city, mozambique (2008 to 2010)

Em Moçambique, os Adolescentes e Jovens (AJ) têm enfrentado múltiplos riscos e desafios durante a sua transição para a idade adulta. Estudos têm demonstrado que muitos AJ morrem prematuramente devido a acidentes, suicídio, violência, complicações relacionadas com a gravidez e outros problemas/eventos de interesse para a saúde pública que podem ser prevenidos ou tratados. Informações sobre tendências da utilização dos Serviços de Saúde Amigos de Adolescentes e Jovens (SAAJ) em Moçambique ainda são escassas. Este estudo visava avaliar a tendência da utilização do SAAJ e seus determinantes no Hospital Central de Maputo e Cantos de Aconselhamento das Escolas sob tutela dos SAAJ, pelos adolescentes e jovens da Cidade de Maputo. Método: O estudo decorreu no SAAJ do HCM e Cantos de Aconselhamento das Escolas Secundárias, Comercial e Industrial, sob tutela do SAAJ do HCM. A população do estudo foi constituída por AJ (homens e mulheres) dos 15 a 26 anos de idade, provedores do SAAJ do HCM (activistas e enfermeiras) e professores responsáveis pelos cantos de aconselhamento das escolas seleccionadas. Foi usada uma abordagem mista para responder os objectivos do estudo, sendo a abordagem retrospectiva para avaliar a tendência da utilização dos serviços do SAAJ com base nos dados de registo do período entre 2008 a 2010 e; abordagem transversal para identificação de determinantes associados a procura e utilização dos serviços do SAAJ, com base nos dados obtidos através de entrevistas individuais entre Abril a Maio de 2012. As informações dos dados quantitativos foram gerados a partir das bases de dados e analisados com recurso ao programa estatístico SPSS versão 15 e os qualitativos gerados a partir de perguntas abertas contidas nos questionários auto-administrados e analisados com recurso ao Software qualitativo MAXQda...

In Mozambique, Adolescents and Youth have faced multiple risks and challenges during their transition to adult age. Studies have shown that many adolescents and young people die prematurely from accidents, suicide, violence and complications related to pregnancy and other problems / events of public health interest that can be prevented or treated. Information's about youth friendly services (YFS) trends and utilization in Mozambique are still scarce. This study aimed to assess the trend of YFS utilization "SAAJ" and its determinants in Maputo Central Hospital (HCM) and School Counseling Corners related to this by youth in Maputo City. Method: The study took place at HCM YFS and at the Secondary, Commercial and Industrial School Counseling Corners, under the HCM YFS supervision. The study population was composed by adolescent and youth (men and women) with 15 to 26-years-old, HCM youth frendly service providers (activists and nurses) and teachers responsible for counseling corners of the selected schools. A mixed approach was used to tucle the study objectives,when retrospective approach was used to assess the trend of YFS use based on the registred data between 2008 to 2010period, and; cross sectional approach to identify associated determinants related to demand and use of YFS, based on data obtained through individual interviews from April to May 2012. The quantitative data informations were generated from databases and analyzed using the SPSS version 15 and qualitative generated from open questions contained in the self-administered questionnaires and analyzed using the MAXQda qualitative software…

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.