Labour migration and food security in rural Mozambique: Do agricultural investment, asset building and local employment matter?

Connections between labour migration and food security of left-behind households are still poorly understood. Using data from two waves of a longitudinal survey conducted among ever-married women in rural Mozambique, we employ multi-level ordered logit and negative binomial regressions to examine over time three possible pathways linking men's migration and its economic success to food security of left-behind households-agricultural investment, household material assets and women's local gainful employment. Our analyses find a significant positive association between migration's success, proxied by remittances, and food security and show that this association is largely mediated by household's possession of material assets.

Características Sociodemográficas e Risco de Transmissão da COVID-19 em Moçambique / Sociodemographic Characteristics and Transmission Risk of COVID-19 in Mozambique

Objectivo: Mapear o potencial risco de transmissão do novo coronavírus em Moçambique de modo a identificar os distritos cujas características sociodemográficas favorecem a propagação do vírus. Métodos: Usou-se a modelação espacial para determinar o risco relativo de propagação da COVID-19 num distrito em relação ao outro com base nos seguintes factores sociodemográficos: densidade populacional, tamanho médio de agregado familiar, percentagem da população jovem de 15-34 anos e percentagem da população que vive num raio de 2 km de uma estrada classificada. Primeiro, para cada factor foi estimado um risco relativo dividindo os distritos em quintis, e, em segundo lugar, os riscos individuais de cada factor foram somados com igual peso para estimar o risco agregado de transmissão da COVID-19 por distrito. Resultados: Dezanove distritos localizados sobretudo nos principais centros urbanos e no corredor da Beira apresentam alto risco de propagação da COVID-19 em função das suas características sociodemográficas; 24 distritos mostram risco médio-alto e distribuem-se pelas regiões centro e sul do país; 60 distritos localizados nas regiões centro e sul e no interior da região norte apresentam risco médio e; 58 distritos mostram risco médio-baixo ou baixo de transmissão da COVID-19 e encontram-se no litoral centro-norte do país. Conclusão: Os distritos cujo perfil sociodemográfico é favorável à rápida propagação do novo coronavírus são os das grandes cidades e os localizados nas principais rotas de transporte. No entanto, este padrão de risco é susceptível de alterações em função da celeridade, abrangência e níveis de observância das medidas de prevenção e/ou de mitigação da COVID-19. Assim, recomenda-se que as medidas de prevenção e mitigação tenham em conta o risco potencial em cada distrito em função das suas características sociodemográficas.

Objective: To map the potential risk of COVID-19 transmission in Mozambique in order to identify districts with sociodemographic characteristics that favour the spread of coronavirus. Methods: Spatial modelling was used to determine the relative risk of COVID-19 transmission in a certain district in relation to other districts based on the following sociodemographic factors: population density, mean number of household members, the percentage of the young population aged 15-34 and the proportion of a district's population living within two kilometres of a classified road. First, a relative risk due to each factor was estimated grouping the districts into quintiles and, second, the individual risks were added with equal weight to estimate the aggregate relative risk of COVID-19 transmission per district. Results: Nineteen districts located in the main urban centres and along the Beira corridor were found to be at a high relative risk of COVID-19 transmission; 24 districts located mainly in central and southern regions display a medium-high risk category; 60 districts located in the central and southern regions and in the hinterland of the northern region show a medium risk category and; 58 districts exhibit a medium-low or low risk category of COVID-19 transmission and are mainly located at the eastern part of the central-north region. Conclusion: The districts with sociodemographic profile favouring the spread of the new coronavirus are those in the big cities and those located along the main transportation routes. However, the pattern of risk is subject to changes due to the speed, coverage and level of compliance with COVID-19 prevention and mitigation measures. It is recommended that COVID-19 prevention and mitigation measures should take into account the potential risk of each district.

Area-Level Normative Social Context and Intimate Partner Physical Violence in Mozambique.

Violence against women is considered a serious public health problem. It is estimated that about 30% of women who have been in a relationship in the world have experienced some form of physical or sexual violence from their intimate partners. In sub-Saharan Africa, one of the regions in the world with the highest prevalence of intimate partner violence, there have been studies of factors associated with intimate partner violence. However, few studies have explicitly examined the influence of the normative social context on women's accepting attitudes toward spousal abuse and their risk of experiencing intimate partner violence in the region. Using data from the 2011 Demographic and Health Survey in Mozambique, we employ multilevel logistic regression to examine the influence of area-level normative social context factors on 4,864 women's accepting attitudes toward spousal abuse and their likelihood of experiencing intimate partner physical violence in Mozambique. Our findings revealed the importance of religious norms in geographic areas as key predictors of women's acceptance of intimate partner violence. Specifically, area-level normative religious predictors were negatively associated with women's acceptance of spousal abuse. The prevalence of early marriages in a given geographic area was positively associated with both acceptance of spousal abuse and experiencing intimate partner physical violence. The level of female education in a geographic area was negatively associated with accepting spousal abuse and having experienced intimate partner physical violence. As intimate partner physical violence in sub-Saharan Africa continues unabated, programs and interventions to address the problem will need to consider the normative context of geographic areas.

Religion and Use of Institutional Child Delivery Services: Individual and Contextual Pathways in Mozambique.

CONTEXT: Research on institutional child delivery in Sub-Saharan Africa typically focuses on availability and accessibility of health facilities. Cultural factors, including religion, that may facilitate or hinder the use of such services have not been well examined and remain poorly understood. METHODS: The relationship between religious affiliation and delivery in a health facility was explored using data from a household survey of 1,297 women aged 18-50 and a census of 825 religious congregations, both conducted in a predominantly Christian district in Mozambique in 2008. Multilevel logistic regression analyses were conducted to predict the likelihood of recent institutional delivery according to both individual religious affiliation and the concentration of religious congregations of certain denominations in the community of residence. RESULTS: Approximately 63% of deliveries occurred in a health facility. The odds of such deliveries were lower among women who belonged to Apostolic churches or had no religious affiliation than among members of Catholic or mainline Protestant churches, net of other factors (odds ratios, 0.5 and 0.6, respectively). In addition, regardless of a woman's religion, the odds that she had an institutional delivery increased by 9% for each additional Catholic or mainline Protestant congregation in her community of residence (1.1). CONCLUSIONS: Organized religion is associated with critical health outcomes in Mozambique and, potentially, in other Sub-Saharan African contexts. Policymakers should consider designing programs and interventions that promote the use of institutional delivery services among members of religious groups characterized by low use of these services and in areas where such religious groups have a strong presence.

RESUMEN Contexto: La investigación sobre los servicios institucionales de parto en África Subsahariana se enfoca generalmente en la disponibilidad y accesibilidad de las instituciones de salud. Los factores culturales, incluida la religión, que pueden facilitar o dificultar el uso de dichos servicios no han sido examinados a fondo y siguen siendo deficientemente comprendidos. Métodos: Se exploró la relación entre la afiliación religiosa y el hecho de atender el parto en una institución de salud mediante el uso de datos de una encuesta de hogares de 1,297 mujeres en edades de 18­50 años y un censo de 825 congregaciones religiosas. Ambos estudios se llevaron a cabo en 2008, en un distrito predominantemente cristiano en Mozambique. Se realizaron análisis de regresión logística multinivel para predecir la probabilidad de un parto institucional reciente con base tanto en la afiliación religiosa individual como en la concentración de congregaciones religiosas de ciertas denominaciones en la comunidad de residencia. Resultados: Aproximadamente, el 63% de los partos tuvieron lugar en una institución de salud. Las probabilidades de ese tipo de partos fueron menores en mujeres que pertenecían a las iglesias apostólicas (razón de probabilidades, 0.5) o que no tenían una afiliación religiosa (0.6), que en miembros de las iglesias católica o protestantes históricas, independientemente de otros factores. Además, sin importar la religión, las probabilidades de que una mujer hubiera tenido un parto institucional aumentaron en 9% por cada congregación católica o protestante histórica adicional en su comunidad de residencia (1.1). Conclusiones: La religión organizada puede tener una influencia fundamental en los resultados de salud en Mozambique y, potencialmente, en otros contextos de África subsahariana. Los encargados de formular políticas deben considerar el diseño de programas e intervenciones que promuevan el uso de servicios de parto institucionales entre miembros de grupos religiosos caracterizados por un reducido uso de estos servicios y en áreas en donde tales grupos religiosos tienen una presencia significativa.

RÉSUMÉ Contexte: La recherche sur l'accouchement médicalisé en Afrique subsaharienne se concentre généralement sur la disponibilité et l'accessibilité de structures sanitaires. Les facteurs culturels, y compris la religion, qui peuvent faciliter ou entraver le recours à ces services ne sont guère examinés et restent mal compris. Méthodes: Le rapport entre l'affiliation religieuse et l'accouchement en établissement de santé a été étudié sur la base des données d'une enquête de ménages concernant 1 297 femmes âgées de 18 à 50 ans et d'un recensement de 825 congrégations religieuses, menés tous deux dans un district principalement chrétien du Mozambique en 2008. Des analyses de régression logistique multiniveaux ont été effectuées pour prédire la probabilité d'un accouchement récent en milieu médicalisé en fonction de l'affiliation religieuse individuelle et de la concentration de congrégations religieuses de certaines confessions dans la communauté de résidence. Résultats: Environ 63% des accouchements avaient eu lieu en structure sanitaire. La probabilité de ces accouchements était moindre parmi les femmes membres d'Églises apostoliques (RC, 0,5) ou sans affiliation religieuse (0,6), par rapport aux membres de l'Église catholique ou des Églises protestantes traditionnelles, après correction d'autres facteurs. De plus, indépendamment de la religion de la femme, la probabilité qu'elle ait accouché en milieu médicalisé augmentait de 9% par congrégation catholique ou protestante traditionnelle dénombrée dans sa communauté de résidence (1,1). Conclusions: La religion organisée peut affecter d'importants résultats de santé au Mozambique et, potentiellement, dans d'autres contextes d'Afrique subsaharienne. Les décideurs politiques doivent envisager la conception de programmes et d'interventions qui favorisent le recours aux services d'accouchement médicalisé parmi les membres des groupes religieux caractérisés par un faible recours à ces services et dans les zones où ces groupes ont une forte présence.

Determinants of poor self-rated health among adults in urban Mozambique.

BACKGROUND: Self-rated health is a measure expressing the general condition of health of individuals. Self-rated health studies are common in developed countries and in some developing regions. Despite increasing proportion of adult and older population in sub-Saharan Africa and poor population health indicators, there is a dearth of studies on self-rated health in the region. This study examines factors associated with poor self-rated health among adult individuals in Maputo metropolitan area in Mozambique. METHODS: Data for this study come from a survey of 1768 individuals aged 18 years or more carried out in Maputo metropolitan area, Mozambique, in 2015. Employing multiple logistic regression, the study used a subsample of 677 female and male respondents aged 40 years or more to estimate the determinants of poor self-rated health. RESULTS: About 54 % of respondents aged 40 years or more believed that their health status was poor. Female respondents [Odds Ratios (OR) = 3.43, p <0.01], single (OR = 4.71, p < 0.05), widow (OR = 1.81, p < 0.05), separated or divorced (OR = 2.08, p < 0.05) and those believing that hypertension or heart problem was a major community health problem (OR = 1.56, p < 0.05) displayed higher odds of reporting poor health than their peers, net of other factors. Furthermore, individuals aged 40-49 years (OR = 0.45, p < 0.01), or 50-59 years (OR = 0.59, p < 0.05), those whose work involves intensive physical activity (OR = 0.60, p < 0.05) and those from households treating drinking water (OR = 0.49, p < 0.01) showed lower odds of reporting poor health, adjusting for other factors. CONCLUSION: Overall, the results point to the importance of age, gender, marital status, socioeconomic circumstances, individuals' health behaviors and perceived community health problems as key determinants of poor self-rated health among adults in Maputo metropolitan area. Given the growing number of adult and older people in sub-Saharan Africa, the rising importance of non-communicable diseases and the scarcity of studies on determinants of poor self-rated health among adults in the region, our findings may have implications for a better understanding of the drivers of poor health among adults in urban sub-Saharan Africa.

Female Migration, Local Context and Contraception Use in Urban Mozambique.

Although there are studies of the influence of rural-urban migration on contraceptive use in Africa, one question poorly explored is how the urban destination context shapes rural-urban migrants' use of contraceptives. Using data from the 2003 Mozambique Demographic and Health Survey, we examine the effect of community context in urban areas on recent female migrants' use of modern contraceptives. We find that recent female migrants, particularly newer migrants, have disadvantages in using modern contraceptives. We also find that the context of migrants' receiving areas in urban areas shapes migrants' use of contraceptives. Living in a community with high percentage of women who discussed family planning with others, in a community with high level of female education or in a wealthy community has a positive effect on using modern contraceptives. While residing in a community with major transport problems has a negative effect. The study finds, however, that it is the persisting high level of strong fertility desires which is a major barrier to contraceptive use in urban communities.

Community influences on contraceptive use in Mozambique.

Fertility in sub-Saharan Africa remains the highest in the world. Yet, the average contraceptive prevalence in Africa is the lowest in major world regions and there is limited understanding of the mechanisms through which community context shapes contraceptive use in the region. Using data from the 2011 Mozambique Demographic and Health Survey, we examine the mechanisms through which community context influences women's use of modern methods of contraception in Mozambique. We find that community context influences the use of modern methods of contraception by shaping the environment in which women live.

Religious affiliation and under-five mortality in Mozambique.

The influence of religion on health remains a subject of considerable debate both in developed and developing settings. This study examines the connection between the religious affiliation of the mother and under-five mortality in Mozambique. It uses unique retrospective survey data collected in a predominantly Christian area in Mozambique to compare under-five mortality between children of women affiliated to organized religion and children of non-affiliated women. It finds that mother's affiliation to any religious organization, as compared with non-affiliation, has a significant positive effect on child survival net of education and other socio-demographic factors. When the effects of affiliation to specific denominational groups are examined, only affiliation to the Catholic or mainstream Protestant churches and affiliation to Apostolic churches are significantly associated with improved child survival. It is argued that the advantages of these groups may be achieved through different mechanisms: the favourable effect on child survival of having mothers affiliated to the Catholic or mainstream Protestant churches is probably due to these churches' stronger connections to the health sector, while the beneficial effect of having an Apostolic mother is probably related to strong social ties and mutual support in Apostolic congregations. The findings thus shed light on multiple pathways through which organized religion can affect child health and survival in sub-Saharan Africa and similar developing settings.

Labor migration and child mortality in Mozambique.

Male labor migration is widespread in many parts of the world, yet its consequences for child outcomes and especially childhood mortality remain unclear. Male labor migration could bring benefits, in the form of remittances, to the families that remain behind and thus help child survival. Alternatively, the absence of a male adult could imperil the household's well-being and its ability to care for its members, increasing child mortality risks. In this analysis, we use longitudinal survey data from Mozambique collected in 2006 and 2009 to examine the association between male labor migration and under-five mortality in families that remain behind. Using a simple migrant/non-migrant dichotomy, we find no difference in mortality rates across migrant and non-migrant men's children. When we separated successful from unsuccessful migration based on the wife's perception, however, stark contrasts emerge: children of successful migrants have the lowest mortality, followed by children of non-migrant men, followed by the children of unsuccessful migrants. Our results illustrate the need to account for the diversity of men's labor migration experience in examining the effects of migration on left-behind households.

Men's migration and women's fertility in rural Mozambique.

Labor migration profoundly affects households throughout rural Africa. This study looks at how men's labor migration influences marital fertility in a context where such migration has been massive while its economic returns are increasingly uncertain. Using data from a survey of married women in southern Mozambique, we start with an event-history analysis of birth rates among women married to migrants and those married to nonmigrants. The model detects a lower birth rate among migrants' wives, which tends to be partially compensated for by an increased birth rate upon cessation of migration. An analysis of women's lifetime fertility shows that it decreases as the time spent in migration by their husbands accrues. When we compare reproductive intentions stated by respondents with migrant and nonmigrant husbands, we find that migrants' wives are more likely to want another child regardless of the number of living children, but the difference is significant only for women who see migration as economically benefiting their households. Yet, such women are also significantly more likely to use modern contraception than other women. We interpret these results in light of the debate on enhancing versus disrupting effects of labor migration on families and households in contemporary developing settings.

Health Costs of Wealth Gains: Labor Migration and Perceptions of HIV/AIDS Risks in Mozambique.

The study employs survey data from rural Mozambique to examine how men's labor migration affects their non-migrating wives' perceptions of HIV/AIDS risks. Using a conceptual framework centered on tradeoffs between economic security and health risks that men's migration entails for their left-behind wives, it compares women married to migrants and those married to non-migrants while also distinguishing between economically successful and unsuccessful migration. The analysis finds that the economic success of men's migration, rather than migration itself, significantly predicts women's worries about getting infected by their husbands or their own extramarital partners, and their husbands' stance on condom use. These findings are situated within a broader context of socio-economic, gender, and marital dynamics and vulnerabilities produced or amplified by male labor migration in sub-Saharan and similar developing settings.