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 Much of the evidence generated in country is disseminated through project reports and briefings, not peer-reviewed literature.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.

Adherence to COVID-19 Preventive Measures in Mozambique: Two Consecutive Online Surveys.

We assessed adherence to government recommendations implemented shortly after the introduction of COVID-19 in Mozambique in March 2020, through two online cross-sectional surveys in April and June 2020. We quantified adherence to preventive measures by a composite score comprising of five measures: physical distancing, face mask use, hand hygiene, cough hygiene, and avoidance of touching the face. 3770 and 1115 persons participated in the first and second round respectively. Wearing face masks, regular handwashing and cough hygiene all reached compliance rates of over 90% while physical distancing and avoiding to touch the face reached a compliance rate of 80-90%. A multivariable model investigating factors associated with adherence found that being older, more educated, and belonging to the healthcare sector increased the odds for higher adherence. Private workers and retired people, respondents receiving COVID-19 information through social media, and those who reported flu-like symptoms were less likely to adhere. 6% of respondents reported flu-like symptoms which aligned with the WHO clinical definition of COVID-19, suggesting low level community transmission. In conclusion, most respondents in this online survey in Mozambique complied well with strategies to prevent COVID-19. Whether the good preventive behaviour explains the low grade COVID-19 transmission requires further study.

Adherence to COVID-19 Preventive Measures in Mozambique: Two Consecutive Online Surveys

We assessed adherence to government recommendations implemented shortly after the introduction of COVID-19 in Mozambique in March 2020, through two online cross-sectional surveys in April and June 2020. We quantified adherence to preventive measures by a composite score comprising of five measures: physical distancing, face mask use, hand hygiene, cough hygiene, and avoidance of touching the face. 3770 and 1115 persons participated in the first and second round respectively. Wearing face masks, regular handwashing and cough hygiene all reached compliance rates of over 90% while physical distancing and avoiding to touch the face reached a compliance rate of 80-90%. A multivariable model investigating factors associated with adherence found that being older, more educated, and belonging to the healthcare sector increased the odds for higher adherence. Private workers and retired people, respondents receiving COVID-19 information through social media, and those who reported flu-like symptoms were less likely to adhere. 6% of respondents reported flu-like symptoms which aligned with the WHO clinical definition of COVID-19, suggesting low level community transmission. In conclusion, most respondents in this online survey in Mozambique complied well with strategies to prevent COVID-19. Whether the good preventive behaviour explains the low grade COVID-19 transmission requires further study.

Response of the social systems to Covid-19 in Mozambique, Tanzania and Zambia: A synthesis of the challenges and opportunities

Objective: This synthesis aimed to assess prevailing social systems and behaviours to identify challenges and opportunities towards COVID-19 responses in Mozambique, Tanzania and Zambia. Methods: We searched information using set of broad topic-related terms to include articles and documents reporting country specific information on the identified factions of the social systems. The sources included country specific websites, Pub-Med, Google and Google scholar, with full text documents retrieved from HINARI. Results: The challenges identified include media's overemphasis of contagious nature of the disease leading into resentment of the infected people in the community; the cultural practices such as greetings by shaking hands and large gatherings in weddings and funerals which are likely to increase risks of transmission of COVID-19; limited access to water challenging hand washing practices; and unreliable income sources to majority of the community members leading to reliance on daily informal activities to earn a living. All such activities make physical distancing less practical. The opportunities included involvement of religious institutions in provision of health education; enhancing risk communication with the public through different digital and traditional media channels; and the extended family living arrangements as protection to vulnerable elderly population. Conclusion: The synthesis has identified several challenges and opportunities of the social system in COVID-19 response in Mozambique, Tanzania and Zambia. The opportunities should be capitalized upon to inform context specific preventive measures and challenges be addressed for prompt prevention of infection transmissions..

Práticas Tradicionais de Nutrição na Província de Cabo Delgado / Traditional Nutrition Practices in Cabo Delgado Province

A ideia de realizar o presente estudo surge a partir da altura que constatou-se que em Moçambique há muito esforço com vista a mitigação do problema da desnutrição, mas a desnutrição ainda prevalece nas Comunidades. De referir que trata-se de um fenómeno que não afecta intensivamente apenas Moçambique, mas sim toda região da África Subsaariana e Ásia. Neste contexto, o Ministério da Saúde, através do Instituto de Medicina Tradicional, em colaboração com o Departamento de Nutrição, DPS Cabo Delgado, Centro de Investigação de Saúde da Manhiça (CISM), Secretariado Técnico para a Segurança Alimentar (SETSAN) e Ministério da Indústria e Comércio (MIC), realizou um Estudo do âmbito Socioantropológico para captar as Percepções Socioculturais e práticas da Nutrição que podem constituir barreiras ou vantagens, para alimentar estratégias de intervenção comunitária baseadas numa abordagem sociocultural viável no âmbito de combate a desnutrição crónica. Referir que visitou-se outros Estudos socioculturais no âmbito da nutrição onde constatou-se uma exploração superficial da nutrição enquanto um fenómeno complexo e que havia necessidade de mergulhar mais ao fundo das percepções e estabelecer a correlação existente entre as diferentes práticas que de algum modo exercem influência para a prevalência de altos índices de desnutrição no país. Para o efeito, escolheu-se a província de Cabo Delgado como local de Estudo, pelo facto desta apresentar altos índices de baixo peso a nascença. Foram seleccionados três distritos, sendo Quissanga, Chiúre e Nangade; e Postos Administrativos de Bilibiza, Chiúre Velho e Ntamba respectivamente. O estudo decorreu de 3 a 17 de Novembro de 2014. Quanto a metodologia, é um estudo de carácter qualitativo que visa explorar as percepções que determinam as diferentes práticas de nutrição. Para a recolha de dados foram usadas as técnicas de discussão em grupo focal com Praticantes de Medicina Tradicional e Parteiras Tradicionais, Líderes Comunitários, Padrinhos e Madrinhas dos Ritos de Iniciação, Líderes Religiosos, professores, Mães de Crianças Menores de 5 anos, APES e outros Voluntários, Alunos/Estudantes, representantes de ONG's, Tias/os, avôs e sogras/os, Pais, Mulheres Grávidas Jovens e Adolescentes. Foram igualmente aplicadas entrevistas individuais com informantes-chave, tais como Directores Distritais e Provinciais (Saúde, Unidade Sanitária, Educação e Cultura, Indústria, Mulher e Acção Social e Comércio, Actividades Económicas). As discussões em grupos focais eram moderadas por facilitadores formados e em línguas locais (macua, maconde) e Português. Os dados simultaneamente manuscritos e gravados. As notas e cartões de memórias foram transcritos e 5 analisados com recurso ao programa informático NVivo. Para melhor seguimento em termos de aplicação dos resultados do estudo, estiveram envolvidos na equipe de recolha de dados os técnicos provinciais e distritais de SMI, IMT, Nutrição, envolvimento comunitário e SETSAN. No estudo foram constatadas de forma generalizada barreiras culturas para o alcance de alimentação adequada, que são práticas alimentares que se fundam na tradição e que tem uma ligação com os aspectos de Género, Sexualidade, Religião (Islâmica) e Poder resultantes de um processo de Socialização. Também foram constatados alguns pontos positivos, o facto de a alimentação ser interpretada como útil a vida é um ponto forte que pode ser capitalizado no âmbito de combate a desnutrição