Changing patterns in the burden of paediatric injuries during the COVID-19 pandemic: a study in Mozambique's central hospitals.

INTRODUCTION: There is a substantial body of knowledge on the effects of the COVID-19 pandemic on injuries showing frequent but inconsistent reductions in both volume and pattern. Yet, studies specifically addressing children are less common, not least from low- and middle-income countries. This study investigated whether changes in the pattern and outcome of paediatric injury admissions to Mozambique's four regional referral hospitals during 2020. METHODS: Clinical charts of paediatric patients presenting to the targeted hospitals with acute injuries were reviewed using a set of child, injury, and outcome characteristics during each of two consecutive restriction periods in 2020 using as a comparator the same periods in 2019, the year before the pandemic. Differences between 2020 and 2019 proportions for any characteristic were examined using the t-test (significance level 0.05). RESULTS: During both restriction periods, compared with the previous year, reductions in the number of injuries were noticed in nearly all aspects investigated, albeit more remarkably during the first restriction period, in particular, greater proportions of injuries in the home setting and from burns (7.2% and 11.5% respectively) and a reduced one of discharged patients (by 2.5%). CONCLUSION: During the restrictions implemented to contend the pandemic in Mozambique in 2020, although each restriction period saw a drop in the volume of injury admissions at central hospitals, the pattern of child, injury and outcome characteristics did not change much, except for an excess of home and burn injuries in the first, more restrictive period. Whether this reflects the nature of the restrictions only or, rather, other mechanisms that came into play, individual or health systems related, remains to be determined.

Effect of the COVID-19 pandemic on emergency department attendances for pediatric injuries in Mozambique's central hospitals: an interrupted time series and a comparison within the restriction periods between 2019 and 2020.

Objectives: Hospital-based studies indicate that restriction measures imposed during the COVID-19 pandemic have affected the number and characteristics of pediatric injuries. However, few studies have been conducted in resource-poor countries. This study aimed to determine whether injury-related emergency department (ED) attendances in Mozambique were affected during the restriction periods in 2020 and how the pattern of injury changed. Methods: Mozambique faced two restriction periods in 2020. An interrupted time series was applied to weekly data of pediatric injuries from the ED records of four central hospitals in Mozambique in 2019 and 2020. Weekly numbers of injuries were modeled using a Poisson regression model to estimate the effect of COVID-19 restrictions on trends over calendar time. Then, for each restriction period, differences in injury mechanisms, severity, need for surgery, and intensive care unit (ICU) attendances were compared between 2019 and 2020. Results: During the 76 weeks preceding the restrictions, there was a stable trend in ED attendances. The weekly number dropped by 48.7% after implementation of the first restrictions. By the end of 2020, the weekly numbers were back to the levels observed before the restrictions. Road traffic injuries (RTIs) and falls dropped during the first restriction period and RTIs and burns during the second. There was an increase of 80% in ICU attendances in all periods of 2020 at three hospitals during the first and second restriction periods. Conclusion: The COVID-19 restrictions yielded a reduction in the weekly number of pediatric injuries seen at Mozambique's central hospitals, above all RTIs and falls. The drop reflects reductions in visits most importantly for RTIs, falls, and burns, but was accompanied by an increase in the proportion of ICU cases. This effect was not maintained when the restrictions were relaxed. Whether this reflects reduced exposure to injury or hesitancy to seek care remains to be determined. Level of evidence: Level III, retrospective study with up to two negative criteria.

Assessment of critical resource gaps in pediatric injury care in Mozambique's four largest Hospitals.

BACKGROUND: Hospitals from resource-scarce countries encounter significant barriers to the provision of injury care, particularly for children. Shortages in material and human resources are seldom documented, not least in African settings. This study analyzed pediatric injury care resources in Mozambique hospital settings. METHODS: We undertook a cross-sectional study, encompassing the country's four largest hospitals. Data was collected in November 2020 at the pediatric emergency units. Assessment of the resources available was made with standardized WHO emergency equipment and medication checklists, and direct observation of premises and procedures. The potential impact of unavailable equipment and medications in pediatric wards was assessed considering the provisions of injury care. RESULTS: There were significant amounts of not available equipment and medications in all hospitals (ranging from 20% to 49%) and two central hospitals stood out in that regard. The top categories of not available equipment pertained to diagnosis and monitoring, safety for health care personnel, and airway management. Medications to treat infections and poisonings were those most frequently not available. There were several noteworthy and life-threatening shortcomings in how well the facilities were equipped for treating pediatric patients. The staff regarded lack of equipment and skills as the main obstacles to delivering quality injury care. Further, they prioritized the implementation of trauma courses and the establishment of trauma centers to strengthen pediatric injury care. CONCLUSION: The country's four largest hospitals had substantial quality-care threatening shortages due to lack of equipment and medications for pediatric injury care. All four hospitals face issues that put at risk staff safety and impede the implementation of essential care interventions for injured children. Staff wishes for better training, working environments adequately equipped and well-organized. The room for improvement is considerable, the study results may help to set priorities, to benefit better outcomes in child injuries.

Burnout, workplace violence and social support among drivers and conductors in the road passenger transport sector in Maputo City, Mozambique.

OBJECTIVES: Workplace violence is a work stressor which is presumed to lead to burnout, whereas social support is hypothesized to buffer the impact of such a stressor on health outcomes. In this study the association between burnout and workplace violence was investigated, and the role played by social support in moderating the relationship assessed. The study group consisted of workers in the road passenger transport sector in Maputo City, Mozambique. METHODS: A random sample of 504 participants was selected from a register of 2,618 drivers and conductors working with road passenger transport. The study design was cross-sectional. Previously validated measures of burnout, workplace violence and social support were used. RESULTS: The prevalence of severe burnout was 3.6% and of mild burnout 30.1%. Workplace violence was significantly associated with burnout after control for potential confounders. Burnout was more common among workers lacking social support following workplace violence than among peers who had received supported following an incident of violence. CONCLUSIONS: The study suggests that burnout is a public health problem among workers in the road passenger transport sector, and may be closely and independently linked to workplace violence. Social support appears to buffer or moderate the effect of workplace violence on burnout. This has implications for policy in the workplace. Strategies and guidelines are needed to support workers following workplace violence, since these may prove vital in reducing burnout and other psychosocial consequences.

Workplace violence in the road passeger transport sector in Maputi cinty, Mozambique: extent, causes, consequences and prevention

Background: Every year millions of workers around the world are victims of workplace violence (WPV). Globally, WPV is a major occupational health and safety hazard, and it has been regarded as a public health problem. There is no WPV preventive program specifically designed for low-income countries (LICs). WPV preventive intervention models usually come from high-income countries (HICs), and they may not be sustainable, feasible or effective in other settings. With regard to WPV, there is a need better to understand its extent, nature, risk factors, causes, consequences and means of prevention, especially in LICs. The overall aim of this thesis was to study WPYV in the road passenger transport sector in Maputo City, Mozambique. Methods: Four studies were conducted. In studies I-III the design was cross- sectional. A random sample of 504 participants was selected from a register of 2,618 transport workers in the road passenger transport sector. Data were collected using a structured questionnaire covering socio-demographic characteristics, access to information, literacy level, occupational experience, organizational changes, work environment, work conditions, health conditions, quality of life, and WPV and its consequences. Data were analyzed using Chi-square test, Student's t-test, linear logistic regression, and multivariate logistic regression. In Study IV the design was qualitative. Participants were purposefully selected from among drivers and conductors identified in the quantitative investigation, reported in Study I, as victims of WPV, all with six or more years of experience in the road transport sector. Data were collected in semi-structured interviews. The open questions covered individual views on causes of WPV and suggestions for its prevention, based on the interviewees' experiences of WPV while on duty. Thirty-two transport workers were interviewed. The data were analyzed using qualitative content analysis....

Exposure to workplace violence and quality of life among drivers and conductors in Maputo city, Mozambique.

This cross-sectional study examined exposure to workplace violence and its consequences on quality of life (QOL) among workers in the road passenger transport sector in Maputo city, Mozambique. A random sample of 504 drivers and conductors were interviewed using structured questionnaires. Many participants reported experiencing psychological or physical violence at work. Sequelae of violence included sick leave following abuse (20%), physical injuries (32%), financial loss (28%), and various emotional reactions (28-56%). Exposure to workplace violence was a significant predictor of QOL even after adjusting for confounding. Mechanisms to detect and deal with both immediate and long term consequences of work-related violence on QOL are recommended.