Circumstances and Consequences of Violence-Related Injuries Presenting at Hospital. A Study at the Pediatric Emergency and Forensic Medicine Units of Maputo Central Hospital, Mozambique.

Rates of violence against children are high in Sub-Saharan Africa and information is scarce on the resulting injuries. This study investigates sex-related differences in the circumstances and consequences of sexual and physical violence in the Mozambican context. Hospital records from 2019 at the pediatric emergency and forensic medicine units of Maputo Central Hospital were scrutinized using a standardized form. Of the 321 cases identified, 60% resulted from sexual violence. Girls represented 86.4% of the victims of sexual violence and boys, 66.1% of those from physical violence. Being injured in a familiar environment and by a parent, a relative, or someone known was strikingly common. The injury pattern varied by form of violence and sex of the child. About half of the injuries sustained by physical violence were minor/superficial. Severe injuries requiring hospitalization (33% in total) and some specialized care (27% in total) were mainly sustained by girl victims of sexual violence. While circumstances and consequences of violence-related injuries have several similarities, being severely injured is more typical of girl victims of sexual violence. Besides medical care, hospital services in Mozambique must be prepared to offer pediatric victims of violence the necessary social care.

Explaining utilization of HIV prevention and testing services among university students in Mozambique: results from a mixed methods study.

BACKGROUND: In Mozambique, HIV infection disproportionately affects young adults, particularly women. Despite awareness and knowledge of HIV transmission, many university students have not received HIV testing and continue to engage in high-risk sexual behaviors, including inconsistent condom use. Further understanding of patterns of engagement with HIV prevention and testing is key to reducing HIV transmission in this at-risk population. METHODS: This study used a sequential mixed methods approach to examine patterns of engagement and perceptions of HIV prevention and testing services among higher education students in Mozambique. Survey data were collected from a representative sample of 501 students from Universidade Eduardo Mondlane (UEM) in Maputo, Mozambique to assess the primary outcomes of 1) HIV testing within the last 12 months; and 2) condom use during last sexual encounter. We employed univariate and multivariate regression models. The survey was followed by qualitative interviews with 70 survey participants which were analyzed using an inductive, content-focused analysis to further explain and contextualize survey findings. RESULTS: Over 85% of students reported to be sexually active, among these 74% reported condom use during their last sexual encounter, and 64.2% reported an HIV test within the past 12 months. Females were more likely to have had HIV testing in the past 12 months in comparison to their male peers (aOR 1.82, 95% CI 1.11, 2.99), but were half as likely to have used a condom with their last sexual encounter (aOR 0.52, 95% CI 0.33, 0.83), when controlling for other factors. Qualitative data suggests that these discrepancies may be explained by differential perceptions in risk and trust/mistrust, with women being more concerned about infidelity by their male partner(s) and assuming more responsibility for knowing their own serostatus. Women were also subject to negative stereotypes for possessing condoms in comparison to men, which could explain lower propensity for use. CONCLUSION: Given gendered differences in uptake of condom use and HIV testing, and perceived HIV risk, interventions tailored specifically to male and female students may impact engagement with HIV prevention and testing and empower informed choices about sexual behaviors.

A critical cartography of domestic violence policies in Mozambique.

BACKGROUND: Domestic violence (DV) affects millions of people worldwide, especially women impacting their health status and livelihoods. To prevent DV and to improve the quality of victims' lives, Mozambican governmental and non-governmental entities are making efforts to develop adequate policies and legislation and to improve the accessibility of services for victims of DV. However, a critical review of whether or not current policies and legislation concerning DV in Mozambique are in agreement with international guidelines has yet to be examined. Therefore, this paper aims to map the Mozambican legislative and policy responses to DV. It also strives to analyse their alignment with international treaties and conventions and with each other. METHODS: Through a critical cartography, documents were selected and their content analysed. Some of these documents were not available online, printed versions were not available on the field and some were not up to date. Therefore, we had to search for them via physical office visits at governmental institutions with a responsibility to deal with DV aspects. These documents were listed and analysed for key content applying a framework inquiring on recommendations of international agencies such as World Health Organization. Subsequently, we compared these policies with international conventions and treaties of which Mozambique is signatory and with each other to identify discrepancies. RESULTS: Overall, six institutions were visited assuring identification of all available information and policy documents on DV. We identified a total of fifteen national DV documents of which five were on laws, one on policy and nine institutional strategic/action plans. Most of the national DV documents focused on strategies for assistance/care of victims and prevention of DV. Little focus was found on advocacy, monitoring and evaluation. CONCLUSIONS: Mozambique has demonstrated its commitment by signing several international and regional treaties and conventions on DV. Despite this, the lack of consistency in the alignment of international treaties and conventions with national policies and laws is remarkable. However, a gap in the reliable translation of national policies and laws into strategic plans is to be found particularly in relation to naming type, beneficiaries, main strategies and multi-sectorial approach.

Domestic violence in Mozambique: from policy to practice.

BACKGROUND: To reduce the impact of domestic violence (DV), Mozambican governmental and non-governmental entities are making efforts to strengthen the legislative framework and to improve the accessibility of care services for survivors of violence. Despite this remarkable commitment, the translation of policies and legislation into actions remains a considerable challenge. Therefore, this paper aims to identify gaps in the implementation of existing national policies and laws for DV in the services providing care for survivors of DV. METHODS: This qualitative study comprised of two approaches. The first consisted of content analysis of guidelines and protocols for DV care provision. The second consisted of in-depth interviews with institutional gender focal points (Professionals with experience in dealing with aspects related to DV). The analysis of the document content was based on a framework developed according to key elements recommended by international agencies (PAHO and UN) for design of DV policies and strategies. Data from the in-depth interviews, where analysed in accordance with the study objectives. RESULTS: Eleven (11) guidelines/protocols of care provision and innumerable brochures and pamphlets were identified and analysed. There is a standardised form which contains fields for police and the health sector staff to complete, but not for Civil Society Organisations. However, there is no specific national DV database. Although the seventeen (17) focal points interviewed recognised the relevance of the reviewed documents, many identified gaps in their implementation. This was related to the weaknesses of the offender's penalisation and to the scarcity of care providers who often lack appropriate training. The focal points also recognised their performance is negatively influenced by socio-cultural factors. CONCLUSION: Within services providing care to survivors of DV, a scarcity of guidelines and protocols exist, compromising the quality and standardisation of care. The existence of guidelines and protocols was regarded as a strength, however its implementation is still problematic. There was also recognition for the need to strengthening by governmental and non-governmental entities the defined policies and strategies for DV prevention and control into practice.

Characteristic of victims of family violence seeking care at health centers in Maputo, Mozambique.

BACKGROUND: Family violence (FV) is a common, yet often invisible, cause of violence. To date, most literature on risk factors for family, interpersonal and sexual violence is from high-income countries and might not apply to Mozambique. AIMS: To determine the individual risk factors for FV in a cohort of patients seeking care for injuries at three health centers in Maputo, Mozambique. SETTING AND DESIGN: A prospective multi-center study of patients presenting to the emergency department for injuries from violence inflicted by a direct family member in Maputo, Mozambique, was carried out. MATERIALS AND METHODS: Patients who agreed to participate and signed the informed consent were verbally administered a pilot-tested blank-item questionnaire to ascertain demographic information, perpetrator of the violence, historical information regarding prior abuse, and information on who accompanied the victim and where they received their initial evaluation. De-identified data were entered into SPSS 13.0 (SPSS, version 13.0) and analyzed for frequencies. RESULTS: During the 8-week study period, 1206 assault victims presented for care, of whom 216 disclosed the relationship of the assailant, including 92 being victims of FV (42.6%). The majority of FV victims were women (63.0%) of age group 15-34 years (76.1%) and were less educated (84%) compared to national averages. Of the patients who reported assault on a single occasion, most were single (58.8%), while patients with multiple assaults were mostly married (63.2%). Most commonly, the spouse was the aggressor (50%) and a relative accompanied the victim seeking care (54.3%). Women most commonly sought police intervention prior to care (63.2%) in comparison to men (35.3%). CONCLUSION: In Mozambique, FV affects all ages, sexes and cultures, but victims seeking care for FV were more commonly women who were less educated and poorer.

Treatment, Services and Follow-up for Victims of Family Violence in Health Clinics in Maputo, Mozambique.

BACKGROUND: Family violence (FV) is a global health problem that not only impacts the victim, but the family unit, local community and society at large. OBJECTIVE: To quantitatively and qualitatively evaluate the treatment and follow up provided to victims of violence amongst immediate and extended family units who presented to three health centers in Mozambique for care following violence. METHODS: We conducted a verbally-administered survey to self-disclosed victims of FV who presented to one of three health units, each at a different level of service, in Mozambique for treatment of their injuries. Data were entered into SPSS (SPSS, version 13.0) and analyzed for frequencies. Qualitative short answer data were transcribed during the interview, coded and analyzed prior to translation by the principal investigator. RESULTS: One thousand two hundred and six assault victims presented for care during the eight-week study period, of which 216 disclosed the relationship of the assailant, including 92 who were victims of FV. Almost all patients (90%) waited less than one hour to be seen, with most patients (67%) waiting less than 30 minutes. Most patients did not require laboratory or radiographic diagnostics at the primary (70%) and secondary (93%) health facilities, while 44% of patients received a radiograph at the tertiary care center. Among all three hospitals, only 10% were transferred to a higher level of care, 14% were not given any form of follow up or referral information, while 13% required a specialist evaluation. No victims were referred for psychological follow-up or support. Qualitative data revealed that some patients did not disclose violence as the etiology, because they believed the physician was unable to address or treat the violence-related issues and/or had limited time to discuss. CONCLUSION: Healthcare services for treating the physical injuries of victims of FV were timely and rarely required advanced levels of medical care, but there were no psychological services or follow-up referrals for violence victims. The healthcare environment at all three surveyed health centers in Mozambique does not encourage disclosure or self-report of FV. Policies and strategies need to be implemented to encourage patient disclosure of FV and provide more health system-initiated victim resources.