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Abstract Background The purpose of the study was to assess the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and past 12-month suicidal behaviour (PSB) among adolescents in Mozambique. Methods Data from 3,109 females (aged 15–19 years) and 1,439 males (aged 15–19 years) that participated in the 2022-23 Mozambique Demographic and health Survey were analysed. MDD was assessed with the PHQ-9 and GAD with the GAD-7. Results Results indicate that among girls the prevalence of PSB was 4.3% (attempt 1.0%, plan 1.9% and/or ideation 3.6%) and among boys 2.5% (attempt 0.3%, plan 0.7% and/or ideation 2.4%). Among girls and boys, the prevalence of MDD (≥ 8 scores) was 15.5% and 3.7%, respectively, and the prevalence of GAD (≥ 5 scores) was 25.0% and 10.3%, respectively. In adjusted logistic regression analysis, among girls, GAD was positively and solid fuel use was negatively associated with PSB, while among boys MDD and urban residence were positively associated with PSB. Among female adolescents, currently being pregnant and “big problem to get money for medical treatment” increased the odds of MDD. While among male adolescents, urban residence, having a genital sore or ulcer, has living children, and early sexual debut were positively associated with MDD. Urban residence, current alcohol use, and early sexual debut were positively associated with GAD in male adolescents, while poorer wealth status, being pregnant, and having a “big problem to get money for medical treatment” were positively associated with GAD in female adolescents. Conclusion About 3% of participants had PSB, among girls one in five had MDD or GAD and among boys more than 5% had MDD or GAD. Public health interventions can be guided by several associated factors that have been identified.

Abstract Background Despite receiving adequate treatment, many tuberculosis (TB) survivors are left with post-tuberculosis complications, possibly due to lung tissue damage incurred during the active period of the disease. Current TB programs worldwide deliver quality care throughout the course of active TB treatment, yet often fail to provide organized follow-up once treatment ends. Post-tuberculosis lung disease (PTLD) is a prominent, yet underrecognized cause of chronic lung disease, managed similarly to chronic respiratory diseases with pharmacotherapy and/or personalized pulmonary rehabilitation interventions. Basic pulmonary rehabilitation packages for people finishing TB treatment are still lacking in low- and middle-income countries (LMICs). We offer a study protocol to evaluate the implementation of spirometry and symptom screening for PTLD among people who have completed TB treatment in a rural district in Mozambique. Methods The overall objective of this study is to evaluate the introduction of a new screening program that utilizes symptom screening and spirometry for diagnosing PTLD among adolescents and adults that have completed TB treatment. This research protocol consists of three complementary components: 1) assessing the prevalence of PTLD among patients enrolled in the National TB Control Program (NTCP) at Carmelo Hospital (CHC) in Chókwè District, Mozambique; 2) evaluating anticipated implementation outcomes through the identification of the site-, provider-, and individual-level determinants that either facilitate or hinder the successful adoption, implementation, and maintenance of the spirometry screening program, and 3) evaluating the real-time implementation outcomes/processes in order to provide practical evidence-based key indicators of successful implementation of the spirometry screening program. Discussion Providing well-organized, evidence-based care for individuals with a history of TB who are experiencing symptoms of PTLD can relieve chronic respiratory issues, enhance quality of life, and potentially lower the risk of further pulmonary infections, including recurrent TB. However, there is a significant gap in the literature regarding the implementation of best practices of HIV and TB health services delivery. Addressing this gap could assist Mozambique in improving diagnosis, treatment, and continuity of care for people formerly living with TB. The insights from this study will help decision-makers improve spirometry screening coverage, enhance intervention effectiveness, and translate our findings to evidence-based programming. Trial registration ISRCTN92021748 retrospectively registered.

Abstract Mozambique implemented in 2021 a formative assessment in 22 prisons to identify the operational and logistical needs for the second round of the Biobehavioral Survey (BBS). Barriers and facilitators that could be anticipated in conducting BBS in prisons, in preparation for implementation, was evaluated using semi-structured questionnaires administered to key informants (directors and other kind of managers staff). The data were cleaned and analyzed using Microsoft Excel, and the categorical variables were summarized by means of simple frequencies and percentages. In most prisons the current prison capacity far exceeds the theoretical capacity, 40.9% have a theoretical capacity of ≥ 50 inmates, 81.8% have inmates who exceed their theoretical capacity. In the country half of the prisons receive only male inmates, and only one female, 54.5% of the prisons visited have inmates under 18 years of age, 72.7% of the prisons had a private space available for the survey, the penitentiary establishments have the physical space for study; ensuring the safety of staff within the facilities; involvement of correctional officers and a clinical focal point. However, barriers such as time management due to prison opening hours, prison laws, restrictions, or permits for research may change without notice due to security, lockdowns, riots, or other situations that may hinder the implementation of research. The implementation of successive and regular rounds of BBS in different environments, contexts and populations constitute opportunities for generating information and indicators not always captured by programmatic data and not only as an opportunity for offering and making healthcare available in prison environments that in a routine context, but these populations normally have also not had equal opportunities. Currently, little is known about the implementation of a BBS in a correctional environment and only a few barriers can be anticipated, for Mozambique’s context, these challenges and obstacles can be overcome through clear communication and collaboration with officials at all levels.

Abstract Background Female sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, combination of factors, including inconsistent condom use, engagement in risky sexual behaviors, and various socio-ecological determinants of health. Understanding the determinants of these practices is crucial for developing targeted interventions. Methods This cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019 to 2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Modified Poisson regression models were used to assess the effect of various socio-demographic, economic, and behavioral factors on the outcomes, providing adjusted relative risk (aRR) with 95% confidence intervals (CI). Results Among the 2,565 FSWs who reported inconsistent condom use, younger FSWs (15–24 years old, 29.1%), single (27.3%), with secondary or higher education (26.1%), nationals (25.9%), and residents of Tete City (30.5%) had a higher prevalence of inconsistent condom use. Initiating sex work

Abstract Antibiotics are often prescribed inappropriately, either when they are not needed or with an unnecessarily broad spectrum of activity. This is a serious problem that can lead to the development of antimicrobial resistance (AMR). This study was conducted to assess the antibiotic prescribing pattern in pediatric patients hospitalized at a quaternary hospital in Nampula, Mozambique, using the WHO indicators and Framework as a reference. A retrospective study was conducted using secondary data obtained from medical records. The study population consisted of children aged 0–10 years who were hospitalized in a quaternary-level hospital ward in Nampula, Mozambique. The pattern of antibiotic prescriptions was assessed using indicators and the WHO classification of antibiotics into AWaRe categories. Descriptive statistics were applied. A total of 464 antibiotics were prescribed during the study. The age groups of 1–3 years and 28 days-12 months were prescribed more antibiotics. The most common antibiotics were ceftriaxone and crystallized penicillin, which were frequently prescribed for patients suffering from bronchopneumonia, gastroenteritis, and malaria. 74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions of antibiotics from the Reserve group. The average number of antibiotics per prescription was 1.51 (SD ± 0.725). The percentage of antibiotic prescribing was 97.5%, with 96.20% by injection. All antibiotics prescribed were on the essential medicines list and prescribed by generic name. These results are concerning and highlight the urgency of strengthening antimicrobial optimization measures, as well as implementing the AWaRe framework in antibiotic prescribing as an essential strategy to combat AMR.

Abstract Background A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up. Methods We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes. Results The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare. Conclusions Primary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care.

Abstract Background Obstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012–2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique. Methods We carried out a retrospective evaluation, from the provider’s perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets’ costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included. Results The mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294). Conclusion Without neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).

Abstract Background HIV remains a critical global public health challenge. In 2022, it was estimated that approximately 39.0 million people worldwide were living with HIV, and of these, around 29.8 million were receiving antiretroviral therapy (ART). The objective was to evaluate the clinical and epidemiological profile and factors associated with viral load (VL) non-suppression in people living with HIV/AIDS at the Maputo Military Hospital (CITRA/MMH). Methods A retrospective cross-sectional analytical study was conducted on 9105 people aged 15 years and over. We use secondary data from participants on ART for at least 2 years being followed up between the years 2019–2020 at CITRA/MMH. Those recently enrolled (on ART

Abstract Background The Aedes albopictus mosquito is of medical concern due to its ability to transmit viral diseases, such as dengue and chikungunya. Aedes albopictus originated in Asia and is now present on all continents, with the exception of Antarctica. In Mozambique, Ae. albopictus was first reported in 2015 within the capital city of Maputo, and by 2019, it had become established in the surrounding area. It was suspected that the mosquito population originated in Madagascar or islands of the Western Indian Ocean (IWIO). The aim of this study was to determine its origin. Given the risk of spreading insecticide resistance, we also examined relevant mutations in the voltage-sensitive sodium channel (VSSC). Methods Eggs of Ae. albopictus were collected in Matola-Rio, a municipality adjacent to Maputo, and reared to adults in the laboratory. Cytochrome c oxidase subunit I (COI) sequences and microsatellite loci were analyzed to estimate origins. The presence of knockdown resistance (kdr) mutations within domain II and III of the VSSC were examined using Sanger sequencing. Results The COI network analysis denied the hypothesis that the Ae. albopictus population originated in Madagascar or IWIO; rather both the COI network and microsatellites analyses showed that the population was genetically similar to those in continental Southeast Asia and Hangzhou, China. Sanger sequencing determined the presence of the F1534C knockdown mutation, which is widely distributed among Asian populations, with a high allele frequency (46%). Conclusions These results do not support the hypothesis that the Mozambique Ae. albopictus population originated in Madagascar or IWIO. Instead, they suggest that the origin is continental Southeast Asia or a coastal town in China. Graphical Abstract

Abstract Background Providing nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers’ nurturing care practices and sources of parenting knowledge in rural Mozambique. Methods This is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers’ and fathers’ daily caregiving experiences. Data were analyzed using thematic content analysis. Results Caregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child’s health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers. Conclusions These findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.

Satellite-based field delineation has entered a quasi-operational stage due to recent advances in machine learning for computer vision. Transfer learning allows for the resource-efficient transfer of pre-trained field delineation models across heterogeneous geographies. However, the scarcity of labeled data for complex and dynamic smallholder landscapes remains a major bottleneck. The key innovation of this study is to overcome this challenge by using pre-trained models to generate sparse (i.e., not fully annotated) field delineation pseudo-labels for fine-tuning models across geographies and sensor characteristics. We build on a FracTAL ResUNet trained for crop field delineation in India (median field size of 0.24 ha) based on multi-spectral imagery at 1.5 m spatial resolution. We use this model to generate pseudo-labels for the use in Northern Mozambique (median field size of 0.06 ha) based on sub-meter resolution true-color satellite imagery. We designed multiple pseudo-label selection strategies based on field-level probability scores and compared the quantities, area properties, seasonal distribution, and spatial agreement of the pseudo-labels against human-annotated training labels (n = 1,512). We then used the human-annotated labels and the pseudo-labels for model fine-tuning and compared predictions against human field annotations (n = 2,199). We evaluated performance with regards to object-level spatial agreement and site-level field size estimation. Our results indicate i) a good baseline performance of the pre-trained model in both field delineation (mean intersection over union (mIoU) of 0.634) and field size estimation (mean root mean squared error (mRMSE) of 0.071 ha), and ii) the added value of regional fine-tuning with performance improvements in nearly all experiments (mIoU increases of up to 0.060, mRMSE decreases of up to 0.034 ha). Moreover, we found iii) substantial performance increases when using only pseudo-labels (up to 77 % of the mIoU increases and 68 % of the mRMSE decreases obtained by human-annotated labels), and iv) additional performance increases (mIoU+0.008, mRMSE: −0.003 ha) when complementing human annotations with pseudo-labels. Pseudo-labels are architecture-agnostic, can be efficiently generated at scale, and thus facilitate domain adaptation in label-scarce settings. The workflow presented here is a stepping stone for overcoming the persisting challenges in mapping heterogeneous smallholder agriculture.

Objective: to explore the influence of retention of civil society organizations (CSOs) members on political participation. Theoretical framework: members of CSOs are likely to engage in various political activities. The propensity of members to participate in political practices may be influenced by their retention, which enables the development of democratic competencies and values, civic skills and virtues, and other political resources that foster political engagement. Methods: an explanatory quantitative research was carried out, using data from 234 members of CSOs in Mozambique, collected through a questionnaire consisting of validated scales of members’ retention and political participation. Structural equation modeling was performed to test the five research hypotheses, using weighted least squares mean and variance adjusted (WLSMV) as the estimation method, considering member retention practices as a second-order construct to explain each of the dimensions of political participation. Results: The hypothesis testing pointed to the non-rejection of two hypotheses, demonstrating that: member retention practices significantly explain political contact; and member retention practices significantly explain civic engagement. Conclusion: the study demonstrates that the propensity of CSOs members to participate in various political practices can be explained by member retention, which adds value to the literature. The findings contribute to human resource management in CSOs seeking to foster individual capacity to participate in democratic political processes, as well as those aiming to promote the expansion of democracy in society.

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

Abstract Background The COVID-19 pandemic has put the provision of health services globally at risk. In Sub-Saharan Africa, it had a major impact on HIV services. However, there is a lack of data on the post-pandemic period. This study aims to evaluate the resumption of HIV services and retention in care for adolescents and young people in the period following the COVID-19 pandemic. Methods A retrospective cohort study was conducted using interrupted time series analysis. Three periods were considered: pre-pandemic (form June 2019 to March 2020), pandemic (form April 2020 to March 2022) post-pandemic (from April 2022 to March 2023). Six outcome measures were considered: number of outpatient visits, HIV tests, HIV positivity ratio, the antiretroviral treatment (ART) non-adherence ratio, recall ratio, and the return ratio for adolescent and young adults on ART. Results During the study period, 447,515 outpatient visits and 126,096 HIV tests were recorded. After a reduction at the beginning of the pandemic period, both visits and tests increased during the pandemic (p

Abstract Background Men who have sex with Men (MSM) are known to contribute to increased HIV prevalence as an integral part of key populations with high vulnerability to HIV/AIDS due to their sexual behaviours. Mozambique conducted two rounds of bio-behavioral surveys (BBS) in this population with the main objective of estimating HIV prevalence and associated risk behaviors among MSM in Mozambique. The present study aims to estimate the trend of HIV prevalence and determine the correlations of HIV infection among MSM. Methods A repeated cross-sectional analytical study was conducted from secondary data from the first and second rounds of BBS in Mozambique conducted in 2011 and 2020–2021 respectively. Each round used a similar methodology which allowed for comparison between the two surveys. Chi-square test and logistic regression was used to compare the HIV prevalence between the BBS rounds, identify factors associated with HIV, and assess changes in HIV prevalence across selected risk factors. Results There was a significant increase in HIV prevalence among MSM (7.1–14.9%), living in Maputo (9.3–14.7%), uncircumcised (11.7–25.1%), and those who reported two sexual partners in the last year (5.2–14.4%). In contrast, there was a decrease in prevalence among adult MSM aged between 25 and 29 years (24.7–13.9%), aged 30 years or older (45.7–27.7%), married (29.1–16.8%), with higher education (16.7–5.9%) and moderate perception of HIV risk (10.9–3.4%). Multivariable analysis showed that factors such as age, marital status, religion, sexual identity, circumcision, and the use of lubrication during anal sex are significantly associated with the risk of HIV infection. Conclusions This study underscores the continuing need for HIV prevention and education efforts. The rise in prevalence among specific population segments and the sustained presence of risk factors emphasize the requirement for holistic strategies tailored to the unique requirements of each subgroup. Understanding trends and risk factors is crucial to guiding public health policies and designing efficacious prevention programs that aim to curtail HIV transmission while enhancing the well-being of those impacted by the condition.

Abstract Background Retention in prevention of mother-to-child transmission of HIV programs is critical to reduce vertical transmission. To addresses challenges with retention, Mozambique launched a peer-support program in 2018, in which HIV-positive mothers provide adherence support as mentor mothers (MMs) for HIV-positive pregnant and lactating women and HIV-exposed and infected children. Methods A descriptive qualitative evaluation was conducted across nine facilities in Gaza Province to assess the acceptability and barriers to implementation of the mentor mother program (MMP) among those receiving services and providing services. In-depth interviews and focus group discussions were conducted with MMs, MM supervisors, health care workers (HCWs), HIV-positive mothers enrolled in the MMP, HIV-positive mothers who declined MMP enrollment, and key informants involved in the implementation of the program. Thematic analysis identified emerging recurrent themes and patterns across the participants’ responses. Data were collected between November-December 2020. Results There were initial challenges with acceptability of the MMP, especially regarding confidentiality concerns and MM roles. Sharing additional information about MMs and making small changes during the beginning of the MMP resulted in generally high acceptance of the MMP. HIV-positive mothers reported that counseling from MMs improved their understanding of the importance of anti-retroviral treatment (ART) and how to take and administer ART. HIV-positive mothers reported having reduced guilt and shame about their HIV-status, feeling less alone, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. However, MMs also reported feeling that they had inadequate resources to perform optimal job functions; they listed inadequate transportation, insufficient stipends, and false addresses of clients among their constraints. Overall, HCWs felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility. Conclusions This study found that the MMP was considered a substantive and highly valued support to HIV-positive mothers, resulting in increased ART literacy among patients, improved self-reported well-being and sense of community and reduced feelings of isolation. Recommendations include strengthening MM training, increasing financial and materiel resources, additional information provided to newly enrolled mothers and support for the male partners.

This paper investigated South African media’s framing of the terrorism insurgency in Mozambique. It specifically sought to understand how South Africa’s flagship online publications: News24, TimesLive, and IOL, framed the insurgency. Methodologically, the study employed a qualitative content analysis with the framing theory as our theoretical lens. Our findings show that South African media’s coverage of terrorist attacks in Mozambique is informed by five prominent frames: the social consequences frame, the morality frame, the economic consequences frame, war against Islam militants frame and the national interest frame. We argue that the use of these frames in the construction of the terrorism attacks in Mozambique limit the South African media’s ability to provide a nuanced picture of the complex and multi-faceted nature of the terrorist insurgency in Mozambique. Our findings show that the reliance on official lines tends to influence the manner in which the terrorist attacks in Mozambique are framed by the three South African publications. We also argue that the use of these five frames in the reportage on the terrorist insurgency in Mozambique limit the South African media’s ability to provide the South African public and policy makers with a balanced perspective on the insurgency in Mozambique. In conclusion we recommend that future news reportage as well as future studies consider looking at the complexity surrounding the socio- economic status of the regions experiencing terrorists activities. Such studies and future news stories could be enhanced by looking at multiple stakeholders, including affected communities, to get a broader understanding of the causal effects and possible solutions to terrorism.

Although there are several studies analyzing how cost leadership and cost focus competitive strategies influence export performance, this article examines the relationship between innovation capabilities (ICs) and export performance (ExPf), as well as the mediating effects of cost leadership and cost focus competitive strategies among small and medium enterprises (SMEs) in Mozambique. Based on empirical survey data collected from 250 SME managers in Mozambique, we utilized Partial Least Squares Structural Equation Modelling (PLS-SEM) for data analysis. Findings demonstrate that both cost leadership and cost focus competitive strategies partially mediate the ICs-ExPf relationship. Furthermore, these competitive strategies enhance the direct effect of ICs on export performance. These results suggest that SMEs from emerging countries, such as Mozambique, can effectively develop ICs and leverage cost leadership and cost focus advantages to successfully compete in international markets. The implications of this study are significant for owners and managers of SMEs from emerging countries, as it provides valuable insights into the impact of cost leadership and cost focus advantages of firms’ innovation capabilities. By understanding these relationships, SMEs can make more informed decisions and adopt more effective management approaches when seeking to compete in internationally, particularly among SMEs in emerging countries.

ABSTRACTOn 13 October 2023, the National Directorate for Livestock Development in Mozambique was notified of a suspected outbreak of avian influenza in commercial layers. Samples were screened by real-time and conventional RT–PCR and were positive for both H7 and N6. Full genome sequences were obtained for three representative samples. Sequence analysis of the H7 cleavage site confirmed that the viruses were highly pathogenic (i.e. 333- PEPPKGPRFRR/GLF-346). In addition, the H7 and N6 sequences were highly similar (from 99.4-99.5% and 99.6-99.7% for the HA gene and the NA gene, respectively) to the sequences of a H7N6 virus identified in the Republic of South Africa in May 2023 indicating a similar origin of the viruses. The identification of H7N6 HPAIV in Mozambique has important implications for disease management and food security in the region.

There is a recognised need for innovative methods to elicit the perspective of adolescents on public health issues, particularly when addressing sensitive topics such as the impact of mining projects on their health. Participatory approaches such as “photovoice” allow for deep engagement of vulnerable and marginalised populations, including adolescents. However, few existing studies have used the photovoice method to reflect on issues related to the environment and its impact on public health. To date, no studies have been found that have used photovoice to gain insight into adolescentsʼ perspectives in mining areas. In this paper, we discuss the application of the photovoice method to understand adolescents’ perceptions about the impact of mining on their health and well-being in rural areas in Mozambique. The study was conducted in northern and central Mozambique. Photovoice was successfully integrated into eight focus group discussions with adolescent girls and boys aged 15 to 17 years. Several lessons for guiding future research were learned. First, it provided an understanding of the perceived impacts of mining on their health and well-being. Second, photovoice promoted active engagement and interest in the study by the adolescents. Finally, compared to its ability to capture perceptions of physical and environmental aspects affecting adolescents’ well-being, the method was less straightforward in revealing their concerns regarding social, relational and community aspects that are less tangible. Programs can make use of photovoice to address health issues without setting adolescents’ views and priorities aside, allowing them to influence health decisions on issues that are meaningful to them. Future studies should explore strategies to minimise the role of the power dynamics that affect the engagement and contribution of adolescents in advocating for necessary and meaningful changes. Additionally, it is important to investigate how health programs and policies can help to reduce the impact of existing inequalities.

ABSTRACTTuberculosis is recognised as a disease of the economically disadvantaged people due to its association with financial vulnerability. Mozambique still faces the challenge of the high burden of TB and associated costs. We aimed to understand the social and economic impacts of TB and the need for social support among people with TB in Mozambique. We conducted a qualitative study using a phenomenological approach focusing on the lived experiences and perceptions of people with TB. A total of 52 semi-structured one-to-one in-depth interviews were conducted and data were analysed using a reflexive thematic analysis. Three themes were drawn from the analysis: (i) TB has a social and economic impact that requires adaptation and resourcefulness amongst those affected; (ii) People with TB have different preferences and needs for social support, and (iii) People with TB have different knowledge of, and experiences with, formal social support. TB affects family and community relationships mainly due to impacts on the household’s finances. People with TB in Mozambique are not entitled to any form of social support, and they need to rely on help from family and the community which is often insufficient. Further investigation is needed on how social support schemes can be developed in Mozambique.

Background: Africa has a high double burden of infectious and non-communicable diseases underscoring the critical need for robust scientific research. However, it is also associated with low scientific research productivity. Mozambique, which gained independence in 1975, serves as a poignant example. However, there remains a notable scarcity of evidence evaluating the country's trajectory in scientific and academic development. This study aims to evaluate 43 years of health-related scientific knowledge production through bibliometric analysis, focusing on key indicators. Additionally, it seeks to characterize the higher education institutions within the country. Methods: The data was retrieved from the Web of Science Core Collection using an advanced search tool with Boolean research strategies, covering the period from 1976 to 2022 for all PALOP and 1976 to 2019 for Mozambique. To map Mozambican higher institutions, information was sourced from the Ministry of Science Technology and Higher Education database. Descriptive statistics were employed to summarize the findings, while the VOSviewer program version 1.6.19 was utilized to visualize distance-based bibliometric networks, focusing on co-authorship among institutions and keyword co-occurrence. Results: Portuguese-speaking African countries (PALOP) contribute 2.5 % (10,933 out of 442,309) to Africa's total scientific output, with Mozambique leading at 63.6 % (6,951 publications) followed by Angola at 16.6 % (1,811 publications). All PALOP countries experienced decreased scientific productivity during the third year of the COVID-19 pandemic. In Mozambique, over 70 % (1,710 out of 2,380) of health-related publications from 2011 to 2019 were concentrated in this period. Key journals for health sciences include PLOS ONE, Malaria Journal, and Tropical Medicine & International Health, focusing on HIV, malaria, and tuberculosis. Higher education institutions in Mozambique show regional disparities, with 67.9 % in the South and only 8.9 % in the North, indicating significant inequality in their distribution across the country. Conclusion: This study highlights Mozambique's significant progress in health research productivity over 43 years, establishing it as a leader among PALOP countries. The substantial increase in publications, particularly after 2008, underscores the nation's growing research capacity and commitment to addressing critical health challenges such as HIV, malaria, and tuberculosis. However, regional disparities in higher education access and limited research contributions from private universities remain high in Mozambique.

Data collection was implemented through an initiative by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network to assess whether lockdowns and other social distancing policies during COVID-19 had implications for household economic status, maternal and child health, and healthcare accessibility for pregnant women and children. The data were collected from April 2021 until February 2022 from a population living in a rural community of Mozambique. This rural community is located within a Health and Demographic Surveillance System (HDSS) that operates in the Manhiça district of Maputo province. The survey instrument used for data collection was specifically designed to examine household awareness, knowledge, and prevalence of COVID-19; it was also designed to document hardships experienced by households during the pandemic period such as food insecurity, job losses and/or business closures of household members, and access to healthcare. The data are generalizable to a contiguous community in Manhiça, Mozambique of approximately 200,000 inhabitants.

Background: In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings. Objectives: We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV. Method: We conducted a retrospective cohort study involving children aged 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors. Results: Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63–0.80]) and a recorded weight (AOR = 55.58 [33.88–91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03–1.34]) and previous VLS (AOR = 2.27 [1.27–4.06]). Conclusion: Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.

El presente artículo se centra en cuestiones relacionadas con los derechos reproductivos y el parto por cesárea de las mujeres en Mozambique. El objetivo fue analizar las acciones/estrategias gubernamentales y no gubernamentales que buscan la efectividad de los derechos reproductivos de las mujeres sometidas a cesárea en Mozambique, discutiendo las debilidades que constituyen la violación de estos derechos. Para ello, se realizó una revisión integradora de la literatura en las bases de datos Elsevier, GALE, PubMed, Web of Science y DOAJ a partir de la combinación de los descriptores cesarean section OR reproductive rights AND Mozambique. Después de aplicar las estrategias de inclusión y exclusión, se obtuvieron 13 artículos elegibles para la elaboración del presente estudio. Los resultados señalan la falta de aplicabilidad de las acciones gubernamentales que, a pesar de existir, aún son ineficaces para garantizar y atender los derechos reproductivos de las mujeres en Mozambique.

Abstract Background Scarce evidence exists on audit and feedback implementation processes in low-resource health systems. The Integrated District Evidence to Action (IDEAs) is a multi-component audit and feedback strategy designed to improve the implementation of maternal and child guidelines in Mozambique. We report IDEAs implementation outcomes. Methods IDEAs was implemented in 154 health facilities across 12 districts in Manica and Sofala provinces between 2016 and 2020 and evaluated using a quasi-experimental design guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Reach is the proportion of pregnant women attending IDEAs facilities. Adoption is the proportion of facilities initiating audit and feedback meetings. Implementation is the fidelity to the strategy components, including readiness assessments, meetings (frequency, participation, action plan development), and targeted financial support and supervision. Maintenance is the sustainment at 12, 24, and 54 months. Results Across both provinces, 56% of facilities were exposed to IDEAs (target 57%). Sixty-nine and 73% of pregnant women attended those facilities’ first and fourth antenatal consultations (target 70%). All facilities adopted the intervention. 99% of the expected meetings occurred with an average interval of 5.9 out of 6 months. Participation of maternal and child managers was high, with 3076 attending meetings, of which 64% were from the facility, 29% from the district, and 7% from the province level. 97% of expected action plans were created, and 41 specific problems were identified. “Weak diagnosis or management of obstetric complications” was identified as the main problem, and “actions to reinforce norms and protocols” was the dominant subcategory of micro-interventions selected. Fidelity to semiannual readiness assessments was low (52% of expected facilities), and in completing micro-interventions (17% were completed). Ninety-six and 95% of facilities sustained the intervention at 12 and 24 months, respectively, and 71% had completed nine cycles at 54 months. Conclusion Maternal and child managers can lead audit and feedback processes in primary health care in Mozambique with high reach, adoption, and maintenance. The IDEAs strategy should be adapted to promote higher fidelity around implementing action plans and conducting readiness assessments. Adding effectiveness to these findings will help to inform strategy scale-up.

Abstract Background Women in Mozambique are often disempowered when it comes to making decisions concerning their lives, including their bodies and reproductive options. This study aimed to explore the views of women in Mozambique about key elements of empowerment for reproductive decisions and the meanings they attach to these elements. Methods Qualitative in-depth interviews were undertaken with 64 women of reproductive age (18–49 years) in two provinces in Mozambique. Participants were recruited through convenience sampling. Data collection took place between February and March 2020 in Maputo city and Province, and during August 2020 in Nampula Province. A thematic analysis was performed. Results Women described crucial elements of how power is exerted for reproductive choices. These choices include the ability to plan the number and timing of pregnancies and the ability either to negotiate with sexual partners by voicing choice and influencing decisions, or to exercise their right to make decisions independently. They considered that women with empowerment had characteristics such as independence, active participation and being free. These characteristics are recognized key enablers for the process of women’s empowerment. Conclusions This study’s findings contribute to an expanded conceptualization and operationalization of women’s sexual and reproductive empowerment by unveiling key elements that need to be considered in future research and approaches to women’s empowerment. Furthermore, it gave women the central role and voice in the research of empowerment's conceptualization and measurement where women’s views and meanings are seldom considered.

Summary Background The Ministry of Health of Mozambique (MISAU) and the World Health Organization (WHO) recommend enhancing pregnant women’s satisfaction with health care services in order to advance maternal and child health. This study aims to assess the levels and determinants of pregnant women’s satisfaction regarding their interactions with antenatal care (ANC) providers, the services of which were provided at the primary health care level in southern Mozambique. Methodology We conducted an observational, quantitative, and cross-sectional study from November 4 to December 10, 2021. A structured questionnaire was administered to pregnant women who attended ANC during that period. The characteristics of the participants were illustrated using descriptive statistics; to analyse pregnant women’s satisfaction determinants, we estimated crude and adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) using logistic regression models. All analyses were performed in SPSS version 24 using a 5% significance level. Results We selected 951 pregnant women with a mean age of 25 years old; 14% attained a secondary educational level, 36% were married or living in a marital relationship, and 85.9% reported being satisfied with their current ANC. Factors that reduced the odds of being satisfied were the following: an “insufficient” ANC duration (AOR = 0.173; 95% CI: 0.079, 0.381); inadequate ANC waiting area (AOR = 0.479; 95% CI: 0.265, 0.863); women’s perception about the existing norm of nonattendance in case of late arrival to the ANC (AOR = 0.528; 95% CI 0.292, 0.954); the perception of the existing norm that women are obliged to give birth in same health facility where ANC occurred (AOR = 0.481; 95% CI: 0.273, 0.846); and the perception that delivered ANC is not important for foetal health (AOR = 0.030; 95% CI:0.014, 0.066). Conclusions Most of the pregnant women mentioned being satisfied with the ANC they received. The perception of short consultation duration, inadequate waiting spaces, strict linkage rules to specific health facilities and ANC norms, the perception that the received ANC is not relevant for foetal well-being are determinants of not being satisfied with ANC, and these determinants can be addressed by reorganizing ANC and, indeed, are modifiable by the improved paced implementation of the MISAU strategies for quality maternal and child health care.

Abstract Background In 2021, there were approximately 450,000 cases of drug-resistant tuberculosis (DR-TB) worldwide. The treatment of DR-TB historically included expensive and toxic injectable drugs leading to adverse effects including ototoxicity and Electrocardiogram (ECG) abnormalities. This study described the perspectives of healthcare providers and people with DR-TB on the usability of simplified audiometry and ECG for monitoring treatment adverse effects. Methods A qualitative study was conducted in December 2019 across four provinces in Mozambique, namely Maputo, Gaza, Zambézia, and Nampula. Sixteen outpatient primary care health facilities equipped with simplified Audiometry and/or ECG devices (specifically, SHOEBOX Audiometer® and/or SmartHeart Pro ECG®) installed for at least 6 months before the study initiation were selected. The data was collected using in-depth interviews (IDI) and Focus Group Discussions (FGD) techniques. Interviews were audio-recorded, transcribed verbatim in Portuguese, coded, and analyzed using Nvivo 12 software®. We generated two themes and fit our results into a conceptual framework consisting of three domains in the implementation of technological innovations in health. Results A total of 16 healthcare providers and 91 people undergoing treatment for DR-TB were enrolled in the study. Most people with DR-TB had experienced audiometry testing and demonstrated a good understanding of the assessments. Conversely, while most healthcare providers demonstrated robust knowledge of the importance of both audiometry and ECG assessments, they were not confident in managing ECG devices and interpreting the results. Conclusions While healthcare providers demonstrated a consolidated understanding of the importance of audiometry, the limited number of devices and lack of training were constraints, impeding optimal usage and service delivery.

Abstract Globally, People Who Inject Drugs (PWID) have limited healthcare, treatment, and prevention services, and they frequently experience stigma and negative attitudes toward healthcare providers when accessing services. Mozambique, with a general population HIV prevalence of 12.5%, has one of the highest rates in the world, and the PWID population has the highest HIV prevalence among key populations, estimated at nearly 50%. Less than half of HIV positives who inject drugs are linked to HIV treatment and are retained in care. One of the main reasons is that HIV treatment is mainly provided in a public health facility and PWID delayed accessing healthcare since they anticipated mistreatment from multiple levels of healthcare providers. To improve the health outcomes in this group, we need to treat them where they feel comfortable and respected. In this commentary, we outline the importance of innovative approaches to enhance the management of HIV-positive PWID. As a country gets close to controlling the HIV epidemic, refocusing and targeting responses to the highest-risk groups becomes even more essential for shaping more effective HIV interventions and achieving epidemic control.

Based on fieldwork interviews with the internally displaced Muslims from the regions affected by the insurgency, such as Palma, Mocímboa da Praia, Macomia, Quissanga and others, this article unpacks the context, ideology and protagonists that gave rise and afforded sustenance to the insurgency in Cabo Delgado. After providing an overview of the historical trajectory of Islam in Mozambique, the article presents the ideological and historical underpinnings of the contemporary global jihadi movements, expanding into Africa and Mozambique. The article argues that for jihadism to take roots in any place, there should exist militant protagonists and the grievances that serve as emotional entry points for recruitment. Thus, the article examines the processes by which jihadi protagonists emerged in various communities and the grievances they articulated in order to provoke the insurgency against the State.

Displacement is an endemic phenomenon that affects those uprooted, the communities that feel the impact of those arriving, governments, and the international agencies which are increasingly engaged in organising the displaced. The current war in the north of Mozambique, which has caused a massive displacement of people from 2017 onwards, may be related to a number of factors, including economic, social and even political. Although some actors and analysts include ethnicity as part of the causes, this has more often than not been analytically downplayed when grappling with the dynamics of, particularly, the groups that oppose the Mozambican government. This article analyses the dynamics of relationships between internally displaced people and host communities in Cabo Delgado, especially underlining, firstly, the resilience of communities in the face of extremist violence and, secondly, the distrust that typically shapes conflict. The latter dimension is aggravated by a historical past based on ethnic, political and social differences - cleavages that are accentuated and reproduced within the centres of displaced people and between these and host communities. We argue that factors such as poverty, hunger, lack of jobs or work opportunities, as well as poor access to arable land for family food production, exacerbate the relationship dynamics and create an environment conducive to the outbreak of small-scale conflicts that can, in the medium and long term, open spaces for radicalisation and more violence.

Forced displacement and silencing are inextricably bound for communities who have experienced different forms of violence in different contexts. This article explores the narratives about the war that began on 5 October 2017 in the district of Mocímboa da Praia, on the coast of the province of Cabo Delgado, northern Mozambique, by a group of radical guerrillas locally known as mashababe. Since then, from isolated attacks on remote villages, violence has spread to more districts in the region, with kidnappings of civilians, looting of barns and houses, thus imposing the forced displacement of hundreds of thousands of people in addition to an inestimable number of dead and missing people. This article combines the history and ethnographic work carried out between 2018 and 2021 with the homeless populations from conflict regions and hosted in the 'Nacaca Displaced Persons Camp' (Campo de Deslocados de Nacaca), built in the district of Montepuez, south of Cabo Delgado, a region previously considered safe. The aim of this paper is to analyse how the multiple faces of traumatic violence (physical, psychological and symbolic) are processed in which war victims are continually exposed through silencing imposed by different actors who frequent their new places of refuge.

This article studies the Islamic State's only remaining periodical, Al-Naba, identifying the most common tropes and patterns in the periodical's Sub-Saharan Africa coverage, and on Mozambique in particular. The Islamic State's increasingly important coverage of Africa focuses on terror attacks, military campaigns and on the fight against Christianity. However, it also employs more traditional anti-colonial arguments that have been used by other, more accepted, political actors during the struggle for decolonisation. Al-Naba also functions as a 'shamer' of non-African Muslims, to get them to join jihad by pointing to the African successes of the organisation and set these successes up as examples to be followed. In this sense, the article illustrates how African jihadist branches can have global agency.

In Cabo Delgado, Mozambique, the year of 2020 marked a dramatic escalation of military activities of the Islamist insurgent group locally known as Al-Shabab or mashababe. This intensification was accompanied by a more immaterial phenomenon: the rise in prominence of social media, both as battleground and as public forum. While the insurgents sacked and occupied major towns and district headquarters, the Web 2.0 networks - Facebook and WhatsApp especially - became the central arena in which the war was apprehended and discussed. This essay is an exploration of the entwining of social media with the 'new war' in Cabo Delgado, focussing on the events that surround the conquest of the Makonde plateau, mythical cradle of the Mozambican liberation struggle. Building on a budding literature on digital militarism, the essay dwells especially on orality and the use of the voice note as a medium to convey information deemed to be more trustworthy and stable than images. Tracking these media and their interrelations, the essay establishes a narrative, however fragmentary, of the downfall of the Makonde plateau; highlights recurring features of violence in the Cabo Delgado conflict; and provides fresh insight into the formation of the Local Force (Força Local), a State-sponsored militia largely constituted by war veterans.

A long history of extractive industries and activities have shaped the societies of northern Mozambique, and the Cabo Delgado province in particular. For centuries, the growing international demand on local resources had a great impact on the northern micro-societies. The demand for cheap labour and natural resources, ranging from ivory and cotton, to timber, rubies, land, gas and more, involved thousands of local actors in its extraction, reproducing systems of local power. The persistence of poverty, inequality and conflicts, as well as simmering and sometimes grand-scale violence, fits into a long-term trend of extractivism. Through a historical approach and field observations, we focus on the political economy of extracting natural resources. We point out the persisting basic patterns of extractivism that accompanied Mozambique's integration into global markets, and continued or even deepened, in the post-independence period. These activities are oriented towards foreign markets. They are instigated by foreign investment, but invariably carried out in collaboration with a chain of national gatekeepers. In a clientelist system, local elites resort to their proximity to the state to reproduce their power, often at the expense of state expropriation. Weak state institutions have the functional effect of reproducing the elites, also serving the interests of extractivist capital. It is, however, a system with many and profound contradictions, producing conflict and violence, which also recurrently put those interests at risk.

Abstract Background Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. Methods We conducted a cross-sectional study in May–September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. Results Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. Conclusion In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users’ confidence to schedule a visit, and preparing users for possible positive testing results.

States in the Global South have consistently invested in large-scale, vanity infrastructure projects, which are often not used by the majority of their residents. Using a mixed-method and comparative approach with findings from Greater Maputo, Mozambique, and the Gauteng City-Region exposes how internationally-supported and expensive transport projects do not meet the needs of lower-income urban residents, and meanwhile, widespread, everyday modes of commuting such as trains, paratransit, and pathways for walking deteriorate. State-led development thus often generates an infrastructural landscape characterised by “ruin” and “indifference.” These choices are anachronistic, steeped in a desire for a modernist-inspired future and in establishing narratives of control. In the cases of Gauteng and Maputo, whether or not the infrastructure is “successfully” implemented, these choices have resulted in a distancing of the state from the majority of urban residents.

Sustainable growth and development in Africa will continue to depend mainly on how land and land-related resources are secured, used, and managed, which is extremely important for the socio-economic development of women and men. Equitable land rights support the eradication of poverty, increase food security, and respond to climate change. However, women's land rights are strongly gendered across many regions of the globe, especially in Africa, where access to and control over land and productive resources is affected by customary norms, usually discriminatory against women. Additionally, women face legal and institutional constraints to access and protect their land. These barriers place women in a fragile position and constitute a social rights problem and a severe violation of human rights. Recognizing the need to change this scenario, countries engaged in reforms to comply with international best practices and promote equitable access, secure tenure, and sustainable use of land and its natural resources for all. This paper focuses on Mozambique's legal reform and institutional capacity-building efforts, with special attention to social institutions, in order to promote equitable land rights and enhance land tenure security. It is based on specific practices in documenting customary and statutory access, control, and ownership of land, considering both the ongoing legal reform and the systematic land registration program the country has been promoting over the past decade. This paper intends to document these efforts and good practices so that they can be used as a reference and others can benefit from them.

Abstract Introduction In 2018, the Mozambique Ministry of Health launched guidelines for implementing differentiated service delivery models (DSDMs) to optimize HIV service delivery, improve retention in care, and ultimately reduce HIV‐associated mortality. The models were fast‐track, 3‐month antiretrovirals dispensing, community antiretroviral therapy groups, adherence clubs, family approach and three one‐stop shop models: adolescent‐friendly health services, maternal and child health, and tuberculosis. We conducted a cost‐effectiveness analysis and budget impact analysis to compare these models to conventional services. Methods We constructed a decision tree model based on the percentage of enrolment in each model and the probability of the outcome (12‐month retention in treatment) for each year of the study period—three for the cost‐effectiveness analysis (2019–2021) and three for the budget impact analysis (2022–2024). Costs for these analyses were primarily estimated per client‐year from the health system perspective. A secondary cost‐effectiveness analysis was conducted from the societal perspective. Budget impact analysis costs included antiretrovirals, laboratory tests and service provision interactions. Cost‐effectiveness analysis additionally included start‐up, training and clients’ opportunity costs. Effectiveness was estimated using an uncontrolled interrupted time series analysis comparing the outcome before and after the implementation of the differentiated models. A one‐way sensitivity analysis was conducted to identify drivers of uncertainty. Results After implementation of the DSDMs, there was a mean increase of 14.9 percentage points (95% CI: 12.2, 17.8) in 12‐month retention, from 47.6% (95% CI, 44.9–50.2) to 62.5% (95% CI, 60.9–64.1). The mean cost difference comparing DSDMs and conventional care was US$ –6 million (173,391,277 vs. 179,461,668) and –32.5 million (394,705,618 vs. 433,232,289) from the health system and the societal perspective, respectively. Therefore, DSDMs dominated conventional care. Results were most sensitive to conventional care interaction costs in the one‐way sensitivity analysis. For a population of 1.5 million, the base‐case 3‐year financial costs associated with the DSDMs was US$550 million, compared with US$564 million for conventional care. Conclusions DSDMs were less expensive and more effective in retaining clients 12 months after antiretroviral therapy initiation and were estimated to save approximately US$14 million for the health system from 2022 to 2024.

Abstract The population size and conservation status of wildlife in post‐conflict areas is often uncertain. In Mozambique, decades of armed conflict resulted in large‐scale wildlife population depletion with limited conservation and research opportunities. The African leopard (Panthera pardus) is a large carnivore with great ecological and economic significance, yet their population status is largely unknown within Mozambique. Using camera trapping in conjunction with robust spatially explicit capture‐recapture modeling, we estimated leopard density in 2021 for Coutada 11, a wildlife management area in the postwar Zambezi Delta landscape of central Mozambique. Leopard density was relatively low (1.57 ± 0.37 SE [latent‐mixture‐model] and 1.84 ± 0.41 [sex‐mixture‐model] leopards/100 km2), occurring in the bottom fourth of 161 range‐wide leopard densities, and similar to those from semiarid and human‐dominated landscapes. Prey‐based carrying capacity estimates suggested that leopard density should be at least twice as large. Despite a recent and substantial reduction in poaching activity, evidence of snared leopards indicates that sustained bushmeat poaching, combined with sustainable, but additional legal offtake is suppressing leopard population recovery. This study provides important baseline insight into leopard population density in Mozambique and joins mounting evidence indicating that anthropogenic pressures limit large carnivore populations which is of major national and global concern. We suggest long‐term monitoring of this leopard population to determine trends over time and implement effective conservation interventions in response to population changes. This population clearly has the capacity to recover if hunting quotas are reduced to account for illegal offtake and, more importantly, if anti‐poaching efforts are redoubled to reduce unsustainable anthropogenic mortality of leopards.

In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018–January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%–82.5% and a specificity of 14%–15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.

Today, urban flood resilience constitutes an academic and political discourse as well as a ‘proposed state’ to be achieved within urban management, planning, and development. Matola, a major Mozambican coastal city, has witnessed many floods, mainly caused by rainfall, the most devastating of which happened in 2000. This study analyses the actions the urban planners took during that major flood event, what flood mitigation and adaptation strategies and measures for increased flood resilience they have developed since that flood event, and the contribution of urban planning to building flood resilience under financial and technical constraints. The study is based on interviews with 32 urban planners from Matola and observations in the field. In addition to financial limitations, the main challenge in promoting flood resilience in Matola is the deficient and insufficient coordination in mitigation and adaptation actions among urban planners, political elites, and members of low-income urban communities, who use floodplain areas for purposes that contradict resilience-building actions. During the 2000 floods, mitigation actions were carried out by rescuing people and goods and placing them in accommodation centres. After the 2000 floods, gradual adaptation strategies and measures were carried out, such as hiring and training staff, designing a new urban plan, gradual resettlement, opening drainage channels, and allocating water pumping systems in some areas to promote flood resilience. The study concludes that urban planning contributed significantly to the building and promotion of flood resilience in Matola: the strategies and measures taken so far have contributed significantly to reducing the exposure and vulnerability to flooding of the population, their assets, and urban infrastructure, as well as improving the ecosystem in lowlands and coastal protection wetlands. The study brings a contribution from retrospective and prospective resilience thinking to the debate on building and promoting resilience in urban socio-ecological systems, showing the role of urban planners, and planning and management activity since the 2000 floods, and perspectives on the future. The study demonstrates that the development of competences or technical skills to plan and manage strategies and measures to promote resilience is a key factor in promoting socio-ecological resilience.

As part of the water supply services decentralization in Mozambique, water user committees play a key role to manage water supply systems. However, they struggle with sustainability issues, which affect the water access to the communities. This paper intends to understand the sustainability of water systems in Mozambique based on the sociocultural dynamics, normative and institutional framework, and the interaction of social actors involved in the community management of water systems. This is a qualitative study based on phenomenology principles whose experiences were based on field work carried out in Gaza province, Mozambique. The study revealed that community management of water supply systems in Mozambique was a policy option for decentralization of water supply management, in response to the weak capacity (resources and technicians) for this purpose. The study shows that, in practice, there has yet to be much success in achieving the objectives of the Water User Committee, as they have proven to be less effective in meeting water access needs. There are challenges affecting the sustainability of the Water User Committee, such as weak understanding of their roles, conflicts, transparency, accountability and, in turn, the sustainability of water sources. HIGHLIGHTS Understand how water committees implement the promotion of WASH in study sites in Mozambique and how the water committees promote the sustainability of WASH.; Recommend changes to water committees' guidance and policy to increase their outcomes.; Understand the different interpretations and perspectives on WASH supply and the complexities involved in the triangle of policymakers, water committees' members, and users.;

Africa has abundant solar resources but only 2% of its current capacity is generated from renewable sources. Photovoltaics (PV) offer sustainable, decentralized electricity access to meet development needs. This review synthesizes the recent literature on PV in Africa, with a focus on Mozambique. The 10 most cited studies highlight the optimization of technical components, such as storage and bifacial modules, and challenges in integrating large-scale PV. Case studies demonstrated Mozambique’s potential for PV applications in water heating, irrigation, and rural electrification. These benefits include reduced emissions and energy access. However, barriers, such as high costs, lack of infrastructure, and training, exist. While solar cookers are insufficient, thermal systems have unrealized potential. Mozambique’s urban and rural electrification rates are 57% and 13%, respectively, despite its energy resources. Targeted policies, financing, and community engagement are essential for promoting adoption. While PV can sustainably expand electricity access, coordinated efforts must address costs, infrastructure, maintenance, and social factors for successful implementation. Mozambique has immense solar potential, but strategic planning and support are critical to unlocking these benefits. This review provides insights into optimizing PV systems and policy frameworks for a clean and inclusive energy production future in Africa, to synthesize the 10 most cited studies on photovoltaic solar energy in Africa, and to deeply reflect upon the current energy needs in Mozambique, the benefits of employing PV and solar thermal systems, and the challenges of implementing such systems within the Mozambican context.

Abstract Introduction In Sofala province (Mozambique), young people living with HIV (YPLHIV) are estimated at 7% among people aged 15–24 years. Even though the COVID-19 pandemic threatened HIV health services, data on the impact of COVID-19 on YPLHIV people are lacking. This study aimed at exploring the seroprevalence of SARS-CoV-2 and associated factors among young people based on their HIV status. Methods A cross-sectional study was conducted, including people aged 18–24 attending a visit at one of the adolescent-friendly health services in Sofala province between October and November 2022. People vaccinated against SARS-COV-2 or YPLHIV with WHO stage III-IV were excluded. A SARS-CoV-2 antibodies qualitative test and a questionnaire investigating socio-demographic and clinical characteristics were proposed. SARS-CoV-2 seroprevalence was calculated with Clopper-Pearson method. The odds ratio (OR) of a positive SARS-CoV-2 antibodies test was estimated through multivariable binomial logistic regression. Results In total, 540 young people including 65.8% women and 16.7% YPLHIV participated in the survey.. The mean age was 20.2 years (SD 2.0). Almost all the sample (96.1%) reported adopting at least one preventive measure for COVID-19. The weighted seroprevalence of SARS-CoV-2 in the whole sample was 46.8% (95%CI 42.6–51.2) and 35.9% (95%CI 25.3–47.5) in YPLHIV. The adjusted OR of testing positive at the SARS-CoV-2 antibodies test was higher in students compared to workers (aOR:2.02[0.95CI 1.01–4.21]) and in those with symptoms (aOR:1.52[0.95CI 1.01–2.30]). There were no differences based on HIV status(aOR:0.663[95%CI 0.406–1.069]). Overall, COVID-19 symptoms were reported by 68 (28.2%) people with a positive serological SARS-CoV-2 test and by 7 (21.7%) YPLHIV (p = 0.527). No one required hospitalization. Conclusions SARS-CoV-2 seroprevalence was 46.8% without differences in risk of infection or clinical presentation based on HIV status. This result may be influenced by the exclusion of YPLHIV with advanced disease. The higher risk among students suggests the schools’ role in spreading the virus. It’s important to continue monitoring the impact of COVID-19 on YPLHIV to better understand its effect on screening and adherence to treatment.

The article explores the role of folklore tradition in the short prose of modern Mozambique. The symbiosis of the European cultural matrix, inseparable from the language in which the work is written, and the oral heritage of the Mozambican people is analyzed on the material of one of Aldino Muianga’s short stories. The story «Rosa Maria» is included in the author’s debut collection «Xitala Mati», the main material for which became the folklore «scary stories» about witchcraft and the living dead. And while in his later works Muianga focuses on acute social plots of the colonial past and post-colonial present, in the world of «Xitala Mati» there is practically no place for white people: it is not colonizers and the colonized that interact there, but it is people and spirits. The text of «Rosa Maria» is filled with numerous «conventional signs» by means of which, in the paradigm of the traditional culture of the peoples of Mozambique, the world of the dead communicates with the world of the living. These signs are intuitive to the African reader, while the European must identify and decipher them. At the same time, «Rosa Maria» shows motifs and imagery characteristic of the Gothic novel, albeit reinterpreted and modified to suit African realities. Such components of the poetics as the encounter with the infernal in the image of a beautiful woman, the gloomy colouring supported by the landscape and ominous animals, and the interest in the emotional reactions of the characters, typical of Gothic literature, allow us to see in «Rosa Maria» a hybrid genre, the roots of which should be sought both in the European literary tradition and in the folk tales of Mozambique.

Abstract 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.

This study intends to frame Mozambican rap within a revolutionary perspective that uses the Portuguese language with “Mozambicanisms” as a vehicle for the construction of an identity discourse in young people with critical and creative thinking about Mozambican democracy. This allows for the (re)construction of a collective memory of experiences lived in a globalized world. This study springs from the debate about the place of the Portuguese and Bantu languages in the rap music produced in the country and its role as an identity framework for Mozambican culture in its relationship with collective memory. A content analysis of four songs by the Mozambican rapper Azagaia was carried out, using two categories of analysis: (1) Rap as a space of action promoting an alternative project of governance in Mozambique and (2) Rap as a vehicle of vocalization of collective memory about social injustice in Mozambique.