Districts In Mozambique Research Articles

Ongoing transmission of trachoma in low prevalence districts in Mozambique: results from four cross-sectional enhanced impact surveys, 2022

Mozambique is making progress towards elimination of trachoma as a public health problem, but in some districts trachomatous inflammation—follicular (TF) prevalence remains above the 5% elimination threshold despite years of various interventions, including antibiotic mass drug administration. To characterize transmission in four districts, we incorporated testing of ocular infection and serology into routine trachoma impact surveys (TIS) in August 2022. We examined residents aged ≥ 1 year for trachoma and collected information on household water, sanitation, and hygiene. Among children aged 1–9 years, we tested conjunctival swabs for Chlamydia trachomatis nucleic acid and dried blood spots for C. trachomatis antibodies. We modeled age-dependent seroprevalence to estimate seroconversion rate (SCR). We examined 4841 children aged 1–9 years. TF prevalence ranged between 1.1 and 6.0% with three districts below the 5% threshold. PCR-confirmed infection prevalence ranged between 1.1 and 4.8%, and Pgp3 seroprevalence ranged between 8.8 and 24.3%. Pgp3 SCR was 1.9 per 100 children per year in the district with the lowest TF prevalence. Two other districts with TF < 5% had SCR of 5.0 and 4.7. The district with TF ≥ 5% had a SCR of 6.0. This enhanced TIS furthered understanding of transmission in these districts and provides information on additional indicators for monitoring trachoma programs.

Providers’ perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry

BackgroundA 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.MethodsWe 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.ResultsThe 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.ConclusionsPrimary 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.

Measuring preparedness to infectious diseases among people exposed to climate disasters in Cabo Delgado, Mozambique: a cross-sectional study

IntroductionClimate change is contributing to increase the frequency and severity of climate disasters in Mozambique, leading, since 2019, to extensive damage to infrastructure and displacement 1.3 million people. Aim of this study is to evaluate baseline preparedness to vector-borne and water-borne infections among households and internally displaced people exposed to climate disasters in Mozambique.MethodsThis was a cross-sectional, community-based survey assessing the preparedness to infectious diseases outbreaks among people exposed to climate disasters in six districts in Mozambique. Structured form was delivered via face-to-face between October 15th and November 7th, 2022. Study outcome was defined as a seven-point score of preparedness to infectious disease outbreaks. Multivariable analysis of the score was conducted using Conway-Maxwell-Poisson regression.ResultsThis study included 2,140 households and 11,239 people, with IDPs accounting for 30% of them. Overall, 1,186 (55.4%) households were overcrowded. Median score of preparedness was 3 points (IQR 2–4). At multivariable analyses, districts with low preparedness were Montepuez and Mueda. Higher preparedness was associated with family planning (p < 0.0001), access to primary education for all children living in the household (p < 0.001) and possession of a birth certificate for all children aged < 5y (p < 0.0001), while preparedness was heterogeneous among the districts (p < 0.05). Households composed by IDPs were not associated with a lower preparedness score.ConclusionsIn climate-vulnerable communities in Mozambique, households practicing family planning, providing access to primary education and birth certificate for all children were less vulnerable to water-borne and vector-borne infectious disease outbreaks. Being family planning and childcare primarily performed by women, our findings can inform policymakers and practitioners on the importance of addressing women to mitigate the impact of climate disasters and reduce the risk of infectious disease outbreaks.

Improving the Quality and Use of Malaria Surveillance Data: Results from Evaluating an Integrated Malaria Information Storage System at the Health Facility Level in Selected Districts in Mozambique.

Mozambique addressed critical malaria surveillance system challenges by rolling out an integrated malaria information storage system (iMISS) at the district level in February 2021. The iMISS integrates malaria data from existing systems across thematic program areas to improve data availability and use. In seven districts, the platform was extended to health facilities (HFs), allowing HFs to access iMISS and use tablets to submit monthly malaria reports to a central database, eliminating the need for paper-based reporting to districts. A structured evaluation of the iMISS rollout to HFs was carried out in February-July 2021. The four evaluation areas were data quality (reporting rate, timeliness, and fidelity) of monthly malaria reports electronically submitted to the iMISS, adoption of the iMISS for data-informed decision-making, system maintenance, and acceptability of the iMISS among target users. All 94 HFs in the seven targeted districts were assessed. Over the 6-month period, 86.1% of reported cases on the iMISS were consistent with cases recorded in paper-based reports, allowing for up to 10% discrepancy. In addition, 69.0% of expected monthly district meetings were held, and information from iMISS was discussed during 58.6% of these meetings. Maintenance issues, mostly related to tablet access and internet connectivity, were experienced by 74.5% of HFs; 33.7% of issues were resolved within 1 month. The iMISS and electronic submission of malaria reports were well accepted by HF- and district-level users. Continued political commitment and timely execution of issue management workflows are crucial to ensure trust in the new platform and facilitate higher levels of data use.

Potential contribution of agronomic practices and conservation agriculture towards narrowing smallholders’ yield gaps in Southern Africa: lessons from the field

Summary Smallholders in Southern Africa continue to grapple with low maize productivity despite this being the staple food crop. This study sought to analyze and isolate the relative contribution of agronomic practices to maize yields obtained by smallholders in Malawi and Mozambique using data generated from on-farm trials testing the performance of conservation agriculture cropping systems. The trials were implemented in two communities, namely Kasungu district in Malawi and Sussundenga district in Mozambique, and ran for seven consecutive growing seasons starting in 2010–2011. Maize yield was measured annually in the on-farm trials, which included a ‘control treatment’ representing an improved farm practice, and in neighboring fields managed by the same farmers on their own, hence representing a ‘true farm practice’. Results indicated that maize yield increased linearly with increasing plant population at harvest at both sites. On average, an increase in plant population at harvest by 1000 plants ha–1 resulted in an increase in maize yield of 90 and 63 kg ha–1 at Kasungu and Sussundenga, respectively. The greatest maize yields were obtained when plant population at harvest exceeded 40 000 plants ha–1. Yet, the plant population at harvest was below the generally recommended optimum for most of the cropping systems studied and in most growing seasons. Furthermore, the use of agronomic practices alone without conservation agriculture (i.e., improved varieties, fertilizer management, and timely weed control) resulted in maize yield gains of as much as 54% and 43% relative to the ‘true farm practice’ at Kasungu and Sussundenga, respectively. Overall, the proportion of these yield increases relative to the ‘true farm practice’ accounted for by agronomic practices amounted to 53–70% and 57–85% at Kasungu and Sussundenga for the highest to the lowest-yielding cropping system. Although conservation agriculture significantly improved maize yield at both sites, such increases were smaller in magnitude compared to the yield gains derived from improved agronomic practices. The study suggests that considerable strides toward narrowing maize yield gaps in Southern Africa can be achieved through improvement of current crop management practices, let alone adhering to the conservation agriculture principles of minimum tillage, residue retention, and crop diversification.

Self-sampling for human papilloma virus DNA as a strategy to increase access to cervical cancer screening: patients' and providers' perspectives on facilitators and barriers to scale.

Self-sampling represents a high accuracy approach to human papilloma virus DNA (HPV-DNA) testing that allows for privacy and autonomy. As part of a larger study to evaluate cervical cancer screening in Mozambique, we explored user-driven facilitators and barriers to, and provider perspectives on, self-sampling. Our study was conducted in 4 public health facilities in 2 districts in Mozambique. Women aged 30-49 were prospectively enrolled for HPV screening and were offered provider or self-collected sampling. We used enrolment data from 9014 participants to examine characteristics of women choosing self-sampling and conducted in depth interviews with 104 women and 15 providers to understand facilitators and barriers to self-sampling. 97.5% of participants chose self-sampling over provider sampling. Participant-reported barriers included fear about technique, discomfort and inadequate training. Facilitators to self-sampling included increased privacy and having been exposed to a peer who previously self-sampled. Providers expressed concern about their limited role in the screening process with a self-sampling technique. Self-sampling for HPV is an acceptable approach to cervical cancer screening but barriers such as fear of sampling incorrectly and discomfort with their bodies remain.

Spatial distribution and determinants of tuberculosis incidence in Mozambique: A nationwide Bayesian disease mapping study

IntroductionMozambique is a high-burden country for tuberculosis (TB). International studies show that TB is a disease that tends to cluster in specific regions, and different risk factors (HIV prevalence, migration, overcrowding, poverty, house condition, temperature, altitude, undernutrition, urbanization, and inadequate access to TB diagnosis and treatment) are reported in the literature to be associated with TB incidence. Although Mozambique has a higher burden of TB, the spatial distribution, and determinants of TB incidence at the sub-national level have not been studied yet for the whole country. Therefore, we aimed to analyze the spatial distribution and determinants of tuberculosis incidence across all 154 districts of Mozambique and identify the hotspot areas. MethodWe conducted an ecological study with the district as our unit of analysis, where we included all cases of tuberculosis diagnosed in Mozambique between 2016 and 2020. We obtained the data from the Mozambique Ministry of Health and other publicly available open sources. The predictor variables were selected based on the literature review and data availability at the district level in Mozambique. The parameters were estimated through Bayesian hierarchical Poisson regression models using Markov Chain Monte Carlo simulation. ResultsA total of 512 877 people were diagnosed with tuberculosis in Mozambique during our five-year study period. We found high variability in the spatial distribution of tuberculosis incidence across the country. Sixty-two districts out of 154 were identified as hotspot areas. The districts with the highest incidence rate were concentrated in the south and the country's central regions. In contrast, those with lower incidence rates were mainly in the north. In the multivariate analysis, we found that TB incidence was positively associated with the prevalence of HIV (RR: 1.23; 95 % CrI 1.13 to 1.34) and negatively associated with the annual average temperature (RR: 0.83; 95 % CrI 0.74 to 0.94). ConclusionThe incidence of tuberculosis is unevenly distributed across the country. Lower average temperature and high HIV prevalence seem to increase TB incidence. Targeting interventions in higher-risk areas and strengthening collaboration between HIV and TB programs is paramount to ending tuberculosis in Mozambique, as established by the WHO's End TB strategy and the Sustainable Development Goals.

Alternative approaches for creating a wealth index: the case of Mozambique

IntroductionThe wealth index is widely used as a proxy for a household’s socioeconomic position (SEP) and living standard. This work constructs a wealth index for the Mopeia district in Mozambique...

Early effects of COVID-19 on maternal and child health service disruption in Mozambique.

After the World Health Organization declared COVID-19 a pandemic, more than 184 million cases and 4 million deaths had been recorded worldwide by July 2021. These are likely to be underestimates and do not distinguish between direct and indirect deaths resulting from disruptions in health care services. The purpose of our research was to assess the early impact of COVID-19 in 2020 and early 2021 on maternal and child healthcare service delivery at the district level in Mozambique using routine health information system data, and estimate associated excess maternal and child deaths. Using data from Mozambique's routine health information system (SISMA, Sistema de Informação em Saúde para Monitoria e Avaliação), we conducted a time-series analysis to assess changes in nine selected indicators representing the continuum of maternal and child health care service provision in 159 districts in Mozambique. The dataset was extracted as counts of services provided from January 2017 to March 2021. Descriptive statistics were used for district comparisons, and district-specific time-series plots were produced. We used absolute differences or ratios for comparisons between observed data and modeled predictions as a measure of the magnitude of loss in service provision. Mortality estimates were performed using the Lives Saved Tool (LiST). All maternal and child health care service indicators that we assessed demonstrated service delivery disruptions (below 10% of the expected counts), with the number of new users of family planing and malaria treatment with Coartem (number of children under five treated) experiencing the largest disruptions. Immediate losses were observed in April 2020 for all indicators, with the exception of treatment of malaria with Coartem. The number of excess deaths estimated in 2020 due to loss of health service delivery were 11,337 (12.8%) children under five, 5,705 (11.3%) neonates, and 387 (7.6%) mothers. Findings from our study support existing research showing the negative impact of COVID-19 on maternal and child health services utilization in sub-Saharan Africa. This study offers subnational and granular estimates of service loss that can be useful for health system recovery planning. To our knowledge, it is the first study on the early impacts of COVID-19 on maternal and child health care service utilization conducted in an African Portuguese-speaking country.

Neighbors’ use of water and sanitation facilities can affect children’s health: a cohort study in Mozambique using a spatial approach

BackgroundImpact evaluation of most water, sanitation and hygiene (WASH) interventions in health are user-centered. However, recent research discussed WASH herd protection – community WASH coverage could protect neighboring households. We evaluated the effect of water and sanitation used in the household and by household neighbors in children’s morbidity and mortality using recorded health data.MethodsWe conducted a retrospective cohort including 61,333 children from a district in Mozambique during 2012–2015. We obtained water and sanitation household data and morbidity data from Manhiça Health Research Centre surveillance system. To evaluate herd protection, we estimated the density of household neighbors with improved facilities using a Kernel Density Estimator. We fitted negative binomial adjusted regression models to assess the minimum children-based incidence rates for every morbidity indicator, and Cox regression models for mortality.ResultsHousehold use of unimproved water and sanitation displayed a higher rate of outpatient visit, diarrhea, malaria, and anemia. Households with unimproved water and sanitation surrounded by neighbors with improved water and sanitation high coverage were associated with a lower rate of outpatient visit, malaria, anemia, and malnutrition.ConclusionHousehold and neighbors’ access to improve water and sanitation can affect children’s health. Accounting for household WASH and herd protection in interventions’ evaluation could foster stakeholders’ investment and improve WASH related diseases control.Graphical Distribution of main water and sanitation facilities used during study period.

COVID-19-related healthcare impacts: an uncontrolled, segmented time-series analysis of tuberculosis diagnosis services in Mozambique, 2017–2020

IntroductionCurrently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased...

Nutritional Characterization of Strychnos madagascariensis Fruit Flour Produced by Mozambican Communities and Evaluation of Its Contribution to Nutrient Adequacy.

The indigenous fruit Strychnos madagascariensis is usually processed to flour, called nfuma, being highly consumed during staple food shortage. This study aimed to evaluate the nutritional composition of nfuma and its nutrient adequacy. Flours from four districts of Mozambique were analyzed using AOAC methods for proximate composition, HPLC for sugar, amino acids (AA), vitamin E and carotenoids and ICP-MS and FAAS for minerals. The results showed that nfuma stands out for its high content of fat (26.3–27.8%), mainly oleic acid, fiber (>6%), vitamin E (6.7 to 8.0 mg/100 g) and carotenes (2.2 to 2.6 mg/100 g). The main amino acids of nfuma protein were Arg, Asp and Glu, and Lys was the limiting one. The mineral composition reveals K (~1200 to 1700 mg/100 g) as the main macromineral followed by Mg > Ca > Na. The main trace element was Mn (~4 mg/100 g) followed by Fe > Zn > Cu > Cr > Co. Aluminum (~3 mg/100 g) was the main non-essential element and Rb, Ni, Sr, Ba, V, Cd were also quantified. Assuming the daily consumption of 50 g, nfuma provides 82% of Vitamin A dietary reference value for toddlers, while the consumption of 100 g contributes to 132% and 60% of Mn and vitamin A DRV for adults, respectively. Despite the nutritional advantages of nfuma, this flour can be a source of Ni, highlighting the importance of the study of good practices in its preparation to decrease the exposure to non-essential elements.

Concurrent wasting and stunting among children 6\u201359\u2009months: an analysis using district-level survey data in Mozambique

BackgroundIn the past it was believed that wasting and stunting were independent of each other. Recent work has shown that they can occur concurrently in a child and that increases considerably the risk of mortality. Concurrent wasting and stunting (WaSt) is currently defined as WHZ < -2 AND HAZ < -2. Wasting is measured by WHZ and MUAC and evidence shows that they tend to identify different sets of children. Our study aimed to look at the effect of adding MUAC on the prevalence and burden of WaSt, and to assess diagnosis of WaSt with a single measurement.MethodsWe analyzed population-based anthropometric surveys from 37 districts in Mozambique conducted by the Government of Mozambique between 2017 and 2019. We proposed a new case-definition for WaSt that includes MUAC in acknowledgement of the different children with wasting diagnosed by WHZ and MUAC. We estimated how many WaSt cases are eligible to be included in the existing treatment program in Mozambique by calculating the True Positive and False Positive Values of WaSt using our proposed case-definition against the wasting admission criteria. AUC of ROC curves used for MUAC and WAZ and optimal cut-offs were determined using Youden’s Index.ResultsIncluding MUAC in the concurrent WaSt case-definition identified more children with WaSt compared to the original case-definition and more younger children and girls were identified. Using both MUAC and WHZ and enrolling severe and moderate wasting is already picking up most of the WaSt cases: 100% in health facilities and 79.40% with MUAC mass screenings at community level. Cut-off values from the ROC curve for the proposed case-definition were MUAC ≤133 mm and WAZ ≤ 2.145 Z-scores, however, they yielded many false positive values.ConclusionWaSt case-definition should include MUAC. WaSt should commence to be reported in surveys and Mozambique should also start monitoring and treating children with WaSt. A cost-effective approach to identify all children with WaSt without adding too many false positive is needed, as well as understanding how to achieve optimal treatment outcomes within existing programs.

Obstacles to Job Satisfaction Among Workers Living with War Caused Disabilities in ‎Changara District in Mozambique. ‎

Job satisfaction of all categories of workers is one of the key antecedents that ensure increased competiveness of organizations. The need to establish factors that impede job satisfaction among people living with war induced disabilities was the main aim of this study. Furthermore, effects of war that adversely affect the attitude of workers with war induced disabilities towards their work were a major driver of this paper. The study employed a pure qualitative research approach where data was collected using face to face interview from 29 participants and analyzed using the thematic data analysis method. Participants were selected using snowballing sampling technique. Job satisfaction was found to be extremely low among employees living with war induced disabilities. People with different disabilities experience a host of work and home related challenges which significantly affect their job satisfaction levels. The problems encountered by people living with disabilities that affect their job satisfaction are mainly centered on ergonomics, lack of relevant assistive technology, stigmatization, discrimination and lack of physical and emotional protection from weather conditions, workmates and supervisors. The link between job satisfaction of workers with war induced disabilities and organizational competitiveness would further advance theory of job satisfaction and provide managerial implications that is helpful for an improved organizational performance. The study recommended that organizations should re-organize their work stations so as to accommodate the needs of people with disability.

Conservation agriculture's effect on smallholder farmer wellbeing in Mozambique

AbstractConservation agriculture (CA) is an important technology in many developing countries for increasing smallholder agricultural productivity and conserving arable soils. This study focuses on the effect of CA on smallholder household wellbeing including productive assets, livestock and housing material quality. The study uses a survey of CA adopters and non-adopters in the Tete and Barue districts of Mozambique. Propensity score matching was used to develop two counterfactual groups; (1) non-adopters in the communities that had received technical assistance on implementing CA, and (2) non-adopting households in communities that had not received CA instruction. Results suggest that CA adopters realized higher levels of farm production assets and better quality housing materials. CA adoption had no association with livestock ownership. The findings are encouraging with respect to demonstrating the relationship between CA adoption and improvements in smallholder household wellbeing.

Towards soil-transmitted helminths transmission interruption: The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique.

World Health Organization goals against soil-transmitted helminthiases (STH) are pointing towards seeking their elimination as a public health problem: reducing to less than 2% the proportion of moderate and heavy infections. Some regions are reaching WHO goals, but transmission could rebound if strategies are discontinued without an epidemiological evaluation. For that, sensitive diagnostic methods to detect low intensity infections and localization of ongoing transmission are crucial. In this work, we estimated and compared the STH infection as obtained by different diagnostic methods in a low intensity setting. We conducted a cross-sectional study enrolling 792 participants from a district in Mozambique. Two stool samples from two consecutive days were collected from each participant. Samples were analysed by Telemann, Kato-Katz and qPCR for STH detection. We evaluated diagnostic sensitivity using a composite reference standard. By geostatistical methods, we estimated neighbourhood prevalence of at least one STH infection for each diagnostic method. We used environmental, demographical and socioeconomical indicators to account for any existing spatial heterogeneity in infection. qPCR was the most sensitive technique compared to composite reference standard: 92% (CI: 83%- 97%) for A. lumbricoides, 95% (CI: 88%- 98%) for T. trichiura and 95% (CI: 91%- 97%) for hookworm. qPCR also estimated the highest neighbourhood prevalences for at least one STH infection in a low intensity setting. While 10% of the neighbourhoods showed a prevalence above 20% when estimating with single Kato-Katz from one stool and Telemann from one stool, 86% of the neighbourhoods had a prevalence above 20% when estimating with qPCR. In low intensity settings, STH estimated prevalence of infection may be underestimated if based on Kato-Katz. qPCR diagnosis outperformed the microscopy methods. Thus, implementation of qPCR based predictive maps at STH control and elimination programmes would disclose hidden transmission and facilitate targeted interventions for transmission interruption.

Improved detection and management of advanced HIV disease through a community adult TB-contact tracing intervention with same-day provision of the WHO-recommended package of care including ART initiation in a rural district of Mozambique.

IntroductionAIDS‐mortality remains unacceptably high in sub‐Saharan Africa, largely driven by advanced HIV disease (AHD). We nested a study in an existing tuberculosis (TB) contact‐tracing intervention (Xpatial‐TB). The aim was to assess the burden of AHD among high‐risk people living with HIV (PLHIV) identified and to evaluate the provision of the WHO‐recommended package of care to this population.MethodsAll PLHIV ≥14 years old identified between June and December 2018 in Manhiça District by Xpatial‐TB were offered to participate in the study if ART naïve or had suboptimal ART adherence. Consenting individuals were screened for AHD. Patients with AHD (CD4 < 200 cells/μL or WHO stage 3 or 4) were offered a package of interventions in a single visit, including testing for cryptococcal antigen (CrAg) and TB‐lipoarabinomannan (TB‐LAM), prophylaxis and treatment for opportunistic infections, adherence support or accelerated ART initiation. We collected information on follow‐up visits carried out under routine programmatic conditions for six months.ResultsA total of 2881 adults were identified in the Xpatial TB‐contact intervention. Overall, 23% (673/2881) were HIV positive, including 351 TB index (64.2%) and 322 TB contacts (13.8%). Overall, 159/673 PLHIV (24%) were ART naïve or had suboptimal ART adherence, of whom 155 (97%, 124 TB index and 31 TB‐contacts) consented to the study and were screened for AHD. Seventy percent of TB index‐patients (87/124) and 16% of TB contacts (5/31) had CD4 < 200 cells/µL. Four (13%) of the TB contacts had TB, giving an overall AHD prevalence among TB contacts of 29% (9/31). Serum‐CrAg was positive in 4.6% (4/87) of TB‐index patients and in zero TB contacts. All ART naïve TB contacts without TB initiated ART within 48 hours of HIV diagnosis. Among TB cases, ART timing was tailored to the presence of TB and cryptococcosis. Six‐month mortality was 21% among TB‐index cases and zero in TB contacts.ConclusionsA TB contact‐tracing outreach intervention identified undiagnosed HIV and AHD in TB patients and their contacts, undiagnosed cryptococcosis among TB patients, and resulted in an adequate provision of the WHO‐recommended package of care in this rural Mozambican population. Same‐day and accelerated ART initiation was feasible and safe in this population including among those with AHD.

‘It's not my story to tell’: ownership and the politics of history in Mocímboa da Praia, Mozambique

AbstractThe recent history of the northernmost districts of Mozambique has been one of movement and conflict leading people far from their areas of origin and into places where they have to rebuild networks and establish relationships. The Makonde moved from their original area in the Mueda Plateau to neighbouring districts and have to negotiate questions of legitimacy and belonging with the autochthonous population, the Mwani, seen as the ‘owners of the land’ and also the rightful bearers of the histories of the area. Recounting history – owning it – is loaded with references to identity, and weaves in memories and competing experiences of the past. Drawing on literature on history and legitimacy and local understandings of ownership, I discuss the importance of memory and storytelling in the maintenance and reshaping of past events and the different narratives that people create. I investigate how the past is appropriated by different groups and defines belonging by claiming or refusing ownership of local histories.

Cost and cost-effectiveness of indoor residual spraying with pirimiphos-methyl in a high malaria transmission district of Mozambique with high access to standard insecticide-treated nets

BackgroundAs malaria cases increase in some of the highest burden countries, more strategic deployment of new and proven interventions must be evaluated to meet global malaria reduction goals.MethodsThe cost and cost-effectiveness of indoor residual spraying (IRS) with pirimiphos-methyl (Actellic®300 CS) were assessed in a high transmission district (Mopeia) with high access to pyrethroid insecticide-treated nets (ITNs), compared to ITNs alone. The major mosquito vectors in the area were susceptible to primiphos-methyl, but resistant to pyrethoids. A decision analysis approach was followed to conduct deterministic and probabilistic sensitivity analyses in a theoretical cohort of 10,000 children under five years of age (U5) and 10,000 individuals of all ages, separately. Model parameters and distributions were based on prospectively collected cost and epidemiological data from a cluster-randomized control trial and a literature review. The primary analysis used health facility-malaria incidence, while community cohort incidence and cross-sectional prevalence rates were used in sensitivity analyses. Lifetime costs, malaria cases, deaths and disability-adjusted life-years (DALYs) were calculated to determine the incremental costs per DALY averted through IRS.ResultsThe average IRS cost per person protected was US$8.26 and 51% of the cost was insecticide. IRS averted 46,609 (95% CI 46,570–46,646) uncomplicated and 242 (95% CI 241–243) severe lifetime cases in a theoretical children U5 cohort, yielding an incremental cost-effectiveness ratio (ICER) of US$400 (95% CI 399–402) per DALY averted. In the all-age cohort, the ICER was higher: US$1,860 (95% CI 1,852–1,868) per DALY averted. Deterministic and probabilistic results were consistent. When adding the community protective effect of IRS, the cost per person protected decreased (US$7.06) and IRS was highly cost-effective in children U5 (ICER = US$312) and cost-effective in individuals of all ages (ICER = US$1,431), compared to ITNs alone.ConclusionThis study provides robust evidence that IRS with pirimiphos-methyl can be cost-effective in high transmission regions with high pyrethroid ITN coverage where the major vector is susceptible to pirimiphos-methyl but resistant to pyrethroids. The finding that insecticide cost is the main driver of IRS costs highlights the need to reduce the insecticide price without jeopardizing effectiveness.Trial registration: ClinicalTrials.gov identifier NCT02910934 (Registered 22 September 2016). https://clinicaltrials.gov/ct2/show/NCT02910934?term=NCT02910934&draw=2&rank=1

Speciation driven by recombination in the evolution of tomato curly stunt virus in Mozambique

AbstractBegomoviruses constitute a group of viruses of great economic importance in agriculture, mainly in tropical and subtropical regions, including southern Africa. Tomato curly stunt virus (ToCSV) is an important begomovirus described in South Africa and later reported in Mozambique impacting tomato cultivation. In Mozambique, the severe disease caused by ToCSV limits tomato cultivation and compromises the income of small and medium farms. Due to the scarcity of information about this pathogen, in this study we explored its genetic variability to elucidate the mechanisms that drive its evolution. In 2019, 27 ToCSV full‐length sequences were obtained from tomato foliar samples with virus‐like symptoms collected in the district of Chokue in Gaza province, Mozambique. Sequence analysis showed that isolates from Mozambique have a nucleotide identity of 90.9%–96.9% with the isolate from South Africa (AF261885) and are grouped into two distinct strains that we named ToCSV‐Chok I and ToCSV‐Chok II. The ToCSV‐Chok II strain has a higher nucleotide diversity than ToCSV‐Chok I in the Rep gene. Recombination is involved in the evolutionary history of ToCSV, with both intraspecific and interspecific recombination events detected in the Rep gene. Our results indicate a prevalence of ToCSV in tomato crops in the Chokue district of Mozambique (the major tomato‐producing region of the country) and suggest that ToCSV is undergoing speciation due to the effect of recombination.