Migrações sul-sul: a recente onda de imigrantes zimbabweanos em Tete - Moçambique (2007-2016) / South-south migration: the recent wave of Zimbabwean immigration in Tete − Moçambique (2007-2016) / Migraciones sur-sur: la reciente ola de inmigrantes zimbabuense en Tete − Mozambique (2007-2016)

O objetivo deste artigo é analisar a dinâmica das migrações internacionais sul-sul a partir do estudo de caso da recente imigração de zimbabweanos para a província de Tete, Moçambique, historicamente uma região de emigração. Nesse sentido, examinamos as características sociodemográficas desses novos imigrantes, assim como as condições e motivações individuais, familiares e estruturais subjacentes ao fluxo migratório. Para tanto, combinamos dados quantitativos provenientes do Censo moçambicano de 2007 e dos registros de trabalhadores imigrantes da Direção Provincial de Trabalho, Emprego e Segurança Social, com entrevistas semiestruturadas junto aos imigrantes zimbabweanos em Tete. Os resultados indicam uma multiplicidade de fatores que contribuíram para a recente onda de imigração em Tete, com destaque, além das motivações econômicas e de subsistência familiares, para aspectos sociais e culturais relacionados à longa tradição da mobilidade intrarregional na África Austral, facilitada por fronteiras relativamente porosas e fortes laços culturais, linguísticos e de parentesco. Discutimos, também, como a instalação de megaprojetos de mineração com capital brasileiro, em Tete, contribuiu para torná-la atrativa como destino migratório, num contexto em que se assistiam violentas ondas de xenofobia contra imigrantes na África do Sul, principal destino das migrações na região.

This article analyses the dynamics of international South-South migration through the case study of the recent immigration of Zimbabweans to the province of Tete, Mozambique, historically a region of emigration. We examine immigrants' socio-demographic characteristics, as well as the individual, family and structural conditions and motivations underlying this new migration flow. The analysis combines quantitative data from the 2007 Mozambican Census and administrative records for immigrant workers from the Provincial Directorate of Labour, Employment and Social Security, with semi-structured interviews with Zimbabwean immigrants in Tete. The results indicate a multiplicity of factors that contributed to the recent wave of immigration in Tete. In addition to economic and subsistence motivations, social and cultural aspects related to the long tradition of intra-regional mobility in Southern Africa, facilitated by relatively porous borders and strong cultural, linguistic and kinship ties, seem to be important. We also discussed how the installation of mining megaprojects with Brazilian capital in Tete, contributed to its appeal as a migrant destination, in a context in which violent waves of xenophobia against immigrants were occurring in South Africa, the main destination for migrants in the region.

El objetivo de este artículo es analizar la dinámica de la migración internacional sur-sur a partir del estudio de caso de la reciente inmigración de zimbabuenses a la provincia de Tete, Mozambique, históricamente una región de emigración. En este sentido, examinamos las características sociodemográficas de estos nuevos inmigrantes, así como las condiciones y motivaciones individuales, familiares y estructurales inherentes a este flujo migratorio. Para este fin, combinamos datos cuantitativos del censo de Mozambique de 2007 y registros de trabajadores inmigrantes de la Dirección Provincial de Trabajo, Empleo y Seguridad Social, con entrevistas semiestructuradas con inmigrantes zimbabuenses en Tete. Los resultados indican una multiplicidad de factores que contribuyeron a la reciente ola de inmigración en Tete, entre los que se destacan, además de las motivaciones económicas y de subsistencia familiar, aspectos sociales y culturales relacionados con la larga tradición de movilidad intrarregional en el sur de África, facilitada por fronteras relativamente porosas y por fuertes lazos culturales, lingüísticos y de parentesco. También discutimos cómo la instalación de megaproyectos mineros con capital brasileño en Tete contribuyó con su atractivo como destino migratorio, en un contexto en el que se asistía a violentas oleadas de xenofobia contra inmigrantes en Sudáfrica, el principal destino de las migraciones en la región.

Nuevo modelo de distribución de mosquiteros impregnados con insecticida y su impacto durante la Campaña de Cobertura Universal en Mozambique, 2017 / New model for the distribution of mosquito nets impregnated with insecticide and its impact during the Universal Coverage Campaign in Mozambique, 2017

Introducción: En 2017 se realizó la Campaña de Cobertura Universal, en que se aplicó el nuevo modelo de distribución de mosquiteros impregnados con insecticida de larga duración, después de las bajas coberturas encontradas en 2015. Objetivo: Caracterizar el nuevo modelo de distribución de mosquiteros con insecticida de larga duración, aplicado en la Campaña 2017, en la provincia de Tete, Mozambique. Métodos: Se realizóun estudio cuantitativo, descriptivo, observacional y transversal. A partir de estadísticas univariadas, se estimó el porcentaje y sus intervalos de confianza del 95 % para los indicadores de registro correctos. Para encontrar la asociación entre los hogares registrados y los hogares de posesión, se calculó el coeficiente de correlación de Pearson (r) y el coeficiente de determinación (R2). Resultados: De los 3 284 hogares evaluados en la etapa de registro, al 98 por ciento se les asignaron calcomanías, al 99 por ciento cupones, y el criterio de adjudicación de mosquiteros impregnados con insecticida de larga duración fue correcto en el 97 por ciento, respectivamente. De los hogares registrados, 1 086 (97 por ciento) tuvieron acceso a al menos un mosquitero impregnado con insecticida de larga duración y 1 041 (92,9 por ciento) durmieron con estos mosquiteros la noche anterior a la encuesta. Conclusiones: La Campaña de Cobertura Universal, utilizando el nuevo modelo de distribución de mosquiteros impregnados con insecticida de larga duración, asegura un adecuado registro de los hogares, lo que ha contribuido al aumento de su posesión y uso, y al avance hacia el logro de las metas de cobertura universal en la comunidad(AU)

Introduction: As part of the Universal Coverage Campaign implemented in 2017, a new model was applied for the distribution of mosquito nets impregnated with long-lasting insecticide. Coverage had been found to be low in 2015. Objective: Characterize the new model for the distribution of mosquito nets impregnated with long-lasting insecticide applied in the 2017 Campaign in Tete Province, Mozambique. Methods: A cross-sectional observational descriptive quantitative study was conducted. Starting from univariate statistics, estimation was made of percentage and its 95 percent confidence intervals for correct registry indicators. Pearson's correlation coefficient (r) and the coefficient of determination (R2) were estimated to find the association between registered and possessing households. Results: Of the 3 284 households evaluated during the registration stage, 98 percent were given stickers and 99 percent received coupons. The criterion followed for the assignment of mosquito nets impregnated with long-lasting insecticide was correct in 97 percent , respectively. Of the households registered, 1 086 (97 percent) had access to at least one mosquito net impregnated with long-lasting insecticide, whereas 1 041 (92 percent) had slept under these mosquito nets the night before the survey. Conclusions: With the use of the new model for the distribution of mosquito nets impregnated with long-lasting insecticide, the Universal Coverage Campaign ensures the appropriate registration of households, contributing to an increase in their possession and use, and the attainment of universal coverage goals in the community(AU)

Tuberculosis space-temporal distribution from 2011 to 2016 in the municipality of Maputo, Mozambique / Distribución espacio-temporal de la tuberculosis de 2011 al 2016 en el municipio de Maputo, Mozambique

Abstract: Objective: Carry out a spatial-temporal characterization of the incidence of tuberculosis (TB) in Maputo, Mozambique. Method: a descriptive ecological study of tuberculosis cases reported in an information system. The annual mean incidence rate and the number of TB notification cases in the municipality of Maputo from 2011 to 2016 were analyzed. Descriptive statistics were used with calculations of measures of central tendency (mean) and an application of the Poisson linear regression model. Trimester notifications were stratified by district, clinical form, and age group. The quarterly average temperature of the evaluated area was added as a covariate in the model seasonal. Results: 34,623 TB cases were notified from 2011 to 2016, with a trimester average of 1,443 cases. The average annual incidence was higher in the Kampfumo district, with 909.8 per 100 thousand inhabitants (95% CI 854.1 - 968.2); almost twice as much as the incidence of the municipality of Maputo, 527.8 (95% CI 514, 3-541.6), and the country of Mozambique, 551 (95% CI 356 - 787). The clinical diagnosis of the tested cases was higher concerning the bacteriological diagnosis; 44%, and 35%, respectively. Conclusion: Maputo had similar incidence rates to the country of Mozambique, however, there was a heterogeneity rate by district and a reduction in the number of TB cases in both the general population (not co-infected with HIV) and those over 15 years old, being higher in the first trimester.

Resumen: Objetivo: realizar una caracterización espacio-temporal de la incidencia de tuberculosis (TB) en Maputo, Mozambique. Método: estudio ecológico descriptivo de casos de tuberculosis reportados en un sistema de información. Se analizó la tasa de incidencia media anual y el número de casos de notificación de TB en el municipio de Maputo entre 2011 y 2016. Se utilizó estadística descriptiva para calcular las medidas de tendencia central (media) y la aplicación del modelo de regresión lineal de Poisson Las notificaciones trimestrales se estratificaron por distrito, forma clínica y grupo de edad. Resultados: se notificaron 34,623 casos de TB entre 2011 y 2016, con un promedio trimestral de 1,443 casos. La incidencia anual promedio fue mayor en el distrito de Kampfumo, 909.8 por cada 100 mil habitantes (IC 95% 854.1 - 968.2), casi el doble que la incidencia del municipio de Maputo, 527.8 (IC 95% 514 , 3-541.6), y el país de Mozambique, 551 (95% CI 356 - 787). El diagnóstico clínico de los casos fue mayor en relación al diagnóstico bacteriológico, 44% y 35%, respectivamente. Conclusión: Maputo tuvo tasas de incidencia similares a las del país, sin embargo, hubo una heterogeneidad en las tasas por distrito y una reducción en el número de casos de TB en la población general (no coinfectados con VIH) y en los mayores de 15 años, siendo mayores en el primer trimestre.

"Xilala is only treated with a good hand": a study on the treatment of malnutrition in Mozambique / "A xilala só é tratada com uma boa mão": um estudo sobre o tratamento da desnutrição em Moçambique / "La xilala sólo puede tratarse con una buena mano": un estudio del tratamiento de la malnutrición en Mozambique

Abstract: In Mozambique old and new evils of body and spirit intertwine, thus allowing particular contours to modern life. Traditional diseases are reconfigured along the lines of a new thinking, and what Western medicine calls malnutrition is defined as xilala by the local traditional thinking. This study aimed to understand the point of view of both caregivers (mothers and grandmothers) of children participating in a Nutritional Rehabilitation Program and ethnomedicine experts, who find themselves entangled in a complex set of relationships through which different forms to comprehend body, health, and disease circulate. The supplement, as an object, has a life of its own and takes on new meanings when it leaves the hospital. When its use happens at home, it acquires a particularity: it becomes food. Thus, it ceases to be something inert and impersonal, which is a feature of standard medicine of the health institution. The local view centered on ethnomedicine is based on the certainty that a situation affecting a child cannot have a healing outcome if not by traditional medicine. Biomedical rationality erected from the confluence of the biological and technical sciences with their scientific postulates does not constitute the authorized discourse in this context.

Resumo: Em Moçambique, males velhos e novos do corpo e espírito se entrelaçam, permitindo contornos particulares na vida moderna. As doenças tradicionais são reconfiguradas em linha com um novo pensamento, e aquilo que a medicina ocidental chama de desnutrição é definida como xilala de acordo com o pensamento tradicional local. O estudo buscou compreender o ponto de vista das cuidadoras (mães e avós) de crianças participando em um Programa de Reabilitação Nutricional e de especialistas em etnomedicina, que se encontram emaranhados em um conjunto complexo de relações através das quais circulam diferentes maneiras de compreender o corpo, a saúde e a doença. Enquanto objeto, o suplemento alimentar tem vida própria e assume novos significados quando sai do hospital. Quando seu uso ocorre no domicílio, adquire uma particularidade: torna-se alimento. Portanto, deixa de ser algo inerte e impessoal, que é uma característica da medicina convencional nas instituições de saúde. A visão local centrada na etnomedicina tem como base a certeza de que a situação que aflige uma criança não pode ter a cura como desfecho, a não ser através da medicina tradicional. A racionalidade biomédica construída pela confluência das ciências biológicas e técnicas, com seus postulados científicos, não constitui o discurso autorizado nesse contexto.

Resumen: En Mozambique los viejos y nuevos demonios del cuerpo y el espíritu se entrelazan, permitiendo así conformar las particularidades de la vida moderna. Las enfermedades tradicionales se reconfiguran a lo largo de líneas nuevas de pensamiento, y lo que la medicina occidental denomina malnutrición se define como xilala por el pensamiento tradicional local. El objetivo de este estudio fue comprender el punto de vista de ambos proveedores de cuidados (madres y abuelas) de niños que participaban en el Programa de Rehabilitación Nutricional y expertos en etnomedicina, que se encuentran a sí mismos enmarañados en un complejo conjunto de relaciones, a través de las cuales existen diferentes formas de entender el cuerpo, la salud y la trasmisión de enfermedades. El suplemento alimenticio, como un objeto, tiene vida por sí mismo y toma nuevos significados cuando abandona el hospital. Cuando su consumo se produce en casa, adquiere una particularidad: se transforma en comida. Por ello, cesa de ser algo inerte e impersonal, que es una característica de la medicina estándar de una institución de salud. El punto de vista local centrado en la etnomedicina está basado en la certeza de que la situación que afecta al niño no puede tener un resultado curativo, si no es mediante la medicina tradicional. La racionalidad biomédica se erigió a partir de la confluencia de las ciencias biológicas y técnicas con sus postulados científicos, pero no constituye un discurso autorizado en este contexto.

Digital Assessment of Dental Parameters in Italian and Mozambican Subjects with Ideal Occlusion and Permanent Dentition

ABSTRACT Objective: To obtain reference values for tip, torque and in-out from digital models of Italian and Mozambican subjects in ideal occlusion using a repeatable and validated method and to compare these measurements with previously reported values. Material and Methods: Dental parameters were acquired from digital models of each subject, categorized to one of two groups: Italians (23 males, 27 females; mean age 28.3 years, ±5.7 years) and Mozambicans (14 males, 15 females; mean age, 23.4 years, ±5.9), using VAM software. All subjects had ideal occlusion, permanent dentition and no previous orthodontic treatment, fillings or prostheses. After normality of data was assumed (p<0.05), a paired t-test was performed to detect any statistical differences between the two groups (p<0.05). Then, classical inference (t-test and power analysis) was used to compare our data to those reported by other authors. Results: Mozambicans' incisors were more proclined, while their upper molars appeared to be more prominent regarding Italians'. Italians shown greater tip values, especially at the upper first premolars and lower first molars. In-out values were comparable between the two groups, except for the upper molars (more prominent in Mozambicans) and lower first molar (more prominent in Italians). Unlike other reports, upper second molars displayed negative tip in our samples. Conclusion: Pre-adjusted appliances with standard prescription should not be expected to guarantee optimal outcomes. Prescriptions specific for ethnicities are recommended and reference values should be reconsidered.

Antenatal care in Mozambique: Number of visits and gestational age at the beginning of antenatal care / Atención prenatal en Mozambique: número de consultas y edad gestacional al inicio del control prenatal / Assistência ao pré-natal em Moçambique: número de consultas e idade gestacional no início do pré-natal

Objective: 1)to assess the gestational age at the beginning of antenatal care and its covariates; 2)to assess the number of antenatal visits and its covariates; and 3)to identify the reasons for the late initiation of antenatal care and for attending less than four visits among postpartum women living in Nampula, Mozambique. Method: cross-sectional study conducted with 393 mothers who answered a structured instrument in face-to-face interviews. Logistic regression was used to analyze the covariates of having initiated antenatal care up to the 16thgestational week, having attended four or more antenatal visits, and reporting both situations simultaneously. Results: all postpartum women underwent antenatal care, but only 39.9% started it until the 16thgestational week, 49.1% attended four or more visits, and 34.1% reported both events. Having concluded high school (ORadj=1.99; 95%CI=1.19-3.31) or college (ORadj=3.87; 95%CI=1.47-10.18) were aspects associated with reporting both situations. The reasons for the late initiation of antenatal care and attending less than four visits were as follows: not finding it important to attend several visits, not having easy access to the health facility, not being aware about pregnancy, and not having a companion for the visits. Conclusion: the gestational age at the beginning of antenatal care and the number of antenatal visits are lower than the current recommendations in the country.

Objetivo: 1) analizar la edad gestacional al inicio del control prenatal y aspectos asociados; 2) analizar el número de consultas realizadas y aspectos asociados; y 3) identificar las razones del inicio tardío del control prenatal y de la realización de menos de cuatro consultas por parte de las mujeres posparto que residen en Nampula, Mozambique. Método: estudio transversal con 393 puérperas, que respondieron a un instrumento estructurado en entrevistas presenciales. Se utilizó regresión logística para analizar aspectos asociados a haber iniciado el control prenatal como máximo en la semana 16 de gestación, haber asistido a cuatro o más consultas prenatales y reportar ambas situaciones simultáneamente. Resultados: todas las puérperas realizaron el control prenatal, pero solo el 39,9% lo inició como máximo en la semana 16 de gestación; el 49,1% realizó cuatro o más consultas y el 34,1% informó ambos eventos. La educación secundaria (ORaj=1,99; IC95%=1,19-3,31) o la educación superior (ORaj=3,87; IC95% 1,47-10,18) fueron aspectos asociados al informe de ambas situaciones. Las razones del inicio tardío del control prenatal y de la realización de menos de cuatro consultas fueron: no considerar que fuera importante realizar varias consultas, no tener fácil acceso al centro de salud, no saber que estaba embarazada y no tener acompañante para las consultas. Conclusión: la edad gestacional para iniciar el control prenatal y el número de consultas realizadas son inferiores a las recomendaciones vigentes en el país.

Objetivo: 1) analisar a idade gestacional de início do pré-natal e aspectos associados; 2) analisar o número de consultas realizadas e aspectos associados; e 3) identificar as razões para o início tardio do pré-natal e para a realização de menos de quatro consultas entre puérperas residentes em Nampula, Moçambique. Método: estudo transversal com 393 puérperas, que responderam a um instrumento estruturado em entrevistas face a face. Utilizou-se regressão logística para analisar aspectos associados a ter iniciado o pré-natal até 16ª semana de gestação, ter realizado quatro ou mais consultas de pré-natal e relatar as duas situações simultaneamente. Resultados: todas as puérperas realizaram pré-natal, mas apenas 39,9% iniciaram pré-natal até a 16ª semana de gravidez; 49,1% realizaram quatro ou mais consultas e 34,1% relataram ambos eventos. O ensino secundário (ORaj=1,99; IC95%=1,19-3,31;) ou superior (ORaj=3,87; IC95% 1,47-10,18) foram aspectos associados a reportar ambas situações. As razões para início tardio do pré-natal e realização de menos de quatro consultas foram: não achar importante realizar várias consultas, não ter fácil acesso ao centro de saúde, não saber que estava grávida e não ter acompanhante para as consultas. Conclusão: a idade gestacional de início do pré-natal e o número de consultas realizadas são inferiores às recomendações vigentes no país.

Depresión en pacientes con diabetes mellitus y su relación con el control glucémico / Depression in patients with diabetes mellitus and its relationship with the glycemic control

Introducción: Algunos estudios resaltan la presencia de manifestaciones psiquiátricas en pacientes con diabetes mellitus. La depresión es el trastorno mental más frecuente en diabéticos; se considera que 1 de cada 3 pacientes con diabetes tienen depresión y, a su vez, el riesgo de tener un trastorno depresivo es 2 veces mayor que en la población general. Objetivo: Identificar algunos factores asociados con la depresión en pacientes diabéticos y su efecto en el control glucémico. Métodos: Se realizó un estudio descriptivo y transversal de 457 pacientes diabéticos, atendidos en el Hospital Central de Nampula, Mozambique, desde marzo de 2014 hasta diciembre de 2016. Como principales variables figuraron: frecuencia de los síntomas de depresión, trastornos depresivos, características sociodemográficas, eventos vitales actuales y control glucémico. Se utilizó el porcentaje como medida de resumen y como estadística inferencial la prueba de X2 de independencia y odds ratio, con un intervalo de confianza de 95 %. Resultados: La frecuencia de síntomas de depresión y de trastornos depresivos en la consulta externa fue de 32,3 y 24,3 %, respectivamente. Los factores mayormente asociados con la depresión fueron: el sexo femenino, estar viudo o divorciado y ser ama de casa. Por otra parte, experimentar 2 o más eventos vitales actuales incrementó la probabilidad de depresión y esta última se asoció con un mal control glucémico (p<0,05). Conclusiones: La frecuencia de depresión en pacientes diabéticos es elevada y está asociada con algunas variables sociodemográficas, con eventos vitales actuales y con un mal control glucémico.

Introduction: Some studies emphasize the presence of psychiatric signs in patients with diabetes mellitus. The depression is the most frequent mental disorder in diabetic patients; it is considered that 1 out of 3 patients with diabetes have depression and, in turn, the risk of having a depressive disorder is 2 times higher than in the general population. Objective: To identify some factors associated with the depression in diabetic patients and their effect in the glycemic control. Methods: A descriptive and cross-sectional study of 457 diabetic patients, assisted in the Central Hospital of Nampula, Mozambique, was carried out from March, 2014 to December, 2016. As main variables we can mention: frequency of the depression symptoms, depressive disorders, sociodemographic characteristics, current vital events and glycemic control. The percentage was used as summary measure and as inference statistics the chi-squared test of independence and odds ratio, with a 95 % confidence interval. Results: The frequency of depression symptoms and depressive disorders in the outpatient service was 32.3 and 24.3 %, respectively. The factors mostly associated with the depression were: the female sex, being widower or divorced and being a housewife. On the other hand, to experience 2 or more current vital events increased the depression probability and the latter was associated with a poor glycemic control (p <0.05). Conclusions: The frequency of depression in diabetic patients is high and it is associated with some sociodemographic variables, with current vital events and with a poor glycemic control.

Primeira Conferência Científica sobre COVID-19 em Moçambique com Uso Combinado de Plataformas de Informação e Comunicação / First Scientific Conference on COVID-19 in Mozambique with Combined Use of Information and Communication Platforms

O Instituto Nacional de Saúde (INS) organi zou, entre os dias 17 e 18 de Junho do presen te ano, a primeira Conferência Científica sobre a COVID-19 no país. O evento teve lugar nas instalações do INS, em Marracuene, tendo sido transmitida em directo por várias plataformas de comunicação e informação, uma vez que, pelo contexto da pandemia, não era possível realizar um evento presencial abrangente. Em cada um dos dias, houve uma sessão plenária seguida de painéis, com um orador e três comentadores. As sim, a conferência ligou entre si investigadores, académicos e público em geral através de várias plataformas de comunicação e informação (televi são, rádio, jornal e plataformas digitais: facebook, youtube e zoom) num evento que visava promo ver o debate científico sobre a COVID-19, e os desafios que ela coloca à sociedade moçambicana. Pretendia também analisar a resposta à pandemia em Moçambique e no mundo, nos planos eco nómico, social, cultural e, particularmente, no campo das ciências biomédicas. O modelo virtual desta conferência, permitiu a interacção com os participantes, tendo estes gozado da possibilidade de colocar questões aos membros do painel.

The National Institute of Health (INS) organized, between the 17th and 18th of June of this year, the first Scientific Conference on COVID-19 in the country. The event took place at the INS premises, in Marracuene, and was broadcast live by various communication and information platforms, since, due to the context of the pandemic, it was not possible to hold a comprehensive face-to-face event. On each day, there was a plenary session followed by panels, with one speaker and three commentators. Thus, the conference connected researchers, academics and the general public through various communication and information platforms (television, radio, newspaper and digital platforms: facebook, youtube and zoom) in an event that aimed to promote the scientific debate on COVID-19, and the challenges it poses to Mozambican society. It also intended to analyze the response to the pandemic in Mozambique and in the world, at the economic, social, cultural levels and, particularly, in the field of biomedical sciences. The virtual model of this conference allowed interaction with the participants, who enjoyed the possibility of asking questions to the panel members.

Physical activity among women of low socioeconomic status living with HIV in two major cities of Brazil and Mozambique: A cross-sectional comparative study

OBJECTIVES: Physical activity (PA) may reduce cardiovascular risk and preserve functional capacity of people living with human immunodeficiency virus (HIV). However, only limited research objectively measured PA in patients with low socioeconomic status (SES) in low-income countries, particularly in South America and sub-Saharan Africa. This study compared the PA assessed by accelerometers in women of low SES living with HIV under common antiretroviral therapy (cART) from two major cities in Brazil (Rio de Janeiro, n=33; 40.1±6.1 years) and Mozambique (Maputo, n=50; 38.8±8.7 years). METHODS: Eligible women wore triaxial accelerometers during seven consecutive days, to estimate their habitual PA and daily energy expenditure. RESULTS: The proportion of participants with overweight/obesity was greater in Rio than Maputo (57% vs. 30%; p=0.021), as well as those classified as sedentary based on steps/day (45% vs. 22%; p=0.02). Sedentary time was prevalent (Median±IQD: Rio-1236±142 vs. Maputo-1192±135 min/day; p=0.15). Time spent in PA was short, but Brazilians exhibited lower amount of light (111±56 vs. 145±51 min/day; p<0.001) and moderate-to-vigorous PA (88±3 vs. 64±36 min/day; p=0.001) vs. Mozambicans. The proportion of patients performing 60 min/day of moderate-to-vigorous PA were 58% (Rio) and 82% (Maputo), respectively. Despite of this, estimated daily energy expenditure was equivalent in both groups (1976±579 vs. 1933±492 kcal; p=0.731). CONCLUSIONS: Women with low SES living with HIV in Maputo were more active vs. patients from Rio de Janeiro. Albeit sedentary behavior was prevalent, the proportion of patients complying with the minimum recommended PA for health was higher than values usually reported in developed countries.

Potential impact of temperature and atmospheric pressure on the number of cases of COVID-19 in Mozambique, Southern Africa

The potential reasons why COVID-19 is not spreading rapidly in Sub-Saharan Africa include sociopolitical, biological and environmental variables. Among the latter, some studies indicate temperature and atmospheric pressure as significantly influential. Could they have impact on the number of COVID-19 cases in Mozambique? The aim of this study is to analyze the relationships between weather and the frequency of confirmed COVID-19 cases in Mozambique, Southern Africa. The study was conducted in Mozambique, Maputo area (Province and City) and Nampula Province. Daily history of weather variables ­ daily maximum and minimum temperatures and atmospheric pressure ­ was obtained from three online databases (AccuWeather, Time and Date AS and WeatherSpark) and the number of COVID-19 cases from official Government's daily Bulletins. The main statistical analyses were Pearson correlations between the variables. The first case was observed in the Maputo area on 22 March, 2020 and the cases in Mozambique increased exponentially up to 769 by 24 June, 2020. The first three cases in Nampula province were observed on 24 May 2020 but its frequency surpassed Maputo area's within one month. Temperatures showed negative correlations with the number of cases in all areas and pressure showed positive correlations in Maputo area and Nampula Province. A bubble chart allowed the visualization of the combined relationship of both weather variables and the number of cases, suggesting that the number of cases increases as temperature decreases and pressure increases. Temperature and atmospheric pressure seems to be correlated with the number of confirmed cases of COVID-19 in Mozambique. Thus, decision-makers should consider weather as a predictor of the rate at which the pandemic is spreading in the country

Travessias entre litorais: proposições para a saúde mental em moçambique / Travesías entre costas: proposiciones para la salud mental en mozambique / Crossing between coastlines: proposals for mental health in mozambique

Resumo O presente artigo se constrói a partir de reflexões baseadas numa psicanálise brasileira com interface na psicologia social, com o objetivo de dialogar com a Saúde Mental de Moçambique, um país que se subjetiva numa lógica não-ocidentalizada, cujo sistema de cuidado existente há séculos provém do curandeirismo, (re)conhecido no país como Medicina Tradicional. Sendo as políticas públicas de saúde mental regidas a partir de uma visão ocidental, este estudo questionou as reformulações teóricas necessárias para a inserção de novos dispositivos clínicos no país que incluíssem o saber tradicional. Como se trata de uma travessia, optou-se pelo método de escrita de cartas para melhor contemplar o encontro entre estas duas realidades tão diferentes e ao mesmo tempo tão semelhantes.

Resumen El presente artículo se construye desde reflexiones basadas en un psicoanálisis brasileño con interfaz en la psicología social, con el objetivo de dialogar con la Salud Mental de Mozambique, un país que se subjetiva en una lógica no occidentalizada, cuyo sistema de cuidado existente desde hace siglos se deriva del curanderismo, (re)conocido en el país como Medicina Tradicional. Siendo las políticas públicas de salud mental regidas dentro de una lógica occidental, se cuestionó las reformulaciones teóricas necesarias para la inserción de nuevos dispositivos clínicos en el país que incluyeran el saber tradicional. Como se trata de una travesía, se optó por el método de escritura de cartas para mejor contemplar el encuentro entre estas dos realidades tan diferentes y al mismo tiempo tan semejantes.

Abstract This article is built on reflections based on a Brazilian psychoanalysis with an interface in social psychology, aiming to integrate it into the Mozambican Mental Health. Mozambique is a country that operates in a non-westernized logic; with a care system that for centuries has come from healing practices, known in the country as Traditional Medicine. As public mental health policies are governed by a Western perspective, a question was raised about the theoretical reformulations that might be necessary for the insertion of new clinical devices in the country, including traditional knowledge. Being a traverse, the method of writing letters was chosen to better contemplate the encounter between these two realities, so different and yet so similar.

40 years of immunization in Mozambique: a narrative review of literature, accomplishments, and perspectives / Quarenta anos de imunização em Moçambique: uma revisão narrativa da literatura, avanços e perspectivas / 40 años de inmunización en Mozambique: una revisión narrativa de la literatura, logros y perspectivas

In Mozambique, the Expanded Program on Immunization (EPI) was implemented in 1979 with the objective of reducing child mortality and morbidity through the provision of immunization services. This study aims to describe the characteristics of the EPI and review the available information related to immunization service in Mozambique, its accomplishments and perspectives. A narrative review of the literature was carried out and the electronic databases accessed were VHL, Google Scholar, and PubMed between 1979 and 2019, using descriptors related to the theme. A total of 28 articles and other relevant sources have been consulted for the review. The national immunization coverage in Mozambique between 1997 (47%) and 2015 (66%) improved 19 percentual points; also immunization coverage of children under 12 months has increased from 44.3% (1997) to 57% (2015). The 2015 survey showed that out of the 11 provinces, only the southern and Cabo Delgado province could reach the 80% recommended goal at the provincial level. Zambézia, Nampula, and Tete provinces have been reporting low coverage over the years and Cabo Delgado presents coverage oscillation. The BCG, DPT3, Polio 3, and measles have reached 80% of coverage goal from 1997 to 2015. Our analysis have shown important improvements in national immunization, characterized by an overall increase in the national and provincial coverage and a decrease in the number of children that did not receive any vaccine. Despite these improvements, some provinces have lower coverages than expected and it is necessary to understand the determinants of dropout in children to retain them and provide timely and full immunization.

Em Moçambique, o Programa Alargado de Vacinação (PAV) foi implementado em 1979 com o compromisso de reduzir a morbimortalidade na população infantil através dos serviços de imunização. O presente estudo tem como objetivo descrever as características do PAV e revisar as informações disponíveis relacionadas aos serviços de imunização em Moçambique, os avanços e perspectivas. Foi realizada uma revisão narrativa da literatura, e as bases de dados acessadas foram BVS, Google Scholar e PubMed, entre 1979 e 2019, usando descritores relacionados ao tema. A revisão acessou um total de 28 artigos científicos, além de outras fontes relevantes. A cobertura nacional de vacinação em Moçambique entre 1997 (47%) e 2015 (66%) aumentou 19 pontos percentuais, e a cobertura de vacinação em crianças abaixo de 12 meses de idade aumentou de 44,3% (1997) para 57% (2015). De acordo com os dados de 2015, das 11 províncias, apenas as do Sul e a de Cabo Delgado atingiram a meta de cobertura recomendada de 80%. As províncias de Zambézia, Nampula e Tete mostraram baixas coberturas ao longo dos anos, enquanto Cabo Delgado mostrou oscilação na cobertura. As vacinas BCG, DPT3, Polio 3 e sarampo atingiram a meta de cobertura de 80% entre 1997 e 2015. Nossa análise mostrou avanços importantes na vacinação nacional, caracterizados por um aumento geral nas coberturas nacional e provinciais e uma queda no número de crianças que não receberam nenhuma vacina. Apesar desses avanços, algumas províncias tiveram coberturas aquém das metas, o que reforça a necessidade de entender os determinantes do abandono da imunização nas crianças, para retê-las e assegurar a imunização oportuna e completa.

En Mozambique, el Programa de Inmunización Expandido (EPI por sus siglas en inglés) fue implementado en 1979, con el compromiso de reducir la mortalidad infantil y la morbilidad a través de la provisión de servicios de inmunización. El objetivo del presente estudio es describir las características del EPI y revisar la información disponible, relacionada con el servicio de inmunización en Mozambique, así como sus logros y perspectivas. Se llevó a cabo una revisión narrativa de la literatura y se accedió a las siguientes bases de datos electrónicas: BVS, Google Scholar y PubMed para el período de 1979 a 2019, usando descriptores relacionados con el tema. Se tuvo acceso a un total de 28 artículos y otras fuentes relevantes para la revisión. La cobertura nacional de inmunización en Mozambique de 1997 (47%) a 2015 (66%) mejoró 19 puntos porcentuales y la cobertura de inmunización de los niños con menos de 12 meses se incrementó de un 44,3% (1997) a un 57% (2015). La encuesta de 2015 mostró que, de las 11 provincias, solamente la provincia del sur y la provincia de Cabo Delgado podrían alcanzar el 80% de la meta recomendada a nivel provincial. Las provincias de Zambézia, Nampula, y Tete han estado informando de baja cobertura a largo de estos años y Cabo Delgado tiene oscilaciones en la cobertura. BCG, DPT3, Polio 3 y sarampión han alcanzado un 80% de la meta de la cobertura de 1997-2015. Nuestro análisis ha mostrado importantes mejoras en la inmunización nacional, caracterizada por un aumento en general en la cobertura nacional y provincial, así como un decremento en el número de niños que no recibieron ninguna vacuna. A pesar de estas mejoras, algunas provincias tienen coberturas más bajas que las esperadas y existe una necesidad para entender los determinantes del abandono en niños para retenerlos y proporcionarles a tiempo una completa inmunización.

Molecular and serological characterization of occult hepatitis B among blood donors in Maputo, Mozambique

BACKGROUND Occult hepatitis B virus (HBV) - characterized by the absence of detectable HBsAg in the presence of HBV DNA - represents a potential threat for blood safety. OBJECTIVES This study was conducted with the aim to investigate the serological and molecular characterization of occult HBV infection (OBI) among blood donors in Mozambique. METHODS 1,502 blood donors were tested for HBsAg. All HBsAg-negative individuals were tested for HBV DNA. Antibodies against HBV core, surface and HBe antigen (anti-HBc, anti-HBs, HBeAg) were measured in HBV DNA positive individuals. FINDINGS 1435 serum samples were HBsAg negative and 16 positive for HBV DNA, 14 confirmed to have OBI, corresponding to a frequency of 0.98%. Of the 14 OBI infections identified, 13/14 (92.8%) were positive for anti-HBc, 4/14 (28.5%) for anti-HBs, and no samples were reactive for HBeAg. Of the 14 OBI cases, nine samples (64.2%) were sequenced for the S/P region. Eight samples (88.9%) belonged to genotype A1 and one (11.1%) to genotype E. One escape mutation (T123A) associated with OBI and various amino acid substitutions for genotype A1 and E were observed. MAIN CONCLUSIONS Our results show the importance of using nucleic acid amplification test to detect occult hepatitis B infection in blood donors in Mozambique.

Air pollution and other risk factors might buffer COVID-19 severity in Mozambique

Mozambique is located on the East Coast of Africa and was one of the last countries affected by COVID-19. The first case was reported on 22 March 2020 and since then the cases have increased gradually as they have in other countries worldwide. Environmental and population characteristics have been analyzed worldwide to understand their possible association with COVID-19. This article seeks to highlight the evolution and the possible contribution of risk factors for COVID-19 severity according to the available data in Mozambique. The available data highlight that COVID-19 severity can be magnified mainly by hypertension, obesity, cancer, asthma, HIV/SIDA and malnutrition conditions, and buffered by age (youthful population). Due to COVID-19 epidemic evolution, particularly in Cabo Delgado, there is the need to increase laboratory diagnosis capacity and monitor compliance of preventive measures. Particular attention should be given to Cabo Delgado, including its isolation from other provinces, to overcome local transmission and the spread of SARS-CoV-2

Towards post-colonial capacity-building methodologies - some remarks on the experiences of health researchers from Mozambique and Angola / Em torno de metodologias de capacitação pós-coloniais: algumas notas acerca das experiências de pesquisadores de saúde de Moçambique e Angola

Abstract This paper analyzes capacity building in practice, addressing the expectations, imaginaries and experiences of health researchers from Mozambique and Angola. The empirical data stems from the Erasmus+ funded project "University Development and Innovation - Africa (UDI-A)", a consortium established between European and African institutions to promote the mobility and empowerment of African academics, the establishment of North/South research partnerships and the strengthening of African institutions. Through qualitative research methods - semi-structured interviews and a focus group with African participants, and participant observation - this article analyzes the experiences of African academics working in the health field, their perceptions of capacity building and aspirations during their stay in Portugal in 2018. By addressing some of their concerns and achievements, this paper reflects on the performativity of capacity building methodologies, exploring a wide range of issues that emerge within the framework of North/South partnerships, inquiring whether it would be possible to decolonize capacity-building methodologies.

Resumo Este artigo analisa dispositivos de capacitação na prática, explorando as expetativas, os imaginários e as experiências de pesquisadores de saúde de Moçambique e Angola. Os dados empíricos resultam do projeto "University Development and Innovation - Africa (UDI-A)", financiado pelo programa Erasmus+, um consórcio estabelecido entre instituições europeias e africanas para promover a mobilidade e a capacitação de académicos africanos, o estabelecimento de parcerias de investigação Norte/Sul e o fortalecimento das instituições africanas. Através de metodologias qualitativas - entrevistas semiestruturadas e grupos de discussão com participantes africanos, e observação participante - este artigo analisa as experiências de académicos africanos trabalhando no setor da saúde, as suas perceções da capacitação e as suas ambições durante a estadia em Portugal em 2018. Através da análise das suas preocupações e sucessos, este artigo reflete acerca da performatividade das metodologias de capacitação, explorando um vasto leque de tópicos que emergem no contexto das parcerias Norte/Sul, questionando a possibilidade de uma descolonização das metodologias de capacitação.

Avaliação das práticas de higiene nos serviços de restauração da Universidade Eduardo Mondlane / Evaluation of hygiene practices in the food services of the Eduardo Mondlane University Mondlane University (UEM)

O presente trabalho tinha como objectivo avaliar as práticas de higiene associadas aos factores de riscos de doenças bacterianas de origem alimentar nos serviços de restauração da Universidade Eduardo Mondlane. O estudo foi realizado nos serviços de restauração da UEM de Maputo e Inhambane. Foram inqueridos, através de um questionário de perguntas semi-estruturadas, 37 trabalhadores com a categoria de cozinheiros e auxiliares de cozinha, foram visitadas as instalações e tiraram-se algumas fotografias por meio de uma máquina fotográfica digital da marca SAMSUNG. 80% dos inquiridos tinha escolaridade básica; 48% eram do sexo feminino e 52% masculino, a idade dos inquiridos variava de 22 a 57 anos e o tempo de serviço de 3 a 31 anos. Segundo os resultados do estudo os inquiridos têm consciência da necessidade de implementação das práticas correctas de higiene no decurso das suas actividades de modo a prevenir as doenças de origem alimentar. Contudo, foram observadas práticas que constituem factores de risco para a ocorrência de doenças bacterianas de origem alimentar. Os factores de risco observados estavam relacionados a prática incorrectas de armazenamento, higiene pessoal e geral, manipulação das sobras de alimentos, acondicionamento de lixo e controle de pragas. Conclui-se que a falta de observância de práticas correctas de higiene nos serviços de restauração concorre para o surgimento de doenças bacterianas de origem alimentar. Recomenda-se a implementação de programas educativos integrados regulares no sector, supervisão permanente e encorajamento de mudanças de comportamento na manipulação de alimentos.

The objective of the present study was to assess the practices of hygiene associated to the risks of foodborne diseases at restauration services of Eduardo Mondlane University (UEM). The study took place at services of restauration of UEM of Maputo and Inhambane; the data was collated using a questionnaire, with semi-structure questions. The questionnaire was submitted to 37 works namely cookers and auxiliaries of cookers, the installations were visited and some photography was taken using a SUMSUNG digital camera. 80% of the enquired has basic education; 48% were female and 52 were male; the age of the enquired varied from 22 to 57 years and the period of time of work varied from 3 to 31 years. According to the results of the study the inquired was aware about the need of the implementation of correct practices of hygiene during the work in order to avoid the foodborne diseases. However, was observed practices which constitute risk factor to the occurrence of foodborne diseases. The risk factors observed were related to storage, general and personal hygiene and handle of leftover, waste and pest control. It was concluded that the lack of correct practices of hygiene in the service of restauration constitute risk factor for the occurrence of foodborne diseases. It recommends the implementation of regular program of education, permanent supervision and encouraging of change of behaver in the handle of food.

Mycobacterium tuberculosis spoligotypes and drug-resistant characterization from Beira compared to genotypes circulating in Mozambique

Abstract INTRODUCTION Mozambique is one of three countries with high prevalence of tuberculosis (TB), TB/human immunodeficiency virus coinfection, and multidrug-resistant TB. We aimed to describe Mycobacterium tuberculosis spoligotypes circulating among drug resistant (DR) strains from Beira, Mozambique comparing them with genotypes in the country. METHODS: We performed spoligotyping of 79 M. tuberculosis suspected of DR-TB compared all spoligotype patterns published on the international database and PubMed. RESULTS: Both in Beira and Mozambique (n=578), the main clades were Latin-American-Mediterranean, East-African-Indian, Beijing and T, with no extensively DR TB cases. CONCLUSIONS: Beira and Mozambique share the same population genetic structure of M. tuberculosis.

Hansen's disease deformities in a high risk area in Mozambique: A case study

Abstract INTRODUCTION: Hansen's disease is no longer a public health problem in Mozambique, since 2008 (incidence under 1 / 10,000 inhabitants). The country is one of the most affected in the world and Nampula province's Murrupula district (incidence 1.7 / 10,000) has a high deformity rate (22% in 2010). This study aimed to identify high deformity rate associated determinants and proposals for better health program results. METHODS: This study involved a descriptive quantitative survey, systematic observation of patients and health professionals, and a survey of community volunteers. Data were analyzed using Epi Info 7.2. Pearson's chi-square and Fisher's exact test were used to assess statistical association with deformity, with a significance level of 5% and 95% confidence interval. Ethical procedures followed the Helsinki declaration (2013). RESULTS: Among 238 subjects, 175 were patients and 63 leprosy health staff. Most patients relied on subsistence agriculture facing social exclusion (43, 25%). The waiting time from first symptoms to diagnosis was over one year for 63%. Deformity affected 116 subjects (68%), particularly those who considered the disease as God's desire (p = 0.01), and practiced traditional treatments (p = 0.001). Among leprosy health staff, 35 (52%) were not trained on diagnosis and management. CONCLUSIONS: High deformity rate is associated with low economic status, the belief that the disease is God's desire, the use of traditional healers, late diagnosis, and poor disease management. A health education program targeting professionals and population, with infection screening and self-care groups can prevent deformities.

Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique

Introduction The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results : 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for 'green'/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for 'red'/urgent (IQR 2­40 min). Conclusion : In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings