Perceptions and compliance with COVID-19 preventive measures in Southern and Central regions of Mozambique: a quantitative in-person household survey in the districts of Manhica and Quelimane (preprint)

Background The COVID-19 pandemic has led countries into urgent implementation of stringent preventive measures at the population level. However, implementing these measures in low-income countries like Mozambique was incredibly difficult, coupled with lack of scientific evidence on the community understanding and compliance with these measures. This study assessed the perceptions and implementation of COVID-19 preventive measures recommended by Mozambican authorities in Manhica and Quelimane districts, taking confinement, social distancing, frequent handwashing, mask wearing, and quarantine as the key practices to evaluate. Methods A quantitative survey interviewing households heads in-person was conducted in October 2020 and February 2021; collecting data on perceptions of COVID-19, symptoms, means of transmission/prevention; including self-evaluation of compliance with the key measures, existence of handwashing facilities, and the ratio of face-masks per person. The analysis presents descriptive statistics on perceptions and compliance with anti-COVID-19 measures at individual and household levels, comparing by district and other variables. T-test was performed to assess the differences on proportions between the districts or categories of respondents in the same district. Results The study interviewed 770 individuals of which 62.3% were heads of households, 18.6% their spouses, and 11.0% sons/daughters. Most participants (98.7%) had heard of COVID-19 disease. The most difficult measure to comply with was staying at home (35.8% of respondents said they could not comply with it at all); followed by avoiding touching the month/nose/eyes (28.7%), and social distancing at home (27.3%). Mask wearing in public places was the measure that more respondents (48.8%) thought they complied 100% with it, followed by avoiding unnecessary traveling (40.0%), avoiding crowed places (34.0%), and social distancing outside home (29.0%). Only 30.4% of households had handwashing devices or disinfectant (36.7% in Manhica and 24.1% in Quelimane); and of those with devices, only 41.0% had water in the device, 37.6% had soap, and 22.6% had other disinfectant. The ratio of masks per person was only 1, which suggests that people may have used the same mask for longer periods than recommended. Conclusions Community members in Manhica and Quelimane were aware of COVID-19 but they lacked understanding for implementing the preventive measures. This, together with socio-economic constraints, led to lower levels of compliance with the key measures. Understanding and addressing the factors affecting proper implementation of these measures is crucial for informing decision-makers about ways to improve community knowledge and practices to prevent infectious diseases with epidemic potential.

Knowledge of pregnant women in rural Mozambique on routine practices to prevent and treat common conditions at the antenatal care clinic (preprint)

Background: Despite an increasing proportion of pregnant women accessing antenatal care (ANC) in low-income countries, preventable maternal morbidity and mortality remains high. Limited women’s knowledge on common diseases during pregnancy and on the indications of routine health interventions delivered at the ANC clinic may reduce the compliance and effectiveness of these interventions. We assessed pregnant women’s knowledge on common diseases in pregnancy and on routine interventions delivered at the ANC clinic as well as their compliance with these interventions. Methods: From December-2019 to October-2020, we undertook a qualitative study using individual semi-structured and in-depthinterviews in 79 pregnant women attending the ANC clinic of a rural hospital in Mozambique. Participant’s ability to identify the drugs administrated was assessed by showing them the drugs without the label (antiretroviral, ferrous sulfate, cotrimoxazole, isoniazid, mebendazol and antimalarial). Interviews were recorded, transcribed, coded and a combined Content and Thematic analysis technique used. NVivo 12 software was used to store and retrieve the data. Results: Most of the participants recognized that infectious diseases such as HIV, malaria, sexually transmitted infections, tuberculosis and COVID-19, could be harmful in pregnancy. Overall, knowledge on the indication of the prescribed drugs was limited, being higher for antiretroviral drugs and ferrous sulfate, and lower for mebendazol and isoniazid. The general perception was that all drugs prescribed at the ANC clinic prevent or treat malaria infection. Knowledge on the indication of the prescribed drugs was generally higher in HIV-infected pregnant women compared to HIV uninfected women. Forgetting daily medication intake, non-compliance with the drug intake schedule and perceived importance given to some drugs instead of others, were practices found regarding compliance to the pharmacological interventions. Conclusion: Knowledge of Mozambican pregnant women on health interventions delivered at the ANC clinic was generally limited. The latter may reduce compliance and adherence with these interventions and thus their effectiveness and safety. Reinforcing Information and education on ANC health interventions targeting women of childbearing age would improve maternal and infant health.