Development of a model of care based on the chronic care and collaborative care models to improve cardiometabolic health in low-to- middle income countries

Background: Non-communicable diseases (NCDs) are rising in low middle income countries (LMICs) mainly driven by cardiometabolic disease (cardiovascular disease, diabetes, and hypertension). Aim(s): To develop a model of care, based on the chronic care model and collaborative care model, to improve care, outcomes and risk factor control for adults with cardio metabolic disease in LMICs in the Covid-19 era. This will contribute to the sustainable development goals of promoting good health, well-being and reducing inequalities. Method(s): Using an iterative consultative approach with healthcare workers, clients, and community leaders in Kenya, Ghana and Mozambique, we developed a model of care, which includes core features from chronic care models: self-management support;decision support;clinical information systems;delivery system design;and community linkages. Result(s): We produced a culturally adapted self-management education programme, a training package for educators delivering the programme, as well as a training package for community and healthcare professional leaders to increase awareness and self-care for cardiometabolic disease. Given the lack of a robust health information system, we are offering a global registry to provide real world data on patient management and quality of care for people with type 2 diabetes, hypertension, heart failure and chronic kidney disease. Conclusion(s): This intervention will be tested in a mixed-methods single-arm feasibility study in five sites across three African countries: Kenya, Ghana, Mozambique.

Reactivation of Surgical Campaigns after the Covid Pandemic: Surgeons in Action with Hernia International Foundations in 2022

Aim: The Cirujanos en Accion and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed. Material/ Methods: We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge. Result(s): Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals);local staff;1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.) Conclusion(s): 9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future.

Efficacy of government laws to contain SARS-CoV-2 spread in Mozambique.

Background: The purpose of this research was to assess the relationship between infection by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) containment measures implemented in Mozambique and the spread of SARS-CoV-2 from March 17, 2020, to September 30, 2021. Materials and Methods: The number of SARS-CoV-2 tests conducted, the positivity rate for SARS-CoV-2, the daily hospitalization due to COVID-19, and the average number of patients hospitalized with COVID-19 each day were all documented in a database, from which the positivity rate and weekly growth rate were calculated. Seven milestones were specified, each corresponding to a critical date in the legal measures linked to confinement and relaxation of measures. To compare SARS-CoV-2 data, three periods were created for each milestone: Period 1 = 15 days before the date of the decree; Period 2 = Date of the decree to the 15th day after; and Period 3 = from the 16th day to the 30th day of the decree date. ANOVA was used to compare the average values for each indicator between the three times for each milestone. Results: A comparison of all indicators in each milestone's three periods reveals no consistent significant impact of the measures, regardless of the tendency to lockdown or provide relief. Conclusion: No relationship was discovered between the legal measures for SARS-CoV-2 pandemic control and the positive rate and growth rates, as well as the number of hospitalized people. Because it was not feasible to determine the degree of efficacy of each specific measure, this conclusion is related to the measures as a whole.

Outbreaks of different viral etiologies amidst COVID-19 pandemic

The COVID-19 pandemic has severely affected public health system and surveillance of other communicable diseases across the globe. The lockdown, travel constraints and COVID phobia turned down the number of people with illness visiting to the clinics or hospitals. Besides this, the heavy workload of SARS-CoV-2 diagnosis has led to the reduction in differential diagnosis of other diseases. Consequently, it added to the underlying burden of many diseases which remained under-diagnosed. Amidst the pandemic, the rise of emerging and re-emerging infectious diseases was observed worldwide and reported to the World Health Organization i.e., Crimean Congo Hemorrhagic Fever (2022, Iraq;2021 India), Nipah virus (2021, India), Zika virus (2021, India), and H5N1 influenza (2021, India), Monkeypox (2022, multicountry outbreak), Ebola virus disease (2022, DRC, Uganda;2021, DRC, Guinea;2020, DRC), Marburg (2022, Ghana;2021, Guinea), Yellow fever (2022, Uganda, Kenya, West and Central Africa;2021, Ghana, Venezuela, Nigeria;2020, Senegal, Guinea, Nigeria, Gabon;2020, Ethiopia, Sudan, Uganda), Dengue (2022, Nepal, Pakistan, Sao Tome, Temor-Leste;2021, Pakistan), Middle east respiratory syndrome coronavirus (2022, Oman, Qatar;2021, Saudi Arabia, UAE;2020, Saudi Arabia, UAE), Rift valley fever (2021, Kenya;2020, Mauritania), wild poliovirus type 1 (2022, Mozambique), Lassa fever (2022, Guinea, Togo, Nigeria;2020, Nigeria), Avian Influenza (H3N8) (2022, China), Avian Influenza (H5N1) (2022, USA), H10N3 influenza (2021, China), Hepatitis E virus (2022, Sudan), Measles (2022, Malawi, Afghanistan;2020, Burundi, Mexico), Mayaro virus disease (2020, French Guiana), Oropouche virus disease (2020, French Guiana). All these diseases were associated with high morbidity and burdened the public health system during the COVID-19 pandemic. During this critical public health menace, majority of the laboratory workforce was mobilized to the SARS-CoV-2 diagnosis. This has limited the surveillance efforts that likely led to under diagnosis and under-detection of many infectious pathogens. Lockdowns and travel limitations also put a hold on human and animal surveillance studies to assess the prevalence of these zoonotic viruses. In addition, lack of supplies and laboratory personnel and an overburdened workforce negatively impacted differential diagnosis of the diseases. This is especially critical given the common symptoms between COVID-19 and other pathogens causing respiratory illnesses. Additionally, the vaccination programs against various vaccine preventable diseases were also hampered which might have added to the disease burden. Despite these challenges, the world is better prepared to detect and respond to emerging/re-emerging pathogens. India now has more than 3000 COVID-19 diagnostic laboratories and an enhanced hospital infrastructure. In addition, mobile BSL-3 facilities are being validated for onsite sampling and testing in remote areas during outbreak situations and surveillance activities. This will undoubtedly be valuable as the COVID-19 pandemic evolves as well as during future outbreaks and epidemics. In conclusion, an increase in the emergence and re-emergence of viruses demonstrates that other infectious diseases have been neglected during the COVID-19 pandemic. Lessons learned from the infrastructure strengthening, collaborations with multiple stakeholders, increased laboratory and manufacturing capacity, large-scale COVID-19 surveillance, extensive network for laboratory diagnosis, and intervention strategies can be implemented to provide quick, concerted responses against the future threats associated with other zoonotic pathogens.

Excess of Mortality in Older People during the Covid-19 Pandemic in Mozambique

Background: The impact of COVID-19 pandemic was apparently less severe in African continents, probably underestimated due to the limited testing capacities and access to health facilities, particularly in rural areas. Hospital and community surveillance of COVID-19 was established in Manhica District, rural Mozambique to understand the epidemic curve and natural history of SARSCoV- 2 including age-specific incidence of severe COVID-19 and reproduction number and effects of interventions through mathematical modelling Methods: Suspected cases visiting the Manhica District Hospital were screened for SARS-CoV-2 by qRT-PCR. Four age-stratified (0-19, 20-39, 40-59 and >=60 years, n=300 each) community-based serosurveys were conducted (Apr 2021-Feb 2022) to estimate the prevalence of antibodies (Abs) against SARS-CoV-2. We fitted a statistical model within a Bayesian framework, to estimate the extent to which older people were over-represented in mortality data throughout the pandemic. This involved training the model on data from the pre-pandemic period and then using this model to generate estimates of the expected levels of mortality in the absence of COVID-19 in adults aged 40+ using data from our reference category (15-39 year olds). Result(s): Between Dec 2020 and Aug 2022, 31.2% of 1332 swabs tested positive for SARS-CoV-2, with high proportion among people aged 50-59 years (62.1%, 36/58). Abs against SARS-CoV-2 were detected in 28% (180/666) of subjects enrolled in survey one, which increased two and tri-fold, in surveys 2 (64%, 595/936) and 3 (91%, 700/768);remaining stable (91.3%, 1023/1121) in 4. Age-specific analysis showed consistency on Abs detection over the surveys, including people non-eligible for vaccination (0-17 years) where >80% (165/188) had Abs detected. 93% (359/384) of subjected with Abs in survey 3, remained positive 3 months later. Shifting age-patterns throughout the pandemic are consistent with a high impact of the disease particularly in older ages. Depending on assumptions made in our modelling, we estimate a cumulative excess mortality rates in adults aged 80+ of between 8 and 17% with the largest peak coinciding with the peak in the delta variant wave. Conclusion(s): Our data reveal that people in rural areas were widely exposed across including unvaccinated ones;and there was a signature COVID-19-like shift in mortality patterns towards older ages, suggesting substantial impact, of the pandemic that is largely not reflected in patterns of confirmed COVID-19 deaths. Quantitative estimates of shift in age-patterns throughout the pandemic. (A) Shows the fit of the model to age-patterns of mortality in the pre-pandemic period 2018-2020. This model is then used to generate the expected numbers of deaths in individuals aged 40+ throughout the pandemic (2020-2022). (B) excess deaths in the pandemic relative to the model, shown in (A), black lines and grey shaded regions show estimates assuming that declines in reported mortality in under 40s are due to declines in mortality (assumption 1), coloured show equivalent estimates assuming that declines in mortality in under 40s are due to declines in ascertainment (assumption 2). (C) Shows estimates from (A) as mortality per 1000 individuals within the age strata, (D) shows each excess mortality estimate as a proportion of the population within the age strata, with seroprevalence estimated from the first two cross-sectional surveys highlighted for reference.

The Differential Effects of Oil Prices on the Development of Renewable Energy in Oil-Importing and Oil-Exporting Countries in Africa

The shift to renewable sources of energy has become a critical economic priority in African countries due to energy challenges. However, investors in the development of renewable energy face problems with decision making due to the existence of multiple criteria, such as oil prices and the associated macroeconomic performance. This study aims to analyze the differential effects of international oil prices and other macroeconomic factors on the development of renewable energy in both oil-importing and oil-exporting countries in Africa. The study uses a panel vector error correction model (P-VECM) to analyze data from five net oil exporters (Algeria, Angola, Egypt, Libya and Nigeria) and five net oil importers (Kenya, Ethiopia, Congo, Mozambique and South Africa). The study finds that higher oil prices positively affect the development of renewable energy in oil-importing countries by making renewable energy more economically competitive. Economic growth is also identified as a major driver of the development of renewable energy. While high-interest rates negatively affect the development of renewable energy in oil-importing countries, it has positive effects in oil-exporting countries. Exchange rates play a crucial role in the development of renewable energy in both types of countries with a negative effect in oil-exporting countries and a positive effect in oil-importing countries. The findings of this study suggest that policymakers should take a holistic approach to the development of renewable energy that considers the complex interplay of factors, such as oil prices, economic growth, interest rates, and exchange rates.

Leveraging Digital Financial Inclusion: How G7's "Build Back Better" Can Promote Gender Equality in Africa

Women, the rural poor, young people, and other vulnerable groups should not have to bear the brunt of the pandemic's socio-economic implications.6 First introduced in Kenya in 2007, the digital payment service "M-Pesa" has grown rapidly, becoming the most common mode of payment for goods and services in the East African region.7 Basking in the service's success facilitating payment transactions, Kenya has risen to the top of regional rankings in both the supply of mobile money services and bank account ownership (Figure 1). According to the 2017 Findex Report, the global trend of bank account ownership in middle to low-income countries stood at 63 percent in 2017. [End Page 79] smartphones and digital literacy are associated with poverty and are the main barriers to getting online.14 According to Research ICT Africa's Retail Africa Mobile Pricing (RAMP) Index, price is another barrier, since data is still quite expensive in many African countries.15 Financial inclusion during COVID-19 According to an International Finance Institution (IFC) study of thirteen countries in sub-Saharan Africa, women-owned micro, small, and medium-sized firms (MSMEs) were most adversely affected by COVID-19, due to their smaller size and high concentration of ownership.16 Many of these female owners indicated that their companies had lost more than half of their revenues and that they had experienced an increase in the cost of their operations due to the pandemic. According to the Research ICT Africa's phone survey,19 58 percent of those who received the facility were individuals and women-owned small and medium-sized enterprises (WOSME).20 This demonstrates that women, particularly those working in the

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

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.

Effects of the COVID-19 crisis on household food consumption and child nutrition in Mozambique

This study investigates the short-term impacts of an aggregate socioeconomic shock on household food consumption and children's nutrition using the case of the COVID-19 pandemic in Mozambique. In response to the economic downturn, households are expected to adjust their food choices both in terms of quality, towards cheaper and unhealthier food, and quantity, reducing diet diversification and increasing the exposure to malnutrition, mainly for children. Empirical evidence on such immediate effects is still scarce, mainly due to a lack of data. This paper aims to fill the evidence gap by relying on household survey data from 2019-20, which includes a detailed consumption module and anthropometric measures for children under five. We use a repeated cross-sectional econometric analysis to look at the variation in household food consumption and child nutrition before and after the pandemic. The results show that there has been a significant reduction in household food consumption and per capita caloric intake and an increase in stunting, especially among newborn children.

Climate disasters, altered migration and pandemic shocks: (im)mobilities and interrelated struggles in a border region

Shocks linked to climate disasters are increasingly understood as intertwined with inequities, devastating livelihoods, exacerbating food insecurities and impacting migration economies. Yet there is often a lack of sustained and situated attention to how these – and diverse secondary and tertiary shocks – are experienced in relation to gender and class inequalities, other social differences and underlying forces shaping differentiated mobility-related challenges over time. Divergent experiences and histories of shocks are often simplified, with (im)mobility-related struggles misunderstood or only ly represented. Amid these concerns, this article explores the 'mobilities turn' in climate disaster research, focusing on experiences articulated by people along the Zimbabwe-Mozambique border, examining multiple impacts of climate disasters and changing dynamics of (im)mobility converging with pandemic shocks and interrelated political and socio-economic struggles. In this region, impacted by one of the world's most severe tropical cyclones in recent memory, we explore the embeddedness of shocks in dynamic political-economic landscapes and life trajectories. Part of a multi-method 5-year project, we focus on stories where articulations around mobilities, translocal connections and mobility disruptions, including from COVID-19, call for carefully understanding socio-economic ties and histories, land alienation and access inequities, mutating meanings of borders, and factors intensifying economic insecurities amid increasingly severe and frequent climate shocks. [ FROM AUTHOR] Copyright of Mobilities is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The feminisation of poverty: A study of Ndau women of Muchadziya village in Chimanimani Zimbabwe

Poverty statistics in many countries of the developing world, with Zimbabwe being no exception, continue to show a gender-skewed trend, with women more than men increasingly being more affected. This is worrying, considering the fact that it is women who are the majority, and they carry the brunt of the burden for most household duties. Zimbabwe adopted the Sustainable Development Goals (SDGs), and yet women continue to be hit hard by poverty. This was a qualitative study involving interviews and focus group discussions with 58 purposively sampled participants from Muchadziya village to determine the extent to which women in Muchadziya village are contributing towards sustainable development in Zimbabwe. The aim of this article, was to explore the ways in which women in Muchadziya village are contributing towards the alleviation of poverty. In the process, they will be contributing towards the attainment of some of the SDGs, such as the ones focusing on ending poverty in all its forms everywhere (SDG 1) and ending hunger, achieving food security and improved nutrition and promoting sustainable agriculture (SDG 2). Using Africana womanism theoretical framework, the article maintained that African women should be perceived as agents, not subjects, of development and transformation in their communities. Findings indicated that women in Muchadziya village are selling various products and have sought markets in Beitbridge, Gweru and Zvishavane to sell them;others have set up shops and flea markets, and others make use of the land even though they do not own it to produce farm products to fight against poverty. The study concluded that women, despite being in difficult circumstances, are capable of contributing towards the achievement of the SDGs, particularly SDG 5 focusing on women's empowerment and attaining gender equality. It is therefore recommended that women be given the necessary support to achieve more. Contribution: In a context where women are the most affected by poverty, Ndau women have proven that they can be agents of change by contributing towards the achievement of SDGs such as ending poverty in all its forms, zero hunger, education, gender equality and women's empowerment and water and sanitation. Not much scholarly attention has been paid to the agency of women in Chimanimani in enhancing Zimbabwe's sustainable development. This gap in literature might be influenced by the fact that African women, particularly women in rural areas, are perceived as beneficiaries or recipients of aid or development initiatives. As such, most programmes mainstreamed by aid or donor agencies in Africa have a specific focus on distributing aid to women and girl-children. Unfortunately, such programmes rarely seek to capacitate or empower their beneficiaries;hence, their interventions eventually disempower the intended beneficiaries.

Test positivity and clinical presentation of COVID-19 in Mozambican infants hospitalized during the second wave of the pandemic in 2021.

Introduction: during the second wave of the COVID-19 pandemic in Mozambique, there was a surge in pediatric hospitalizations at a time when there was relatively little evidence, but significant concern about clinical outcomes in African children, particularly in higher-risk infants requiring, and health system capacity to respond. Methods: a retrospective cohort study was conducted for patients 1-12 months of age admitted to the Breastfeeding ward at Hospital Central de Maputo from January-February 2021. All had routine SARS-CoV-2 PCR testing performed. For patients with positive results, hospital charts were retrospectively reviewed. Descriptive analyses were performed. Results: of 209 patients that had SARS-CoV-2 PCR testing performed, 102 (48.8%) received results, of which 37 (36.3%) were positive. Positive results were received prior to discharge for 14 patients (37.8%). Median duration of hospitalization was 3 days. There were two deaths in COVID-positive patients (5.4%), both with complex comorbidities. For the 35 COVID-19 positive patients whose charts were located, the principal admission diagnosis was respiratory for 22 (62.9%), and 14 (40.0%) had oxygen saturation <94% at admission. The white blood cell count was >12.0 x 103cells/mL in 10 patients (28.6%) and the most common abnormal finding on chest radiograph was peribronchial thickening (38.5% of patients with results). Oxygen therapy was needed for 20 patients (57.1%). Conclusion: the majority of infants with COVID-19 had a mild, short-duration respiratory illness that did not exceed ward capacity for care, including oxygen treatment. Laboratory capacity for PCR testing was overwhelmed, delaying the return of results and complicating inpatient infection control measures.

Smallholder views on Chinese agricultural investments in Mozambique and Tanzania in the context of VGGTs

Based on a case study in each country, this study documents the views of Mozambican and Tanzanian smallholders regarding Chinese agricultural investments and the extent to which investors abide by their legitimate land tenure rights as defined by the Voluntary Guidelines for the Responsible Governance of Tenure of Land, Forests and Fisheries in the Context of National Food Security (VGGTs). The VGGTs offer guidelines to government on how to protect the land tenure of rural communities when land is being acquired for large-scale land investments. The study also assessed the impact of the COVID-19 pandemic on smallholders. Due to COVID-19, instead of fieldwork, we conducted telephone interviews with 20 smallholders in Mozambique and 35 in Tanzania. The Mozambican case showed that even when land set aside for investors was not in dispute, smallholders still had unmet expectations, especially regarding investors' corporate social responsibility activities. In the Tanzanian case, even though the land leased by the Chinese investor had been designated as general land, it had laid fallow for a long period, and smallholders had moved back onto the land, only to be displaced in 2017. Although smallholders' views on the investment were mixed, the case underscored the need for government to assess current land use before allocating it to investors - regardless of how the land is classified and especially in areas where land shortages are creating conflict. The cases show that even if communities are consulted about proposed land investments, guidelines need to include clauses that allow for ongoing communications between investors, communities and government officials such that if communities are unsatisfied with the results of the investment, renegotiation is possible. Further, in the event of crises, such as COVID-19, investors should partner with communities and government to limit the extent of harm in communities as a result of the crisis.

Assessment of strategies to enhance the online presence of the Mozambican government website on tourism destination marketing

PurposeThe purpose of the present paper was to explore the best practices of destination management in promoting tourist destinations through the Mozambique government website (INATUR) and identify strategies that enhance its visibility and online presence. This was only possible by (1) exploring if people are aware of the government website's existence;(2) examining the existence of indicators of the engagement behaviors for the web-users (visitors) in their searching process on the government website;(3) exploring if the engagement behavior and website features have influence on the government website visitors' satisfaction and (4) providing measures to enhance the popularity of the government website at INATUR.Design/methodology/approachThe study combined a qualitative and quantitative methodological approach from the primary data collected via an online questionnaire survey of 269 random respondents, and the selected data was analyzed and processed using Stata 13 with the descriptive statistic and ANOVA [Analysis of Variance (an econometric model)] technique. The data was collected from secondary sources and from the interview, a strengths, weaknesses, opportunities, and threats (SWOT) analysis was applied with an interpretive approach.FindingsThe government website presents the minimum of relevant information to respond to the users' needs and expectations. There is little knowledge regarding the existence of the government website for tourism destination marketing. Few respondents were surprised about this website's existence. The optimistic side of responses came from those peple who used the website and it helped their expectation. The correlation analysis showed a significant positive relationship between the government website features and the visitors' searching satisfaction;the interview outputs noted that the shortage of staff at INATUR with knowledge of digital marketing engagement plays a role in solving the problem of the visibility and online presence of the website.Research limitations/implicationsOne of the apparent limitations of this research was the world pandemic situation (Covid-19), which influenced to make abrupt arrangements in conducting the questionnaire survey and interview compared to the planned schedule. The interview was supposed to be a field research to have direct contact with her respondents and collect nonverbal information through the respondents' body language, but unfortunately, it was not possible. Improvising was one of the solutions and had to design an online questionnaire survey for national and international tourist respondents and an emailed interview with INATUR director. Because of that, the results showed a very significant gap between African nationals and international respondents in number of 264 and 5, respectively (about in 98,14%) caused by the lockdown and traveling limitation.Practical implicationsThe adoption of the contents in "Recommendations for policy and decision-making” can help in synergizing an integrative marketing communication strategy that enables all actors to maximize local economic benefits without spending many financial resources, and support sustainability, different tourist destination suppliers, authorities and local communities' development. Ensuring effective and efficient communication, and above all, enhancing the provision of reliable information. Reinforce the importance of the practical teaching and learning of digital platforms in tourism schools and universities;offer a thematic tool to serve as an analytical basis in future studies, encouraging continuous scientific research on the subject under study.Social implicationsRaising the awareness of the government website among tourist consumers;promoting Mozambique as a reference destination and its tourist diversity through the use of the government website;capitalizing tourists' enterprises for communities' development;improving the competitiveness of destinations through greater exposure of tourism products and services on the government website bo sts the economic gains for the development of the tourism sector in the country. Accessibility to the information channel of Mozambican tourist destinations via the government website, and stimulating the desire to visit;improve and enrich the visitor's experience quality on the government website in the tourist information consultation.Originality/valueIt is the first research in the country about tourism destination marketing using indicators like customers' behavioral engagement levels based on social interactions such as likes, shares and comments on the government website, as well as its awareness and performance aspects, to analyze if the INATUR government website is being successful on its tourism destination marketer role. The research was also done to bring solutions to the current trends of the Covid-19 pandemic that has affected and disrupted the tourism industry.

Malaria vaccine: the tale of terror, triumph, tyranny, and trust

Malaria is an endemic disease in a true sense. It is an acute febrile disease caused due to the parasite Plasmodium. However, unlike COVID-19, it failed to raise an international concern or gain the scientific limelight. Most of the 200 million globally affected by malaria, half of them are from Africa. Four of the nations, Nigeria (25%), the Democratic Republic of the Congo (11%), Mozambique (5%), and Uganda (4%), account for half of the world's malaria burden and is the leading cause of illness and death. In 2019, an estimated 5-6 million people died of malaria - most of them are young children in sub-Saharan Africa. Many of the countries affected by malaria have the lowest economic status. In the malaria-endemic region, the most vulnerable groups are young children and pregnant women. The costs of malaria are enormous to individuals, families, communities, societies, and nations. After a struggle for three decades, the much-awaited malaria vaccine, RTS, S (brand name Mosquirix), was finally launched;but it came with its controversies and allegations. This review explored the different angles of this disease, the vaccine development, and the emerging debates.

Determinants of COVID-19 vaccine acceptance in Mozambique: The role of institutional trust.

BACKGROUND: Vaccination plays an imperative role in protecting public health and preventing avoidable mortality. Yet, the reasons for vaccine hesitancy in African countries are not well understood. This study investigates the factors associated with the acceptance of COVID-19 vaccine in Mozambique, with a focus on the role of institutional trust. METHODS: The data came from the three waves of the COVID-19 Knowledge, Attitudes and Practices (KAP) survey which followed a cohort of 1,371 adults in Mozambique over six months (N = 3809). We examined vaccine acceptance based on three measurements: willingness to take vaccine, perceived vaccine efficacy, and perceived vaccine safety. We conducted multilevel regression analysis to investigate the trajectories of, and the association between institutional trust and vaccine acceptance. RESULTS: One third of the survey participants (37%) would definitely take the vaccine. Meanwhile, 31% believed the vaccine would prevent the COVID-19 infection, and 27% believed the vaccine would be safe. There was a significant decrease in COVID-19 vaccine acceptance between waves 1 and 3 of the survey. Institutional trust was consistently and strongly correlated with different measures of vaccine acceptance. There was a greater decline in vaccine acceptance in people with lower institutional trust. The positive correlation between institutional trust and vaccine acceptance was stronger in younger than older adults. Vaccine acceptance also varied by gender and marital status. CONCLUSIONS: Vaccine acceptance can be volatile even over short periods of time. Institutional trust is a central driver of vaccine acceptance and contributes to the resilience of the health system. Our study highlights the importance of health communication and building a trustful relationship between the general public and the institutions in the context of a global pandemic.

Understanding livelihood changes in the charcoal and baobab value chains during Covid-19 in rural Mozambique: The role of power, risk and civic-based stakeholder conventions.

Non-pharmaceutical interventions (NPIs) to reduce the transmission of Covid-19 had different repercussions for domestic, regional and global value chains, but empirical data are sparse on specific dynamics, particularly on their implications for value-chain stakeholders' local livelihoods. Through research including weekly phone interviews (n = 273 from May to July 2020) with panellists in six Mozambican communities, our research traced firstly how the baobab and charcoal value chains were affected by Covid NPIs, particularly in terms of producers' livelihoods. Secondly, we ask how our findings advance our understanding of the role of civic-based stakeholder conventions and different types of power in building viable local livelihoods. Our conceptual lens is based on a synthesis of value-chain and production-network analysis, convention theory and livelihood resilience focusing on power and risk. We found that Covid trading and transport restrictions considerably re-shaped value chains, albeit in different ways in each value chain. The global baobab value chain continued to provide earnings particularly to women, when other income sources were eliminated, with socially oriented stakeholders altering their operations to accommodate pandemic restrictions. By contrast, producers involved in the domestic, solely market-oriented charcoal value chain saw their selling opportunities and incomes reduced, with hunger rising in charcoal-dependent communities. Our paper argues that local livelihoods were more resilient under Covid NPIs if civic-based conventions and collective, social power were present.

Managers' and providers' perspectives on barriers and facilitators for the implementation of differentiated service delivery models for HIV treatment in Mozambique: a qualitative study.

INTRODUCTION: In 2018, Mozambique's Ministry of Health launched a guideline for a nationwide implementation of eight differentiated service delivery models to optimize HIV service delivery and achieve universal coverage of HIV care and treatment. The models were (1) Fast-track, (2) Three-month Antiretrovirals Dispensing, (3) Community Antiretroviral Therapy Groups, (4) Adherence Clubs, (5) Family-approach, and three one-stop shop models for (6) Tuberculosis, (7) Maternal and Child Health, and (8) Adolescent-friendly Health Services. This study identified drivers of implementation success and failure across these differentiated service delivery models. METHODS: Twenty in-depth individual interviews were conducted with managers and providers from the Ministry of Health and implementing partners from all levels of the health system between July and September 2021. National-level participants were based in the capital city of Maputo, and participants at provincial, district and health facility levels were from Sofala province, a purposively selected setting. The Consolidated Framework for Implementation Research (CFIR) guided data collection and thematic analysis. Deductively selected constructs were assessed while allowing for additional themes to emerge inductively. RESULTS: The CFIR constructs of Relative Advantage, Complexity, Patient Needs and Resources, and Reflecting and Evaluating were identified as drivers of implementation, whereas Available Resources and Access to Knowledge and Information were identified as barriers. Fast-track and Three-month Antiretrovirals Dispensing models were deemed easier to implement and more effective in reducing workload. Adherence Clubs and Community Antiretroviral Therapy Groups were believed to be less preferred by clients in urban settings. COVID-19 (an inductive theme) improved acceptance and uptake of individual differentiated service delivery models that reduced client visits, but it temporarily interrupted the implementation of group models. CONCLUSIONS: This study described important determinants to be addressed or leveraged for the successful implementation of differentiated service delivery models in Mozambique. The models were considered advantageous overall for the health system and clients when compared with the standard of care. However, successful implementation requires resources and ongoing training for frontline providers. COVID-19 expedited individual models by loosening the inclusion criteria; this experience can be leveraged to optimize the design and implementation of differentiated service delivery models in Mozambique and other countries.

Sociodemographic characteristics of professional categories most affected by COVID-19 in Mozambique from March to July 2020.

Introduction: the risk of a worker becoming ill due to coronavirus disease 2019 (COVID-19) is related to occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the need to restore work activities in Mozambique, the study was conducted with the aim of identifying the occupational categories most affected by COVID-19 in the former in the period from March to July 2020. Methods: this is a cross-sectional descriptive study, in which data from professions of confirmed cases of COVID-19 from 22 March to 29 July 2020 in Mozambique were analyzed. The professionals' data were reported daily by the National Institute of Health (NIH) and merged into a single database and exported to Excel, the latter categorized according to standard operating procedure (SOP) and descriptive statistics performed for its analysis. Results: in the period under analysis, 1,127 professionals were diagnosed with COVID-19, divided into 11 categories. Nampula province had the highest frequency of cases with 25.00% (277). The highest frequency of cases was registered in the domestic professional category, which had 16.77% (189/1,127) with the female sex being more frequent, 79.37% (150/189); and defense and security had 14.20% (160/1,127) of cases and male gender with 91.25% (146/160); Health workers had 13.04% (147/1,127), and the maximum number of COVID-19 cases was recorded in June with 58.50% (86/147). Conclusion: the professional categories most affected by COVID-19 in the period under review correspond to those groups that carry out activities requiring a physical presence at the workplace and from this; it is recommended that professionals reinforce preventive measures.

Play and learn: Children's agency through the COVID‐19 pandemic in Mozambique

Social distancing, one of the measures adopted in the context of the COVID‐19 pandemic, profoundly impacted on the lives of children. The consequences were, however, not homogenous. By focusing on the daily practices of 41 Mozambican children aged 3–10, we consider how differences in socioeconomic backgrounds led children to respond to the social restrictions in ways that made sense to them. Inspired by Abebe (2019), we identify how the interruptions of daily routines enabled specific instances of agency on children's part. These, we argue, produce new forms of continuity.