Artigos de revistas sobre o tema "Country risk – Mozambique"

Malaria remains one of the most prevalent infectious diseases in the tropics and subtropics, and Mozambique is not an exception. To design geographically targeted and effective intervention mechanisms of malaria, an up-to-date map that shows the spatial distribution of malaria is needed. This study analyzed 2018 Mozambique Malaria Indicator Survey using geostatistical methods to: i) explore individual, household, and community-level determinants of malaria in under-five children, ii) prepare a malaria prevalence map in Mozambique, and iii) produce prediction prevalence maps and exceedence probability across the country. The results show the overall weighted prevalence of malaria was 38.9% (N = 4347, with 95% CI: 36.9%–40.8%). Across different provinces of Mozambique, the prevalence of malaria ranges from 1% in Maputo city to 57.3% in Cabo Delgado province. Malaria prevalence was found to be higher in rural areas, increased with child’s age, and decreased with household wealth index and mother’s level of education. Given the high prevalence of childhood malaria observed in Mozambique there is an urgent need for effective public health interventions in malaria hot spot areas. The household determinants of malaria infection that are identified in this study as well as the maps of parasitaemia risk could be used by malaria control program implementers to define priority intervention areas.

PurposeThe purpose of this paper is threefold: to validate the consumer ethnocentrism tendencies (CET) scale in Mozambique and to describe the profile of CET in that country; to describe the effects of consumer ethnocentrism through the moderator of product type; and to discuss implications of Mozambican consumer ethnocentrism and its effects and make recommendations for practitioners.Design/methodology/approachA questionnaire‐based survey was carried out to collect data from 448 consumers in Southern Mozambique. The data were analyzed by using exploratory factor analyses, confirmatory factor analyses and structural equation modelling.FindingsThe CET scale has satisfactory psychometric qualities and can be used as a two‐dimensional construct in Mozambique. Mozambican consumers were found to be moderately ethnocentric. Their ethnocentric tendencies underpinned negative attitudes toward South African consumables. The study demonstrates the moderating role of product type and concludes that importers of South African agricultural consumables into Mozambique are more susceptible to the effects of consumer ethnocentrism than are importers of processed goods.Research limitations/implicationsThe results cannot be generalized to countries and products which were not included into this study. The conclusions about the CET effects are valid only for the southern part of the country where the survey took place.Practical implicationsThe authors suggest that South African marketing managers should pay closer attention to the competitiveness of agricultural consumables in Mozambique. By contrast, processed consumables from South Africa represent a lower risk. As the employment issue plays a central role in Mozambican consumer ethnocentric tendencies, the national policy makers might incorporate it into the messages of buy‐local campaigns. In addition, the buy local campaigns should position growing national industry as a future large employer in the country. The national suppliers of agricultural consumables are at less risk. On the contrary, national producers of processed consumables are at a disadvantage because ethnocentricity does not result in strong support of these products. Advertising messages with patriotic appeals may be ineffective. Thus, instead of country of origin, other extrinsic cues (e.g. brand, package and price) may be used to enhance competitiveness on the national market.Social implicationsMozambican consumers are moderately ethnocentric. Consumer ethnocentricity and its effects in Mozambique are shaped by pragmatic motives originating from socio‐economic pressures such as the under‐development of the national production sector and high unemployment in the country.Originality/valueThe paper will be of interest to practitioners, e.g. foreign companies, exporters and Mozambican policy makers and producers. The findings suggest that foreign companies should not be overly cautious about selling their products in Mozambique because, being moderately ethnocentric, Mozambican consumers are open to purchasing foreign imports where there is good reason, for example, when locally made products are unavailable.

Mozambique is a country in Southern Africa with around 30 million inhabitants. Malaria is the leading cause of mortality in the country. According to the WHO, Mozambique has the third highest number of malaria cases in the world, representing approximately 5% of the world total cases. Sussundenga District has the highest incidence in the Manica province and environmental conditions are the major contributor to malaria transmission. There is a lack of malaria risk maps to inform transmission dynamics in Sussundenga village. This study develops a malaria risk map for Sussundenga Village in Mozambique and identifies high risk areas to inform on appropriate malaria control and eradication efforts. One hundred houses were randomly sampled and tested for malaria in Sussundenga Rural Municipality. To construct the map, a spatial conceptual model was used to estimate risk areas using ten environmental and anthropic factors. Data from Worldclim, 30 × 30 Landsat images were used, and layers were produced in a raster data set. Layers between class values were compared by assigning numerical values to the classes within each layer of the map with equal rank. Data set input was classified, using diverse weights depending on their appropriateness. The reclassified data outputs were combined after reclassification. The map indicated a high risk for malaria in the northeast and southeast, that is, the neighborhoods of Nhamazara, Nhamarenza, and Unidade. The central eastern areas, that is, 25 de Junho, 1 and 2, 7 de Abril, and Chicueu presented a moderate risk. In Sussundenga village there was 92% moderate and 8% high risk. High malaria risk areas are most often located in densely populated areas and areas close to water bodies. The relevant findings of this study can inform on effective malaria interventions.

Risk management and risk communication affect everybody’s daily life. Local authorities have the duty to manage public structures, to inform civilians of the risks coming from these structures, to implement prophylaxis procedures. Military storage sites are fully included in this category. This article presents – through a qualitative methodology based on risk analysis – how risk management and communication in weapons and ammunition warehouses is managed in a “partially free” country, using as a case-study, the Malhazine depot in Mozambique, which resulted in more than 100 deaths. In 2007, an extraordinary accident related to the management of obsolete conventional weapons occurred at the Malazhine warehouse. In this circumstance, the Mozambican Government adopted a policy of classifying the information “highly confidential”. This policy aimed at obscuring facts and responsibilities by hiding the causes of such a huge tragedy. This article concludes with the consideration that a high level of confidentiality in treating issues of public interest, such as the one kept in regard to Malhazine, does not help public authorities to effectively manage and prevent similar risks from occurring again, with resulting negative impacts on local populations. Keywords: military storage, Malhazine, local authorities, confidentiality.

AbstractHuman–wildlife conflicts are common across Africa. In Mozambique, official records show that wildlife killed 265 people during 27 months (July 2006 to September 2008). Crocodile Crocodylus niloticus, lion Panthera leo, elephant Loxodonta africana and hippopotamus Hippopotamus amphibius caused most deaths but crocodiles were responsible for 66%. Crocodile attacks occurred across Mozambique but 53% of deaths occurred in districts bordering Lake Cabora Bassa and the Zambezi River. Hippopotamus attacks were also concentrated here. Lion attacks occurred mainly in northern Mozambique and, while people were attacked by elephants across the country, 67% of deaths occurred in northern Mozambique. Attacks by lions, elephants or hippopotamuses were relatively rare but additional data will probably show that attacks by these species are more widespread than the preliminary records suggest. Buffalo Syncerus caffer, hyaena Crocuta crocuta and leopard Panthera pardus were minor conflict species. Good land-use planning, a long-term solution to many conflicts, is particularly relevant in Mozambique, where the crocodile and hippopotamus populations of protected areas are often in rivers that border these areas, and cause conflicts outside them, and where people commonly live within protected areas. Poverty may prompt fishermen to risk crocodile attack by entering rivers or lakes. The high incidence of conflicts near Limpopo and South Africa’s Kruger National Parks (both within the Great Limpopo Transfrontier Conservation Area) highlights the problems created for people by facilitating the unrestricted movement of wildlife between protected areas across their land.

AbstractDisasters, such as cyclones, create conditions that increase the risk of infectious disease outbreaks. Epidemic forecasts can be valuable for targeting highest risk populations before an outbreak. The two main barriers to routine use of real-time forecasts include scientific and operational challenges. First, accuracy may be limited by availability of data and the uncertainty associated with the inherently stochastic processes that determine when and where outbreaks happen and spread. Second, even if data are available, the appropriate channels of communication may prevent their use for decision making.In April 2019, only six weeks after Cyclone Idai devastated Mozambique’s central region and sparked a cholera outbreak, Cyclone Kenneth severely damaged northern areas of the country. By June 10, a total of 267 cases of cholera were confirmed, sparking a vaccination campaign. Prior to Kenneth’s landfall, a team of academic researchers, humanitarian responders, and health agencies developed a simple model to forecast areas at highest risk of a cholera outbreak. The model created risk indices for each district using combinations of four metrics: (1) flooding data; (2) previous annual cholera incidence; (3) sensitivity of previous outbreaks to the El Niño-Southern Oscillation cycle; and (4) a diffusion (gravity) model to simulate movement of infected travelers. As information on cases became available, the risk model was continuously updated. A web-based tool was produced, which identified highest risk populations prior to the cyclone and the districts at-risk following the start of the outbreak.The model prior to Kenneth’s arrival using the metrics of previous incidence, projected flood, and El Niño sensitivity accurately predicted areas at highest risk for cholera. Despite this success, not all data were available at the scale at which the vaccination campaign took place, limiting the model’s utility, and the extent to which the forecasts were used remains unclear. Here, the science behind these forecasts and the organizational structure of this collaborative effort are discussed. The barriers to the routine use of forecasts in crisis settings are highlighted, as well as the potential for flexible teams to rapidly produce actionable insights for decision making using simple modeling tools, both before and during an outbreak.

AbstractBased on the concept of limited and open access orders (LAO/OAO), this paper explains what appears to be a paradox: how was it possible that a former civil war country, Mozambique, which had been extremely successful in attracting foreign direct investment (FDI) and which the International Monetary Fund praised as a great Sub-Sahara African success story in 2007, only a few years later found itself on the brink of a new civil war? We argue that the destabilization of the country was the result of a toxic mix of domestic politics and a massive inflow of FDI. FDI provided rents to an increasingly dominant state party, FRELIMO, which could be appropriated one-sidedly. It then used these rents to oppress RENAMO, its previous civil war enemy and currently its main opposition party, to monopolize power. This strategy seemed to be successful until RENAMO, faced with the risk of being politically marginalized (and of losing its rents accordingly), returned to armed conflict in 2013. By analyzing the links between the macro-level of national politics and the micro-level of an enterprise and by embedding the interplay between polity and economy into an international context, the paper also makes a theoretical contribution to the LAO/OAO concept.

Mozambique has a high burden of HIV and is currently ranked sixth worldwide for adult prevalence. In Mozambique, HIV prevalence is not uniformly distributed geographically and throughout the population. We investigated the spatial distribution of HIV infection among adolescents and young people in Mozambique using the 2009 AIDS Indicator Survey (AIS). Generalized geoadditive modeling, combining kriging and additive modeling, was used to study the geographical variability of HIV risk among young people. The nonlinear spatial effect was assessed through radial basis splines. The estimation process was done using two-stage iterative penalized quasi-likelihood within the framework of a mixed-effects model. Our estimation procedure is an extension of the approach by Vandendijck et al., estimating the range (spatial decay) parameter in a binary context. The results revealed the presence of spatial patterns of HIV infection. After controlling for important covariates, the results showed a greater burden of HIV/AIDS in the central and northern regions of the country. Several socio-demographic, biological, and behavioral factors were found to be significantly associated with HIV infection among young people. The findings are important, as they can help health officials and policy makers to design targeted interventions for responding to the HIV epidemic.

AbstractBackground:In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average.Objectives:To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations.Methods:The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD = 1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births).Results:In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30 000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group.Discussion:Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers’ training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.

This article analyzes the effects of household-level activity choices on farm household welfare in a developing country affected by mass violent armed conflict. The study uses household survey data from postwar Nampula and Cabo Delgado provinces in Northern Mozambique capturing many activity choices, including market participation, risk and activity diversification, cotton adoption, and social exchange, as well as income-and consumption-based measures of welfare. The study advances the literature on postwar coping and rural poverty at the micro level by estimating potentially endogenous activity choices and welfare outcomes using instrumental variables. The study finds that increasing the cultivated area and on-farm activities enhances postwar welfare of smallholders exploiting wartime survival techniques. Subsistence farming reduces income but does not affect consumption, while market participation has positive welfare effects. This suggests that postwar reconstruction policies should encourage the wartime crop mix but offer enhanced marketing opportunities for such crops. Cotton adoption, which was promoted by aid agencies in the postwar period, reduces household welfare per capita by between 16% and 31%, controlling for market access. This contradicts previous studies of postwar rural development that did not control for the war-related endogeneity. Hence, addressing the potential endogeneity of activity choices is important because the standard regression approach may lead to biased estimates of the impact of activity choice on welfare, which in turn may lead to biased policy advice. The article discusses and contextualizes these findings, concluding with a discussion of suitable pro-poor reconstruction policies for national governments and donors.

Abstract HIV viral suppression through antiretroviral (ARV) treatment has public health benefits in potentially reducing the risk of subsequent HIV transmissions. Mozambique has adopted the World Health Organization (WHO) “Test and Start” strategy, which assumes that all people who test positive for HIV start ARV treatment immediately. In order that treatment is guided by the respective HIV viral load (VL) test results, the MOH expanded the network of VL testing laboratories. About 26 VL testing instruments are now operational in the country. Although the increase in testing platforms increased VL tests performed, problems associated with errors, failures in user maintenance, and equipment malfunctions occur frequently. Delays in resolving equipment malfunctions contributed to lower laboratory productivity in certain periods of 2018. Therefore, the MOH, in coordination with the American Society for Clinical Pathology (ASCP) and VL testing instrument manufacturers, provided targeted training for VL laboratory Super Users (SUs). The SUs are primarily composed of laboratory technicians representing all VL laboratories. Training focused on equipment maintenance, software configuration, and troubleshooting the most common instrument-related problems and errors. Following this training, the SUs worked as in-laboratory equipment supervisors, helping laboratory staff to better perform equipment maintenance procedures. Furthermore, they worked remotely with representatives and field technicians of the instrument manufacturers to resolve small problems, such as accessory replacement and adding new users to the systems, in their own laboratories. This has led to a reduction in the overall time to equipment repair, less reliance on external field technicians, and correspondingly increased overall lab productivity and workforce capacity building for VL laboratory SU.

Objectives Feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) are immunosuppressive viruses in cats that increase their susceptibility to zoonotic pathogens. This study aimed to determine the occurrence of one or both viruses, the risk factors associated with infection, and to develop further recommendations. Methods This was a cross-sectional study conducted at the Veterinary Faculty of Eduardo Mondlane University, Mozambique, between March and December 2017, in 145 cats. From each of 145 cats, we took 1.5 ml of blood by jugular puncture for detection of antibodies to FIV and FeLV antigens in whole blood using a commercial test kit, DFV Test FeLV/FIV. Results We found an overall prevalence of 11.0% and 14.5% for FIV antibodies and FeLV antigens, respectively, with four (2.8%) cats coinfected by both pathogens. Male cats were more likely to be infected with FIV (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.3–4.0) compared with female cats. Clinically ill cats were more likely to have a positive result for FeLV antigen infection (OR 18.8, 95% CI 5.2–68.3). Moreover, cats living in suburban areas have a greater chance of a positive result for FeLV infection (OR 3.7, 95% CI 1.4–9.6) compared with cats living in urban areas. Conclusions and relevance FIV and FeLV occur in cats from Maputo and possibly all over the country. Further studies should be conducted in Mozambique and other African countries to define the burden of both pathogens in cats, coinfection with other zoonotic pathogens and the possible role played by the cats on the transmission of zoonotic and opportunistic diseases to humans.

Abstract Objectives Within formative research to inform behavioral interventions since 2013, we have sought to understand community risk perceptions toward nutrition-related illnesses. This analysis compares findings from 6 countries to 1) describe the extent to which nutrition-related illnesses are salient to community members, and 2) to compare malnutrition risk perception across cultural contexts. Methods We conducted formative research in 6 countries between 2013–2018 to inform preventative nutrition interventions where behavior change was a focus. In both rural and urban sites of each country context, we used two ethnographic methods for cultural domain analysis. Free listing of ‘childhood illnesses’ was conducted in Malawi (n = 64), Mozambique (n = 115), Nigeria (n = 81), Marshall Islands (n = 86), Solomon Islands (n = 89), and Kiribati (n = 84). Smith's statistic (S) was used to assess illness term salience. The most salient terms in each setting were then pile sorted by participants who were asked to sort illness terms by perceived severity/seriousness for young child health. Data were analyzed using ANTHROPAC. Semi-structured interview data contextualized and triangulated findings. Results Across 6 global contexts, community members perceived nutrition-related illnesses to be less serious/severe than other childhood illnesses. Consistently, the most salient child illness terms identified were malaria/fever, flu/cough, and stomachache/diarrhea. Terms referring to malnutrition were mentioned in just half of the country contexts, with iron deficiency anemia (‘loss of blood’) and wasting-related terms the most salient. Local terms referring to the biomedical equivalent of stunting did not exist in most contexts. Most participants categorized nutrition-related illness terms into ‘least serious/severe’ or ‘moderately serious/severe’ rather than ‘most serious/severe’ where other more salient childhood illnesses were placed. Interview data corroborated these findings, revealing an important discrepancy between the priorities of global nutrition practitioners and the communities with whom they work, regardless of cultural or geographic context. Conclusions This study provides insight into why nutrition interventions where behavior change is needed may face challenges achieving desired effectiveness. Funding Sources Not applicable.

ABSTRACT Excess salt intake contributes to hypertension and increased cardiovascular disease risk. Efforts to implement effective salt-reduction strategies require accurate data on the sources of salt consumption. We therefore performed a systematic review to identify the sources of dietary salt around the world. We systematically searched peer-reviewed and gray literature databases for studies that quantified discretionary (salt added during cooking or at the table) and nondiscretionary sources of salt and those that provided information about the food groups contributing to dietary salt intake. Exploratory linear regression analysis was also conducted to assess whether the proportion of discretionary salt intake is related to the gross domestic product (GDP) per capita of a country. We identified 80 studies conducted in 34 countries between 1975 and 2018. The majority (n = 44, 55%) collected data on dietary salt sources within the past 10 y and were deemed to have a low or moderate risk of bias (n = 75, 94%). Thirty-two (40%) studies were judged to be nationally representative. Populations in Brazil, China, Costa Rica, Guatemala, India, Japan, Mozambique, and Romania received more than half of their daily salt intake from discretionary sources. A significant inverse correlation between discretionary salt intake and a country's per capita GDP was observed (P < 0.0001), such that for every $10,000 increase in per capita GDP, the amount of salt obtained from discretionary sources was lower by 8.7% (95% CI: 5.1%, 12%). Bread products, cereal and grains, meat products, and dairy products were the major contributors to dietary salt intake in most populations. There is marked variation in discretionary salt use around the world that is highly correlated with the level of economic development. Our findings have important implications for the type of salt-reduction strategy likely to be effective in a country.

BackgroundEarly childhood diagnosis of HIV is a challenge in many developing countries, including Mozambique. Approximately 50% of exposed children and HIV-positive are lost to follow-up, i.e. during Postpartum Consultation (CPP), at-risk child consultation (CCR) or ART consultation in the country. The objective was to carry out an intervention to reduce the loss to follow-up of children exposed to and positive for HIV in Manica and Sofala provinces.MethodsIntervention study in HIV-positive women and their children in CPP and CCR in six health facilities in 2016. Stepped-wedge design with 3 cohorts for 3 months of two health facilities randomly selected. Interventions included activist allocation, telephone calls to contact the mothers, guide the mothers with exposed child from CPP to CCR, active outreach to missed mothers, and initiation of ART in the CCR for 3 months. Data were collected from the health facilities and study books. Analysis was binomial logistic regression model with mixed effects.ResultsOf the aggregated data, PCR +was 7.7%, and proportion of HIV-positive women in CPP 17.4%. In the control group only 24% of the mothers had more than 2 visits with us, compared with 60% in the intervention group [OR=2.05 (95% CI: 1.60, 2.62)]. In the intervention group, more children were transferred to CCR 52% vs 32% in the control [OR=1.7 (CI: 1.3–2.41)], 65% of the mothers in intervention group reached at CCR vs 57% of the mothers in the control group [OR=1.69 CI: 1.27–2.41)] and returned to receive the PCR result of their child, 6.7% in the control vs 8.2% in intervention [OR=2.3 (CI: 1.36, 3.87)].ConclusionThe intervention had a greater impact on the number of visits to CPP, the transfer of mothers from CPP to CCR, and the reception of PCR results in CCR by the companion.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.

Mozambique is located on the East Coast of Africa. In this country, obesity, poor knowledge regarding diabetes, and a lack of awareness of the complications of diabetes are prevalent. Furthermore, most of the population utilizes traditional healers for the treatment of diabetes. There are unhealthy food habits, a sedentary lifestyle in the urban population, and increased economic growth among office-related professions, which is one of the risk factors that cause diabetes and its complications. Currently, no study has been conducted for patients on the effects of education in various modalities of diabetes. Accordingly, there is an extreme need to educate diabetic patients to improve their control of diabetes and to reduce its complications. Adequate medical management and proper lifestyle measures should start directly at the time of the diagnosis of diabetes, which can result in the diabetic individual living a life just as cheerful as that of a non-diabetic person. However, this objective requires proper counselling of the patient specifically at the time of diagnosis, which can be achieved by well-planned educational programs that target the newly diagnosed diabetic individual and create awareness about diabetes. In central hospital Nampula in diabetic OPD, three education sessions were organized, at an interval of one month (baseline, first follow up and second follow up). Each participant was evaluated in each session regarding their BMI, blood pressure, plasma glucose, cholesterol concentrations. The statistical analysis showed strong significantly positive correlation effects with glucose to BMI, blood pressure, cholesterol on controlling each of these parameters. Prior to the commencement of the baseline education session, an evaluation of the evolution of patient knowledge regarding diabetes mellitus (the pretest) was performed. At the end of the second follow up, a posttest was performed, which showed strong significant increases in the knowledge of diabetes.

<p><span style="font-size: medium;">There has been an increasing debate on higher education (HE) transformation in developing countries over the past decades. The main assumption underlying this focus often centers on the arguments contrary to the dominant narratives, which have been skeptical that HE plays a considerable role for economic and social transformation. The rise of certain Asian economies including Taiwan and South Korea, which were at the same level in terms of GDP with African nation states such as Nigeria, Tanzania and Ghana in the 1960s, has confirmed the theory that maximization of knowledge is key to achieve development. Furthermore, the successful stories from the newly industrialized countries especially the BRICS</span><a title="" href="file://fclar.unesp.ad/FS/Alunos/pedro/Desktop/HE.docx#_ftn1"><strong><strong>[1]</strong></strong></a><span style="font-size: medium;"> have considerably increased the possibilities that Mozambique can learn from borrowed and contextualized policies from those states. In this article, I highlight the main changes that have recently shaped HE policy and governance including today challenges it faces. In so doing, I outline recommendations for both policy makers and higher education leaders on how they can make appropriation of the experiences that have worked in the global context to ensure the creation of local workforce capable of driving both economic and social development in the country based on knowledge investment. </span></p><div><br clear="all" /><hr align="left" size="1" width="33%" /><div><p><a title="" href="file://fclar.unesp.ad/FS/Alunos/pedro/Desktop/HE.docx#_ftnref1"><span style="font-family: Times New Roman;">[1]</span></a> An acronym applied to refer to the newly emerging economies such as Brazil, Russia, India, China and South Africa</p></div></div>

In this paper, the fixed effects method known as the least squares dummy variable (LSDV) technique was applied to investigate the possibility of a trade-off between bank profitability indicators and banking outreach (expanding access to banking services) by analysing a panel of 10 South African Development Countries (SADC). Of the fifteen SADC member countries (Angola, Botswana, Democratic Republic Of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, United Republic Of Tanzania, Zambia, and Zimbabwe), five (Botswana, Congo, Lesotho, Malawi and Zimbabwe) had to be excluded for lack of consistent data throughout our period of analysis. The author investigates whether expanding banking access and pursuing profitability are complementary goals in the same direction or are two conflicting goals. For estimation robustness, two indicators of profitability were used namely return on average assets (ROAA) and return on average equity (ROAE). IMF Financial Access Survey (FAS) data for each country namely, deposit accounts per capita and the number of bank branches per 1000 km2 were used as indicators of bank outreach or access. Operational inefficiency, insolvency risk and credit risk were found to exert a negative impact on both ROA and ROE. Net interest margin a proxy for interest based services and off-balance sheet activities were statistically significant and positively related with bank profitability. Central to the study was that expanding banking access was found to exert a statistically significant and positive impact on profitability for some SADC countries. However, contrary to the author`s expectation, for some countries, the indicator of outreach was inversely related with the chosen indicators of profitability. The researcher however, argues that any form of intervention aimed at improving the state of access to those financially excluded cannot be evaluated from a cost or profit perspective alone but must be all-inclusive taking into account the social and economic benefits to the society as a whole. The major purpose of financial inclusion is to reach the poor and disadvantaged segments of the population. Hence, the author cautions that although attaining high profitability is an important policy objective for ensuring sustainability and financial stability, it is certainly not the only priority. Access to banking services, social inclusion and consumer protection are equally important policy priorities. There is therefore need for government support and a general holistic stakeholder approach to the problem of banking exclusion in order to generate solutions that achieve both profitability and outreach in a balanced fashion.

Background: Co-infection with malaria and chikungunya could exert a significant public health impact with infection misdiagnosis. Therefore, this study aimed to collect qualitative and quantitative evidence of malaria and chikungunya co-infection among febrile patients. Methods: Potentially relevant studies were identified using PubMed, Web of Science, and Scopus. The bias risk of the included studies was assessed using the checklist for analytical cross-sectional studies developed by the Joanna Briggs Institute. The pooled prevalence of malaria and chikungunya co-infection among febrile patients and the pooled prevalence of chikungunya virus (CHIKV) infection among malaria patients were estimated with the random effect model. The odds of malaria and chikungunya co-infection among febrile patients were also estimated using a random effect model that presumed the heterogeneity of the outcomes of the included studies. The heterogeneity among the included studies was assessed using the Cochran Q test and I2 statistics. Publication bias was assessed using the funnel plot and Egger’s test. Results: Of the 1924 studies that were identified from the three databases, 10 fulfilled the eligibility criteria and were included in our study. The pooled prevalence of malaria and chikungunya co-infection (182 cases) among febrile patients (16,787 cases), stratified by diagnostic tests for CHIKV infection, was 10% (95% confidence interval (CI): 8–11%, I2: 99.5%) using RDT (IgM), 7% (95% CI: 4–10%) using the plaque reduction neutralization test (PRNT), 1% (95% CI: 0–2%, I2: 41.5%) using IgM and IgG ELISA, and 4% (95% CI: 2–6%) using real-time RT-PCR. When the prevalence was stratified by country, the prevalence of co-infection was 7% (95% CI: 5–10%, I2: 99.5%) in Nigeria, 1% (95% CI: 0–2%, I2: 99.5%) in Tanzania, 10% (95% CI: 8–11%) in Sierra Leone, 1% (95% CI: 0–4%) in Mozambique, and 4% (95% CI: 2–6%) in Kenya. The pooled prevalence of CHIKV infection (182 cases) among malaria patients (8317 cases), stratified by diagnostic tests for CHIKV infection, was 39% (95% CI: 34–44%, I2: 99.7%) using RDT (IgM), 43% (95% CI: 30–57%) using PRNT, 5% (95% CI: 3–7%, I2: 5.18%) using IgM and IgG ELISA, and 9% (95% CI: 6–15%) using real-time RT-PCR. The meta-analysis showed that malaria and chikungunya co-infection occurred by chance (p: 0.59, OR: 0.32, 95% CI: 0.6–1.07, I2: 78.5%). Conclusions: The prevalence of malaria and chikungunya co-infection varied from 0% to 10% as per the diagnostic test for CHIKV infection or the country where the co-infection was reported. Hence, the clinicians who diagnose patients with malaria infections in areas where two diseases are endemic should further investigate for chikungunya co-infection to prevent misdiagnosis or delayed treatment of concurrent infection.

Mean sea-level is expected to rise significantly by 2100 in all scenarios, including those compatible with the objectives of the Paris Climate Agreement. Global sea level rise projections indicate devastating implications for populations, ecosystem services and biodiversity. The implications of the sea-level rise (SLR) on low-lying islands and coastal regions and communities are substantial and require deep-rooted coping measures. In the absence of adequate responses for coping, Mozambique is expected to record huge losses, with an impact on the economy and development in many sectors of its coastal regions mainly in northern Mozambique. This research aimed to perform projections on SLR in Mozambique, and to understand its role and implications on the north coast of the country. SLR was estimated through the analysis of model outputs that support the global estimates of the fifth IPCC report near the Mozambican coast, for each of the four representative concentration pathways (RCPs) scenarios. Regional coastline retreat and coastal erosion were estimated through the results of global sandy coastlines projections developed by Vousdoukas. Mean sea-level rise projections indicate that regional estimates for the Mozambican coast are relative higher than global estimates (~0.05 m) for all representative concentration pathways (RCPs). Yet, we highlight significant differences in sea-level rises of 0.5 m, 0.7 m or 1.0 m by 2100 compared to the global mean. It is expected that with the increase in the mean sea level in the northern part of the Mozambican coast, erosive effects will increase, as well as the retreat of the coastline until 2100. With this, the tourism sector, settlements, ecosystem services and local populations are expected to be significantly affected by 2050, with increased threats in 2100 (RCP4.5, RCP8.5). Local responses for coping are proposed and properly discussed for the RCP4.5 and RCP8.5 scenarios through 2100.

Adolescent sexual and reproductive health (ASRH) challenges in Mozambique include early marriages, early pregnancies and HIV/AIDS. In 1999 the Programa Geração Biz (PGB) was created to address youths’ problems and improve their sexual and reproductive health (SRH). However, studies show Mozambican youths continue to be exposed to risks related to their SRH. Mozambique is a multicultural country but only 40% of Mozambicans speak Portuguese, the official language, while 93.5% of the population uses a Bantu language as their mother tongue. This raises an important issue – should PGB communication strategies (CS) take into account the country’s complex cultural reality? Studies recognise the role of culture in enhancing effective delivery of communication programmes. Concurrently, studies point to a lack of research analyzing CS of health campaigns. This paper’s aims are: (i) to examine PGB communication strategies; (ii) identify cultural challenges to these strategies; and (iii) determine the implications of these impediments for the PGB. Research methods included non-participant observation, in-depth interviews and focus group discussions. Research questions were based on the McGuire Communication/Persuasion Model, and data analyzed thematically using Nvivo Pro11. Results revealed the following: (i) interpersonal methods are used to deliver preventive messages, with sociocultural approaches often ignored or not used to reduce cultural barriers; (ii) cultural chal¬lenges identified include initiation rites, taboos surrounding sexuality, language and health terminologies, and parents’ attitudes towards early marriages; and (iii) these factors hinder effective delivery of programme messages. The conclusion is that the CS used by PGB does not sufficiently take into account the Mozambican sociocultural context. Taboos around sexuality have silenced open communication in this regard. Ideas of sexual abstinence, condom use and campaigns against early marriage stand in opposition to certain orientations of traditional initiations.

While the nineteenth century was the century of ‘gold nuggets’, the twentieth century of ‘black gold’, the twenty-first century will be the century of wars for ‘bread’ and ‘blue gold’ and related crises. Approximately eighteen thousand children die every day from hunger or malnutrition as 850 million people go to bed with an empty stomach. Mozambique, Eritrea, Afghanistan are just a few countries whose instability result from hunger and water shortages. C. Clausewitz argued that each era has its own war. So do our times. They will have their war too. Deficiencies related to the insufficiency of life is a key category of internal security of each country and region. Therefore, to determine their contemporary character is the starting point for local but also global safety. Today, more and more domestic security is related to the global security situation and vice versa. Risks associated with lack of basic life-giving ‘materials’, which is food and water, could become a potential situation that might affect values and national interests, posing a threat to the life, health and living conditions of hundreds of thousands or millions of peo-ple.

Over the past decade, the rise of what has been called the Global Land Grab suggests the return of rural development as a privileged (if problematic) site for accumulation, modernization, and growth. In this paper, I analyze a set of rural development efforts in Mozambique, a country seen by many as the potential heart of a new African food regime. I build a framework for understanding contemporary dynamics by drawing on the triple metaphor of fields: first, I build on the sociological concept of field as strategic social space; second, I bring together disparate disciplinary fields, including political economy, development, science and technology studies, and agrarian studies; and third, I situate the paper on fields as cultivated ground, the literal arena in and on which rural development takes place. The paper is narrated through four stories that illuminate the relationships and dynamics within and across different “strategic action fields.” These stories highlight the role of knowledge and power within distinct but related arenas of rural development and suggest the importance of seeing fields as in contestation even when they are not necessarily in conversation.

Over the past decade, the rise of what has been called the Global Land Grab suggests the return of rural development as a privileged (if problematic) site for accumulation, modernization, and growth. In this paper, I analyze a set of rural development efforts in Mozambique, a country seen by many as the potential heart of a new African food regime. I build a framework for understanding contemporary dynamics by drawing on the triple metaphor of fields: first, I build on the sociological concept of field as strategic social space; second, I bring together disparate disciplinary fields, including political economy, development, science and technology studies, and agrarian studies; and third, I situate the paper on fields as cultivated ground, the literal arena in and on which rural development takes place. The paper is narrated through four stories that illuminate the relationships and dynamics within and across different “strategic action fields.” These stories highlight the role of knowledge and power within distinct but related fields of rural development and suggest the importance of seeing them as in contestation even when they are not necessarily in conversation.

BackgroundTechnological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity.MethodsInclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483).ResultsFourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth.ConclusionsIncreasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.

Background Natural resource extraction projects offer both opportunities and risks for sustainable development and health in host communities. Often, however, the health of the community suffers. Health impact assessment (HIA) can mitigate the risks and promote the benefits of development but is not routinely done in the developing regions that could benefit the most. Objective Our study aims to investigate health and health determinants in regions affected by extractive industries in Burkina Faso, Ghana, Mozambique, and Tanzania. The evidence generated in our study will inform a policy dialogue on how HIA can be promoted as a regulatory approach as part of the larger research initiative called the HIA4SD (Health impact assessment for sustainable development) project. Methods The study is a concurrent triangulation, mixed methods, multi-stage, multi-focus project that specifically addresses the topics of governance and policy, social determinants of health, health economics, health systems, maternal and child health, morbidity and mortality, and environmental determinants, as well as the associated health outcomes in natural resource extraction project settings across four countries. To investigate each of these health topics, the project will (1) use existing population-level databases to quantify incidence of disease and other health outcomes and determinants over time using time series analysis; (2) conduct two quantitative surveys on mortality and cost of disease in producer regions; and (3) collect primary qualitative data using focus groups and key informant interviews describing community perceptions of the impacts of extraction projects on health and partnership arrangements between the projects and local and national governance. Differences in health outcomes and health determinants between districts with and without an extraction project will be analyzed using matched geographical analyses in quasi-Poisson regression models and binomial regression models. Costs to the health system and to the households from diseases found to be associated with projects in each country will be estimated retrospectively. Results Fieldwork for the study began in February 2019 and concluded in February 2020. At the time of submission, qualitative data collection had been completed in all four study countries. In Burkina Faso, 36 focus group discussions and 74 key informant interviews were conducted in three sites. In Ghana, 34 focus group discussions and 64 key informant interviews were conducted in three sites. In Mozambique, 75 focus group discussions and 103 key informant interviews were conducted in four sites. In Tanzania, 36 focus group discussions and 84 key informant interviews were conducted in three sites. Quantitative data extraction and collection is ongoing in all four study countries. Ethical approval for the study was received in all four study countries prior to beginning the fieldwork. Data analyses are underway and results are expected to be published in 2020 and 2021. Conclusions Disentangling the complex interactions of resource extraction projects with their host communities requires an integrative approach drawing on many methodologies under the HIA umbrella. By using complementary data sources to address the question of population health in project areas from several angles, bias and missing data will be reduced, generating high-quality evidence to aid countries in moving toward sustainable development. International Registered Report Identifier (IRRID) DERR1-10.2196/17138

The inadequacy of information impedes society’s competence to find out the cause or degree of a problem or even to avoid further losses in an ecosystem. It becomes even harder to identify all the biological resources at risk because there is no exhaustive inventory of either fauna or flora of a particular region. Coastal forests of Kenya are located in the southeast part of Kenya and are distributed mainly in four counties: Kwale, Kilifi, Lamu, and Tana River County. They are a stretch of fragmented forests ca. 30−120 km away from the Indian Ocean, and they have existed for millions of years. Diversity of both fauna and flora is very high in these relicts and the coastal forests of Eastern Africa, extending along the coast from Somalia through Kenya and Tanzania to Mozambique, are ranked among the priority biodiversity hotspot in the world. In spite of the high plant species richness and their importance towards supporting the livelihoods of the communities that live around them, floristic studies in these forests have remained poorly investigated. Hence, based on numerous field investigations, plant lists from published monograph/literature, and data from BRAHMS (Botanical Records and Herbarium Management System) database at East African herbarium (EA), we present a detailed checklist of vascular plants recorded in this region. Our results show that Kenyan coastal forests play an essential role in the flora of Kenya and the plant diversity of the coastal forests of East Africa. The checklist represents 176 families, 981 genera, 2489 species, 100 infraspecific taxa, 90 endemic plants species, 72 exotic species, and 120 species that are included in the current IUCN Red List of Threatened Species as species of major concern. We also discovered three new species to the world from these relicts. Thus, Kenyan coastal forests present a remarkable and significant center of plant diversity.

Purpose The purpose of this paper is to explore the relationship between advances in educational attainment on the one hand, and structural change in employment on the other, in four countries in Sub-Saharan Africa for selected periods. Design/methodology/approach The paper is based on a decomposition of changes in education intensity, which is complemented by an analysis of rates of return to education. For all countries the analysis is based on labour market microdata from nationally representative household surveys, and on economic data from national accounts. Findings It is demonstrated that if countries want to exploit structural change, levels of education need to rise. Low levels of education explain why the increase in educational attainment in Tanzania was barely sufficient to keep up with structural change in this country, and Mozambique would have been in the same situation if structural change would have occurred. In Ghana and Namibia, levels of educational attainment are much higher, and the paper demonstrates how education was used differently to accommodate structural change in these countries. Rates of return to education in all four countries appear consistent with patterns of education intensity. Research limitations/implications The analysis demonstrates that labour market monitoring should not be limited to (broad) sectoral aggregates. The analysis of more detailed breakdowns of employment is needed to gain insights into economies and labour markets of countries, including with regard to the role of education. Originality/value The paper is original in that an identical methodology is used in four African countries to decompose changes in education intensity, to relate these changes to employment patterns and to calculate rates of return to education. Although such work has been undertaken in individual countries, it is rarely done in a comparative way.

Industrial mining projects can play an important role in global sustainable development if associated health risks are minimised and opportunities maximised. While a broad body of evidence from quantitative studies exists that establishes the interlinkages between mining operations and effects on public health, little research has been conducted investigating health impacts from the perspective of affected communities. This is particularly true in sub-Saharan Africa, where about a third of the remaining global mineral resources are endowed and health-related indicators for sustainable development are lagging behind. In this multi-country qualitative study, we explore community perceptions regarding impacts of industrial mining on their health and well-being. In nine study sites in Burkina Faso, Mozambique and Tanzania, we conducted 83 participatory focus group discussions with a total of 791 participants (385 men, 406 women). Our findings reveal a broad range of perceived impacts on environmental, economic and social determinants of health, with secondary health implications related to morbidity, mortality and well-being. Overall, perceived negative impacts prevailed, mainly related to environmental pollution, change in livelihoods or social disruption. Perceived positive impacts on health and well-being were related to interventions implemented by the mines such as new or improved water sources, health care facilities, roads and schools. The consistency of these findings across countries and study sites suggests a structural problem and indicates a pressing need to address health by acting on the wider determinants of health in mining regions. Participatory health impact assessment should be strengthened in host countries to foster strategic interventions, include marginalised population groups, and protect and promote the health of local communities. By including community perspectives on health before and during project implementation, policymakers can take advantage of economic opportunities while avoiding the pitfalls, bringing their communities closer to achieving good health and well-being goals by 2030 and beyond.

Abstract Background Mozambique, same as many other tropical countries, is at high risk of arthropod-borne virus (arbovirus) diseases and recently two dengue virus (DENV) outbreaks occurred in the northern part of the country. The occurrence of some important vector species, such as Aedes (Stegomyia) aegypti (Linnaeus) and Ae. (Stg.) albopictus (Skuse), besides several other sylvatic vectors, have been reported in the country, which may indicate that the transmission of some arboviruses of public health importance may involve multiple-vector systems. Therefore, knowing the occurrence and distribution of existing and the new important vectors species, is crucial for devising systematic transmission surveillance and vector control approaches. The aim of this study was to map the occurrence and distribution of mosquito species with potential for transmitting arboviruses of human and veterinary relevance in Niassa Province, Northern Mozambique. Methods Field entomological surveys were undertaken in April 2016 in Lago District, Niassa Province, northern Mozambique. Breeding sites of mosquitoes were inspected and immature stages were collected and reared into adult. Mosquitoes in the adult stages were morphologically identified using taxonomic keys. Morphological identification of Aedes (Stegomyia) luteocephalus (Newstead) were later confirmed using dissected male genitalia and molecular based on the phylogenetic analyses of the sequenced barcode (cox1 mtDNA) gene. Results A total of 92 mosquito larvae collected developed into adults. Of these, 16 (17.39%) were morphologically identified as Ae. luteocephalus. The remaining specimens belonged to Ae. (Stg.) aegypti (n = 4, 4.35%), Ae. (Aedimorphus) vittatus (n = 24, 26.09%), Anopheles garnhami (n = 1, 1.09%), Culex (Culiciomyia) nebulosus (n = 28, 30.43%), Eretmapodites subsimplicipes (n = 18, 19.57%) and Toxorhynchites brevipalpis (n = 1, 1.09%), taxa already known to the country. Male genitalia and phylogenetic analyses confirmed the identity of Ae. luteocephalus specimens collected in this study. Conclusions To our knowledge, this is the first detection of Ae. luteocephalus in Mozambican territory, a vector species of yellow fever virus (YFV), Zika virus (ZIKV) and dengue virus (DENV) in Africa. Further studies are encouraged to investigate the role of Ae. luteocephalus in the transmission of arboviral diseases in Mozambique.

Intimate Partner Violence (IPV) has been linked to poor health. Economic position may be an important risk factor for IPV. We examined the association between economic position and IPV at country and individual levels. We analyzed Demographic and Health Surveys data of 187,716 ever-partnered women between ages 10 and 59 from 20 low- and middle-income countries. We calculated direct age-standardized 12-month prevalence of physical IPV and performed ecological analysis using Gini coefficients and Concentration indexes to assess correlation with 12-month prevalence of physical IPV. We conducted multivariable logistic regression for each country to assess the association between wealth status and physical IPV and a meta-analysis of the regression model to present results across countries. Compared to the Poorest quintile, odds of IPV among wealthier quintiles varied by country. In the Middle quintile, India had significantly reduced IPV (OR 0.75, 95%CI: 0.68-0.83). In the Richer and Richest quintiles, 4 and 6 countries had significant reductions in IPV, respectively. Only Mozambique was found to have significant increased IPV in the wealthiest quintile (OR 2.51, 95%CI: 1.45-4.38). Gini coefficient and physical IPV had a correlation coefficient of 0.502 ( p value 0.033), while Concentration index had –0.276 ( p value .253). Standardized prevalence for physical IPV ranged from 1.58% to 18.91%. Findings suggest that the relationship between wealth and IPV vary considerably in the included low- and middle-income countries, and that risk of IPV may not necessarily be higher among women in lower wealth brackets. Mozambique was the only country with increased odds of IPV among the Richest group as compared to the Poorest group. This study provides evidence IPV may transcend economic boundaries, and that studies looking at the link between inequality and IPV are paramount for designing adequate preventative policies.

Disasters are on the increase globally with accompanying devastating effects on dairy supply chains. The devastating effects, caused by disasters on economies in various countries such as United States of America, Japan, Kenya, Uganda, Mozambique and Zimbabwe call for urgent sustainable mitigating measures in disaster risk reduction. These countries have experienced notable natural and man-made disasters in the past. The disasters negatively impacted the economies of both developed and developing countries, causing misery to people as hunger and poverty drastically increased. Zimbabwe’s dairy industry was not spared from these devastating effects as it was vulnerable to disasters such as droughts and cyclones. Disasters adversely affected supply chains in the country as evidenced by the closure of some dairy firms between the years 2000 and 2014. This article is set against the backdrop of declining output across all agricultural sectors in Zimbabwe, evident particularly in the dairy farming sector which has witnessed inadequate supply of raw milk and dairy products by local producers. The article assesses the impact of dairy organisations’ partnerships with government departments and non-governmental organisations in reducing disaster risks on the dairy supply chain cost efficiency. It also aims to show how partnerships can reduce disaster risks and weighs the benefits of reduced supply chain costs in improving the affordability of milk and milk products to the general public. The study employs a mixed-methods approach comprising structured questionnaires, administered to a sample of 92 respondents out of a randomly sampled population of 122 participants from dairy farming clusters across the country, with an 85% response rate. Key informants in the form of 18 dairy officers were purposively sampled for interviews throughout the dairy farming regions. The research findings will help government in the formulation of public policies for the dairy sector network in reducing disaster risks.

Abstract Background In Mozambique, infection by intestinal parasites is reported all over the country. However, infection in children with diarrhoea is mostly focused in the southern region of Mozambique. This work aims to determine the frequency and potential risk factors for infection by Cryptosporidium spp., Giardia lamblia, and Entamoeba histolytica in children under-five years hospitalized with diarrhoea in Hospital Central de Nampula, northern Mozambique. Methods A cross-sectional hospital-based surveillance was conducted between March 2015 and January 2018 in children admitted with diarrhoea in Hospital Central de Nampula. Sociodemographic information was obtained through semi-structured interviews applied to the children’s caregivers. A single stool sample was collected from each child to detect antigens from Cryptosporidium spp., G. lamblia, and E. histolytica using an immune-enzymatic technique. Crude and adjusted odds ratios (with 95% Confidence Intervals) were obtained by logistic regression models to identify factors associated with infection by Cryptosporidium spp. and G. lamblia. Results The median age and interquartile intervals of our sample population was 12 months (8–20). Intestinal protozoa were detected in 21.4% (59/276). Cryptosporidium spp. was the most common protozoa (13.9% - 38/274), followed by G. lamblia (9.1% - 25/274) and E. histolytica (0.4% - 1/275). Children with illiterate caregiver’s (p-value = 0.042) and undernourished (p-value = 0.011) were more likely to be infected by Cryptosporidium spp. G. lamblia was more common in children living in households with more than four members (p-value = 0.039). E. histolytica was detected in an eleven month’s child, co-infected with Cryptosporidium spp. and undernourished. Conclusion Cryptosporidium spp. and Giardia lamblia were the most common pathogenic intestinal protozoa detected in children with diarrhoea hospitalized in the Hospital Central de Nampula. Our findings obtained highlight the importance of exploring the caregiver’s education level, children’s nutritional status for infections with Cryptosporidium spp., and living conditions, namely crowded households for infections with G. lamblia in children younger than five years.

Sexually transmitted infections are among the most common public health problems worldwide. Female and male infertility, mother to child transmission, causing miscarriages or congenital disease, and increased risk for Human Immunodeficiency Virus infection (HIV) are some of their consequences. In Sub-Saharan Africa countries, such as Mozambique, the prevalence of these infections is high, women being those who carry the higher burden. Thus we developed this cross-sectional study with objective of characterizing some sexually transmitted infections, HIV infection, syphilis and trichomoniasis in pregnant women, verifying if their management was in accordance with guidelines and recommendations in the country and identifying practice, Knowledge and associated risk factors. Samples were collected from 253 pregnant women attending Centro de Saúde de Maxixe. Vaginal samples were obtained and observed microscopically by wet mount and direct microscopic examination (Trichomonas vaginalis). HIV antibody testing was performed with the tests Determine HIV-1/2 and Uni-GoldTM and against, T. pallidum by RPR, SD BIOLINE Syphilis 3.0 and Determine TP tests in plasma samples. In this study, 11.1% of the pregnant women were infected with HIV, 2.8% with active syphilis, 5.1% with Trichomonas vaginalis and 9.1% with yeast. Antibodies against T. pallidum were identified in 8,3% of these women. In relation to HIV, 7, 5% of them were new cases. Samples were taken from 253 pregnant women attending ante-natal outpatient consultation at the health centre, which were informed about the nature of the study and submitted to a semi-structured interview after signing the free informed consent. In this study, the inconsistency on condoms use and the existence of multiple partners by the participants contributing for these infections transmission. Participants have shown that they had information about these infections modes of transmission, as also which measures to use to prevent them. A significant number of women present with any symptom related to infections that were diagnosed to them, proving that the use of syndrome approach in vaginal discharge must be given some thought in relation to its value in this situation. The data obtained in this study shows that some gaps also exist in the prenatal care clinics of this Centre, from routine procedures that are not performed in accordance with MISAU recommendations. The high prevalence of some STI found in this population, their risk behavior, together with the non-observance of some guidelines in the management of those infections by the health personal very worrying. The implementation of a teaching program on quality control, prevention and management of these infections by the health professional seems to us to be of utmost importance, so these can act in accordance with the present guidelines and transmit correct information to the pregnant women who attend prenatal care.

Abstract Background The growing burden of non-communicable diseases (NDC), particularly in low-and middle-income countries, poses a significant threat to global health. Obesity and overweight constitute major risk factors of NCDs such as heart diseases, diabetes, and kidney disease, and as a result, contribute significantly to the development of chronic morbidities, reduced quality of life, and increased risk of premature death. This study described evidence on the prevalence, incidence, and trends of childhood overweight and obesity in sub-Sahara Africa (SSA). Methods We conducted a systematic scoping review employing the Arksey and O’Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute guidelines. To obtain relevant published articles for this review, we performed a comprehensive keywords search in PubMed, Google Scholar, Web of Science, and CINAHL via EBSCOhost platform for studies published between 2009 and June 2019. Guided by the eligibility criteria, title and abstracts, as well as the full-text articles were independently screened in parallel by two investigators. All relevant data were independently extracted by two investigators using a piloted form designed in Microsoft and thematic analysis conducted. Results Of the 81 included studies obtained from 250,148 potentially eligible articles, the majority (25) conducted in South Africa followed by 18 in Nigeria. Six studies were conducted in Ethiopia (6), Tanzania (5), Kenya (4), Cameroon (4), Ghana (3), Uganda (2), Mozambique (2), and Sudan (2). One study each was conducted in Botswana, Gambia, Lesotho, Mauritius, Seychelles, Togo, and Zimbabwe. The remaining three articles were multi-country studies. Most (81.5%) of the included studies were cross-sectional surveys and the majority (79) focused on both male and female participants. The majority (80/81) of the included studies reported on the prevalence of childhood overweight/obesity, 8 on the trends of childhood overweight/obesity, and one presented evidence on the incidence of childhood overweight and obesity in SSA. Conclusion This review demonstrates limited studies on childhood overweight/obesity in most SSA countries although the included studies suggest an increasing burden. Considering the consequences of childhood obesity, there is a need for more primary researches to inform policies decision and implementation to halt the rise of childhood obesity/overweight in SSA.

Abstract Background Early and unprotected sex with multiple partners among adolescents carries a high risk of acquiring HIV infections, other sexually transmitted infections as well as high rates of teenage pregnancy. Sub-Saharan Africa (SSA) has a higher burden of HIV/AIDS: the leading cause of deaths among adolescents. We estimated the prevalence and examined the correlates of sexual intercourse among in-school adolescents of SSA. The purpose is to inform the public health programs dedicated to tackling the burden of HIV/AIDS. Methods We did a secondary analysis of the Global School-based Student Health Surveys (GSHS) datasets pooled from five SSA countries Benin, Mozambique, Namibia, Seychelles, and Tanzania. Our current analysis included a sample of 15,318 in-school adolescents. The primary independent variables were ever had sexual intercourse and sex with multiple partners, while the dependent variables were smoking cigarettes, alcohol use, use of marijuana and amphetamine, and parental connectedness. We performed descriptive statistics, and multivariate logistic regression stratified by gender using SPSS Complex Sample Statistics. A p-value of less than 0.05 was considered statistically significant at 95% confidence intervals. Results Out of 15,318 participants, the overall prevalence of ever had sexual intercourse and sex with multiple partners were 43·5% (6670) and 20·9% (3204), respectively. In overall and across each country, male adolescents had a significantly higher proportion of sex with multiple partners than female adolescents, p < 0·001. The predictors of sexual intercourse with multiple partners in both male and females were smoking cigarettes, alcohol use, and use of marijuana and amphetamine. Female adolescents who smoked cigarettes and used marijuana had a significant likelihood of sex with multiple partners than male adolescents: [aOR 3.6, 95% CI: 2.6-5.1] vs [aOR 2.1, 95% CI: 1.7-2.7] and [aOR 2.4, 95% CI: 1.6-3.7] vs [aOR 1.9, 95% CI: 1·3-2·7], respectively. Conclusions Adolescents sexual intercourse and more especially sex with multiple partners was prevalent and strongly correlated with substance use. However, the correlation was higher among female adolescents than male adolescents. A customized public health intervention that targets multiple risk factors concurrently may benefit adolescents with clustering of sexual and non-sexual risk-taking behaviors.

Despite the rise of the global availability of biodiversity data by digitisation, essential regions of the world remain poorly documented (Peterson et al. 2015). Research-neglected regions that lack quality information, are mainly the species-rich and developing nations (Gaikwad and Chavan 2006). Mozambique is an African country without a wide-ranging knowledge regarding its fauna’s diversity and distribution (Neves et al. 2018). Undeniably, this country's knowledge gaps constitute a significant impediment for the improvement of effective conservation measures. Primary species occurrence data across dispersed data sources can be a cost-effective resource for boosting knowledge about a country’s biodiversity. Aiming to aggregate a comprehensive dataset of Mozambique’s terrestrial mammals, we compiled primary species occurrence data from dispersed data sources. The produced dataset not only gathered digitalised accessible knowledge (DAK) from the Global Biodiversity Information Facility (GBIF) and natural history collections, but also retrieved and digitalised species occurrence data enclosed in grey and scientific literature. Particularly for poorly documented countries, filling data gaps are crucial for new and broad insights for biodiversity research and preservation. Thus, quantification of the effects of data digitisation and mobilisation goes beyond the specific goals of organisations, institutions or data-sharing resources. The impact of data digitisation should be disseminated, not only by the number of publications and times data are accessed (Nelson and Ellis 2018), but also by the actual achievements in regions covered by DAK. To highlight the impact of further data digitisation in a poorly documented country, we examine the effective gain of further digitisation and data cleaning on the terrestrial mammals from Mozambique. We demonstrate the increase in the overall knowledge, not merely in terms of number of species, number of records, and country’s coverage, but from the production of outputs with potential value for data-driven conservation research and planning. More than 17000 records were compiled. The digitisation of data in literature as well as data cleaning and quality improvements resulted in a substantial increase in the amount of DAK, which acknowledges Mozambique’s high species diversity (Fig. 1). The digitisation and data mobilisation hereby described allowed for the update of the country’s terrestrial mammals checklist (Neves et al. 2018). The final dataset also expands the knowledge of the most poorly documented provinces, allowing generation of a data-driven proposal of priority areas to survey (in review). Also, an assessment of Mozambique’s conservation network effectiveness for mammal protection was performed, and additional relevant areas were suggested (in prep.). The dataset compiled is an important "stepping stone" towards an enhanced knowledge of Mozambique’s fauna. Biodiversity conservation and management in developing countries rich in natural resources, which often must deal with a lack of internal capacity for applied research and conservation actions, are challenges. Considering that digitisation and mobilisation of biodiversity data are resourceful processes for improving knowledge, collaborative work between institutions of those countries and international data-provider communities could, in the short term, successfully improve the information baseline to support decision-making in future conservation and management actions.

Subject area of the teaching case The subject area is international business and strategy. The case allows scope for the following areas: internationalisation, market strategy, emerging market multinational companies, and doing business in Africa. Student level The primary target audience for this teaching case is postgraduate business students such as Master of Business Administration (MBA), or postgraduate management programmes. The case is primarily designed for use in courses that cover strategy or international business. Brief overview of the teaching case This case centres on the international growth strategy of FMBcapital Holdings Group (FMB), the Malawian commercial banking firm. The case finds the founder and current group chairman, Hitesh Anadkat, in 2016, as he and the FMB board are about to decide on the next move in their Southern African strategy. Since opening the first FMB branch in Malawi and becoming the country's first commercial banker in 1995, Anadkat and his team have ridden a wave of financial deregulation across the region to successfully expand into neighbouring Botswana, Zambia, and Mozambique. Now, an opportunity to gain a foothold in Zimbabwe means the leaders must decide (1) whether they want to continue to grow the FMB footprint across the region, or focus on their integration and expansion efforts within existing markets; and (2) how they will realise this strategy. Expected learning outcomes International expansion – identifying the need to expand into new markets; identifying the combination of internal strengths and external conditions that make international expansion viable; and identifying and analysing each possible new market(s) and the decision-making process involved. Political, social and economic factors in Africa – understanding how these external institutional factors present constraints, risks and opportunities for internationalisation and hence shape strategy; understanding that these factors may vary significantly across countries on the continent (in spite of their geographic proximity) and in some cases, within a single country; and understanding that by selecting markets with extreme socially and politically volatile contexts, the risk of a worst-case scenario transpiring (in which institutional forces trump business strategy) is appreciable. Combination of resource- and institutional-based approaches – recognising that successful internationalisation requires capitalising upon both internal resources and institutional mastery. Choosing expansion strategies – assessing the type of new market entry (e.g. greenfield or acquisition of existing operations) and its adequacy for penetrating a new market. Using networks and local partners – to substitute and enhance the benefits that originally flow from a small (and sometime family-established) business, with an emphasis on acquisition of skills and networks in foreign countries. Regional integration – optimising business operations through a sharing or pooling of resources and improved capital flow between subsidiaries, in some instances by taking advantage of economies of scale (this extends to enhancing the reputation and awareness of a brand across a wider region). Family businesses – identifying the value that can be gained through establishing a family business with the support of many “close” stakeholders while also noting the limitation that exist as expansion and growth is required.

Adolescent sexual and reproductive health (ASRH) challenges in Mozambique include early marriages, early pregnancies and HIV/AIDS. In 1999 the Programa Geração Biz (PGB) was created to address youths’ problems and improve their sexual and reproductive health (SRH). However, studies show Mozambican youths continue to be exposed to risks related to their SRH. Mozambique is a multicultural country but only 40% of Mozambicans speak Portuguese, the official language, while 93.5% of the population uses a Bantu language as their mother tongue. This raises an important issue – should PGB communication strategies (CS) take into account the country’s complex cultural reality? Studies recognise the role of culture in enhancing effective delivery of communication programmes. Concurrently, studies point to a lack of research analyzing CS of health campaigns. This paper’s aims are: (i) to examine PGB communication strategies; (ii) identify cultural challenges to these strategies; and (iii) determine the implications of these impediments for the PGB. Research methods included non-participant observation, in-depth interviews and focus group discussions. Research questions were based on the McGuire Communication/Persuasion Model, and data analyzed thematically using Nvivo Pro11. Results revealed the following: (i) interpersonal methods are used to deliver preventive messages, with sociocultural approaches often ignored or not used to reduce cultural barriers; (ii) cultural challenges identified include initiation rites, taboos surrounding sexuality, language and health terminologies, and parents’ attitudes towards early marriages; and (iii) these factors hinder effective delivery of programme messages. The conclusion is that the CS used by PGB does not sufficiently take into account the Mozambican sociocultural context. Taboos around sexuality have silenced open communication in this regard. Ideas of sexual abstinence, condom use and campaigns against early marriage stand in opposition to certain orientations of traditional initiations. KEY WORDS: COMMUNICATION STRATEGIES, SEXUAL AND REPRODUCTIVE HEALTH, PROGRAMA GERAÇÃO BIZ, McGUIRE’S COMMUNICATION/PERSUASION MODEL, CULTURAL CHALLENGES

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. 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