Jovens e associações em Moçambique: motivações e dinâmicas actuais

This article reflects on youth associations dynamics in Postcolonial Mozambique. The aim is to identify and analyze motivations for young people's involvement in such groups. Based on empirical work with two youth associations - namely "Associação Aro Juvenil" and "Associação Positiva Juvenil" - the assessment finds that youth associations dynamics highlights intricate relationships involving identity, context, private, public and affective milieus. Although there are multiple motivations, young people's adherence to associations is combined with individual life stories and expectations. At the discourse level, entrance to the associative life represents a form of socio-political legitimation in response to other narratives that consider young people very passive and less intervening in finding solutions to their own problems, and society's in general. At the level of day-to-day practices, young people re-interpret and give a different sense to their motivations and commitment: beyond formal objectives - arguably development-oriented, altruistic and humanistic - associations are a life strategy for the accomplishment of individual achievements. To create an association and/or take part in one may imply greater possibilities of accessing and controlling diversified resources and capitals, such as a job/occupation, money, work, power, recognition, prestige, and training, among others, which would be otherwise impossible.O presente artigo é uma reflexão sobre dinâmicas associativas de jovens no Moçambique pós colonial. O objectivo desta reflexão foi identificar e analisar as motivações de engajamento dos jovens nesses agrupamentos. Baseando-se em aproximações empíricas feitas a duas associações de jovens - Associação Aro Juvenil e Associação Positiva Juvenil - a análise demonstra que dinamica associativa de jovens mete em evidência relações complexas entre identidade, contexto, o privado, o público e o afectivo. Embora haja múltiplas motivações, a adesão dos jovens em associações associa trajectórias e expectativas individualizadas. A nível discursivo, a entrada na vida associativa representa uma forma de legitimação sóciopolítica em resposta a um discurso que considera os jovens passivos e pouco intervenientes na solução dos problemas que lhes afecta em particular e à sociedade no geral. A nível das práticas associativas quotidianas, os jovens reintrepretam e dão outro sentido às motivações do seu engajamento: para lá dos objectivos formais, pretensamente desenvolvimentistas, altruistas e humanitários, o associativismo é uma estratégia de vida e de realização de projectos individuais. Criar uma associação e/ou nela aderir pode significar maiores possibilidades de aceder e controlar recursos e capitais diversificados como emprego/profissão, dinheiro, trabalho, poder, reconhecimento e prestigio, formações entre outros que de outra forma não seria possível

Provision of medical supply kits to improve quality of antenatal care in Mozambique: a stepped-wedge cluster randomised trial

Background High levels of maternal and newborn mortality and morbidity remain a daunting reality in many low-income countries. Several interventions delivered during antenatal care have been shown to improve maternal and newborn outcomes, but stockouts of medical supplies at point of care can prevent implementation of these services. We aimed to evaluate whether a supply chain strategy based on the provision of kits could improve quality of care. Methods We did a pragmatic, stepped-wedge, cluster-randomised controlled trial at ten antenatal care clinics in Mozambique. Clinics were eligible if they were not already implementing the proposed antenatal care package; they served at least 200 new pregnant women per year; they had Maternal and Child Health (MCH) nurses; and they were willing to participate. All women attending antenatal care visits at the participating clinics were included in the trial. Participating clinics were randomly assigned to shift from control to intervention on prespecified start dates. The intervention involved four components (kits with medical supplies, a cupboard to store these supplies, a tracking sheet to monitor stocks, and a one-day training session). The primary outcomes were the proportion of women screened for anaemia and proteinuria, and the proportion of women who received mebendazole in the first antenatal care visit. The intervention was delivered under routine care conditions, and analyses were done according to the intention-to-treat principle. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201306000550192. Findings Between March, 2014, and January, 2016, 218 277 antenatal care visits were registered, with 68 598 first and 149 679 follow-up visits. We found significant improvements in all three primary outcomes. In first visits, 5519 (14·6%) of 37 826 women were screened for anaemia in the control period, compared with 30 057 (97·7%) of 30 772 in the intervention period (adjusted odds ratio 832·40; 99% CI 666·81–1039·11; p<0·0001); 3739 (9·9%) of 37 826 women were screened for proteinuria in the control period, compared with 29 874 (97·1%) of 30 772 in the intervention period (1875·18; 1447·56–2429·11; p<0·0001); and 17 926 (51·4%) of 34 842 received mebendazole in the control period, compared with 24 960 (88·2%) of 28 294 in the intervention period (1·88; 1·70–2·09; p<0·0001). The effect was immediate and sustained over time, with negligible heterogeneity between sites. Interpretation A supply chain strategy that resolves stockouts at point of care can result in a vast improvement in quality during antenatal care visits, when compared with the routine national process for procurement and distribution of supplies. Funding Government of Flanders and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.Fil: Betrán, Ana Pilar. Organizacion Mundial de la Salud; ArgentinaFil: Bergel, Eduardo. World Health Organization; Suiza. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Griffin, Sally. International Centre For Reproductive Health; MozambiqueFil: Melo, Armando. Mozambique Ministry Of Health; MozambiqueFil: Nguyen, My Huong. World Health Organization; SuizaFil: Carbonell, Alicia. World Health Organization; SuizaFil: Mondlane, Santos. Consultório de Estatística E Serviço de Soluções; MozambiqueFil: Merialdi, Mario. World Health Organization; SuizaFil: Temmerman, Marleen. World Health Organization; SuizaFil: Gülmezoglu, A Metin. World Health Organization; SuizaFil: Aleman, Alicia. World Health Organization; SuizaFil: Althabe, Fernando. World Health Organization; Suiza. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Biza, Adriano. World Health Organization; SuizaFil: Crahay, Beatrice. World Health Organization; SuizaFil: Chavane, Leonardo. World Health Organization; SuizaFil: Colomar, Mercedes. World Health Organization; SuizaFil: Delvaux, Therese. World Health Organization; SuizaFil: Dique Ali, Ussumane. World Health Organization; SuizaFil: Fersurela, Lucio. World Health Organization; SuizaFil: Geelhoed, Diederike. World Health Organization; SuizaFil: Jille-Taas, Ingeborg. World Health Organization; SuizaFil: Malapende, Celsa Regina. World Health Organization; SuizaFil: Langa, Célio. World Health Organization; SuizaFil: Osman, Nafissa Bique. World Health Organization; SuizaFil: Requejo, Jennifer. World Health Organization; SuizaFil: Timbe, Geraldo. World Health Organization; Suiz

Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study

Background: Maternal mortality remains a daunting problem in Mozambique and many other low-resource countries. High quality antenatal care (ANC) services can improve maternal and newborn health outcomes and increase the likelihood that women will seek skilled delivery care. This study explores the factors influencing provider uptake of the recommended package of ANC interventions in Mozambique. Methods: This study used qualitative research methods including key informant interviews with stakeholders from the health sector and a total of five focus group discussions with women with experience with ANC or women from the community. Study participants were selected from three health centers located in Maputo city, Tete, and Cabo Delgado provinces in Mozambique. Staff responsible for the medicines/supply chain at national, provincial and district level were interviewed. A check list was implemented to confirm the availability of the supplies required for ANC. Deductive content analysis was conducted. Results: Three main groups of factors were identified that hinder the implementation of the ANC package in the study setting: a) system or organizational: include chronic supply chain deficiencies, failures in the continuing education system, lack of regular audits and supervision, absence of an efficient patient record system and poor environmental conditions at the health center; b) health care provider factors: such as limited awareness of current clinical guidelines and a resistant attitude to adopting new recommendations; and c) Users: challenges with accessing ANC, poor recognition amongst women about the purpose and importance of the specific interventions provided through ANC, and widespread perception of an unfriendly environment at the health center. Conclusions: The ANC package in Mozambique is not being fully implemented in the three study facilities, and a major barrier is poor functioning of the supply chain system. Recommendations for improving the implementation of antenatal interventions include ensuring clinical protocols based on the ANC model. Increasing the community understanding of the importance of ANC would improve demand for high quality ANC services. The supply chain functioning could be strengthened through the introduction of a kit system with all the necessary supplies for ANC and a simple monitoring system to track the stock levels is recommended

Provision of medical supply kits to improve quality of antenatal care in Mozambique: a stepped-wedge cluster randomised trial

Background: High levels of maternal and newborn mortality and morbidity remain a daunting reality in many low-income countries. Several interventions delivered during antenatal care have been shown to improve maternal and newborn outcomes, but stockouts of medical supplies at point of care can prevent implementation of these services. We aimed to evaluate whether a supply chain strategy based on the provision of kits could improve quality of care. Methods: We did a pragmatic, stepped-wedge, cluster-randomised controlled trial at ten antenatal care clinics in Mozambique. Clinics were eligible if they were not already implementing the proposed antenatal care package; they served at least 200 new pregnant women per year; they had Maternal and Child Health (MCH) nurses; and they were willing to participate. All women attending antenatal care visits at the participating clinics were included in the trial. Participating clinics were randomly assigned to shift from control to intervention on prespecified start dates. The intervention involved four components (kits with medical supplies, a cupboard to store these supplies, a tracking sheet to monitor stocks, and a one-day training session). The primary outcomes were the proportion of women screened for anaemia and proteinuria, and the proportion of women who received mebendazole in the first antenatal care visit. The intervention was delivered under routine care conditions, and analyses were done according to the intention-to-treat principle. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201306000550192. Findings: Between March, 2014, and January, 2016, 218 277 antenatal care visits were registered, with 68 598 first and 149 679 follow-up visits. We found significant improvements in all three primary outcomes. In first visits, 5519 (14·6%) of 37 826 women were screened for anaemia in the control period, compared with 30 057 (97·7%) of 30 772 in the intervention period (adjusted odds ratio 832·40; 99% CI 666·81–1039·11; p<0·0001); 3739 (9·9%) of 37 826 women were screened for proteinuria in the control period, compared with 29 874 (97·1%) of 30 772 in the intervention period (1875·18; 1447·56–2429·11; p<0·0001); and 17 926 (51·4%) of 34 842 received mebendazole in the control period, compared with 24 960 (88·2%) of 28 294 in the intervention period (1·88; 1·70–2·09; p<0·0001). The effect was immediate and sustained over time, with negligible heterogeneity between sites. Interpretation: A supply chain strategy that resolves stockouts at point of care can result in a vast improvement in quality during antenatal care visits, when compared with the routine national process for procurement and distribution of supplies. Funding: Government of Flanders and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction

Additional file 1: of Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study

Detailed methods. Includes: population served by the clinics, detailed description of focus groups, detailed of the training conducted for the facilitators of the focus groups, description of the recording of the interviews and focus groups discussions, and the informed consent form. (PDF 92 kb