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Background: Health information systems are crucial to provide data for decision-making and demand for data is constantly growing. However, the link between data and decisions is not always rational or linear and the management of data ends up overloading frontline health workers, which may compromise quality of healthcare delivery. Despite limited evidence, there is an increasing push for the digitalization of health information systems, which poses enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used in combination with digital solutions and this calls for efforts to make them more responsive to local needs. Paper-based Health Information Systems in Comprehensive Care (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based health information systems in three sub-Saharan African countries., Methods/design: The PHISICC initiative is being carried out in remote, rural settings in Côte d'Ivoire, Mozambique and Nigeria through partnership with ministries of health and research institutions. We began with research syntheses to acquire the most up-to-date knowledge on health information systems. These were coupled with fieldwork in the three countries to understand the current design, patterns and contexts of use, and healthcare worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries in three cluster-randomized controlled trials. Throughout the project, we have engaged with a wide range of stakeholders and have maintained the highest scientific standards to ensure that results are relevant to the realities in the three countries., Discussion: We have deployed a comprehensive research approach to ensure the robustness and future policy uptake of findings. Besides the innovative PHISICC paper-based tools, our process is in itself innovative. Rather than emphasizing the technical dimensions of data management, we focused instead on frontline health workers' data use and decision-making. By tackling the whole scope of primary healthcare areas rather than a subset of them, we have developed an entirely new design and visual language for a suite of tools across healthcare areas. The initiative is being tested in remote, rural areas where the most vulnerable live., (© 2021. The Author(s).)

Introduction: Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems., Methods and Analysis: Study areas are in rural zones of Côte d'Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes' data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects., Ethics and Dissemination: Ethics committees in Côte d'Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS., Trial Registration Number: PACTR201904664660639; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

The article presents consideration of Ruth First's works during her final year at the University of Dar es Salaam in Tanzania and Universidade Eduardo Mondlane in Maputo, Mozambique (UEM). It states that, this consideration has been done with reference to her own biographical trajectory. It also states that reconsideration of her work has been given just because of her own views on public spheres, personal papers and pedagogical practices.

The wasps' nest was only about 15 cm from the water surface, but the growing vegetation structures in the floating mat may have prevented it from sinking further towards the water. GLO:7ZA/01dec20:aje12772-fig-0001.jpg PHOTO (COLOR): 1 Nest of Polistes paper wasps attached to remains of an herbaceous plant protruding from a transient floating vegetation mat in the Aluize, Mozambique (November 2017). [Extracted from the article]

Background: Due to the threat of emerging anti-malarial resistance, the World Health Organization recommends incorporating surveillance for molecular markers of anti-malarial resistance into routine therapeutic efficacy studies (TESs). In 2018, a TES of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) was conducted in Mozambique, and the prevalence of polymorphisms in the pfk13, pfcrt, and pfmdr1 genes associated with drug resistance was investigated. Methods: Children aged 6–59 months were enrolled in four study sites. Blood was collected and dried on filter paper from participants who developed fever within 28 days of initial malaria treatment. All samples were first screened for Plasmodium falciparum using a multiplex real-time PCR assay, and polymorphisms in the pfk13, pfcrt, and pfmdr1 genes were investigated by Sanger sequencing. Results: No pfk13 mutations, associated with artemisinin partial resistance, were observed. The only pfcrt haplotype observed was the wild type CVMNK (codons 72–76), associated with chloroquine sensitivity. Polymorphisms in pfmdr1 were only observed at codon 184, with the mutant 184F in 43/109 (39.4%) of the samples, wild type Y184 in 42/109 (38.5%), and mixed 184F/Y in 24/109 (22.0%). All samples possessed N86 and D1246 at these two codons. Conclusion: In 2018, no markers of artemisinin resistance were documented. Molecular surveillance should continue to monitor the prevalence of these markers to inform decisions on malaria treatment in Mozambique. [ABSTRACT FROM AUTHOR]

Combining online and offline data collection during six months of ethnographic fieldwork in Southern Mozambique in early 2021, this paper explores how media and its everyday use in the Global South are impacting on, and are in turn being transformed by China. It specifically looks into the creative and personalised ways in which Chinese-made garments are sold and promoted in Mozambique via the messenger service WhatsApp. Examining how Mozambican and West African traders use WhatsApp groups and status updates to mediate the fashionability of these Chinese goods, this paper shows that the consequences of Chinese interactions with the Global South on the global media landscape transcend the mere spread of Chinese hardware and software. Going beyond dominant, state-centred narratives of Chinese influence abroad, this paper demonstrates the key role of individuals and their agency in shaping the digital impact of Global China. By doing so, it also highlights the importance of analysing media practices in their specific local contexts. [ABSTRACT FROM AUTHOR]

Abstract: Satellite imagery can be used to assess the state of vegetation in areas that are rarely visited. Here we report how satellite imagery clearly shows the outline of Mucheve Forest Reserve in Mozambique because the vegetation within the park has been severely degraded. This is contrast to several other protected areas, where the vegetation outside their boundaries is often more degraded than within. Possible reasons for the difference between the vegetation structure inside and outside the reserve are shortly discussed. [Copyright &y& Elsevier]

The province of Cabo Delgado, located in the north of Mozambique, has been inflicted by the conflict and terrorist actions since 2017. The threats they pose, and the unfolding fragility of the security situation have forced over 1.4 million people to flee their homes and communities. While thousands of displaced people are reluctant to risk their lives and return, over five hundred thousand displaced people made their spontaneous way back "home," and the country continues to struggle with such a reality. In the face of violent disruption and displacement, this paper offers an exploratory review of return from the perspective of encountering and giving meaning to places. Leaving culture (reflexivity again) a bit out, the paper closely looks at the (social and economic) experiences people have developed and carried with them through their displacement (and return) narratives as the main factors influencing the decision to or not to return. This article would then have a twofold purpose. On the one hand, it contributes to the existing debate on conflict, displacement, place and place-making. On the other hand, it would be beneficial to enrich the ongoing research further. [ABSTRACT FROM AUTHOR]

Context and background Sustainable growth and development in Africa will continue to depend mainly on how land and land-related resources are secured, used, and managed, which is extremely important for the socio-economic development of women and men. Equitable land rights support the eradication of poverty, increase food security, and respond to climate change. However, women's land rights are strongly gendered across many regions of the globe, especially in Africa, where access to and control over land and productive resources is affected by customary norms, usually discriminatory against women. Goal and Objectives: This paper focuses on Mozambique's legal reform and institutional capacity-building efforts, with special attention to social institutions, to promote equitable land rights and enhance land tenure security. It is based on specific practices in documenting customary and statutory access, control, and ownership of land, considering both the ongoing legal reform and the systematic land registration program the country has been promoting over the past decade. This paper intends to document these efforts and good practices so that they can be used as a reference and others can benefit from them. Methodology: The research follows a pragmatic value-driven philosophy, focusing on practical solutions and outcomes to improve future practice, taking gender inequality in land access as a starting point. The approach to theory development is abductive, moving from theory to data (deduction) and from data to theory (induction). Multi-methods, qualitative and quantitative, are used to ensure a richer approach. Results: Mozambique's legal framework has been reformed to accommodate several improvements related to gender equality. The family and the succession laws, are a clear break from the past merely patriarchal vision cemented in inequality. The recently approved land policy and the land law provide gender equality and protection of women's land rights. The Constitution and the land law recognize legal pluralism, having statutory and customary norms co-existing in land management and land administration, provided that the Constitution is not violated. Mozambique launched a massive systematic land registration, having designed and implemented its Fit-For-Purpose Land Administration approach, formatted to the country's context, intertwining three pillars: people, processes, and technology. There are still challenges to overcome, mainly due to complexity, contradictions, and overlaps within legal pluralism, as sometimes traditional and cultural norms prevent women from accessing, controlling, or owning land and participating in decision-making. [ABSTRACT FROM AUTHOR]

In this article, the author seeks to examine the effects of neoliberalism on curricula in Mozambique. Despite the fact that the introduction of neoliberal policies in Mozambique has affected the whole system of education, the focus in this article is only on curriculum reforms in secondary and technical/vocational education. The description and the comparison of the pro-liberal curricula with the 'non-liberal' or "transition-from-socialism-to-neoliberalism" period's curricula enables an insight into the sense of the curriculum policy shift: the ongoing neoliberal policies are tending to shift from the former disciplinary-based curriculums, to interdisciplinary, hybrid, flexible, professional-skills-based curricula, oriented to adjust to market demands. It is argued in this article is that a-social realist, socio-constructivist and social-realist epistemologies and their implications in terms of curriculum policies can be used to critically analyse and understand the curriculum policy shifts in Mozambique, in particular how neoliberalism is shaping curricula.

Micrasterias foliacea (Desmidiales, Zygnematophyceae) is an interesting desmid species as its filamentous life form is quite different from all other species within the genus. Due to the large size of the filaments and cells, accurate species identification is easy. After its original description from Rhode Island (USA) it was recorded from five continents, but no record could be found of its presence in Europe. In this paper a review of the worldwide distribution of M. foliacea (Desmidiales, Zygnematophyceae) is presented, together with notes on the species' ecology. In addition to its currently known geographical distribution, the paper also records the species' presence at two new locations in southern Africa, namely Botswana (Okavango River) and Mozambique (Palma, Cabo Delgado). The paper presents a discussion of taxonomical levels of intraspecific taxa, based on morphological characteristics. It is proposed that the taxonomical status of M. foliacea Bailey ex Ralfs f. nodosa should be raised to the variety, as its nodular cell wall thickenings are unique morphological features. [ABSTRACT FROM AUTHOR]

Background: The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance. Methods: The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial. Results: Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care. Conclusions: There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys. Trial registration: NCT01911494, Date Registered 30/07/2013. [ABSTRACT FROM AUTHOR]

Background: Mozambique has one of the highest burdens of neglected tropical diseases in Africa. Lymphatic filariasis, schistosomiasis and soil-transmitted helminths are being targeted for elimination as part of integrated mass drug administration campaigns. The progress made towards interruption of transmission has been affected by recent conflict in Cabo Delgado province. The aim of this paper was to determine the potential impact of this crisis on the neglected tropical diseases programme and the challenges in reaching the elimination goals of 2030. Methodology: A desk-based secondary data analysis was conducted on publicly available sources of neglected tropical diseases, conflict incidents, internally displaced persons and geographical access between 2020 and 2022. Data were summarised and mapped using GIS software. A combined risk stratified assessment at district level was developed with five classifications i) Very high-risk; ii) High-risk; iii) Medium to high-risk; iv) Medium risk; and v) Not at risk due to conflict absence but co-endemic. Results: Lymphatic filariasis, schistosomiasis and soil-transmitted helminths were co-endemic in 115 out of 156 (74%) districts. Between 2020 and 2022 a total of 1,653 conflict-related incidents were reported, most of them in Cabo Delgado province (n = 1,397, 85%). A five-fold increase of internally displaced persons was recorded from April 2020 (n = 172,186) to November 2022 (n = 935,130). Geographical accessibility also deteriorated across the province with an increase from five (29%) in 2021 to seven (41%) districts in 2022 classified as hard-to-reach. The combined risk stratification identified that most districts (n = 7; 41%) in Cabo Delgado province had medium to high-risk; very high-risk (n = 5, 29%); medium risk (n = 3, 18%); high-risk (n = 2, 12%). Conclusion: Most of the districts of Cabo Delgado were considered to be at risk of not meeting the neglected tropical diseases road map 2021–2030 targets due to the humanitarian crisis ongoing. There is the need for practical strategies and funding to overcome these hostile challenges. Author summary: Neglected tropical diseases (NTDs) are a group of diseases that usually affect the most vulnerable population in tropical countries. Mozambique has been tackling lymphatic filariasis, schistosomiasis and soil-transmitted helminths for two decades with the aim of eliminating them through large-scale distribution of drugs to interrupt transmission. In recent years, internal conflict has emerged and led to an escalating humanitarian crisis in the endemic province of Cabo Delgado which has hampered elimination efforts. This study aimed to shed light on the situation and to determine the potential impact on the Mozambique NTDs' programme. We used a range of open-source data on NTDs, conflict, internally displaced persons and geographical access to summarise, describe, and map the situation at the district level in the most affected province. We used this data to also examine their geographical overlap and to develop a risk assessment tool to highlight the high risk and most vulnerable areas. We found that between 2021–2022 more than 1,300 conflict incidents occurred, and almost 1 million people were displaced in Cabo Delgado province with many districts having limited geographical access which impacted the NTDs programme's ability to work. The study highlights the important challenges of conflict and displacement of vulnerable populations, and the need for support and set of guidelines for NTDs endemic programmes to use to help to overcome key barriers and meet the targets of elimination set by the World Health Organization for 2030. [ABSTRACT FROM AUTHOR]

Agriculture is the main economic activity of Mozambique and there is a lack of information about the quality of agricultural soils. In this paper, five soils from the Manica and Sussundenga districts (Manica province) sampled in the years 2021/2022 and 2022/2023 (before and after the rainy seasons) were subjected to an agronomical and environmental chemical analysis to assess their quality, from the fertility and environmental contamination points of view. Standard analytical methodologies from external certified laboratories and local X-ray fluorescence measurements were used. All the studied soils were acidic (pH ranging from 4.5 to 5.4), had no salinity problems (conductivity ranging from 4.2 to 11.8 mS/m), and had a low amount of soil organic matter (0.90% to 1.81%). Soils from the Sussundenga district had a very low cation exchange capacity (CEC) (average of 3.33 cmolc/kg), while that of those from the Manica district ranged from very low to average CEC (3.59 to 13.11 cmolc/kg). Sussundenga soils also had a phosphorous deficiency (values ranging from <20 to 38.5 mg/kg) and there were deficiencies and/or excesses of some macro and micronutrients in all soil samples. Manica soils were contaminated, apparently from geogenic origin, with Cr (280 to 1400 mg/kg), Co (80 mg/kg), Ni (78 to 680 mg/kg) and V (86 mg/kg). Agricultural soil monitoring must be fostered in Mozambique in order to improve food quality and quantity to ensure economic and environmental sustainability. [ABSTRACT FROM AUTHOR]

Accurate land use and land cover (LULC) mapping is essential for scientific and decision-making purposes. The objective of this paper was to map LULC classes in the northern region of Mozambique between 2011 and 2020 based on Landsat time series processed by the Random Forest classifier in the Google Earth Engine platform. The feature selection method was used to reduce redundant data. The final maps comprised five LULC classes (non-vegetated areas, built-up areas, croplands, open evergreen and deciduous forests, and dense vegetation) with an overall accuracy ranging from 80.5% to 88.7%. LULC change detection between 2011 and 2020 revealed that non-vegetated areas had increased by 0.7%, built-up by 2.0%, and dense vegetation by 1.3%. On the other hand, open evergreen and deciduous forests had decreased by 4.1% and croplands by 0.01%. The approach used in this paper improves the current systematic mapping approach in Mozambique by minimizing the methodological gaps and reducing the temporal amplitude, thus supporting regional territorial development policies. [ABSTRACT FROM AUTHOR]

Background: Vibrio cholerae is endemic in South Asia and Africa where outbreaks of cholera occur widely and are particularly associated with poverty and poor sanitation. Knowledge of the genetic diversity of toxigenic V. cholerae isolates, particularly in Africa, remains scarce. The constraints in improving this understanding is not only the lack of regular cholera disease surveillance, but also the lack of laboratory capabilities in endemic countries to preserve, store and ship isolates in a timely manner. We evaluated the use of simplified sample preservation methods for molecular characterization using multi-locus variable-number tandem-repeat analysis (MLVA) for differentiation of Vibrio cholerae genotypes., Methods and Findings: Forty-seven V. cholerae isolates and 18 enriched clinical specimens (e.g. stool specimens after enrichment in broth) from cholera outbreaks in Cameroon were preserved on Whatman filter paper for DNA extraction. The samples were collected from two geographically distinct outbreaks in the Far North of Cameroon (FNC) in June 2014 and October 2014. In addition, a convenience sample of 14 isolates from the Philippines and 8 from Mozambique were analyzed. All 87 DNAs were successfully analyzed including 16 paired samples, one a cultured isolate and the other the enriched specimen from which the isolate was collected. Genotypic results were identical between 15 enriched specimens and their culture isolates and the other pair differed at single locus. Two closely related, but distinct clonal complexes were identified among the Cameroonian specimens from 2014., Conclusions: Collecting V. cholerae using simplified laboratory methods in remote and low-resource settings allows for subsequent advanced molecular characterization of V. cholerae O1. These simplified DNA preservation methods identify V. cholerae and make possible timely information regarding the genetic diversity of V. cholerae; our results set the stage for continued molecular epidemiological research to better understand the transmission and dissemination of V. cholerae in Africa and elsewhere worldwide.

Most planktonic foraminifera migrate vertically through the water column during life, meeting a range of depth-related conditions as they grow and calcify. For reconstructing past ocean conditions from geochemical signals recorded in their shells it is therefore necessary to know vertical habitat preferences. Species with a shallow habitat and limited vertical migration will reflect conditions of the surface mixed layer and short-and meso-scale (i.e. seasonal) perturbations therein. Species spanning a wider range of depth habitats, however, will contain a more heterogeneous, intra-specimen variability (i.g. Mg/Ca and δ18 O), which is less for species calcifying below the seasonal mixed layer (SML). Here we present results on single-chamber Mg/Ca combined with single shell δ18 O and δ18 C of surface water Globigerinoides ruber, the thermocline-dwelling Neogloboquadrina dutertrei and Pulleniatina obliquiloculata and the deep dweller Globorotalia scitula from the Mozambique Channel. Species-specific Mg/Ca, δ18C and δ18O data combined with a depth-resolved mass balance model confirm distinctive migration and calcification patterns for each species as a function of hydrography. Whereas single specimen δ18 O not always reveal changes in depth habitat related to hydrography (i.g. temperature), measured Mg/Ca of the last chambers can only be explained by active migration in response to changes in temperature stratification. Since species show different responses to changes in hydrography, their shell chemistry can be used to reconstruct different components of the past ocean climate system such as seasonality and depth stratification. Here we present combined single-specimen δ18O and single-chamber Mg/Ca measurements for different species, providing a composite of thermocline and sub-thermocline conditions. These results allow for species-specific reconstruction of calcification depths, using a mass balance model, of four species of planktonic foraminifera. This shows that the single chamber Mg/Ca and single test ͐18 O are in agreement with each other and in line with the changes in hydrography induced by eddies. Whereas single chamber Mg/Ca are most affected eddy frequency, seasonality is reflected more clearly in single test δ18 O. [ABSTRACT FROM AUTHOR]

Land use allocation (LUA) is of prime importance for the development of urban sustainability and resilience. Since the process of planning and managing land use requires balancing different conflicting social, economic, and environmental factors, it has become a complex and significant issue in urban planning worldwide. LUA is usually regarded as a spatial multi-objective optimization (MOO) problem in previous studies. In this paper, we develop an MOO approach for tackling the LUA problem, in which maximum economy, minimum carbon emissions, maximum accessibility, maximum integration, and maximum compactness are formulated as optimal objectives. To solve the MOO problem, an improved non-dominated sorting genetic algorithm III (NSGA-III) is proposed in terms of mutation and crossover operations by preserving the constraints on the sizes for each land use type. The proposed approach was applied to KaMavota district, Maputo City, Mozambique, to generate a proper land use plan. The results showed that the improved NSGA-III yielded better performance than the standard NSGA-III. The optimal solutions produced by the MOO approach provide good trade-offs between the conflicting objectives. This research is beneficial for policymakers and city planners by providing alternative land use allocation plans for urban sustainability and resilience. [ABSTRACT FROM AUTHOR]

Mozambique is experiencing the consequences of a severe energy crisis with economic and social impacts. Its strict dependence on hydroelectric sources is being severely tested by recent droughts that have drastically reduced water levels in dams. However, Mozambique is addressing energy poverty by exploring renewable energy sources thanks to investments in the sector by the European Union. The research concerns an energy analysis profile of the country and the penetration of renewable energy, presenting an energy upgrading scope through a semi-automatic calculation methodology in a Building Information Modeling (BIM) environment. The building under study, located in Maputo, is the Natural History Museum, which plays an important role in biodiversity conservation. Therefore, this paper proposes a BIM methodology for sizing an environmental control system tailored to serve the museum. The proposed system replaces the previous one and includes a photovoltaic system that not only meets the museum's load but also supplies electricity to the surrounding area. Energy production from renewable sources with a surplus of 30% has been achieved. The proposed digital methodology has identified a maximum gap of 1.5% between the dimensions of the BIM duct and those of a traditional plant design, meeting ASHRAE requirements for environmental control. [ABSTRACT FROM AUTHOR]

Tropical-cyclone impacts can have devastating effects on the population, infrastructure, and natural habitats. However, predicting these impacts is difficult due to the inherent uncertainties in the storm track and intensity. In addition, due to computational constraints, both the relevant ocean physics and the uncertainties in meteorological forcing are only partly accounted for. This paper presents a new method, called the Tropical Cyclone Forecasting Framework (TC-FF), to probabilistically forecast compound flooding induced by tropical cyclones, considering uncertainties in track, forward speed, and wind speed and/or intensity. The open-source method accounts for all major relevant physical drivers, including tide, surge, and rainfall, and considers TC uncertainties through Gaussian error distributions and autoregressive techniques. The tool creates temporally and spatially varying wind fields to force a computationally efficient compound-flood model, allowing for the computation of probabilistic wind and flood hazard maps for any oceanic basin in the world as it does not require detailed information on the distribution of historical errors. A comparison of TC-FF and JTWC operational ensembles, both based on DeMaria et al. (2009), revealed minor differences of <10 %, suggesting that TC-FF can be employed as an alternative, for example, in data-scarce environments. The method was applied to Cyclone Idai in Mozambique. The underlying physical model showed reliable skill in terms of tidal propagation, reproducing the storm surge generation during landfall and flooding near the city of Beira (success index of 0.59). The method was successfully applied to forecasting the impact of Idai with different lead times. The case study analyzed needed at least 200 ensemble members to get reliable water levels and flood results 3 d before landfall (<1 % flood probability error and <20 cm sampling errors). Results showed the sensitivity of forecasting, especially with increasing lead times, highlighting the importance of accounting for cyclone variability in decision-making and risk management. [ABSTRACT FROM AUTHOR]

Under the framework of SDG 16, namely Peace, Justice and Strong Institutions, one key underexplored area of inclusion relates to the means of ensuring access to justice through the equitable governance of scarce resources, and mechanisms to promote equal and structural access to opportunities across society. This research sets out to answer the following questions across three case studies: (1) What is the relationship between critical or scarce resources and political conflict in the region under study?; (2) On what basis is the scarce or critical resource currently distributed within the region under study?; (3) What formal or informal governance mechanisms are in place to manage access to critical or scarce resources, and resolve conflicts created by it?; and (4) What improvements could be made to ensure more inclusive and equitable access to the distribution of this resource? The three proposed case studies, namely, Central Mali (land), Northeastern Kenya (water), and northern Mozambique (extraction and revenues of natural gas), have unique political and geographic features that are indivisible from peace and security. In each case, a blend of formal and informal mechanisms is used, but these often involve competing mandates, are guided by socio-economic dynamics or are unenforced, potentially leading to different types of localised conflict. This paper argues that, in order to prevent conflict around the governance of natural resources, communities need to be involved in a blend of informal and formal governance mechanisms from the outset. While the exact nature of these governance mechanisms may differ according to the nature of the natural resource and its extraction, there is a need to move from top-down towards people-centred approaches. Moreover, there should be efforts to develop specific SDG 16 targets related to environmental governance. [ABSTRACT FROM AUTHOR]

There remains a gap between the production of scientifically robust forecasts and the translation of these forecasts into useful information such as daily "bulletins" for decision-makers in early warning systems. There is significant published literature on best practice in communicating risk information but very little to guide and provide advice on the process of how these bulletins have been, or should be, developed. This paper reviews two case studies where bulletins were developed for national and district-level government agencies and humanitarian responders: daily reports in response to cyclones Idai and Kenneth in Mozambique and prototype landslide forecast bulletins in the Nilgiris and Darjeeling districts of India. Primary data were collected from producers and intermediaries of the bulletins via interview, and secondary data were analysed on iterative changes in the bulletin development, minutes from internal discussions, and feedback from users to extract learning on both the content and process of developing the bulletins. There were significant similarities in the type of content included in the bulletins, such as the layout, choice of words, and use of visualisation that was consistent with published best practices. Both case studies experienced challenges dealing with uncertainty, complexity, and whether to include advice. There were also similarities in the processes and approaches taken to develop the bulletins. Both case studies took an iterative approach, developed feedback mechanisms, benefitted from experienced multidisciplinary teams, and emphasised the need for strong inter-relationships and the importance and value of preparedness and protocols. A major challenge was the difficulty in balancing science capabilities, including issues related to data scarcity, with user needs, which did not become significantly easier to deal with given more time availability. In particular, there were tensions between developing new forecast products that were urgently needed by users against the limited time for testing and refinement of those forecasts and the risk of misinforming decisions due to uncertainty in the information based on limited data. The findings indicate that whilst more research is needed into existing or best practice processes to develop content for forecast bulletins, there is an existing body of experiential and intuitive knowledge and learning that already exists but that is not yet captured in an appropriate format that could be of significant interest and value to those developing forecast information. This paper goes some way to capturing some of the learning from translating scientific forecasts into useful information, in particular on both the content and the process of developing forecast bulletins for decision-making. [ABSTRACT FROM AUTHOR]

Background: Many low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality. Objective: The objective is to inform on potential options for measuring maternal mortality. Methods: This paper uses a case study approach to compare methodologies and estimates of pregnancy-related mortality ratio (PRMR)/maternal mortality ratio (MMR) obtained from four different data sources from similar time periods in Bangladesh, Mozambique, and Bolivia—national population census; post-census mortality survey; household sample survey; and sample vital registration system (SVRS). Results: For Bangladesh, PRMR from the 2011 census falls closely in line with the 2010 household survey and SVRS estimates, while SVRS' MMR estimates are closer to the PRMR estimates obtained from the household survey. Mozambique's PRMR from household survey method is comparable and shows an upward trend between 1994 and 2011, whereas the post-census mortality survey estimated a higher MMR for 2007. Bolivia's DHS and post-census mortality survey also estimated comparable MMR during 1998–2003. Conclusions: Overall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia. It also outlines recommendations to estimate maternal mortality based on the advantages and disadvantages of several approaches. Contribution: Recommendations in this paper can help health administrators and policy planners in prioritizing investment for collecting reliable and contemporaneous estimates of maternal mortality while progressing toward a complete civil registration system. [ABSTRACT FROM AUTHOR]

This paper presents the development of hybrid machine learning models to forecast the natural flows of water bodies. Five models were considered under the analysis: extreme gradient boosting (XGB), extreme learning machine (ELM), support vector regression (SVR), elastic net linear model (EN), and multivariate adaptive regression splines (MARS). The grey wolf optimization algorithm (GWO) optimized all of the models' internal parameters. A feature selection approach was embedded in the hybrid model to reduce the number of input variables. The hybrid model performed the forecasts considering one, three, five, and seven days ahead on data collected from Cahora Bassa dam, Mozambique. In the experiments conducted in this paper, XGB outperformed EN, ELM, MARS, and SVR, presenting lower prediction error and uncertainty. The proposed XGB model arises as an alternative to help with flow prediction, which is crucial for hydroelectric power plant activity. [ABSTRACT FROM AUTHOR]

WWDISA is an optional module of the DISA Laboratory Information system (LIS) that offers a web portal that allows access to test results over the internet for patient clinical management. This study aims to assess the applicability of using the WWDISA web application, and the lessons learned from its implementation in six health facilities in Mabote district, Inhambane province. Data from 2463 and 665 samples for HIV-viral load (HIVVL) tests, extracted from paper-based and WWDISA systems, respectively, were included, from January to December 2020. Data were simultaneously collected on a quarterly basis from both systems to allow comparison. The WWDISA turnaround time (TAT) from sample collection to results becoming available was found to be 10 (IQR: 8–12) days and significantly lower than the health unit manual logbook (p value < 0.001). Regarding the system efficiency, it was found that among 1978 search results, only 642 (32.5%) were found, and the main challenges according to the users were lack of connectivity (77%) and the website going down (62%). The WWDISA module has been shown to be effective in reducing the TAT, although a stable internet connection and accurate data entry are essential to make the system functional. [ABSTRACT FROM AUTHOR]

As is being done in most of the world, South Africa has commenced the transition from a fossil fuel-based electricity generation system to one based on renewable sources to meet greenhouse gas emission reduction goals. This paper explores the role of natural gas in South Africa to support the transition to a renewable energy-driven power grid. Specifically, the paper quantifies the firm and dispatchable power requirement to accommodate variability in solar and wind generation sources based on real-time series data from current renewable energy power plants for the country, and demonstrates that natural gas could be one of the elements to meet the medium-term need for this dispatchable power requirement, based on current regional gas resources. A range of alternative natural gas sources are considered in this analysis, covering existing gas resources from Mozambique, deep-water offshore potential from the southern Cape, shale gas from the Karoo basin, as well as liquefied natural gas imports. In addition, the alternatives to natural gas to supply the required dispatchable energy are considered. The analysis shows that the major challenge is to have sufficient gas storage available to be able to provide gas at the very high instantaneous rates required, but where the gas is only used for short periods of time and at low annual rates. [ABSTRACT FROM AUTHOR]

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This document includes eight studies showcasing good practices in support of sustainable small-scale fisheries. FAO commissioned these studies aiming to share experiences and promote the implementation of the Voluntary Guidelines for Securing Sustainable Small-Scale Fisheries in the Context of Food Security and Poverty Eradication (SSF Guidelines). The case studies were also intended to promote participatory approaches - in line with the SSF Guidelines principles - and to promote increased interaction between research and fishing communities, including the use of traditional knowledge and participatory research. It is hoped that the case studies will inform policy and policy processes and, in this way, promote sustainable small-scale fisheries according to the SSF Guidelines and the human rights-based approach to development (HRBA). The case studies constitute a rich selection of experiences and are diverse, not only with regard to their geographical setting but also in scope and approach. They span from looking at one specific tool for sharing experiences (the fisheries learning exchanges methodology in Madagascar and Mozambique) or examining the enabling environment in a specific thematic area (disaster risks in Bangladesh), to regional policy formulation on small-scale fisheries (the SSF Guidelines protocol for Caribbean policies) and reflection on how to use the SSF Guidelines in participatory processes (the Myanmar step-by-step approach to discussions with small-scale fisheries communities). A few of the papers look at co-management, in some cases combining fisheries management and social development (Senegal, Uruguay and Nepal), with one focusing on the role of small-scale fisheries and community organizations (India). Generally, the case studies refer to HRBA but, perhaps because many of the activities have taken place in the past, it seems that HRBA has rarely been consciously and explicitly implemented. Still, the case studies bear witness to a number of experiences and practices that are clearly steps in the right direction. Key good practices emerging from the studies refer to, among other things, holistic approaches to co-management and social responsibility; broad engagement, inclusiveness and partnerships; the power of communication; and gender equality and the role of women. As more experience is gained, our knowledge of how to go about implementing the SSF Guidelines will improve and nurture new and continued initiatives. For the present and the future, efforts should be made to apply HRBA, while continuing to share experiences and good practices showing how to do so when implementing the SSF Guidelines. [ABSTRACT FROM AUTHOR]

This paper analyzed the solid waste management process in the municipality of Quelimane, Mozambique. The methodology of this study is based on reviewing the scientific literature through fieldwork and observations on how urban solid waste management reaches its final destination. For that purpose, the population selected for this article was interviewed for a better perspective. As a result, it was possible to obtain answers that impacted the public management of the municipality since the level of attention to control depends on the location of the houses and also lacks a great deal of training for the workers who collect solid waste in the Quelimane region, along with awareness, environmental education programs for the population. [ABSTRACT FROM AUTHOR]

Lília Momplé, a Mozambican author, portrays the coexistence between black and white men and women in her works. By contesting the colonial legacy, the author contributes to the subaltern's voice. In this paper, we discuss how black characters, women in particular, in the short story collection No One Killed Suhura, are oppressed by colonialist societies. This text addresses the violence of social, racial, and sexual inequalities and the power relations established between colonizers and colonized during the twentieth century in Mozambique. We will see that some of the literary strategies used include the omniscient focus of the narrator, the relationship between history and literature, and irony. [ABSTRACT FROM AUTHOR]

In the recent decade, Volunteered Geographical Information (VGI), in particular the OpenStreetMap (OSM), has helped to fill substantial data gaps in base maps, especially in Global South, thus has become a promising source of massive, free training data together with rich and detailed semantic information for geospatial artificial intelligence (GeoAI) applications. Although intensive works have explored the potential of generating training data from OSM, a systematic approach of harvesting OSM contribution as quality-aware training data for different GeoAI tasks is still missing. To fill this research gap, we proposed a conceptual model consisting of three major components: historical OSM and external datasets, quality indicators, and GeoAI models. As a proof of concept, we validated our conceptual model with an example task of detecting OSM missing buildings in Mozambique, where the impact of different error sources (e.g., completeness, alignment, rotation) in training data were compared and investigated in a quantitative manner. The lessons learned in this paper shed important lights on cooperating OSM data quality aspects with the development of more explainable GeoAI models. [ABSTRACT FROM AUTHOR]

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Copyright of Review of African Political Economy is the property of Review of Political Economy (ROAPE) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Etnográfica: Revista do Centro de Estudos de Antropologia Social is the property of Centro em Rede de Investigacao em Antropologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Etnográfica: Revista do Centro de Estudos de Antropologia Social is the property of Centro em Rede de Investigacao em Antropologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Low-and-middle-income countries (LMICs) bear a disproportionate burden of communicable diseases. Social interaction data inform infectious disease models and disease prevention strategies. The variations in demographics and contact patterns across ages, cultures, and locations significantly impact infectious disease dynamics and pathogen transmission. LMICs lack sufficient social interaction data for infectious disease modeling. Methods: To address this gap, we will collect qualitative and quantitative data from eight study sites (encompassing both rural and urban settings) across Guatemala, India, Pakistan, and Mozambique. We will conduct focus group discussions and cognitive interviews to assess the feasibility and acceptability of our data collection tools at each site. Thematic and rapid analyses will help to identify key themes and categories through coding, guiding the design of quantitative data collection tools (enrollment survey, contact diaries, exit survey, and wearable proximity sensors) and the implementation of study procedures. We will create three age-specific contact matrices (physical, nonphysical, and both) at each study site using data from standardized contact diaries to characterize the patterns of social mixing. Regression analysis will be conducted to identify key drivers of contacts. We will comprehensively profile the frequency, duration, and intensity of infants' interactions with household members using high resolution data from the proximity sensors and calculating infants' proximity score (fraction of time spent by each household member in proximity with the infant, over the total infant contact time) for each household member. Discussion: Our qualitative data yielded insights into the perceptions and acceptability of contact diaries and wearable proximity sensors for collecting social mixing data in LMICs. The quantitative data will allow a more accurate representation of human interactions that lead to the transmission of pathogens through close contact in LMICs. Our findings will provide more appropriate social mixing data for parameterizing mathematical models of LMIC populations. Our study tools could be adapted for other studies. [ABSTRACT FROM AUTHOR]

Background: Service providers' attitudes toward interventions are essential for adopting and implementing novel interventions into healthcare settings, but evidence of evaluations in the HIV context is still limited. This study is part of the CombinADO cluster randomized trial (ClinicalTrials.gov NCT04930367), which is investigating the effectiveness of a multi-component intervention package (CombinADO strategy) aimed at improving HIV outcomes among adolescents and young adults living with HIV (AYAHIV) in Mozambique. In this paper we present findings on key stakeholder attitudes toward adopting study interventions into local health services. Methods: Between September and December 2021, we conducted a cross-sectional survey with a purposive sample of 59 key stakeholders providing and overseeing HIV care among AYAHIV in 12 health facilities participating in the CombinADO trial, who completed a 9-item scale on attitudes towards adopting the trial intervention packages in health facilities. Data were collected in the pre-implementation phase of the study and included individual stakeholder and facility-level characteristics. We used generalized linear regression to examine the associations of stakeholder attitude scores with stakeholder and facility-level characteristics. Results: Overall, service-providing stakeholders within this setting reported positive attitudes regarding adopting intervention packages across study clinic sites; the overall mean total attitude score was 35.0 ([SD] = 2.59, Range = [30–41]). The study package assessed (control or intervention condition) and the number of healthcare workers delivering ART care in participating clinics were the only significant explanatory variables to predict higher attitude scores among stakeholders (β = 1.57, 95% CI = 0.34–2.80, p = 0.01 and β = 1.57, 95% CI = 0.06–3.08, p = 0.04 respectively). Conclusions: This study found positive attitudes toward adopting the multi-component CombinADO study interventions among HIV care providers for AYAHIV in Nampula, Mozambique. Our findings suggest that adequate training and human resource availability may be important in promoting the adoption of novel multi-component interventions in healthcare services by influencing healthcare provider attitudes. [ABSTRACT FROM AUTHOR]

According to reports from international institutions such as Intergovernmental Panel on Climate Change, United Nations Development Programme, and the World Bank, the impacts of climate change will continue affecting the Least Developed Countries (LDC) for the coming years and the less resilient countries, defined by the climate vulnerability index (CVI), will be the most vulnerable. The CVI relates the Exposure and Adaptive Capacity for a specific Hazard, offering feasible supports for decision-makers in identifying country-specific needs to adapt to climate change. However, even with this scenario, the LDCs are still unable to cope with the impact of extreme events. Therefore, the main question is, which part of Adaptive Capacity needs more effort to deal with extreme weather events? To address this issue, this paper discusses the governance role in the CVI definition, suggesting an alternative approach to assess climate vulnerability. Overall, we propose a tool, taking into account four main components: Exposure, Sensitivity, Adaptive Capacity, and Governance. In this case, the Governance component represents organizations, policies, and qualified human resources that could improve the planning and management of a specific system. More specifically, we explicitly considered the Governance component in the climate vulnerability function by adding specific indicators. As a study case, we consider Mozambique, a highly vulnerable country to the adverse impact of climate change. The results have shown that by adding the Governance component to assess climate vulnerability, the function becomes more sensitive. In conclusion, Governance is accepted as a powerful component in the CVI definition. [ABSTRACT FROM AUTHOR]

In low-and middle-income countries, many infants and children remain unregistered in both civil registration and healthcare records, limiting their access to essential rights-based services, including healthcare. A novel biometric registration prototype, applying a non-touch platform using smart phones and tablets to capture physical characteristics of infants and children for electronic registration, was tested in rural Mozambique. This study assessed acceptability and perceived barriers and facilitators to the usability of this biometric registration prototype in Manhiça district, southern Mozambique. The study followed a qualitative design consisting of 5 semi-structured interviews with healthcare providers, 7 focus group discussions with caregivers of infants aged between 0 and 5 years old, and 2 focus group discussions with data collectors involved in the implementation of the biometric registration pilot project. Data were thematically analysed. The results of this study show that there is wide acceptability of the biometric registration prototype among healthcare providers and caregivers. Participants were aware of the benefits of the biometric registration prototype. The perceived benefits included that the biometric registration prototype would solve the inefficiency of paper-based registration, and the perception of biometric registration as "healthcare norm". Perceived potential barriers to the implementation of the biometric registration prototype included: myths and taboos, lack of information, lack of time, lack of father's consent, and potential workload among healthcare providers. In conclusion, the biometric prototype was widely accepted due to its perceived usefulness. However, there is a need to address the perceived barriers, and involvement of children's fathers and/or other relevant family members in the process of biometric registration. [ABSTRACT FROM AUTHOR]

Copyright of Critical African Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Small and medium-sized enterprises (SMEs) play an important role in economic and development growth, particularly in developing countries. Their success depends on the expansion of their markets across borders, based on the strategies adopted, in which differentiation strategies and positional advantages play an important role. As an emerging country, Mozambican SMEs face a lack of resources and business environmental challenges in deploying their unique advantages when competing abroad. As such, the objective of this paper is to study the impact of differentiation strategies on the export performance of Mozambican SMEs, and the mediating effect of positional advantage on the relationship between the differentiation strategy and export performance of SMEs. To achieve this objective, an empirical study was conducted, based on a sample of 250 Mozambican firms, to test a theoretical model that applied Structural Equation Modeling using the Partial Least Squares (PLS-SEM) algorithm, based on SmartPLS software version 3.3.6 (SmartPLS GmbH, Oststeinbek, Germany). The results show that differentiation strategies positively impact the export performance of SMEs and that positional advantage mildly mediates the relationship between the differentiation strategy and export performance. This suggests that Mozambican SMEs may not be properly taking advantage of the positional advantage of the differentiation strategies, as the added value generated by the positional advantage is relatively modest. As such, Mozambican SMEs still need to support their positional advantages to overcome fierce international competition. This study contributes to the knowledge about the consequences of adopting differentiation strategies and positional advantages on the export performance of SMEs, particularly in the context of emerging countries. [ABSTRACT FROM AUTHOR]

Floods are one of the most frequent natural disasters worldwide. Although the vulnerability varies from region to region, all countries are susceptible to flooding. Mozambique was hit by several cyclones in the last few decades, and in 2019, after cyclones Idai and Kenneth, the country became the first one in southern Africa to be hit by two cyclones in the same raining season. Aiming to provide the local authorities with tools to yield better responses before and after any disaster event, and to mitigate the impact and support in decision making for sustainable development, it is fundamental to continue investigating reliable methods for disaster management. In this paper, we propose a fully automated method for flood mapping in near real-time utilizing multi-temporal Sentinel-1 Synthetic Aperture Radar (SAR) data acquired in the Beira municipality and Macomia district. The procedure exploits the processing capability of the Google Earth Engine (GEE) platform. We map flooded areas by finding the differences of images acquired before and after the flooding and then use Otsu's thresholding method to automatically extract the flooded area from the difference image. To validate and compute the accuracy of the proposed technique, we compare our results with the Copernicus Emergency Management Service (Copernicus EMS) data available in the study areas. Furthermore, we investigated the use of a Sentinel-2 multi-spectral instrument (MSI) to produce a land cover (LC) map of the study area and estimate the percentage of flooded areas in each LC class. The results show that the combination of Sentinel-1 SAR and Sentinel-2 MSI data is reliable for near real-time flood mapping and damage assessment. We automatically mapped flooded areas with an overall accuracy of about 87–88% and kappa of 0.73–0.75 by directly comparing our prediction and Copernicus EMS maps. The LC classification is validated by randomly collecting over 600 points for each LC, and the overall accuracy is 90–95% with a kappa of 0.80–0.94. [ABSTRACT FROM AUTHOR]

Background: The collections of the Natural History Museum of Maputo have a crucial role in the safeguarding of Mozambique's biodiversity, representing an important repository of data and materials regarding the natural heritage of the country. In this paper, a dataset is described, based on the Museum's Entomological Collection recording 409 species belonging to seven orders and 48 families. Each specimen's available data, such as geographical coordinates and taxonomic information, have been digitised to build the dataset. The specimens included in the dataset were obtained between 1914-2018 by collectors and researchers from the Natural History Museum of Maputo (once known as "Museu Alváro de Castro") in all the country's provinces, with the exception of Cabo Delgado Province. New information: This paper adds data to the Biodiversity Network of Mozambique and the Global Biodiversity Information Facility, within the objectives of the SECOSUD II Project and the Biodiversity Information for Development Programme. The aforementioned insect dataset is available on the GBIF Engine data portal (https://doi.org/10.15468/j8ikhb). Data were also shared on the Mozambican national portal of biodiversity data BioNoMo (https://bionomo.openscidata.org), developed by SECOSUD II Project. [ABSTRACT FROM AUTHOR]

Background: Adjuvants are widely used to enhance and/or direct vaccine-induced immune responses yet rarely evaluated head-to-head. Our trial directly compared immune responses elicited by MF59 versus alum adjuvants in the RV144-like HIV vaccine regimen modified for the Southern African region. The RV144 trial of a recombinant canarypox vaccine vector expressing HIV env subtype B (ALVAC-HIV) prime followed by ALVAC-HIV plus a bivalent gp120 protein vaccine boost adjuvanted with alum is the only trial to have shown modest HIV vaccine efficacy. Data generated after RV144 suggested that use of MF59 adjuvant might allow lower protein doses to be used while maintaining robust immune responses. We evaluated safety and immunogenicity of an HIV recombinant canarypox vaccine vector expressing HIV env subtype C (ALVAC-HIV) prime followed by ALVAC-HIV plus a bivalent gp120 protein vaccine boost (gp120) adjuvanted with alum (ALVAC-HIV+gp120/alum) or MF59 (ALVAC-HIV+gp120/MF59) or unadjuvanted (ALVAC-HIV+gp120/no-adjuvant) and a regimen where ALVAC-HIV+gp120 adjuvanted with MF59 was used for the prime and boost (ALVAC-HIV+gp120/MF59 coadministration). Methods and findings: Between June 19, 2017 and June 14, 2018, 132 healthy adults without HIV in South Africa, Zimbabwe, and Mozambique were randomized to receive intramuscularly: (1) 2 priming doses of ALVAC-HIV (months 0 and 1) followed by 3 booster doses of ALVAC-HIV+gp120/MF59 (months 3, 6, and 12), n = 36; (2) 2 priming doses of ALVAC-HIV (months 0 and 1) followed by 3 booster doses of ALVAC-HIV+gp120/alum (months 3, 6, and 12), n = 36; (3) 4 doses of ALVAC-HIV+gp120/MF59 coadministered (months 0, 1, 6, and 12), n = 36; or (4) 2 priming doses of ALVAC-HIV (months 0 and 1) followed by 3 booster doses of ALVAC-HIV+gp120/no adjuvant (months 3, 6, and 12), n = 24. Primary outcomes were safety and occurrence and mean fluorescence intensity (MFI) of vaccine-induced gp120-specific IgG and IgA binding antibodies at month 6.5. All vaccinations were safe and well-tolerated; increased alanine aminotransferase was the most frequent related adverse event, occurring in 2 (1.5%) participants (1 severe, 1 mild). At month 6.5, vaccine-specific gp120 IgG binding antibodies were detected in 100% of vaccinees for all 4 vaccine groups. No significant differences were seen in the occurrence and net MFI of vaccine-specific IgA responses between the ALVAC-HIV+gp120/MF59-prime-boost and ALVAC-HIV+gp120/alum-prime-boost groups or between the ALVAC-HIV+gp120/MF59-prime-boost and ALVAC-HIV+gp120/MF59 coadministration groups. Limitations were the relatively small sample size per group and lack of evaluation of higher gp120 doses. Conclusions: Although MF59 was expected to enhance immune responses, alum induced similar responses to MF59, suggesting that the choice between these adjuvants may not be critical for the ALVAC+gp120 regimen. Trial registration: HVTN 107 was registered with the South African National Clinical Trials Registry (DOH-27-0715-4894) and ClinicalTrials.gov (NCT03284710). Zoe Moodie and colleagues investigate the safety and immunogenicity of a subtype C ALVAC-HIV vaccine prime plus bivalent subtype C gp120 vaccine boost adjuvanted with MF59 or alum in healthy adults without HIV. Author summary: Why was this study done?: Vaccines may use an adjuvant to help the body produce a stronger immune response. Results from animal studies suggested that the MF59 adjuvant generates better immunogenicity than the alum adjuvant when given as part of an HIV vaccine and could also allow a lower dose of protein to be used. Our clinical trial was done to directly assess in humans whether MF59 leads to better immune responses than alum when given with protein in a subtype C canarypox vaccine (ALVAC-HIV) prime followed by ALVAC-HIV plus a bivalent gp120 protein vaccine boost (gp120). What did the researchers do and find?: Vaccines were safe and well-tolerated over the 18 months of follow-up. 100% of vaccinees had vaccine-specific gp120 IgG binding antibodies at month 6.5. Immune responses for the ALVAC-HIV+gp120/MF59 group and the ALVAC-HIV+gp120/alum group were similar. What do these findings mean?: Contrary to expectation, the choice between MF59 and alum does not seem critical to the immune responses assessed in the peripheral blood for this subtype C ALVAC-HIV+gp120 prime-boost regimen. The main limitations of our study were the small vaccine group sample sizes and that higher doses of gp120 protein were not evaluated. [ABSTRACT FROM AUTHOR]

Background: World Health Organization (WHO) guidelines recommend cotrimoxazole prophylaxis for children who are HIV-exposed until infection is excluded and vertical transmission risk has ended. While cotrimoxazole has benefits for children with HIV, there is no mortality benefit for children who are HIV-exposed but uninfected, prompting a review of global guidelines. Here, we model the potential impact of alternative cotrimoxazole strategies on mortality in children who are HIV-exposed. Methods and findings: Using a deterministic compartmental model, we estimated mortality in children who are HIV-exposed from 6 weeks to 2 years of age in 4 high-burden countries: Côte d'Ivoire, Mozambique, Uganda, and Zimbabwe. Vertical transmission rates, testing rates, and antiretroviral therapy (ART) uptake were derived from UNAIDS data, trial evidence, and meta-analyses. We explored 6 programmatic strategies: maintaining current recommendations; shorter cotrimoxazole provision for 3, 6, 9, or 12 months; and starting cotrimoxazole only for children diagnosed with HIV. Modelled alternatives to the current strategy increased mortality to varying degrees; countries with high vertical transmission had the greatest mortality. Compared to current recommendations, starting cotrimoxazole only after a positive HIV test had the greatest predicted increase in mortality: Mozambique (961 excess annual deaths; excess mortality 339 per 100,000 HIV-exposed children; risk ratio (RR) 1.06), Uganda (491; 221; RR 1.04), Zimbabwe (352; 260; RR 1.05), and Côte d'Ivoire (125; 322; RR 1.06). Similar effects were observed for 3-, 6-, 9-, and 12-month strategies. Increased mortality persisted but was attenuated when modelling lower cotrimoxazole uptake, smaller mortality benefits, higher testing coverage, and lower vertical transmission rates. The study is limited by uncertain estimates of cotrimoxazole coverage in programmatic settings; an inability to model increases in mortality arising from antimicrobial resistance due to limited surveillance data in sub-Saharan Africa; and lack of a formal health economic analysis. Conclusions: Changing current guidelines from universal cotrimoxazole provision for children who are HIV-exposed increased predicted mortality across the 4 modelled high-burden countries, depending on test-to-treat cascade coverage and vertical transmission rates. These findings can help inform policymaker deliberations on cotrimoxazole strategies, recognising that the risks and benefits differ across settings. Mathur and colleagues estimate the potential impact of alternative cotrimoxazole strategies on mortality in children born to mothers with HIV in Côte d'Ivoire, Mozambique, Uganda, and Zimbabwe. Author summary: Why was this study done?: Cotrimoxazole prophylaxis is recommended in World Health Organization (WHO) guidelines for all children born to mothers with HIV until HIV infection has been excluded by an age-appropriate HIV test to establish the final diagnosis after complete cessation of breastfeeding. Though there is a proven mortality benefit for children who acquire HIV, recent trial evidence has shown that cotrimoxazole does not reduce mortality for majority of children who are HIV-exposed uninfected (HEU), which has led to countries considering changing their guidelines. In many resource-limited settings, however, it is difficult to reliably distinguish children with HIV from children who are HEU, due to incomplete coverage of early infant diagnosis (EID) of HIV. There is a need to model to what extent alternative cotrimoxazole strategies, which either do not provide universal cotrimoxazole for all infants who are HIV-exposed, or provide it for a shorter duration, would be predicted to increase mortality in different settings among infants who acquire HIV but are undiagnosed. What did the researchers do and find?: This study uses mathematical modelling based on epidemiological data from 4 high-burden settings (Côte d'Ivoire, Mozambique, Uganda, and Zimbabwe) to estimate the effect on mortality of alternative programmatic cotrimoxazole strategies. The model incorporates the HIV status of the infant, perinatal and postnatal transmission rates, testing rates, and mortality benefits from trial evidence for cotrimoxazole and antiretroviral therapy (ART) across 6 different programmatic strategies: maintaining current recommendations; reducing the duration of cotrimoxazole provision to 3, 6, 9, or 12 months; or starting cotrimoxazole only once a child tests positive for HIV. We demonstrate that changing the current strategy is predicted to increase mortality in all 4 settings, with the greatest increase in mortality in countries with the highest vertical transmission rates. Increased predicted mortality persisted in sensitivity analyses considering conservative model estimates, although cotrimoxazole had fewer predicted benefits when vertical transmission rates were lowered, testing coverage improved or uptake of cotrimoxazole was reduced. What do these findings mean?: Changing the current strategy of cotrimoxazole provision for all children born to mothers with HIV is estimated to increase mortality in these 4 high-burden settings to varying degrees as countries continue to scale up prevention of mother-to-child transmission (PMTCT) of HIV and EID coverage. Cotrimoxazole continues to provide important protection to children who acquire HIV and are missed by gaps in the test-to-treatment cascade, but does not replace the importance of timely testing and treatment. Our study is limited by lack of cost-effectiveness analysis, lack of data on cotrimoxazole uptake, and limited antimicrobial resistance surveillance data in sub-Saharan Africa. Policymakers need to weigh the risks and benefits of cotrimoxazole prophylaxis through any change to current recommendations, noting that these differ across settings: where lower vertical transmission rates and improved testing and treatment uptake occurs, the estimated mortality benefits of cotrimoxazole are attenuated. [ABSTRACT FROM AUTHOR]