Encouraging local transport programs and transport infrastructure in poorly-resourced communities can help improve community access and strengthen engagement with health systems. Mobilizing community resources and leadership to implement a community-based transport scheme in rural Mozambique to support referrals to health facilities can help improve maternal and child health outcomes.

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

Delays to seek medical help can contribute to maternal deaths particularly in community settings at home or on the road to a health facility. Community engagement (CE) can improve care-seeking behaviours and complements community-based interventions strengthening maternal health. The purpose of this paper is to describe the process undertaken to develop and implement a large-scale community engagement strategy in rural southern Mozambique. The CE strategy was developed within the context of the “Community-Level Interventions for Pre-eclampsia” (NCT01911494) conducted between 2015–2017 in southern Mozambique. Key CE messages included pregnancy complications and their warning signs, including pre-eclampsia and eclampsia, as well as emergency readiness, birth preparedness, decision-making mechanisms, transport options and information about the trial. CE meeting logs were used to record quantitative and qualitative information on demographic data and feedback. Quantitative data was analyzed using RStudio (RStudio Inc, Boston, United States) and community feedback was qualitatively analyzed on NVivo12 (QSR International, Melbourne, Australia). CE activities reached 19,169 participants during 4,239 meetings. CE activities were reported to be well received by community members though there was a relatively lower participation of men (3565 /18.6%). The use of recognized local leaders and personnel, such as community leaders, nurses and community health workers, allowed for greater acceptance of CE activities and maximized coverage of health messages in the community setting. Our CE strategy was effective in integrating maternal health promoting activities in routine care of community health workers and nurses in the area. Understanding district differences, engaging husbands, partners, mothers-in-law and community-level decision-makers to build local support for maternal health and flexibility to tailor messages to local needs were important in developing sustainable forms of CE. Better strategies are needed to effectively engage men in maternal health promotion who were less available due to working outside of the home or neighbourhoods