We conducted a controlled before-and-after trial to evaluate the impact of an onsite urban sanitation intervention on the prevalence of enteric infection, soil transmitted helminth re-infection, and diarrhea among children in Maputo, Mozambique. A non-governmental organization replaced existing poor-quality latrines with pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before and 12 and 24 months after the intervention, with concurrent measurement among children in a comparable control arm. Despite nearly exclusive use, we found no evidence that intervention affected the prevalence of any measured outcome after 12 or 24 months of exposure. Among children born into study sites after intervention, we observed a reduced prevalence of Trichuris and Shigella infection relative to the same age group at baseline (<2 years old). Protection from birth may be important to reduce exposure to and infection with enteric pathogens in this setting.

Background. Onsite sanitation serves more than 740 million people in urban areas, primarily in low-income countries. Although this critical infrastructure may play an important role in controlling enteric infections in high-burden settings, its health impacts have never been evaluated in a controlled trial. Methods. We conducted a controlled before and after trial to evaluate the impact an onsite urban sanitation intervention on the prevalence of bacterial and protozoan infection (primary outcome), soil transmitted helminth (STH) re-infection, and seven-day period prevalence of diarrhoea among children living in informal neighborhoods of Maputo, Mozambique. A non-governmental organization replaced existing shared latrines in poor condition with engineered pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before the intervention and at 12 and 24 months following intervention. We measured outcomes concurrently among children served by the sanitation improvements and those in a comparable control arm served by existing poor sanitation. The trial was registered at ClinicalTrials.gov, number NCT02362932. Findings. At baseline, we enrolled 454 children from 208 intervention clusters and 533 children from 287 control clusters. We enrolled or re-visited 462 intervention and 477 control children 12 months 60 after intervention and 502 intervention and 499 control children 24 months after intervention. Despite nearly exclusive use of the intervention, we found no evidence that engineered onsite sanitation affected the overall prevalence of any measured bacterial or protozoan infection (12-month adjusted prevalence ratio 1.05, 95% CI [0.95-1.16]; 24-month adjusted prevalence ratio 0.99, 95% CI [0.91-1.09]), any STH re-infection (1.11 [0.89-1.38]; 0.95 [0.77-1.17]), or diarrhoea (1.69 [0.89-3.21]; 0.84 [0.47-1.51]) after 12 or 24 months of exposure. Among children born into study sites after the intervention and measured at the 24-month visit, we observed a reduced prevalence of any STH re-infection of 49% (adjusted prevalence ratio 0.51 [95% confidence interval 0.27 - 0.95]), Trichuris of 76% (0.24 [0.10 - 0.60]), and Shigella infection by 51% (0.49 [0.28-0.85]) relative to the same age group at baseline. Interpretation. The intervention did not reduce the overall prevalence of enteric infection and diarrhoea among all enrolled children but may have substantially reduced the prevalence of STHs and Shigella among children born into clusters with sanitary improvements.

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Introduction the prevalence of human immunodeficiency virus (HIV) in Mozambique has increased from 11.5% in 2009 to 13.2% in 2015. The Mozambique Ministry of Health (MOH) developed a 5-year strategy (2013-2017) for male voluntary medical circumcision (VMMC) to increase in the provinces where there is the greatest number of HIV. We aimed to evaluate the health information system for monitoring and evaluating VMMC in Mozambique from 2013-2019. Methods we reviewed the records of the National Health Information System for Monitoring and Evaluation (SIS-MA) database for VMMC of the MOH. The evaluation was based on the updated guidelines for the evaluation of public health surveillance systems of the Centers for Disease Control and Prevention. Results the coverage rate for VMMC in Mozambique in the period under study was (89%) (1,784,335/2,000,000). The system was expected to circumcise for the year 2019 (162,052) and 390,590 was reached, exceeding the target 241.0% (390,590/162,052). Of the total number of men circumcised, 0.7% (12,391/1,784,335) were HIV-positive (previously tested) and 0.4% (6,382/1,784,335) had a record of adverse events in the period under review (2013-2019). Zambézia Province had the highest VMMC coverage (in numbers) at 16.0% (396,876/2,476,395) while Maputo City had the least 19.7% (107,104/543,096). The system was able to operate both online and offline and continue functioning with introducing new changes (e.g. the new male circumcision complication reporting). Conclusion the system was representative, flexible, simple, with good data quality and low acceptability. We recommended continuous and routine entry of quality data into the system, guide organizations for improved functioning.