Influence of population density and access to sanitation on Covid-19 in Mozambique. Rev. Ang. de Ciênc. da Saúde. 2021 Jan – Jul ; 2 (1): 3-8

Poor sanitation, hygiene, and weak healthcare systems were the pillars of argumentation for TedrosGhebreyesus 6 and Melinda Gates 7 , who wrongly predicted a higher impact of COVID-19 in Africa thananywhere else. Their logic seemed reasonable, with historical examples of diarrheal and other hygiene-relatedmaladies 8 . However, they overlooked several variables such as immunity, weather, and the leaders’commitment to the World Health Organization guidelines 1,9 . Poor sanitation was not initially a major problembecause COVID-19 entered Mozambique through people from the upper classes who came from Europeancountries or South Africa, had access to the best sanitation, and had little contact with the “common” population 10 , transmitting to few people. Eventually, the disease reached crowded areas with poor hygiene practices suchas markets 11,12 , and only then, sanitation became a significant issue.The current study aims to validate that population density and access to sanitation are among the variablesinfluencing the dissemination of COVID-19 in Mozambique. In addition, the results will provide support to healthpersonnel, policy-makers, and scholars who need to understand better the pattern of dissemination of COVID-19 in Mozambique and countries with similar natural and social settings.

MATERIAL AND METHODS Mozambique (10°27’S and 26°52’S;30°12’E and 40°51’E) is a country on the southeastern coast of Africa (Map 1), bordered by the Indian Ocean (east), Tanzania and Malawi (North), Zambia and Zimbabwe (West),South Africa, and Eswatini (southwest) 13 . The population is approximately 27,909,798, with 28.7inhabitants/km 2 as density 14 . Mozambique has ten provinces plus the capital and largest urban area, MaputoCity (considered a province), located in the southern area 15 .By 2015, approximately 46% of the population lived below the poverty line (US $1.9 purchasing powerparity), and 40% had access to improved sanitation 16 . Limited access to sanitation is among the causes ofCholera 17 and other hygiene-related diseases 18 , certainly increasing the risk of COVID-19 among theMozambican population. According to World Bank Group 16 , only 14% of the population below the poverty lineand 42% above it had sanitation facilities in 2015.

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Map 1 - Mozambique. Source: Library of Congress 19 , under public domain.

Data retrieval and analysis The data was retrieved the data on 11 February 2021:Mozambican population density (in inhabitants/km 2 )per province from Census 2017 report 20 and data on the percentage of the population with access to sanitation

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