Survey Data

Data were collected from 12 May to 15 June 2014. This timing corresponds to the harvest period, a period of relative plenty in rural Mozambique. The design and implementation of the survey are detailed elsewhere (Victor et al., 2014). A total of 255 enumeration areas (EA) were selected with probability proportional to size. Two samples were taken such that 3 districts (Namacurra, Morrumbala, and Alto Molócuè) were heavily sampled with 206 EA (Figure 1), with another 49 EAs being drawn from the remaining districts across Zambézia Province, for a total of 3,892 households. At the time of survey administration, the Ministry of Health considered adults to be aged 16 or older, and this was an inclusion criterion for this study. Fifteen household interviews were planned per EA. Interviews were conducted with the self-reported female head-of-household. A female head-of-household is defined as the woman living in a given household who is responsible for household decision-making. This female head-of-household is not limited to women of a particular marital status; rather, it reflects her important role in the family structure. Interviews covered various topics including socio-demographics; knowledge, attitudes, practices, and access to health services and products; access to improved water and sanitation; nutrition; agricultural production; perceived economic stability and status; depression; and alcohol use (T.D. Moon et al., 2015; T. D. Moon, Sidat, Vergara, & Vermund, 2010; Victor et al., 2014). Of the 3,892 households, 3,543 (91%) respondents reported their age and all were 16 or older. In total, 2,752 (72%) of women answered questions about their alcohol intake. AUDIT items were more likely completed among single (p = 0.006), slightly better educated (mean: 2.9 vs. 3.4 years; p < 0.001) women, and those with a self-reported income of “less than sufficient” (p < 0.001).

Local authorities were notified prior to study initiation to ensure local support for the survey team. Fourteen all female teams, consisting of a team leader and four interviewers, collected the survey data with a mean survey completion time of 54 minutes (interquartile range, IQR: 39–88). All participants provided written informed consent (a fingerprint was sufficient for those unable to read and write). Consent forms were read aloud to each participant, and a written copy was provided before the interview began. No one refused to participate. Participants were read questions in their language of preference; the Bantu languages spoken in the province have no systematic written form but the survey was translated with the assistance of native speakers and a linguist fluent in all study languages from Universidade Politecnica (located in the provincial capital) to ensure understanding. The protocol for data collection was approved by the Mozambican National Bioethics Committee for Health and the Institutional Review Board of Vanderbilt University.