Abordagens e desafios para o controlo da malária em Moçambique

Introdução: A malária é um dos principais problemas de saúde pública em Moçambique e, apesar de todos os esforços que têm sido efetuados para o seu controlo, a sua prevalência e mortalidade permanecem elevadas. Este trabalho teve como objetivo avaliar fatores relacionados com a elevada prevalência e mortalidade por malária em diferentes zonas de transmissão, em Moçambique. Para tal foram realizados três estudos: 1- Comportamento de procura de cuidados de saúde e práticas de tratamento de malária em crianças menores de cinco anos em Moçambique; 2- Fatores de risco associados a letalidade intra-hospitalar por malária em três unidades sanitárias de uma região de alta incidência de malária, no centro de Moçambique; 3- Padrões de idade de crianças com malária complicada, numa área de baixa transmissão em Moçambique. Métodos: 1- Estudo quantitativo e observacional. Análise secundária de dados do Inquérito Demográfico e de Saúde 2011 e do Inquérito de Indicadores de Imunização, HIV/SIDA e Malária 2015; 2- Estudo descritivo e retrospetivo, com base na análise dos processos clínicos de doentes hospitalizados com o diagnóstico de malária em três unidades sanitárias da província da Zambézia; 3- Estudo observacional e transversal, com base na avaliação de doentes dos dois aos 14 anos, internados por malária complicada no Hospital Central de Maputo. Resultados: 1– A procura de cuidados de saúde foi de 62.6% (835/1432) em 2011 e 63.7% (974/1529) em 2015 e maioritariamente em unidades sanitárias públicas (86.2%; 773/897 em 2011 e 86.7%; 844/974 em 2015). Foi também maior em mães com nível de escolaridade secundário (AOR=2.27 [95% CI 1.15–4.49]) e no quintil de riqueza baixo, em relação ao mais baixo (AOR=1.46 [95% CI 0.83–1.90]). 2- Houve 75 mortes em 893 casos (taxa de letalidade: 8,4%). A letalidade foi associada à presença de complicações (p=0.000), gravidade da doença (p=0.001), idade igual ou superior a 30 anos (p=0.000), preenchimento inadequado da ficha clínica do doente (p=0.013) e atendimento em unidade sanitária de nível primário (p=0.000). 3- Foram incluídas no estudo 50 crianças, das quais 27 (54.0%) eram menores de cinco anos. O sintoma mais comum foi a febre (49/50; 98%), seguida de vómitos (28/50; 56%) e cefaleias (23/50; 46%). Embora os vómitos e as cefaleias tenham sido mais frequentes entre crianças dos cinco aos 14 anos, não se verificou nenhuma relação entre a idade e a apresentação destes sintomas (p=0.577 e p=0.570, respetivamente). A frequência de parasitémia elevada foi igual entre os grupos (11/27; 40.7% dos dois aos quatro anos e 9/23; 39.1% dos cinco aos 14 anos). Conclusões: Há necessidade de se reforçar as estratégias de comunicação para mudança social e de comportamento para aumentar a procura de cuidados de saúde para febre, para reduzir o risco de doença grave e morte. Para reduzir tais mortes é necessário também que haja uma melhoria nos serviços prestados, especialmente em unidades sanitárias de nível primário. É necessário desenvolver estratégias de vigilância para deteção das mudanças epidemiológicas para que se possa intervir de forma adequada nos diferentes contextos de transmissão.Introduction: Malaria is one of the major public health problems in Mozambique and, despite all the efforts that have been put in place to its control, its prevalence and mortality remain high. This study aimed to evaluate factors related to the high prevalence and mortality from malaria in differen t transmission areas in Mozambique. To answer this objective, three studies were implemented: 1- Care-seeking behavior and malaria treatment practices in children under five years in Mozambique; 2- Risk factors associated with malaria in-hospital deaths in three health facilities in a high burden malaria region in central Mozambique; 3- Age patterns of children with complicated malaria in a low-transmission area in Mozambique. Methods: 1- Quantitative and observational study. Secondary data analysis of Demographic and Health Survey 2011 and Indicators of Immunization, HIV/AIDS and Malaria Survey 2015; 2- Descriptive and retrospective study, based on the analysis of the clinical files of hospitalized patients diagnosed with malaria in three health facilities of Zambézia province; 3- Observational and transversal study, based on the evaluation of patients from two to 14 years of age hospitalized for complicated malaria in Maputo Central Hospital. Results: 1- Care-seeking was 62.6% (835/1432) in 2011 and 63.7% (974/1529) in 2015 and was mostly in public health facilities (86.2%, 773/897 in 2011 and 86.7%, 844/974 in 2015). Care-seeking was higher for mothers with secondary education (AOR=2.27 [95% CI 1.15-4.49]) and the poor wealth quintile, compared to the poorest (AOR=1.46 [95% CI 0.83-1.90]). 2- There were 75 deaths of 893 cases (case fatality rate: 8.4%). Lethality was associated with the presence of complications (p=0.000), disease severity (p=0.001), 30 years of age or over (p=0.000), inadequate patient record filling (p=0.013) and assistance in a primary level facility (p=0.000). 3- Fifty children were enrolled, of which 27 (54.0%) were younger than five years. The most common symptom was fever (49/50), followed by vomiting (28/50, 56%) and headache (23/50, 46%). Although vomiting and headache were more frequent among children five to 14 years old, there was no relationship between age and presentation of these symptoms (p=0.577 and p=0.570, respectively). The frequency of high parasitemia was similar between groups (11/27, 40.7% from two to four years and 9/23, 39.1% from five to 14 years). Conclusions: There is a need to strengthen social and behavioral change communication strategies to increase care-seeking for fever, thus reducing the risk of developing complications and progression to death. To reduce these deaths, it is also necessary to improve health services provided in the health facilities, especially in the primary level. It is necessary to develop surveillance strategies for epidemiological changes in order to intervene adequately in the different transmission contexts

a secondary analysis of 2011 DHS and 2015 IMASIDA datasets

BACKGROUND: In Mozambique, the prevalence of malaria in children under 5 years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5 years of age and to assess the treatment practices for malaria. METHODS: Secondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data. RESULTS: A total of 10,452 and 5168 children under 5 years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether-lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR = 2.27 [95% CI 1.15-4.49]) and among those in poorer quintile (AOR = 1.46 [95% CI 0.83-1.90]). Mothers with higher education level (AOR = 0.16 [95% CI 0.34-0.78]) were less likely to seek out care. People from Manica (AOR = 2.49 [1.03-6.01]), Sofala ([AOR = 2.91 [1.03-8.24]), Inhambane (AOR = 3.95 [1.25-12.45]), Gaza (AOR = 3.25 [1.22-8.65]) and Maputo Province (AOR = 2.65 [1.10-6.41]) were more likely to seek care than people from Maputo City. CONCLUSION: Data from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified.publishersversionpublishe

Care-seeking behaviour and treatment practices for malaria in children under 5 years in Mozambique: a secondary analysis of 2011 DHS and 2015 IMASIDA datasets

Abstract Background In Mozambique, the prevalence of malaria in children under 5 years of age is among the highest in the world, but limited data exist on determinants of care-seeking behaviour for malaria. This study aimed at determining the trends and factors associated with care-seeking behaviour for fever among children under 5 years of age and to assess the treatment practices for malaria. Methods Secondary data analysis of two cross-sectional studies. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using data from the 2011 Demographic and Health Survey and 2015 Indicators of Immunization, Malaria and HIV/AIDS Survey. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio and respective 95% confidence intervals, only for 2015 IMASIDA data. Results A total of 10,452 and 5168 children under 5 years of age were enrolled in the 2011 DHS and 2015 IMASIDA, respectively. Care-seeking for fever in public and private sectors remained stable during this period (62.6%; 835/1432 in 2011 and 63.7%; 974/1529 in 2015). The main place where care was sought in both surveys was public hospitals (86.2%; 773/897 in 2011 and 86.7%; 844/974 in 2015). Prescription of anti-malarial drugs increased from 42.9% (385/897) in 2011 to 53.8% (524/974) in 2015. Artemether–lumefantrine was the most used anti-malarial drug for febrile children in both surveys and its use increased from 59.0% (219/373) in 2011 to 89.3% (457/512) in 2015. Data from 2015 elucidated that care-seeking was more common in children whose mothers had a secondary level of education (AOR = 2.27 [95% CI 1.15–4.49]) and among those in poorer quintile (AOR = 1.46 [95% CI 0.83–1.90]). Mothers with higher education level (AOR = 0.16 [95% CI 0.34–0.78]) were less likely to seek out care. People from Manica (AOR = 2.49 [1.03–6.01]), Sofala ([AOR = 2.91 [1.03–8.24]), Inhambane (AOR = 3.95 [1.25–12.45]), Gaza (AOR = 3.25 [1.22–8.65]) and Maputo Province (AOR = 2.65 [1.10–6.41]) were more likely to seek care than people from Maputo City. Conclusion Data from this study showed that care-seeking in Mozambique remained suboptimal. Interventions to raise the awareness for early care-seeking during episodes of fever should be urgently reinforced and intensified