Inequalities in Maternal and Child Health in Mozambique: A Historical Overview

Inequity in access and utilisation of health-care services contribute to bad health outcomes, particularly among high risk groups such women and children. Since the declaration of independence in Mozambique in 1975, the newly formed government established, as a priority, maternal and child health (MCH) and the fight against the inequity between the rural and urban areas of residence. In the following years, Mozambique witnessed the improvement of access to and utilisation of the MCH services throughout the country. With the aim to examine the degree of inequity on MCH access, utilisation and outcomes across the country and among different determinants, we conducted a desk review, founded mainly on nationwide surveys such as Demographic and Health Surveys, the Multi-indicator Cluster Survey and the Aids and Malaria Indicators Survey in addition to evidence from articles published in peer reviewed journals, Ministry of Health data bases and reports, International Agencies Reports and other grey literature. We conclude that there are signs of inequity reduction in the MCH health indicators. Areas requiring further investment include the need to reduce the geographical differences to access and utilisation of health services, and the need to continue investing in women’s education as key to improving the health of mothers and children.Economic and Social Research CouncilDepartment for International Developmen

Assessing women's satisfaction with family planning services in Mozambique

Background: The contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic and Health Survey. The impact of family planning (FP) on women's health and on the reduction of maternal mortality is well known. Methods: Acknowledging the importance of user satisfaction in the utilisation of health services, exit interviews were used to assess women's satisfaction with FP services in Mozambique. The survey, conducted in 174 health facilities, was representative at the national level, covered all provinces, and both urban and rural areas. Results: Overall, 86% of respondents were satisfied with FP services, but issues such as insufficient supplies of oral contraceptives and the low quality of healthcare provider/client interactions were given as reasons for women's dissatisfaction. Conclusion: Defined actions at the level of health service provision are needed to tackle the identified issues and ensure improved satisfaction with, and better utilisation of, FP services in Mozambique

Assessing women\u27s satisfaction with family planning services in Mozambique

Background: The contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic and Health Survey. The impact of family planning (FP) on women’s health and on the reduction of maternal mortality is well known. Methods: Acknowledging the importance of user satisfaction in the utilisation of health services, exit interviews were used to assess women’s satisfaction with FP services in Mozambique. The survey, conducted in 174 health facilities, was representative at the national level, covered all provinces, and both urban and rural areas. Results: Overall, 86% of respondents were satisfied with FP services, but issues such as insufficient supplies of oral contraceptives and the low quality of healthcare provider/client interactions were given as reasons for women’s dissatisfaction. Conclusion: Defined actions at the level of health service provision are needed to tackle the identified issues and ensure improved satisfaction with, and better utilisation of, FP services in Mozambique

Maternal death and delays in accessing emergency obstetric care in Mozambique

Background: Despite declining trends maternal mortality remains an important public health issue in Mozambique. The delays to reach an appropriate health facility and receive care faced by woman with pregnancy related complications play an important role in the occurrence of these deaths. This study aims to examine the contribution of the delays in relation to the causes of maternal death in facilities in Mozambique. Methods: Secondary analysis was performed on data from a national assessment on maternal and neonatal health that included in-depth maternal death reviews, using patient files and facility records with the most comprehensive information available. Statistical models were used to assess the association between delay to reach the health facility that provides emergency obstetric care (delay type II) and delay in receiving appropriate care once reaching the health facility providing emergency obstetric care (delay type III) and the cause of maternal death within the health facility. Results: Data were available for 712 of 2,198 maternal deaths. Delay type II was observed in 40.4% of maternal deaths and delay type III in 14.2%.and 13.9% had both delays. Women who died of a direct obstetric complication were more likely to have experienced a delay type III than women who died due to indirect causes. Women who experienced delay type II were less likely to have also delay type III and vice versa. Conclusions: The delays in reaching and receiving appropriate facility-based care for women facing pregnancy related complications in Mozambique contribute significantly to maternal mortality. Securing referral linkages and health facility readiness for rapid and correct patient management are needed to reduce the impact of these delays within the health system

Mapping maternal mortality rate via spatial zero-inflated models for count data : a case study of facility-based maternal deaths from Mozambique

Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with overdispersion and clustered counts when analyzing data on maternal deaths and related risk factors within health facilities in Mozambique. This paper aims at providing additional insights over previous analyses and presents an extension of such models to account for spatial variation in a disease mapping framework of facility-based maternal mortality in Mozambique

Diversity and convergence in health Indicators in Brazil and Mozambique

O artigo apresenta um panorama da trajetória recente das desigualdades em saúde nos dois países. Partindo da sistematização de dados produzidos pelos órgãos oficiais, de estatística e saúde, mostra como evoluíram os indicadores de acesso à saúde. Observa‑se a redução das desigualdades em período recente em ambos os países, sendo de forma mais acentuada em Moçambique, em função do aumento da atenção primária à saúde nas áreas rurais.The article presents an overview of the recent trends on health inequalities in two countries. It shows how service provision and social health‑related indicators have progressed using administrative data produced by official authorities. Both countries present reduction on health inequalities. Mozambique has produced further pronounced results due to increasing access to primary health care in rural areas

Acknowledging HIV and malaria as major causes of maternal mortality in Mozambique

To review national data on HIV and malaria as causes of maternal death and to determine the importance of looking at maternal mortality at a subnational level in Mozambique

Conhecimentos, Atitudes e Práticas dos Funcionários Públicos de Moçambique em relação à Prevenção da COVID-19

In the middle of December 2019, COVID-19 appeared in the Chinese City of Wuhan. It is a pathology that quickly spread around the world, counting, until the completion of the present study, with more than 2 million infected and about 140 thousand dead. The aim of the present study was to analyze knowledge, attitudes and practices of public workers from Mozambique on the prevention of COVID-19. To this end, 126 public workers in Mozambique (79 men, 43 women and 4 who chose not to disclose their gender) answered a closed questionnaire applied to the Google Form online platform. The questionnaire was open for 5 days (two weekend days and three business days). The results revealed that most employees have basic knowledge and appropriate measures for the prevention of COVID-19, more than half adopt behaviors conducive to disease prevention and less than half effectively comply with preventive actions guided by governmental and the health sector. The results suggest that public officials are knowledgeable, however efforts should be made to carry out educational actions to improve attitudes and change practices related to the prevention of COVID-19.Nos meados do mês de Dezembro do ano 2019, surgiu a COVID-19, na Cidade Chinesa de Wuhan. Trata-se de uma patologia que rapidamente se espalhou pelo mundo, contando, até a realização do presente estudo, com mais de 2 milhões de infectados e cerca de 140 mil mortos. O objectivo do presente estudo foi de analisar o grau de conhecimentos, atitudes e práticas dos funcionários públicos de Moçambique sobre a prevenção da COVID-19. Para tal, 126 funcionários públicos de Moçambique (79 homens, 43 mulheres e 4 que preferiram não revelar o sexo) responderam a um questionário fechado aplicado na plataforma online Google Form. Refira-se que o questionário esteve aberto durante 5 dias (dois de final de semana e três dias úteis). Os resultados revelaram que a maior parte dos funcionários tem conhecimentos básicos e de medidas apropriadas para a prevenção da COVID-19, mais que a metade assume comportamentos conducentes à prevenção da doença e menos que a metade cumpre eficazmente com acções preventivas orientadas pelas entidades governamentais e de saúde. Os resultados sugerem que os funcionários públicos têm conhecimentos, contudo devem ser envidados esforços no sentido de serem realizadas acções educativas para o melhoramento das atitudes e mudança das práticas relativas à prevenção da COVID-19

Implementation of evidence-based antenatal care in Mozambique: a cluster randomized controlled trial: study protocol

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of the package of evidence-based services included in the WHO ANC model in Mozambique. The primary hypothesis is that the intervention will increase the use of evidence-based practices during ANC visits in comparison to the standard dissemination channels currently used in the country. Methods: This is a demonstration project to be developed through a facility-based cluster randomized controlled trial with a stepped wedge design. The intervention was tailored, based on formative research findings, to be readily applicable to local prenatal care services and acceptable to local pregnant women and health providers. The intervention includes four components: the provision of kits with all necessary medicines and laboratory supplies for ANC (medical and non-medical equipment), a storage system, a tracking system, and training sessions for health care providers. Ten clinics were selected and will start receiving the intervention in a random order. Outcomes will be computed at each time point when a new clinic starts the intervention. The primary outcomes are the delivery of selected healthcare practices to women attending the first ANC visit, and secondary outcomes are the delivery of selected healthcare practices to women attending second and higher ANC visits as well as the attitude of midwives in relation to adopting the practices. This demonstration project is pragmatic in orientation and will be conducted under routine conditions. Discussion: There is an urgent need for effective and sustainable scaling-up approaches of health interventions in low-resource countries. This can only be accomplished by the engagement of the country’s health stakeholders at all levels. This project aims to achieve improvement in the quality of antenatal care in Mozambique through the implementation of a multifaceted intervention on three levels: policy, organizational and health care delivery levels. The implementation of the trial will probably require a change in accountability and behaviour of health care providers and we expect this change in ‘habits’ will contribute to obtaining reliable health indicators, not only related to research issues, but also to health care outcomes derived from the new health care model. At policy level, the results of this study may suggest a need for revision of the supply chain management system. Given that supply chain management is a major challenge for many low-resource countries, we envisage that important lessons on how to improve the supply chain in Mozambique and other similar settings, will be drawn from this study

The triple threat of pregnancy, HIV infection and malaria: reported causes of maternal mortality in two nationwide health facility assessments in Mozambique, 2007 and 2012

Abstract Background The paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection. Methods Two national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes. In 2007, 2,199 cases of maternal deaths were documented over a 12 month period; in 2012, 459 cases were identified over a three month period. In 2007, data collection also included reviews of maternal deaths when records were available (n = 712). Results Institutional maternal mortality declined from 541 to 284/100,000 births from 2007 to 2012. The rate of decline among women dying of direct causes was 66 % compared to 26 % among women dying of indirect causes. Cause-specific mortality ratios fell for all direct causes. Patterns among indirect causes were less conclusive given differences in cause-of-death recording. In absolute numbers, the combination of antepartum and postpartum hemorrhage was the leading direct cause of death each year and HIV and malaria the main non-obstetric causes. Based on maternal death reviews, evidence of HIV infection, malaria or anemia was found in more than 40 % of maternal deaths due to abortion, ectopic pregnancy and sepsis. Almost half (49 %) of all institutional maternal deaths took place in the largest hospitals in 2007 while in 2012, only 24 % occurred in these hospitals. The availability of antiretrovirals and antimalarials increased in all types of facilities, but increases were most dramatic in health centers. Conclusions The rate at which women died of direct causes in Mozambique’s health facilities appears to have declined significantly. Despite a clear improvement in access to antiretrovirals and antimalarials, especially at lower levels of health care, malaria, HIV, and anemia continue to exact a heavy toll on child-bearing women. Going forward, efforts to end preventable maternal and newborn deaths must maximize the use of antenatal care that includes integrated preventive/treatment options for HIV infection, malaria and anemia