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

Waiting time, wasted time : a pilot study to investigate the effect of reduced waiting time on demand for antenatal care, South region Mozambique 2016

This one-page brief outlines a study aimed at reducing wait times for antenatal care. The intervention had significant impacts on workload management. The caseload was better distributed with health facilities less overwhelmed in the first hours of the day, thus allowing for nurses to better manage concurrent tasks. Of 1600 pregnant women surveyed, 99% were satisfied with the intervention. Workable appointment systems can be implemented in low-income countries, improving antenatal care

Effects of appointment scheduling on waiting time and utilisation of antenatal care in Mozambique

Background Poor patient experience, including long waiting time, is a potential reason for low healthcare utilisation. In this study, we evaluate the impact of appointment scheduling on waiting time and utilisation of antenatal care. Methods We implemented a pilot study in Mozambique introducing appointment scheduling to three maternity clinics, with a fourth facility used as a comparison. The intervention provided women with a return date and time for their next antenatal care visit. Waiting times and antenatal care utilisation data were collected in all study facilities. We assessed the effect of changing from first come, first served to scheduled antenatal care visits on waiting time and complete antenatal care (≥4 visits during pregnancy). Our primary analysis compared treatment facilities over time; in addition, we compared the treatment and comparison facilities using difference in differences. Results We collected waiting time data for antenatal care from 6918 women, and antenatal care attendance over the course of pregnancy from 8385 women. Scheduling appointments reduced waiting time for antenatal care in treatment facilities by 100 min (95% CI -107.2 to -92.9) compared with baseline. Using administrative records, we found that exposure to the scheduling intervention during pregnancy was associated with an approximately 16 percentage point increase in receipt of four or more antenatal care visits during pregnancy. Conclusions Relatively simple improvements in the organisation of care that reduce waiting time may increase utilisation of healthcare during pregnancy. A larger scale study is needed to provide information about whether appointment scheduling can be sustained over time. Trial registration number NCT02938936

Client experiences with antenatal care waiting times in southern Mozambique

BACKGROUND: Antenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling. METHODS: This study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software. RESULTS: Clients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts. CONCLUSIONS: Findings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times

First confirmed occurrence of the yellow fever virus and dengue virus vector Aedes (Stegomyia) luteocephalus (Newstead, 1907) in Mozambique

Background: Mozambique, same as many other tropical countries, is at high risk of arthropod-borne virus (arbovirus) diseases and recently two dengue virus (DENV) outbreaks occurred in the northern part of the country. The occurrence of some important vector species, such as Aedes (Stegomyia) aegypti (Linnaeus) and Ae. (Stg.) albopictus (Skuse), besides several other sylvatic vectors, have been reported in the country, which may indicate that the transmission of some arboviruses of public health importance may involve multiple-vector systems. Therefore, knowing the occurrence and distribution of existing and the new important vectors species, is crucial for devising systematic transmission surveillance and vector control approaches. The aim of this study was to map the occurrence and distribution of mosquito species with potential for transmitting arboviruses of human and veterinary relevance in Niassa Province, Northern Mozambique. Methods: Field entomological surveys were undertaken in April 2016 in Lago District, Niassa Province, northern Mozambique. Breeding sites of mosquitoes were inspected and immature stages were collected and reared into adult. Mosquitoes in the adult stages were morphologically identified using taxonomic keys. Morphological identification of Aedes (Stegomyia) luteocephalus (Newstead) were later confirmed using dissected male genitalia and molecular based on the phylogenetic analyses of the sequenced barcode (cox1 mtDNA) gene. Results: A total of 92 mosquito larvae collected developed into adults. Of these, 16 (17.39%) were morphologically identified as Ae. luteocephalus. The remaining specimens belonged to Ae. (Stg.) aegypti (n = 4, 4.35%), Ae. (Aedimorphus) vittatus (n = 24, 26.09%), Anopheles garnhami (n = 1, 1.09%), Culex (Culiciomyia) nebulosus (n = 28, 30.43%), Eretmapodites subsimplicipes (n = 18, 19.57%) and Toxorhynchites brevipalpis (n = 1, 1.09%), taxa already known to the country. Male genitalia and phylogenetic analyses confirmed the identity of Ae. luteocephalus specimens collected in this study. Conclusions: To our knowledge, this is the first detection of Ae. luteocephalus in Mozambican territory, a vector species of yellow fever virus (YFV), Zika virus (ZIKV) and dengue virus (DENV) in Africa. Further studies are encouraged to investigate the role of Ae. luteocephalus in the transmission of arboviral diseases in Mozambique.publishersversionpublishe

A survey of RNA viruses in mosquitoes from Mozambique reveals novel genetic lineages of flaviviruses and phenuiviruses, as well as frequent flavivirus-like viral DNA forms in Mansonia

Background: Mosquito-borne diseases involving arboviruses represent expanding threats to sub-Saharan Africa imposing as considerable burden to human and veterinary public health. In Mozambique over one hundred species of potential arbovirus mosquito vectors have been identified, although their precise role in maintaining such viruses in circulation in the country remains to be elucidated. The aim of this study was to screen for the presence of flaviviruses, alphaviruses and bunyaviruses in mosquitoes from different regions of Mozambique. Results: Our survey analyzed 14,519 mosquitoes, and the results obtained revealed genetically distinct insect-specific flaviviruses, detected in multiple species of mosquitoes from different genera. In addition, smaller flavivirus-like NS5 sequences, frequently detected in Mansonia seemed to correspond to defective viral sequences, present as viral DNA forms. Furthermore, three lineages of putative members of the Phenuiviridae family were also detected, two of which apparently corresponding to novel viral genetic lineages. Conclusion: This study reports for the first-time novel insect-specific flaviviruses and novel phenuiviruses, as well as frequent flavivirus-like viral DNA forms in several widely known vector species. This unique work represents recent investigation of virus screening conducted in mosquitoes from Mozambique and an important contribution to inform the establishment of a vector control program for arbovirus in the country and in the region.publishersversionpublishe

Spatio-temporal modelling of weekly malaria incidence in children under 5 for early epidemic detection in Mozambique

Malaria is a major cause of morbidity and mortality in Mozambique. We present a malaria early warning system (MEWS) for Mozambique informed by seven years of weekly case reports of malaria in children under 5 years of age from 142 districts. A spatio-temporal model was developed based on explanatory climatic variables to map exceedance probabilities, defined as the predictive probability that the relative risk of malaria incidence in a given district for a particular week will exceed a predefined threshold. Unlike most spatially discrete models, our approach accounts for the geographical extent of each district in the derivation of the spatial covariance structure to allow for changes in administrative boundaries over time. The MEWS can thus be used to predict areas that may experience increases in malaria transmission beyond expected levels, early enough so that prevention and response measures can be implemented prior to the onset of outbreaks. The framework we present is also applicable to other climate-sensitive diseases

implication for assessing the risk of arbovirus outbreaks

Funding Information: This work was also supported by the U.S. Centers for Disease Control and Prevention through a cooperative agreement number 5NU14GH001237-03-00. The views expressed in this written publication do not necessarily reflect the official policies of the U.S. Department of Health and Human Services. European Foundation Initiative into Neglected Tropical Disease also supported this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank all community leaders, household heads staff from the provincial health directorates, staff from the Medical Entomology Laboratory from the National Institute of Health, staff from National Malaria Control Programme, and staff from the Laboratório de Transmissores de Hematozoários of the Oswaldo Cruz Institute for their support during field work, laboratory testing and identification of Aedes spp. We also thank José Feriano Américo who produced the maps of this work. Ours special thanks goes to Professor J. Dereck Charlwood who revised the English grammar and typos of the entire manuscript. Consent for publication Our manuscript does not present any individual person's data. Publisher Copyright: © 2018 Abílio et al. http://creativecommons.org/licenses/by/4.0/.Background: Aedes-borne arboviruses have emerged as an important public health problem worldwide and, in Mozambique, the number of cases and its geographical spread have been growing. However, information on the occurrence, distribution and ecology of Aedes aegypti and Ae. albopictus mosquitoes remain poorly known in the country. Methods: Between March and April 2016, a cross-sectional study was conducted in 32 districts in Mozambique to determine the distribution and breeding sites of Ae. aegypti and Ae. albopictus. Larvae and pupae were collected from a total of 2,807 water-holding containers using pipette, dipper, funnel and sweeping procedures, depending on the container type and location. Both outdoor and indoor water-holding containers were inspected. The immature forms were reared to adults and the identifications of the mosquito species was carried out with a stereomicroscope using a taxonomic key. Results: Aedes aegypti was found in every district sampled, while Ae. albopictus was only found in Moatize district, situated in Tete Province in the central part of the country. Six hundred and twenty-eight of 2,807 (22.4%) containers were positive for Ae. aegypti but only one (0.03%) was positive for Ae. albopictus. The Container Index (CI) of Aedes was highest in densely populated suburban areas of the central region (260/604; 43.0%), followed by suburban areas in northern areas (228/617; 36.9%) whilst the lowest proportion was found in urbanized southern areas (140/1586; 8.8%). The highest CI of Aedes was found in used tires (448/1268; 35.3%), cement tanks (20/62; 32.3%) and drums (21/95; 22.1%). Conclusion: Data from our study showed that Ae. aegypti is present nation-wide, since it occurred in every sampled district, whilst Ae. albopictus had a limited distribution. Therefore, the risk of transmission of dengue and chikungunya is likely to have been underestimated in Mozambique. This study highlights the need for the establishment of a national entomological surveillance program for Aedes spp. in Mozambique in order to gain a better understanding about vector bionomics and to support the development of informed effective vector control strategies.publishersversionpublishe

Barriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions

From Europe PMC via Jisc Publications Router.Publication status: PublishedFunder: NIMH NIH HHS, Grants: T32 MH080634Funder: NIAID NIH HHS, Grants: P30 AI028697BACKGROUND:In mid-2016, Mozambique began phased implementation of the 'Test-and-Treat' policy, which enrolls HIV positive clients into antiretroviral treatment (ART) immediately regardless of CD4 cell count or disease stage. Novel insights into barriers and facilitators to ART initiation among healthy clients are needed to improve implementation of Test and Treat. METHODS AND FINDINGS:A cross-sectional qualitative study was conducted across 10 health facilities in Mozambique. In-depth interviews (IDIs) were conducted with HIV-positive clients (60 who initiated/20 who did not initiate ART within Test and Treat) and 9 focus group discussion (FGDs) were conducted with health care workers (HCWs; n = 53). Data were analyzed using deductive and inductive analysis strategies. Barriers to ART initiation included: (1) feeling 'healthy'; (2) not prepared to start ART for life; (3) concerns about ART side effects; (4) fear of HIV disclosure and discrimination; (5) poor interactions with HCWs; (6) limited privacy at health facilities; and (7) perceptions of long wait times. Facilitators included the motivation to stay healthy and to take care of dependents, as well as new models of ART services such as adaptation of counseling to clients' specific needs, efficient patient flow, and integrated HIV/primary care services. CONCLUSIONS:ART initiation may be difficult for healthy clients in the context of Test-and-Treat. Specific strategies to engage this population are needed. Strategies could include targeted support for clients, community sensitization on the benefits of early ART initiation, client-centered approaches to patient care, and improved efficiency through multi-month scripting and increased workforce.13pubpub1