A snap shot assessment of obstetric care at rural hospitals of Mozambique

Serving large catchment areas, rural hospitals (RH) in Mozambique are the first level of care where comprehensive response to perinatal complications begins. This one-page policy brief provides an overview of the maternal and child health care strategies and contexts for obstetric care in Mozambique. Strengthening the continuum of perinatal care is still required and recommended through a systemic approach. Vertical solutions and “one size-fits-all facilities” should be avoided

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

Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1–59 months

Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the “Three Delays-in-Healthcare”, and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1–59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the “Three Delays-in-Healthcare”. Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12–59 months experienced more delay than infants aged 1–11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted

Reaching substantive female representation among decision-makers: A qualitative research study of gender-related experiences from the health sector in Mozambique.

BACKGROUND:Achieving significant female representation in government at decision-making levels has been identified as a key step towards achieving gender equality. In 2015, women held 39.6% of parliamentary seats in Mozambique, which is above the benchmark of 30% that has been suggested as the turning point for minority representation to move from token status to having a sizable impact. We undertook a study to identify gender-related barriers and facilitators to improving women-centered policies in the health sector. METHODS:We conducted in-depth interviews with 39 individuals (32 women, 7 men) involved at a senior level in policy making or implementation of woman-centric policies within the Mozambique Ministry of Health and affiliated institutions. We used a semi-structured interview guide that included questions on difficulties and facilitating factors encountered in the policy making process, and the perceived role of gender in this process. We used both deductive and inductive analysis approaches, starting with a set of pre-identified themes and expanding this to include themes that emerged during coding. RESULTS:Our data suggest two main findings: (1) the women who participated in our study generally do not report feeling discrimination in the workplace and (2) senior health sector perceive women to be more personally attuned to women-centric issues than men. Within our specific sample, we found little to suggest that gender discrimination is a problem professionally for female decision-makers in Mozambique. However, these findings should be contextualized using an intersectional lens with recognition of the important difference between descriptive versus substantive female representation, and whether "percentage of women" is truly the best metric for gaging commitment to gender equality at the policy making level. CONCLUSIONS:Mozambique's longstanding significant representation of women may have led to creating an environment that leads to positive experiences for female decision-makers in the government. However, while the current level of female representation should be celebrated, it does not negate the need for continued focus on female representation in decision-making positions

Czech Presidency of the Council of the EU: preparation, process and results

The thesis deals with preparation, process, results and evaluation of the first Czech Presidency of the Council of the European Union

Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months.

Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted

Proportion of deceased infants and children who experienced each delay in the “Three Delays-in-Healthcare” model.

Proportion of deceased infants and children who experienced each delay in the “Three Delays-in-Healthcare” model.</p

Venn diagram of each type of delay among deceased infants and children (N = 1,326).

Venn diagram of each type of delay among deceased infants and children (N = 1,326).</p

CHAMPS consortium members.

Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the “Three Delays-in-Healthcare”, and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1–59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the “Three Delays-in-Healthcare”. Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12–59 months experienced more delay than infants aged 1–11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.</div