ORCID Profile
0000-0002-2498-9373
Current Organisation
Instituto Nacional de Saúde, Moçambique
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 03-2023
DOI: 10.1002/JIA2.26076
Abstract: In 2018, Mozambique's Ministry of Health launched a guideline for a nationwide implementation of eight differentiated service delivery models to optimize HIV service delivery and achieve universal coverage of HIV care and treatment. The models were (1) Fast‐track, (2) Three‐month Antiretrovirals Dispensing, (3) Community Antiretroviral Therapy Groups, (4) Adherence Clubs, (5) Family‐approach, and three one‐stop shop models for (6) Tuberculosis, (7) Maternal and Child Health, and (8) Adolescent‐friendly Health Services. This study identified drivers of implementation success and failure across these differentiated service delivery models. Twenty in‐depth in idual interviews were conducted with managers and providers from the Ministry of Health and implementing partners from all levels of the health system between July and September 2021. National‐level participants were based in the capital city of Maputo, and participants at provincial, district and health facility levels were from Sofala province, a purposively selected setting. The Consolidated Framework for Implementation Research (CFIR) guided data collection and thematic analysis. Deductively selected constructs were assessed while allowing for additional themes to emerge inductively. The CFIR constructs of Relative Advantage, Complexity, Patient Needs and Resources, and Reflecting and Evaluating were identified as drivers of implementation, whereas Available Resources and Access to Knowledge and Information were identified as barriers. Fast‐track and Three‐month Antiretrovirals Dispensing models were deemed easier to implement and more effective in reducing workload. Adherence Clubs and Community Antiretroviral Therapy Groups were believed to be less preferred by clients in urban settings. COVID‐19 (an inductive theme) improved acceptance and uptake of in idual differentiated service delivery models that reduced client visits, but it temporarily interrupted the implementation of group models. This study described important determinants to be addressed or leveraged for the successful implementation of differentiated service delivery models in Mozambique. The models were considered advantageous overall for the health system and clients when compared with the standard of care. However, successful implementation requires resources and ongoing training for frontline providers. COVID‐19 expedited in idual models by loosening the inclusion criteria this experience can be leveraged to optimize the design and implementation of differentiated service delivery models in Mozambique and other countries.
Publisher: MDPI AG
Date: 27-07-2021
Abstract: A high worldwide SARS-CoV-2 vaccine coverage must be attained to stop the COVID-19 pandemic. In this study, we assessed the level of willingness of Mozambicans to be vaccinated against COVID-19. Data were collected between 11 and 20 March 2021, through a self-administered online survey. Of the 1878 respondents, 30.1% were healthcare workers, 58.3% were aged between 18 and 35 years, 60% were male, and 38.5% were single. Up to 43% had been tested for COVID-19 and 29% had tested positive. Overall vaccine acceptability was 71.4% (86.6% among healthcare workers, 64.8% among other respondents p 0.001). Reasons for vaccine hesitancy included: fear of vaccine side effects (29.6%) and the belief that the vaccine is not effective (52%). The acceptability of the SARS-CoV-2 vaccine increased with increasing vaccine efficacy. Using logistic regression, determinants for acceptability of the vaccine were: older age, a past COVID-19 test, a concern of becoming (re)infected by COVID-19, having a chronic disease, and considering vaccination important for personal and community health. In conclusion, vaccine acceptability in Mozambique was relatively high among healthcare workers but significantly lower in the rest of the population. This suggests that there is a need to educate the general population about SARS-CoV-2 vaccination and its importance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2016
Publisher: Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs
Date: 15-09-2022
Publisher: Springer Science and Business Media LLC
Date: 06-04-2021
DOI: 10.1186/S12939-021-01403-8
Abstract: This study aims to assess the COVID-19 response preparedness of the Mozambican health system by 1) determining the location of oxygen-ready public health facilities, 2) estimating the oxygen treatment capacity, and 3) determining the population coverage of oxygen-ready health facilities in Mozambique. This analysis utilizes information on the availability of oxygen sources and delivery apparatuses to determine if a health facility is ready to deliver oxygen therapy to patients in need, and estimates how many patients can be treated with continuous oxygen flow for a 7-day period based on the available oxygen equipment at health facilities. Using GIS mapping software, the study team modeled varying travel times to oxygen-ready facilities to estimate the proportion of the population with access to care. 0.4% of all health facilities in Mozambique are prepared to deliver oxygen therapy to patients, for a cumulative total of 283.9 to 406.0 patients-weeks given the existing national capacity, under varying assumptions including ability to ert oxygen from a single source to multiple patients. 35% of the population in Mozambique has adequate access within one-hour driving time of an oxygen-ready health facility. This varies widely by region 89.1% of the population of Maputo City was captured by the one-hour driving time network, as compared ot 4.4% of the population of Niassa province. The Mozambican health system faces the dual challenges of under-resourced health facilities and low geographic accessibility to healthcare as it prepares to confront the COVID-19 pandemic. This analysis also illustrates the disparity between provinces in preparedness to deliver oxygen therapy to patient, with Cabo Delgado and N ula being particularly under-resourced.
Publisher: Public Library of Science (PLoS)
Date: 24-01-2019
Publisher: Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs
Date: 15-09-2022
Publisher: MDPI AG
Date: 27-06-2022
Abstract: Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal consultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1 95% CI = 1.2–3.7), rural residency (AOR = 1.5 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.
Publisher: Springer Science and Business Media LLC
Date: 08-2019
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/BMJGH-2021-007878
Abstract: Currently, COVID-19 dominates the public health agenda and poses a permanent threat, leading to health systems’ exhaustion and unprecedented service disruption. Primary healthcare services, including tuberculosis services, are at increased risk of facing severe disruptions, particularly in low-income and middle-income countries. Indeed, corroborating model-based forecasts, there is increasing evidence of the COVID-19 pandemic’s negative impact on tuberculosis case detection. Applying a segmented time-series analysis, we assessed the effects of COVID-19-related measures on tuberculosis diagnosis service across districts in Mozambique. Ministry health information system data were used from the first quarter of 2017 to the end of 2020. The model, performed under the Bayesian premises, was estimated as a negative binomial with random effects for districts and provinces. A total of 154 districts were followed for 16 consecutive quarters. Together, these districts reported 96 182 cases of all forms of tuberculosis in 2020. At baseline (first quarter of 2017), Mozambique had an estimated incidence rate of 283 (95% CI 200 to 406) tuberculosis cases per 100 000 people and this increased at a 5% annual rate through the end of 2019. We estimated that 17 147 new tuberculosis cases were potentially missed 9 months after COVID-19 onset, resulting in a 15.1% (95% CI 5.9 to 24.0) relative loss in 2020. The greatest impact was observed in the southern region at 40.0% (95% CI 30.1 to 49.0) and among men at 15% (95% CI 4.0 to 25.0). The incidence of pulmonary tuberculosis increased at an average rate of 6.6% annually however, an abrupt drop (15%) was also observed immediately after COVID-19 onset in March 2020. The most significant impact of the state of emergency was observed between April and June 2020, the quarter after COVID-19 onset. Encouragingly, by the end of 2020, clear signs of health system recovery were visible despite the initial shock.
Publisher: Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs
Date: 15-09-2022
Publisher: Springer Science and Business Media LLC
Date: 25-01-2019
Publisher: MDPI AG
Date: 31-05-2022
DOI: 10.3390/HEALTHCARE10061013
Abstract: Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients’ files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had “high obstetric-risk” and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8 95% Confidence Interval (95%CI) = 1.3–2.6], preecl sia [aOR (95%CI) = 2.0 (1.2–3.3)], age [aOR (95%CI) = 0.96 (0.93–0.99)] and “high obstetric-risk” [aOR (95%CI) = 0.54 (0.37–0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8–2.6)], “high obstetric-risk” [aOR (95%CI) = 1.6 (1.3–1.96)], preecl sia [aOR (95%CI) = 1.5 (1.2–1.8), mother’s age [aOR (95%CI) = −2% (−3%, −0.1%)] and gestational age [aOR (95%CI) = −8% (−13%, −6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals’ performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads.
Publisher: Informa UK Limited
Date: 05-2004
Publisher: Public Library of Science (PLoS)
Date: 03-10-2018
Publisher: Public Library of Science (PLoS)
Date: 07-04-2020
Publisher: FapUNIFESP (SciELO)
Date: 12-2016
DOI: 10.1590/1806-93042016000400004
Abstract: Abstract Objectives: to identify the determinants of stillbirths in Zambezia province, Mozambique. Methods: a retrospective cross-sectional ecological study was carried out in 2013-2014 by using perinatal indicators captured by the health information system in Zambezia. Sequentially perinatal care indicators, bivariate analysis and multiple adjusted regression at a 5% significance level with possible explainable variables of stillbirths were described. Results: a median proportion of stillbirths was 1.6%, low birth weight and preterm birth and obstetric complications were 4.9%, 1.9% and 4.1%, respectively. The bivariate analysis demonstrated association of stillbirths with anemia (p=0.043), antepartum hemorrhage (p=0.009), dystocic delivery (p .001), obstructed labor (p=0.004). In the analysis of multiple adjusted regression, the obstructed labor were a predictor (ß=0.435 p=0.03) to stillbirths Conclusions: the most important factor associated to stillbirths in health facilities in Zambezia province in 2013-2014 was the obstructed labor. The strengthening of diagnostic analysis and the attempt to handle obstetric complications is still a priority in Zambezia, in being able to decrease the avoidable perinatal deaths.
Publisher: Springer Science and Business Media LLC
Date: 16-04-2015
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-051395
Abstract: This study aims to identify the child-level, maternal-level, household-level and community-level determinants of anaemia among children aged 6–59 months, and determine the inequities of anaemia prevalence across communities in Mozambique. Cross-sectional study. Mozambique. This study used data of a weighted population of 3946 children, 6–59 months, delivered by women between 15 and 49 years of age, from the 2018 Mozambique Malaria Indicator Survey. Child’s anaemic status, measured as altitude-adjusted haemoglobin concentration (in g/L) the severity of anaemia was categorised based on predefined threshold values. Multilevel Bayesian linear regressions identified key determinants of childhood anaemia. Based on data availability and policy implications, spatial analysis was used to determine geographical variation of anaemia at the community level and areas with higher risks. The mean prevalence of childhood anaemia was 77.7% (SD: 5.5%). Provincially, Cabo Delgado province (86.2%) had the highest prevalence, Maputo province (70.2%) the lowest. Children with excess risk were mostly found in communities that had proximity to provincial borders: Niassa-Cabo Delgado-N ula triprovincial border, Gaza-Inhambane border, Zambezia-N ula border and provinces of Manica and Inhambane. Children with anaemia tended to be younger, males and at risk of having malaria because they were not sleeping under mosquito nets. In addition, children from poor families relative to children from wealthier households and those living in female-headed households were prone to anaemia. Findings from this study provide evidence that spatial inequities in childhood anaemia exist in Mozambique, mostly concentrated in the communities living close to the provincial borders. Anaemia among children could be effectively reduced through malaria prevention, for ex le, bed netting. Interventions are needed that generate income for households, increase community support for households headed by women, improve malaria control, build capacity of healthcare workers to manage severely anaemic children and health education for mothers.
Publisher: Public Library of Science (PLoS)
Date: 26-12-2018
Publisher: Frontiers Media SA
Date: 17-04-2023
DOI: 10.3389/FPUBH.2023.1075691
Abstract: This article is part of the Research Topic ‘ Health Systems Recovery in the Context of COVID-19 and Protracted Conflict ' After the World Health Organization declared COVID-19 a pandemic, more than 184 million cases and 4 million deaths had been recorded worldwide by July 2021. These are likely to be underestimates and do not distinguish between direct and indirect deaths resulting from disruptions in health care services. The purpose of our research was to assess the early impact of COVID-19 in 2020 and early 2021 on maternal and child healthcare service delivery at the district level in Mozambique using routine health information system data, and estimate associated excess maternal and child deaths. Using data from Mozambique's routine health information system (SISMA, Sistema de Informação em Saúde para Monitoria e Avaliação), we conducted a time-series analysis to assess changes in nine selected indicators representing the continuum of maternal and child health care service provision in 159 districts in Mozambique. The dataset was extracted as counts of services provided from January 2017 to March 2021. Descriptive statistics were used for district comparisons, and district-specific time-series plots were produced. We used absolute differences or ratios for comparisons between observed data and modeled predictions as a measure of the magnitude of loss in service provision. Mortality estimates were performed using the Lives Saved Tool (LiST). All maternal and child health care service indicators that we assessed demonstrated service delivery disruptions (below 10% of the expected counts), with the number of new users of family planing and malaria treatment with Coartem (number of children under five treated) experiencing the largest disruptions. Immediate losses were observed in April 2020 for all indicators, with the exception of treatment of malaria with Coartem. The number of excess deaths estimated in 2020 due to loss of health service delivery were 11,337 (12.8%) children under five, 5,705 (11.3%) neonates, and 387 (7.6%) mothers. Findings from our study support existing research showing the negative impact of COVID-19 on maternal and child health services utilization in sub-Saharan Africa. This study offers subnational and granular estimates of service loss that can be useful for health system recovery planning. To our knowledge, it is the first study on the early impacts of COVID-19 on maternal and child health care service utilization conducted in an African Portuguese-speaking country.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2022
DOI: 10.1186/S12936-022-04128-3
Abstract: Mozambique is ranked fourth in a list of the 29 countries that accounted for 95% of all malaria cases globally in 2019. The aim of this study was to identify factors associated with care seeking for fever, to determine the association between knowledge about malaria and care seeking and to describe the main reasons for not seeking care among children under five years of age in Mozambique. This is a quantitative, observational study based on a secondary data analysis of the 2018 Malaria Indicator Survey. This weighted analysis was based on data reported by surveyed mothers or caregivers of children aged 0–59 months who had fever in the two weeks prior to the survey. Care was reportedly sought for 69.1% [95% CI 63.5–74.2] of children aged 0–59 months old with fever. Care-seeking was significantly higher among younger children, 6 months old (AOR = 2.47 [95% CI 1.14–5.31]), 6–11 months old (AOR = 1.75 [95% CI 1.01–3.04]) and 12–23 months old (AOR = 1.85 [95% CI 1.19–2.89]), as compared with older children (48–59 months old). In adjusted analysis, mothers from the middle (AOR = 1.66 [95% CI 0.18–3.37]) and richest (AOR = 3.46 [95% CI 1.26–9.49]) wealth quintiles were more likely to report having sought care for their febrile children than mothers from the poorest wealth quintile. Additionally, mothers with secondary or higher education level were more likely to seek care (AOR = 2.16 [95% CI 1.19–3.93]) than mothers with no education. There was no association between maternal malaria knowledge or reported exposure to malaria messages and care-seeking behaviours. The main reasons reported for not seeking care included distance to health facility (46.3% of respondents), the perception that the fever was not severe (22.4%) and the perception that treatment was not available at the health facility (15%). Health facility access and socioeconomic barriers continue to be important constraints to malaria service utilization in Mozambique.
Publisher: Wiley
Date: 27-03-2023
DOI: 10.1002/HEC.4677
Abstract: Most evidence on Performance Based Financing (PBF) in low‐income settings has focused on services delivered by providers in targeted health administrations, with limited understanding of how effects on health and care vary within them. We evaluated the population effects of a program implemented in two provinces in Mozambique, focusing on child, maternal and HIV/AIDS care and knowledge. We used a difference‐in‐difference estimation strategy applied to data on mothers from the Demographic Health Surveys, linked to information on their closest health facility. The impact of PBF was limited. HIV testing during antenatal care increased, particularly for women who were wealthier, more educated, or residing in Gaza Province. Knowledge about transmission of HIV from mother‐to‐child, and its prevention, increased, particularly for women who were less wealthy, less educated, or residing in N ula Province. Exploiting the roll‐out by facility, we found that the effects were concentrated on less wealthy and less educated women, whose closest facility was in the referral network of a PBF facility. Results suggest that HIV testing and knowledge promotion increased in the whole district, as a strategy to boost referral for highly incentivized HIV services delivered in PBF facilities. However, demand‐side constraints may prevent the use of those services.
Publisher: MDPI AG
Date: 27-06-2022
DOI: 10.3390/HEALTHCARE10071200
Abstract: The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.
Publisher: Edward Elgar Publishing
Date: 28-10-2016
Publisher: International Global Health Society
Date: 14-10-2018
Publisher: Informa UK Limited
Date: 28-09-2023
DOI: 10.1080/09540121.2022.2125159
Abstract: Psychosocial support (PSS) to caregivers of HIV-infected infants on antiretroviral treatment (ART) is crucial to ensure ART adherence and sustained long-term viral suppression in children. A specific approach including tools to monitor and understand adherence behavior and risk factors that prevent optimal treatment compliance are urgently needed. This qualitative exploratory study, conducted in southern Mozambique, monitored the infants' viral response trajectories during 18 months follow-up, as a measure of adherence, reviewed the caregiver's PSS session notes and the answers to a study questionnaire, to analyze whether the standard PSS checklist applied to infants' caregivers can identify barriers influencing their adherence. Only 9 of 31 infants had sustained virologic response. Reported factors affecting adherence were: difficulties in drugs administration, shared responsibility to administer treatment disclosure of child's HIV status to family members but lack of engagement mother's ART interruption and poor viral response. In conclusion, we found that the standard PSS approach alone, applied to caregivers, was lacking focus on many relevant matters that were identified by the study questionnaire. A comprehensive patient-centered PSS package of care, including an adherence risk factor monitoring tool, tailored to caregivers and their children must be developed.
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12992-019-0508-4
Abstract: Countries must be able to describe and monitor their populations health and well-being needs in an attempt to understand and address them. The Sustainable Development Goals (SDGs) have re-emphasized the need to invest in comprehensive health information systems to monitor progress towards health equity however, knowledge on the capacity of health information systems to be able do this, particularly in low-income countries, remains very limited. As a case study, we aimed to evaluate the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with SDG 3 (Good Health and Well Being for All at All Ages). A data source mapping of the health information system in Mozambique was conducted. We followed the World Health Organization’s methodology of assessing data sources to evaluate the information available for every equity stratifier using a three-point scale: 1 - information is available, 2 - need for more information, and 3 - an information gap. Also, for each indicator we estimated the national average inequality score. Eight data sources contain health information to measure and monitor progress towards health equity in line with the 27 SDG3 indicators. Seven indicators bear information with nationally funded data sources, ten with data sources externally funded, and ten indicators either lack information or it does not applicable for the matter of the study. None of the 27 indicators associated with SDG3 can be fully disaggregated by equity stratifiers they either lack some information (15 indicators) or do not have information at all (nine indicators). The indicators that contain more information are related to maternal and child health. There are important information gaps in Mozambique’s current national health information system which prevents it from being able to comprehensively measure and monitor health equity. Comprehensive national health information systems are an essential public health need. Significant policy and political challenges must also be addressed to ensure effective interventions and action towards health equity in the country.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Springer Science and Business Media LLC
Date: 16-06-2020
DOI: 10.1186/S40249-020-00692-5
Abstract: Cyclone Idai, which hit Mozambique in March 2019, was one of the worst climate-related natural disasters on record in the Southern Hemisphere causing massive destruction of housing and disruption to vital infrastructure including the electrical grid, communications and water supply. Almost two million people were affected with over 600 deaths, hundreds of thousands of people displaced accompanied by rapid spread of cholera. We describe emergency measures taken by the Government of Mozambique, in collaboration with multilateral partners, to establish a real-time disease surveillance system, implement interventions recommended by a Water, Sanitation and Hygiene (WASH) taskforce and rapidly scale up a massive community vaccination program to control a cholera epidemic.
Publisher: Elsevier BV
Date: 04-2023
Publisher: American Society of Tropical Medicine and Hygiene
Date: 02-05-2023
Abstract: Donor transitions, where externally funded programs transfer to country ownership and management, are increasingly common. The Countrywide Mortality Surveillance for Action – Mozambique (COMSA) project established a nationwide surveillance system capturing vital events at the community level with funding from the Bill and Melinda Gates Foundation. COMSA was implemented in partnership between Johns Hopkins University (a U.S.-based academic institution) and the Instituto Nacional de Saúde (National Institute for Health) and Instituto Nacional de Estatística (National Institute for Statistics), two Mozambican public institutions. Midway through the project, the Gates Foundation directed COMSA’s partners to develop and implement a transition plan that ensured COMSA’s activities could be institutionalized after Gates Foundation funding ended. Here we describe the process and activities that COMSA underwent for transition planning, including stakeholder engagement and advocacy, securing financial commitments, documenting operational activities, capacity building, and supporting strategic planning. Facilitators included a project model that already embedded significant implementation and management responsibility with local agencies, high-level commitment to COMSA’s activities from local stakeholders, establishing dedicated personnel and budget to manage transition, and fortuitous timing for financing. Challenges included needing to engage multiple government agencies to ensure buy-in, navigating tensions around future roles and responsibilities, reviewing and adjusting existing implementation structures, and the reality that this transition involved shifting financing from one development partner to another. Transition implementation was also constrained by the COVID-19 pandemic because key stakeholders were engaged in response efforts. COMSA’s experience highlights lessons and threats for future programs facing donor transition in uncertain environments.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 02-05-2023
Abstract: Sub-Saharan Africa lacks timely, reliable, and accurate national data on mortality and causes of death (CODs). In 2018 Mozambique launched a s le registration system (Countrywide Mortality Surveillance for Action [COMSA]-Mozambique), which collects continuous birth, death, and COD data from 700 randomly selected clusters, a nationally representative population of 828,663 persons. Verbal and social autopsy interviews are conducted for COD determination. We analyzed data collected in 2019–2020 to report mortality rates and cause-specific fractions. Cause-specific results were generated using computer-coded verbal autopsy (CCVA) algorithms for deaths among those age 5 years and older. For under-five deaths, the accuracy of CCVA results was increased through calibration with data from minimally invasive tissue s ling. Neonatal and under-five mortality rates were, respectively, 23 (95% CI: 18–28) and 80 (95% CI: 69–91) deaths per 1,000 live births. Mortality rates per 1,000 were 18 (95% CI: 14–21) among age 5–14 years, 26 (95% CI: 20–31) among age 15–24 years, 258 (95% CI: 230–287) among age 25–59 years, and 531 (95% CI: 490–572) among age 60+ years. Urban areas had lower mortality rates than rural areas among children under 15 but not among adults. Deaths due to infections were substantial across all ages. Other predominant causes by age group were prematurity and intrapartum-related events among neonates diarrhea, malaria, and lower respiratory infections among children 1–59 months injury, malaria, and diarrhea among children 5–14 years HIV, injury, and cancer among those age 15–59 years and cancer and cardiovascular disease at age 60+ years. The COMSA-Mozambique platform offers a rich and unique system for mortality and COD determination and monitoring and an opportunity to build a comprehensive surveillance system.
Publisher: Public Library of Science (PLoS)
Date: 21-08-2020
Publisher: Informa UK Limited
Date: 14-01-2019
DOI: 10.1080/13691058.2018.1535091
Abstract: HIV test-and-treat programmes are being implemented throughout sub-Saharan Africa, enrolling HIV-positive clients into antiretroviral treatment (ART) immediately after diagnosis, regardless of clinical stage or CD4 count. This study conducted in Mozambique examined what influenced clients who tested HIV-positive in the context of test-and-treat to make ART initiation decisions. Eighty in-depth interviews with HIV-positive clients and nine focus group discussions with health care workers were completed across 10 health facilities. 'Good health' acted simultaneously as a barrier and facilitator clients in good health often found a positive HIV diagnosis hard to cope with since HIV was traditionally associated with ill health. Concerns about ART side effects, fear of inadvertent HIV status disclosure and discrimination, limited privacy at health facilities and long waiting times were also barriers to initiation. In contrast, being in good health also acted as a motivator to start treatment so as to remain healthy, maintain responsibilities such as work and caring for dependents and avoid unwanted disclosure. Study findings offer an in-depth understanding of the complex dynamics between in idual perceptions of 'being healthy' and its influence on ART initiation within the context of test-and-treat programme implementation.
Publisher: Oxford University Press (OUP)
Date: 02-11-2018
Abstract: To assess the inequalities in the access to and quality of care and its related direct payments. Secondary analysis of the cross-sectional Mozambican Household Budget Survey (HBS). Nationally-representative s le of households in Mozambique. 11 480 households (58 118 in iduals) interviewed during HBS 2014/15. None. Equity, utilization of healthcare, access to quality care and direct payments. About 12.2% of women and 10.1% of men of the survey report a perceive health need. About 72.1% of women and 72.9% men use healthcare. Population in a disadvantaged position living in rural areas have less probabilities of using healthcare for equal health compared to the in iduals of a wealthier position and living in urban settings. With regard to quality care, 47.7% women and 46.8% men do not report quality problems. No differences for women's wealth. Men in a disadvantaged position report less chances of accessing quality care compared to men of advantaged position. Also, women and men living in rural areas have less probabilities of accessing quality care. Finally, the majority of people who access healthcare paid 1 Mt during their visit. This study tackles a fundamental policy concern for health systems of Sub-Saharan Africa and points to areas that urge action to address the existent of socioeconomic and geographical inequalities in the access to and quality of care for women and men, including the strengthening of health facilities in rural and deprived areas to ensure that access to adequate care of acceptable quality is distributed according to need.
Publisher: Public Library of Science (PLoS)
Date: 28-07-2014
Start Date: 2022
End Date: 2023
Funder: Bill and Melinda Gates Foundation
View Funded ActivityStart Date: 2017
End Date: 2020
Funder: Wellcome Trust
View Funded ActivityStart Date: 2017
End Date: 2021
Funder: Medical Research Council
View Funded Activity