Challenges and facilitators to evidence-based decision-making for maternal and child health in Mozambique: district, municipal and national case studies.

BACKGROUND: The need for evidence-based decision-making in the health sector is well understood in the global health community. Yet, gaps persist between the availability of evidence and the use of that evidence. Most research on evidence-based decision-making has been carried out in higher-income countries, and most studies look at policy-making rather than decision-making more broadly. We conducted this study to address these gaps and to identify challenges and facilitators to evidence-based decision-making in Maternal, Newborn and Child Health and Nutrition (MNCH&N) at the municipality, district, and national levels in Mozambique. METHODS: We used a case study design to capture the experiences of decision-makers and analysts (n = 24) who participated in evidence-based decision-making processes related to health policies and interventions to improve MNCH&N in diverse decision-making contexts (district, municipality, and national levels) in 2014-2017, in Mozambique. We examined six case studies, at the national level, in Maputo City and in two districts of Sofala Province and two of Zambézia Province, using individual in-depth interviews with key informants and a document review, for three weeks, in July 2018. RESULTS: Our analysis highlighted various challenges for evidence-based decision-making for MNCH&N, at national, district, and municipality levels in Mozambique, including limited demand for evidence, limited capacity to use evidence, and lack of trust in the available evidence. By contrast, access to evidence, and availability of evidence were viewed positively and seen as potential facilitators. Organizational capacity for the demand and use of evidence appears to be the greatest challenge; while individual capacity is also a barrier. CONCLUSION: Evidence-based decision-making requires that actors have access to evidence and are empowered to act on that evidence. This, in turn, requires alignment between those who collect data, those who analyze and interpret data, and those who make and implement decisions. Investments in individual, organizational, and systems capacity to use evidence are needed to foster practices of evidence-based decision-making for improved maternal and child health in Mozambique.

Knowledge about HIV, HBV and HCV modes of transmission among pregnant women in Nampula - Mozambique.

The assessment of pregnant women's knowledge about modes of infections transmission is essential to tailor programs to their needs. This study aimed to assess knowledge about human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among pregnant women in Nampula - Mozambique, a high-risk area for sexually transmitted infections. At their first antenatal visit, women were invited to participate and data were collected by trained nurses at six public health facilities. Knowledge about HIV transmission modes was high but relevant misconceptions remained. However, knowledge regarding HBV and HCV transmission modes was very limited. There was a significant association between knowledge level and socioeconomic position, making education and women's empowerment key factors in a comprehensive strategy to prevent infections.

Sexual and physical intimate partner violence among women using antenatal care in Nampula, Mozambique.

The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.