Covid-19 pandemic impact on maternal and child health services access in Nampula, Mozambique: a mixed methods research.

BACKGROUND: The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people's movements and reduced public services, leading to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community. METHODS: Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites. RESULTS: Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%. CONCLUSION: Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.

Quality assessment in primary health care: Adolescent and Youth Friendly Service, a Mozambican case study.

INTRODUCTION: despite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective. METHODS: we implemented a descriptive cross-sectional quantitative study sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding. RESULTS: a total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (<19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The "overall satisfaction" rate was more frequent in both groups, being answered by 93.8% of youth and adults (>= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p <0.05). CONCLUSION: while most users are satisfied with the services there was, however, some sharp criticism. Health professionals' practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.

Conhecimento da população urbana sobre cólera em Nampula. Moçambique / Urban population's knowledge about cholera, Nampula, Mozambique

Introdução: os surtos de cólera, uma infecção bacteriana aguda intestinal causada pela ingestão de alimentos ou água contaminados com o Vibrio cholerae, devem-se a condições inadequadas de habitação, saneamento e falta de água potável. Esta doença é endémica em Moçambique, tendo ocorrido tumultos na população de Nampula alegando que as autoridades locais seriam responsáveis. O objectivo deste estudo foi avaliar o conhecimento da população sobre a cólera, identificando erros de conceitos e sua contribuição para o aparecimento da doença. Métodos: estudo descritivo qualitativo, realizado no bairro de Namicópo, cidade e província de Nampula, em Moçambique, com 20 adultos de ambos os géneros. Foram entrevistados 12 adultos e realizados dois grupos de discussão focal com quatro adultos cada. Os dados foram tratados com o programa informático de análise qualitativa Max qualitative data analysis (MAXQDA) para análise de conteúdo. Foram respeitadas todas as orientações da Declaração de Helsínquia, revisão de 2013. Resultados: os 20 participantes possuem um conhecimento básico sobre a doença, porém existem erros de conceito. Em relação à causa a resposta mais frequente foi que a cólera é causada por má higiene pessoal, colectiva ou alimentar. Sobre o tratamento caseiro a resposta mais frequente foi desconhecimento seguido de hidratação oral. Constataram-se erros de conceito sobre a transmissão da cólera (12 participantes), a prevenção (8), causa (3), conceito (2) e tratamento (1). Existe na comunidade a crença de que agentes governamentais são responsáveis por surtos de cólera no bairro. Conclusão: consideramos necessário realizar actividades de educação para a saúde junto da população urbana sobre esta doença, incidindo na transmissão e prevenção.

Introduction: Outbreaks of cholera, an acute bacterial intestinal infection caused by ingestion of food or water contaminated with Vibrio cholerae, are due to inadequate housing conditions, sanitation, and lack of drinking water. This disease is endemic in Mozambique, and there have been riots in the population of Nampula claiming that local authorities are responsible. The objective of this study was to evaluate the population's knowledge about cholera, identifying misconceptions and their contribution to the onset of the disease. Methods: a qualitative descriptive study, carried out in the district of Namicópo, city and province of Nampula, Mozambique, with 20 adults of both genders. Twelve adults were interviewed and two focus groups with four adults each were conducted. Data were processed with the Max qualitative data analysis (MAXQDA) computer program for content analysis. All guidelines of the Declaration of Helsinki, 2013 revision were followed. Results: the 20 participants have a basic knowledge about the disease, however there are concept errors. Regarding the cause the most frequent answer was that cholera is caused by poor personal, collective or food hygiene. About home treatment the most frequent answer was ignorance followed by oral hydration. Misconceptions were found about cholera transmission (12 participants), prevention (8), cause (3), concept (2), and treatment (1). There is a belief in the community that government agents are responsible for cholera outbreaks in the neighborhood. Conclusion: we consider it necessary to conduct health education activities with the urban population about this disease, focusing on transmission and prevention. Translated with www.DeepL.com/Translator (free version)