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Background: The healthcare system in Mozambique is striving to reduce the high maternal and child mortality rates and stay on par with the Sustainable Development Goals (SDG 3.1). A key strategy to curb maternal and child mortality is to promote the use of professional childbirth services proven to be highly effective in averting maternal deaths. Currently, little is known about the use of childbirth services in Mozambique. The present study investigated the prevalence of professional healthcare delivery services and identified their sociodemographic correlates. Methods: This study used cross-sectional data on 7080 women aged 15–49 years who reported having a child during the past 5 years. The data were collected from the 2011Mozambique Demographic and Health Survey. The outcome variables were the choice of childbirth services that included 1) place of delivery (respondent's home versus health facility), and mode of delivery (caesarean section versus vaginal birth). Data were analyzed using descriptive and multivariate regression methods. Results: The prevalence of health facility and C-section delivery was 70.7 and 5.6%, respectively. There was a difference in the use of professional birthing services between urban and rural areas. Having better educational status and living in households of higher wealth quintiles showed a positive association with the use of facility delivery services among both urban and rural residents. Regarding ethnicity, women of Portugais [2.688,1.540,4.692], Cindau [1.876,1.423,2.474] and Xichangana [1.557,1.215,1.996] had relatively higher odds of using facility delivery services than others. Antenatal care (ANC) visits were a significant predictor of facility delivery services both in urban [OR = 1.655, 95%CI = 1.235,2.218] and rural [OR = 1.265, 95%CI = 1.108,1.445] areas. Among rural women, ANC visit was a significant predictor of C-section delivery [1.570,1.042,2.365]. Conclusion: More than a quarter of the women in Mozambique were not using health facility delivery services, with the prevalence being noticeably lower in the rural areas. [ABSTRACT FROM AUTHOR]

Background: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission.Methods: P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery.Results: P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (-1.17 g/dL, 95% CI -2.09 to -0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (-1.66 g/dL, 95% CI -2.68 to -0.64) and Gabonese (-0.91 g/dL, 95% CI -1.79 to -0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (-0.16 g/dL, 95% CI -0.29 to -0.02) and increases in the drop of haemoglobin levels (-0.29 g/dL, 95% CI -0.44 to -0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417).Conclusions: The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease.Trial Registration: ClinicalTrials.gov NCT00811421 . Registered 18 December 2008. [ABSTRACT FROM AUTHOR]

Background: In countries, such as Mozambique, where maternal mortality remains high, the greatest contribution of mortality comes from the poor and vulnerable communities, who frequently reside in remote and rural areas with limited access to health care services. This study aimed to understand women's health care seeking practices during pregnancy, taking into account the underlying social, cultural and structural barriers to accessing timely appropriate care in Maputo and Gaza Provinces, southern Mozambique. Methods: This ethnographic study collected data through in-depth interviews and focus group discussions with women of reproductive age, including pregnant women, as well as household-level decision makers (partners, mothers and mothers-in-law), traditional healers, matrons, and primary health care providers. Data was analysed thematically using NVivo 10. Results: Antenatal care was sought at the heath facility for the purpose of opening the antenatal record. Women without antenatal cards feared mistreatment during labour. Antenatal care was also sought to resolve discomforts, such as headaches, flu-like symptoms, body pain and backache. However, partners and husbands considered lower abdominal pain as the only symptom requiring care and discouraged women from revealing their pregnancy early in gestation. Health care providers for pregnant women often included those at the health facility, matrons, elders, traditional birth attendants, and community health workers. Although seeking care from traditional healers was discouraged during the antenatal period, they did provide services during pregnancy and after delivery. Besides household-level decision-makers, matrons, community health workers, and neighbours were key actors in the referral of pregnant women. The decision-making process may be delayed and particularly complex if an emergency occurs in their absence. Limited access to transport and money makes the decision-making process to seek care at the health facility even more complex. Conclusions: Women do seek antenatal care at health facilities, despite the presence of other health care providers in the community. There are important factors that prevent timely care-seeking for obstetric emergencies and delivery. Unfamiliarity with warning signs, especially among partners, discouragement from revealing pregnancy early in gestation, complex and untimely decision-making processes, fear of mistreatment by health-care providers, lack of transport and financial constraints were the most commonly cited barriers. Women of reproductive age would benefit from community saving schemes for transport and medication, which in turn would improve their birth preparedness and emergency readiness; in addition, pregnancy follow-up should include key family members, and community-based health care providers should encourage prompt referrals to health facilities, when appropriate. [ABSTRACT FROM AUTHOR]

Background: Climatic conditions and seasonal trends can affect population health, but typically, we consider the effect of climate on the epidemiology of communicable diseases. However, climate can also have an effect on access to care, particularly in remote rural areas of low- and middle-income countries. In this study, we investigate associations between the rainy season and the utilization of maternal health services in Mozambique.Methods: We examined patterns in the number of women receiving antenatal care (ANC) and delivering at a health facility for 2012-2019, using data from Mozambique's Health Management Information Systems. We investigated the association between seasonality (rainfall) and maternal health service utilization (ANC and institutional delivery) at national and provincial level. We fit a negative binomial regression model for institutional delivery and used it to estimate the yearly reduction in institutional deliveries due to the rainy season, with other factors held constant. We used the Lives Saved Tool (LiST) to model increases in mortality due to this estimated decrease in institutional delivery associated with the rainy season.Results: In our national analysis, the rate of ANC visits was 1% lower during the rainy season, adjusting for year and province (IRR = 0.99, 95% CI: 0.96-1.03). The rate of institutional deliveries was 6% lower during the rainy season than the dry season, after adjusting for time and province (IRR = 0.94, 95% CI: 0.92-0.96). In provincial analyses, all provinces except for Maputo-Cidade, Maputo-Province, Nampula, and Niassa showed a statistically significantly lower rate of institutional deliveries in the rainy season. None were statistically significantly lower for ANC. We estimate that, due to reductions in institutional delivery attributable only to the rainy season, there were 74 additional maternal deaths and 726 additional deaths of children under the age of 1 month in 2021, that would not have died if the mothers had instead delivered at a facility.Conclusion: Fewer women deliver at a health facility during the rainy season in Mozambique than during the dry season. Barriers to receiving care during pregnancy and childbirth must be addressed using a multisectoral approach, considering the impact of geographical inequities. [ABSTRACT FROM AUTHOR]