Public health risks of humanitarian crises in Mozambique

Coproducing Quality and Safety Improvement Projects in Resource-Constrained Countries: Lessons From Mozambique

Objectives

Mozambique is a large country with low GDP and dispersed population. The health service has limited human and physical resources. These constraints have the potential to result in poor quality of care with an impact on patient safety and person experience.

Methods

This paper is a "before and after" assessment of a quality and safety improvement project based on a qualitative and quantitative review.

Results

Four case studies illustrate the success of the programme with gains in terms of reduction of maternal death and Key lessons are that aid agencies need to coproduce solutions with the local MoH and clinical teams so that there is ownership of the programme. Thus, all interventions need to be financially light, i.e., aiming to achieve success with minimal funding, so that when the programme ends there is a sustainable plan that can be maintained.

Conclusion

In this review of quality improvement initiatives in Mozambican hospitals we have demonstrated the potential to enhance patient outcomes despite resource constraints. The key to the success of the initiative has been collaborative work as equal partners.

Classifying disaster risk reduction strategies: conceptualizing and testing a novel integrated approach

BACKGROUND

Although disaster risk reduction (DRR) addresses underlying causes and has been shown to be more cost-effective than other emergency management efforts, there is lack of systematized DRR categorization, leading to insufficient coherence in the terminology, planning, and implementation of DRR. The aim of this study was to conceptualize and test a novel integrated DRR framework that highlights the intersection between two existing classification systems.

METHODS

Grounded theory was used to conceptualize a novel DRR framework. Next, deductive conceptual content analysis was used to categorize interventions from the 2019 Cities100 Report into the proposed DRR framework. The term "connection" indicates that an intervention can be categorized into a particular section of the novel integrated approach. A "connection" was determined to be present when the intervention description stated an explicit connection to health and to the concept within one of the categories from the novel approach. Further descriptive statistics were used to give insight into the distribution of DRR interventions across categories and into the application of the proposed framework.

RESULTS

The resulting framework contains nine intersecting categories: "hazard, prospective", "hazard, corrective", "hazard, compensatory", "exposure, prospective", "exposure, corrective", "exposure, compensatory", "vulnerability, prospective", "vulnerability, corrective", and "vulnerability, compensatory". The thematic analysis elucidated trends and gaps in the types of interventions used within the 2019 Cities100 Report. For instance, exposure-prospective, exposure-compensatory, and vulnerability-compensatory were the most under-utilized strategies, accounting for only 3% of the total interventions. Further descriptive statistics showed that upper middle-income countries favored "hazard, corrective" strategies over other DRR categories while lower middle-income countries favored "exposure, corrective" over other DRR strategies. Finally, European cities had the highest percentage of DRR connections (51.39%) compared to the maximum possible DRR connections, while African cities had the lowest percentage of DRR connections (22.22%).

CONCLUSIONS

The study suggests that the proposed DRR framework could potentially be used to systematically evaluate DRR interventions for missing elements, aiding in the design of more equitable and comprehensive DRR strategies.

The impact of COVID-19 on self-reported burnout and health and mental health services in Nampula, Mozambique

Background

The purpose of this study was to examine the impact of the COVID-19 pandemic on self-reported burnout of health workers, quality of care, and perceptions of COVID-19-related stigma in Mozambique.

Method

We conducted a cross-sectional quantitative assessment of 170 frontline health workers in Nampula District, Mozambique, including 149 (87.6%) primary care providers and 21 (12.4%) mental health specialists.

Results

Of the 170 frontline workers, only 10.1% of frontline workers were experiencing more professional burnout, whereas 33.3% felt it had lessened. The perceived impact on quality of care also varied, without any significant differences by sex, education level, or mental health training background. Compared to the beginning of the COVID-19 pandemic in March 2020, 42.3 and 38.1% providers felt that their ability to provide mental health and general health care, respectively, had worsened, compared to 57.7 and 61.9% who believed that either there was no change, or that the work had become easier. Likewise, 26.8% of providers felt that their ability to meet patients' needs had gotten more difficult, whereas 43.4% reported no change and 29.8% reported that it was easier. Twenty-two percent of providers reported an overall increase in caseloads since before the pandemic whereas the majority (67.9%) reported a decrease. Providers believed that 57.1% of people in general were afraid of people with COVID-19, 27.5% were afraid of a person recovered from COVID-19, and 39.9% were afraid of a person with family members with COVID-19. The perceived stigma about healthcare professionals was also low; only 27.4% believed that people in general were afraid of healthcare providers who deliver care to people with COVID-19.

Conclusion

In contrast with other global studies, many healthcare workers in our sample reported a reduction in burnout, which may be associated with the lower overall caseloads seen during this period. Similarly, the quality of care was minimally impacted. More research is needed to determine whether the experience in Mozambique is unique, or similarly observed in other low-resource settings.

Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice

OBJECTIVE

Immunisations are highly impactful, cost-effective public health interventions. However, substantial gaps in complete vaccination coverage persist. We aimed to describe caregivers' immunisation experiences and identify determinants of vaccine dropout.

DESIGN

We used a community-based participatory research approach employing Photovoice, SMS (short messaging service) exchanges and in-depth interviews. A team-based approach was used for thematic analysis. The Increasing Vaccination Model guided the analysis and identification of vaccination facilitators and barriers.

SETTING

This study was conducted in Zambézia province, Mozambique, in Namarroi and Gilé districts, where roughly 19% of children under 2 start but do not complete the recommended vaccination schedule.

PARTICIPANTS

Participants were identified through health facility vaccination records and included caregivers of children aged 25-34 months who were fully vaccinated (n=10) and partially vaccinated (n=22). We also collected data from 12 health workers responsible for delivering immunisations at the selected health facilities.

RESULTS

Four main patterns of barriers leading to dropout emerged: (1) social norms and limited family support place the immunisation burden on mothers; (2) perceived poor quality of health services reduces caregivers' trust in vaccination services; (3) concern about side effects causes vaccine hesitancy; and (4) caregivers hesitate to seek and advocate for vaccination due to power imbalances with health workers. COVID-19 created additional barriers related to social distancing, mask requirements, supply chain challenges and disrupted outreach services. For most caregivers, dropout becomes increasingly likely with compounding barriers. Caregivers of fully-vaccinated children noted facilitators, including accompaniment to health facilities or assistance caring for other children, which enabled them to complete vaccination.

CONCLUSIONS

Overcoming immunisation barriers requires strengthening health systems, including improving logistics to avert vaccine stockouts and building health worker capacity, including empathic communication with caregivers. Consistent and reliable immunisation outreach services could address access challenges and improve immunisation uptake, particularly in distant communities.