Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis.

Autor:	Fernandes Q; National Directorate of Public Health, Ministry of Health, Mozambique. ferq09@gmail.com.; Department of Global Health, University of Washington, Seattle, WA, USA., Augusto O; Department of Global Health, University of Washington, Seattle, WA, USA.; Eduardo Mondlane University, Maputo, Mozambique., Chicumbe S; Instituto Nacional de Saúde, Ministry of Health, Mozambique., Anselmi L; Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom., Wagenaar BH; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Epidemiology, University of Washington, Seattle, WA, USA., Marlene R; Mozambique Permanent Mission, Geneva, Switzerland., Agostinho S; National Directorate of Planning and Cooperation, Ministry of Health, Mozambique., Gimbel S; Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA., Pfeiffer J; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Anthropology, University of Washington, Seattle, WA, USA., Inguane C; Department of Global Health, University of Washington, Seattle, WA, USA., Uetela DM; Department of Global Health, University of Washington, Seattle, WA, USA.; Instituto Nacional de Saúde, Ministry of Health, Mozambique., Crocker J; Department of Global Health, University of Washington, Seattle, WA, USA., Ramiro I; Comité para a Saúde de Moçambique, Maputo, Mozambique., Matsinhe B; National Directorate of Public Health, Ministry of Health, Mozambique., Tembe S; National Directorate of Public Health, Ministry of Health, Mozambique.; Department of Global Health, University of Washington, Seattle, WA, USA., Carimo N; Department of Global Health, University of Washington, Seattle, WA, USA., Gloyd S; Department of Global Health, University of Washington, Seattle, WA, USA., Manhiça I; National Directorate of Public Health, Ministry of Health, Mozambique., Tavede E; Provincial Social Affairs Services, Manica, Mozambique., Felimone P; Provincial Social Affairs Services, Sofala, Mozambique., Sherr K; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Epidemiology, University of Washington, Seattle, WA, USA.; Department of Industrial & Systems Engineering, University of Washington.
Jazyk:	angličtina
Zdroj:	Global health, science and practice [Glob Health Sci Pract] 2022 Sep 15; Vol. 10 (Suppl 1). Date of Electronic Publication: 2022 Sep 15 (Print Publication: 2022).
DOI:	10.9745/GHSP-D-21-00796
Abstrakt:	Introduction: Climate change-related extreme weather events have increased in frequency and intensity, threatening people's health, particularly in places with weak health systems. In March 2019, Cyclone Idai devastated Mozambique's central region, causing infrastructure destruction, population displacement, and death. We assessed the impact of Idai on maternal and child health services and recovery in the Sofala and Manica provinces. Methods: Using monthly district-level routine data from November 2016 to March 2020, we performed an uncontrolled interrupted time series analysis to assess changes in 10 maternal and child health indicators in all 25 districts before and after Idai. We applied a Bayesian hierarchical negative binomial model with district-level random intercepts and slopes to estimate Idai-related service disruptions and recovery. Results: Of the 4.44 million people in Sofala and Manica, 1.83 (41.2%) million were affected. Buzi, Nhamatanda, and Dondo (all in Sofala province) had the highest proportion of people affected. After Idai, all 10 indicators showed an abrupt substantial decrease. First antenatal care visits per 100,000 women of reproductive age decreased by 23% (95% confidence interval [CI]=0.62, 0.96) in March and 11% (95% CI=0.75, 1.07) in April. BCG vaccinations per 1,000 children under age 5 years declined by 21% (95% CI=0.69, 0.90) and measles vaccinations decreased by 25% (95% CI=0.64, 0.87) in March and remained similar in April. Within 3 months post-cyclone, almost all districts recovered to pre-Idai levels, including Buzi, which showed a 22% and 13% relative increase in the number of first antenatal care visits and BCG, respectively. Conclusion: We found substantial health service disruptions immediately after Idai, with greater impact in the most affected districts. The findings suggest impressive recovery post-Idai, emphasizing the need to build resilient health systems to ensure quality health care during and after natural disasters. (© Fernandes et al.)
Databáze:	MEDLINE
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