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.

Background: High maternal and neonatal mortality rates in Mozambique, are due to adolescent pregnancies, difficulties in accessing health services, traditional constraints, and gender inequalities. An implementation research project, Alert Community to Prepared Hospital in Natikiri, Nampula, Mozambique was developed to reduce maternal and new-born mortality. From 2016 to 2020, it implemented activities to improve population knowledge and function in sexual and reproductive health, and to enable community participation in maternal health services. In this paper we will assess and discuss the impact of community participation on improving sexual and reproductive health.Methods: Implementation research with community intervention and programmed mid-term evaluations, using mixed methods research, with descriptive quantitative surveys and qualitative focus groups discussions and interviews, applied from 2017 to 2020. Local health committees, traditional birth attendants, traditional healers and local leadership all participated: trained in sexual and reproductive health and participated in radio discussion groups; community and hospital members of the co-management committee enabled local programming. Maternal and child health indicators were evaluated with health unit’s operational data. Quantitative data were captured in Microsoft Office Excel, analysed with SPSS21 to find frequency, percentage, mean and standard deviation; qualitative data registered in Word was analysed with NVIVO. This research received bioethical approvals from both the Mozambique and Canadian universities and followed Helsinki Declaration recommendations.Results: Comparing changes from 2016 to 2019, the number of health committees operating in Natikiri rose from 7 to 20. Each committee integrated four Family Health Champions, who attained 24738 residents with health education interventions on reproductive health. A theatre group developed dramas about the same key messages, presented in communities. Population access to contraceptives was facilitated, from 42% to 91% in women and from 65% to 90% in men. At Marrere Health Centre, women with four ante-natal visits rose by 185%, and children less than one year of age’ visits 89%; at Marrere General Hospital deliveries rose 60%.Conclusion: Community participation, at all levels of maternal and child health service care continuum, from community to hospital, enhanced with complementary interventions well contextualised, is effective in improving adolescent and adult sexual and reproductive health.Trial registrationThis study was not registered in any data base.

Introduction: Hansen's disease is no longer a public health problem in Mozambique, since 2008 (incidence under 1 / 10,000 inhabitants). The country is one of the most affected in the world and Nampula province's Murrupula district (incidence 1.7 / 10,000) has a high deformity rate (22% in 2010). This study aimed to identify high deformity rate associated determinants and proposals for better health program results. Methods: This study involved a descriptive quantitative survey, systematic observation of patients and health professionals, and a survey of community volunteers. Data were analyzed using Epi Info 7.2. Pearson's chi-square and Fisher's exact test were used to assess statistical association with deformity, with a significance level of 5% and 95% confidence interval. Ethical procedures followed the Helsinki declaration (2013). Results: Among 238 subjects, 175 were patients and 63 leprosy health staff. Most patients relied on subsistence agriculture facing social exclusion (43, 25%). The waiting time from first symptoms to diagnosis was over one year for 63%. Deformity affected 116 subjects (68%), particularly those who considered the disease as God's desire (p = 0.01), and practiced traditional treatments (p = 0.001). Among leprosy health staff, 35 (52%) were not trained on diagnosis and management. Conclusions: High deformity rate is associated with low economic status, the belief that the disease is God's desire, the use of traditional healers, late diagnosis, and poor disease management. A health education program targeting professionals and population, with infection screening and selfcare groups can prevent deformities.

BackgroundThe Covid-19 pandemic limited access to health services in most countries, impacting negatively global health. Last March 2020 in Mozambique, a public state of emergency restrained people’s movements, reduced public services, and launched a national information campaign. The Alert Community for a Prepared Hospital implementation research, has been promoting access to maternal and child health care, at Marrere General Hospital and Marrere Health Centre, in Natikiri, Nampula, the city with the third highest incidence of Covid-19 in Mozambique. Our research aimed to assess the impact of Covid-19 on access to maternal and children health services in Nampula and estimate Alert Community for a Prepared Hospital project sustainability.MethodsMixed-methods research, descriptive, cross-sectional, and retrospective, using review of patient visits documentation, comparing March to May 2019 to same months in 2020, and interviews with health professionals, traditional birth attendants and patients. We involved two health centres and two hospitals. The two Marrere centres were Alert Community for a Prepared Hospital intervention centres, and the other two were control centres, compared using KrushKall Wallis, One-way Anova, mean and standard deviation tests.ResultsComparing 2019 maternal health services indicators with those from 2020, the intervention area had decreases of 28% in family planning visits, 26% in women in first ante-natal visits in the first trimester, and a 74% increase in home deliveries, all without statistical significance. The decrease in hospital maternity deliveries (4%) was statistically significant (p=0.046). The non-intervention area showed a decrease in women in first ante-natal visits in the first trimester (12%). Concerning child health, the intervention area had a 20% reduction in children presenting for vaccination and an 18% in children completely vaccinated, comparable to a reduction of 16% in the non-intervention area. Interviews revealed that most health professionals, traditional birth attendants and patients, have adequate knowledge about Covid-19. ConclusionOur results demonstrate negative collateral effects of Covid-19 on maternal and child health access and a deficient health information system in Mozambique. The Government’s media campaign promoting access to preventive health services, is not achieving its aim. The Alert Community project will need further research, to assess lasting effect on reducing the negative effects of Covid-19 on sexual and reproductive health.Trial registrationThis study was not registered in any data base.

Background: Access to and quality of maternal and child health services are essential to reduce morbidity and mortality in these groups, which are extremely high in Africa, including Mozambique. The reasons for this are complex but one important factor is the availability of efficient, timely, patient centred antenatal care for all pregnant women. Antenatal visits are important, and they should be performed as early as possible during pregnancy. To contribute to reduce maternal and new-born mortality rates in Nampula, the Faculty of Health Sciences at Lúrio University and the University of Saskatchewan, carried out an implementation research, including training activities for local health units’ professionals in maternal and child health care. This research will assess the impact of health professionals training in ​​maternal and child health, on the quality of services of antenatal visits at the Marrere Health Centre in Nampula, Mozambique. Methods: Descriptive, quantitative pre-post study, applying three cross-sectional surveys on user’s opinion about antenatal visit quality. The baseline surveys included a sample of women in antenatal consultation (with a 10% margin error and 90% confidence interval) and for post surveys, after completion of four and eight professional training modules, the samples were calculated with a 95% confidence interval and a 5% margin of error. The three groups of different subjects underwent a private survey, using a five-point Likert scale, after signing an informed consent form. The surveys were entered into a database, and analysed to assess frequency, percentage, average and standard deviation. This research was approved by the Lúrio University and the University of Saskatchewan’ Bioethics Committees. Results: 309 pregnant women were surveyed during antenatal visits, and the principles of good care assessment shows a positive evolution about communication and information; some shortcomings persist. Regarding labour conditions and new-born care, we see a positive evolution, such as with receiving information about the right they have to a companion during childbirth (72.9%, namely a traditional birth attendant) and the importance to start breastfeeding in the first hour following delivery (88.7%). Pregnant women globally rated their experience in antenatal consultation in 2019 as excellent (42.5%) and good (48%). The evolution of this service, however, was unfavourable in terms of privacy. Conclusion: Antenatal visits quality at Marrere Health Centre, in the users’ opinion, improved and health professionals are practising according to the national Ministry of Health protocol, yet with some deficiencies in information and communication, to overcome by continuous professional development. The women’ low level of schooling, needs an information campaign on sexual and reproductive health and family planning, widely disseminated in rural communities and among most disadvantaged populations.