When it rains, it pours: detecting seasonal patterns in utilization of maternal healthcare in Mozambique using routine data

Abstract

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.

Spatial accessibility of continuous maternal and perinatal healthcare services in Mozambique

“…In our study, Maputo City was found to be the only city located in the southern region that provided effective access to three service packages investigated, which was consistent with previous ndings from other studies that 46% of pregnant women residing in southern Mozambique were able to access the nearest primary healthcare institute within 1-hour walking distance, while the other 64% of women living in the region were able to receive life-saving service delivery within 2 hours 35 . In addition, the frequent occurrence of natural disasters that posed huge hinderance to healthcare service delivery procedures further added to health inequity between southern and northern regions, leading to lower rates of both ANC and ID visits in the southern region, corresponding to 74 additional maternal deaths and 726 additional deaths of children under the age of 1 month by the end of 2021 37 . Under such circumstances, effective activities to address such inequity issue should include the implementation of decentralized allocation strategies, which has been recognized as an effective measure to facilitate the promotion of both accessibility and coverage of maternal health resources, thus contributing to higher hospital delivery rates as well as the reduction of both maternal and newborn mortality China's successful experience provides valuable lessons for other nations confronted with similar challenges 40 .…”

Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systems

“…Examining reporting over time was important for understanding reporting seasonality and changes to the health information systems relative to potential changes due to COVID-19. In countries with marked changes in climatic conditions, existing studies show that seasonal pattern exists between disease incidence (e.g., malaria, cholera, respiratory diseases) or health outcome and utilization of MCH services ( 26 – 28 ).…”

Peripartum access to care in Mozambique: Opportunities for reducing maternal mortality

“…In that period there was reduction of around 6% less in maternal health service utilisation in all during rainfall season, except in the 2 biggest cities in the country (Maputo and Nampula) and 2 of the less populated provinces (Maputo and Niassa). (26) Despite 96% healthcare facilities having access to an ambulance for referrals, women identify lack of transport to bring women from the community to the healthcare facility as a major barrier to use of maternal care services in southern Mozambique. (27) We suggest that women's perception of 3rd phase delays in health facilities, lack of equipment, shortage of supervisors, irregular drug availability, absence of integration of care and lack of multidisciplinary teams as additional barriers at health system level.…”