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. 2022 Sep 15;10(Suppl 1):e2100796.
doi: 10.9745/GHSP-D-21-00796. Print 2022 Sep 15.

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

Affiliations

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

Quinhas Fernandes et al. Glob Health Sci Pract. .

Abstract

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.

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Figures

FIGURE 1
FIGURE 1
Map of Sofala and Manica Provinces in Mozambique
FIGURE 2
FIGURE 2
Average Counts for Service Delivery Indicators in 25 Districts Before and After Cyclone Idai in Sofala and Manica Provinces, Mozambiquea Abbreviations: ANC, antenatal care; BCG, bacillus Calmette-Guerin; CCR, child at risk consultation; DPT-Hib3, diphtheria, pertussis, tetanus, and Haemophilus influenzae type b; FP, family planning; IPTp4, at least 4 doses of intermittent preventive treatment prophylaxis. aCyclone Idai March 2019 (dashed red line); observed counts (dots); model expected under Idai (solid thick line) and its 95% confidence interval (dashed lines); counterfactual model expected without Idai (solid thin line).
FIGURE 3
FIGURE 3
Relative Losses After Cyclone Idai, by Service Delivery Indicator and District-Level Destruction Strata, Sofala and Manica Provinces, Mozambique Abbreviations: ANC, antenatal care; BCG, bacillus Calmette-Guerin; CCR, child at risk consultation; DPT-Hib3, diphtheria, pertussis, tetanus, and Haemophilus influenzae type b; FP, family planning; IPTp4, at least 4 doses of intermittent preventive treatment prophylaxis.

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