RT Journal Article
SR Electronic
T1 Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2100796
DO 10.9745/GHSP-D-21-00796
VO 10
IS Supplement 1
A1 Fernandes, Quinhas
A1 Augusto, Orvalho
A1 Chicumbe, Sérgio
A1 Anselmi, Laura
A1 Wagenaar, Bradley H.
A1 Marlene, Rosa
A1 Agostinho, Sãozinha
A1 Gimbel, Sarah
A1 Pfeiffer, James
A1 Inguane, Celso
A1 Uetela, Dorlim Moiana
A1 Crocker, Jonny
A1 Ramiro, Isaías
A1 Matsinhe, Benigna
A1 Tembe, Stélio
A1 Carimo, Naziat
A1 Gloyd, Stephen
A1 Manhiça, Ivan
A1 Tavede, Esperança
A1 Felimone, Priscilla
A1 Sherr, Kenneth
YR 2022
UL http://www.ghspjournal.org/content/10/Supplement_1/e2100796.abstract
AB Key FindingsSubstantial disruptions in service delivery were observed immediately after Cyclone Idai, with severely affected districts showing greater disruptions. Overall, first antenatal care visits, postpartum visits within 3–7 days, new family planning users, measles vaccinations, first at-risk children’s consultations, and fully immunized children under age 1 were the most affected indicators.Within 3 months of the cyclone, we observed the recovery, across all districts, of indicators to levels equal to or higher than pre-Idai. This quick recovery showcases Mozambique’s health system resilience, particularly in the central region.Implementation research methods combined with high-quality routine data provide relevant evidence to support policy making and strategic decisions, particularly in scenarios of extreme weather events such as Cyclone Idai; therefore, they should be prioritized.Key ImplicationWhile maternal and child health care delivery is negatively impacted by extreme weather events, lessons learned from the recovery process can help strengthen health systems. Policy makers should prioritize routine health information data as a valuable tool for tracking health system resilience.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.