Background Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. Methods We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban–rural residence and educational status (primary or less versus secondary or higher education). Results In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000–2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10–14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban–rural and wealth-related inequalities remained stagnant or widened during 2000–2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. Conclusion Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

Background Over the past 20 years, Mozambique has achieved substantial reductions in maternal, neonatal, and child mortality. However, mortality rates are still high, and to achieve the Sustainable Development Goals (SDGs) for maternal and child health, further gains are needed. One technique that can guide policy makers to more effectively allocate health resources is to model the coverage increases and lives saved that would be achieved if trends continue as they have in the past, and under differing alternative scenarios. Methods We used historical coverage data to project future coverage levels for 22 child and maternal interventions for 2015-2030 using a Bayesian regression model. We then used the Lives Saved Tool (LiST) to estimate the additional lives saved by the projected coverage increases, and the further child lives saved if Mozambique were to achieve universal coverage levels of selected individual interventions. Results If historical trends continue, coverage of all interventions will increase from 2015 to 2030. As a result, 180 080 child lives (0-59 months) and 3640 maternal lives will be saved that would not be saved if coverage instead stays constant from 2015 to 2030. Most child lives will be saved by preventing malaria deaths: 40.9% of the mortality reduction will come from increased coverage of artemisinin-based compounds for malaria treatment (ACTs) and insecticide treated bednets (ITNs). Most maternal lives will be saved from increased labor and delivery management (29.4%) and clean birth practices (17.1%). The biggest opportunity to save even more lives, beyond those expected by historical trends, is to further invest in malaria treatment. If coverage of ACTs was increased to 90% in 2030, rather than the anticipated coverage of 68.4% in 2030, an additional 3456 child lives would be saved per year. Conclusions Mozambique can expect to see continued reductions in mortality rates in the coming years, although due to population growth the absolute number of child deaths will decrease only marginally, the absolute number of maternal deaths will continue to increase, and the country will not achieve current SDG targets for either child or maternal mortality. Significant further health investments are needed to eliminate all preventable child and maternal deaths in the coming decades.

Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission of HIV. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban–rural disparities. Methods HIV prevalence data at ages 15–19 years were obtained for 31 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Country medians and average annual rates of changes were used to summarize the trends for two subregions in sub-Saharan Africa, Eastern and Southern Africa and West and Central Africa, which largely correspond with higher and lower HIV prevalence countries. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban–rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in eastern and Southern Africa from 5.7 to 2.6% during 2005–2015 (country median), corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1 to 1.2%. Changes were also observed in West and Central Africa where median HIV prevalence among girls decreased from 0.7 to 0.4% (average annual rate of reduction 5.9%), but not for boys (0.3%). Girl-boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts in both subregions, and since the urban–rural declines were similar, the gaps persisted during 2005–2015. Conclusions HIV prevalence among adolescents declined in almost all countries during the last decade, in both urban and rural settings. The urban–rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in Eastern and Southern African countries.

Background Despite substantial investment in women’s health over the past two decades, and enthusiastic government support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest in the world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408; the estimated HIV prevalence for women of 15–24 years is over twice that for men; and only 12.1% of women are estimated to be using modern contraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates on the challenges that are preventing Mozambique from achieving greater gains in women’s health. Methods We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health and affiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic random sampling and snowball sampling. Participants were asked about their experiences formulating and implementing health policies and programs, what is needed to improve women’s health in Mozambique, and the barriers and opportunities to achieving such improvement. Results Participants unanimously argued that women’s health is already sufficiently prioritized in national health policies and strategies in Mozambique; the problem, rather, is the implementation and execution of existing women’s health policies and programs. Participants raised challenges related to the policy making process itself, including an ever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignment of programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership, rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported a disconnect between policy makers at the national level and realities on the ground, with poor dissemination of strategies, limited district resources, and poor consideration of local cultural contexts. Conclusions To achieve meaningful gains in women’s health in Mozambique, more focus must be placed on resolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiple health systems components, therefore, solutions to address them must also reach across these multiple components. A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed.

Introduction: Globally, anemia is still a public health issue faced by people in low and high-income countries. This study gives an overview of published scientific articles related to the prevalence, nutritional indicators, and social determinants of anemia in pregnant women and children aged 6 to 59 months living in Mozambique and Portugal. Methods: We performed a review of scientific literature in April 2021, searching for published indexed articles in the last 15 years (2003–2018) in electronic databases. Subsequently, quality assessment, data extraction, and content analysis were performed. Results: We have identified 20 relevant publications. Unsurprisingly, anemia plays a relevant role in disability and life imbalances for these subgroups in Mozambique compared with Portugal. For both countries, data on anemia and iron deficiency in pregnant women and children aged 6 to 59 months old are either outdated or remain unclear. Similarly, studies on social determinants and anemia are also still scarce. Conclusions: A gap of information on anemia, other nutritional indicators, and social determinants in pregnant women and children between 6 and 59 months of age living in Mozambique and Portugal is highly observed. More research is crucial to help achieve the goals established by the Sustainable Development Goals.

Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. Methods HIV prevalence data were obtained for 30 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Countries were grouped into 2% or higher and lower than 2% HIV prevalence among girls 15–19 years in the first survey. Country medians and average annual rates of changes were used to summarize the trends. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in the higher HIV prevalence group from 5.7–2.6% during 2005–2015, corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1–1.2% in the higher prevalence group. Smaller changes were observed in the lower prevalence country group where median HIV prevalence among girls decreased from 0.7–0.4% (average annual rate of reduction 5.9%). Girl – boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts, and all experienced similar declines during 2005–2015. Condom use and HIV testing increased among adolescents in both higher and lower prevalence countries, but indicators of sexual activity showed little change over time. Conclusions HIV prevalence declined in almost all countries during the last decade, in both urban and rural settings, for both sexes. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in eastern and southern African countries.

Background: malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. The insecticide-treated bed nets (ITNs) is one of malaria control strategies that, due to its cost effectiveness, is largely used in the country. Data on the actual coverage and usage of bed nets is unreliable, as it is based only on administrative data from distributed ITNs. Objective: this study assesses knowledge about malaria and bed net use in two areas of high malaria transmission. Methods: a qualitative study was conducted in 6 (six) rural communities in two malaria high burden districts in Zambézia province. About 96 adults were recruited from the communities and enrolled to participate in focus group discussions. Data were transcribed verbatim, coded and thematically analysed using Nvivo11.0. Results: participants mentioned the mosquito as the only cause of malaria and that the use of bed nets was highlighted as the most proficient protection against mosquito bites and malaria. Children and pregnant women were described as being the priority groups to sleep under a bed net protection in the household. The use of bed nets was common among households, although not sufficient for the number of household members. In addition, the preservation of the nets was considered inadequate. Conclusions: the findings of this study highlight the need to increase public knowledge about malaria and nets and to strengthen the communication and logistics component of the net distribution campaign to ensure that households have enough nets for their members and use them appropriately.

BackgroundAchieving significant female representation in government at decision-making levels has been identified as a key step towards achieving gender equality. In 2015, women held 39.6% of parliamentary seats in Mozambique, which is above the benchmark of 30% that has been suggested as the turning point for minority representation to move from token status to having a sizable impact. We undertook a study to identify gender-related barriers and facilitators to improving women-centered policies in the health sector.MethodsWe conducted in-depth interviews with 39 individuals (32 women, 7 men) involved at a senior level in policy making or implementation of woman-centric policies within the Mozambique Ministry of Health and affiliated institutions. We used a semi-structured interview guide that included questions on difficulties and facilitating factors encountered in the policy making process, and the perceived role of gender in this process. We used both deductive and inductive analysis approaches, starting with a set of pre-identified themes and expanding this to include themes that emerged during coding.ResultsOur data suggest two main findings: (1) the women who participated in our study generally do not report feeling discrimination in the workplace and (2) senior health sector perceive women to be more personally attuned to women-centric issues than men. Within our specific sample, we found little to suggest that gender discrimination is a problem professionally for female decision-makers in Mozambique. However, these findings should be contextualized using an intersectional lens with recognition of the important difference between descriptive versus substantive female representation, and whether “percentage of women” is truly the best metric for gaging commitment to gender equality at the policy making level.ConclusionsMozambique’s longstanding significant representation of women may have led to creating an environment that leads to positive experiences for female decision-makers in the government. However, while the current level of female representation should be celebrated, it does not negate the need for continued focus on female representation in decision-making positions.