Maternal and Child Health Implementation Research in Mozambique: Effective Community Interventions to Promote Sexual and Reproductive Health

Abstract

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.

Operational Research on Transformative Education about Health and Sexual and Reproductive Rights During Adolescents’ Initiation Rituals

“…The teaching about respecting one's partner is mentioned by 13 interviewees: respecting the difference, respecting the partner when getting married, taking good care of each other and the house, knowing how to talk about problems, not cheating, when the woman doesn't want to have sex, she shouldn't be forced to; however, this orientation is stronger for the woman in relation to the man. Four interviewees (one woman) do not address this issue [3].…”

Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature

“…Studies were published between 2020 and 2023 solely in English. Overall, 14 studies reported data from four low-income countries (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47), 21 studies were focused on 13 lower-middle income countries , seven studies were conducted in five upper-middle income countries (69)(70)(71)(72)(73)(74)(75) and three were multi-centred (76)(77)(78). Out of 45 included studies, 11 studies were cross-sectional (41, 45, 48, 51, 55-57, 65, 69, 70, 76), 14 were pre-post studies (34,38,49,50,52,53,56,62,64,(72)(73)(74)(75)77), nine were time-series (35,37,39,43,58,59,67,71,78), five were mixed methods (36,…”

“…Included studies showed mixed results concerning institutional deliveries that comprise normal vaginal deliveries and caesarean sections. Even though eight studies highlighted a reduction in the number/proportion of institutional deliveries (36, 49-51, 56, 61, 62, 67, 71), six reports (38,43,63,(73)(74)(75) observed growth and two studies (34, (36,62) and reduced in Ghana (48).…”

“…Considering that COVID-19 was a completely new disease and there was little information available, participants demonstrated only basic and rather limited knowledge about its causes, symptoms, transmission and potential consequences (36,46,47). It was noted that COVID-19 is "a very dangerous disease" (46), which "can be transmitted through air/breathing, shaking hands, kissing, contact with others" (47).…”

“…It was noted that COVID-19 is "a very dangerous disease" (46), which "can be transmitted through air/breathing, shaking hands, kissing, contact with others" (47). The essential measures, such as wearing a mask (36,47), washing hands (36) and social distancing (36) were mentioned as helping to protect yourself and others from the disease.…”