Papers by Martinho Dgedge
Mais de 70% do suporte financeiro ao sistema de saude de Mocambique provem de parceiros de saude ... more Mais de 70% do suporte financeiro ao sistema de saude de Mocambique provem de parceiros de saude internacionais. Durante a ultima decada, apoio substancial foi alocado atraves das Iniciativas de Saude Globais. Porem, as implicacoes concretas dessas Iniciativas sobre o sistema nacional de saude nao sao conhecidas, dai a necessidade de se a nalizar, como objectivo, as implicacoes das Iniciativas de Saude Globais para o Sistema Nacional de Saude. Baseando-se em metodos qualitativos, entre Marco de 2007 a Maio de 2011, 26 gestores seniores de saude ao nivel nacional e 66 gestores e provedores de saude de Gaza, Zambezia e Nampula foram entrevistados. Tambem foi conduzida analise de documentos que relatam o contexto do sector de saude nacional, politicas, grau de implementacao e o papel da ajuda internacional. Como resultados , nos ultimos anos, os Programas de Saude foram impulsionados por fundos destas Iniciativas e assim o volume de actividades de controlo de doencas seleccionadas aume...
RESUMO: Mais de 70% do suporte financeiro ao sistema de saúde de Moçambique provém de parceiros d... more RESUMO: Mais de 70% do suporte financeiro ao sistema de saúde de Moçambique provém de parceiros de saúde internacionais. Durante a última década, apoio substancial foi alocado através das Iniciativas de Saúde Globais. Porém, as implicações concretas dessas Iniciativas sobre o sistema nacional de saúde não são conhecidas, daí a necessidade de se analizar, como objectivo, as implicações das Iniciativas de Saúde Globais para o Sistema Nacional de Saúde. Baseando-se em métodos qualitativos, entre Março de 2007 a Maio de 2011, 26 gestores seniores de saúde ao nível nacional e 66 gestores e provedores de saúde de Gaza, Zambézia e Nampula foram entrevistados. Também foi conduzida análise de documentos que relatam o contexto do sector de saúde nacional, políticas, grau de implementação e o papel da ajuda internacional. Como resultados, nos últimos anos, os Programas de Saúde foram impulsionados por fundos destas Iniciativas e assim o volume de actividades de controlo de doenças seleccionadas aumentou de forma marcante. Apesar deste aumento, o Sistema Nacional de Saúde ainda permanece pobre em muitos aspectos (infra-estruturas, pessoal qualificado, monitoria e avaliação, sistemas de informação de saúde, entre outros). Muitas Organizações Não-Governamentais apoiadas pelas Iniciativas de Saúde Globais continuam a atrair o pessoal de saúde pública qualificado, contribuindo para enfraquecer o sistema e induzem a geo-discrepância e iniquidades para além de tornar ineficazes os sistemas de monitoria e avaliação. O Ministério da Saúde ainda joga um papel marginal em termos de gestão e controlo dos fundos e, portanto, a execução dos planos estratégicos existentes é repleto de incertezas, situação agravada pela imprevisibilidade dos desembolsos prometidos. Muito recentemente, algumas destas iniciativas mudaram seu foco passando a apoiar no fortaleciemento do sistema de saúde, mas o impacto destes esforços só será visível a longo prazo. A ênfase exagerada de suporte no controlo de doenças seleccionadas limita a abordagem de integração para a saúde da população. Recomenda-se que Iniciativas de Saúde Globais devem basear-se em compromissos de longo prazo e apoiarem abordagens que estão em consonância com o Compacto de Parceria para Saúde que centra-se no fortalecimento do Sistema Nacional de Saúde como um todo. Palavras-chave: dependência da ajuda, apoio externo, Iniciativas de Saúde Globais e sistemas de saúde ABSTRACT: Over 70% of financial support to the health system in Mozambique comes from international health partners. During the last decade, substantial support was allocated through the Global Health Initiatives, however, the concrete implications of these Global Health Initiatives on national health system are not known. Drawing upon qualitative methods, between March 2007 to May 2011, 26 senior managers from the national level, 66 health managers and providers from Gaza, Zambézia and Nampula provinces were interviewed. We also conducted an extensive review of the documents that report the context of national health policy, degree of implementation and the role of international aid. As results, during the last years, Health Programs have been boosted by funds from the Global Health Initiatives and thus the volume of interventions to control selected diseases has increased markedly. Despite this increase, the National Health System remains poor in many aspects (infrastructure, personnel, monitoring and evaluation, health information systems, etc). Many Non-Governamental Organizations supported by these Global Initiatives continue to attract qualified public health personnel, helping to weaken the system and induce geo-discrepancies and inequities while rendering ineffective monitoring and evaluation systems. The Ministry of Health still plays a marginal role in terms of management and control of funds and therefore the implementation of existing strategic plans is full of uncertainties. The unpredictability of promised disbursements mainly due to the weak capacity of the Ministry of Health accountability system aggravates the situation. Very recently, some Global Health Initiatives started to strengthen the national health system, but the impact of these efforts will only be visible in the long term. The exaggerated emphasis on supporting disease specific interventions limits the integration approach to the health of the population. Global Health Initiatives should be based on a longterm commitment and support approaches that are consistent with the Compact of the International Health Partnership, which focuses on strengthening the National Health System as a whole.
Avaliação de Necessidades em Saúde Materna e Neonatal em Moçambique (Parte I)
Cordon sanitaire or laissez faire: differential dispersal of young and old females of the malaria vector Anopheles funestus Giles (Diptera: Culicidae) in southern Mozambique
African Entomology, 1998
The dispersal of Anopheles funestus Giles was studied in two suburban areas 10 and 35 km south of... more The dispersal of Anopheles funestus Giles was studied in two suburban areas 10 and 35 km south of Maputo, Mozambique, in April 1995. Population densities per house differed significantly between areas. The number of female mosquitoes in houses decreased with distance from the breeding site. Young pre-gravid females were concentrated dose to the breeding site. There was no correlation between the number of male and female mosquitoes in houses or between the number of males and distance from the breeding site. There was also no correlation between Anopheles arabiensis Patton and An. funestus recorded in houses. The results are discussed in relation to the design and implementation of a cordon sanitaire for malaria control in such areas.
Introduction: In recent decades, countries and health systems have been paying increasing attenti... more Introduction: In recent decades, countries and health systems have been paying increasing attention to planning practice for sustainable development. Recognizing the specific challenges facing health planning, this article aims to contribute to the reflection on the concept and procedural and methodological characteristics of sustainable health planning, based on the main messages gathered in a panel discussion of the 5th National Congress of Tropical Medicine. Material and methods: We used the panel presentations and discussion interventions, in addition with documentary sources resulting from a narrative literature review. All material was subject to documentary analysis. Results and discussion: Participatory approaches to health planning, integrating community participation and intersectoral action, with a particular focus on reducing health inequities and achieving universal coverage, were considered to be among the most effective to achieve health and well-being goals aligned with the principles of sustainable development. Conclusion: Social and community mobilization in the health planning process seems to contribute to the selection and implementation of health strategies in the context of sustainable development.
Bulletin of the World Health Organization, 2007
PROBLEM New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preve... more PROBLEM New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management. APPROACH A pilot MiP programme in Mozambique was designed to determine requirements for scale-up. LOCAL SETTING The Ministry of Health worked with a nongovernmental organization and an academic institution to establish and monitor a pilot programme in two impoverished malaria-endemic districts. RELEVANT CHANGES Implementing the pilot programme required provision of additional sulfadoxine-pyrimethamine (SP), materials for directly observed SP administration, bednets and a modified antenatal card. National-level formulary restrictions on SP needed to be waived. The original protocol required modification because imprecision in estimation of gestational age led to missed SP doses. Multiple incompatibilities with other health initiatives (including programmes for control of syphilis, anaemia and HIV) were discovered and overcom...
BMC pregnancy and childbirth, Jan 22, 2018
Despite declining trends maternal mortality remains an important public health issue in Mozambiqu... more Despite declining trends maternal mortality remains an important public health issue in Mozambique. The delays to reach an appropriate health facility and receive care faced by woman with pregnancy related complications play an important role in the occurrence of these deaths. This study aims to examine the contribution of the delays in relation to the causes of maternal death in facilities in Mozambique. Secondary analysis was performed on data from a national assessment on maternal and neonatal health that included in-depth maternal death reviews, using patient files and facility records with the most comprehensive information available. Statistical models were used to assess the association between delay to reach the health facility that provides emergency obstetric care (delay type II) and delay in receiving appropriate care once reaching the health facility providing emergency obstetric care (delay type III) and the cause of maternal death within the health facility. Data were ...
The Matola Malaria Project: a Temporal and Spatial Study of Malaria Transmission and Disease in a Suburban Area of Maputo, Mozambique
The American Journal of Tropical Medicine and Hygiene, 1997
A temporal and spatial study of malaria transmission in a suburban area of Maputo, Mozambique wit... more A temporal and spatial study of malaria transmission in a suburban area of Maputo, Mozambique with a mean population density of 2,737/km2 was made from December 1992 to June 1995. A steep but continuous gradient was observed in the Plasmodium falciparum prevalence from 59.0% adjacent to the breeding sites to 5.4% only a few hundred meters distant. The entomologic inoculation rate ranged from a number too low to be determined in some districts to 20 infectious bites per person per year in the others. The risk of malaria was 6.2 times higher for individuals living less than 200 meters from the breeding sites than for individuals living 500 meters or more away from the breeding sites. In areas of high human density, mosquito and parasite dispersion is very limited, and therefore malaria control strategies could be more specifically targeted.
Journal of Obstetrics and Gynaecology, 2017
Facility-based maternal mortality remains an important public health problem in Mozambique. A num... more Facility-based maternal mortality remains an important public health problem in Mozambique. A number of factors associated with health system functioning can be described behind the occurrence of these deaths. This paper aimed to evaluate the magnitude of the health facility-based maternal mortality, its geographical distribution and to assess the health facility factors implicated in the occurrence of these deaths. A secondary analysis was done on data from the survey on maternal health needs performed by the Ministry of Health of Mozambique in 2008. During the study period 2.198 maternal deaths occurred out of 312.537 deliveries. According to the applied model the availability of Maternal and Child Health (MCH) nurses performing Emergency Obstetric Care functions was related to the reduction of facility-based maternal mortality by 40%. No significant effects were observed for the availability of medical doctors, surgical technicians and critical delivery room equipment. IMPACT STATEMENT Is largely known that the availability of skilled attendants assisting every delivery and providing Emergency Obstetric Care services during the pregnancy, labor and Childbirth is key for maternal mortality reduction. This study add the differentiation on the impact of different cadres of health services providers working on maternal and child health services on the facility based maternal mortality. In this setting the study proven the high impact of the midlevel skilled maternal and child health nurses on the reduction of maternal mortality. Another important add from this study is the use of facility based maternal mortality data to inform the management process of maternal healthcare services. The findings from this study have potential to impact on the decision of staffing prioritization in setting like the study setting. The findings support the policy choice to improve the availability of maternal and child health nurses.
Human Resources for Health, 2016
Introduction: Over the past decade, governments and international partners have responded to call... more Introduction: Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. The purpose of this case presentation is to document for the first time Mozambique's novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. Case presentation: Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a "health extension" which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique's health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals' physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following:
The journal of family planning and reproductive health care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists, Jan 8, 2016
The contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic an... more The contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic and Health Survey. The impact of family planning (FP) on women's health and on the reduction of maternal mortality is well known. Acknowledging the importance of user satisfaction in the utilisation of health services, exit interviews were used to assess women's satisfaction with FP services in Mozambique. The survey, conducted in 174 health facilities, was representative at the national level, covered all provinces, and both urban and rural areas. Overall, 86% of respondents were satisfied with FP services, but issues such as insufficient supplies of oral contraceptives and the low quality of healthcare provider/client interactions were given as reasons for women's dissatisfaction. Defined actions at the level of health service provision are needed to tackle the identified issues and ensure improved satisfaction with, and better utilisation of, FP services in Mozambique.
BMJ Open, 2016
To compare routine versus selective (ie, screening and treatment for anaemia) prenatal iron proph... more To compare routine versus selective (ie, screening and treatment for anaemia) prenatal iron prophylaxis in a malaria-endemic and HIV-prevalent setting, an extended analysis including previously missing data. Design: A pragmatic randomised controlled clinical trial. Setting: 2 health centres in Maputo, Mozambique. Participants: Pregnant women (≥18 years old; non-high-risk pregnancy) were randomly allocated to routine iron (n=2184) and selective iron (n=2142) groups.
The burden of disease in Maputo City : registered and autopsied deaths in 1994
Revista Medica De Mocambique, 1995
Human resources for health, Jan 16, 2015
Mozambique suffers from critical shortages of healthcare workers including non-physician clinicia... more Mozambique suffers from critical shortages of healthcare workers including non-physician clinicians, Tecnicos de Medicina Geral (TMGs), who are often senior clinicians in rural health centres. The Mozambique Ministry of Health and the International Training and Education Center for Health, University of Washington, Seattle, revised the national curriculum to improve TMG clinical knowledge and skills. To evaluate the effort, data was collected at graduation and 10 months later from pre-revision (initial) and revised curriculum TMGs to determine the following: (1) Did cohorts trained in the revised curriculum score higher on measurements of clinical knowledge, physical exam procedures, and solving clinical case scenarios than those trained in the initial curriculum; (2) Did TMGs in both curricula retain their knowledge over time (from baseline to follow-up); and (3) Did skills and knowledge retention differ over time by curricula? Post-graduation and over time results are presented. t...
Education for health (Abingdon, England)
Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lo... more Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lowest ratios of health care providers to population in the world. To rapidly scale up health care coverage, the Mozambique Ministry of Health has pushed for greater investment in training nonphysician clinicians, Tιcnicos de Medicina (TM). Based on identified gaps in TM clinical performance, the Ministry of Health requested technical assistance from the International Training and Education Center for Health (I-TECH) to revise the two-and-a-half-year preservice curriculum. A six-step process was used to revise the curriculum: (i) Conducting a task analysis, (ii) defining a new curriculum approach and selecting an integrated model of subject and competency-based education, (iii) revising and restructuring the 30-month course schedule to emphasize clinical skills, (iv) developing a detailed syllabus for each course, (v) developing content for each lesson, and (vi) evaluating implementation a...
Cadernos de Saúde Pública, 2013
The aim of this study was to contribute to the better planning of measles elimination actions in ... more The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improveme...
BMJ open, 2013
To present the pregnancy results and interim birth results of a pragmatic randomised controlled t... more To present the pregnancy results and interim birth results of a pragmatic randomised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV. A pragmatic randomised controlled trial. Two health centres (1° de Maio and Machava) in Maputo, Mozambique, a setting of endemic malaria and high prevalence of HIV. Pregnant women (≥18-year-olds; non-high-risk pregnancy, n=4326) attending prenatal care consultation at the two health centres were recruited to the trial. The women were randomly allocated to either Routine iron (n=2184; 60 mg ferrous sulfate plus 400 μg of folic acid daily throughout pregnancy) or Selective iron (n=2142; screening and treatment for anaemia and daily intake of 1 mg of folic acid). The primary outcomes were preterm delivery (delivery <37 weeks of gestation) and low birth weight (<2500 g). The secondary outcomes were symptoms suggestive of malaria and self-reported ma...
Tropical Medicine and International Health, 2003
We describe the frequency of Plasmodium falciparum clones infecting individuals living in a rural... more We describe the frequency of Plasmodium falciparum clones infecting individuals living in a rural area of southern Mozambique and analyse the relationship between multiplicity of infection, age and other malariometric indices, including prospective risk of clinical malaria. The genotyping was based on the use of restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) analysis of P. falciparum merozoite surface protein 2 (msp2). We analysed 826 samples collected during five crosssectional surveys from residents of Manhiça ranging in age from 4 months to 83 years. We also determined the multiplicity of infection in samples obtained from 6-month-old infants (n ¼ 79) and children <10 years (n ¼ 158) who were then treated and followed prospectively for 1 year or 75 weeks, respectively. Multiplicity of infection did not vary significantly during the first year of life, but increased thereafter, and decreased during adulthood to the levels found in infants. With increasing multiplicity of infection, there was a statistically significant decrease in the risk of submicroscopic infections. There was also a significant correlation between multiplicity of infection and parasite density in infants, children <4 years of age and adults, suggesting that high densities increase the probability of discriminating more clones in complex infections. We found that the relationship between multiple infections and malaria morbidity is age-dependent. In infants, the risk of subsequent episodes of clinical malaria was related to the parasite density but not to baseline multiplicity of infection. In older children, however, the more clones a child carried, the more likely they were to have a clinical malaria episode, and this was true after adjusting for parasite densities. This change in the association between multiplicity and risk of clinical malaria may indicate a shift in the host response to P. falciparum.
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Papers by Martinho Dgedge