Chadreque Muluana - GFMER Coordinator for Mozambique

Chadreque Muluana

GFMER Coordinator for Mozambique

Chadreque Muluana

Chadreque Muluana, MD, MSc, General Practitioner
Ministry of Health, National Institute of Health, Mozambique
E-mail: muluana2002@yahoo.com.br

Chadreque Muluana, born in Mozambique. General Practitioner, graduated in Human Medicine at Eduardo Mondlane University - Mozambique, Master in International Health for Cooperation with Developing Countries - Università degli Studi di Parma, Italy.

Worked 4 years at Milange District, a 515.000 inhabitant’s district, with a District Hospital, as Hospital Director, Medical Manager and District Director. Worked 2 years at Chókwè Health Research and Training Center as Site and Research Coordinator.

Mozambique sexual and reproductive health situation in Mozambique

Mozambique is a low income country located at Southeastern Africa region, with an area of 801,537 km2 and an estimated population of 23,515,934 inhabitants by 2012. Mozambique has recently gone through a period of political and civil unrest that resulted population displacements, huge destruction of social and economic infrastructures, and drove the populations to extreme poverty and vulnerability. Health coverage is still far from the expected covering not more than half of population.

The following are some country health and demographic data:

Population Structure:
- 0-14 years: 45.7% (male 5,405,274/ female 5,350,732)
- 15-64 years: 51.3% (male 5,722,152/ female 6,341,765)
- 65 years and over: 3% (male 320,066/ female 375,945) (2012 est.)
Population growth rate: 2.442% (2012 est.)
Birth rate: 39.34 births/1,000 population (2012 est.)
Maternal mortality rate: 490 deaths/100,000 live births (2010)
Infant mortality rate: 76.85 deaths/1,000 live births
Life expectancy at birth: 52.02 years (2012 est.)
Physicians’ density: 0.027 physicians/1,000 population (2006)
Literacy rate: 56.1% (2012 est.)
Fertility rate: 5.4 children born/woman (2012 est.)

Maternal health

Maternal mortality ratio (MMR), continues to be very high in Mozambique, as compared to other countries in the world. According to 2010 WHO/UNICEF/UNFPA/World Bank MMR report, MMR in Mozambique is 490 deaths per 100,000 live births in 2010. Although this rate is high, Mozambique has registered significant MMR improving since 1990 with an acceptable rate of decline, from an estimated 910 deaths per 100,000 live births.

A national study showed that 76.4% maternal deaths were due to direct causes and the remaining, to indirect causes. From the direct causes of death, the uterine rupture is the first leading cause with 27.8%, followed by the overall hemorrhages 24%, with emphasis on post-partum hemorrhage with 12.6% of all deaths. Sepsis is the third leading cause of death with 17.2% of direct related causes.
While the majority of pregnant women use antenatal care (98%), only a smaller proportion, 55.2 % deliver with the assistance of skilled medical personnel, and an undesirable number of deliveries are still occurring in the community by the traditional midwives and parturient relatives.

HIV and AIDS

HIV prevalence estimates obtained by INSIDA in 2009 show that 11.5% Mozambican adult, aged 15-49 years are infected. Prevalence is higher in female than in male (13.1 and 9.2%, respectively). The risk of infection is significantly higher among residents aged 15-49 years of urban areas (15.9%) than in rural areas (9.2%). The prevalence among women from urban area is 18.4% compared to those from rural areas 10.7%, and among men from urban area is 12.8%, compared to 7.2% from the rural area.

HIV prevalence by sex and age specific shows that prevalence in women and men increases with age to a peak, which in women is between 25-29 years old (16.8%) and in men is between 35-39 years (14.2%).

Prevalence varies among provinces. Taking as reference women aged 15-49 years in Niassa Province (3.3%), the prevalence rate among women in the Provinces of Manica and Zambézia (15.3 and 15.6%, respectively) are about five times higher and the Gaza (29.9%) is about 10 times higher.

PMTCT

Mozambique is one of 16 countries in the world that contribute with 60% to the global number of pregnant women living with HIV in terms of the number of yearly infected pregnant women.

Mozambique started to implement the PMTCT in 2002, in 8 health facilities, and this became a nationwide program in 2004 and was integrated into the Maternal and Child Healthcare services in 2006. By the end of 2010, the expansion of the PMTCT services had reached 909 (86%) of the 1,063 health facilities through ANC.

In 2010, about 98,128 pregnant women were estimated to be HIV positive, and according to data from the program, in the same year 736,794 pregnant women (64.6%) out of all the women present at the 1st ANC appointment received HIV counseling and testing, and 59,087 received anti-retroviral prophylaxis, totaling a coverage of 60.2% of all the pregnant women infected with HIV. With respect to exposed children, 42,162 (44%) receive anti-retroviral prophylaxis.

Family planning

Prevalence rate of contraception remains very low despite of some improvements. The contraceptive rate among married or marital union women together increased from 6% in 1997 to 17% in 2003, 12% of which from modern contraceptives. The rural area has increased from 3% in 1997 to 12% 2003, and the urban area from 18% in 1997 to 28% in 2003, with a significant increase in all provinces.

Coverage of new users increased from 12.5 in 2008 to 13.5% in 20097, and the unmet need for FP services is 18.4%, with 18% in rural areas and 20% in urban areas. Condom use in high-risk situations increased in rural areas almost three times (from 8% to 23%) and in urban areas in two-thirds (34% to 58%).

Total Fertility Rate fell from 6.6 in 1980 to 5.6 in 1997 and 5.5 in 2003.

Adolescent Fertility Rate is high, 179 reported births among 1000 women aged 15-19 years, affecting not only their and their children’s health but also the continuation of their education.

Abortion

In Mozambique, like in other low-income countries, unsafe abortion is one of the main causes of maternal mortality. The real extent of the levels of unsafe abortion is not known.

Data from the Department of Obstetrics and Gynecology, Maputo Central Hospital (HCM), 1990-2000, shows that 8-11% of maternal deaths during this period were due to complications of unsafe abortion.

The study also shows that women under 20 years represent 44.3% of the women entering the hospital to treat the consequences of an illegal abortion. Moreover, there is a belief that such percentages represent only the tip of the iceberg, since it does not include those women who had no complications that needed hospital care or who, for several reasons, did not seek for hospital assistance, many of whom eventually died. At Mavalane hospital, 3,400 women were treated for complications from clandestine abortions, representing 40% of all the women admitted through the hospital’s Gynecological Emergencies Services.

In Mozambique, the prevailing legislation in abortion, which is dated 1886, stipulates that abortion is prohibited in all circumstances and penalizes the woman and the abortion practitioner. As a result, women with unwanted pregnancies are forced to resort to illegal abortion practitioners, where they are subjected to abortion practices in unsafe conditions, that is, without the minimum conditions of hygiene and technical safety.

Since 1985, in recognition of the magnitude of maternal mortality resulting from abortions in risk conditions, Mozambique is implementing an interim policy, offering safe abortion care. Some big heath unities and some few urban health facilities are authorizing abortion services for pregnancies that have until 12 weeks and having selected specific criteria. However, the current services based in urban hospitals do not reach the majority of Mozambican women who are more likely to experience an unwanted pregnancy and abortion in unsafe conditions - poor women, rural, young or less educated.

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