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Abstract Background The entire population of Mozambique is at risk for malaria, which remains one of the leading causes of death. The 2017–2022 National Malaria Strategic Plan focuses on reducing malaria morbidity and mortality in high- and low-transmission areas. This study aimed to estimate the costs and health benefits of six variations of the World Health Organization’s “test-and-treat” strategy among children under five. Methods A decision tree model was developed that estimates the costs and health outcomes for children under five. Data on probabilities, costs, weights for disability-adjusted life years (DALYs), and quality-adjusted life years (QALYs) were based on peer-reviewed, grey literature, and primary data analysis of the 2018 Malaria Indicator Survey. Six scenarios were compared to the status quo and calculated the incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, DALY averted, and life saved. Deterministic and probabilistic sensitivity analyses were conducted to understand the effect of parameter uncertainty on the findings. Results In the base case, reaching the target of 100% testing with rapid diagnostic tests (RDTs; Scenario 1) is more cost-effective than improving the testing rate alone by 10% (Scenario 2). Achieving a 100% (Scenario 3) or a 10% increase in treatment rate (Scenario 4) have ICERs that are lower than Scenarios 1 and 2. Both Scenarios 5 and 6, which represent combinations of Scenarios 1–4, have lower ICERs than their constituent strategies on their own, which suggests that improvements in treatment are more cost-effective than improvements in testing alone. These results held when DALYs averted or lives saved were used as health outcomes. Deterministic and probabilistic sensitivity analyses revealed that the cost-effectiveness of Scenarios 1–6 are subject sensitive to parameter uncertainty, though Scenarios 4 and 5 are the optimal choice when DALYs averted or QALYs gained were used as the measure of health outcomes across all cost-effectiveness thresholds. Conclusions Improving testing rates alone among children at risk for malaria has the potential to improve health but may not be the most efficient use of limited resources. Instead, small or large improvements in treatment, whether alone or in conjunction with improvements in testing, are the most cost-effective strategies for children under five in Mozambique.

Abstract Background Antenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling. Methods This study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software. Results Clients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts. Conclusions Findings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.

Background Poor patient experience, including long waiting time, is a potential reason for low healthcare utilisation. In this study, we evaluate the impact of appointment scheduling on waiting time and utilisation of antenatal care.Methods We implemented a pilot study in Mozambique introducing appointment scheduling to three maternity clinics, with a fourth facility used as a comparison. The intervention provided women with a return date and time for their next antenatal care visit. Waiting times and antenatal care utilisation data were collected in all study facilities. We assessed the effect of changing from first come, first served to scheduled antenatal care visits on waiting time and complete antenatal care (≥4 visits during pregnancy). Our primary analysis compared treatment facilities over time; in addition, we compared the treatment and comparison facilities using difference in differences.Results We collected waiting time data for antenatal care from 6918 women, and antenatal care attendance over the course of pregnancy from 8385 women. Scheduling appointments reduced waiting time for antenatal care in treatment facilities by 100 min (95% CI −107.2 to -92.9) compared with baseline. Using administrative records, we found that exposure to the scheduling intervention during pregnancy was associated with an approximately 16 percentage point increase in receipt of four or more antenatal care visits during pregnancy.Conclusions Relatively simple improvements in the organisation of care that reduce waiting time may increase utilisation of healthcare during pregnancy. A larger scale study is needed to provide information about whether appointment scheduling can be sustained over time.Trial registration number NCT02938936.

A high worldwide SARS-CoV-2 vaccine coverage must be attained to stop the COVID-19 pandemic. In this study, we assessed the level of willingness of Mozambicans to be vaccinated against COVID-19. Data were collected between 11 and 20 March 2021, through a self-administered online survey. Of the 1878 respondents, 30.1% were healthcare workers, 58.3% were aged between 18 and 35 years, 60% were male, and 38.5% were single. Up to 43% had been tested for COVID-19 and 29% had tested positive. Overall vaccine acceptability was 71.4% (86.6% among healthcare workers, 64.8% among other respondents; p < 0.001). Reasons for vaccine hesitancy included: fear of vaccine side effects (29.6%) and the belief that the vaccine is not effective (52%). The acceptability of the SARS-CoV-2 vaccine increased with increasing vaccine efficacy. Using logistic regression, determinants for acceptability of the vaccine were: older age, a past COVID-19 test, a concern of becoming (re)infected by COVID-19, having a chronic disease, and considering vaccination important for personal and community health. In conclusion, vaccine acceptability in Mozambique was relatively high among healthcare workers but significantly lower in the rest of the population. This suggests that there is a need to educate the general population about SARS-CoV-2 vaccination and its importance.

Summary Background The Ministry of Health of Mozambique (MISAU) and the World Health Organization (WHO) recommend enhancing pregnant women’s satisfaction with health care services in order to advance maternal and child health. This study aims to assess the levels and determinants of pregnant women’s satisfaction regarding their interactions with antenatal care (ANC) providers, the services of which were provided at the primary health care level in southern Mozambique. Methodology We conducted an observational, quantitative, and cross-sectional study from November 4 to December 10, 2021. A structured questionnaire was administered to pregnant women who attended ANC during that period. The characteristics of the participants were illustrated using descriptive statistics; to analyse pregnant women’s satisfaction determinants, we estimated crude and adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) using logistic regression models. All analyses were performed in SPSS version 24 using a 5% significance level. Results We selected 951 pregnant women with a mean age of 25 years old; 14% attained a secondary educational level, 36% were married or living in a marital relationship, and 85.9% reported being satisfied with their current ANC. Factors that reduced the odds of being satisfied were the following: an “insufficient” ANC duration (AOR = 0.173; 95% CI: 0.079, 0.381); inadequate ANC waiting area (AOR = 0.479; 95% CI: 0.265, 0.863); women’s perception about the existing norm of nonattendance in case of late arrival to the ANC (AOR = 0.528; 95% CI 0.292, 0.954); the perception of the existing norm that women are obliged to give birth in same health facility where ANC occurred (AOR = 0.481; 95% CI: 0.273, 0.846); and the perception that delivered ANC is not important for foetal health (AOR = 0.030; 95% CI:0.014, 0.066). Conclusions Most of the pregnant women mentioned being satisfied with the ANC they received. The perception of short consultation duration, inadequate waiting spaces, strict linkage rules to specific health facilities and ANC norms, the perception that the received ANC is not relevant for foetal well-being are determinants of not being satisfied with ANC, and these determinants can be addressed by reorganizing ANC and, indeed, are modifiable by the improved paced implementation of the MISAU strategies for quality maternal and child health care.