Mozambique

Malaria is endemic in Mozambique and the entire population is at risk of contracting the disease. Pregnant women and children under the age of five have the greatest risk of developing severe malaria. Plasmodium falciparum accounts for 90% of all malaria infections, while P. malariae accounts for 9% and P. ovale for 1%. [1] As of 2021, the predominant vectors in Mozambique are Anopheles funestus s.l. and Anopheles gambiae s.l. Most biting occurs around midnight and in the early morning hours for both An. funestus s.I. and An. gambiae s.I.  

Mozambique is among the four countries that accounted for the highest rates of malaria cases and deaths worldwide (4.1% of global cases and 3.8% of global deaths in 2021). [2] The country has the second highest prevalence of malaria in Eastern and Southern Africa (18% in 2021), and is one of the five countries with the highest levels of severe anaemia among children under five years of age. [2] Between 2020 and 2021, cases stagnated at from 320 per 1000 of the population at risk, while deaths fell by 8.6% (from 0.76  to 0.69 per 1000 of the population at risk). [2]

In 2015, malaria was responsible for 45% of outpatient visits and 56% of paediatric admissions. [4] Malaria caused 29% of all hospital deaths among the general population and 42% of deaths in children under five years of age. [4] Malaria prevalence among children aged 6 to 59 months remained stable from 2011 to 2018 at around 40 percent, but the prevalence of low hemoglobin in the same ages increased from 9 percent in 2011 to 14 percent in 2018.  

Data from the 2018 Malaria Indicator Survey (MIS) showed that malaria prevalence varies across the country. Prevalence is higher in the Northern and Central regions (ranging from 29 percent in Sofala to 57 percent in Cabo Delgado) and lower in the Southern region (ranging from 1 percent in Maputo city to 35 percent in Inhambane).[1] 

Between 2015 and 2018, the proportion of the population that slept under an insecticide-treated net (ITN) the previous night increased from 45% to 68%. In the same period, the proportion of children under five years of age who slept under an ITN the previous night increased from 48% to 73%, and the proportion of pregnant women who slept under an ITN the previous night increased from 52% to 76%.[1] 

The National Malaria Control Programme aims to ensure that 70 percent or more of people seek appropriate and timely health care and that at least 85 percent of the population uses an appropriate malaria protection methods. 

Some of the main challenges in the fight against malaria are the shortage of and high turnover of health care workers, who also lack training in malaria treatment and prevention and in health information system (HIS) and Logistics Management Information System (LMIS) data management.  

Data management 

Although the country accepted the District Health Information Software 2 (DHIS2) system as the only health information system, data entry at the peripheral level is challenging due to lack of staff and unreliable access to electricity and internet. Another point of weakness is the lack of staff trained in supply planning processes and the limited availability and poor quality of LMIS data, resulting in multiple stockouts. 

Case management 

Injectable artesunate is used as treatment for severe malaria in all groups; rectal artesunate is used as a pre-referral intervention at the community level among children under six years of age.[1] 

Malaria in pregnancy 

Mozambique has been implementing the WHO updated guidelines on IPTp since 2014, which recommend administering IPTp as early as possible starting in the second trimester (13 weeks) and monthly at ANC visits until the time of delivery the provision of ITNs at the first ANC visit. However, coverage of at least four ANC visits remains low, around 55 percent. In addition, less than 20 percent of women start their ANC during the first trimester of pregnancy.  

The proportion of pregnant women who received four or more doses of IPTp increased from 44 percent in 2018 to 56 percent in 2021. For uncomplicated malaria, pregnant women are treated with quinine during the first trimester and with artemether-lumefantrine in the second and third trimesters. For severe malaria, women are treated with injectable artesunate during all trimesters. 

The 2017–2023 NMSP aims to have 80 percent of pregnant women receiving at least three doses of IPTp (in 2019, only 56 percent of pregnant women did so). Barriers to IPTp uptake include women’s late initiation of pregnancy care, the insufficient training in MIP of health providers, and the noncompliance to MIP national guidelines. Based on the 2019 SARA, 86 percent of health facilities had IPTp commodities available while 71 percent had ITNs available.