Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis.
Maternal and Child Health Care Service Disruptions and Recovery in Mozambique After Cyclone Idai: An Uncontrolled Interrupted Time Series Analysis.
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DOI：
10.9745/ghsp-d-21-00796
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发表时间：
2022-09-15
影响因子：
4
通讯作者：
Sherr, Kenneth
中科院分区：
文献类型：
--
作者：
Fernandes, Quinhas;Augusto, Orvalho;Chicumbe, Sergio;Anselmi, Laura;Wagenaar, Bradley H.;Marlene, Rosa;Agostinho, Saozinha;Gimbel, Sarah;Pfeiffer, James;Inguane, Celso;Uetela, Dorlim Moiana;Crocker, Jonny;Ramiro, Isaias;Matsinhe, Benigna;Tembe, Stelio;Carimo, Naziat;Gloyd, Stephen;Manhica, Ivan;Tavede, Esperanca;Felimone, Priscilla;Sherr, Kenneth
及时和相关的信息对于帮助确定和跟踪极端天气事件发生后和紧急情况期间的改善领域至关重要，以确定有限资源的优先次序。常规数据可以为卫生系统在自然灾害期间和之后的表现提供有用的证据，有助于有效和高效地应对。飓风艾达过后，服务立即中断，受影响严重的地区出现了更大的中断。总体而言，产前第一次就诊、产后3-7天内就诊、新的计划生育使用者、麻疹疫苗接种、首次高危儿童会诊和1岁以下儿童充分接种疫苗是受影响最大的指标。在飓风过后的3个月内，我们观察到所有地区的指标都恢复到等于或高于IDAI之前的水平。这种快速恢复显示了莫桑比克卫生系统的韧性，特别是在中部地区。执行研究方法与高质量的常规数据相结合，为政策制定和战略决策提供了相关证据，特别是在飓风艾达等极端天气事件的情况下；因此，应将其列为优先事项。虽然妇幼保健服务的提供受到极端天气事件的负面影响，但从恢复过程中吸取的经验教训有助于加强卫生系统。政策制定者应该优先考虑常规卫生信息数据，将其作为跟踪卫生系统复原力的有价值的工具。与气候变化有关的极端天气事件在频率和强度上有所增加，威胁着人们的健康，特别是在卫生系统薄弱的地方。2019年3月，飓风艾达摧毁莫桑比克中部地区，造成基础设施破坏、人口流离失所和死亡。我们评估了IDAI对索法拉省和马尼卡省妇幼保健服务和恢复的影响。我们利用2016年11月至2020年3月的区级月度常规数据，进行了非受控中断时间序列分析，评估了IDAI前后所有25个区10项妇幼健康指标的变化。我们应用贝叶斯分层负二项模型来估计与IDAI相关的服务中断和恢复。在索法拉和马尼卡的444万人中，有183万人(41.2%)受到影响。布齐、纳马坦达和东多(都在索法拉省)受影响的比例最高。在IDAI之后，所有10个指标都出现了突然的大幅下降。3月份每10万育龄妇女首次产前检查次数下降23%(95%可信区间=0.62，0.96)，4月份下降11%(95%CI=0.75，1.07)。3月份每千名5岁以下儿童卡介苗接种量下降21%(95%CI=0.69，0.90)，麻疹疫苗接种量下降25%(95%CI=0.64，0.87)，与4月份持平。在飓风过后的3个月内，几乎所有地区都恢复到了艾迪之前的水平，包括布齐，首次产前就诊次数和卡介苗接种次数分别相对增加了22%和13%。我们发现，在IDAI之后，立即出现了大量的卫生服务中断，在受影响最严重的地区影响更大。研究结果表明，爱达伊灾后出现了令人印象深刻的复苏，强调需要建立有弹性的卫生系统，以确保自然灾害期间和之后的高质量卫生保健。
Timely and relevant information is vital to help identify and track areas of improvement after extreme weather events and during emergencies to prioritize limited resources. Routine data can provide useful evidence of health system performance during and after natural disasters, contributing to an effective and efficient response. Substantial disruptions in service delivery were observed immediately after Cyclone Idai, with severely affected districts showing greater disruptions. Overall, first antenatal care visits, postpartum visits within 3–7 days, new family planning users, measles vaccinations, first at-risk children’s consultations, and fully immunized children under age 1 were the most affected indicators. Within 3 months of the cyclone, we observed the recovery, across all districts, of indicators to levels equal to or higher than pre-Idai. This quick recovery showcases Mozambique’s health system resilience, particularly in the central region. Implementation research methods combined with high-quality routine data provide relevant evidence to support policy making and strategic decisions, particularly in scenarios of extreme weather events such as Cyclone Idai; therefore, they should be prioritized. While maternal and child health care delivery is negatively impacted by extreme weather events, lessons learned from the recovery process can help strengthen health systems. Policy makers should prioritize routine health information data as a valuable tool for tracking health system resilience. Climate change-related extreme weather events have increased in frequency and intensity, threatening people’s health, particularly in places with weak health systems. In March 2019, Cyclone Idai devastated Mozambique’s central region, causing infrastructure destruction, population displacement, and death. We assessed the impact of Idai on maternal and child health services and recovery in the Sofala and Manica provinces. Using monthly district-level routine data from November 2016 to March 2020, we performed an uncontrolled interrupted time series analysis to assess changes in 10 maternal and child health indicators in all 25 districts before and after Idai. We applied a Bayesian hierarchical negative binomial model with district-level random intercepts and slopes to estimate Idai-related service disruptions and recovery. Of the 4.44 million people in Sofala and Manica, 1.83 (41.2%) million were affected. Buzi, Nhamatanda, and Dondo (all in Sofala province) had the highest proportion of people affected. After Idai, all 10 indicators showed an abrupt substantial decrease. First antenatal care visits per 100,000 women of reproductive age decreased by 23% (95% confidence interval [CI]=0.62, 0.96) in March and 11% (95% CI=0.75, 1.07) in April. BCG vaccinations per 1,000 children under age 5 years declined by 21% (95% CI=0.69, 0.90) and measles vaccinations decreased by 25% (95% CI=0.64, 0.87) in March and remained similar in April. Within 3 months post-cyclone, almost all districts recovered to pre-Idai levels, including Buzi, which showed a 22% and 13% relative increase in the number of first antenatal care visits and BCG, respectively. We found substantial health service disruptions immediately after Idai, with greater impact in the most affected districts. The findings suggest impressive recovery post-Idai, emphasizing the need to build resilient health systems to ensure quality health care during and after natural disasters.
影响因子：
2.9
作者：
Grimm PY;Merten S;Wyss K
通讯作者：
Wyss K