Reducing maternal mortality in Mozambique: challenges, failures, successes and lessons learned

Area of Science:

• Public Health
• Obstetrics & Gynecology
• Global Health

Background:

• High maternal mortality rates in low-resource countries necessitate improved emergency obstetric care (EmOC).
• Standardized definitions for basic (BEmOC) and comprehensive (CEmOC) emergency obstetric care are crucial for strategic implementation.
• Mozambique adopted EmOC definitions to reduce maternal mortality.

Purpose of the Study:

• To describe diverse approaches for enhancing emergency obstetric care accessibility in Mozambique.
• To evaluate the feasibility and impact of different EmOC implementation strategies in a resource-limited context.

Main Methods:

• The study presents four distinct projects implementing EmOC in urban and provincial settings in Mozambique.
• Staffing models included 24-hour physician coverage and training non-physicians in surgical and anesthesiology techniques.
• Data collection focused on service provision (deliveries, cesarean sections) and case fatality rates.

Main Results:

• José Macamo Hospital significantly increased its provision of CEmOC services.
• Mavalane Hospital saw a near doubling of annual deliveries despite not providing CEmOC.
• Manhiça hospital increased its C-section rates, and Sofala Province established new BEmOC and CEmOC facilities, leading to reduced case fatality rates.

Conclusions:

• The strategy for providing emergency obstetric care is achievable even in countries with limited resources and a shortage of physicians.
• Adaptable staffing models, including training non-physicians, can improve EmOC accessibility.
• Successful implementation of EmOC, including basic and comprehensive levels, can lead to reduced maternal mortality.