Differential patterns of disease and injury in Mozambique: New perspectives from a pragmatic, multicenter, surveillance study of 7809 emergency presentations

Abstract

Background: There is a paucity of primary data to understand the overall pattern of disease and injuries as well as related health-service utilization in resource-poor countries in Africa.

Objective: To generate reliable and robust data describing the pattern of emergency presentations attributable to communicable disease (CD), non-communicable disease (NCD) and injuries in three different regions of Mozambique.

Methods: We undertook a pragmatic, prospective, multicentre surveillance study of individuals (all ages) presenting to the emergency departments of three hospitals in Southern (Maputo), Central (Beira) and Northern (Nampula) Mozambique. During 24-hour surveillance in the seasonally distinct months of April and October 2016/2017, we recorded data on 7,809 participants randomly selected from 39,124 emergency presentations to the three participating hospitals. Applying a pragmatic surveillance protocol, data were prospectively collected on the demography, clinical history, medical profile and treatment of study participants.

Findings: A total of 4,021 males and 3,788 (48.5%) females comprising 630 infants (8.1%), 2,070 children (26.5%), 1,009 adolescents (12.9%) and, 4,100 adults (52.5%) were studied. CD was the most common presentation (3,914 cases/50.1%) followed by NCD (1,963/25.1%) and injuries (1,932/24.7%). On an adjusted basis, CD was more prevalent in younger individuals (17.9±17.7 versus 26.6±19.2 years;p<0.001), females (51.7% versus 48.7%-OR 1.137, 95%CI 1.036-1.247;p = 0.007), the capital city of Maputo (59.6%) versus the more remote cities of Beira (42.8%-OR 0.532, 95%CI 0.476-0.594) and Nampula (45.8%-OR 0.538, 95%CI 0.480-0.603) and, during April (51.1% versus 49.3% for October-OR 1.142, 95%CI 1.041-1.253;p = 0.005). Conversely, NCD was progressively more prevalent in older individuals, females and in the regional city of Beira, whilst injuries were more prevalent in males (particularly adolescent/young men) and the northern city of Nampula. On a 24-hour basis, presentation patterns were unique to each hospital.

Interpretation: Applying highly pragmatic surveillance methods suited to the low-resource setting of Mozambique, these unique data provide critical insights into the differential pattern of CD, NCD and injury. Consequently, they highlight specific health priorities across different regions and seasons in Southern Africa.

Fig 1. Geographic and demographic profile of Mozambique.

Demographic profiling data (table inset) were sourced from http://www.ine.gov.mz/estatisticas/ (Accessed February 2019) and the public domain maps from https://www.drivingdirectionsandmaps.com/mozambique-google-map/ (Accessed May 2019).

Fig 2. Hospital Geral de Mavalane (260 beds) in Maputo (Southern Mozambique).

Public domain map of Mozambique sourced from: https://www.drivingdirectionsandmaps.com/mozambique-google-map/ (Accessed May 2019).

Fig 3. Hospital Central da Beira (640 beds) in Beira (Central Mozambique).

Public domain map of Mozambique sourced from: https://www.drivingdirectionsandmaps.com/mozambique-google-map/ (Accessed May 2019).

Fig 4. Hospital Central de Nampula (529 beds) in Nampula (Northern Mozambique).

Public domain map of Mozambique sourced from: https://www.drivingdirectionsandmaps.com/mozambique-google-map/ (Accessed May 2019).

Fig 5. Overview of the MOZART Study cohort.

Randomly selected cases without data comprised 10.5%/15.3% of cases in Maputo, 14.6%/7.8% of cases in Beira & 14.2%/10.0% in Nampula for the April/October survey periods. Historical weather data from: https://www.timeanddate.com/weather/mozambique (accessed May 2018).

Fig 6. Top 15 diagnoses in the MOZART cohort (representing 63% of all diagnoses)–ICD10 coding.

Red segments = CD, Blue segments = NCD, Purple segments = Injury and Grey segment = other diagnoses comprising CD, NCD and Injury.

Fig 7. Pattern of CD, NCD and injury according to age profile.

Fig 8. Twenty most common forms of communicable disease–ICD 10 coding (3,622 Cases).

Fig 9. Twenty most common forms of non-communicable disease–ICD 10 coding (1,415 Cases).

Fig 10. Location of injuries in children (795 injuries), adolescents (495 injuries) and adults (1,496 injuries).

Fig 11. 24-hour distribution of emergency presentations according to type.

Each circle represents the 24-hour clock and the wedges the relative volume of cases per 2-hour period. The peak volumes in cases are indicated by the white circle for each category of presentation.