Demographic and health community-based surveys to inform a malaria elimination project in Magude district, southern Mozambique

Abstract

Objectives: A Demographic and Health Platform was established in Magude in 2015, prior to the deployment of a project aiming to evaluate the feasibility of malaria elimination in southern Mozambique, named the Magude project. This platform aimed to inform the design, implementation and evaluation of the Magude project, through the identification of households and population; and the collection of demographic, health and malaria information.

Setting: Magude is a rural district of southern Mozambique which borders South Africa. It has nine peripheral health facilities and one referral health centre with an inpatient ward.

Intervention: A baseline census enumerated and geolocated all the households, and their resident and non-resident members, collecting demographic and socio-economic information, and data on the coverage and usage of malaria control tools. Inpatient and outpatient data during the 5 years (2010 to 2014) before the survey were obtained from the district health authorities. The demographic platform was updated in 2016.

Results: The baseline census conducted in 2015 reported 48 448 (92.1%) residents and 4133 (7.9%) non-residents, and 10 965 households. Magude's population is predominantly young, half of the population has no formal education and the main economic activities are agriculture and fishing. Houses are mainly built with traditional non-durable materials and have poor sanitation facilities. Between 2010 and 2014, malaria was the most common cause of all-age inpatient discharges (representing 20% to 40% of all discharges), followed by HIV (12% to 22%) and anaemia (12% to 15%). In early 2015, all-age bed-net usage was between 21.8% and 27.1% and the reported coverage of indoor residual spraying varied across the district between 30.7% and 79%.

Conclusion: This study revealed that Magude has limited socio-economic conditions, poor access to healthcare services and low coverage of malaria vector control interventions. Thus, Magude represented an area where it is most pressing to demonstrate the feasibility of malaria elimination.

Trial registration number: NCT02914145; Pre-results.

Keywords: demography; magude project; malaria elimination; population and health; public health.

Figure 1

Map of Magude district (2015). (A) Administrative and permanent river shape files were obtained from DIVA-GIS ((http://www.diva-gis.org/Data), and confirmed with Magude’s key informants. GPS positions of households, health facilities and community health workers obtained directly from the field and mapped using QGIS. (B) Population pyramid of Magude district (2015) showing the proportion of 5-year age and sex groups out of the total population. GPS, geographic positioning system.

Figure 2

Health profile of Magude district prior to the baseline census (2010 to 2014). (A) Most common diseases leading to all-age hospitalisation and later discharge in Magude reported by the District Health Authorities between 2010 and 2014. (B) Weekly number of outpatient malaria cases observed in Magude between 2010 and 2014 reported through the weekly epidemiological bulletin (BES) and monthly rainfall data obtained from the Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS). BES, Boletim Epidemiológico Semanal.