Assucênio Chissaque

Rotarix is a monovalent, two-dose rotavirus vaccine that protects children against rotavirus infection and severe gastroenteritis. When Mozambique introduced Rotarix in September 2015, it was projected to save approximately 8000 lives and over USD 7.1 million in healthcare costs by 2030. However, dropout between doses remains a barrier to full immunization coverage. Using data from the 2022–2023 Mozambique Demographic and Health Survey, this study examined vaccine dropout among 2572 children aged 12–35 months and associated factors. Moran’s I, the Getis-Ord Gi* statistic, and weighted multilevel logistic regression were used to assess spatial patterns and associated factors. The dropout rate was 14.7% (95% CI: 12.8–16.8%), with hot spots in northern and central Mozambique. Rural residence, no antenatal care visits, not presenting a health card, and perceiving distance to a health facility as a major problem were associated with higher odds of dropout. Most provincial differences were attenuated after adjustment, although Inhambane showed lower odds than Maputo City. Integrating immunization into antenatal care, ensuring health card retention and defaulter tracing, expanding rural outreach, and prioritizing northern and central hot spots in district microplanning could reduce dropout and rotavirus disease burden.

Background: Despite the proven role of childhood immunization in reducing child mortality, global coverage targets remain unmet. Zero-dose (ZD) children—those who have not received any DTP vaccine dose—represent a critical challenge. Mozambique is among the lowest-coverage countries, with full immunization declining from 66% in 2015 to 38% in 2022–2023. This study determines the levels and trends of ZD prevalence in Mozambique. Methods: We analyzed data from three nationally representative surveys—DHS 2011, IMASIDA 2015, and DHS 2022/23—focusing on children aged 12–23 and 24–35 months. The analysis examined ZD prevalence trends across provinces and disparities by urban–rural residence, wealth index, and maternal education. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression. Results: ZD prevalence increased from 5.4% to 14.3% (2015–2022) among children aged 12–23 months, and from 6.4% to 16.0% among those aged 24–35 months. Key risk factors included rural residence (PR: 0.50; 95% CI: 0.29–0.88), maternal illiteracy (PR: 0.75; 95% CI: 0.61–0.92), and non-institutional delivery (PR: 0.20; 95% CI: 0.13–0.30). The wealth gap in ZD prevalence widened from 11.3 to 26.3 percentage points, and the urban–rural gap from 3.9 to 15.3 points. Children of mothers with no education had a 22.8% ZD prevalence versus 5.4% among those with secondary or higher education. Conclusion: Rising ZD prevalence and widening inequalities underscore the urgent need for targeted, equity-focused interventions. Strengthening health systems to address these inequities and improve routine immunization services is essential for better child health outcomes in Mozambique.

The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program delivers community- and clinic-based interventions to reduce HIV vulnerability among adolescent girls and young women (AGYW) aged 15–24 years. We conducted a retrospective programmatic financial cost analysis from the implementing partner perspective using financial and programmatic records from October 2022 to June 2023. We estimated the total costs and cost per AGYW enrolled (cost/AGYW) of DREAMS components in Gaza and Inhambane, Mozambique. A total of 19,477 AGYW were enrolled in Gaza and 3320 in Inhambane from October 2022 to June 2023. Clinic-based components cost US$189,047 in Gaza and US$67,826 in Inhambane, which amount to US$10 and US$20 per AGYW enrolled, respectively. Inhambane’s community component cost US$128,344, and US$39 per AGYW enrolled without Siyakha (an economic package that prepares AGYW to enter the job market). Among Siyakha recipients, the combined community and Siyakha cost was US$466 for 59 AGYW receiving the light package without internship and US$551 for 54 AGYW receiving the full package with internship. Human resources were the largest cost category across components, indicating that staffing requirements are a major determinant of DREAMS implementation costs. Human resources were the main cost driver in both components, highlighting the need to optimize staffing models.

Background/Objectives: Girls living with HIV (GLHIV) or vulnerable to HIV have a higher risk of HPV infection and cervical cancer as they age. We determined acceptability and vaccination uptake after integrating HPV vaccination into HIV prevention and treatment services for girls in Mozambique and Zimbabwe. Methods: Pre-integration and integration HPV vaccination information were abstracted from routine records of girls aged 9–14 years offered HPV vaccine through HIV services in 54 health facilities (HFs) and surrounding communities between February and December 2025. Caregivers participated in quantitative surveys about vaccine perceptions and integration model experiences in a subset of 16 HFs. Results: In total, 6377 records of girls (median age: 11 years) were abstracted. Among the vaccine recipients, 63 (3.0%) girls received vaccine pre-integration and 2019 (97.0%) post-integration in Mozambique and 743 (17.3%) pre-integration and 3541 (82.7%) post-integration in Zimbabwe. Among GLHIV, 95.8% and 69.6% received a first HPV vaccine in Zimbabwe and Mozambique, respectively. Full vaccination with two doses occurred in 49.1% of eligible girls in Mozambique and 73.9% in Zimbabwe. Overall, 461 (67.8%) caregivers had heard of the HPV vaccine and 85.9% of cervical cancer, 99.6% were satisfied with vaccination in integration settings, and 78.6% preferred facility-based vaccination models. Conclusions: We demonstrated that HPV/HIV service integration was an effective strategy to increase HPV vaccine uptake among young girls at increased risk of HPV and cervical cancer. We found high vaccine and model acceptability and awareness of cervical cancer among caregivers. Optimization of this approach requires better integrated tools and model adaptations to fit the needs of girls and health systems.

Mozambique introduced the Rotarix monovalent vaccine (RIX4414 Rotarix^MT) into its childhood immunization schedule in September 2015. We aimed to assess the impact of the vaccine in the prevention of infection and in the diversity of RVA genotypes before and after vaccine introduction. A descriptive cross-sectional study in children under five years of age hospitalized with acute diarrhea in the Pediatric Services of Maputo Central Hospital between 2013 and 2018 was conducted. eight hundred and two stool samples were collected during the pre-vaccination period (2013 - 2015) and 196 in the post-vaccination period (2016 - 2018), where a median reduction of 76% of cases of hospitalization for diarrhea was observed, decreasing from 28.7% (82/284) in the pre-vaccine period to 15.50% (10/66) in the post-vaccination period, (p <0.05) in all age groups. Similarly, there was a median reduction of 53.89% in the proportion of hospitalization for rotavirus diarrhea in children <12 months of age, from (28.29%) in the pre-vaccination period to 13.04% in the post-vaccinal. After the introduction of the vaccine, there was a change in the usual seasonal peaks. The most prevalent combinations of rotavirus genotypes in the pre-vaccine period were G2P[4] in 2013 62/86 (72%), G1P[8] 31/48 (65%) in 2014, G9P[8] 48/70 (69%) in 2015 and in the post - vaccination period were: G1P[8] 5 (50%) in 2016 and 5/8 (62.5%) in 2017; G3P[8], G3P[4], G4P[6] 1/3 (33%) in 2018. After vaccine introduction a reduction of diarrhea hospitalization and rotavirus associated were observed and a wide variety of rotavirus strains circulated in the pre- and post-introduction periods of the vaccine. The results of this study support evidence of the impact of rotavirus vaccination highlighting the importance of program continuity as well as monitoring studies of rotavirus genotypes following the introduction of the vaccine in Mozambique.

Mozambique introduced the Rotarix^® vaccine into the National Immunization Program in September 2015. Following vaccine introduction, rotavirus A (RVA) genotypes, G9P[4] and G9P[6], were detected for the first time since rotavirus surveillance programs were implemented in the country. To understand the emergence of these strains, the whole genomes of 47 ELISA RVA positive strains detected between 2015 and 2018 were characterized using an Illumina MiSeq-based sequencing pipeline. Of the 29 G9 strains characterized, 14 exhibited a typical Wa-like genome constellation and 15 a DS-1-like genome constellation. Mostly, the G9P[4] and G9P[6] strains clustered consistently for most of the genome segments, except the G- and P-genotypes. For the G9 genotype, the strains formed three different conserved clades, separated by the P type (P[4], P[6] and P[8]), suggesting different origins for this genotype. Analysis of the VP6-encoding gene revealed that seven G9P[6] strains clustered close to antelope and bovine strains. A rare E6 NSP4 genotype was detected for strain RVA/Human-wt/MOZ/HCN1595/2017/G9P[4] and a genetically distinct lineage IV or OP354-like P[8] was identified for RVA/Human-wt/MOZ/HGJM0644/2015/G9P[8] strain. These results highlight the need for genomic surveillance of RVA strains detected in Mozambique and the importance of following a One Health approach to identify and characterize potential zoonotic strains causing acute gastroenteritis in Mozambican children.

The epidemiology and characteristics of SARS-CoV-2 in the hospitalized Mozambican pediatric population are scarce. We aimed to assess the burden of COVID-19 in the pediatric population at Hospital Central de Maputo and identify comorbidities and factors associated with death among hospitalized COVID-19 cases. A cross-sectional study was conducted from October 2020 to October 2022. Available records were retrieved from admission books. Univariate and bivariate analyses were reported to describe the sample characteristics. The frequency of pediatric cases admitted with COVID-19 was 0.6% (95% confidence interval (CI): 0.5–0.6; 364/63,753), and the frequency of pediatric cases hospitalized with COVID-19 was 2.5% (95% CI: 2.2–2.9; 173/6807). The monthly frequency of pediatric cases admitted and hospitalized with COVID-19 ranged from 0.1% to 5.4% and from 0.2% to 42.1%, respectively. In children hospitalized with COVID-19, underweight was the most observed comorbidity (17.4%; 19/109); death was observed in 30% (95% CI: 22.2–39.1; 33/110), and it was significantly higher in underweight children than in non-underweight children (61.5% [8/13] vs. 21.3% [16/75]; p-value = 0.005). Given the heightened risk of mortality among undernourished children compared to non-undernourished children, vaccination for COVID-19 should be prioritized for undernourished children.

Mozambique has one of the highest child undernutrition rates in Sub-Saharan Africa. The aim of this study was to characterize the profile of children from 1 to 14 years old hospitalized for undernutrition and to explore associated risk factors. Clinical, demographic, socioeconomic, and environmental data were collected. Anthropometric measurements and stool samples were collected from a child and their caretaker. The wealth index was determined using Principal Components Analysis. A total of 449 children and their caretakers were enrolled. The children had a median age of 1.0 year [IQR: 1.0–2.0], and 53.9% (242/449) were male. Most were admitted with severe undernutrition (35.7%, 159/449 kwashiorkor and 82.0%, 368/449 with −3SD Z-score indexes). The most common co-morbidities were HIV (30.0%, 120/400), diarrhea (20.0%; 80/400), and anemia (12.5%; 50/400). Among the caretakers, 9.5% (39/409) were underweight, 10.1% (40/397) were overweight, and 14.1% (56/397) were obese. Intestinal parasites were found in 24.8% (90/363) children and in 38.5% (77/200) caretakers. The majority of children (60.7%, 85/140) came from low- to middle-wealth households. Most were severely undernourished, suggesting that they seek medical care too late. The finding of overweight/obese caretakers in combination with undernourished children confirms that Mozambique is facing a double burden of malnutrition.

Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus (HPV) vaccination was introduced in 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL^® hereafter referred to as GARDASIL-4) and two other vaccines (CECOLIN^® and CERVARIX^®) that could be used in the future. A static cohort model was used to estimate the costs and benefits of vaccinating girls in Mozambique over the period 2022–2031. The primary outcome measure was the incremental cost per disability-adjusted life-year averted from a government perspective. We conducted deterministic and probabilistic sensitivity analyses. Without cross-protection, all three vaccines averted approximately 54% cervical cancer cases and deaths. With cross-protection, CERVARIX averted 70% of cases and deaths. Without Gavi support, the discounted vaccine program costs ranged from 60 million to 81 million USD. Vaccine program costs were approximately 37 million USD for all vaccines with Gavi support. Without cross-protection, CECOLIN was dominant, being cost-effective with or without Gavi support. With cross-protection and Gavi support, CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness ratio. Conclusions: At a willingness-to-pay (WTP) threshold set at 35% of Gross Domestic Product (GDP) per capita, HPV vaccination is cost-effective in Mozambique. The optimal vaccine choice depends on cross-protection assumptions.