Climate change poses severe consequences, particularly in sub-Saharan Africa, where poverty rates may escalate by 2050 without significant climate and development action. The health impacts are diverse, encompassing communicable and non-communicable diseases. Mozambique, a climate-vulnerable nation, has experienced significant natural disasters in the past 42 years, impacting its health system. This study aims to assess Mozambique’s health sector’s vulnerability and adaptation needs to climate change. Following a methodology proposed by the World Health Organization and the Intergovernmental Panel for Climate Change, a six-step vulnerability and adaptation assessment was conducted to conduct the Health Vulnerability Index (HVI) for Mozambique’s regions $(n=161)$. The HVI integrates historical climate, epidemiological, and socio-economic data at the district level, and was computed using exposure, sensitivity, and adaptive capacity dimensions. The results revealed spatial patterns in exposure to climate variables, extreme weather events, and variations in sensitivity and adaptive capacity across the country. The HVI mirrored the exposure findings. Notably, high vulnerability was observed in several districts, while major urban centers displayed lower vulnerability. These findings highlight the country’s vulnerability to climate change and underscore the potential for adverse impacts on livelihoods, the economy, and human health. The study provides a foundation for developing strategies and adaptation actions.

The floods associated with the landfall of cyclones Idai and Kenneth in Mozambique between March and April 2019 had a major impact on the country’s public health and placed the affected population at risk for vector- and rodent-borne diseases. Aiming to improve the diagnostic capacity, yield information to guide public health responses, and assess potential short-term effects of cyclones Idai and Kenneth on arboviruses (dengue, Zika, and chikungunya) and leptospirosis, a clinical and laboratory surveillance for non-malarial acute febrile illness was established in six health units located in different districts within the two provinces (Sofala and Cabo Delgado) affected by the cyclones. Patients were tested using real-time reverse transcriptase polymerase chain reaction (qRT-PCR) for dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viruses and using enzyme linked immunoassays (ELISA) to detect nonstructural DENV protein 1 (NS1), as well as DENV, ZIKV, CHIKV, and Leptospira IgM antibodies. From April to September 2019, 305 patients aged ≥15 years were enrolled, of which 58.4% were women and the median age was 30 years old. All patients were qRT-PCR negative for the targeted arboviruses, but three (1.0%) were positive for DENV NS1 ELISA. Specific IgM antibodies against DENV, ZIKV, CHIKV or Leptospira were found in the serum of 104 (34.1%) patients. Our results indicate that vector- and rodent-borne disease transmission occurred in all districts under investigation in the wake of cyclones Idai and Kenneth, including some regions where cases had not been previously detected. The investigation provided useful information for post-cyclone emergency response purposes.

Background: Emerging zoonotic diseases are an increasing threat to public health. There is little data on the seroprevalence of zoonotic diseases among pastoralists in the country. We aim to carry out a cross-sectional study on the prevalence of major zoonotic diseases among pastoral communities in the Caia and Búzi districts. Methods: Between January and December 2018, a questionnaire was used to solicit socio-demographic data from consenting pastoralists with the collection of blood samples in the Caia and Búzi districts of the Sofala province. All samples were tested using ELISA commercial reagents for the detection of IgM antibodies against Brucella and Leptospira. Likewise, IgM and IgG antibodies against Rickettsia and CCHFV were determined using ELISA kits. Results: A total of 218 samples were tested, of which 43.5% (95/218) were from the district of Caia and 56.4% (123/218) from the Búzi district. Results from both districts showed that the seroprevalence of IgM antibodies against Brucella and Leptospira was 2.7% (6/218) and 30.3% (67/218), respectively. Positivity rates for IgM and IgG anti-Rickettsia and CCHFV were 8.7% (19/218), 2.7% (6/218), 4.1% (9/218), and 0.9% (2/218), respectively. Conclusions: Results from our study showed evidence of antibodies due to exposure to Brucella, Leptospira, Rickettsia, and CCHFV with antibodies against Leptospira and Rickettsia being the most prevalent. Hence, laboratory diagnosis of zoonotic diseases is essential in the early detection of outbreaks, the identification of silent transmission, and the etiology of non-febrile illness in a pastoral community. There is a need to develop public health interventions that will reduce the risk of transmission.

Background: Meningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique. Method: We performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (≥18 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing. Results: Retrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include Neisseria meningitidis (8.9%; 14/158), Escherichia coli (6.3%; 10/158), Haemophilus influenzae (5.1%; 8/158) and S. aureus (4.4%; 7/158), which represent (24.7%; 39/158) of the total confirmed cases. Conclusion: Altogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care.

Introduction: Low- and middle-income countries are facing a new double burden: an increasing frequency of extreme weather events that disrupt healthcare services for people living with non-communicable diseases (NCDs) and a rising prevalence of NCDs. In Mozambique, NCDs are the second leading cause of death among adults, and climate-related disasters, occurring with increasing intensity, exacerbate this problem. Objective: This study aims to understand the challenges and opportunities for addressing the needs of persons living with NCDs in the aftermath of extreme weather events in Mozambique between 2019 and 2023. Methods: This qualitative study employed a combination of focus group discussions (FGD) and in-depth interviews in five provinces severely affected by cyclones. A total of 36 in-depth interviews were conducted with key stakeholders and individuals living with NCDs. Five FGDs were held with community members. Rapid qualitative analysis was used to identify themes, which were presented using the socioecological model (SEM) framework. Results: Three main themes and 14 subthemes emerged. The main themes were: (1) an overall lack of disaster preparedness leading to challenges for the general population; (2) persons with NCDs could not adequately manage their condition; and (3) the need to integrate NCD management into disaster preparedness and response plans. Barriers to NCD management were identified at all levels of the SEM, with the majority at the organisational level. Participants identified recommendations that can serve as models for addressing some identified barriers. Conclusion: Persons living with NCDs cannot adequately manage their conditions during extreme weather events in Mozambique due to barriers at all levels of the SEM. Addressing this challenge requires multilevel strategies that integrate NCD management into disaster preparedness and response plans, leverage existing programmes and strengthen health system resilience. Future work needs to evaluate the implementation of integrated disaster response plans to inform scale-up and scale-out.

Climate change (CC) poses severe consequences, particularly in sub-Saharan Africa, where poverty rates may escalate by 2050 without significant climate and development action. The health impacts are diverse, encompassing communicable and non-communicable diseases. Mozambique, a climate-vulnerable nation, has experienced significant natural disasters in the past 42 years, impacting its health system. This study aims to assess Mozambique’s health sector vulnerability and adaptation needs to climate change. Following a methodology proposed by the World Health Organization and Intergovernmental Panel for Climate Change, a six-step vulnerability and adaptation assessment was conducted. The Health Vulnerability Index (HVI), integrating historical climate, epidemiological, and socio-economic data at the district level (n=162), was computed using exposure, sensitivity, and adaptive capacity dimensions. The Results revealed spatial patterns in exposure to climate variables, extreme weather events, and variations in sensitivity and adaptive capacity across the country. The HVI mirrored the exposure findings. Notably, high vulnerability was observed in several districts, while major urban centers displayed lower vulnerability. These findings highlight the country’s vulnerability to climate change and underscore the potential for adverse impacts on livelihoods, the economy, and human health. The study provides a foundation for developing strategies and adaptation actions.