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Background: Mozambique is ranked fourth in a list of the 29 countries that accounted for 95% of all malaria cases globally in 2019. The aim of this study was to identify factors associated with care seeking for fever, to determine the association between knowledge about malaria and care seeking and to describe the main reasons for not seeking care among children under five years of age in Mozambique. Methods: This is a quantitative, observational study based on a secondary data analysis of the 2018 Malaria Indicator Survey. This weighted analysis was based on data reported by surveyed mothers or caregivers of children aged 0–59 months who had fever in the two weeks prior to the survey. Results: Care was reportedly sought for 69.1% [95% CI 63.5–74.2] of children aged 0–59 months old with fever. Care-seeking was significantly higher among younger children, < 6 months old (AOR = 2.47 [95% CI 1.14–5.31]), 6–11 months old (AOR = 1.75 [95% CI 1.01–3.04]) and 12–23 months old (AOR = 1.85 [95% CI 1.19–2.89]), as compared with older children (48–59 months old). In adjusted analysis, mothers from the middle (AOR = 1.66 [95% CI 0.18–3.37]) and richest (AOR = 3.46 [95% CI 1.26–9.49]) wealth quintiles were more likely to report having sought care for their febrile children than mothers from the poorest wealth quintile. Additionally, mothers with secondary or higher education level were more likely to seek care (AOR = 2.16 [95% CI 1.19–3.93]) than mothers with no education. There was no association between maternal malaria knowledge or reported exposure to malaria messages and care-seeking behaviours. The main reasons reported for not seeking care included distance to health facility (46.3% of respondents), the perception that the fever was not severe (22.4%) and the perception that treatment was not available at the health facility (15%). Conclusion: Health facility access and socioeconomic barriers continue to be important constraints to malaria service utilization in Mozambique.
This is a quantitative, observational study based on a secondary data analysis of the 2018 MIS data. The 2018 MIS collected nationally and provincially representative data from a representative sample of respondents. Consistent with standard MIS methodology, the sampling design had two steps: first selection of a total of 224 enumeration areas (EA) was done for urban and rural areas of each of the eleven provinces using probability proportionate to size, after which 28 households were systematically selected from each included EA. All women aged 15–49 years old who regularly resided or stayed the prior night in included households were included [6]. The survey included a total of 6,196 households and 6184 women aged 15–49 years old. The response rate for the household questionnaire was 99% percent and for the women questionnaire was 98% percent [4]. Data collection took place from March to June 2018. Mozambique is located on the east coast of southern Africa and is divided in 11 provinces, including the country’s capital, Maputo City. Mozambique has a surface of approximately 799,380 km2 [2] and an estimated population of approximately 31 million inhabitants [7]. The two most populous provinces are Nampula and Zambézia, with 6.3 million and 5.7 million inhabitants, respectively. The climate in Mozambique is tropical. The rainy season spans from October to March [2]. There is year-round transmission of malaria with seasonal peaks during the rainy season. This analysis was based on data reported by surveyed mothers or caregivers about their children aged 0–59 months who had fever in the two weeks prior to the survey. The main outcome of this study is care-seeking of children under 5 years who had fever in the two weeks prior to data collection, as reported by mothers/guardians. In this study, care-seeking is defined as a caregiver reporting that he/she sought treatment or counselling for children under 5 years of age with fever, regardless of source of care sought [4]. Potential covariates were identified for inclusion in a predictive model based on variables identified during a literature review of “care seeking” and “treatment seeking” for fever and malaria. A total of 13 socioeconomic and demographic covariates previously shown to be associated with care-seeking [8–12] were identified and used from the 2018 MIS dataset. The covariates included child’s age, sex, place of residence (urban or rural), geographic region (province), household wealth quintile, mother’s level of education, mother’s age, child’s use of a bed net, mothers reporting hearing or seeing a message about malaria in the past 6 months, maternal comprehensive malaria knowledge and three specific questions about malaria knowledge. The following categories were considered for mother’s level of education: no education, primary education, and secondary education or higher. The mother’s level of knowledge was assessed using a composite score based on the following five variables: (i) the mother indicated fever as a symptom of malaria; (ii) the mother indicated mosquito bite as a form of malaria transmission; (iii) The mother knows that should sleep inside a mosquito net to prevent malaria; (iv) The mother knows that malaria has a cure; and (v) The mother indicated correctly at least one medicine to treat malaria. Descriptive statistics were used to summarize socio-economic and demographic characteristics of participants, using the children (KR) dataset. Special (svy) survey commands were used to account for the complex multilevel survey design. Data were weighted using the KR weights (wt = v005/1000000) to account for the differential selection probabilities at the EA, household, and individual levels so that any results with the regional weight factored into it would be representative at the national and regional level. Only weighted survey data are presented in this manuscript. Complex sampling logistic regression model was used to identify factors associated with care-seeking behaviour, with estimated adjusted odds ratio (AOR) and respective 95% confidence intervals (CI). All statistical analysis were performed using STATA, version 15 (Stata Corporation, College Station, Texas).
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