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The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection.
The Beira District is one of the 13 districts of the Sofala Province, laying on the eastern coast of Mozambique, and it is the third largest district in the country. The health system of the Sofala Province is articulated in 146 health facilities (1 per every 12,000 inhabitants) [21] and it is organized into four basic levels of care, including (1) one quaternary-level hospital in Beira, (2) four secondary-level rural hospitals, (3) 114 urban and rural health centers, including Maternal and Child Health Services specific to mothers and children, which are managed by the Ministry of Health (MoH), and (4) 27 health posts [22]. The ARCCs are configured as specific clinics within the Maternal and Child Health Services, and since 2012, most of the 15 ARCCs of the Beira district are supported by Doctors with Africa CUAMM. Each ARCC provides free out-patient consultations dedicated to new-borns and children under five with specific health risks, such as HIV exposed infants (HEI), preterm, malnourished, TB exposed, referred to Maternal and Child Health Services from maternity, health posts, neonatology, or directly accessing the MCH services. Children that are presented in centers are taken charge of by clinical officers and nurses who provide care in an out-patient setting. The ones requiring more complex care and/or admission are addressed to the Beira referral hospital or to chronic disease out-patient services, except for HEI. In fact, since 2013, after a positive screening test with a PCR or Rapid test, a confirmation test with Western Blot [23] has been performed and, if positive again, the HEI remains in charge of ARCCS until 5 years old, together with his mother, in order to guarantee a better continuum of care [24]. We retrospectively analyzed all children accessing one of the 15 Beira ARCCs for a first consultation over a 3-year period, from January 2015 to December 2017. Routine service data were accessed. Data collection in Health Centers (HC) goes through several processes, from registration to assignment to the higher levels (Provincial and National). Firstly, data is recorded in each health section of HC during the consultation using a national format in a daily logbook. Health professionals have to ensure consistency and completeness (filling in all fields) of the registration in order to obtain high quality data. The daily logbook is filled exclusively by the health care professional who delivers the service. At the end of the activities, the daily summary is elaborated on. In this case, the person in charge of this activity verifies the agreement of the data. After the last day of the period under analysis (following the statistical calendar), a monthly summary is made, aggregating the daily summaries corresponding to the period in question. The direction of the HC is responsible for issuing and approving the summaries. Thus, the data analysis is done at the HC level and, subsequently, is reported to the district level and is then sent to higher levels. We accessed the data at the district level, obtaining aggregate information on a number of consultations at each ARCCs. Information about the motives of the first consultation, the type and the timing of the first HIV test that was administered and it’s result, and the type and duration of breastfeeding were also extracted. Motivations were grouped into 5 categories: TB exposure, Moderate Acute Malnutrition (MAM), Severe Acute Malnutrition (SAM), HIV exposure, and other risk conditions (e.g., malaria, preterm). Moderate Acute Malnutrition and Severe Acute Malnutrition were defined according to the z-scores of weight-for-height [25,26]. A database was created on Microsoft Excel software and was analyzed using the STATA 13.0 statistics software. The frequencies for the categorical variables were calculated as descriptive statistics. Data use for publication was approved by the District Health Authority in Beira, the Health District Direction (protocol reference: 293 /15), Mozambique.
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