Intervention heroes of Mozambique from 1997 to 2015: estimates of maternal and child lives saved using the Lives Saved Tool.

BACKGROUND: As one of several countries that pledged to achieve the Millennium Development Goals (MDGs), Mozambique sought to reduce child, neonatal, and maternal mortality by two thirds by 2015. This study examines the impact of Mozambique's efforts between 1997 and 2015, highlighting the increases in intervention coverage that contributed to saving the most lives. METHODS: A retrospective analysis of available household survey data was conducted using the Lives Saved Tool (LiST). Baseline mortality rates, cause-of-death distributions, and coverage of child, neonatal, and maternal interventions were entered as inputs. Changes in mortality rates, causes of death, and additional lives saved were calculated as results. Due to limited coverage data for the year 2015, we reported most results for the period 1997-2011. For 2011-2015 we reported additional lives saved for a subset of interventions. All analyses were performed at national and provincial level. RESULTS: Our modelled estimates show that increases in intervention coverage from 1997 to 2011 saved an additional 422 282 child lives (0-59 months), 85 450 neonatal lives (0-1 month), and 6528 maternal lives beyond those already being saved at baseline coverage levels in 1997. Malaria remained the leading cause of child mortality from 1997 to 2011; prematurity, asphyxia, and sepsis remained the leading causes of neonatal mortality; and hemorrhage remained the leading cause of maternal mortality. Interventions to reduce acute malnutrition and promote artemisinin-based combination therapy (ACT) for malaria were responsible for the largest number of additional child lives saved in the 1997-2011 period. Increases in coverage of delivery management were responsible for most additional newborn and maternal lives saved in both periods in Mozambique. CONCLUSION: Mozambique has made impressive gains in reducing child mortality since 1997. Additional effort is needed to further reduce maternal and neonatal mortality in all provinces. More lives can be saved by continuing to increase coverage of existing health interventions and exploring new ways to reach underserved populations.

Caracterização dos casos fatais por queimaduras térmicas registados no Serviço de Medicina Legal do Hospital Central de Maputo, entre 2009 a 2014 / Characterization of fatal cases due to thermal burns registered in the Forensic Medicine Service of the Central Hospital from Maputo, between 2009 and 2014

De acordo com a Organização Mundial da Saúde, as queimaduras constituem um grande problema de saúde pública no mundo. Só as relacionadas com fogo (chamas), fazem 300 000 mortes por ano e a maior parte delas (95%) ocorre em países de baixa e média renda. Outras queimaduras resultam de líquidos efervescentes, electrocução, químicos e outros. A morte é apenas parte do problema. Para cada pessoa que morre por queimadura, muitas mais sobrevivem com incapacidades e lesões desfigurantes para toda a vida. Apesar das consequências das queimaduras serem causas de doença prolongada e morte prevenívèis, elas ainda não captam a atenção merecida tanto da área médica assim como do público no geral. Objectivo: Descrever as queimaduras fatais e explorar as características que possam contribuir para elaboração de políticas de prevenção das queimaduras e controlo e melhorar a gestão clínica do doente queimado. Métodos: Realizou-se um estudo do tipo trasnversal rectrospectivo, tendo como fonte de dados o livro de registo e relatórios de autópsias do Serviço de Medicina Legal do Hospital Central de Maputo (SML-HCM) correspondentes aos anos de 2009- 2014. Serão considerados para o estudo, todos os casos de queimaduras térmicas fatais, constantes nos registos. Resultados: Foram registados no SML-HCM um total de 605 casos fatais vítimas de queimaduras térmicas. Destes, 336 (55, 54%) foram do sexo masculino. A idade média foi de 20 anos, com uma mediana de 8 anos. As chamas foram responsáveis por 99% das mortes. De todas as queimaduras fatais, 73,6% delas ocorreu no domicílio e 86% foram acidentais e a área média de superfície queimada foi de 36%. Conclusão: A maior parte das queimaduras fatais ocorreu em crianças. A maioria destas queimaduras fatais foram acidentais, sendo causadas maioritariamente por chamas. A principal causa de morte nestes doentes foi choque por queimadura e septicemia. A recomendação principal seria melhor controlo de infecções

According to WHO, the burns are a major public health problem worldwide. Only those related to fire are 300,000 deaths per year, and most of them (95%) occur in low-and middle-income countries. Other more burns result from effervescent liquid, electrocution, chemicals and others. The deaths are just a part of the problem. For every person who dies by burning, many more survive with disabilities and disfiguring injuries for life. Despite of prolonged illness and death caused by burns are the more preventable, they still do not capture the necessary attention both from the medical field as well as the public in general. Objective: To describe fatal burns and to explore the characteristics that may contribute to the elaboration of prevention and control policies and to bring about aspects related to the patient's clinic that may serve to improve the clinical management of the burned patient. Methods: We conducted a longitudinal Retrospective study, with the data using the autopsy record book and reports from SML-HCM for the years 2009 to 2014. For this study, all cases of thermal fatal burns contained in the records were considered. Results: A total of 605 cases fatal victims of thermal burns were recorded in SML-HCM. Of these, 336 (55, 54%) were male. The average age was 20 years old, with a median of 8 years. The flames were responsible for 99% of deaths. Of all fatal burns, 73.6% of them occurred at home and 86% were classified as accidental and the average surface area burned was 36%. Conclusions: Most fatal burns occurred in children. Most of the fatal burns were accidental and by flames. The main cause of death in these patients was shock from burning, followed by septicemia. The main recommendation is to improve the infection control measures.