Mozambique

Malaria Facts

Malaria is endemic in Mozambique and the entire population is at risk of contracting the disease.[1] Pregnant women and children under the age of five have the greatest risk of developing severe malaria. [1] Plasmodium falciparum accounts for 90% of all malaria infections, while P. malariae accounts for 9% and P. ovale for 1%. [1]

Mozambique is among the six countries that accounted for more than half of all malaria cases and deaths worldwide (4% of global cases and deaths). [2] The country also has the 2nd highest prevalence of malaria in Eastern and Southern Africa (17.2%). [2] Between 2016 and 2019, cases fell by 9% from 340 to 308 per 1000 of the population at risk, while deaths fell by 12% from 0.56 to 0.49 per 1000 of the population at risk. [2] It also is one of the five countries with the highest levels of severe anaemia among children under five years of age. [2]

In 2015, malaria was responsible for 45% of outpatient visits and 56% of paediatric admissions. [3] Malaria caused 29% of all hospital deaths among the general population and 42% of deaths in children under five years of age. [3]

The proportion of pregnant women who received two or more doses of intermittent preventative treatment (IPTp2) increased from 35% in 2015 to 61% in 2018. [3] The proportion of pregnant women who received three or more doses of intermittent preventative treatment (IPTp3) increased from 23% to 41% over the same period. [3]

Many donors have reduced their direct (both financial and product-based) contributions to the health sector. [3] This has decreased the country’s capacity to access essential anti-malarial products such as sulfadoxine–pyrimethamine (SP) and vector control products. [3]

Key policies impacting malaria treatment

Injectable artesunate is currently recommended for the treatment of pregnant women with severe malaria at all stages of their pregnancy, which is against the World Health Organization’s recommendation that it should be used only from the second trimester. Quinine was previously the recommended choice for all stages of pregnancy. [3] However, most women start ANC later in their pregnancy and many do not return for the follow up visits, which poses serious challenges to the implementation of this policy.

Artesunate rectal capsules (ARC) is presently endorsed for children under the age of six. Only the 100 mg formulation is recommended. The 50mg and 200mg formulations have been removed from the national guidelines. [3]

Severe malaria policy and practice

National Treatment Guidelines (2011)
Recommendation Treatment
Strong IV artesunate
Strong IM artesunate
Alternative IV quinine
Recommendation Pre-referral
Strong IV or IM artesunate
Alternative Rectal artesunate
Malaria in pregnancy
Recommendation Treatment
Strong IV artesunate
Alternative IV quinine*

*Due to the risk of hypoglycaemia, IV quinine should be given as a an infusion with 30ml dextrose at 30% over 8 hours