Text to be translated into Portuguese

Background Sofala Province, located in central Mozambique, has a relatively high-population

density and an estimated population of more than 1.8 million, 37% of which is urban [1]. Nearly
62% of the population is concentrated along the major shipping and transport route connecting
the sea port of Beira to Zimbabwe. Of the 11 provinces in Mozambique, Sofala ranks among the
poorest, though key health indicators are above the country average and have improved at a
more accelerated pace than other provinces. Latest estimates show that the infant mortality
rate is 81 per 1,000 live births, and the under-5 mortality rate is 134 per 1,000 live births,
compared with 107 per 1,000 live births and 157 per 1,000 live births nationally [2]. Despite
substantial reductions in mortality indices over the past decade, the four principal causes of
under-5 mortality in Sofala remain diseases with available low cost and effective prevention or
treatment strategies, including malaria (32.9%), acute respiratory infections (10.9%), HIV
(9.9%), and diarrheal diseases (8.9%) [3]. High levels of chronic (35.7%) and acute (7.4%)
malnutrition result from persistent food insecurity [4]. Nationally, the maternal mortality ratio,
which has seen a 50% reduction in the last decade, is still high at an estimated 490 per 100,000
live births [5].
Approximately 15.5% (over 185,000) adults aged 15-49 in Sofala Province are HIV-infected, with
60,000 estimated to be eligible for antiretroviral therapy (ART) [6]. Pediatric HIV infection is
high, with an estimated 23,800 HIV infected children in 2007 [7]. Tuberculosis (TB) incidence is
estimated at more than 400 per 100,000 people, and HIV co-infection is common, with more
than 60% of TB patients in Sofala also testing positive for HIV [8].
Health systems coverage Despite the high burden of disease, the use of formal health services
provided through the National Health Service (NHS) remains high, particularly for basic
preventive and curative maternal, newborn, and child health services.
Coverage of antenatal care services (at least one visit) is high in Sofala and has increased from
82% to 95% in the past decade. In the same time period, the institutional birth rate increased
from 51% to 71%. Both measures are higher than the national average [4,9]. Of those receiving
routine antenatal care services, more than 90% received syphilis testing and treatment, 46%
received at least one dose of intermittent preventive treatment for malaria [10], and 74%
received testing for HIV, reflecting variations in the delivery of effective interventions through
the antenatal care platform [2]. Five hospitals in the province are equipped to perform cesarean
births, and they perform these at a low rate of 2% of estimated births. Modern contraceptive
use is low in Sofala among women of reproductive age (8%) and lower than the national
average (12%).
Immunization coverage in Sofala Province is high, with 85% of children 12-23 months having
received diphtheria tetanus-pertussis (DTP3) vaccine, 87% measles vaccine, and 78% receiving
all required vaccinations. An estimated 25% of children under 5 sleep under insecticide treated
bednets [10]. Utilization of formal health services among symptomatic children under-5 is also
high and above the national average, including among those with diarrheal symptoms (71.2% in
Sofala compared with 58.5% nationally) and fever (75.4% compared to 58.8% nationally) [4].
Basic ambulatory care services are broadly available throughout the province and nearly 3
million people are reached annually through outpatient visits [11]. Integration of HIV care into
outpatient services at smaller health centers has improved adult and pediatric access to HIV
care, and in 2012 more than 27,300 people (nearly 50% of ART eligible patients) are on ART,
including more than 2,800 children under 15 [12]. Case detection of new sputum smear positive
pulmonary TB cases is estimated at 88.3%, and 83% of those initiating TB treatment are treated
to completion [13].