Desastres Naturais e Emergências em Saúde em Moçambique: uma análise com enfoque no impacto dos Ciclones Idai e Kenneth para a Saúde Pública.

Abstract

Mozambique is exposed to multiple hydrometeorological hazards (drought, cyclones and floods) that have repeatedly affected many families in different provinces in recent years. Between 2015 and 2016, the country faced the worst drought in 35 years and between March and April 2019, it was hit by cyclones Idai and Kenneth accompanied by torrential rains that triggered floods. Added to these events, the largest record of people displaced (in decades) from their regions of origin due to violent terrorist attacks that devastate the province of Cabo Delgado, since the end of 2017 and; the ongoing Covid-19 pandemic exacerbated the vulnerability of the population. The succession / overlapping of these events triggered a humanitarian crisis that can exhaust the resilience of the most vulnerable communities, and generate short to long-term health problems. The study evaluated the impact of these disasters in the context of Public Health, focusing on the impact of cyclones Idai and Kenneth in the provinces of Sofala (districts of Beira, Búzi, Dondo and Nhamatanda) and Cabo Delgado (district of Macomia and city of Pemba), around three aspects: immediate impact on the well-being of affected families; food security and associated health problems (pellagra) and surveillance of acute febrile illnesses (malaria, dengue, chikungunya, Zika, leptospirosis and diarrheal diseases including cholera), sensitive to ecological changes induced by cyclones and floods. The study presents a mixed approach: i - descriptive research with a quali-quantitative approach, based on the review of official documents and scientific reports produced by agencies involved in the response to cyclones Idai and Kenneth and descriptive analysis of epidemiological data on cases of diarrhea, malaria and malnutrition, collected by the Ministry of Health in 2019, including the comparison of monthly frequencies of cases of malaria and diarrheal diseases recorded in 2018 and 2019; ii – a case-control study to investigate the pellagra outbreak in Nhamatanda-Sofala and, iii – a cross-sectional study based on an acute febrile illness surveillance system for the diagnosis of arboviruses infections (DENV, ZIKV and CHIKV) and/or zoonosis (Leptospirosis) in the cyclone-affected districts. Together, Cyclones Idai and Kenneth left 2.2 million people in need of protection and humanitarian assistance, in addition to those who were food insecure (about 2.1 million people) after the previous drought. The total damage and loss caused by the two cyclones was estimated at 2.8 billion dollars. The frequency of cases of diarrhea registered in the districts of Beira, Búzi, Dondo and Nhamatanda increased 1.2-3.8 times between March and June 2019, compared to the same period in 2018. At least 6,773 cumulative cases of cholera (attack rate: 571.4 cases per 100,000 population) and 8 disease-related deaths (lethality rate: 0.12%) were officially registered in the four districts affected by Idai. In Cabo Delgado, 346 cumulative cases of cholera were registered (attack rate: 105.5 cases per 100,000 population), with no related deaths. The district of Búzi was the only one that showed an increase in malaria cases between March and June 2019 compared to the same period in 2018. In Sofala, 160,992 children <5 years of age were examined for malnutrition, of which 2345 (1.5%) had moderate acute malnutrition and 952 (0.6%) had severe acute malnutrition. In Cabo Delgado, 61,834 children were examined, of which 1,405 (2.3%) had moderate acute malnutrition and 302 (0.5%) had severe acute malnutrition. Pellagra affected about 2,300 people (707.9/100,000 inhabitants) in Nhamatanda; cases were more likely to be female (P < 0.01) and less educated (P < 0.01) than controls. Insufficient consumption of chicken and peanuts before the arrival of cyclone Idai was statistically associated with pellagra (P < 0.05). Of the families interviewed during the study, 51% were facing food shortages even before the arrival of Idai. From the arbovirus surveillance, 305 patients aged 15 years or older were enrolled, of which 58.4% were women and the median age was 30 years (IQR: 23 – 41 years). Three (1.0%) patients were positive by the DENV NS1 ELISA, of which one also had positive IgM against DENV and CHIVK. Specific IgM antibodies against DENV, ZIKV, CHIKV or Leptospira were found in the serum of 104 (34.1%) patients, of them, 73 (23.9%) had evidence of a recent single infection and 19 (6.2%) had evidence of a recent infection by more than one arbovirus, and 12 (3.9%) by an arbovirus and Leptospira. Previous CHIKV and ZIKV infections, were found for 141 (46.2%) patients. Socio-environmental conditions continue to deteriorate in different areas in the two provinces as a direct consequence of climate catastrophes and terrorism, creating an even more challenging scenario for the health sector. Therefore, it is crucial to empower the National Health System and enable it not only to provide a rapid response to emergencies, but also to participate in multi-sector actions for prevention, mitigation, preparation, response and recovery from the effects of disasters in places where populations are constantly exposed to cyclones, floods and droughts.