Mozambique's Zambezia province is making strides to catch up on rotavirus vaccinations, a critical step in the fight against diarrhoea-related illnesses in children. During the COVID-19 crisis, while many immunization programs faltered, Mozambique's rotavirus vaccine coverage climbed from 67% to 75%. However, in Zambezia, the country's second-most populous province, rotavirus vaccination rates declined during the pandemic. This was concerning, as rotavirus is a leading cause of moderate-to-severe diarrhoea in Mozambique, which is a leading cause of death in early childhood. Five years on, Zambezia is 'racing' to catch up, according to Quinhas Fernandes, the National Director of Public Health at Mozambique's Ministry of Health. The decline in Zambezia can be attributed to various factors, including long waiting periods for vaccination appointments, travel challenges within the vast and rugged province, and limited numbers of health workers staffing public clinics. However, the main impediment to rotavirus uptake after March 2020 was the borders set up within the province, which limited human movement in Zambezia. As COVID-19 began to spread in Zambezia, panic set in, and frightened parents considered getting the COVID-19 vaccine or sheltering in place as more important than the 'normal' rotavirus disease vaccine. The health sector resource crunch also meant that nurses and community healthcare patrollers were in 'panic-mode', focusing their resources on protecting their families against COVID-19. This meant often not coming to work at the clinics or stopping all street public health patrols. Rotavirus became a complete 'afterthought'. In contrast, the southern-lying Maputo province, the most urbanized province of Mozambique, continued its usual rotavirus vaccination drive alongside new anti-COVID-19 measures. Today, panic-mode is in the past, and Zambezia is busy making up for lost time on rotavirus coverage. The aggressive catch-up initiative, led by the provincial government and Ministry of Health, picked up pace in late 2023, targeting all parts of the province but doubling down especially in rural districts. The drive involves sending out hundreds of community volunteers, health workers with megaphones, bicycles, motorised roadshows, music concerts, and sensitising mothers who come to clinics for other reasons than the need for rotavirus vaccination for their kids. The rotavirus publicity blitz is yielding 'gradual results' at the Hospital Central de Quelimane, with the rate of rotavirus vaccination increasing from 50 per month in 2022 to an average of 220 doses per month currently. However, keeping children diarrhoea-free in Icidua, one of the poorest neighbourhoods of Quelimane, isn't easy, as safe municipal water is a privilege of more affluent suburbs. The vaccination gives peace of mind for our babies, says Ona Bhunu, 39, a mother of twins in Icidua. Dube and her colleagues are also on the case, asking all mothers coming into the clinic for HIV tests, family planning, or HPV stuff: 'Hey, the COVID crisis is over – does you or anyone you know haven't got the rotavirus vaccine for your kids?'
