A research project entitled “The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994” in the 2001 Bulletin of the World Health Organization provides an informative overview of the kinds of health problems that are common in Mozambique. As suggested by the title, the data was gleaned from Maputo City death register and autopsy records for 1994.

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The report found the “infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register.” While AIDS did not show up as a major cause of mortality, the report notes the ” AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City.”

It was found that “perinatal disorders (1,643 deaths) were the overall leading cause of death.” It appeared that “malaria was the second leading cause of death...” even though there are a number of factors that might lead to its being either over or under reported. Also it was suggested “the high ranking of diarrheal diseases in both the young and old was partly due to epidemics of shillelagh dysentery.” With regard to the possible relationship between tuberculosis, diarrhea and AIDS, the report noted that “many tuberculosis deaths in the sexually active age groups were probably due to co infection with HIV. Given the 2.7% HIV seroprevalence rate of women in antenatal clinics, we might have expected more deaths from AIDS than the 22 registered. Probably many deaths registered as diarrheal diseases and malaria also had AIDS as the underlying cause.”

The findings on violent deaths was especially instructive. “A comparison of data from the city death register and medico legal autopsies showed that there were more deaths from homicide listed in the autopsy records (343 in autopsies; 188 in the register) suggesting that homicide may be under registered as a cause of death in the city death register. In the city register for 1990, only 72 deaths were due to homicide. In medico legal autopsy records, deaths from homicides rose from 176 in 1990 (Maputo Central Hospital Medico legal Department data) to 343 in 1994 (this study). The large proportion of deaths from injuries, especially in young men, shows the heavy toll of violence in Maputo City (Table 1 and Table 5). Ironically, post-war peace in Mozambique has been associated with a rise in violent crime in the capital.”

The following two tables summarize much of the relevant data in that was gathered in this study. Table 1. Distribution of registered deaths by group and level-two cause in Maputo City, Mozambique, 1994

Cause of death No. of deaths (%)

Group 1

Infectious and parasitic diseases 2776 (34.2) Perinatal disorders 164 (20.2) Respiratory infections 43 (5.3) Nutritional disorders 411 (5.1) Maternal disorders 58 (0.7) Total 5319 (65.6)

Group 2

Cardiovascular disorders656 (8.1) Malignant neoplasms 313 (3.9) Digestive disorders209 (2.6) Respiratory disorders 181 (2.2) Neuropsychiatric disorders 139 (1.7) Congenital abnormalities115 (1.4) Genitourinary disorders 106 (1.3) Diabetes mellitus 73 (0.9) Skin disorders 23 (0.3) Other 19 (0.2) Total 1834 (22.6)

Group 3

Unintentional injuries497 (6.1) Intentional injuries230 (2.8) Ill-defined injuries 234 (2.9) Total 961 (11.8)

All defined causes8114 (100.0)

Table 2. The 20 leading causes of registered deaths, Maputo City, Mozambique,

1994 Legend for Chart:

A - Rank B - Cause of death C - No. of deaths (%)

AB C

1 Perinatal disorders 1643 (20.2)

2 Malaria 928 (11.4)

3 Diarrheal diseases 814 (10.0)

4 Tuberculosis 56 (5.6)

5 Lower respiratory infections 416 (5.1)

6 Road-traffic accidents 371 (4.6)

7 Anemia 269 (3.3)

8 Cerebrovascular disease 269 (3.3)

9 Homicide 188 (2.3)

10Bacterial meningitis 178 (2.2)

11Hypertension 171 (2.1)

12 Protein-energy malnutrition 141 (1.7)

13 Congenital anomalies 115 (1.4)

14 Sepsis 79 (1.0)

15 Cirrhosis of the liver 74 (0.9)

16 Cirrhosis of the liver 74 (0.9)

17 Maternal disorders 58 (0.7)

18 Nephritis and nephrosis 52 (0.6)

19 Liver cancer 49 (0.6)

20 Measles 43 (0.5)

All defined causes 8114 (100.0)

For rhe complete report see: http://www.who.int/docstore/bulletin/bu0516.pdf