STUDY REVEALS LESSONS ON THE REAL IMPACT OF COVID-19 IN MANHIÇA
A mortality analysis before and during the COVID-19 pandemic in the district of Manhiça, in Maputo Province, reveals an increase in deaths during the pandemic period, after several years of a declining trend. The research, led by Charfudin Sacoor, researcher at the Centro de Investigação em Saúde da Manhiça (CISM), also highlights weaknesses in the country’s health information systems, which make it difficult to accurately measure the real impact of the pandemic.
Based on data from the Manhiça Health and Demographic Surveillance System (HDSS), the study compared the pre-pandemic period (2016–2019) with the pandemic years (2020–2021), analysing trends in mortality, life expectancy, and differences between men and women. The results show a continuous reduction in mortality up to 2019, followed by an increase in 2021, reversing the gains observed in previous years.
Despite an apparent improvement in 2020, the data reveal that the most significant impact of the pandemic occurred in 2021, a period associated with more intense waves of the disease and disruptions in health services. Life expectancy decreased in both sexes that year, and mortality rates rose again.
The analysis of excess mortality showed differentiated impacts across population groups. Men, particularly those aged 65 and older, experienced the highest levels of mortality, confirming a persistent gender gap. However, an unexpected increase in mortality was also observed among girls aged 5 to 14, suggesting indirect effects of the pandemic that are still poorly understood.
“One of the main warnings of the study relates to the limitations of health information systems in Mozambique. Poor coverage and incomplete death registration, especially at community level, make it difficult to estimate the real impact of the pandemic. Thus, official numbers may represent only part of the reality,” said the researcher.
More than deaths directly caused by COVID-19, the study points to an increase in indirect deaths resulting from the disruption of essential health services, difficulties in accessing care, and pressure on an already fragile system. In this sense, the pandemic not only triggered a health crisis but also exposed deep structural vulnerabilities.
Another noteworthy finding is the unexpected rise in mortality in specific groups, such as older men—the most affected—but also girls aged 5 to 14. This pattern departs from the typical profile of the disease and suggests social impacts and limitations in access to care that are still not well understood.
For the researcher and first author of the article, Charfudin Sacoor, “the results of this study reinforce the urgent need to invest in robust demographic and health surveillance systems capable of capturing more accurately the effects of health crises.” He further adds that “the main implication goes beyond the technical aspect: those who die outside the system remain, to a large extent, invisible in official statistics.”
At a time when the world is seeking to learn lessons from the pandemic, this study offers an important reflection for the country. Beyond acknowledging the increase in mortality, it is essential to understand who was affected, where deaths occurred, and why they continue, in part, to go uncounted.
This work was generously supported by the Bill & Melinda Gates Foundation and involved collaboration with the South African Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), the Nyanja Health Research Institute, the South African Population Research Infrastructure Network (SAPRIN), the Child Health and Mortality Prevention Surveillance Network (CHAMPS), and AECID.
Reference:
Sacoor C, Nhacolo A, Muir JA, Jamisse E, Barr BT, Nhacolo A, Kabudula C, Bashingwa JJH, Augusto O, Chaúque A, Matsena T, Malheia A, Hunguana A, Saúte F, Argeseanu SA, Tollman S, Sevene E, Bassat Q, Mandomando I. Mortality before and during the COVID-19 pandemic in Manhiça district, Southern Mozambique. Popul Health Metr. 2026 Mar 18;23(Suppl 2):76. doi: 10.1186/s12963-025-00449-y. PMID: 41851768; PMCID: PMC13001221.
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