“TODAY I KNOW THAT TO HAVE A HEALTHY BABY, I ALSO NEED TO BE HEALTHY”

Ana Tanque and his son

Ana Tanque, a native and resident of the Manhiça District, has frequently traveled to South Africa, where her husband works and lives. During her first pregnancy in 2021, Ana began her prenatal care in the fifth month after returning from the neighboring country. Unfortunately, during this pregnancy, Ana faced a painful situation. On 6 March 2021, at 7:00 a.m., while preparing to give birth at the Manhiça District Hospital (HDM), the doctors informed the 21-year-old that her baby had already passed away before the expected delivery date.

"It was difficult to know that I was giving birth to a baby who had already died. When I went to the hospital on 4 March, they told me to go back home, even though I said I was in a lot of pain. Later, during the night of 5 March, I returned and they allowed me to stay at the hospital. Then, I gave birth the next morning (6 March) and the baby was stillborn. After what happened, I met the team from the Manhiça Health Research Center (CISM), and they spoke with my father-in-law because I was not feeling well. They said they would analyze my baby’s body and would visit some time later to provide the results regarding the cause of death."

Manuel Homo, sogro da Ana

Manuel Homo, Ana’s father-in-law, provided further details about the day. “When I learned that my daughter-in-law was pregnant, she was already three months along, and she opened her prenatal record two months after we found out. After registering, she attended all follow-up appointments. When the expected dates approached, she began to feel pains. We took her to the hospital and returned home the same day; she felt pain again, and the next morning we received the news that the child had passed away. That’s when I met Mrs. Eugênia Bilana (CHAMPS consenting officer) and Dulce Mazive (Social Science Assistant). She spoke with me because my wife was with Ana. I was then asked to go to the hospital the next day, where Mrs. Eugênia explained the Child Health and Mortality Prevention Surveillance (CHAMPS) program, and that it was possible to find out why my grandson had died. We learned that there would be follow-up and that the stillborn baby would be taken for examinations, and we would wait for the results. We were encouraged to accept, and later I signed some documents from CISM. On 8 March, we returned home with some medication for Ana to take for a while. Indeed, about a month later, the CISM team came to our home to perform a verbal autopsy, and sometime afterward, they provided the results on the cause of death,” said Homo.

With the consent of Ana and her father-in-law, the stillborn baby underwent an approach involving the collection of tissue and non-tissue samples using minimally invasive tissue sampling (MITS) techniques, which determined that the baby’s death was due to intrauterine hypoxia. Less than a year later, in May 2022, Ana and her in-laws received the results regarding the cause of death of their male baby, who had died on 6 March 2021.

At the time of receiving the results, Ana was already pregnant with her second child. However, due to her pale appearance and fatigue, the CHAMPS team advised her to visit the hospital for general examinations, where she was diagnosed with anemia, as reported by her father-in-law, Manuel Homo. “Since her first pregnancy, she hasn’t been eating well, consuming small amounts and few meals a day. My wife and I always have to remind her to eat because my son, her husband, is not here at home; we play this dual role,” he explained.

"When they gave me the results, I was already six months into my second pregnancy and had just returned from South Africa. After learning what had caused my child to die, I was scared. The CISM team continued visiting me to monitor my condition. The follow-up was excellent; I attended consultations twice a month—once at the maternity, where they performed ultrasounds to check my health and the baby’s—something I didn’t have during my first pregnancy. It was good and different," Ana shared with a smile, adding, “Today I know that to have a healthy baby, I need to be healthy first.”

Following this, the CHAMPS/CISM team conducted frequent home visits to Ana, encouraging her to open her prenatal record and teaching her healthy, nutritious recipes for pregnant women. This support ensured that her second pregnancy progressed healthily. “I just want to thank CISM for the patience they had with me. I strongly hope they continue like this, not just with me but with other women as well,” Ana emphasized.

On the night of 30 June 2022, little Manuel, Ana’s son, was born. The birth was scheduled for 1 July, but Ana experienced labor pains the previous night, and the Social Action transport arrived after the baby had been born. Thus, the baby was born at home and was immediately taken to the hospital. Today, Ana cuddles her one-year-old son while recalling the details of his birth day. Ana’s family recognizes the crucial role of CISM in her recovery. “I don’t know how to thank CISM for everything they have done and continue to do for us. This is the first time I’ve seen follow-up care of this magnitude. I don’t want to downplay the good care from hospitals, but this is the best model. My daughter-in-law gave birth in my hands; everything was fast, I received the child, and that’s why he was given my name,” said Manuel Homo.

In Mozambique, the Manhiça Health Research Center conducts the CHAMPS study in the districts of Manhiça, located 80 kilometers north of the capital, Maputo, and in Quelimane, the capital of Zambézia Province, situated in the central region of the country. This initiative is carried out in partnership with the National Institute of Health (INS), the Barcelona Institute for Global Health (ISGlobal), the Provincial Health Directorate (DPS), and the District Services of Health, Women and Social Action (SDSMAS), along with other collaborators at local, provincial, and national levels.

The CHAMPS program provides detailed information on specific causes of death, enabling the development of strategies to reduce child mortality from preventable causes. Currently, the study is ongoing in nine countries, including South Africa, Bangladesh, Ethiopia, Mali, Mozambique, Nigeria, Pakistan, Kenya, and Sierra Leone. Funded by the Gates Foundation and coordinated by Emory University in the United States, CHAMPS plays a crucial role in understanding and addressing the causes of child mortality across different regions.