# Mortality before and during the COVID-19 pandemic in Manhiça district, Southern Mozambique

## TL;DR

This study analyzed mortality trends in Mozambique before and during the pandemic, finding increased deaths in 2021, especially among the elderly.

## Contribution

The study provides empirical evidence of excess mortality in a resource-limited setting using a health and demographic surveillance system.

## Key findings

- Life expectancy for males and females initially increased but declined during the pandemic.
- Excess mortality was highest among males aged 65+ and females aged 5–14 during the pandemic.
- Mortality rates rose in 2021, highlighting the pandemic's impact on public health in Mozambique.

## Abstract

Mozambique reported its first COVID-19 case in March 2020, and the pandemic exposed significant vulnerabilities in its healthcare system. Measuring mortality attributable to COVID-19 in Mozambique, has been challenging due to limitations in health information systems and incomplete death documentation outside health facilities. By mid-2023, a total of 2,234 deaths from 233,334 cases were confirmed but the figures can be much higher.

We conducted a trend analysis of mortality using data from the Manhiça Health and Demographic Surveillance System from the periods before (2016-2019) and during the pandemic (2020-2021) to measure sex differences in mortality patterns (life expectancy and mortality rates). Excess mortality ratios during the pandemic were assessed using time series analysis with COVID-19 a generalized additive model.

From 2019 to 2020, the life expectancy in males increased 5.1%, from 61.3 (95% CI: 60.3–62.2) years to 64.4 (95% CI: 63.5–65.3) years, and 6.1%, from 69.3 (95% CI: 68.5–70.2) years to 73.5 (95% CI: 72.6–74.3) years in females. However, from 2020 to 2021, a decline was observed in both males and females. In males, it dropped 3.1% while in females the life expectancy dropped 3.5%. All-age male mortality rates decreased from 15.3 to 11.2 (26.8%) deaths per 1000 person-years from 2016 to 2020, then rose to approximately 13.4 in 2021. All-age female mortality experienced a similar trend, with an increase of 9.0% from 6.7 deaths per 1000 person-years in 2020 to 7.3 in 2021. During pandemic, the male elderly population (65+ years old) experienced the highest excess mortality in July 2021, reaching a ratio of 1.57 (CI: 1.37–1.84), whereas for females, the highest excess mortality among females was observed in the age group of 05–14 years, with a ratio of 1.86 (CI: 1.44 - 2.17) in January 2021 between the observed and expected deaths.

Mortality in Manhiça district declined from 2016 until 2019 but increased during COVID-19 pandemic with excess deaths in 2021, particularly among those aged 65 and older. This study highlights the value of robust health and demographic information systems in resource-limited settings for assessing public health impacts.

The online version contains supplementary material available at 10.1186/s12963-025-00449-y.