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Nutritional Rehabilitation Programme helps children at risk

© UNICEF Mozambique/Emidio Machiana
Delfina and her 14-month-old son João at the paediatric ward of the Central Hospital in Xai-Xai.

Mozambique, December 2009 - It is late morning in the city of Xai-Xai, the capital of the province of Gaza. In the paediatric ward of the Central Hospital, 14-month-old João plays happily on the lap of her mother Delfina. João has a good reason to feel content: he has just eaten, with great appetite, his therapeutic food, prepared under the close supervision of a well trained and attentive nurse.

"I came for a consultation with João last week because he had swollen feet. After examining him, the doctor said he was severely malnourished”, explains Delfina.

Children like João, who suffer from severe malnutrition and medical complications, are immediately admitted and incorporated into the Nutrition Rehabilitation Programme, where they are treated with therapeutic milks known as F-75 and F100 - provided with support from UNICEF.

The programme was put in place by the Ministry of Health, and includes the provision of an integrated package of basic health and nutrition services such as therapeutic feeding for infants and young children, maternal nutrition, micronutrient supplementation, deworming and growth monitoring.

In addition, mothers are involved in nutrition education activities, with practical demonstrations on how to prepare balanced and enriched meals, good hygiene practices and health care in relation to common childhood diseases.

"Since we’ve been here João has received medication and special milk. I also learned how to make enriched porridge for him. He is much better now, “says Delfina, with relief.

Recent data indicate that 44 per cent of the children in Mozambique suffer from chronic malnutrition, and 18 per cent of children under five are underweight for their age.

To address this widespread challenge, health authorities have also introduced the treatment and monitoring of malnutrition through outreach and outpatients services, with the involvement of communities.

The outpatient interventions include vitamin A supplementation, nutritional screening, nutritional rehabilitation of malnourished children, nutrition education, promotion of exclusive breastfeeding in communities and training of community health workers.

One of the benefits of this approach is that it allows the treatment of severe malnutrition (without complications) at home by administering a ready-for-use therapeutic food generally known as PlumpyNut – also provided with support from UNICEF and the Clinton Foundation.

Children like João, who need to be hospitalized to control medical complications, may benefit from this treatment as an outpatient after treatment of his complications.

But AIDS is complicating the situation. The province of Gaza has the highest HIV prevalence in the country; about 27 per cent of pregnant women are living with HIV. In several paediatric wards, including in the Central Hospital of Xai-Xai, about half of the children suffering from severe malnutrition are infected with HIV.

João was not spared by the pandemic. Delfina has just received the news that his malnutrition problem is associated with HIV. But she is hopeful that with the treatment available in the hospital, both will be able to live a normal life.

"What we do here is the treatment of opportunistic infections and antiretroviral treatment for HIV positive pregnant women, children, adolescents and adults. We have a room for specialized paediatric care, “explains Dr. Eunice, a doctor on duty that day.

The Nutrition Rehabilitation Programme and the paediatric treatment of HIV and AIDS, both supported by UNICEF and other partners, are interlinked and are part of the Integrated Management of Neonatal and Childhood Illness (IMNCI). The approach was introduced in Mozambique in order to address the major causes of child mortality and promote best health practices for children and their families.



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