Nutrition

Chronic malnutrition in Mozambique has remained relatively unchanged for the past 15 years. Extremely high levels of chronic malnutrition (43 per cent) in Mozambique affect almost one in every two children under the age of 5. As well as contributing to infant deaths and poor child health, chronic malnutrition has a detrimental impact on school performance, household income, and perpetuates the inter-generational cycle of deprivation.

Although chronic malnutrition is a national challenge, it is more pronounced amongst children living in the northern provinces of Nampula, Cabo Delgado, Niassa and Zambézia, where the prevalence is double that of the southern province of Maputo, and amongst poor families whose risk of chronic malnutrition is double that of the wealthiest families.

The reasons for chronic malnutrition are many and complex. A major challenge is that 81 per cent of the population relies on agriculture for livelihood and over 95 per cent of food crops are produced under rain-fed conditions in a country that suffers frequent drought and floods. 

Moreover, poor sanitation and hygiene practices lead to diarrhoea; besides being one of the leading causes of child death, repeated episodes of diarrhoea are also associated with stunting.

Another significant cause of stunting is the lack of appropriate infant and young child feeding (IYCF) practices. Less than half of children under 6 months have been exclusively breastfed and only 13 per cent of children aged 6–23 months receive the minimum recommended diet. This is coupled with low coverage of integrated behaviour change communication activities, with nutrition education messages reaching just 18 per cent of children in schools.

Working with the Government of Mozambique and in collaboration with other partners, UNICEF will aim to improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multi-sectoral nutrition actions delivered at scale. Through the global Scale-up Nutrition (SUN) movement, Mozambique has committed at the highest levels to improve nutrition programmes by aligning multiple actors, advancing policies and legislation, and rapidly scaling-up effective nutrition interventions. 

Nutrition will support the goal of the the Government’s Five-Year Plan to reduce stunting amongst children under 5 to 35 per cent by 2020, and to achieve the six maternal, infant and young child nutrition targets of the World Health Assembly in line with the Sustainable Development Goals (SDGs). 

The main areas of support are to:
 

At first Juliana, 22, a mother of four children, looks on the verge of tears as she tells the nutritionist about the problems she faces feeding her 18-month-old daughter, Eva. (The names of Juliana and Eva have been changed to protect their privacy).

Although Juliana looks elegant, with neatly-braided hair and large, hauntingly beautiful eyes, she is emaciated. And baby Eva – who has a charming smile on her face as she peeps out of the green capulana (traditional cotton cloth) in which Juliana carries her – is tiny, with thinning hair and sunken cheeks.

Juliana has brought Eva to have her growth monitored at the health centre in Nicoadala, in the central province of Zambézia. As she waits to be called to hear the outcome of her consultation, nutritionist Edgar Caetano chats with her.

Juliana gradually gains confidence as the nutritionist, Caetano, who is of a similar age, listens and offers her advice without judging. He also engages with baby Eva. Juliana says, “I feed her maize porridge or rice, greens and beans.” She also exclusively breastfed Eva for the first six months.
With further gentle probing, however, Caetano finds out that Juliana only feeds Eva twice a day – in the morning and in the afternoon. “She has fallen asleep by the evening,” says Juliana. Caetano tells her this is not enough, and stresses the importance of feeding at least three times a day, along with other nutritious snacks.
 

Juiana, who had her first child when she was only 14 years, also explains that she is living with HIV. She successfully went on the Prevention of Mother-to-Child Transmission (PMTCT) of HIV programme when pregnant and Eva has tested HIV negative. Yet, Juliana is finding it difficult to take antiretroviral treatment for her HIV infection. “I vomit so much that now I can only eat once a day,” she says, adding, “I feel too weak to farm.” This is a problem as she and her four children depend on a plot for survival. Moreover, her husband, who is a carpenter, no longer lives with them. “He lives with another woman,” she says, and again her eyes well up. 

There is only one father with a child at the clinic at the time of the interview; his name is Benidito Lindo. Sitting slightly aside from the mothers who are chatting as they wait for their consultations, Benidito holds his 14-month-old son, Aguinele, close to his chest. “My wife is sick with a fever, but we have never missed the clinic with any of our children, so I had to come,” Benidito says. He has also brought Aguinele for growth monitoring and nutrition counselling. He adds that his son is fully immunized.
 

Child malnutrition is complex and has a myriad of causes, says Mathieu Joyeux, UNICEF Nutrition specialist. “In Mozambique, nearly half of children under 5 suffer chronic malnutrition, meaning the child is too short for his or her age. It is the ninth highest rate in Africa.”

He stresses, “If those children are not receiving a minimum adequate diet, care and prevention and/or treatment of diseases during the first 1,000-day period, starting from conception, the child can suffer chronic malnutrition leading to life-long cognitive and physical negative consequences. This is a tragedy not just for the child but for the development of Mozambique: a recent estimate established that as much as 8 per cent of Mozambique GDP is lost every year due to chronic malnutrition. Therefore, UNICEF support to address child malnutrition is focused on this critical window of opportunity.”
 

Sources: SETSAN Baseline Food and Nutrition Security Assessment (2013); Demographic Heath Survey (2011).