For every child, nutrition
Nutrition situation in Mozambique
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.
Programme priorities 2017–2020
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:
Strengthen institutional capacities to coordinate, monitor and evaluate government multisectoral, food and nutrition security policies and action plans.
UNICEF will train government and key implementing partners on programme planning, management, leadership and provide technical guidance.
Adopt and implement national, evidence-based, nutrition-related policies, legislation and strategies.
The focus is to use evidence to ensure the needs of the most nutritionally disadvantaged are met and that national nutrition policies, including policies that impact child nutrition such as agriculture and social protection policies, serve to improve the nutrition situation of the most vulnerable children.
Service providers and communities to provide infant and young child nutrition services.
The focus is on supporting caregivers and communities to provide adequate care and feeding practices for young children, particularly during the first 1,000 days of a child’s life. This will include improving Infant and Young Child Feeding (IYCF) with communication for behaviour and social change.
Other key initiatives include community-based nutritional counselling, with a particular sensitivity to mothers living with HIV; micronutrient supplementation, including the provision of multi-micronutrient powders, vitamin A and de-worming, iron and folic acid supplements; and food fortification for all children. There is also a renewed drive towards universal salt iodization. UNICEF will also continue supporting treatment of acute malnutrition for children under 5 through building the capacity of health workers for quality treatment and provision of Ready to Use Therapeutic Food (RUTF).
Empowering parents to address malnutrition
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.
I breastfed exclusively my little Eva (18 months) for the first six months.
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.”
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.
On this day, under the shade of a tree outside the health centre, mothers are benefitting from a food preparation demonstration by Ancha Pinto, a young mother of four, who is preparing a huge pot of porridge (known as papas) with all sorts of nutritious ingredients. She engages in a vibrant way with a group of mothers, all of whom have babies on the programme for moderate and severe malnutrition.
Ancha mixes the pot of porridge with such vigour that one would think she is a paid worker. But she is not; she does it to help other mothers. “I love to do this as I’m helping other mothers who have problems with feeding, and as I’m doing it, I’m learning at the same time,” she says.
For example, Ancha says, “Before, I didn’t know that you could mix eggs and bananas into the porridge as well as greens and cassava. I was only using porridge, sugar and salt.” After the preparation, Ancha serves the babies the papas in plastic cups. They relish it.
Meanwhile, Cataeno has counselled Juliana to book an appointment with the doctor to change her ARV treatment. And as Eva is suffering from severe acute malnutrition, a life-threatening condition if left untreated, Juliana is given sachets of Ready-to Use Therapeutic Food (RUTF). This is a high-energy, peanut-based food which Eva has to take while receiving other medical treatment. The advantage of this treatment is that Juliana can give it to Eva at home. Moreover, Juliana will also benefit from individual and group counselling on infant feeding with another mother, possibly Ancha. All of these interventions will empower Juliana to nourish baby Eva back to health.
Nutrition in Mozambique at a glance
|Families who are food insecure||>50%|
|Level of chronic malnutrition||43%|
|Children exclusively breastfed in the
first six months
|Coverage of iodized salt||<50%|
|Level of iron-fortified food product||<25%|
|Children aged 6–23 months receiving
the minimum acceptable diet
|Children in schools reached with
nutrition education messages
|Access to improved sanitation in
|Access to improved sanitation in
urban and peri-urban areas
Sources: SETSAN Baseline Food and Nutrition Security Assessment (2013); Demographic Heath Survey (2011).