Battling child malnutrition on all fronts

Adolfo Guambe with baby Laura and APE, Judith, talking to Hortencia who is holding her other twin, Albert.

Raquel Meque, 19, a mother of a 4-year-old girl and a 1-month-old baby boy, realises how dangerous malnutrition is. She remembers how last year her daughter, Vina, got sick and her legs began to swell. “I thought she was losing blood, so I took her to a traditional healer who gave me some powder to put on her food to cleanse her body.”

The powder gave Vina diarrhoea and it did not reduce the swelling in her legs or make her eat. Raquel waited for another two days, but when she saw that Vina was getting worse, she rushed her to the nearby health centre.

The nutritionist, Lourinda Sardinha, explained Vina was suffering from marasmus, a severe form of acute malnutrition, which was also complicated by malaria. Vina was immediately hospitalized at the health centre in Chitima, in the district of Cahora Basa, in the northern province of Tete. Over three weeks, besides treatment for malaria, Vina was given therapeutic milk and a high-energy peanut-based mixture, which is supplied by UNICEF through health facilities.

When asked about the causes of malnutrition, young reporters Clayton Banda, 15, and Rosa Azeite, 15, know about the importance of a balanced diet as well as good sanitation and hygiene.
When asked about the causes of malnutrition, young reporters Clayton Banda, 15 (left), and Rosa Azeite, 15 (right), know about the importance of a balanced diet as well as good sanitation and hygiene.
"If a child eats a balanced diet but then has diarrhoea due to poor hygiene and sanitation, the weight they have gained will just fall off" — Clayton, 15.

Today, in the grounds of the bustling health centre, Vina is a different girl. There seems to be a special bond between Vina and the nutritionist, Sardinha, who is plaiting Vina’s hair whenever Vina sits still for a few minutes.

According to Sardinha, Cahora Basa district has about 800 cases of children who are being treated as outpatients for acute malnutrition. Besides these cases of moderate and severe acute malnutrition, the chronic malnutrition levels in certain districts and indeed countrywide are a major challenge.

Nearly half of all children are stunted in Mozambique, the ninth highest rate in Africa. Dr. Benedito Toalha, nutrition and health consultant at UNICEF, says that these children have “suffered chronic malnutrition as a result of poor nutrition and environmental factors, like poor sanitation. Tragically, if the condition of the child is not taken care of during the critical 1,000-day window, his or her physical and cognitive growth will be irreversibly impaired.

Fabula Da Silva, nutrition manager for the Ministry of Health in Tete province, points out that although social services have improved, there is still a need for more provision of safe water and sanitation facilities at household level, as many families still have no toilets and some even have to dig in dried up river beds for their drinking water. He adds that families too need to change their behaviour, particularly around infant feeding practices. Although breastfeeding rates are good, exclusive breastfeeding for the first six months is still a challenge. “Mothers often breastfeed while walking or doing chores and the baby is unable to feed properly. Then, when the baby cries and the grandmother says the baby is hungry and needs shima (maize meal), the mother gives in, and feeds shima to her baby when the baby is less than six months.”

Da Silva adds that the high prevalence of teenage mothers also contributes to high levels of malnutrition. “Many girls start having babies at around 15 years of age, before they are physically and mentally ready, and this can lead to low birthweight babies who tend to be more vulnerable to illness and malnutrition.”

Therefore, malnutrition needs to be tackled on all fronts. To this end, Mozambique approved a Multi-sectoral Action Plan for the Reduction of Chronic Undernutrition (PAMRDC) in 2010, coordinated by the Technical Secretariat for Food and Nutrition Security (SETSAN) within the Ministry of Agriculture, in collaboration with government representatives from education, health and WASH (Water, Sanitation and Hygiene).

Rosa is different from many girls in Tete, and indeed in many parts of Mozambique. She is still in school and is thinking about her future career rather than having children.
"Mothers should exclusively breastfeed and should make sure they give their infants a balanced age-appropriate diet, and should not have children at a young age" — Rosa, 15.

Raquel Meque with her daughter Vina In the Health and Nutrition sector, the government focus is on promoting exclusive breastfeeding and preparing nutritious, well-balanced and age-appropriate infant feeding. “Infant feeding has improved in recent years, particularly with the help of volunteers who have learnt how to prepare nutritious food, often after their own children were treated for malnutrition,” says Da Silva. “They do food preparation demonstrations and other activities around nutrition in the community and at the health facility.”

Moreover, Da Silva says as traditional healers have such a strong influence in rural areas, the government, with UNICEF support, runs regular training sessions for them. Last year, a 14-day training for traditional healers focused on how to identify and refer cases of malnutrition. “We teach them to recognize childhood illnesses, including malnutrition, and stress the importance of referring them to the health facilities, allowing them if necessary to ‘cleanse the child of evil spirits’ after they have been treated.”

Ezequiel John 39, who has been a traditional healer since 2005, says he welcomed the training last year. “I learnt when a child’s upper arm measurement is on the yellow or red area, I must fill out a form and refer the child to the hospital.” John adds that, although he knows how to treat a variety of illnesses, he now knows to refer them to the health centre if the child is not getting any better.

Many traditional healers and mothers, however, are not as sensitised to the dangers of malnutrition in all its forms. In Vina’s case, it could have meant her losing her life; in many others, malnutrition results in children never reaching their physical or cognitive potential, a loss for the individual and for the country.

unicef nutrition work in Mozambique