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Field article
Brief history and background
National nutrition and health situation
Mozambique has just over 20 million inhabitants,
of whom approximately 17% are less than
five years of age. More than half of the population
(55%) lives in poverty 1 . In 2003, under-five
mortality was 153 per 100,000 live births 2 . By
2008, this had reduced to 141 3 . During the same
period, infant mortality also slightly reduced
from 101 to 95 per 100,000. The main causes of
child deaths are malaria (33%), lower respiratory
tract infections and HIV/AIDS (10% each),
followed by prematurity (8%) and gastrointestinal
infections (7%). Acute undernutrition
accounts for 4% of deaths in under-fives 4 . It has
been estimated that undernutrition is a
contributing factor to 36% of child deaths 5 .
In 2008, 16% of newborns had a low birth
weight (less than 2.5 kg). The prevalence of
chronic undernutrition has remained stubbornly
high for many years: 48% in 2003 6 and
44% in 2008. However, the prevalence of acute
undernutrition is relatively low: 5% in 2003 and
4% in 2008 (2.9% in urban areas and 4.7% in
rural areas), with a 1.3% prevalence of severe
acute malnutrition (SAM). There has been more
improvement in child health and nutrition indicators
in rural than in urban areas. There are
also marked differences between provinces,
with the prevalence of chronic undernutrition
(height for age < -2 z scores) ranging from 56%
in the northern province Cabo Delgado to 25%
in the capital city Maputo. Key indicators are
summarised in Table 1. A map of Mozambique
with the acute malnutrition regional data from
the Multi Indicator Cluster Survey (MICS) 2008
is shown in
The first ever population-based HIV prevalence
survey conducted in 2009 found a
prevalence of 11.5% in people between 15 and
49 years of age, 13.1% for women and 9.2% for
men. In children up to 11 years, the prevalence
was 1.4%, and in children under 12 months it
was 2.3%. The northern region showed a much
lower prevalence (5.6%) than the central and
southern regions (12.5 and 17.8%, respectively).
Prevalence in urban areas was significantly
higher (15.7%) than in rural areas (9.2%) across
all regions 7 .
Vulnerability to emergencies
Mozambique is prone to emergencies, including
floods, cyclones and droughts. There are
frequent floods in the Zambezi river basin
affecting the provinces of Tete, Sofala and
Zambézia. Other rivers in the centre and south
of the country, such as the Limpopo and Buzi
rivers, are also prone to flooding. The highest
chance of flooding is from October to March,
the southern Africa rainy season, and the
cyclone season is usually around
February/March. In addition, large parts of the
country, particularly in the south, are prone to
periods of drought, the impact of which is
mostly felt between November and January.
The number of people affected by emergencies
varies considerably. The 2007 floods
affected about 300,000 people, cyclone Flávio
affected approximately 135,000 people in 2007
and a drought in the south in 2009 affected just
over 250,000 people. Future climate scenarios
suggest that Mozambique’s exposure to natural
hazards will increase as extreme weather
patterns become more prevalent as a result of
climate change.
Where nutrition sits in government systems
and structures
The Ministry of Health (MoH) has a Nutrition
Department under the National Directorate of
Public Health, which is responsible for policy
and protocol development, as well as the planning
and oversight of nutrition activities at all
levels. The treatment of acute malnutrition is
mainstreamed into regular health services (both
during and outside of emergency situations).
The responsibilities of the Nutrition
Department are divided into five main areas:
1) Nutritional Surveillance,
2) Nutrition Education,
3) Prevention and Control of Undernutrition
and Micronutrient Deficiencies,
4) Nutrition and HIV and Tuberculosis and
5) Nutrition and Non-Communicable Diseases.
At present, the following programmes are
being managed by the Nutrition Department:
1. Nutrition Rehabilitation Programme
(Programa de Reabilitação Nutricional (PRN))
2. Micronutrient Supplementation Programmes,
including de-worming in preschool children
3. Nutrition and HIV and Tuberculosis
4. Infant and Young Child Feeding (IYCF)
5. Food Fortification
6. Health and Nutrition Promotion and School
Nutrition
The government has markedly strengthened its
emergency preparedness and response since
the beginning of 2000. Multi-sectoral coordination
at the national level is the responsibility of
the National Institute for Disaster Management
(INGC), and each community has focal persons
assigned to emergency preparedness and
response.
The Technical Secretariat for Food and
Nutrition Security (SETSAN) is mandated with
the multi-sectoral coordination of food and
nutrition security. Originally, the main focus
was on food security. Since 2011, coordination
of the implementation of the Multi-sectoral
Action Plan for the Reduction of chronic undernutrition
(see below) has been added to its
mandate. SETSAN carries out vulnerability
Figure 1: Map of Mozambique with acute malnutrition
regional data (MICS, 2008)
assessments three time per year (around
February, May and October) to document the
extent of acute and chronic food insecurity.
Linkages with the Scaling Up Nutrition (SUN)
Global Initiative
The Council of Ministers approved the Multisectoral
Action Plan for the Reduction of
Chronic Undernutrition in September 2010. The
Technical Secretariat for Food and Nutrition
Security (SETSAN) coordinates the implementation.
The plan includes all components of the
package of interventions included in the
Scaling Up Nutrition (SUN) roadmap.
However, it does not include the components
related to the treatment of acute malnutrition
(the PRN programme is not included) in order
to avoid overloading the plan. The government
participates in inter-governmental meetings
relating to SUN and Mozambique received
early riser status in September 2011.
CMAM/PRN scale-up
The introduction of CMAM in Mozambique
Until 2004, the standard treatment for SAM
among children in Mozambique was inpatient
care with specially formulated therapeutic
milks (F100 and F75), which were introduced
into the routine health system in 2002, following
a flood emergency. However, coverage of
the programme was low, children were often
discharged early or their families took them out
of hospital before treatment was complete, risks
for cross infections were high, and mortality
rates in most centres were above the threshold
outlined in international standards 8,9 .
Recognising these limitations, the MoH in
Mozambique revised the PRN and introduced
the Community-based Management of Acute
Malnutrition (CMAM) as a key component.
Initially the programme focused on HIV positive
children, but it was soon broadened to
cover all children less than 5 years of age with
acute malnutrition, regardless of HIV status.
Table 1: Key indicators for Mozambique
Indicator 2003 (DHS) 2008 (MICS)
Poverty 55% (2008– 2009)*
HIV prevalence 11.5% (2009)**
Under five mortality 153 per 100,000 141 per 100,000
Infant mortality 101 per 100,000 95 per 100,000
Chronic undernutrition 48% 44%
(stunting, height for age)
Acute undernutrition 5% 4%
(weight for height z score)
Underweight (weight for age) 22% 18%
Source: *See footnote 1. ** See footnote 7.
1
Ministry of Planning and Development, 2010.
Third National Poverty Assessment, 2008-
2009.
2
All 2003 data (unless stated otherwise) are
from the Demographic and Health Survey
(DHS) 2003 (Ministry of Health/National
Statistics Institute, 2004).
3
All 2008 data (unless stated otherwise) are
from the Multiple Indicator Cluster Survey
(MICS) 2008 (National Statistics Institute,
2009).
4
Ministry of Health, 2009. Mozambique
National Child Mortality Study, 2009. The
methodology used was verbal autopsies of
family members, about child deaths reported
during the 2007 General Census. A definition
of undernutrition in this report was not given.
5
USAID, 2006. Nutrition of young children
and mothers in Mozambique.
6
The nutrition data from 2003 (originally
based on the NCHS reference population)
were re-calculated based on the 2006 WHO
growth standards.
7
National Institute of Health, National
Statistics Institute and ICF Macro 2010.
Inquérito Nacional de Prevalência, Riscos
Comportamentais e Informação sobre o HIV
e SIDA em Moçambique, 2009 (INSIDA).
8
MoH 2006. Proposta para o programa de
reabilitação nutricional (CMAM).
9
UNICEF, 2006 .Draft terms of reference for
technical support to introducing community
treatment of severe malnutrition in
Mozambique.
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