rethinking strategies to address micronutrient ... · mozambique faces high rates of child anemia...
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Rethinking Strategies to Address Micronutrient
Deficiencies in Children Under 5 in
Mozambique
Ms. Melanie Picolo
Senior Nutrition Advisor, Mozambique
February 12, 2019
Mozambique faces high rates of
child anemia & stunting and some reduction in wasting
• Only ~15% meet criteria for minimum acceptable diet
• 64% of children are anemic
• 69 % have Vitamin A deficiency
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1997 2003 2011
Perc
ent
of ch
ildre
n
Stunting and Wasting in Children Under 5
Children stunted Children wasted
Mozambique DHS, 2003, 2011, Global Nutrition Report 2017
0
50
100
150
200
250
1990 1995 2000 2005 2010 2015
Under
5 c
hild
deat
hs
per
1,0
00
bir
ths
Under 5 Child Mortality in
Mozambique
Background: Nampula & Sofala Provinces
• Nampula: MCSP supported 81of
222 (36%) facilities and 636
communities
• Sofala: MCSP supported 30 of 159
(19%) facilities and178 communities
• Preventive and curative nutrition
interventions targeting mothers and
children were integrated in RMNCH
services
Figure 1. Geographical distribution of stunting in
Mozambique. Source: SETSAN based on DHS 2011
Niassa
47
Cabo
Delgado
53
Nampula
55
Zambezia
45
Tete
44
Manica
42
Sofala
36
Inhambane
36Gaza
27
Prevalence of stunting
by province
25%-30%
35%-40%
40%-45%
45%-50%
>50%
Policy Environment – Multisectoral Engagement for
Addressing Micronutrient Deficiencies
Health Sector Strategic Plan 2014–2019;
Multisectoral Action Plan for the Reduction of
Chronic Malnutrition 2011–2014
• Vitamin A supplementation
• Micronutrient powders
• Deworming
• Complementary feeding
• Food fortification
Key Interventions to Address Micronutrient
Deficiencies Within Health Programing
Photo Credit: Kate Holt/MCSP
• Objective: Case study on
micronutrient deficiency interventions
targeting children under 5
• Three interventions:
• Twice-yearly, Vitamin A
supplementation
• Point-of-use fortification -
micronutrient powders
• Promotion of dietary diversity
Achievements: Vitamin A Supplementation (VAS)
Delivery model of VAS in Mozambique, 1999-2018
0%
20%
40%
60%
80%
100%
1999-2001 2002-2007 2008-2015 2016-2018
Cove
rage
of ro
utine V
AS
VAS integrated in
routine child
health services
helped reduced
the high cost of
campaigns
Twice-yearly
“national health
weeks” delivered
routine VAS
Transition from twice
yearly to a yearly NHW
campaign; launch of
Planning Guide of
Vitamin A
Supplementation and
Deworming Activities in
Routine Health Services
VAS delivered
through national
immunization
days
Challenges: Vitamin A Supplementation
• Low demand: Caregivers don’t return for VAS once immunization is completed
• Missed opportunities for VAS during health facility at-risk and sick child visits
• Low capacity for reporting and analysing routine VAS data from all
delivery platforms
• Localized stock-outs of supplements
• Large VAS campaigns made demotivate health workers to provide Vitamin A
during routine services
• Low quality microplanning and lack of implementation of outreach activities
for hard-to-reach children
Achievements and Challenges: Micronutrient
Powders (MNPs)
• Developed a Strategy for the
Implementation of Home
Fortification with MNPs–2015
• Developed SBCC materials for
promotion of MNP
• Availability of MNPs through free
or subsidized distribution in
select areas
• Inclusion of MNPs in child health
cards and registers
• Cost and funding for
commodities are limitations
• Lack of SBCC strategies to guide
implementation and limited
caregivers’ acceptance of MNP
• Limited use of vouchers resulted
in low coverage of MNPs in
subsidized model
• Top-down commodity
distribution limited efficiency of
supply chain
ACHIEVEMENTS CHALLENGES
ACHIEVEMENTS CHALLENGES
Achievements and Challenges:
Promotion of Dietary Diversity
• Since 1994, enriched
porridges promoted via
nutrition education & cooking
demonstrations
• In 2014, MOH adapted the
generic UNICEF IYCF
community counselling
package to the Mozambican
context
• Complementary feeding
counselling focused on “enriched
porridges,” not on community
needs & cultural beliefs
• Slow roll out of community
counselling package
• No parallel integration of
adequate IYCF counselling in
child health services at the
facility level
Recommendations for the Way Forward:
Sustainability and Scale up
• Periodically monitor and evaluate the prevalence of micronutrient
deficiencies in the target population to understand extent of nutrient
deficiencies
• Generate evidence on micronutrient deficiency reduction
interventions’ cost‐effectiveness, feasibility, and acceptability
• Roll out guidelines (including the planning guide for VAS and
deworming and the RED/REC guide)
Recommendations for the Way Forward:
Sustainability and Scale up
• Plan and forecast resources and supplies to meet needs in an equitable
manner
• Scale up demand generation activities (songs, theatre, cooking
demonstrations, group talks, and home visits)
• Develop a cohesive national strategy for the prevention and control of
micronutrient malnutrition to ensure coordinated, harmonized and cost-
effective efforts
For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the United States Agency for International
Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the
authors and do not necessarily reflect the views of USAID or the United States Government.
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