Child Poverty in Mozambique. A Situation and Trend ... - Unicef

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Figure 3.19: Knowledge of mother-to-child transmission of HIV among Mozambicans (15-49 years of age) 100 % 80 81 60 58 40 20 28 29 32 35 36 40 46 48 49 0 Zambezia Cabo Delgado Inhambane Gaza Niassa Maputo City Sofala Maputo P. Nampula Manica Tete Source: DHS 2003 A series of interventions are available to prevent HIV transmission from mother to child. In Mozambique, the most commonly used protocol is single dose Nevirapine (sdNVP) given to the mother at the onset of labour, and to the baby no later than 72 hours after birth. This protocol reduces the risk of transmission from mother to child by more than 40 per cent (to 10-15 per cent). Since the establishment of a national PMTCT programme in 2002, the number of heath facilities offering PMTCT services has expanded rapidly, from 8 in 2002 to 113 by mid-2006. However, coverage remains very low and highly unequal. By mid 2006, only about 5 per cent of the total estimated HIV-positive pregnant women in the country received PMTCT prophylaxis (fewer than 6 per cent of pregnant women in sub-Saharan Africa in 2005 were offered services for PMTCT). Most services are still concentrating in and around provincial capitals. Since the start of the national programme until mid 2006, 71 per cent of pregnant women who attended ante-natal care (ANC) in the PMTCT sites accepted counselling and testing for HIV. Of those, 14.5 per cent tested positive. Acceptance of testing is declining. In some provinces, such as Gaza, acceptance of testing was as low as 50 per cent in 2005. This might be explained by a decline in the quality of counselling and the fact that the rapid expansion of sites was not accompanied by a similar expansion in the capacity of the Ministry of Health for close supervision. Another factor which may influence levels of acceptance of counselling and testing is related to high levels of stigma and fear of discrimination. In 2003, the DHS indicated that only 8 per cent of women and 16 per cent of men had an accepting attitude towards those living with HIV. 40 40 “Accepting attitude” is measured as the proportion of respondents who report an accepting or supportive attitude on all the following four component questions: (1) would be willing to care for a family member who became sick with the AIDS virus; (2) would buy fresh vegetables from a vendor whom they knew was HIV-positive; (3) female teacher who is HIV-positive but not sick should be allowed to continue teaching in school; and (4) would not want to keep the HIV-positive status of a family member a secret. CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 107
Table 3.3: Overview of PMTCT programme performance between 2002 and 2006 Total Pregnant Total HIV+ HIV+ Babies who pregnant women pregnant pregnant women who received women counselled women women who delivered in ARV attending and tested HIV+ received a health prophylaxis ANC ARV facility prophylaxis 2002 5,685 4,641 951 253 391 328 2003 27,437 24,260 4,273 877 1,428 1,490 2004 65,562 46,583 6,576 3,182 3,002 3,335 2005 158,273 102,116 14,193 7,690 5,754 5,439 2006* 94,916 72,308 10,319 8,728 8,855 5,500 Total 351,873 249,908 36,312 20,730 19,430 16,092 Source: MISAU, 2006 * Data for 2006 are from January to June only Between the start of the national programme in 2002 and mid-2006, about 54 per cent of the pregnant women that tested HIV positive delivered in a health facility and 57 per cent received ARV prophylaxis, while 44 per cent of their infants received it. The uptake of Nevirapine is improving, from 27 per cent in 2002 to 85 per cent at mid year in 2006. The proportion of children who received Nevirapine in PMTCT programmes and who were subsequently tested at 18 months is only around 8 per cent. Of those, 89 per cent tested negative and 11 per cent tested positive. The status of the vast majority of the children who received PMTCT services is unknown, as the children are lost to follow-up during the 18 months before the HIV antibody test becomes possible. One of the most important factors associated with increased risk of mother to child transmission is the mode and duration of breastfeeding, together with vaginal delivery and maternal HIV viral load (Lancet, 2006 Feb; Vol 6: 83-90). No data is yet available in Mozambique concerning the percentage of HIV positive mothers who choose replacement feeding over breast milk, or at what point these mothers stop breast feeding. According to health worker reports, however, the vast majority of mothers follow the usual tradition and breastfeed until a child is 18-24 months old, albeit with early cessation of exclusive breastfeeding. Preliminary results of an evaluation of Early Breastfeeding Cessation and Replacement Feeding conducted in 2005 by the Elizabeth Glazer Paediatric AIDS Foundation and Health Alliance International in three provinces of Mozambique indicated that the majority of mothers did not have the means to provide an adequate replacement diet for their babies. Prioritising access to Highly Active ARV Therapy (HAART) by pregnant women is critical, given the very high risk of post-natal transmission in breastfeeding mothers with low CD4 and high viral load and in the context of the challenges faced by mothers in implementing recommended infant feeding options. Women with CD4 counts less than 200 cells/µl are 5 times more likely to transmit HIV during breastfeeding as compared with CD4 counts over 500 cells/ µl (Iliff, 2005). HAART can further reduce the risk of transmission to approximately 2 per cent, as compared to the more widespread interventions currently used, e.g. single dose Nevirapine (10-15 per cent). Currently, the Ministry of Health policy is that pregnant women with CD4 counts of under 350 are eligible for HAART, as opposed to the standard adult criteria of under 200. However, very few pregnant women are enrolled in treatment centres. In 2005, about 550 pregnant HIV-positive women were enrolled on HAART (out of a total of about 20,000 people on HAART and over 14,000 HIV positive pregnant women tested in PMTCT sites). Increasing enrolment of pregnant and lactating women requires close coordination between PMTCT programmes and ARV treatment sites and the initiation of HAART within PMTCT programmes. 108 CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS
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CHILDHOOD POVERTY IN MOZAMBIQUE A S
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ACKNOWLEDGEMENTS This report on the
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CONTENTS ACKNOWLEDGEMENTS………
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4. Access to schooling and attendan
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TABLES AND FIGURES List of tables T
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Figure 4.20: Estimated spending on
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GBS GDP GER GNI GoM HAART HDI HIPC
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MAP OF MOZAMBIQUE Zumbu Magoe M
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een strongly positive in recent yea
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Child protection concerns Chapter F
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vaccination or malaria campaigns, w
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1. Objective of the Situation Analy
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Box 1.1: Human rights conventions r
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of poverty, defined as: “Impossib
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Table 1.1: Deprivation-based indica
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The Ministries of Planning and Deve
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34 CHILDHOOD POVERTY IN MOZAMBIQUE:
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1. Introduction This chapter focuse
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Table 2.1: Progress towards the MDG
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3. Economic growth and macroeconomi
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Evidence as to what extent these
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The percentage of the population li
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Arndt et al. (2005) show that, on a
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B. Assessing childhood poverty In a
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Figure 2.9: Households living below
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severe deprivation. In the poorest
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The second PARPA for the period 200
Page 57 and 58: Box 2.3: Civil society engagement i
Page 59 and 60: A key cause of these weaknesses is
Page 61 and 62: One possible way forward in tacklin
Page 63 and 64: Box 2.4: Corruption and its impact
Page 65 and 66: (vi) Analysis of monitoring and rev
Page 67 and 68: There are two principal drivers beh
Page 69 and 70: This has troubling implications for
Page 71 and 72: 70 CHILDHOOD POVERTY IN MOZAMBIQUE:
Page 73 and 74: 1. Introduction Every child has the
Page 75 and 76: B. Severe nutrition deprivation amo
Page 77 and 78: Zambezia and Tete provinces. Severe
Page 79 and 80: If this downward trend continues, M
Page 81 and 82: Figure 3.5: Percentage of women rec
Page 83 and 84: Mozambique has achieved a continual
Page 85 and 86: The second reason is that deaths oc
Page 87 and 88: 5. Childhood illnesses A major publ
Page 89 and 90: Figure 3.9: Malaria prevention: use
Page 91 and 92: The 2005 Nutrition Survey conducted
Page 93 and 94: Box 3.3: Combating measles and poli
Page 95 and 96: (ii) Stunting prevalence (chronic m
Page 97 and 98: Alarmingly high levels of stunting
Page 99 and 100: Figure 3.16: Underweight prevalence
Page 101 and 102: There are 86 known salt producers r
Page 103 and 104: Among children, there were no varia
Page 105 and 106: Box 3.5: Infant feeding in the cont
Page 107: highly in PARPA II, which sets a ta
Page 111 and 112: The reduction of mother-to-child tr
Page 113 and 114: It is only recently that paediatric
Page 115 and 116: 100 Figure 3.22: Use of safe water
Page 117 and 118: A. Inequitable access to and fundin
Page 119 and 120: The 2004/2005 IFTRAB survey also su
Page 121 and 122: provincial level reported that only
Page 123 and 124: Table 3.4: Ministry of Health budge
Page 125 and 126: Figure 3.29: Total sector resources
Page 127 and 128: Figure 3.31: Indicative per capita
Page 129 and 130: The agenda for expanding water supp
Page 131 and 132: and was revised in 2005. The on-bud
Page 133 and 134: supported by key sector stakeholder
Page 135 and 136: 1. Introduction Education is a fund
Page 137 and 138: B. Severe information deprivation a
Page 139 and 140: Secondary education consists of fiv
Page 141 and 142: Table 4.3: Gross and net enrolment
Page 143 and 144: Table 4.4: Gross enrolment ratio, a
Page 145 and 146: 57 per cent, compared with a NER of
Page 147 and 148: DHS data show that the wealth level
Page 149 and 150: Figure 4.11: Distribution of 11-yea
Page 151 and 152: Lack of literacy is directly correl
Page 153 and 154: In addition, there is a serious gap
Page 155 and 156: The IAF showed that in 2002/3 expen
Page 157 and 158: Absenteeism is also common among te
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to the need for two or even three s
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The system is faced with a number o
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• The school represents or is a l
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(iv) Impact of natural disasters In
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The associated large off-budget res
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The Ministry of Education and Cultu
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sense of providing education for ev
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172 CHILDHOOD POVERTY IN MOZAMBIQUE
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I. Introduction All children have t
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involving children. 45 per cent of
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Box 5.1: Street children in Maputo:
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Girls at greatest risk of abuse wer
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The aspirations expressed by the yo
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Against this background, Caia and C
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“Trafficking in women and childre
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Mozambique, girls aged 15-19 in the
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The survey indicates that 32 per ce
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Figure 5.5: School attendance among
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• Labour law does not define the
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- To use child labour (children age
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from their parents. Thus, the law d
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C. Birth registration - guaranteein
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such as hospitals and schools for b
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Sofala province also accounts for t
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Evidence points to worrying increas
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Figure 5.9: Primary school attendan
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activities to strengthen the capaci
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The responsibility for implementing
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214 CHILDHOOD POVERTY IN MOZAMBIQUE
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Conclusions Mozambique is one of Af
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planning in Mozambique, and has the
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7- Implementing social communicatio
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Form of Severe Deprivation Food Wat
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ANNEX II Calendar of the planning,
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ANNEX IV State Budget recurrent and
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REFERENCES AND MATERIALS CONSULTED
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Deaton, A., Ruiz-Castilo, J., and T
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Klasen, S. and Woltermann, S., ‘T
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Government of Mozambique, ‘Progra
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World Bank (WB), ‘World Developme
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World Bank (WB), ‘Mozambique Publ
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Ministry of Women and Co-ordination
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United Nations Children’s Fund (U
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Child Poverty in Mozambique. A Situation and Trend ... - Unicef

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