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

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Box 3.2: A look at three information sources on causes of child mortality The Health Information System (HIS) The HIS records deaths among children under 8 years of age in 29 paediatric wards of rural and general hospitals in the country, capturing about two thirds of the rural and general hospitals in the country. Deaths that occur in other health facilities, such as health centres and health posts are not captured by the HIS (there were more than 1,200 such sites throughout the country in 2005). While most health facilities maintain records on the causes of child mortality, the information does not flow regularly to the central level and is therefore not systematically consolidated into the HIS. In addition, the national HIS records deaths among the age group 0 to 8, without further disaggregation of the figures for the age groups 0 to 1 or 0 to 5, thus making it impossible to report on the causes of infant and under-five mortality. In 2004, the national HIS recorded 2,746 deaths among children aged 0 to 8 years of age, which, according to the current mortality estimates, represents less than 5 per cent of all deaths among children in Mozambique. Among deaths recorded in 2004, malaria was by far the first cause of mortality (39 per cent), followed by malnutrition (16 per cent) and pneumonia (8 per cent). Data for all available years in the system (since 1999) indicate similar findings and consistently show that malaria ranked as the first cause of mortality, followed by malnutrition and pneumonia. An important proportion of all deaths registered by the HIS record the cause of death as “other” (16 per cent in 2004). While AIDS is emerging as a major killer of children, it does not yet appear in the HIS on a scale commensurate with the scale of the epidemic. Among all deaths recorded, 131, or 5 per cent, were attributed to AIDS related causes. In 2004, it was estimated, however, that more than 17,500 children under the age of five died as a result of AIDS related causes, accounting therefore for about 14 per cent of all deaths among under-five children that year (estimated at 122,000, SOWC, UNICEF 2005). The low reporting of AIDS-related deaths is due to the lack of means of detection, high level of stigma among health workers who tend not to record AIDS as a cause of mortality and the fact that many AIDS-related deaths may be recorded in the HIS as either malaria, pneumonia, malnutrition, tuberculosis or anaemia, all of which can be caused and aggravated by AIDS. Maputo Central Hospital data An analysis of child mortality data recorded by the paediatric ward of Maputo Central Hospital, which are not included in the HIS, indicates that the hospital’s own monitoring system disaggregates data by age (i.e. 0-1; 1-4; and over 59 months). In 2004, the Maputo Central Hospital recorded 1,012 deaths among children under 5 years of age, which is equivalent to over one third of all deaths recorded by the entire HIS in the same year. The first cause of mortality was acute respiratory infections (19 per cent), followed by malaria (16 per cent) and AIDS (14 per cent). Similarly to the HIS, an important proportion of child deaths recorded by the Maputo Central Hospital reported the cause as “other” (25 per cent). Zambezia Mortality Study Conducted in 2001 in Mocuba district, Zambezia province, the study findings provided detailed insight into the causes of neo-natal, infant and under-five mortality in a rural area of Mozambique. Malaria was found to be the major killer among children under the age of five, accounting for more than a quarter of all deaths (27 per cent). The second most common cause of death among underfive children was pneumonia (18 per cent) and the third cause was meningitis (10 per cent). The relatively high incidence of meningitis probably related to a particular epidemic of meningitis in the rural district of Mocuba. In this study, AIDS accounted for 3 per cent of all deaths. The study indicated three major causes of mortality among newborns (less than 1 month old), i.e. septicaemia (35 per cent), prematurity (18 per cent) and pneumonia (15 per cent). The high proportion of neonatal deaths due to septicemia was most probably related to unhygienic delivery conditions. CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 85
5. Childhood illnesses A major public health intervention to address childhood illness has been the development of the Integrated Management of Childhood Illness (IMCI) programme, which has three components: building the capacity of health professionals, strengthening the health system and improving family and community health practices. IMCI was introduced to Mozambique in 1998, when the Ministry of Health began gradual implementation, starting in 29 districts. Since then IMCI coverage has increased and now reaches 130 districts in 2005. In health facilities, IMCI promotes an integrated holistic approach to the case management of the sick child, looking at the top causes of child mortality (malaria, pneumonia, diarrhoea, malnutrition, measles). The programme was updated in 2006 to include neo-natal and HIV/AIDS components. At community level, the programme is essentially implemented by NGOs and focuses on preventive and promotive care. However, it does not at present involve community-based treatment. The strengthening and expansion of the programme is a key strategy of the Government outlined in PARPA II for further reducing child mortality and morbidity, with a target set for 80 per cent of health facilities to be implementing IMCI by the year 2009, compared with an estimated 60 per cent in 2005 (GoM 2006). An evaluation of IMCI conducted in 2005 showed that the programme had improved performance levels of heath facilities and led to better health services for children since the IMCI baseline survey conducted in 2001, but that in general management of childhood illnesses by health workers remained poor (MISAU 2005). 35 While important progress was made in reducing childhood illnesses, the overall situation remains daunting. Particular successes and challenges in combating childhood illness in Mozambique in the areas of malaria, acute respiratory infection, diarrhoea and vaccine preventable diseases are presented below. A. Malaria Malaria is the leading killer of children in Mozambique despite the fact that it is both preventable and can be treated. Due to the poor health information system, it is difficult to quantify the exact proportion of deaths among children due to malaria. It is estimated, however, that more than one in four deaths among under-five children is due to malaria. The disease accounts for 40 per cent of all out-patient consultations and up to 60 per cent of in-patients in paediatric wards as a result of severe malaria illness (MISAU, PNCM). The 2002 National Survey on Vitamin A deficiency and Anaemia indicated that 42 per cent of children were infected with the malaria parasite Plasmodium falciparum, with a much higher prevalence in rural areas (58 per cent) than urban areas (21 per cent) (MISAU 2002). The Ministry of Health has made malaria a high priority in terms of control and prevention, adopting the principles of the global Roll Back Malaria (RBM) initiative in 1999. As part of the RBM inception process, Mozambique signed up to the Abuja Declaration targets in 2000. While progress has been recorded in the fight against malaria, particularly on the side of prevention, the country is seriously off-track for meeting the Abuja targets. One of the key malaria-related treatment targets agreed at the Abuja RBM summit was to ensure that by 2005 60 per cent of those suffering from malaria should be able to access and use correct, affordable and appropriate treatment within 24 hours of 35 For example, the evaluation indicated that less than half of children in need of oral antibiotics or antimalarials were correctly prescribed medication. 86 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
Page 35 and 36: 34 CHILDHOOD POVERTY IN MOZAMBIQUE:
Page 37 and 38: 1. Introduction This chapter focuse
Page 39 and 40: Table 2.1: Progress towards the MDG
Page 41 and 42: 3. Economic growth and macroeconomi
Page 43 and 44: Evidence as to what extent these
Page 45 and 46: The percentage of the population li
Page 47 and 48: Arndt et al. (2005) show that, on a
Page 49 and 50: B. Assessing childhood poverty In a
Page 51 and 52: Figure 2.9: Households living below
Page 53 and 54: severe deprivation. In the poorest
Page 55 and 56: 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: The second reason is that deaths oc
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 and 108: highly in PARPA II, which sets a ta
Page 109 and 110: Table 3.3: Overview of PMTCT progra
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
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B. Severe information deprivation a
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Secondary education consists of fiv
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Table 4.3: Gross and net enrolment
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Table 4.4: Gross enrolment ratio, a
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57 per cent, compared with a NER of
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DHS data show that the wealth level
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Figure 4.11: Distribution of 11-yea
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Lack of literacy is directly correl
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In addition, there is a serious gap
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The IAF showed that in 2002/3 expen
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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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