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

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the onset of symptoms. In areas where malaria is common, such as Mozambique, it is recommended that any fever in a child is treated as if it were malaria and that the child be given a full course of anti-malarial tablets. In 2003, the DHS indicated a very high prevalence of fever among children, with 27 per cent of all children under-five years of age reported to have had fever in the two weeks prior to the survey. Among children with fever, only 15 per cent were given anti-malaria drugs and only 8 per cent were given the drugs within 24 hours. These low rates of appropriate treatment indicate, on the one hand, low awareness and demand among care-givers for treatment (only about half of children with fever were taken to a health facility), and on the other hand low access to health facilities and low availability of drugs. Outside the formal health system, only registered pharmacies and a few specially registered shops can supply antimalarial drugs. As approximately one million pregnancies every year are thought to be complicated by co-infection with malaria and HIV in sub-Saharan Africa, particular attention needs to be given to this issue. Both malaria and HIV infection in pregnancy are associated with maternal anaemia, low birthweight, and maternal and infant mortality, with HIV infection presenting an increased risk of malaria. In the presence of co-infection, the prevalence of anaemia and low birthweight incidence may exceed 35 per cent (Brentlinger, 2006). The WHO now recommends the use of intermittent presumptive therapy (IPT) and insecticide treated nets (ITNs) for all pregnant women living in high risk malaria areas. In accordance with this, the Ministry of Health in Mozambique also strengthened preventive treatment and introduced IPT in 2006, which involves the provision of at least two treatment doses of Sulphadoxine Pyramethamine (SP) during routine antenatal clinic visits. The situation regarding prevention and control of malaria is more positive. There are two major control tools promoted by Mozambique for malaria control, i.e. Indoor Residual Spraying (IRS) using long lasting insecticides and the use of ITNs, which are considerably more effective than un-treated nets. The Government in PARPA II identified IRS as a key strategy for malaria control and prevention, establishing a target of 50 per cent IRS coverage by the year 2009, compared with about 18 per cent in 2005. Together with IRS, the other effective means of malaria control is the use of ITNs, particularly Long Lasting Insecticide Nets (LLINs). More than 40 field trials in Africa in the past two decades have shown that ITNs reduced overall child mortality by 20 per cent and malaria episodes by 50 per cent. Furthermore, it has also been found that the protective efficacy of ITNs in pregnant women of unknown HIV status was approximately 42 per cent (Brentlinger, 2006). In 2000, two major ITN programmes were initiated in Zambézia and Gaza provinces. These initiatives have expanded over time and by the end of 2005 there were ITN programmes in nine of the eleven provinces of Mozambique. Until 2006, the major thrust of these programmes was the provision through the health system of highly subsidised ITNs (costing about US$1.25) to pregnant women and children under five years of age. Starting in 2006, the Ministry of Health announced that all ITNs distributed through health facilities will be distributed free of charge. In 2003, around 18 per cent of mothers aged 15-49 with children under five years of age owned a mosquito bednet (treated or not). The percentage of mothers with bednets was over twice as high in urban areas as in rural, at 28 per cent and 12 per cent respectively. Coverage of bednets varied considerably between provinces, ranging from 9 per cent of mothers with bednets in Manica province to 40 per cent in Gaza province. Of those women owning bednets, 42 per cent had treated nets. CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 87
Figure 3.9: Malaria prevention: use of bednet 25 % 20 21 15 16 10 9 5 7 0 Women sleeping under bednet Children sleeping under bednet Urban Rural Source: DHS 2003 However, the use of bednets remains very low. The 2003 DHS indicated that while 18 per cent of women with children owned a bednet, only 13 per cent of women and 10 per cent of children were using the net (i.e. were reportedly sleeping under the net the night prior to the survey). Disparities between provinces and areas of residence were significant. In rural areas, only 7 per cent of children were using a bednet compared to 16 per cent in urban areas. Use of bednets varied from 22 per cent in Gaza province to only 4 per cent in Sofala province. It is very likely that ITN coverage has significantly increased since the DHS was conducted, as over one million ITNs were distributed across the country in 2004-5. B. Acute respiratory infection (ARI) Like malaria, acute respiratory infection (ARI) is among the leading causes of morbidity and mortality among young children in the country, with pneumonia being the most serious infection. The World Health Organization estimates that 60 per cent of ARI deaths can be prevented by the selective use of antibiotics, but the success of treatment relies upon early detection and access to medical facilities. According to the 2003 DHS, about 10 per cent of Mozambican children under five years of age had shown symptoms of ARI in the two weeks preceding the survey, with children aged between 6-11 months being the most affected (39 per cent). In contrast to other indicators of child well-being, children from poorer households and those whose mothers had no education were less likely to suffer from the symptoms of ARI than those from better off households and with well-educated mothers. The prevalence of ARI symptoms was 8.4 per cent among children of mothers with no education and 14.6 per cent among children of mothers with secondary level education or higher. 88 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:
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 and 86: The second reason is that deaths oc
Page 87: 5. Childhood illnesses A major publ
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
Page 137 and 138: 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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