Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T05:10:27.540Z Has data issue: false hasContentIssue false
  • English
  • Français

Mortality Rates, Prevalence of Malnutrition, and Prevalence of Lost Pregnancies among the Drought-Ravaged Population of Tete Province, Mozambique

Published online by Cambridge University Press:  28 June 2012

Andre M.N. Renzaho
Andre M.N. Renzaho*
Affiliation:
Program Quality Advisor, World Vision Australia and Honorary Fellow, School of Health and Social Development, Deakin University, Melbourne, Australia
*
Senior Research Fellow School of Health and Social Development Faculty of Health, Medicine, Nursing and Behavioural Sciences Deakin University 221 Burwood Highway Burwood 3125 Victoria, Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs.

Objective:

The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis.

Methods:

A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people.

Results:

Anthropometric data were collected among children 6–59 months of age. In addition, crude mortality rates (crude mortality rates), under five mortality rates (under 5 mortality rate), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI) = 6.2–9.8%) for acute malnutrition, 26.9% (95% CI = 24.0–29.9%) for being underweight, and 37.0% (95% CI = 33.8–40.2%) for chronic malnutrition. Boys were more likely to be under-weight than were girls (odds ratio (OR) = 1.34; 95% CI = 1.00, 1.82;p <0.05) after controlling for a, household size, and food aid beneficiary status. Similarly, children 30–59 months of age were significantly less likely to suffer from acute malnutrition (OR = 0.45; 95% CI = 0.26, 0.79; p <0.01) and less likely to be underweight (OR = 0.37; 95% CI = 0.27, 0.51;p <0.01) than children 6–29 months of a, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI = 4.5–11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10,000/day (95% CI = 1.08–1.38), and an under 5 mortality rate was 1.03/10,000/day (95% CI = 0.71–1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths.

Conclusions:

The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies.The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid program objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.

Keywords

human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)lost pregnanciesmalnutritionmortalityMozambiqueTete Province
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 1 , February 2007 , pp. 26 - 34
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Food and Agriculture Organization/World Food Program (FAO/WFP): Special Report: FAO/WFP Crop and Food Supply Assessment Mission to Mozambique, May 1996. Available at http://www.fao.org/documents/show_cdr.asp?url_file=/docrep/004/w1549e/w1549e00.htm. Accessed 20 April 2004.Google Scholar
2.Schlosser, S, Saulnier, V: Mozambique: A country ravaged by civil war and nature. Journal of Mine Action. Version 4.9. Available at http://www.maic.jmu.edu/journal/4.2/Features/Mozambique/mozambique.htm. Accessed 12 February 2004.Google Scholar
3.McEwan, M:human immunodeficiency virus and acquired immunodeficiency syndrome and Food and Nutrition Security Linkages in Mozambique: Background Document for Mainstreaming human immunodeficiency virus and acquired immunodeficiency syndrome Considerations into the National Food and Nutrition Security Strategy. Technical Secretariat for Food and Nutrition Security: Maputo, 2004.Google Scholar
4.Martel, P: Summary of the Additional Analysis of the Demographic, Nutrition and Health Findings: Multi-Sectoral Assessment of the Impact of the Humanitarian Situation on the Lives of Mozambican Children and Women. Maputo: SETSAN and UNICEF, 2003.Google Scholar
5.Sylvester, K, Fidalo, L: Changara Livelihoods Study: 20 years of Change in Chingara, Tete Province. Maputo: World Vision Mozambique, 2004.Google Scholar
6.FAO:Conducting Small-Scale Nutrition Surveys. A field manual. Nutrition in Agriculture No. 5. Rome: Policy and Nutrition Division, 1990.Google Scholar
7.Médecins sans Frontières: Nutrition Guidelines to Facilitate the Application of Fundamental Concepts and Principles Necessary for the Assessment of Nutritional Problems and the Implementation of Nutritional Programmes in Emergency Situations 1st ed; Paris: Médecins sans Frontières, 1995.Google Scholar
8.Magnani, R: Sampling guide. IMPACT Food Security and Nutrition Monitoring Project. Arlington: International Science and Technology Institute, 1997.Google Scholar
9. United Nations Population Division: 2000 World Population Prospects: Population Database: The 2002 Revision; http://esa.un.org/unpp. Accessed on 01 September 2002.Google Scholar
10. World Health Organization/African Regional Office Mozambique: Population profile. Available at http://www.afro.World Health Organization.int/malaria/country-profile/mozambique.pdf. Accessed 03 June 2004.Google Scholar
11.Henderson, R, Sundaresan, T: Cluster sampling to assess immunisation coverage: A review of experience with a simplified sampling method.Bull World Health Organ 1982;60:253–260.Google ScholarPubMed
12.Checchi, F, Roberts, L: Interpreting and Using Mortality Data in Humanitarian Emergencies: A Primer for Non-Epidemiologists. London: Humanitarian Practice Network, 2005.Google Scholar
13.Coghlan, B, Brennan, R, Ngoy, P,et al: Mortality in the Democratic Republic of Conon-governmental organization: A nationwide survey.Lancet 2006;367:44–51.CrossRefGoogle ScholarPubMed
14.Coghlan, B, Brennan, R, Ngoy, P,et al: Mortality in the Republic of Conon-governmental organization: Results from a Nationwide Survey. Burnet Institute and International Rescue Committee: 2004.Google Scholar
15.The Sphere Project:The Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: Sphere Project, 2004.Google Scholar
16.Centers for Disease Control and Prevention: Famine-affected, refugee, and displaced populations: Recommendations for public health issues.MMWR 1992;41:1–76.Google Scholar
17.UNAIDS/World Health Organization Working Group on Global human immunodeficiency virus/acquired immunodeficiency syndrome: Mozambique: Epidemiological Fact-Sheets on HIV/AIDS and Sexually Transmitted Infection. Geneva: World Health Organization, 2002.Google Scholar
18.Instituito Nacional de Estatística (INE) Mozambique: Demographic and Health Survey 2003. Measure DHS+/ORC Macro.; INE: Maputo, 2004.Google Scholar
19.Salama, P, Assefa, F, Talley, L, et al: Malnutrition, measles, mortality and the humanitarian response during a famine in Ethiopia.JAMA 2001;286:563–571.Google Scholar
20.Toole, M, Waldman, R: Prevention of excess mortality in refugee and displaced populations in developing countries.JAMA 1990;263:3296–3302.Google Scholar
21.Médecins sans Frontières: Refugee Health: Approach to Emergency Situations. London: MacMillan Eductaion Ltd, 1995.Google Scholar
22.Pelletier, D, Frongillo, E, Schroeder, D, Habicht, J: The effect of malnutrition on child mortality in developing countries. Bull World Health Organ 1995;73:443–448.Google Scholar
23.Fauveau, V, Briend, A, Chakraborty, J, Sarder, A: The contribution of severe malnutrition to child mortality in rural Bangladesh: Implications for targeting nutritional interventions.Food Nutr Bull 1990;12:215–228.Google Scholar
24.Schofield, C, Ashworth, A: Why have mortality rates for severe malnutrition remained so high? Bull World Health Organ 1996;74:223–229.Google ScholarPubMed
25.Bouma, M, Parvez, S, Sondorp, E: Treatment of tents with permethrin for the control of vector-borne diseases. Medical News 1992;1:5–8.Google Scholar
26.Decludt, B, Pecoul, B, Biberson, P,et al: Malaria surveillance among displaced Karen population in Thailand, April 1984 to February 1989, Mae Sot, Thailand.Southeast Asian J Trop Med Public Health 1991;22:504–508.Google Scholar
27.Shears, P, Berry, A, Murphy, R, Nabil, M: Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985.BMJ 1987;295:314–317.Google Scholar
28.Cai, Y, Feng, W: Famine, social disruption, and involuntary fetal loss: Evidence from Chinese survey data.Demography 2005;42:301–322.Google Scholar
29.World Health Organization:Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. Geneva: World Health Organization, 2001.Google Scholar
30.de Onis, M, Blössner, M: World Health Organization Global Database on Child Growth and Malnutrition. Geneva: World Health Organization, 1997.Google Scholar
31. World Health Organization, UNHCR, International Federation of Red Cross and Red Crescent Societies, World Food Program: The Management of Nutrition in Major Emergencies. Geneva: World Health Organization, 2000.Google Scholar