Learning from a community health activist about nutrition challenges in Mozambique

This week, I am in Mozambique to report on the Home Fortification project, designed by the Global Alliance for Improved Nutrition (GAIN) and the Mozambique Minister of Health (MISAU in Portuguese) and implemented jointly with PSI and Save The Children Mozambique. The objective of this project is to improve the nutrition of young children aged between 6 months and 23 months old through the distribution of sachets of multi-nutrient powders. This critical life period is part of the 1000 days window between a woman’s pregnancy and her child’s second birthday. Improving nutrition during these 1000 days has a profound impact on a child’s ability to grow, learn and thrive — and a lasting effect on a country’s health and prosperity.

Each sachet of multi-nutrient powders, called VitaMais, contains a colorless and tasteless powder of 15 essential vitamins and minerals that can be added to the food that young children regularly eat. The use of micronutrient powders is a proven intervention which prevents micronutrient deficiencies among children, while still promoting the use of local available foods.

One of the key components of this project are the health facility workers and community activists who have been trained to make sure that every eligible child is enrolled in program and who provide essential nutrition education to families. They also distribute the vouchers that mothers can exchange at the health facilities to receive VitaMais sachets for their kids. In particular, they make sure that mothers and caregivers receive appropriate counselling to exclusively breastfeed until children turn six months and initiate complementary feeding at six months, at which time they also eligible for their first voucher for the multi-nutrient powders.

I had the privilege to meet and chat with Zadia, one the community activists who operate in the community of Ceramica, in Dondo, near the city of Beira. Zadia is a nurse by training and has been part of the VitaMais program for over a year and half. When I asked her about the main challenges faced by this community, she had no doubts about her answer: “Malaria is the main challenge. Many people, especially children, are affected by it because of the many puddles around their houses. Malaria is endemic here.” Diarrhea and other conditions caused by lack of safe water and good sanitation also represent an important threat and aggravate the existing malnutrition problem.

Zadia told me that VitaMais are very well received by the population: “Mothers that are not receiving vouchers because their children are not yet 6 months old want to make sure that when the time is right their children get the sachets. They hear about the benefits from other mothers and they know that these micronutrients will help their children grow and develop fully.” One of the things she enjoys most about the work is talking to families about the importance of good nutrition: “Traditionally, people in these communities would eat mostly porridge made from maize flour with water, salt, sugar and occasionally cassava leaves. Now they are adding peanuts, mango, coconut and other vegetable leaves to their porridge making it more nutritious for them and their children”.

Zadia with a mother whose twins were born underweight. Photo credit: Beatrice Montesi/GAIN

The nutrition situation is slowly improving in Mozambique, but more than 43 percent of children under the age of five still suffer from chronic undernutrition. “The children who have been taking multinutrient powders are stronger and do better in school. We see a big difference between them and those from the previous generation who have not benefited from the program”, said Zadia. “As a community activist, I want to continue to provide counseling to families so that they get the health and nutrition they need to live healthy lives.”

These are very promising signs, but only after rigorous impact evaluations, we will be able to draw conclusions about the impact of multinutrient powders in these communities. One thing is certain: the success of the project depends in large part to the commitment and passion of these community health activists who volunteer their time and energy to make sure that no child is left behind.

To find out more about GAIN’s work in Mozambique and globally, visit www.gainalliance.org