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Executive summary
The ongoing insurgency in North Mozambique has resulted in the deaths and displacement of large numbers of people, creating a dire humanitarian situation. The affected communities face high levels of food insecurity due to the combined effects of conflict, recurrent natural hazards, and the rising inflation that has led to increase in food prices and other socioeconomic vulnerabilities.
The main objective of the SMART surveys was to assess the nutritional status of children aged 6-59 months, and pregnant and lactating women. Additionally, the surveys investigated the morbidity status and health seeking behaviours, coverage of health programs (immunization, micronutrient supplementation and deworming), infant and young child feeding practices, as well as the food security and livelihoods situation. A total of ten SMART surveys were conducted in nine districts of Cabo Delgado province and one district in Nampula province.
The Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology was used. A cross-sectional study design with two stage cluster sampling was applied. Stage one involved the random selection of clusters in every district, while stage two involved the selection of households using simple random sampling. A household was the basic sampling unit.
The prevalence of global acute malnutrition (GAM) based on WHZ<-2 was below 5% in all the surveyed districts, and is considered acceptable as per the WHO acute malnutrition threshold. Although GAM levels were low, several cases of severe acute malnutrition were observed in Mecufi, Mueda, Metuge and Erati districts as well as one case of edema in Erati. The GAM prevalence based on MUAC<125mm and/or edema shows several districts having medium levels of acute malnutrition (<10%) including Chiure, Mecufi, Balama, Namuno and Erati. The difference in GAM results by MUAC may partly be attributed to measurement errors. However, studies have demonstrated discrepancies between MUAC and WHZ measurements, and it is recommended that these two criteria be used independently to diagnose acute malnutrition.
The prevalence of underweight in most of the districts was below 20%, except in the districts of Balama, Namuno, and Erati. There were minor differences in underweight by age group (6-23 months and 24-59 months), but these differences are not statistically significant in most of the districts (p>0.05). Very high stunting levels were observed across all districts and exceeded the 30% WHO threshold for very high stunting. A comparison of stunting between the age groups (6-23 months and 24-59 months) showed some differences, but the differences were not statistically significant in nearly all the districts except Namuno (p=0.021).
According to the findings, the most common illnesses were fever and cough, with rates exceeding 30% in seven of the ten surveyed districts. Diarrhea incidence varied between the districts, and affected about one-quarter of the children in Balama, Namuno, and Erati. Health seeking during illness was slightly above average.
Only half of the districts reached the SPHERE recommended ≥80% coverage for measles vaccine in the districts of Pemba, Ancuabe, Mecufi, Mueda, and Metuge. Vitamin A coverage at 6 months (first dose) was lower than the recommended target of ≥80% in seven of the ten districts, except Pemba, Mueda, and Metuge. The coverage of vitamin A at 12 months (second dose) was much lower, with none of the districts reaching the recommended target of 80% or more. Deworming coverage in the last 12 months (one dose) was low in all the districts except in Mueda. Similarly, the rate of deworming in the last 12 months (two doses) was lower than the recommended target of ≥80% in all the districts. Mosquito net coverage was above average, with six of the ten surveyed districts reaching the desired ≥80%.
Infant and young child feeding indicators were assessed using the final anthropometry sample sizes calculated for each district. IYCF results should be interpreted cautiously due to the small sample sizes. A greater majority of the children under 2 years were breastfed at some point, averaging 96% in almost all the districts except in Mueda. Initiation to breastfeeding in the first hour of birth was lower than the recommended ≥80% in most of the districts apart from Pemba, Balama, and Montepuez. Exclusive breastfeeding was also low, with only four of the ten districts (Pemba city, Ancuabe, Montepuez, and Metuge) reaching ≥80%. As for the timely introduction of solid, semi-solid and soft foods at 6 months, only the four districts of Pemba, Balama, Chiure, and Mueda achieved the recommended 80% or more. Regarding the minimum dietary diversity (at least four food groups), none of the districts achieved the ≥80% target. The minimum meal frequency was low in all the districts except in Ancuabe. The minimum acceptable diet had the lowest rates in all the districts.
The prevalence of acute malnutrition among PLWs using MUAC was low in the survey areas. Metuge district had the lowest prevalence of moderate wasting (3.0%), while Namuno (18.3%) and Erati (18.2%) had relatively higher rates. Severe wasting among PLWs was very low in nearly all the districts except Namuno where several cases were reported (3.8%). The dietary diversity of women of reproductive age (WRA) was low in the target districts. Results indicate that these women consumed less than the required 5 food groups in nearly all the districts except Balama (84.8%).