Prehospital and Disaster Medicine http://pdm.medicine.wisc.eduVol.22,No.1
Mortality Rates, Prevalence of Malnutrition,
and Prevalence of Lost Pregnancies among
the Drought-Ravaged Population of Tete
Program Quality Advisor,World Vision
Australia and Honorary Fellow, School of
Health and Social Development, Deakin
University, Melbourne, Australia
Dr Andre M.N. Renzaho, PhD, MPH
Senior Research Fellow
School of Health and Social Development
Faculty of Health, Medicine, Nursing and
221 Burwood Highway
F Fu un nd di in ng g
This study was fully funded by World Vision
Australia, and there was no external funding
virus/acquired immunodeficiency syndrome
(HIV/AIDS); lost pregnancies; malnutrition;
mortality; Mozambique; Tete Province
AIDS = acquired immunodeficiency
CMR = crude mortality rate
CSB = Corn and Soya Blend
H/A = height-for-age
HIV = human immunodeficiency virus
MCH = Maternal and Child Health
NGO = non-governmental organization
TB = tuberculosis
U5MR = under 5 mortality rate
W/H = weight-for-height
WFP = World Food Programme
Received:01 June 2006
Accepted: 10 July 2006
Revised: 14 July 2006
Web publication:16 February 2006
A Ab bs st tr ra ac ct t
B Ba ac ck kg gr ro ou un nd d: : Tete Province,Mozambique has experienced chronic food inse-
curity 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.
O Ob bj je ec ct ti iv ve e: : The objective of this study was to document mortality rates, caus-
es of death, the prevalence of malnutrition, and the prevalence of lost preg-
nancies after 2.5 years of humanitarian response to the crisis.
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.
R Re es su ul lt ts s: : Anthropometric data were collected among children 6–59 months of
age. In addition, crude mortality rates (CMRs), under five mortality rates
(U5MRs), causes of deaths, and prevalence of lost pregnancies were deter-
mined 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 age, 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 chil-
dren 6–29 months of age, after adjusting for the other, aforementioned fac-
tors. 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 U5MR 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.
C Co on nc cl lu us si io on ns s: :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 cur-
rent humanitarian response in Tete Province would benefit from an improved
alignment of food aid programming in conjunction with diarrheal disease con-
trol, HIV/AIDS, and malaria prevention and treatment programs.The impact
of the food programs would be improved if mutually acceptable food aid pro-
gram objectives,verifiable indicators relevant to each objective,and beneficiary
targets and selection criteria are developed. Periodic re-assessments and evalu-
ations of the impact of the program and evidenced-based decision-making
urgently are needed to avert a chronic dependency on food aid.
Me et th ho od ds s: : A two-stage, 30-cluster household survey was conducted in the
Renzaho AMN:Mortality rates,prevalence of malnutrition,and prevalence
of lost pregnancies among the drought-ravaged population of Tete Province,
Mozambique.Prehosp Disast Med 2007;22(1):26–34.
January–February 2007 http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine
dren >5 years of age, and pregnant and lactating
mothers. From February 2003 to June 2004, the
average quantity of CSB distributed per eligible ben-
eficiary was 5.5 kg.
3. A home-based feeding program for the chronically
ill (mainly for people living with HIV/AIDS and
tuberculosis)—By 01 October 2004, the average
quantity of food distributed per eligible beneficiary
was 25.8 kg of maize, 3.1 kg of sorghum, and 8.2 kg
4. The Vulnerable Group Feeding Program—By 01
October 2004, the average quantity of food distrib-
uted per eligible beneficiary was 8.6 kg of maize,3.8
kg of sorghum,0.4 kg of beans,0.7 kg of rice,and 0.1
kg of oil.This program is intended for orphans and
vulnerable children, child- or female-headed house-
holds, the elderly, and the disabled.
Despite such intensive and comprehensive interventions,
these programs have not been based on sound epidemiologi-
cal data,nor have they established baseline data against which
to assess the impact of the programs.The purpose of this study
was to document the mortality rates, causes of death, preva-
lence of malnutrition,and prevalence of lost pregnancies after
2.5 years of ongoing humanitarian response to the crisis.
The study design was cross-sectional, and based on a two-
stage,30-cluster household survey in the Cahora Bassa and
Changara districts. When the relief programs were imple-
mented, population-based data on mortality or nutritional
status were available, and existing data had been collected
on an ad hoc basis.Available data on malnutrition indicat-
ed that the prevalence of acute malnutrition in 2003 was
9.9% in Tete Province.4However, given that the Cahora
Bassa and Changara districts were the most severely affect-
ed,in this study,it was assumed that the prevalence of acute
malnutrition in those districts would be higher than the
average of the Province.Due to a lack of data on malnutri-
tion in these districts, a prevalence of acute malnutrition
Me et th ho od ds s
F Fi ig gu ur re e 1 1—Tete Province showing the study area
Renzaho © 2007 Prehospital and Disaster Medicine
I In nt tr ro od du uc ct ti io on n
During the last three decades, Mozambique has been the
scene of multiple disasters. In 1992, following 20 years of
civil war, Mozambique experienced a number of disasters
caused by naturally occurring hazards. In May 1996, the
Programme (WFP) Crop and Food Supply Assessment
Mission to Mozambique found that cyclone Bonita result-
ed in exceptionally heavy rains, that caused widespread
flooding, destroyed 44,200 hectares of crops, and affected
83,528 people. Similarly, in 1994, cyclone Nadia left thou-
sands of people on Mozambique’s northern coast homeless
and hungry for an extended period of time.1Cyclone Eline
in February 2000 and cyclone Hudah in April 2000 left
450,000 people homeless, 160,000 displaced, and 500
dead.2The year 2002 was characterized by sporadic and
insufficient rains in southern Mozambique.Several years of
flooding and droughts combined with a loss of productivi-
ty due to the impact of human immunodeficiency
virus/acquired immunodeficiency syndrome (HIV/AIDS),
have left the community vulnerable to food insecurity and
malnutrition.3By 2003, it was estimated that people in 43
of the 128 (33%) districts in the country suffered from food
shortages, and the number of people needing food assis-
tance escalated between 2002 and 2003.2
Large, semi-arid areas and cyclic problems associated
with food insecurity have severely affected the population of
Tete Province.3Anthropometric data indicate that in 2003,
the prevalence of acute malnutrition was 9.9% for Tete
Province (Figure 1),3.4% for Manica,3.6% for Sofala,2.9%
for Inhambane,and 2.4% for Gaza,averaging 6.4% nation-
ally (Figure 2).4Since 2000,the south and central regions of
Tete Province have experienced irregular and insufficient
rains. Maize yields were reduced greatly, and the following
season for grains and vegetables was affected adversely.
Although sorghum and cassava are more resistant to
drought conditions, an overall reduction in productivity
from plantations due to personnel with HIV/AIDS5has
resulted in at least four years of a meager harvest in Tete.In
September 2002,World Vision and the WFP implemented
nutritional support programs aimed to reduce mortality and
malnutrition among the most severely affected districts of
Tete Province: the Cahora Bassa, Changara, Moatise, and
Mutarara districts.These programs included: (1) the Food-
for-Work Program; (2) the Corn and Soya Blend (CSB)
Supplementary Food Program; (3) a home-based feeding
program; and (4) the Vulnerable Group Feeding Program.
1. The Food-for-Work Program—From October 2002
to July 2004,the average quantity of food distributed
per eligible beneficiary was 10.5 kg of maize,4 kg of
sorghum, 0.9 kg of beans, 2.7 kg of rice, and 0.3 kg
of oil.The work associated with this scheme resulted
in the construction of >47 schools, 12 small dams,
three houses for nurses, two maternity houses, and
five houses for teachers. Roads were rehabilitated,
and >17 farmers’ associations were established to
promote the multiplication of sweet potato and cassava
stakes,vegetable production,and fruit tree plantations;
2. The Corn and Soya Blend (CSB) Supplementary
Food Program—This program is intended for chil-
and Agriculture Organization/World Food
Prehospital and Disaster Medicinehttp://pdm.medicine.wisc.eduVol.22,No.1
34 Mortality Rates,Prevalence of Malnutrition
WFP or NGOs may finance and implement improved
complementary programs may depend on their capacities
to marshal support from their respective donors and/or
A Ac ck kn no ow wl le ed dg ge em me en nt ts s
The author thanks Gabrielle Mahony, World Vision
Australia, Duncan Campbell, FPMG, and World Vision
Mozambique for helping with the coordination of data col-
lection and the logistics. A special thank you to the com-
munity in Chora Basa and Chingara districts for endorsing
the study and participating. Thank you to Dr. Ben
Coghlan, Centre for International Health, Macfarlane
Burnet Institute for Medical Research and Public Health,
for the statistical advice and feedback on the early draft.
2. collect baseline data; and
3. give due consideration and support to improving
monitoring and reporting, periodic re-assessments
and evaluations to confirm progress, and the impact
of the project.
Unless current food aid program selection criteria are
reviewed and made more objective, the project’s impact on
malnutrition will remain nullified and a surge in the
reliance,if not dependency,on food aid will be evident.The
findings of this study suggest that relief programs in Tete
Province would benefit from an improved alignment of
food aid programming with diarrheal disease control and
HIV/AIDS and malaria programs. One example of a
potentially high impact, preventive intervention is the dis-
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