Malnutrition in Children of Northern Mozambique: Only a Small Picture of a Global Reality!

Background: Malnutrition remains a major cause of morbimortality in Mozambique, being related to 45% of deaths among children under five years.

Objective: Characterize nutritional status, comorbidities, dietary pattern and clinical evolution of children hospitalized for undernutrition.

Methods: Prospective study conducted in a Central Hospital in northern Mozambique (Nampula) in August and September 2017. WHO criteria were used to characterize nutritional status and a questionnaire was applied.

Results: 61 children were hospitalized in malnutrition sector, 16.4% with wasting and 83.6% with both stunting and wasting, which was severe in 78.7%, predominantly marasmus (55.7%). The median age was 17 (IQR 11-25) months, 50.8% were male. The majority of mothers breastfed their children (94.7%) for a mean of 12±7 months. Half of parents only spoke Emakhuwa (local language), the majority (53.1%) were Muslim, unemployment in both parents was present in 45.9% and 34.4% reported past use of Mozambican witchdoctors. The majority had neither piped water supply (80.3%) nor electricity (72.1%). They reported a median of 3 meals each day, based predominantly on roots. The most frequent associated conditions were anemia (96.4%), AIDS (31.1%) and malaria (26.2%). There was an association between AIDS and stunting (p=0.023). Severe malnutrition was associated with younger age (p=0.008) and less consumption of fruit and vegetables with marasmus (p=0.004 and p=0.032, respectively). Hospitalization had a median of 15 days, but 13.1% of children left the hospital with their parents without medical discharge and other 13.1% died, mostly as consequence of dehydration/hypovolemic shock.

Conclusion: We emphasize the young age, the severe presentation and the high morbimortality associated with undernutrition, as well as the great prevalence of HIV/AIDS and anemia. Lack of clean water and sanitation in addition to dietary deficiencies are main problems. The high rate of hospital abandonment and witchdoctors attendance reflects the need for health education in Mozambique.