FAO - NUTRITION COUNTRY PROFILES

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1 Nutrition Country Profiles MOZAMBIQUE June 2001, Rome Italy FAO - NUTRITION COUNTRY PROFILES MOZAMBIQUE FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

2 Nutrition Country Profiles MOZAMBIQUE 11 June Note for the reader The objective of the Nutrition Country Profiles (NCP) is to provide concise analytical summaries describing the food and nutrition situation in individual countries with background statistics on food-related factors. The profiles present consistent and comparable statistics in a standard format. This pre-defined format combines a set of graphics, tables and maps each supported by a short explanatory text. Information regarding the agricultural production, demography and socio-economic level of the country are also presented. In general, data presented in the NCP are derived from national sources as well as from international databases (FAO, WHO...). Technical notes giving detailed information on the definition and use of the indicators provided in the profile can be obtained from ESNA upon request. An information note describing the objectives of the NCP is also available. Useful suggestions or observations to improve the quality of this product are welcome. The data used to prepare the maps are available in Excel upon request at: nutrition@fao.org Nutrition Country Profile of Mozambique prepared by Lourdes Fidalgo (ANSA ) and Carina Ismael (MOH) in collaboration with Rosanne Marchesich (ESNA-FAO). The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers. FAO, 2000

3 Nutrition Country Profiles MOZAMBIQUE 11 June Table of contents SUMMARY TABLE 1: GENERAL STATISTICS OF MOZAMBIQUE I. OVERVIEW Geography Population Level of development: poverty, education and health Agricultural production, land use and food security Economy... 8 II. THE FOOD AND NUTRITION SITUATION Trends in energy requirements and energy supplies Trends in food supplies Food consumption Anthropometric data Micronutrient deficiencies REFERENCES MAPS are presented after the <REFERENCES> -General Map of Mozambique -Map 1: Population density in 2000 at the provincial level in Mozambique. -Map 2: The prevalence of underweight among children less than 5 years old in 1995 at the provincial level in Mozambique. -Map 3: The prevalence of stunting among children less than 5 years old in 1995 at the provincial level in Mozambique. -Map 4: The prevalence of wasting among children less than 5 years old in 1995 at the provincial level in Mozambique. Graphs, tables and maps can be visualised by clicking on the words in bold and underline, only in the Full profile pdf file.

4 Nutrition Country Profiles MOZAMBIQUE 10 September SUMMARY Mozambique has a total population of and a population density of inhabitants per square/ km (2001 (Map 1). The malnutrition rates for children under three years old are as follow: 36% of stunting, 8% of wasting and 26% of under weight. The low birth weight rate is 12% (Table 4a, Map 2, Map 3 & Map 4). The national mean Body Mass Index (BMI) for women is 21.6 which reflects a normal situation. Regarding micronutrient deficiency no national survey was done. Some surveys were done at the provincial level. Goiter is endemic in Niassa and Tete provinces with levels of total goiter above 50%. In some districts of Cabo Delgado and Manica provinces goiter seems to be a public health problem (Table 5a & Table 5b). Anaemia is a severe problem in the country, with more than 50% of children and women being anaemic. The levels of anaemia are also high for men, which reflects a high prevalence of parasites. According to a survey in four provinces all the communities surveyed are at risk of Vitamin A deficiency. It is estimated that 64% of the population is food insecure. The prevalence being higher in the southern region (75%). During the food balance showed a deficit of around tons of cereals. The national production only covered around 40% of the national caloric consumption. The cereal gross production is estimated around tons and a human consumption of tons. A food shortage is expected in some areas of the country where the production was insufficient, due to the floods (central and southern region) and drought. The average calorie availability/adult Equivalent Unity (AEU)/ per day in the household is 2761 and a median is 2420 calories. This is below the reference needs of 3000 calories/aeu/day. The main food energy sources are cereals, tubers and roots, and the diet is mainly cereals, tubers, vegetables, green leaves, beans, groundnuts, coconut and fish in the coastal areas. It is estimated that between 49 and 62 % of the population have access to health facilities. The infant mortality and under five mortality rate are still very high: 135/1000 and 200/1000 live births respectively. The literacy rate for males and females are 59.3 and 23.6 per cent respectively. It is estimated that 2/3 of the population live in absolute poverty; the mean monthly consumption is ,00 Mt per person, equivalent to 9.4 USD (IAF, 1998). The GDP from reached a high level, 10% per year, which represents an increase of 7.5% per year in real GDP per capita, in Meticais. In U.S. Dollar term, GDP per capita increased from about US $145 in 1995 to slightly over US $ 240 in The inflation rate decreased to a one digit number; from 50% in 1995/96 to 0.5-2% in 1998.

5 TABLE 1: GENERAL STATISTICS OF MOZAMBIQUE Indicator ( ) Year Unit Indicator ( ) Year Unit Last updated: 19/03/01 A. Land in use for agriculture G. Average Food Supply 1. Agricultural land 1995 ha per person Arable and permanent crop land 1995 ha per person Dietary Energy Supply (DES) Kcal/caput/day 1862 B. Livestock 1. Cattle thousands Sheep & goats thousands Pigs thousands Chickens millions 25 C. Population 1. Total population 1998 thousands years 1998 % of total pop years 1998 % of total pop years 1998 % of total pop >= 60 years 1998 % of total pop Rural population 1998 % of total pop Annual population growth rate, Total % of total pop Annual population growth rate, Rural % of rural pop Projected total population in thousands Agricultural population 1995 % of total pop Population density 1995 pop. per sq Km 21.7 Percentage of DES by major food groups D. Level of Development 1. GNP per capita, Atlas Method 1997 current US$ Human Development Index rating (new) 1997 min[0] - max[1] Note: Value not indicated if below 1% 3. Incidence of poverty, Total 1998 % of population Incidence of poverty, Rural 1998 % of population 71 % Energy from: 5. Life expectancy at birth (both sexes) 1998 years Protein % of total energy Under-five mortality rate 1998 per 1,000 live births Fat % of total energy 15.1 E. Food Trade 4. Proteins g/caput/day Food Imports (US $) % of total imports Vegetable products % of total proteins Food Exports (US $) % of total exports Animal products % of total proteins Cereal Food Aid (100 MT) % of cereals imports 32.7 H. Food Inadequacy F. Indices of Food Production 1. Total population "undernourished" millions Food Production Index = % population "undernourished" % of total pop Food Production Index Per Capita = no data available see References for data sources used See Technical Notes for definitions used. 2% 6% 1% 38% 9% 1% 1% 0% 42% Cereals (excl. beer) Starchy roots Sweeteners Pulses, nuts, oilcrops Fruits & Vegetables Vegetable oils Animal Fats Meat & offals Fish & seafood Milk & Eggs Other

6 Nutrition Country Profiles MOZAMBIQUE 11 June Geography MOZAMBIQUE I. OVERVIEW The Republic of Mozambique is located in the Southeast of the African Continent, between the parallels and southern latitudes, and eastern longitude with an area of 799,380 square kilometres ( square kilometres of inland water). The country stretches along a north south direction from the Rovuma river until Ponta do Ouro, with a coast line of 2,740 Km. It borders with Tanzania, Malawi, Zambia, Zimbabwe, South Africa and Swaziland. The shape and location of Mozambique, crossed by such major rivers as the Zambezi, the Save, the Limpopo, the Incomati, the Sabie, the Umbeluzi and the Maputo, implies great diversity in climatological conditions, ranging from very hot and humid to almost temperate conditions. Mozambique s terrain is mostly coastal low lands, upland in centre, high plateaux in the northwest and mountains in the west. The country has ten administrative provinces, plus the city of Maputo, which is the country capital, also classified as a province. The provinces are subdivided in three regions: North (Niassa, Cabo Delgado and Nampula), Central (Zambezia, Tete, Sofala, Manica) and South (Maputo, Gaza, Inhambane) (General Map). 2. Population The 1997 population census registered a total of inhabitants and for 2001, with 48.1% men and 51.9% women. The urban population is estimated at and the rural at The population density per square/km is 22,08 inhabitants. The annual population growth rate was 2.7 in 1997 (INE, 1997) and the rural population growth was 0.4%. Some 62.3% represent the rural population. The government forecasts that by 2030, the population will reach 33.5 million (UN,98). The provinces of Zambezia and Nampula in the Northern region are the most populated with respectively and inhabitants and Niassa province also in the northern region is the least populated with inhabitants. Life expectancy at birth has decreased from 46.7 years in 1995 to 43.7 years in 1998, or 42.3 years using national data (AIF, 1998) and 41.7 years in 2000 (UN, 98) (Table 1). In 1998 the life expectancy of females was greater than that of males at 42.5 years and 44.9 years, respectively. In 2000, the rate of mortality for children under five years of age is 189 per The under five mortality rate in 1997 was 201 per live births (DHS, 1997). Infant mortality rates for 1998 and 2000 remained constant at 115 per 1000 (UN, 98) but were slightly higher at 135 per 1000 live births in 1997 (DHS, 1997). The birth rate is 38 per 1,000 population in the year 2000 and the total fertility rate is 4.93 children born per women (ODCI, 2000). The global fecundity rate in 1997 was 5.9 children per woman (INE, 1999). The maternal mortality rate has been estimated at 500 to per live births. The population consists mainly of indigenous tribal groups (99%) and are Shangaan, Chokwe, Manyika, Sena, Makwa and others. Only 0.06% are European, 0.2% Euro-African and 0.08% Indians. Their official language is Portuguese but few people (24.3%) can speak and write. The majority of the population speaks one of the 13 national languages. The

7 Nutrition Country Profiles MOZAMBIQUE 11 June national language that prevails is the Makwa, spoken by 27.8% of the population, followed by tsonga, with 12.4%. The muslim religion is predominant in the northern provinces as well as in the central coastal area while the catholic and the protestant religions prevail in the south as well as in the interior of the central province. However many Mozambicans still are animist, believing in alma and spirits. 3. Level of development: poverty, education and health Poverty: The national poverty rate is 69.4% meaning that 2/3rds of the population live in absolute poverty. The incidence is higher in rural areas (71.2%) compared with urban areas (62.0%). About 82% of the poor live in rural areas. The national poverty gap index and the squared poverty gap index are also higher, at 29.3 and % respectively. The incidence of poverty is higher in the central region in terms of the three poverty measures, and the north and south are nearly equal. If Maputo city is excluded from the southern region, it will present higher poverty rates compared to the north but not significantly different from the central region. The mean monthly consumption in Mozambique is MT (9.4 USD) per person. (IAF, 1998). Education As a result of the national education policy and the strategy of implementation (MINED,1995) the numbers of schools had increased from 8 to 9% in 1998 (6.582 schools) compared with 1997 (Cabral Zaida, 1999). During the National Household Survey (IAF) (IAF survey - Feb 96 to April 97), at the national level 60.5% of children between 7 to 17 years old were enrolled at school. In rural areas the percentage of enrollement for the same age group is 54.6 and in the urban areas it is 81.8 %. The lowest enrollement rates were found among girls in rural areas (47.3%). Primary school enrolment net from was 45% for males and 35% for females and attendance in 1998 was 53% and 47% for males and females respectively, also 46% of children reached grade 5 (UNICEF 2000). Secondary school enrolment was 9% for males and 5% for females (UNICEF, 200). In Mozambique, 32% of the adult rural population and 71% of adult urban population are literate. The literacy rates for males and females are 59.3 and 23.6% respectively. Health Access to health services (during IAF survey) was measured as the proportion of children receiving complete vaccination (49.1%) or as those who had a health card (62.6%). In rural areas 55.7% of children had a health card and 41.4% had completed their vaccination programme, while in urban areas 89.2% of children had a health card and 79.2% had completed their vaccination programme. In rural areas only 2.1% of the population have access to a doctor, 16.8% to a nurse, 19.7% to a midwife, 19.1% to a health post, 5.1% to a health center and 4.6% to a pharmacy; while 93.7% use traditional healers. (IAF, 1998)

8 Nutrition Country Profiles MOZAMBIQUE 11 June Agricultural production, land use and food security Agricultural Production and Land Use The majority of the population in Mozambique live in rural areas and agricultural production is the main economic activity. Some 98.5% of rural households have agricultural land compared with 54.4% of urban areas ( urban includes peri-urban areas). At a national level, 89.5% of households have a piece of land for agriculture and a mean area of 2.4 ha. The climate and soil are more favorable for agriculture in the north than in the south region. (IAF, 1998). The agricultural production is predominantly carried out by small-scale farmer or the family sector which is responsable for around 90% of total food production. More than 60% of the agricultural labour force are women. (Plano Accao sobre Alimentacao e Nutricao, 1995). Mozambique is now self-reliant in basic grains; maize importation has declined from metric tones in 1992 to metric tones in (IAF, 1998). There are imports of wheat and rice, which are the more common staples in urban areas. Due to geographical and production characteristics of the country there is more comparative advantage to export the surplus from the northern region to Tanzania and Malawi rather than transport it to the southern region, as a result cereal is imported from South Africa and Zimbabwe to the deficit areas in the southern region. The use of agricultural inputs is low. Only 4.2% of households have land partial or totally irrigated (urban households are more likely to use irrigation than rural ones), 9% use some equipment, 4.9% use animal traction, 2.1% use tractors, 1.8% use fertilisers or pesticides, and 13.2 % hire agricultural labour (IAF, 1998). The main food crops are: maize, cassava, rice, sorghum, millet, sweet potato, beans, groundnuts. The main cash crops are: cashew, copra, cotton, fruit trees (citrus) (Plano de Accao sobre Alimentacao e Nutricao, 1995). Production During the agricultural season the area under cultivation was estimated at ha, from which ha were lost. The total production was estimated at tons of cereals, tons of legumes and tons of cassava. (MADER/DINA Sistema de Aviso Previo para Seguranca Alimentar, Agosto 2000). Total cereal production increased significantly during the period 1992/93 to 1998/1999, however during the season 1999/00 decreased slightly due to the floods as the figures show: tons in 1992/93, tons in 1995/96, tons in 1998/99, tons in 1999/00 ( MADER - DINA, 2000). Total legumes and cassava production follows the same pattern. For legumes total production increased from tons (1992/93) to tons (1998/99) and decreased to tons (1999/2000). The cassava production increased from tons (1992/93) to (1998/99), and decreased to tons (1999/00) (MADER/DINA, 2000). Food Security Estimates show that 64% of the Mozambican population (about 10 million) are food insecure. About 67% of the urban families do not have enough food compared to 63% of the rural families (IAF, 1998). The lowest level of food insecurity is in the rural north (48%), compared to any other rural region or urban area in Mozambique. On the other hand the highest level of food

9 Nutrition Country Profiles MOZAMBIQUE 11 June insecurity is found in the southern region (75%), which corresponds with the higher level of poverty, lower agricultural potential. Seventy eight percent of all food insecure households are found in rural areas. Forty percent of the total population live in the central region,more than twice the number in the north or the south. A total of 2.2 million of the food insecure are found in urban areas. The more vulnerable groups for food insecurity are people displaced by the war and families with children under five. Surprisingly the female headed and the elderly households are not at greater risk of being food insecure. In rural areas, people displaced by the war exibit significantly higher levels of food insecurity than non-migrants ( 73% vs 62%) and somewhat higher levels of food insecurity in urban areas (71% vs 67%) (IAF, 1998). Due to the floods (Feb-2000), many families in the southern and central regions lost their farms, livestock, food stocks, agricultural inputs (seeds and tools) and other personal belongings. According to the Ministry of Agriculture and Rural Development, around 215,000 ha of food crops (maize, cassava, beans, sweet potato, pumpkins, etc.) were lost; and 143,000 families were directly affected. Around 26 % of agricultural land was flooded. As a result of this situation many people became food insecure. Therefore, droughts remain the predominant production risk. Another factor for food insecurity is the isolation created by the difficult physical access to many areas in the country. 5. Economy In the beginning of the nineties Mozambique was classified by the World Bank as the poorest country in the world with a GNP of 80 USD per capita. In 1997 the economic rehabilitation programme started with the main objective of improving the national economy. From 1996 to 1999 Mozambique has registered a positive macroeconomic development. The inflation rate decreased dramatically from 50% in 1995/96 to 0.5-2% in The GDP for the period reached a high level at 10% per year, which represents an increase of 7.5% per year in real GDP per capita, in Meticais. In U.S. Dollar terms, GDP per capita increased from about US $145 in 1995 to slightly over US $ 240 in The mean of investment was 27% (Government of Mozambique, June 2000). The Government has also achieved significant progress in terms of structural adjustment. It has pursued public sector reforms such as new career and remuneration schemes, to improve institutional capacities, and the value added tax (VAT) (Government of Mozambique, June 2000) The floods which occurred in early 2000 have had a negative impact on macroecnomic development; economic growth decreased to 3.8%, and inflation achieved 14%. However, for 2001 a GDP growth of more than 10% is expected and a decrease in the inflation rate down to 5%. Over the period , gross national savings are projected to increase to about 17% of GDP (IMF-Republic of Mozambique, December 2000)

10 Nutrition Country Profiles MOZAMBIQUE 14 June II. THE FOOD AND NUTRITION SITUATION 1. Trends in energy requirements and energy supplies According to the IAF survey, the average per capita caloric requirement is approximately 2150 kcal/day, varying from 2115 to 2217 kcal/per capita between provinces. When refering to FAOSTAT data, from to , the per caput Dietary Energy Supply (DES) decreased from 1979 kcal to 1862 kcal. In the same period, average daily per consumption unit energy requirements decreased from 2205 kcal to 2152 kcal and is forecasted to reach 2218 kcal by the year 2030 (Table 2). FAOSTAT data also shows that from 1965 to 1997 the population almost doubled and is forecasted to increase by almost 50% by The increase in energy requirements reflect the growth needs of the population. The energy requirements of the urban population increased 30.5% from 1965 to 1997 and are projected to increase by another 25.1% by the year Table 2: Total population, urbanisation, energy requirements and dietary energy supplies (DES) per person and per day in 1965, 1997 and 2030 Year Total population (thousands) Percentage urban (%) Per caput energy requirements (kcal/day) Per caput DES (kcal/day) * * Three-year average calculated for and (Source: FAOSTAT) The decrease in DES from to can also be attributed to the lower consumption of daily carbohydrates from 1615 kcal to 1433 kcal (2%) and from protein, 151 to 147 kcal (0.6%) (FAOSTAT,99). An increase in DES for fat can be noted for the same years with 213 kcal in and 281 kcal in Fat intake peaked from at 319 kcal per day (Figure 1).

11 Nutrition Country Profiles MOZAMBIQUE 14 June Figure 1: Share of protein, fat and carbohydrate in Dietary Energy Supply Trends from to DES Kcal/caput/day Mozambique Carbohydrates Protein Fat Source: FAOSTAT 2. Trends in food supplies Quantity: Comparing figure 2 based on FAO food balance sheets with the IAF data about household expenditure in food items both show that cereals and starchy roots are the main food group supply. Although in the IAF the cereals contribution is higher comparing with the roots and tubers. The other food groups also follow the same trends. Information regarding energy supply is not available at the national level, however an IAF survey has information related to the household expenditure on food items. Around 62% of the household income is used for food. From the 62% around 28.3% is spent on cereals, roots and tubers; 10.8% on green leaves, vegetables and fruits; 6.3% on fish and sea food, 4% on beans; 4.9% on meat and meat products, 3.2% on groundnuts and cooking oil. The remain is used on milk products and eggs (0.68%), sugar (1.6%), drinks (0.59%), other foods (1.4%). (IAF, 1998).

12 Nutrition Country Profiles MOZAMBIQUE 14 June Figure 2: Supplies of major food groups (in Kg/caput/year) Trends from to Kg/caput/year Cereals (excl. beer) Starchy roots Sweeteners Pulses, nuts, oilcrops Fruits & Vegetables Vegetable oils Animal Fats Meat & offals Fish & seafood Milk & Eggs Other Mozambique Source: FAOSTAT Energy: The main food energy sources are cereals and tubers and roots. The other food such as oils, animal fat, nuts, eggs, milk products and meat have a insignificant contribution on the energy supply. When referring to FAOSTAT data, up until starchy roots (42.1%) were the main source of energy in the Mozambician diet, however in cereals exceeded the energy intake values of starchy roots at 37.3% DES for cereals and 41.3% DES for starchy roots.. A reduction in the DES of sweeteners, fruits and vegetables, meat and offals, fish, and milk and eggs in noted from to , the most noticable being sweeteners at nearly 50%. The share of all other major food groups has increased, with the DES of vegetable oil more than doubling (FAOSTAT,99) (Figure 3). The average calorie availability/adult Equivalent Unity (AEU)/day in the household is 2761 and a median is 2420 calories. This is below the reference needs of 3000 calories /AEU/Day. (IAF 1998)The median level of calorie availability/aeu/day in the household is almost one third higher in the north region at 3120 calories/aeu/day than in other parts of Mozambique. The lowest calorie availability is 1894 calories/day (63% of the requirements) in the cities excluding Maputo city. In the other areas the medium availability is about calories day, which is equivalent to 65 75% of requirements. (IAF, 1998).

13 Nutrition Country Profiles MOZAMBIQUE 14 June Figure 3: Share of major food groups in Dietary Energy Supply Trends from to Kcal/caput/day Cereals (excl. beer) Starchy roots Sweeteners Pulses, nuts, oilcrops Fruits & Vegetables Vegetable oils Animal Fats Meat & offals Fish & seafood Milk & Eggs Other Mozambique Source: FAOSTAT Major food imports and exports: During the food balance showed a deficit of around tons of cereals. The national production only covered around 40% of the national caloric consumption. The gross cereal production is estimated in around tons for a human consumption of tons (estimation for human consumption was done based on 80% -1680Kcal/person/day- of the total diet kcal/person/day). Cereal imports have increased from 4.1% in to 11% in (Figure 4). A food shortage is expected in some areas of the country where the production was insufficient, due to the floods (central and south region) and drought. For it is expected that food balance will have a total deficit of around 60,000 tons of maize, which will be covered by imports in the southern region and by donations in the flooded areas, for the affected people. However, from the northern and central region, around 60,000 tons of maize will be exported. Regarding rice and wheat the consumption projection is tons and tons respectively. Considering that the national production of rice is around tons it reflects a need of importation tons of rice tons of rice donation is expected. Wheat import of tons are expected. To cover the total consumption needs the country will have to import tons of maize, tons of rice, and tons of wheat.(ministerio da Industria e Comercio, Abril -2000). Also, the consumption needs for sorghum, millet, cassava and other tubers, which are currently covered by national

14 Nutrition Country Profiles MOZAMBIQUE 14 June production. It is expected that these crops will decrease in production by approximately 15% in the next year and may need to be imported. The export of food in Mozambique has shown an overall decrease. The export of sweeteners decreased from 9.9 in to 1% in Treenuts decreased from 3.2% in to 0.1% in with vegetable oils showing a similar decrease. The most pronounced decrease can be seen with oilcrops with a drop from 17.9% in to 2.1% in A pronounced decrease can be seen with oilcrops with a drop from 17.9% in to 2.1% in (Figure 5). However, estimates show a surplus of beans and peanuts of around tons. Some tons of these two crops are expected to be exported. 25 Figure 4: Major food imports as a percentage of Dietary Energy Supply Trends from to % of DES Cereals (excl. beer) Sweeteners Vegetable oils Mozambique Source: FAOSTAT 35 Figure 5: Major food exports as a percentage of Dietary Energy Supply Trends from to % of DES Sweeteners Oilcrops Treenuts Vegetable oils Mozambique Source: FAOSTAT

15 Nutrition Country Profiles MOZAMBIQUE 14 June Food consumption With respect to food consumption patterns, the information available is based on household food expenditure. (See section II.2) (IAF, 1998). Cereals, tubers, vegetables, green leaves, beans and peanuts are the staple diet of the majority of Mozambicans. Cassava is mainly eaten in the northern and Zambezia Province as the first staple food, and in the central and south region maize is a main staple. Rice is also a staple food in the central region. Animal protein foods, such as meat, meat derivatives, and milk are less consumed, only on festive days and traditional ceremonies. In the costal areas people also eat fish and other sea food. ( Perfis Distritais de Seguranca Alimentar e Nutricao, ). Few rich energy foods, such as oil and sugar are consumed in extremely small quantities by most families. However, in the areas where coconut, groundnut, cashewnuts and other oil crops are produced as cash crops they are as well consumed but often only in small quantities (Perfis Distritais de Seguranca Alimentar e Nutricao, ). The majority of the families have on average 2 to 3 meals a day; during the hungry season they reduce the number of meals and consume more wild foods (fruits, tubers, seeds). Related to infant feeding patterns supplementary feeding is very poor in terms of energy and nutrients. It is mainly composed by a cereal porridge not enriched with energy and protein food rich foods as oil, sugar, beans, cashewnuts, peanuts, coconut, etc. 3. Anthropometric data The results of the national demographic health survey (DHS, 1997) show that the malnutrition rates are as follows: stunting 36%, wasting 8% and underweight 26%, in children under 3 years old. Comparing by sex for all the three indicators, the boys registered slightly higher levels of malnutrition. The stunting and underweight rates are higher in the rural areas (38.9% vs 27.3% for stunting and 28.2% vs 20% for underweight); and wasting is higher in the urban area (10.4% vs 7.1%) (Table 4a, Map 2, Map 3 & Map 4). Regarding nutritional information for the adult group, DHS only have information for women. Mean Body Mass Index (BMI) is 21.6 which is considered normal. Ten percent of the women had a BMI below 18.5 which indicates malnutrition. In the rural areas 12.1% of the women have a BMI below 18.5, while in urban areas only 6.8% are below the cut of point (Table 4b). Anthropometric Information regarding adolescent group is not available. The Low Birth Weight rate, according to the MOH for 1999 was 12%. This only reflects the institutional births, which are only 38 % of the total births in the country. It is also important to note that BMI data is not desagregated by the different categories of malnutrition.

16 Nutrition Country Profiles MOZAMBIQUE 14 June Table 4a: Anthropometric data on children Source/ Location Sample Percentage of malnutrition Year of survey Size Number Sex Age Years Underweight Stunting Wasting Overweight % Weight/Age % Height/Age % Weight/Height % Weight/Height < -3SD < -2SD* < -3SD < -2SD < -3SD < -2SD > +2SD DHS National 2837 M/F <3 y Urban 713 " " Rural 2124 " " Province: C.Delgado 167 " " Gaza Inhambane Manica 260 " " Maputo Maputo City Nampula 318 " " Niassa 178 " " Sofala 389 " " Teta 150 " " Zambezia 322 " " MICS, 1995 National 4586 M\F <5y Province: Cabo Delgado 417 M/F <5y Gaza 514 " " Inhambane 373 " " Manica 425 " " Maputo city 441 " " Maputo 373 " " Nampula 393 " " Niassa 464 " " Sofala 489 " " Tete 505 " " Zambezia 189 " " JNSP,1990 National 762 M/F <5y " 369 M " " 393 F " Notes:... no data available The sample for Underweight was 4.408; for stunting was 4.406; and for wasting was Each index is expressed in terms of the number of standard deviations (SD) units from the median of the NCHS/CDC/WHO international reference population. * Includes children who are below -3 SD.

17 Nutrition Country Profiles MOZAMBIQUE 14 June Table 4b: Anthropometric data on adults Source/ Location Sample Year of survey Size Number Sex Age Years Anthropometric status and Percentage of malnutrition Body Mass Index (kg/m 2 ) Chronic Energy Deficiency % BMI Overweight % BMI Obesity % BMI mean <-2SD <18.5 < >30.0 DHS-1997 National 3088 F 15-49y Niassa province 177 F C.Delgado province 179 F Nampula province 530 F Zambezia province 428 F Tete province 139 F Manica province 235 F Sofala province 439 F Inhambane province 287 F Gaza province 320 F Maputo province 201 F Maputo city 152 F Notes:... data not available 5. Micronutrient deficiencies Currently Mozambique has not conducted any national survey of micronutrient deficiencies. However the Ministry of Health Nutrition Unit hasdone some surveys in the following provinces: Niassa, Tete, Cabo Delgado, Manica, Gaza and Maputo. World Vision International have also done micronutrient surveys in Zambezia and Nampula Province. Previous surveys done in Niassa and Tete have shown that Iodine Deficiency Disorders (IDD) is an endemic problem in both Provinces; with levels of total goiter above 50% and urine iodine below 2 µ g/dl in Niassa and below 4.9µ g/dl in Tete. (MOH, 1992, 1995). The results of a micronutrient survey done in 1998 in 4 Provinces (Cabo Delgado, Manica, Gaza, Maputo) show the following for iodine, vitamin A and iron micronutrient deficiencies. Iodine In Cabo Delgado province, IDD is severe with 49.5% of school age children having total goiter. The other provinces respectively: Manica, Gaza and Maputo the status of IDD is mild. As for total goiter rate the severe urine iodine levels were higher in Cabo Delgado province, on the other hand Maputo province showed the lowest prevalence of severe levels of urine iodine (Table 5a). According to these results all of the provinces and districtrs are at risk of Iodine deficiency (total score less than or equal to 6).

18 Nutrition Country Profiles MOZAMBIQUE 14 June :02 17 Vitamin A No clinical study has been carried out in the country. However, in the four provinces where a food frequency study was done the communities were at risk of vitamin A deficiency. The methodology used for the study was the Helen Keller International Food Frequency which give us the risk of deficiency but not deficiency levels. World Vision also did a food frequency survey in 6 districts of two provinces (Erati, Muecate, Murrupula Nampula province; Gurue, Morrumbala and Namacurra Zambezia province) to assess the risk of vitamin A deficiency in the communities. Similar to the MOH results, the communities, where World Vision did the survey, were all at risk of vitamin A deficiency (Table 5b). Iron Anaemia is a severe problem in the country. The majority of cases are related to malaria. In the pre school age group, Cabo Delgado province registered the highest prevalence of anaemia (81.5%) and Maputo Province the lowest (58.2%). Between 40 to 50% of the children had moderate levels of anaemia and 4 to 15% severe.for women, Gaza province registered the higher prevalence of anaemia (65%), and Manica the lowest (44.7%). The majority of women had mild levels of anaemia (33.8% %) and % severe. With respect to men, anaemia was also a problem. In Gaza province 45.9% of the men were anaemic. Maputo and Cabo Delgado had 30% and Manica 19.3% (Table 5b).The high prevalence of anaemia in the men group reflects a high prevalence of parasites.

19 Nutrition Country Profiles MOZAMBIQUE 14 June Table 5a: Surveys on micronutrient deficiencies for iodine Source/ Deficiency Location Sample Percentage Sex Year of survey Iodine Size Number Age Years MOH TGR C.Delgado province 891 M/F 6-17Y 49.5 UI < 2.0 " " 45.5 UI " " 26.3 UI " " 18.2 UI >10 " " 10.1 TGR Manica province 910 M/F 6-17Y 9.5 UI < 2.0 " " 29.5 UI " " 29.5 UI " " 23.8 UI >10 " " 17.1 TGR Gaza province 2098 M/F 6-17Y 10.1 UI < 2.0 " " 16.2 UI " " 20.7 UI " " 21.8 UI >10 " " 41.3 TGR Maputo province 1785 M/F 6-17Y 17.4 UI < 2.0 " " 5.4 UI " " 20.1 UI " " 23.4 UI >10 " " 51.1 Notes:.UI< 6 signifies that there is a risk of deficiency. The HKI-Food Frequency method was used

20 Nutrition Country Profiles MOZAMBIQUE 14 June Table 5b: Surveys on micronutrient deficiencies for vitamin A and iron Source/ Deficiency Location Sample Percentage Sex Year of survey Size Number Age Years Vitamin A MOH-1998 Total score C.Delgado province 822 M/F M 2.4 " Manica province 890 " " 3.7 " Gaza province 883 " " 1.7 " Maputo province 804 " " 3.0 World Vision-98 Total Score Erati District * 750 M/F M 3.3 " Muecate District * 750 " " 4.3 " Murrupula District * 750 " " 2.7 " Gurue District 900 " " 2.8 " Morrumbala District 750 " " 3.7 " Namacurra District 750 " " 2.0 Iron MOH-1998 Hb<11 g/dl C.Delgado province 449 M/F 12-72M 81.5 " Manica province 450 M/F 12-72M 78.2 " Gaza province 450 M/F 12-72M 76.4 " Maputo province 450 M/F 12-72M 58.2 Hb<12 g/dl C.Delgado province 413 F 15-49Y 50.7 " Manica province 397 F 15-49Y 44.7 " Gaza province 389 F 15-49Y 65.0 " Maputo province 428 F 15-49Y 51.2 Hb< 13 g/dl C.Delgado province 65 M >15 Y 30.8 " Manica province 150 M >15 Y 19.3 " Gaza province 149 M >15 Y 46.9 " Maputo province 145 M >15 Y 30.3 Note: HCI methodology was used for vitamin A risk of deficiency analysis. *The first three districts belong to Nampula Province but are Zambezia province

21 Nutrition Country Profiles MOZAMBIQUE 14 June REFERENCES FAO/WFS (World Food Summit) Mapping Undernutrition - an ongoing process-. Poster for the World Food Summit November FAO, Rome FAOSTAT FAO Web page. Statistics database. FAO, Rome Fevereiro, Marco, Abril -2000, Maputo. Government of Mozambique and United Nations Children s Fund. Multiple indicator cluster survey Mozambique MICS Survey. Ministry of Planning and Finance. Maputo, Mozambique, Government of Mozambique, Economic development and Poverty reduction Document to the consultative group, June Governo de Mocambique, Plano de Accao sobre Alimentacao e Nutricao, Maputo,1995. Governo de Mocambique Plano de Accao para a Reducao da Pobreza , Maputo IMF and Government of Mozambique, Staff report for the 2000 Article IV consultation ans Second Review Under the Poverty Reduction and Growth Facilities, December Instituto Nacional de Estatistica, Projeccoes Anuais da Populacao Total Mocambique, Maputo, Instituto Nacional de Estatistica e Macro International Inc, Inquerito Demografico e de Saude ,1998. Joint Nutrition Support Programme (JNSP) in Mozambique. Annual report 1990 and plan of action Geneva: RPM/WHO/UNICEF. Ministerio da Agricultura e Desenvolvimento Rural Direccao Nacional da Agricultura, Informacao comparativa sobre a producao agricola 1992/93 a 1999/2000 (Informacao nao publicada). Ministerio da Agricultura e Desenvolvimento Rural Sistema Nacional de Aviso Previo para a Seguranca Alimentar Estimativa da Producao,superficie cultivada e rendimentos da campanha agricola 1999/2000, Agosto Ministerio da Industria e Comercio Boletim Mensal de Comercio Agricola, N 21, 22, 23, Ministerio da Saude Avaliacao da Deficiencia em micronutrientes a nivel das Provincias de C.Delgado, Manica, Gaza e Maputo, Maputo,1999. Ministry of Health National Micronutrient Strategy, Maputo, Ministry of Planning and Finance, Eduardo Mondlane University and International Food, Maputo, Mocambique inquérito demográfico e de saude Demographic and Health Surveys. Instituo Nacional de Estatistica. Maputo, Mocambique, 1998.

22 Nutrition Country Profiles MOZAMBIQUE 14 June Policy Research Institute, Understanding poverty and well being in Mozambique The First National Assessment ( ). OXFAM Acesso a Educacao Basica e a Saude em Mocambique, Maputo, Tabatabai, H Statistics on poverty and income distribution. An ILO Compendium of UN World Urbanisation Prospects Revision. United Nations Population Division. New York. UN World Population Prospects Database The Revision. United Nations Population Division. New York. UNDP (United Nations Development Programme) Human Development Report. Oxford University Press. New York. UNICEF The State of the World s Children United Nations Children s Fund. Oxford University Press. New York. World Bank The World Development Indicators 1999 CD-ROM. Win*STARS System Version 4.0. World Bank, Washington, D.C. World Vision Results from the baseline food frequency survey, Mocambique - Maputo, References of data presented in Table 1, unless otherwise stated: Source: FAOSTAT Indicator: A.1-2, B, C.10-11, E.1-3, F, G UN. 1998/1999 rev. C.1-9, D.5 World Bank D.1 UNDP D.2 IAF D.3-4 UNICEF D.6 FAO/WFS H

23 Nutrition Country Profiles MOZAMBIQUE 14 June NCP of MOZAMBIQUE MAPS -General Map of Mozambique -Map 1: Population density in 2000 at the provincial level in Mozambique. -Map 2: The prevalence of underweight among children less than 5 years old in 1995 at the provincial level in Mozambique. -Map 3: The prevalence of stunting among children less than 5 years old in 1995 at the provincial level in Mozambique. -Map 4: The prevalence of wasting among children less than 5 years old in 1995 at the provincial level in Mozambique.

24 General Map of Mozambique #S Lichinga #S Pemba #S Tete #S Nampula #S Mocambique Sub-national Boundaries #S Main cities Primary Route Secondary Route Rivers Chimoio #S #S Beira #S Quelimane #S Inhambane N Scale 1 : (approx.) Geographic Projection #S #S Xai-Xai Maputo W S FAO-GIS/ESNA, August 2001 Mozambique E

25 Map 1: Population density in 2000 at the provincial level in Mozambique Source: Nations Children's Fund. Multipe indicator cluster survey Mozambique MICS Surveys. Ministry of Planning and Finance. Maputo, Mozambique, 1996 Nassa Cabo Delgado Tete Zambezia Nampula Population Density (Ha/Km²) Capital (3.44) &V Scale 1 : (approx.) Geographic Projection Sofala Manica Inhambane Gaza Maputo &V Maputo city W N S FAO-GIS/ESNA, August 2001 Mozambique E

26 Scale 1 : (approx.) Geographic Projection Map 2: The prevalence of underweight among children less than 5 years old in 1995 at the provincial level in Mozambique % Underweight (Weight/age <-2SD) &V Capital % Underweight (Weight/age <-3SD) xx.x Source: Government of Mozambique and United Nations Children's Fund. Multipe indicator cluster survey Mozambique MICS Surveys. Ministry of Planning and Finance. Maputo, Mozambique, Tete Gaza Manica 5 Sofala Inhambane 11 Maputo &V Maputo city 10 Nassa 28 Zambezia Cabo Delgado Nampula 8 8 W N S FAO-GIS/ESNA, August 2001 Mozambique E

27 Map 3: The prevalence of stunting among children less than 5 years old in 1995 at the provincial level in Mozambique Source: Government of Mozambique and United Nations Children's Fund. Multipe indicator cluster survey Mozambique MICS Surveys. Ministry of Planning and Finance. Maputo, Mozambique, 1996 % Stunting (Height/age <-2SD) &V Capital % Stunting (Height/age <-3SD) xx.x Scale 1 : (approx.) Geographic Projection 18 Tete Gaza Manica Sofala Inhambane Maputo &V Maputo city Nassa 53 Zambezia 33 Cabo Delgado Nampula 26 W N S FAO-GIS/ESNA, August 2001 Mozambique E

28 Map 4: The prevalence of wasting among children less than 5 years old in 1995 at the provincial level in Mozambique Source: Government of Mozambique and United Nations Children's Fund. Multipe indicator cluster survey Mozambique MICS Surveys. Ministry of Planning and Finance. Maputo, Mozambique, 1996 % Wasting (Weight/height <-2SD) &V Capital % Wasting (Weight/height <-3SD) xx.x Scale 1 : (approx.) Geographic Projection Tete Gaza Maputo &V 3 Manica Sofala Inhambane Nassa 10 Zambezia Nampula 1 Cabo Delgado 2 W N S FAO-GIS/ESNA, August 2001 Mozambique E