1 August 2011

Zimbabwe: Malnutrition - Underlying Cause of Child Mortality

Photo: Elizabeth Glaser/ Pediatric AIDS Foundation
HIV and child birth in Zimbabwe.

Mary Nerwande, a 25-year-old woman who has a five-month-old baby boy from Unit O in Chitungwiza, is a living example of a mother and child health volunteer. Her child is healthy and despite her economic limitations, she and her unemployed husband have struggled for the child to have the best.

From the start, Nerwande proved her interest with consistent participation in child care and development. She has always expressed her opinions, at first only among women.

"I am happy to be a mother and child health volunteer - to be able to help my neighbours attain better practices for caring and feeding their children."

The mother and child health volunteers are now regarded as a local authority - and enjoy the respect and trust of this Chitungwiza community.

Although living positively with HIV, Nerwande is exclusively breastfeeding her child until he is six months.

"Thereafter, I will continue to breastfeed and introduce complimentary foods in his diet," she says.

"From the workshops I have attended, I was taught that babies of HIV positive mothers taking anti-retroviral drugs, are at less risk of infection if they are breastfed exclusively for up to a year.

"Mixing breast milk and formula has been found to be the leading cause of HIV transmission from a mother to her baby," Nerwande says. She is a strong advocate of the Prevention of Mother to Child Transmission.

Formula contains a bacteria that can irritate the walls of the gut of the child hence the virus finds it easy to get into the system, according to the United Nations Children's Fund.

The UN agency says babies that are given mixed feeding are more likely to acquire HIV. More infections, says Unicef, occur during and after the weaning process as mothers introduce formula and other complimentary feeding.

Sixty-two-year old Gogo Gertrude Matsinha is a volunteer community health care giver, also from Unit O in Chitungwiza. She works with four others in this sprawling high-density suburb.

She says: "Human breast milk is the healthiest form of milk for babies. Breastfeeding is culturally acceptable in the community. Also, it is a cost-effective way to feed and nourish the baby."

Gogo Matsinha adds: "We found that mothers could have well-nourished children if they initiated breastfeeding soon after birth, exclusively breast-fed until six months old and then introduced nutrient-dense foods."

The strategy to influence behaviour in this community has changed the lives of children who had been destined for chronic malnutrition. In the process, it has empowered their mothers.

Dr Angela Mushavi,the National PMTCT and Paediatric HIV Care and Treatment Co-ordinator in the Ministry of Health and Child Welfare, says: "We encourage every woman to be tested when pregnant and when found to be HIV positive she would be able to receive treatment so that the child is not infected at birth or during breastfeeding."

Over a third of children under the age of five years in Zimbabwe are chronically malnourished and about 15 000 are at risk of dying from this condition annually.

Suboptimum feeding practices, especially non-exclusive breastfeeding in the first six months of life, results in 1,4 million deaths and 10 percent of disease burden in children younger than five years

According to results of a 2010 National Nutrition Survey in Zimbabwe, chronic malnutrition is high and increasing at 33,8 percent. Exclusive breastfeeding has declined from 26 percent to 5,8 percent, according to Ministry of Health and Child Welfare statistics.

"This is unacceptable for Zimbabwe," says the Secretary for Health, Dr Gerald Gwinji. "Despite the great strides that have been made in promoting, protecting and supporting breastfeeding, we still have challenges to overcome, one of which is the low rate of exclusive breastfeeding."

According to the World Health Organisation underweight for children under the age of five years increased from 13 percent in 1999 to 16, 6percent in 2006 while stunting - worst form of malnutrition - rose from 26,5 percent to 29,4 percent during the same period. Wasting - the acute form of undernutrition remained stable at 6 percent over the years.

The latter half of the 20th century saw significant reductions in child mortality in lower income countries worldwide, says the World Health Organisation. Yet more than 10 million children under the age of five still die every year. Over 98 percent of all child deaths occur in developing countries - 90 percent in only 42 countries, according to World Vision, an international humanitarian organisation.

Underlying these direct causes of death is childhood malnutrition, which is associated with more than half of all child deaths.

"Malnutrition reduces a child's resistance to disease. Even mild nutrition weakens the immune system, rendering a child both more vulnerable to infection and less able to fight it," says Siboniso Chigova, of the Ministry of Health and Child Welfare.

In turn, infections contribute to malnutrition by depressing the appetite just when the baby's effort to combat the illness is depleting stored energy and nutrients.

Chigova says: "This vicious cycle of malnutrition and infection leads to ever-increasing weakness, and too often, to premature death."

Malnutrition encompasses a broad range of nutritional deficits, and relates both to quantity and quality of food. Often, it is assumed that insufficient quantity of food, leading to inadequate intake of energy (kilojoules/calories) and protein, is the major nutrient problem in Zimbabwe.

Indeed, protein energy malnutrition is a serious issue, and research has shown that even mildly underweight children are twice as likely to die from infectious diseases, while moderately or severely underweight children have a five to eight fold increase in mortality risk.

Yet in recent years it has become clear that micro-nutrient malnutrition - vitamin and mineral deficiencies - contribute substantially to the global burden of illness and mortality.

For example, vitamin A deficiency - responsible for 1,5 million child deaths annually - increases the cause of child blindness, a child's risk of death from diarrhoea, measles and malaria by 20-24 percent, while zinc deficiency raises the risk of death from diarrhoea, pneumonia and malaria by 13-21 percent.

"The 1999 national micro-nutrient survey conducted in Zimbabwe by the Ministry of Health and Child Welfare revealed a high prevalence of vitamin A deficiency amongst women and children," says Tendai Gunda,of Helen Keller International.

The survey also showed that 20 percent of the pregnant women, 59 percent of lactating women and 35 percent of children of 6-71 months old were vitamin A deficient.

Micro-nutrient deficiencies are also linked with functional problems such as morbidity from infectious diseases, compromised child development, reduced intellectual capacity and decreased work productivity.

"Thus widespread micro-nutrient malnutrition has major implications not only for the survival and health of affected individuals, but also for the development potential and economic situation of their communities," said Professor Rose Kambarami,of the Maternal and Child Health Integrated Programme.

"If Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health) are to be achieved by 2015, success in improving child health indicators in Zimbabwe will be critical," added Professor Kambarami.

But, the country cannot reach the Millennium Development Goal of reducing child mortality by two-thirds of 1990 levels by 2015 without substantively reducing child malnutrition as it significantly hinders progress towards some other MDGs as well

In fact, providing micro-nutrients to populations with widespread deficiencies has been recognised as one of the best investments in development aid.

Combining nutrition interventions with management of common childhood diseases would reduce child deaths even more dramatically, and is an urgent national health priority for Zimbabwe.

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