RESUMO
BACKGROUND: Despite an increasing need for multisectoral interventions and coordinations for addressing malnutrition, evidence-based multisectoral nutrition interventions have been rarely developed and implemented in low-income and middle-income countries. To identify key determinants of undernutrition for effectively designing a multisectoral intervention package, a nutrition survey was conducted, by comprehensively covering a variety of variables across sectors, in Niassa province, Mozambique. METHODS: A cross-sectional household survey was conducted in Niassa province, August-October 2019. Anthropometric measurements, anaemia tests of children under 5 years of age and structured interviews with their mothers were conducted. A total of 1498 children under 5 years of age participated in the survey. We employed 107 background variables related to possible underlying and immediate causes of undernutrition, to examine their associations with being malnourished. Both bivariate (χ2 test and Mann-Whitney's U test) and multivariate analyses (logistic regression) were undertaken, to identify the determinants of being malnourished. RESULTS: Prevalence rates of stunting, underweight and wasting were estimated at 46.2%, 20.0% and 7.1%, respectively. Timely introduction of solid, semi-solid or soft foods to children of 6-8 months of age was detected as a determinant of being not stunted. Mother-child cosleeping and ownership of birth certificate were a protective factor from and a promoting factor for being underweight, respectively. Similarly, availability and consumption of eggs at the household level and cough during the last 2 weeks among children were likely to be a protective factor from and a promoting factor for being wasted, respectively. CONCLUSION: Timely introduction of solid, semi-solid or soft foods could serve as an entry point for the three sectors to start making joint efforts, as it requires the interventions from all health, agriculture and water sectors. To enable us to make meaningful interprovincial, international and inter-seasonal comparisons, it is crucially important to develop a standard set of variables related to being malnourished.
RESUMO
RESUMO A provisão dos cuidados de saúde implica o princípio dos direitos fundamentais do homem, enfatizado por Moçambique, uma nação emergente, ao considerar a saúde como um bem para o desenvolvimento sustentável previsto na Constituição da República, e garantida de forma equânime. Contudo, observa-se o ingresso preocupante no sistema prisional de mulheres com crianças pequenas que carecem de garantia do acesso a cuidados de saúde especiais. O estudo teve como objetivo fundamental analisar e descrever de que maneira a política de atenção integral à saúde da criança dos 0-5 anos, estabelecida pelo Serviço Nacional de Saúde em Moçambique, está incorporada no Serviço de Cuidados Sanitários Penitenciários. A abordagem qualitativa incidiu sobre as mães de crianças pequenas que vivem no presídio de Ndlavela, tendo em conta as variáveis que descreveram as condições socioeconômicas, demográficas e as relativas às condições biológicas da mulher com crianças. Participaram do estudo, por meio de entrevistas, duas gestantes e cinco mães em coabitação com crianças. Os dados coletados foram tratados por meio da análise de conteúdo segundo Bardin. Essas mulheres são jovens, solteiras, com baixa escolaridade, sem suporte nutricional e de saúde adequados e foram abandonadas pelas suas famílias de origem ou de formação, as quais realizavam atividades domésticas e de comércio informal. Observou-se que esse grupo é duplamente vulnerável e socialmente marginalizado, por ser pouco favorecido pelas políticas públicas de saúde. Conclui-se que a política de saúde necessita ser desdobrada, voltar-se para a necessidade e a importância de uma atenção à saúde mais igualitária, adequada e resolutiva, independentemente da situação legal, razão por que sublinha-se que essa realidade ainda está distante do preconizado sobre a assistência sanitária nos estabelecimentos penitenciários.
ABSTRACT The provision of health care implies the principle of fundamental human rights, emphasized by Mozambique, an emerging nation, when considering health as a good for the sustainable development provided for the Constitution of the Republic, and assured in an equitable manner. However, there is a worrying entrance into the prison system of women with young children who lack access guarantee and special health care. The main objective of this study was to analyze and describe how the comprehensive health care policy for children aged 0-5 years, established by the National Health Service in Mozambique, is incorporated into the Prison Health Care Service. The qualitative approach focused on mothers with small children residing in the Ndlavela prison, taking into account the variables that only described the socioeconomic, demographic conditions and the ones related to biological conditions of women with children. Two pregnant women and five mothers in cohabitation with children participated in the study, through interviews. The data collected were treated by the Bardin content analysis. These women are young, single, low schooling, without adequate nutritional and health support and were abandoned by their families of origin or formed, and who were engaged in domestic activities and informal trade activities. It was observed that this group is doubly vulnerable and socially marginalized, because it is not favored by public health policies. It is concluded that the health policy needs to be unfolded, turning to the need and importance of a more egalitarian, adequate and resolutive health care, regardless of the legal situation, which is why it is emphasized that this reality is still far from the one recommended for health care in prisons.
