Two strong tropical cyclones made landfall in the country during the same season in 2019, leaving a trail of death, damage and destruction whose impacts will be felt well into 2020. A general deterioration of nutrition conditions is also unfolding during the lean season (September 2019 to February 2020).  Also, a violence phenomena generated apparently by islamic extremist groups has been affecting the northern districts of the Cabo Delgado province, generating Food and nutrition security issues and thousands of internal dislocated persons . For the first time since 2001 in Mozambique, cases of pellagra (vitamin B3 deficiency) have been reported in June.  Even though the deficiency is caused by a specific nutrient deficiency, Pellagra is a reflex of a poor diet and the situation has worsened since June and by the end of 2019 a total of 3,652 cases have being diagnosed in the post Idai affected area on the provinces of Sofala and Manica.  An estimated 42,000 children require treatment for malnutrition in the districts classified to be in Integrated Phase Classification (IPC) phase 2 or above for acute malnutrition (AMN), according to the SETSAN nutrition survey. Although the prevalence of Global Acute Malnutrition (GAM) is classified IPC AMN phase 1 “Acceptable” (<5 percent ) for most of the districts, at least 18 districts will surpass the “Alert” level or IPC AMN 2 (5 to 9.9 percent) and within those, 4 districts will reach the serious level (IPC AMN phase 3 : 10 to 14.9 percent) during the period.

Restore and expand capacity for life-saving nutrition interventions thorough health facilities and outreach activities for children under five suffering from Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM), and Pregnant and Lactating Women with Acute Malnutrition living in the affected districts. 

Reinforce the inpatient treatment of SAM cases

Implement active case finding and referral of malnourished children and pregnant and lactating women and monitor the nutrition situation through MUAC screenings.

Undertake rapid nutrition assessments and screening for detection, referral, and follow-up, supported by community health and nutrition workers. 

Ensure nutritional treatment for Pellagra cases following MISAU/WHO guidelines and supplement with multivitamins the affected populations.

Provide nutrition supplies for therapeutic feeding and micronutrient supplements for the nutrition response activities, including VItamin A supplementation and deworming. 

Promote optimal breastfeeding and complementary feeding practices, and overall Infant and Young Child Feeding (IYCF) best practices messages for caregivers of children under two in the affected districts.

Training APEs (Community Health Workers) in a nutrition intervention package and provide advice to mothers and caregivers of children on infant feeding (IYCF)

In response to cholera outbreak, it was set up cholera treatment camps as well as cholera vaccination campaigns in two successive rounds in Sofala and Cabo Delgado Provinces.  In line with this, nutrition cluster through IYCF-E, supported the promotion of infant feeding, nutritional education, culinary demonstration and feeding hygiene reaching a total of 420,914 mothers and caregivers of children under five. Dissemination of these educational messages was possible by setting up radio debates, nutrition fairs and talks.

The Mozambican MoH is the sole provider of nutrition treatments services in country. Scaling up the response as well as accessibility to timely data to inform the response was challenging. This was manly due to capacity constraints and understaffing. 

Due to the limitations in accessing data in a timely manner, it was difficult to depict a true picture of the nutrition situation and nutrition response based on programmatic information.

Limited engagement on the nutrition response from humanitarian actors as a results of under-funding and reluctance from MoH to allow delivery of curative nutrition services by humanitarian actors. 

Key material, guidelines and standards were not translated and validated in Portuguese therefore limiting its utilization by MoH staff and other actors.

External support dwindling when nutritional needs likely to increase (for instance: post cylcones and increasing malnutrition, pellagra for the upcoming lean season) due to deactivation of the emergency phase to early recovery phase.

Weak community outreach components for the timely identification and referral of acutely malnourished children aged below 5 years, done predominantly through health weeks.

Nutrition Cluster was heavily under-funded (5% for the first quarter) with funding limited to UN agencies.This was based on the fact that Nutrition was de-prioritized by bilateral donors and in pooled funding mechanisms (CERF) in light of the low GAM levels at the onset of the crisis, even though there was sub-optimal IYCF practices, high chronic malnutrition levels prior to the crisis and presence of aggravating factors (Cholera outbreak, poor food security, compromised living conditions, poor WASH) that could worsen the situation if preventive efforts were not scaled up and sustained. Funding situation has improved to 33% of the 2019 pledge.

Poor comprehension of the cluster approach and cluster functions by MoH and Nutrition actors which compounded the coordination challenges.

•        Restore and expand capacity for life-saving nutrition interventions through health facilities and outreach activities for children under five suffering from Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM), and Pregnant and Lactating Women with Acute Malnutrition living in the affected districts.

•        Implement active case finding and referral of malnourished children and pregnant and lactating women and monitor the nutrition situation through MUAC screenings.

•        Assure nutritional treatment for Pellagra cases following MISAU/WHO guidelines and supplement with multivitamins the affected populations.

•        Provide nutrition supplies for therapeutic feeding and micronutrient supplements for the nutrition response activities.

•        Undertake rapid nutrition assessments and screening for detection, referral, and follow-up, supported by community health and nutrition workers.

•        Promote optimal breastfeeding and complementary feeding practices, and overall Infant and Young Child Feeding (IYCF) best practices messages for caregivers of children under two in the affected districts.