A Poente...

A Poente...
Na Baía de Nacala!

Alfacinha

Alfacinha
encontra Mapebanes

Luso calaico

Luso calaico
visita Etxwabo

quarta-feira, 22 de novembro de 2017

Abalos tectónicos?


A confirmação da inevitável mudança, atrasando-se na atualização documental da burrocracia ecofágica, parece não se incomodar com a velocidade planetária. O Pós-Doutoramento em Ciências da Paz (Paciência) cristaliza-se na produção de livros na cultura oral; será o cristal estudado? Bem falado? Vilipendiado? Na medida em que o imprevisto é a única coisa previsível, ficamos no “cara ou coroa”!

segunda-feira, 20 de novembro de 2017

Preâmbulo.


Na minha hora (45 min) aeróbica (5 km) interferi com os cães vadios na rua ao lado dos dormitórios dos estudantes e também com os duetos de segurança e polícia armados, não vi mais ninguém! As estrelas agora, com o quarto em crescente, esmorecem. A Via Láctea está discreta, o Cruzeiro do Sul não falha, deitado a ocidente, mas a UM? Virá?

quinta-feira, 9 de novembro de 2017

20 de Setembro 2017


Quarta-feira depois de jantar, duas horas a jobar e uma hora de marcha rápida ~ 5 - 6 km naquela meditação das dezenas de ideias brilhantes que nunca serão conhecidas! Agora acelerei para 3 vezes uma hora por semana, mínimo!

Luto.

Passagem, para a outra margem.

terça-feira, 31 de outubro de 2017

Parto...

NESSE DIA PARTI PARA OUTRA VIDA.

Francamente, não estava preparada. Flutuava descansada no líquido amniótico, sem qualquer outra preocupação, mas a hipófise da minha mãe pensava que era a altura certa e o útero dela começou a expulsar-me. Não tive outra solução que enfiar a cabeça e toca a sair, abrir a boca e inspirar fundo, expirar, engasguei-me um pouco, tossi e começa uma nova fase, tudo diferente. A enfermeira de branco rodou-me, puxou-me um pouco pela cabeça, os ombros saíram certinhos e o resto foi fácil. Já embrulhada na toalha, a enfermeira colocou-me calmamente em cima da barriga da minha mãe. Pensei em chorar, mas de facto não tinha grande vontade. Por cima da minha cabeça, estava um cheiro sedutor e um mamilo apetitoso que me cativou os sentidos. Estiquei o pescoço e a minha boca apanhou o alvo. Pronto, devagarinho reencontrei o meio habitual. Barriga cheia está-se muito melhor. Minha mãe chegou-me um pouco acima, deu-me duas palmadas no rabo e eu arrotei. Nisto, deu-me vontade de dar uma mijinha. Descuidei-me, e molhei a barriga da minha mãe. Chegou o médico para fazer o exame clínico; sacudiu-me um pouco, esticou-me os braços e pernas, colocou-me na balança e depois escreveu no cartão. A enfermeira pegou em mim e colocou-me na cama ao lado da minha mãe. Entrei num sono profundo. Sonhava ainda com aqueles sons fortes do coração da minha mãe, do ruído de fundo da galáxia desconhecida, da circulação rápida no cordão umbilical. Deixei-me ir!”



segunda-feira, 2 de outubro de 2017

Maternal and children nutrition in northern Mozambique: a mixed methods study. Publicado no International Journal of Research, India!

Maternal and children nutrition in northern Mozambique: a mixed methods study.

 Ganhão C,1 Pires P,1 Couto S,1 Valente A,1 Mupueleque M,1 Marega A,1 Muoki P.2
 (1)   Faculdade de Ciências de Saúde, Universidade Lúrio, Marrere, Nampula, Mozambique.
  (2)   International Institute of Tropical Agriculture, Nampula, Mozambique.                                                                                                                              

Introduction: children malnutrition is a public health problem in Mozambique and we know that integrated agriculture and nutrition interventions can mitigate malnutrition adverse effects, especially during the first 1,000 days of life. For an agriculture intervention positively impact on nutrition, the implementation must be purposely designed to achieve this objective; this baseline survey was carried out to benchmark a project progress towards attaining its objectives as well as in guiding implementation process.
Methods: descriptive mixed methods research to evaluate the nutritional status of mother-child (aged from 6 to 24 months) pairs, food availability and consumption trends. Focal group discussions to prepare food demonstration tools, a structured questionnaire for 24h-recall and a food frequency questionnaire to collect data were used. We surveyed randomly selected households in Malema and Gurué districts, Northern Mozambique.
Results: 577 infant-mother pairs were surveyed and we found a high prevalence of children born underweight (18.8 %), a prevalence of chronic and acute malnutrition of 6.0 % and 12.0 %, respectively. A double burden of malnutrition (underweight and overweight) was found among mothers. Both Malema and Gurué districts produce various food crops. Legume crops are the main protein source for most households. The 24 h - recall indicated that the median protein consumption among infants was 25.3 g / day, threefold higher than the recommended protein intake from complementary foods, assuming a child is breastfeeding as is expected for children below two years.
Conclusion: this baseline survey highlighted the nutrition status of infant-mother pairs in Malema and Gurué districts, Mozambique, showing a children nutritional positive evolution since the 2011 Mozambican Demographic and Health Survey. Malnutrition double burden (under and overweight) attains mothers and possible underlying factors for the nutrition status were underscored. Potential intervention niches for an integrated agriculture and nutrition project were highlighted.

Key words:  children, malnutrition, maternal, Mozambique, nutrition, overweight, underweight.

  1. Introduction.
Maternal and children under nutrition in low and middle-income countries encompasses both under nutrition and a growing problem with overweight and obesity. (1) Annually, under nutrition accounts for 3.5 million deaths with over half of the global child mortality occurring in Africa. Under nourished children have an increased death rate from diarrhoea, pneumonia, measles, and other infectious diseases. (2) In Mozambique, the prevalence of stunting is 43 %, (3) and it is responsible for over a third of deaths among children aged less than five years. Undernutrition prevalence rates differ within the country, with the northern part (Nampula Province) having the highest prevalence (55 %). Undernutrition is not only a health but also an economic problem, being responsible for a 2 – 3 % loss of internal product. Chronic under nutrition is recognized as the best indicator of the quality of human capital. (4)
Maternal and child under nutrition including stunting, wasting and deficiency of essential vitamins and minerals has been a subject of discussion by various professional, who agree there is potential for reduction through equitable coverage of proven nutrition interventions. The need to focus on the crucial period from conception, through the first two years of life (the first 1,000 days), during which good nutrition and healthy growth have lasting benefits throughout life has been recommended. (5)
In Sub-Saharan Africa, millions of households depend on agriculture for income and food. In 2006 80 % of Mozambicans lived in rural areas depending on agriculture for their livelihood. Agricultural interventions have long been thought to influence nutrition. In the past 10 - 15 years, people have accepted that for agricultural intervention to have greater chance of affecting nutrition status, they must be implemented with that objective. (6) Northern Mozambique is considered the country’s food basket as most food production happens there. (7) However, there is high prevalence of undernutrition in northern Mozambique compared to other parts of the country, an example that agriculture or high food production does not always translate into better nutritional outcomes.
During 2011 - 2015, the International Institute of Tropical Agriculture (IITA) has set out to implement a nutrition sensitive project, with the aim to increase soybean production and consumption for better nutrition. To effectively implement and measure project’ progress, a baseline survey was performed, in cooperation with Lúrio University (LU) Health Sciences Faculty researchers, to assess the nutritional status of the key beneficiaries of the project (body mass index – BMI - of women and children aged from six months to two years), local dietary characteristics (components and preparation techniques), food availability and consumption trends among this target population.
2. Methods.
Descriptive mixed methods study, using qualitative and quantitative tools to gather data from children of age between 6 and 24 months and their mothers, in Gurué (Zambézia Province) and Malema (Nampula Province) districts in Mozambique, during April and May 2013.
Initial interactions with key informants during focus group discussions (FGD) were used to appraise the type of foods that were commonly eaten in the community and their methods of preparation. FGD also aided to develop the food frequency questionnaire (FFQ) as foods available in the study area were documented. For quantitative data, we used a questionnaire that contained agriculture and nutrition related questions including a 24 h - recall.
FGD and development of a pictorial manual.
FGD were conducted in the study area to gather information on types of food typically eaten, with women of reproductive age group (n = 68). A structured questionnaire was used to guide the discussions.
Using information gathered through FGD, a pictorial manual showing an illustration of food combinations, that would normally be served for a normal meal, was developed. Three local women prepared various recipes described by FGD. The women served the various food combinations, as they would do normally. The weight of each food type on the plate was then recorded and photographed to guide interviewers while filling the 24 h - recall questionnaire.
Sample selection.
A total of 612 households participated in the study. Children aged from 6 to 24 months and their mothers qualified to participate. The number of children to be surveyed, was calculated per district, using Nampula and Zambézia Provincial Health Directorates (Ministry of Health) data about undernutrition prevalence, plus a 10 % chance of non-respondents. The respondents were randomly selected from a list of all qualifying households.
Data collection.
Ethical clearance was provided by the Institutional Bioethics for Health Committee of LU. Data were collected using a structured questionnaire, record of anthropometric measurements of infant - mother pair, 24 h - recall for children and FFQ. BMI was calculated and categorized following the guidelines of National Institute of Health, 1998. Software Antro® of World Health Organization (WHO) was used to determine the undernutrition indicators for children.
For the 24 h - recall of foods eaten, data were collected for all foods and drinks consumed during the last 24 hours before the interview. Details of commercial products were taken so as the detailed ingredients for the various recipes. At the end of the 24 h - recall, the respondent was asked whether food intake in the previous day was normal, whether any supplements or medication was consumed, and whether the infant or mother was sick or had low appetite for food.
Foods recorded in the 24 h - recall were tabulated into specific nutrients using Food Processor Plus® based on United States Department of Agriculture food composition tables. The LU Nutrition Department adapted these tables based on recipes that were typical to Mozambique. Food composition data from Brazil was also used in the absence of some foods in the Mozambican food composition table.
Nutrient consumption evaluation.
The following nutrients were selected to evaluate intake: total energy, carbohydrates, total fat, proteins, vitamin A, D, E, B1, B2, B6, B12, folate, iron, calcium, iodine, zinc, phosphorus and magnesium. Children and adults used the WHO recommendations to determine prevalence of inadequate caloric intake. A comparison was made to the recommended dietary intake of the various nutrients to determine adequate intake. Acceptable macronutrient distribution ranges from 20 – 35 % for protein, 45 – 65 % for carbohydrates and 10 – 35 % for total fat, were used to calculate the contribution of various nutrients to total energy. (8) To calculate inadequacy of micronutrient intake, estimated average requirement (EAR) was used as the cut-off point. (9)
Statistical analysis.
Data analyses used Statistical Package for the Social Sciences version 19.0®. Significance level was set at 5 %. Qualitative variables were represented as proportions and were compared using Chi-square and Fisher whenever applicable. To describe ingestion of various nutrients, median was used and percentile 25 (P25) and 75 (P75). To compare variations in ingestion of nutrients, T – Student test was used or Mann - Whitney test for non - parametric data.
3. Results and discussion.
Study population.
Study population and its characteristics can be seen on table I and II. We interviewed mainly pairs of infant and mother (95 %). The respondents were well distributed between the two districts with the households from Malema and Gurué being 317 and 295, respectively. Boys represented 47.7 %, 577 mothers participated in the study with 292 (50.6 %) and 285 (49.4 %) being from Malema and Gurué districts, respectively.
Over 70 % of both children parents had either never studied or did not complete primary school education, while less than 3 % had completed secondary education. The Mozambique Millennium Development Goals Report 2005 (MMDGR) cited low access to education among women as a challenge to improved child-wellbeing. (10) The 2008 - 2009 Kenya Demographic Health Survey found a direct correlation between mother education and compliance with minimum infant and young child feeding practices. The 2011 Mozambique Demographic and Health Survey (MDHS) found infant mortality to be highest among children born to mothers who have low level of education. Often, these deaths are due to under nutrition.
Families with more than one child aged less than 2 years were 21 %. Short child-birth interval increases chance of a child becoming undernourished. The Kenya National Bureau of Statistics in 2010 found an inverse relationship between the length of the preceding birth interval and the proportion of children who were stunted. Similar trends were reported in the MDHS.

Table I: study population.

Characteristics
Total
n (%)
Malema
n (%)
Gurué
n (%)
Nº of children
612 (94.2)
317 (51.8)
295 (48.2)
Sample distribution



Boys
291 (47.7)
154 (48.6)
137 (46.4)
Girls
321 (52.3)
163 (51.4)
158 (53.6)
Mothers
577 (88.8)
292 (50.6)
285 (49.4)
Missing / other care givers
35 (11.2)
-
-

Table II: parent’s education level.

Parents education level
Malema
Gurué
Father
n (%)
Mother
n (%)
Total
n (%)
Father
n (%)
Mother
n (%)
Total
n (%)
Never studied
44 (15.1)
57 (19.5)
101 (17.3)
52 (18.2)
74 (26.0)
126 (21.6)
Primary (Incomplete)
152 (52.1)
175 (59.9)
327 (56.0)
163 (57.2)
183 (64.2)
346 (60.8)
Primary (Complete)
45 (15.4)
29 (9.9)
74 (12.7)
27 (9.5)
12 (4.2)
39 (6.9)
Secondary (Incomplete)
37 (12.7)
26 (8.9)
63 (10.8)
35 (12.3)
13 (4.6)
48 (8.7)

Nutritional evaluation.

Table III shows infants and mother’s anthropometric data. Children born with low birth weight (< 2,500 g) were 115 (18.8 %); they face numerous challenges and may often not attain their full potential as adults. (11) A cohort of children born underweight followed by WHO for the first eight years of life concluded that these children had poor cognitive function, academic achievement, and behaviours at eight years. The existence of a population born underweight is not only a health concern but also affects this population’ social and economic achievements. (12)
About 30 % of children did not have child growth monitoring cards and did not provide the weight at birth. This is consistent with the findings of the MDHS reporting that 80 % of respondents had a child growth - monitoring card. Major reason for children not having a growth - monitoring card is that the child was born at home. While delivery care is critical for both mother and new-born, slow progress has been registered ensuring women get skilled health professionals delivery care. According to the MMDGR, skilled health personnel attended 48 % of deliveries in 2003 compared with 44 % in 1997. Reasons cited included lack of women’s decision-making power, perceptions of risk, traditional beliefs and practices, long distances and poor transport to a maternity.
Children participating in the study were less than two years of age. Chronic undernutrition attained 6 % while 14.8 % presented acute undernutrition (≥ -2 Z score). Prevalence of acute undernutrition registered in this study was slightly higher than that reported in the MDHS (6.4 -10.5 %). Trends in prevalence of chronic undernutrition observed in this study were lower than the rates reported in the same survey (27.6 - 48.1 %).
Most mothers (71.5 %) had a normal BMI, overweight was observed among 14 % and 12 % were underweight. The referred survey reported underweight levels of 9.8 %, overweight levels of 10.5 % and normal BMI among 79.7 % of rural women. Another study comparing data from 36 developing countries (Mozambique was not included) found that overweight exceeded underweight among women of reproductive age. (13) Underweight among women of reproductive age is a health concern as such women are at a high risk of having low birth weight children, (14) especially if adequate weight is not gained during pregnancy. (15) The MDHS found the mothers’ BMI has an inverse relationship with stunting; mothers who are thin (BMI < 18.5) had children with the highest stunting level (45 %). No anthropometric measurements for both mother and child were significantly different for the two districts (p < 0.05).

Table III: children and mothers’ anthropometric characteristics.

<
Anthropometric characteristics of children and mothers
Total
n (%)
Malema
n (%)
Gurué
n (%)
p

Birth weight < 2,500g
115 (18.8)
57 (18.0)
58 (19.7)
0.084*
Birth weight > 2,500g
330(53.9)