António Bélio is a Nutrition Supervisor, responsible for Nutrition at Sofala Provincial Health Directorate (DPS). 

“We need participatory and engaging development of an emergency response plan, as well as resource mobilization before the disaster.”

01. What is the current situation about Pellagra and malnutrition (chronic and acute) in Sofala Province?

More than 1,800 cumulative cases of acute, moderate and severe malnutrition were reported in the most affected districts (Beira, Buzi, Nhamatanda and Dondo) by Cyclone Idai dated from mid-April to early July. The percentage of children with acute and severe malnutrition increased considerably in the district of Buzi from June to July. 

For Pellagra, as of 22 July 2019, 212 in Nhamatanda, 73 in Buzi and 2 cases in Dondo were notified through Early Warning Alert Response System (EWARS).

After report of the first case at Ndeja Health Center in Nhamatanda, we deployed a team to the field. It was found that most of those affected are female, children under 5 and adolescents. They showed typical lesions to the area exposed to the sun (usually face, arms and neck).

According to the initial survey conducted in Nhamatanda, food shortages and unequal distribution of food among family members are the potential causes of Pellagra. 

02. What are the biggest challenges in nutrition activities at the government level?

Major challenge in Sofala Province is social and behavioral change in communities. Despite access to the abundant nutrition and vitamin rich foods, people either have limited knowledge on preparing meals or sell the entire food products, which leave them with malnutrition.

The other challenges are multi-sectoral interventions for malnutrition response at district level and industrialization, which is the primary cause of losing farms.

There are also people in remote areas. In order to tackle this challenge, we are relying on mobile brigades to reach out further and working closely with communities to involve people in their own health and care. This is to ensure access to health services and share knowledge on preparing healthy meals with nutritious local foods. Community members like Elementary Multipurpose Agents (APEs), Mother Groups for Mothers and Traditional Medicine Practitioners are helping together.

03. What are the lessons learned and good practices regarding malnutrition response in the post-emergency?

Coordinating activities matters. Cooperation can bring synergy among Government institutions and nutrition partners by sharing experiences from different contexts and resources. It also helps to avoid duplicate efforts in certain areas.

Distribution of food kits, ensuring food stock at health facilities, community engagement at all stages of response and delivering key messages through radio are some of the lessons learned. 

But, the biggest takeaway of all is that we must be prepared prior to the emergency. We need participatory and engaging development of an emergency response plan as well as resource mobilization before the disaster. 

A good practice we can share with you is the deployment of teams to accommodation centers and resettlement areas. It has facilitated provision of health services to the people in need and improved identification and early treatment of diseases. This has also allowed us to block the circulations of viruses. 

04. How does DPS contribute to better nutrition and health for all?

In 2018, DPS introduced Community Nutrition Rehabilitation Program sending nutrition technicians to the communities for screening and treatment of malnutrition in children. This effort has been supported and reinforced by many health actors; Mother-to Mother Groups, Community Health Workers (APEs) and Health and Humanization Committees to name a few through cooking demonstrations and nutrition education sessions.

In the most affected districts by Cyclone Idai, people received seeds solely for their consumption, not for sales. Also, preventive interventions have been carried out in schools, which provide girls with ferrous salt, Vitamin A supplementation and deworming. 

For Pellagra prevention, we focus on encouraging community engagement through video projection sessions and promoting debates on malnutrition. Plays, songs and dances are also among effective ways to reach out to the people and deliver messages. Thanks to the support by local journalists from the Community Radios. 

05. How do you see WHO’s contribution to Pellagra prevention and control?

WHO has been supporting DPS in many ways for Cyclone Idai response. They have been providing technical and financial support for training on early diagnosis and treatment for Pellagra, which is essential for the health professionals. The training focuses on information management and communication strategy for Pellagra.  Thanks to WHO, Pellagra cases tend to be reduced. 

It cannot be emphasized enough that we are truly satisfied with the help from WHO, especially in formation of community focal points for epidemiological surveillance in most affected districts by Cyclone Idai.