Knowledge can prevent infant and child mortality

Mozambican mothers have been encouraged to familiarise themselves with a book outlining measures to reduce health risks for their children, but the challenges of a life of poverty make it difficult for many to adhere to the most basic guidelines. In an attempt to empower mothers, the Portuguese version of the third edition of 'Facts for Life', known in Portuguese as 'Saude e Vida', was recently launched in Mozambique. It is co-published by the UN Children's Fund (UNICEF) and a number of other UN agencies. Some 50,000 copies are being distributed through various government ministries and the National AIDS Council to health workers, teachers, school health and community workers, community-based organisations and journalists. "UNICEF appeals to all communicators to join in the common cause and help forward the life- saving information contained in Facts for Life to parents and other caregivers. They have the right to know how they can help their children survive and develop to their full potential. We know that the level of knowledge and education, especially of the mother, has a crucial impact on the survival chances of their children," said UNICEF Representative in Mozambique, Marie-Pierre Poirier. According to the Demographic and Health Survey (DHS) of 2003, children of mothers with no education are 130 percent more likely to die before age five than children whose mothers attended secondary education. IRIN interviewed six mothers selling nuts at a fish market in the capital, Maputo, and found that three of them had lost at least one baby under the age of five. Each of them only had a few years of primary education. According to national statistics, out of 715,000 children born each year, 130,000 children will die before their fifth birthday, mostly due to preventable diseases. "I've lost lots of children," said Angelica Siwea, who, nine months into her pregnancy, was still rushing around the market trying to earn a little money. She told IRIN she had had seven pregnancies including this one, had miscarried once and lost two of her babies before they were one month old. Siwea said she did not understand why her babies died. "I gave birth at home and by the time I got to the hospital my baby had died. The second one was born sick - I suffered with her for one month before she was taken away," she said. All the women interviewed were keen to hear about the book, and three of them knew what it was - but selling their produce was uppermost on their minds. The women, two of them heavily pregnant, chased after potential customers, offering them a handful of peanuts for 12,000 Meticais (US 0.50) or cashew nuts for 20,000 Meticais (just under US $1). Mothers like Siwea may have been able to prevent the deaths of their babies had they been able to access information about proper prenatal and postnatal care. Facts for Life provides caregivers with information on how to prevent some of the main child killers, such as malaria, acute respiratory infections, diarrhoea and measles. Malnutrition is the underlying cause in about half of all cases of child mortality. In Mozambique, 41 percent of children under five are chronically malnourished. HIV/AIDS is now another major threat - it is estimated to have caused 12 percent of all child deaths in 2003. While the book recommends the use of mosquito nets treated with insecticides to prevent malaria, in 2003 only 10 percent of all children under five in Mozambique were sleeping under bed nets. None of the mothers or children IRIN interviewed in the market used treated nets, and all said they suffered regularly from malaria. The book also explains that good hygienic practices and clean water prevent diarrhoea, yet only 36 percent of the population has access to safe drinking water and only 45 percent have access to adequate sanitation facilities. The mothers IRIN spoke to were knowledgeable about treating diarrhoea. Siwea, who said she had read some parts of Facts for Life at a local health centre, said: "If my child has diarrhoea, I know I must give him plenty of water, and if it doesn't stop I must take him to hospital for treatment." The book also gives information about immunisations during the first year of life. Although the immunisation coverage for one-year-old children has improved considerably in Mozambique, it is still low. In 2003, 63 percent of one-year-old children were fully immunised against diphtheria, whooping cough, tetanus, tuberculosis, polio and measles, compared to 47 percent in 1997. Maternal mortality is still very high at 408 women per 100,000 pregnancies. One of the main causes is that only 48 percent of births are attended by skilled health personnel. Some 34 percent of women have their first baby before turning 20 years. The third edition of Facts for Life includes new chapters on HIV/AIDS, emergencies and accidents.