Dissertations and Theses @ UNI


Thesis (UNI Access Only)


Health promotion--Mozambique; Volunteer workers in community health services--Mozambique; Nutrition--Study and teaching--Mozambique;


Undernutrition is one of the world’s most important public health problems, contributing to most of the under-5 child deaths globally. Despite the global efforts to reduce malnutrition, the progress in Sub-Saharan Africa remains insufficient and, at current progress, many of the Millennium Development Goal (MDG) objectives, especially those related to maternal and child mortality may not be achieved until 2165 in this region. This challenge has triggered the interest for community-based preventive interventions that allow high coverage and reduce shortage of human resources. As a result, many countries have witnessed remarkable global efforts and impressive shortterm impacts from community-based nutrition initiatives. However, less is known about the long-term impact of these initiatives. This study shares evidence of long-term impact of community-based nutrition education and low-cost behavior-change interventions from Sofala province of Mozambique.

A United State Agency for International Development (USAID) funded child survival project was implemented from 2005 to 2010 in central Mozambique where households with pregnant women and children under 2 years old were organized into blocks of 12 households and taught by one volunteer peer educator, also called a cascade group volunteer (CGV). About 8-12 CGVs met together as a group every two weeks with a trained promoter to learn nutrition message or skills. These CGVs then shared the nutrition message with mothers in their neighborhood or assigned blocks.

A household survey was conducted with 506 mothers with children under the age of five to measure the long-term impact (five years after the end of grant program) of the cascading health promotion model related to knowledge, behaviors, practice, and childhood nutritional status.

Of the mothers interviewed, 65.7% reported that they had been contacted by CGVs during the previous two weeks. Two-thirds (66.6%) said they still get nutrition and health advice from CGVs whereas 63.6% said they see CGVs as a general source of health information. Moreover, 15.8% of children 0–23 months were undernourished (weight-for-age with z-score of less than -2 standard deviations). This is 10. 1 and 4.7 percentage-points decline from the 2005 and 2010 data, respectively. About one-third, or 34.6% of under-five children were stunted.

The evidence for the long-term impact of using a cascading health promotion approach is compelling. Nevertheless, additional investments are required to integrate the CGVs into the existing health system, and to equip health systems to mobilize communities and to train them on a regular basis.

Year of Submission


Degree Name

Master of Arts


School of Health, Physical Education, and Leisure Services

First Advisor

Disa Cornish, Chair

Date Original


Object Description

1 PDF file (ix, 123 pages)



File Format


Off-Campus Download