An assessment of the causes of malnutrition in Ethiopia: A ...

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clothing, housing, sanitation, protection from dangers, etc.) as well as their socio-emotional or psychological needs (Engle & Ricciuti 1995). 4.2.4.1. Definition of psychosocial care A substantial body of research indicates that children's early mental, motor, and social development is significantly influenced by variations in their early experiences. The following broadly defined qualities of early psychosocial care are considered particularly important, and have generally been found to be associated with positive developmental outcomes in children in a variety of cultural settings: • Responsiveness, sensitivity, and consistency in responding to the child's cues or needs, versus lack of responsiveness, insensitivity, and inconsistency (the extent to which the caregiver is aware of the infant's signals and needs, interprets them accurately, and responds to them promptly, appropriately, and consistently); • Warmth, affection, and acceptance, versus rejection and hostility (reflects balance of positive and negative feelings toward the infant, including accepting characteristics of the infant that might be seen as undesirable); • Involvement with the child, versus lack of involvement and detachment (reflects the degree to which the caregiver or parent cares about the infant's well-being on a dayto-day basis, takes appropriate actions on the infant's behalf, and spends time with the infant when possible); • Encouragement of autonomy, exploration, and learning, versus restrictiveness and interference (extent to which the caregiver provides opportunities for motor, mental, and social development, including independence and self-confidence, through appropriate activities and verbal and social interactions). All four dimensions are likely to be reflected in the extent to which caregiver and child engage in mutually rewarding, age-appropriate, reciprocal interactions. Also, cultural factors will influence the particular ways in which the characteristics of psychosocial care just outlined are expressed, as well as the extent to which particular child-care practices may be valued or discouraged, in light of their adaptive value in a given setting (Engle 1992b; LeVine 1977; Zeitlin et al. 1990). 4.2.4.2. Conceptual model The conceptual model (Figure 4.3) outlines the major pathways through which care may influence a child's growth and development. Psychosocial care and nutritional care are closely interconnected in routine caregiving of everyday life, and thus should be considered holistically. Moreover, the quality of care a child receives will reflect, and to a considerable extent be influenced by, the nature of the overall child-caregiver relationship, a unique pattern of behaviors that develops over time between a parent or caregiver and a particular child (see the box in the center of Figure 4.3). As indicated by the solid arrows, it is well known that the quality of psychosocial care has a direct influence on children's behavioral development (linguistic and cognitive development, growth of social skills, psychological adjustment, and adaptation, and development of motor skills). In addition, the nutritional and health care children receive has a direct effect on their nutrition status and physical growth (Engle & Ricciuti 1995). However, of particular interest is the hypothesis that the quality of psychosocial care may influence the child's nutrition status and growth indirectly, through its linkage with, and possible effect on, the quality of nutritional and health care. At the same time, as suggested by the dotted feedback arrows in Figure 4.3, a poorly nourished, less responsive infant may significantly affect a caregiver's behavior in regard to both psychosocial and nutritional care. Similarly, the child's developmental status and behavior may also influence the quality of care received in both the psychosocial and the nutritional areas. Finally, the model indicates that 88
Figure 4.3: Factors that affect the relationship of the caregiver and the child Support Systems Caregiver Characteristics Resource Constraints Child Characteristics Relationship of Caregiver and Child Psycho-social Care Physical, Health Nutritional Care Behavior & Developmental Status of Child Nutritional Status & Health of Child the child's behavioral development may be directly influenced by their health and nutritional status. Thus it is apparent that the relationships among care, nutrition, growth, and behavioral development may be viewed as interactive or bi-directional (Engle & Ricciuti 1995; Engle 1992a; Werner 1988). The development of a child is best represented by a series of feedback loops, with each change in the child influencing changes in the environment, and vice versa, in a continuous series of interactions. This pattern can be referred to as transactional. It is important to recognize that the nature of the caregiver-child relationship and the quality of psychosocial care or nutritional care that parents or other caregivers are able to provide for children are very much affected by several major sources of influence (Ruel & Arimond 2003). These are 1) the characteristics of the child (age, developmental level, gender, irritability); 2) the characteristics of the relationship between child and caregiver; 3) the characteristics of the caregiver (attitudes and beliefs about caregiving, motivation and physical energy, emotional state, sense of personal efficacy, physical and mental health); 4) the support system (nature of available informational and emotional support); and 5) resource constraints (adverse environmental conditions affecting disease prevention, limited disposable income and unstable food supply, excessive demands on caregiver's time for other tasks). 4.2.5. Nutritional care and HIV/AIDS Source: Engle &. Ricciuti 1995 HIV/AIDS could be considered an immediate cause of malnutrition. Its impact is far reaching and erodes all of the major components of nutritional security. The toll of HIV/AIDS in Sub-Saharan Africa is very high with over 22 million or two thirds of the world’s total population living with the disease. Infection rate in children due to transmission from parents is between 25 and 35 percent, and we know now that transmission can also occur through breastfeeding (EngenderHealth 2004). In Ethiopia, 4.6 million children under 17 years of age are estimated to be orphans, of whom 537,000 were orphaned due to HIV/AIDS (MOH 2004a). 89
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An assessment of the causes of maln
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• Bantirgu Hailemariam coordinate
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3.4. National and Regional Trends:
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LIST OF TABLES Table 2.1: Child stu
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LIST OF ACRONYMS ADLI AGOA AIDS BCC
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Figure 1.1: Stunting among children
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these underlying determinants of th
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experimental body of evidence that
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water can have significant impact o
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2.1. Introduction In the early 1960
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violating the basic tenets presente
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Table 2.3: Regional profile of stun
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A rich food through popularization
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key tenet in the process of identif
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Basic Causes Major Features High im
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commodity trading is the most signi
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Table 2.9: Gross primary enrollment
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following and in alliance with the
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• Accept that agricultural develo
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the other practices that need to be
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CHAPTER 3: FOOD SECURITY AND MALNUT
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Afar in 2000 was 12.6 percent and 5
Page 49 and 50: 3.1. Introduction The economic grow
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Page 61 and 62: viewed as a proxy for household foo
Page 63 and 64: Figure 3.3: Per capita food product
Page 65 and 66: Intermediate means of transport suc
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Page 73 and 74: due to inappropriate land mismanage
Page 75 and 76: 3.6.3.5. HIV/AIDS This disease is w
Page 77 and 78: coordinates the different implement
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Page 81 and 82: households who depend on purchased
Page 83 and 84: • Improve rural radio infrastruct
Page 85 and 86: 3.7.3.6. Improve rural market infra
Page 87 and 88: CHAPTER 4: CARE AND MALNUTRITION IN
Page 89 and 90: household allocation; 5) workload a
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Page 93 and 94: children between 6 and 24 months. T
Page 95 and 96: Care was recognized as one of the u
Page 97 and 98: Figure 4.1: Risk of death in infant
Page 99: Table 4.2: Present discount values
Page 103 and 104: Box 4.2: Reasons why PLWHA are vuln
Page 105 and 106: Figure 4.7: Risk of mother to child
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Page 109 and 110: Figure 4.8: The extended model of c
Page 111 and 112: 4.3.1.2. Recognizing symptoms of il
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Page 115 and 116: Figure 4.13: Prevalence of stunting
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Page 119 and 120: 4.3.3.4. Response to food security
Page 121 and 122: 4.3.6. Time and energy expenditure
Page 123 and 124: Table 4.3: Care focused initiatives
Page 125 and 126: together. This demands an integrate
Page 127 and 128: In an emergency, therefore, care an
Page 129 and 130: • Enhance women’s capacity for
Page 131 and 132: Table 4.4: Analysis of care conside
Page 133 and 134: Sector/ Office Strength Weakness Op
Page 135 and 136: International initiative Strengths
Page 137 and 138: • Rate of continued breastfeeding
Page 139 and 140: Figure 4.17: Community based nutrit
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Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
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Integrating nutrition interventions
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Although the coverage of ENA traini
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Box 5.1: Household and Community In
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The interventions that make up this
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conferences. To this effect, a nati
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with the engineering aspect of wate
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Table 5.1: Prevalence of diarrhea a
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Figure 5.3: Trends in latrine cover
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Institutional arrangements are also
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ehavior are integrated and supplied
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5.4.2. Programs and projects 5.4.2.
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made by NGOs for the affected child
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CHAPTER 6: INSTITUTIONAL FRAMEWORK
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interventions in Ethiopia, includin
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6.2. Challenges and Lessons Learnt
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Training Post-secondary training is
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Table 6.6: (continued) Agency Inter
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Achievements Challenges Sustainabil
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Berhane G. 1995. Nutrition surveill
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Ethiopian PROFILES Team & AED/Linka
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Middlebrook, P. 2002. Social protec
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Raisin, J. 2001b. Improving food se
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Yamano, T., H. Alderman, & L. Chris
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