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

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Figure 4.4: Breastfeeding as a package of care addressing the three underlying causes of malnutrition Child growth, development and survival Food and Nutrition Security Care Health Care and Hygiene BREAST- FEEDING As shown in the framework presented in Figure 4.4, hitherto breastfeeding has been regarded as an act that fulfills all three underlying conditions of nutritional security —food, health, and care. It is estimated that 14 percent of HIV/AIDS infections occur through breastfeeding, and this tends to paralyze the promotion, protection, and support of breastfeeding. Thus HIV has a crippling impact on caring practices, caring capacity, household food security and provision of basic services including health services—all essential practices for nutritional security. Studies have shown a close association between compromised nutrition status and HIV/AIDS (Gillespie et al. 2001). HIV/AIDS and poverty (a large part of which relates to food insecurity) interact in a vicious cycle. Poverty increases the exposure to, as well as the impact of HIV. Poverty also increases the radius of impact of HIV on family and friends for the poor, informal coping mechanisms that are more dependent on family and friends and less so on insurance companies and the state (EngenderHealth 2004). HIV/AIDS in turn strips assets and exposes families to poverty and poor caring practices. The mother has invariably been regarded as the primary caregiver, but this is not the case anymore as more and more children lose their mothers to HIV/AIDS. It is common to find young children taking care of their younger siblings. These children are themselves in need of care and often lack the skills to provide adequate care for their siblings. Due to HIV/AIDS, adult members of the family cannot engage in productive action. Those still healthy members may have to focus their attention on the sick, which includes use of limited household resources to provide medical care (Jonsson 1995; Gillespie et al. 2001). 4.2.5.1. Nutritional care for people living with HIV/AIDS Owing to a frequent illness due to opportunistic infections, nutrient requirements of people living with HIV/AIDS are higher. No single food contains all the nutrients that our bodies need, except for breast milk for babies up to the age of six months. Eating a variety of different foods will supply the nutrients that are essential for our bodies. By carefully choosing foods that are in season and locally available, eating can be enjoyable, healthy, and affordable. 90
Box 4.2: Reasons why PLWHA are vulnerable to nutritional insecurity Increased requirement of nutrients because: • The body's defense system - the immune system - works harder to fight infection and stress due to free radicals and hence needs adequate supply of free radical scavengers (micronutrients) to cope with the situation • This increases energy and other nutrient requirements. Further infection and fever also increase the body's demand for food. • Once people are infected with HIV they have to eat more to meet these extra energy and other nutrient needs. • Such needs will increase even further as the HIV/AIDS symptoms develop and this will lead to rapid progression to AIDS and early death (Figure 4.5 shows the vicious cycle between HIV/AIDS and malnutrition). • 10 percent increase in energy requirement during asymptomatic infection • 20-30 percent increase during secondary infections • 50-100 percent increase for children (WHO 2003) Decreased intake of nutrients because: • The illness and the medicines taken for it may reduce the appetite, modify the taste of food and prevent the body from absorbing it; • Symptoms such as a sore mouth, nausea and vomiting make it difficult to eat; • Tiredness, isolation and depression reduce the appetite and the willingness to make an effort to prepare food and eat regularly; • There is not enough money to buy food (Food insecurity/loss of livelihoods) • One of the consequences of HIV and other infections is that since the gut wall is damaged, food does not pass through properly and is consequently not absorbed. • When a person has diarrhea, the food passes through the gut so quickly that it is not properly digested and fewer nutrients are absorbed. • Metabolic changes • Cytokine-related changes affect appetite. • Impaired transport, storage, utilization of some nutrients (e.g. protein). • Increased utilization of antioxidant vitamins and enzymes, resulting in oxidative stress. As shown in Box 4.2, when infected with the HIV virus, the body will be challenged with two problems: increased requirement and decreased intake of nutrients. Therefore, people living with HIV/AIDS (PLWHA) are very vulnerable to nutrition insecurity due to both biological and social reasons. Nutritional care of PLWHA helps to Figure 4.5: The vicious cycle of HIV/AIDS and malnutrition • Increased HIV replication • Hastened disease progression • Increased morbidity • Insufficient dietary intake; malabsorption • Diarrhea • Altered metabolism & nutrient storage • Increased oxidative stress • Immune suppression • Nutritional deficiencies Source: Adapted from Semba & Tang 1999 91
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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
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3.1. Introduction The economic grow
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Page 87 and 88: CHAPTER 4: CARE AND MALNUTRITION IN
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Page 97 and 98: Figure 4.1: Risk of death in infant
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Page 119 and 120: 4.3.3.4. Response to food security
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Page 125 and 126: together. This demands an integrate
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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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