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

More documents

Recommendations

Info

Figure 4.6: Virtuous cycle of nutritional care and HIV/AIDS Eating well; Good appetite Good nutrition; Maintain body weight Slower HIV/AIDS disease progression; Reduced sickness Stronger immunity and resistance to infection maintain body weight and strength and enhances response to anti-retroviral therapy or treatment of opportunistic infections. It changes the vicious cycle of malnutrition and HIV/AIDS (Figure 4.5) to a virtuous cycle (Figure 4.6). Good nutritional care promotes health and delays the progression of HIV infection to full-blown AIDS in people living with HIV/AIDS (PLWHA), prolonging life and increasing productivity. This has a far-reaching implication related to household-level caring for the vulnerable groups and overall household food security by preventing untimely death of adult breadwinners and enabling the transfer of caring and livelihood skills among household members. Good nutritional care for PLWHA aims at ensuring adequate dietary intake, preventing food-borne & water-borne illnesses and reducing mother to child transmission (MTCT) of HIV by improving nutritional (and health) status, enhancing quality of life, and prolonging survival. Therefore, nutritional care should be part of the overall care and support program of HIV/AIDS. 4.2.5.2. Nutritional care and prevention of mother to child transmission (PMTCT) The emergence of HIV/AIDS and the recognition of the risk of its transmission from mother to child via breast milk have hampered breastfeeding promotion. In developing countries like Ethiopia, regardless of the risk, breast milk cannot be avoided due to the reason that children will be dying from diarrheal attacks should they not feed at their mother’s breast. There were 128,000 HIV positive pregnancies in 2003 in Ethiopia (MOH 2004a). Therefore, this issue needs consideration in the development of a national nutrition strategy. As shown in Figure 4.7, overall, the risk of MTCT (during pregnancy, delivery, and lactation) is 37 percent and the risk of MTCT during breastfeeding is 10-20 percent, if the child is breastfed for 24 months. However, there are maternal and fetal conditions that may increase this risk of transmission. Maternal conditions include breast problems (mastitis, cracked nipple, and abscess), malnutrition, high viral load, low CD4 count, new infection during breastfeeding, and advanced AIDS. The conditions of the baby that increase the MTCT include premature 92
Figure 4.7: Risk of mother to child transmission of HIV. uninfected infected during breastfeeding for 2 yrs infected during delivery infants infected during pregnancy 0 10 20 30 40 50 60 70 Risk of infection (%) Source: Piwoz et al. 2002. birth, sores in the mouth and in the gastro-intestinal tract, age of the child (first months are higher risk), mixed feeding (feeding infants with breast milk in addition to other solids and liquids), infant’s immune response, and the duration of breastfeeding. Maternal nutritional care during breastfeeding is therefore highly important to prevent MTCT and to facilitate adequate nutrient transfer to the baby. Considering the risks attached to not breastfeeding, WHO and UNICEF recommend the feeding options for babies of HIV positive mothers shown in Box 4.3. When replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS), avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life. To minimize HIV transmission risk, breastfeeding should be discontinued as soon as is feasible, taking into account local circumstances, the individual woman’s situation and the risks of replacement feeding, including infections other than HIV and malnutrition (Guyon & Quinn 2004). The WHO/UNICEF/UNAIDS Framework for HIV and infant feeding presents five priority actions to ensure that infants of HIV+ mothers receive proper nutritional care: • Develop a comprehensive Infant & Young Child Feeding (IYCF) strategy. • Implementation of the Code for Marketing Breast Milk substitutes. • Promote, protect, and support YCF in context of HIV. Coordination, capacity building, and support for the Baby Friendly Hospital Initiative (BFHI). • Support for enabling HIV+ women to make informed choices. • Monitoring, evaluation, and operations research. 4.2.6. Effect of care on the immediate determinants of malnutrition Care reduces the level of malnutrition by preventing the occurrence of infectious Box 4.3: Feeding options currently recommended by WHO/UNICEF (2003) Breast milk based feeding • Exclusive breastfeeding. • Early cessation of breastfeeding (as soon as AFASS is feasible). • Expressed, heat-treated breast milk. • Wet-nursing. • Milk banks Replacement feeding • Commercial infant formula. • Home prepared infant formula (modified, with additional nutrients). • Enriched family diet with breast milk substitute and micronutrient supplements after 6 months. 93
Page 1:
An assessment of the causes of maln
Page 4 and 5:
• Bantirgu Hailemariam coordinate
Page 6 and 7:
3.4. National and Regional Trends:
Page 8 and 9:
LIST OF TABLES Table 2.1: Child stu
Page 10:
LIST OF ACRONYMS ADLI AGOA AIDS BCC
Page 14 and 15:
Figure 1.1: Stunting among children
Page 16 and 17:
these underlying determinants of th
Page 18 and 19:
experimental body of evidence that
Page 20 and 21:
water can have significant impact o
Page 22 and 23:
2.1. Introduction In the early 1960
Page 24 and 25:
violating the basic tenets presente
Page 26 and 27:
Table 2.3: Regional profile of stun
Page 28 and 29:
A rich food through popularization
Page 30 and 31:
key tenet in the process of identif
Page 32 and 33:
Basic Causes Major Features High im
Page 34 and 35:
commodity trading is the most signi
Page 36 and 37:
Table 2.9: Gross primary enrollment
Page 38 and 39:
following and in alliance with the
Page 40 and 41:
• Accept that agricultural develo
Page 42 and 43:
the other practices that need to be
Page 45 and 46:
CHAPTER 3: FOOD SECURITY AND MALNUT
Page 47 and 48:
Afar in 2000 was 12.6 percent and 5
Page 49 and 50:
3.1. Introduction The economic grow
Page 51 and 52:
In a more technical way, it is diff
Page 53 and 54: differently, it is important to acc
Page 55 and 56: households will not be as difficult
Page 57 and 58: the drought prone areas, the rain f
Page 59 and 60: insecure, these activities will als
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
Page 67 and 68: educated, environmentally conscious
Page 69 and 70: 1995-96 revealed that ‘the greate
Page 71 and 72: works are key instruments to lay do
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
Page 79 and 80: conception through early pregnancy
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
Page 91 and 92: lack of national nutrition strategy
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 and 100: Table 4.2: Present discount values
Page 101 and 102: Figure 4.3: Factors that affect the
Page 103: Box 4.2: Reasons why PLWHA are vuln
Page 107 and 108: arely provide this kind of benefit.
Page 109 and 110: Figure 4.8: The extended model of c
Page 111 and 112: 4.3.1.2. Recognizing symptoms of il
Page 113 and 114: the direction of the growth curve i
Page 115 and 116: Figure 4.13: Prevalence of stunting
Page 117 and 118: from poor exposure of children to l
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
Page 141: There is a strong need for enhancin
Page 144 and 145: supplies. The available facilities
Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
Page 148 and 149: access to a basic package of qualit
Page 150 and 151: Integrating nutrition interventions
Page 152 and 153: Although the coverage of ENA traini
Page 154 and 155:
Box 5.1: Household and Community In
Page 156 and 157:
The interventions that make up this
Page 158 and 159:
conferences. To this effect, a nati
Page 160 and 161:
with the engineering aspect of wate
Page 162 and 163:
Table 5.1: Prevalence of diarrhea a
Page 164 and 165:
Figure 5.3: Trends in latrine cover
Page 166 and 167:
Institutional arrangements are also
Page 168 and 169:
ehavior are integrated and supplied
Page 170 and 171:
5.4.2. Programs and projects 5.4.2.
Page 172 and 173:
made by NGOs for the affected child
Page 175 and 176:
CHAPTER 6: INSTITUTIONAL FRAMEWORK
Page 177 and 178:
interventions in Ethiopia, includin
Page 179 and 180:
6.2. Challenges and Lessons Learnt
Page 181 and 182:
Training Post-secondary training is
Page 183 and 184:
Table 6.6: (continued) Agency Inter
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Achievements Challenges Sustainabil
Page 205 and 206:
Berhane G. 1995. Nutrition surveill
Page 207 and 208:
Ethiopian PROFILES Team & AED/Linka
Page 209 and 210:
Middlebrook, P. 2002. Social protec
Page 211 and 212:
Raisin, J. 2001b. Improving food se
Page 213:
Yamano, T., H. Alderman, & L. Chris
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?