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

diseases and nutritional deficiency. Caring practices like optimal breastfeeding, optimal
complementary feeding, and psychosocial care are proven to improve and promote child
health, growth, and survival. Personal hygiene like hand washing, keeping the hygiene of the
baby, food and drink, and utensils reduces the occurrence of infectious diseases. By
exclusively breastfeeding for the first six months, both child malnutrition and illness can be
avoided (Guyon & Quinn 2004). Getting children immunized is an important healthcare
seeking behavior that has strong bearing on nutrition. When these caring practices are not in
place, there will be frequent illness and the requirement for nutrients increase (Gillespie &
Haddad 2003; Ruel & Arimond 2003). On the other hand, food intake decreases during illness
due to anorexia and to an endogenous loss of nutrients to fight the infectious process, leading
to malnutrition. This malnutrition depresses immunity, leading to other illnesses. The result is
that children will fail to achieve their genetic potential in terms of both physical growth and
cognitive development.
There should also be sensitive nutritional and psychosocial care for sick children both
during the time of illness and at least for two weeks after recovery. During illness, fluid intake
should be increased including more frequent breastfeeding, and encouraging the child to eat
soft, varied, appetizing, and favorite foods. After their illness has passed, more food should be
given than usual and the child/sick person should be encouraged to eat more (Guyon & Quinn
2004).
4.2.7. Who gives the care within the household?
Mothers are primary caregivers within the household particularly during the first year
of life. However, every member of the household can contribute to the caring practice
afterwards. This will give the mother more time and improve caring practices. In Ethiopia,
caring is considered solely the job of the mother. In most parts of Ethiopia the most
commonly identified barriers associated with providing effective childrearing were the high
workload of mothers, the lack of help available to mothers, children’s illnesses, and accidents
in the home (Yared 2003).
The best person to look after an infant who needs to be breastfed is the mother. If the
mother is away for a long time, she cannot breastfeed, unless she has expressed milk before
leaving. If we want to try to improve exclusive breastfeeding rates and decrease the amount of
inappropriate feeding practices, we need to find ways to keep poorer women at home for
longer post-partum (van Esterik 1995). Older children (6-24 months) also need to be minded
by someone. At this age, children should be receiving both complementary foods and breast
milk.
4.2.7.1. Ways of enhancing the quality of care provided by mothers
Three factors significantly influence the quality of psychosocial care: the
characteristics of the caregiver, the support system for the caregiver, and resource constraints.
There are four intervention approaches: working directly with the child, improving the
caregiver-child relationship, increasing the resources available to the caregiver, and altering
the social support available for the caregiving system (Myers 1992).
Child-centered interventions
Interventions with children alone (not caregivers) have often been successful but
expensive. These programs often focus on cognitive development as an outcome. Strategies
include intensive intervention in hospital or rehabilitation settings to increase the health or
nutrition status of children in order to improve psychosocial functioning. Programs combine
health, nutrition, and psychosocial stimulation (Zeskind & Ramey 1979; Pollitt et al. 1993;
McKay et al. 1978).
Although model child-care programs appear to have beneficial effects on overall
development, institutional day care (not community-based programs) in developing countries
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