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

arely provide this kind of benefit. In addition, most community-based pre-school programs
were found to be more cost-effective than formal day care (Engle & Ricciuti 1995).
Interventions to enhance child-caregiver interactions
A more efficient strategy for improving outcomes for children is to modify the nature
of the child-caregiver interaction. Two main strategies have been used: home visiting
programs, in which a trained educator (often a paraprofessional) visits the caregiver on a
regular basis and provides modeling, materials, and instruction about psychosocial care of the
young child (Myers 1992); and preschool programs, in which mothers or caregivers take a
more active role either by sharing the teaching role with other parents, planning, and making
decisions about the center, or by becoming involved in parent education programs with the
center by taking turns with the other parents (Bashizi 1979; Grantham-McGregor et al. 1987).
During home visiting, an attempt should be made to build on the existing experiences
of caregivers rather than acting as an expert. It works best when the program is combined
with group meetings, involves all family members, focuses on concrete problems and actions,
and when solutions are worked out jointly (Myers 1992).
Home visiting programs have been found to be effective in increasing children's
cognitive development even in having long-term effects on children's nutrition status, as
previously noted (Grantham-McGregor et al. 1994; Slaughter 1984). Home visiting programs
can address feeding as well as non-feeding behaviors, reinforce positive indigenous
caregiving behaviors, and model positive interactions with the infant and toddler. One of the
benefits of the home visitor approach is that the caregiver has the opportunity to observe
someone else interacting with her child, and can develop skills by observation, a valid way of
learning in most parts of the world.
Interventions to enhance the caregiver's resources
Targeting the caregiver can lead to different types of interventions. As mothers may
be depressed or physically ill, an intervention could involve support groups for women, skill
training, health improvement, or self-esteem building. If the primary caregivers are siblings,
approaches that target their needs can be developed. A study in the United States found that
enrolling poor black women in support groups was equally or more effective for changing
children's cognitive levels as specific skill-training in a home visiting program (Seitz & Apfel
1994).
Increasing parental resources can have long-term effects. A program, which provided
resources like medical care, day care, and a home visitor who offered, “psychological, and
social services” to a small sample of high-risk mothers showed significant differences in the
children when they entered school. These effects apparently carried over to the next youngest
sibling when she or he entered school (Aarons & Hawes 1979).
Within the households, low knowledge and wrong beliefs of the caregiver or families
about child feeding and rearing may be one of the issues to be addressed. However, it is
essential to build on existing beliefs, rather than present a new set of “correct” beliefs, thereby
undermining caregivers’ confidence in their existing methods (Myers 1992).
Increasing social support in family and community
The joint UNICEF/JNSP project located in Iringa, Tanzania, reduced the incidence of
severe and moderate malnutrition in 168 villages, compared with control villages. This was
accomplished over four years through a combination of improvements in health care, water
and sanitation, agricultural development, and child care and development. One of the
interventions was the establishment of community-level day-care projects to provide frequent
and regular feeding of children. Rather than supplying them with supplementary foods,
mothers were taught how to use existing foods to meet children's nutrient needs (Werner
1988). Community-based program can include support groups for mothers, credit- and
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