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

The extended care model can be adapted to include the relationship between child and
caregiver(s), as shown in Figure 4.8. This figure expands the central part of the model relating
care, nutrient intake, health, child growth, and child cognitive development. The arrows
illustrate the various ways in which the affective relationship between caregiver and child,
and the resulting care behaviors, can influence the child’s growth, cognitive and psychosocial
development, dietary intake, and health status, and how child growth and development may
influence care and the relationship (Engle et al 1999).
4.3. Dimensions of Care as a Significant Determinant of the Nutritional Status of
4.3.1. Knowledge of the caregiver
the Young Child in Ethiopia
Knowledge of the caregiver about the importance of care for the growth and
development of the child is an important resource for the level of care to be provided.
Education, knowledge, and beliefs represent the capacity of the caregiver to provide
appropriate care (Gillespie & Haddad 2003). A study in northern Ethiopia showed that
children whose mothers attended school are less likely to be malnourished than the children of
uneducated mothers (Save the Children Fund (UK) 2002). Another study in Jimma showed
that health care service utilization showed an increasing trend with educational status of
caregivers (Fasil et al. 2000). Educated mothers are more likely to understand the benefits of
vaccinating their children, and are more likely to make the effort to get their children
vaccinated. They are also in a better position to know the causes of diarrhea, the advantages
of good hygiene and are more likely to prioritize soap use than are uneducated mothers (Engle
1992b). It was also indicated that stunted children in Ethiopia have less educated caregivers
(Woldemariam & Timotiwos 2002).
The importance of promoting female education (enrolment rate) and making
appropriate information on child caring practices part of the syllabus improves the way future
generations of children are cared for. Increasing the knowledge of mothers and other
caregivers on child caring practices, especially breastfeeding, complementary feeding
practices, and the prevention and treatment of diarrhea, should be given priority
(Christiaensen & Alderman 2004).
4.3.1.1. Health seeking behavior
Considering that the potential health service coverage (PHSC) of Ethiopia is very low
(64 percent), the importance of healthcare seeking behavior cannot be overemphasized. A
caregiver’s participation in the promotive, preventive, and therapeutic healthcare is highly
essential. Participation of caregivers in preventive health care (immunization, family
planning, growth monitoring, antenatal and postnatal care, deworming) and therapeutic
supplemental feeding programs are critical aspects of care that have implications on child
malnutrition and survival.
Utilization of all preventive health care services is very low in Ethiopia indicating
low health seeking behavior (MOH 2003/2004). Although generally, utilization of health care
services for therapeutic care seems better, studies show that it is still low. A study on health
care seeking behaviors of caregivers in Jimma showed that only 45 percent of caregivers
sought therapeutic care for their children at health institutions for illnesses like diarrhea,
cough, and fever. More than a quarter of ill infants did not seek any healthcare, be it at home
or at traditional or health institutions (Christiaensen & Alderman 2004). A significantly high
risk of stunting for children was observed among children whose mothers had no prenatal
visits (Save the Children Fund (UK) 2002). Mothers who had better health seeking behavior
are likely to take appropriate actions to improve the health status of their children, which is
also an important component of child nutrition.
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