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

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Figure 4.9: The Triple-A cycle. ACTION based on the Analysis and Available Resources ASSESSMENT of the Situation of Children and Women ANALYSIS of the Cause of the Problem was developed in 2004 and yet institutional arrangements for its implementation are not fully in place. There are insufficient resources, no supplies, and no responsible persons to carry out these nutrition care activities. 4.3.2.3. Growth monitoring and promotion (GMP) Source: UNICEF: 1990 Growth monitoring refers to the regular assessment of growth performance in children in order to apply appropriate interventions based on the analysis of the cause and on available resources. The triple-A cycle of assessment-analysis-action can be used to do this (Figure 4.9). Assessment involves weighing children on a regular basis and determining where they are categorized as compared to a reference standard for their age and sex. In doing so, Figure 4.10: Model of the stages of behavior change Source: AED/Linkages 2004. 100
the direction of the growth curve is determined. Analyze involves analysis of the cause of growth faltering or good growth performance of a particular child through two-way discussion with the caregiver. Action involves counseling the mother or caregiver and finding out feasible solutions together. The actions may involve behavior change communications using different strategies. Ideally, these actions are taken by the caregiver and the household. At the community level, woman’s support groups could be organized through home visiting programs (Pollitt et al. 1993; Slaughter 1984; Seitz & Apfel 1994) by the health worker or by the health extension worker (facilitators). Positive deviance mothers could be used as mobilizers in improving child care practices for better growth performance. After some time the child is weighed again and reassessment is made followed by a new analysis and a new action as necessary (Gillespie & Haddad 2003). For behavior change communication to be effective at least two contacts are required between the caregiver and the care provider. Figure 4.10 illustrates the stages of behavior change (AED/Linkages 2004). On the different contacts, specific interventions need to be done based on the needs of the caregivers and focusing on small doable actions. The sorts of appropriate interventions needed at each step are shown in Error! Reference source not found.. The most important issue in growth monitoring is not the position of the child on the growth curve, but the direction their growth is following. In the Ethiopian healthcare system, growth monitoring and promotion activities are not done based on the triple -A process and behavior change communications are not adequate. Growth monitoring and promotion should identify children who are severely malnourished and in need of medical care. There are very few places in Ethiopia where severely malnourished children can be rehabilitated (CSA 1992). Currently, growth monitoring is being given such little attention that it is no longer listed as one of the preventive activities reported on the national health indicator (MOH 2003/2004). This is because there is no person or party accountable for nutrition promotion in the healthcare delivery system at the woreda or zonal level. Resources are not adequately allocated for the activity. There is insufficient monitoring and evaluation. This substantial gap clearly indicates the low level of attention given to the application of the triple-A cycle in child growth monitoring and to caring practices in general. Results of the 2000 Ethiopia DHS indicate that there is a rapid deterioration in the growth performance of infants and young children during the early ages of their life— indicating an absence of good caring practices. The first 24 months are vulnerable periods in the life of children, often resulting in the deterioration of the nutritional status of infants and young children (Figure 4.11). During the first 24 months, breastfeeding contributes significantly to the nutrient requirements of infants and young children. Therefore, this high rate of malnutrition can be addressed through proper caring practices, which include optimal breastfeeding and optimal complementary feeding (Guyon & Quinn 2004). 101
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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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In a more technical way, it is diff
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differently, it is important to acc
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households will not be as difficult
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the drought prone areas, the rain f
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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
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Page 75 and 76: 3.6.3.5. HIV/AIDS This disease is w
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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
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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 and 104: Box 4.2: Reasons why PLWHA are vuln
Page 105 and 106: Figure 4.7: Risk of mother to child
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Page 109 and 110: Figure 4.8: The extended model of c
Page 111: 4.3.1.2. Recognizing symptoms of il
Page 115 and 116: Figure 4.13: Prevalence of stunting
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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
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Page 144 and 145: supplies. The available facilities
Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
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Page 150 and 151: Integrating nutrition interventions
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Page 154 and 155: Box 5.1: Household and Community In
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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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