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

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).
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