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

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Figure 4.15: Feeding practices of children 6-9 months in Ethiopia. Weaned, 1% Breastmil k & solids, 43% OPTIMAL Exclusive breastfeeding, 12% Breastmil k & water, 15% Breastmil k & other liquids, 29% Source: CSA & ORC Macro 2001 Reports for Ethiopia show that breastfeeding is nearly universal, with 96.3 percent of the children born in the five years preceding the DHS having been breastfed at some time (CSA & ORC Macro 2001). However, 70 percent of under five children in Ethiopia are sub-optimally breastfed. Only 54.6 percent of children under 5 months of age and 44 percent of those under 7 months were found to be exclusively breastfed. A large proportion of infants (21.6 percent) are being exclusively or fully breastfed far beyond the recommended age of six months. Breast milk or other liquids alone are not sufficient to meet the energy and nutrient requirements of infants of this age and older. Only 58 percent newborns were given colostrum after birth and 54 percent exclusively breastfed over the period 0-6 months (Figure 4.14). Regarding the feeding practices of Ethiopian infants 6-9 months, only 43 percent were optimally fed (CSA & ORC Macro 2001). The rest were either weaned totally, exclusive breastfeeding was unduly prolonged, or breast milk and other liquids were given (Figure 4.15). These sub-optimal feeding practices could be addressed by proper behavior change communication (nutrition education) to caregivers about the importance of optimal infant and young child feeding practices. According to the findings of the DHS 2000 (CSA & ORC Macro 2001), the overall prevalence of stunting among Ethiopian children is 51.5 percent and more than one in four children (26 percent) are severely stunted. Forty-seven percent of Ethiopian children were found to be underweight (low weight-for-age) and 16 percent were severely underweight. About 11 percent of the children under five were wasted (thin for their height), and 1 percent are severely wasted. The levels of stunting, underweight, and wasting are higher for rural children than urban children. According to PROFILES, over a six-year period, 412,000 deaths of Ethiopian infants were due to sub-optimal breastfeeding practices (Ethiopian PROFILES Team & AED/Linkages 2005). 4.3.2.5. Exposing children to sunlight Exposing children to ultraviolet light is one of the caring practices that prevent the occurrence of rickets in children. The significance of the vitamin D deficiency that results 104
from poor exposure of children to light is mainly due to the effect it has on child health, development, and survival in general. There is ample evidence demonstrating increased rates of infections in rachitic children (Baser & Cakmakci 1994; Getaneh et al. 1998). In a casecontrol study done in Addis Ababa it was found that the odds of dying in rachitic patients was five times higher than that of controls (Lulseged 1990). Paradoxically, rickets is widely prevalent in many tropical and subtropical regions including Ethiopia, despite abundant sunshine (Salimpour 1975; Aust-Kettis et al. 1965; Reddy & Lamb 1991). A review of pediatric admissions in Jimma hospital indicated that about 7 percent of children under 5 years of age were diagnosed to have rickets (Mojab 2002). A more recent community based study in Jimma town showed rickets prevalence of 4 percent in randomly selected children between 6-59 months of age (Getaneh et al. 1998). Keeping children indoors due to fear that they will catch cold, fear of evil eyes, and the tradition of wrapping children in swaddling clothes contribute to lack of adequate sunlight exposure. The incidence of rickets is particularly high in slum children who live in crowded houses almost devoid of sunlight (Reddy & Lamb 1991). Exposing children to ultraviolet light does not cost anything. The presence of rickets among Ethiopian children where there are 12 months of sunshine is a reflection of the low level of caring practices for children at the household level. 4.3.3. General education attainment and specific nutrition knowledge of caregiver 4.3.3.1. Educational attainment of the caregiver Education is one of the most important resources that enable women to provide appropriate care for their children (Armar-Klemesu et al. 2000). Women who receive even a minimal education are generally more aware than those who have no education of how to utilize available resources for the improvement of their own nutritional status and that of their families. Educating women may enable them to make independent decisions within the household and to have greater access to household resources that are important to nutritional status. In Ethiopia, children whose mothers have some primary education were 1.9 times more likely to be stunted compared to children whose mothers had a secondary or higher education Figure 4.16: Contributions of underlying determinants to reductions in child underweight, 1970-95, 16 developing countries. Food availability, 26% Healthy environment, 19% Women's relative status, 12% Women's education, 43% Source: Smith & Haddad 2000 105
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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
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viewed as a proxy for household foo
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Figure 3.3: Per capita food product
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Page 73 and 74: due to inappropriate land mismanage
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 and 112: 4.3.1.2. Recognizing symptoms of il
Page 113 and 114: the direction of the growth curve i
Page 115: Figure 4.13: Prevalence of stunting
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
Page 148 and 149: access to a basic package of qualit
Page 150 and 151: Integrating nutrition interventions
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Page 154 and 155: Box 5.1: Household and Community In
Page 156 and 157: The interventions that make up this
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Page 162 and 163: Table 5.1: Prevalence of diarrhea a
Page 164 and 165: 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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