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

4.3.3.4. Response to food security and/or health shocks within household
Response to the needs of vulnerable groups in the household for care especially
during times of food insecurity will play a tremendous role in ensuring nutrition security even
during this crisis times. Targeting of women, children, and other vulnerable groups in terms
of resources and attention should therefore be at the heart of intervention efforts. We should
pay a great deal more attention to those individuals who are apparently healthy while
consuming diets that seem to be insufficient (Engle 1992a). There are many who do manage
to rear healthy and active children, and yet who belong to the same community as those who
cannot. How do they manage? Are they following some of the basic rules? What is their
secret? Can it be shared with others? The experiences of these successful positive deviant
caregivers can be shared with the other members of the community through support group
discussions and through the community mobilization and behavior change communication
strategies. Positive deviants are defined as children who grow normally in low-income
families where a large proportion of children suffer from growth retardation (Zeitlin et al.
1990).
4.3.4. Caregiver’s health status and quality of care given
Many factors contribute to a caregiver's ability to care for a young child, and health of
the caregiver is one of them. How do we best support the health of the caregiver so that their
caregiving ability is optimized? To answer this question, we need first to understand the
aspects of caregiving that may be affected by poor health and nutrition status of the caregiver
(Yared 2004)
Caregiving behaviors include breastfeeding; providing emotional security and
reducing the child's stress; providing shelter; clothing, feeding, and bathing; supervision of
the child's toilet habits; preventing and attending to illness; nurturing and showing affection,
interaction, and stimulation; playing and socializing; protecting from exposure to pathogens;
and providing a relatively safe environment for exploration (AED/ Linkages 2004; McGuire
& Popkin 1998). Another set of behaviors includes using resources outside the family, such as
curative and preventive health clinics, prenatal care, traditional healers, or members of an
extended family (Gillespie & Haddad 2003).
Thus, some of the caring activities require physical effort, whereas others require
attention, imagination, and inspiration. Therefore, ill health leading to reduced work capacity,
fatigue, apathy, or depression will likely limit caregiving ability, and reduced status in the
family with resulting decreased access to resources and support.
In Ethiopia, the health status of women as primary caregivers is very low as indicated
by maternal mortality of 871 per 100,000 (MOH 2003/2004). According to the data from
health facilities across the country, 13.8 percent of deaths in women in the childbearing ages
are due to pregnancy related problems (Duffield & Kassay 2003). This mortality rate is the tip
of the iceberg as they are preceded by many episodes of morbidity and disability.
Interventions to raise the health status of women are very central to the improvement of
caring practices.
The nutritional status of mothers as primary caregivers is a key component of their
effectiveness in caring and nurturing, both biologically (in utero) and psychosocially after
delivery. In Ethiopia where there is overall food insecurity and a high level of fertility (TFR
of 5.9 children per women), women most commonly suffer from malnutrition. Inadequate
nutrient intake compounded with repeated pregnancy cycles will lead to the so-called
maternal depletion syndrome (McGuire & Popkin 1998). Utilization of family planning
methods can make a significant contribution to prevention of maternal and child malnutrition
due to the adverse effects of closely spaced pregnancies and teenager pregnancies.
In addition, cultural practices related to maternal nutrition during pregnancy in many
parts of the country cause women to spiral to a lower nutritional status. Formative research in
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