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

together. This demands an integrated approach, careful planning, implementation and
monitoring and evaluation of the household level caring practices. An institutional framework
has to be there and an organizing body needs to be mandated from national level down to both
woreda and community levels.
4.4.2. Content of curricula to include consideration of proper care practices
Curricula on nutrition from elementary to tertiary level do not strongly focus on
caring practices. Integration of the Essential Nutrition Actions (ENA) into the pre-service
curriculum of the health training is underway among the seven-health science higher learning
institutions in Ethiopia. The seven components of the ENA (Guyon & Quinn 2004) are
exclusive breastfeeding for the first six months, optimal complementary feeding at 6 months
with the continuation of breastfeeding up to 2 years and beyond, sick child feeding, maternal
nutrition, and control of the three micronutrient deficiencies (vitamin A, iron, iodine) are in
the process of being integrated into the pre-service curriculum (MOH 2003). There are also a
series of in-service- trainings on ENA, behavior change communication methods, lactational
amenorrhea methods, the baby friendly hospital initiative (BFHI), and the code of marketing
breast milk substitutes.
Nutrition and hygiene are among the modules in the training curriculum for health
extension workers. However, in the curriculum more emphasis needs to be put on caring
practices at the household level, such as maternal nutrition, breastfeeding, complementary
feeding, and hygiene. Doing so will improve household caring practices.
The way nutrition behavior change communication messages are given should
consider local circumstances and contexts. Therefore, greater care needs to be put into the
training of health extension workers. This will have a strong bearing on the sustainability of
behavioral changes, as it will make the BCC messages doable and action oriented.
4.4.3. Development of appropriate timesaving technologies for caregivers
Poor women lack many resources, but one that stands out in studies of nutrition is
their lack of time. A day, of course, has a fixed length, so that one cannot increase the
absolute amount of time available. But one can increase productivity per unit of time and
overall efficiency of time use. Technology, theoretically, can buy time for women.
Mechanical mills can replace time- and energy-intensive hand pounding; wells can reduce the
time and energy involved in water carrying; improved cooking-stoves can reduce fuel
requirements and thus fuel procurement time.
The heavy workload on women prevents them from dedicating time to their children.
This can affect the food intake of the children as well as the health seeking practices. The
main time consuming activity for women is cooking, but food processing, especially milling
and hulling, is the most arduous work. In order to save women's time, promoting appropriate
technologies like a collective mill, developing water points, and using alternate sources of
energy (biogas) will allow women to have time for caring (MOH 2003). The experience in
Ethiopia is that, in the new resettlement programs, time saving interventions for better caring,
such as the development of water points, building of grain mills and health care units, are
done before people move in. Interventions with improved enset processing technologies use
of biogas fuel, and improved stoves, particularly in Silte zone of SNNP, are good examples of
providing women with time saving technologies.
For most women, however, the great promise of technology has yet to be fulfilled.
Improved time-management might help by, for instance, shortening the time required for
cooking, washing clothes, or reaching the fields. However, these measures require motivation,
energy, and planning, which may not be possible because of women's nutritional, educational,
and cultural histories. Women can also gain time by obtaining better wage rates, but their
bargaining power is weak. If the women earned more money, they might not have to take
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