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

More documents

Recommendations

Info

4.7. Care Indicators and the Monitoring and Evaluation of the National Nutrition Strategy 4.7.1. Indicators of caring capacity and their assessment Indicators are variables that enable measurement of changes. Better caring practices have different aspects to be measured. Care has the simplest and yet the most valid and reliable methods and indicators to measure hygienic practices, child feeding practices, and caregiver-child interaction during feeding. 4.7.1.1. Indicators of nutritional care (child feeding practices) Child feeding is a multidimensional concept and feeding practices are age specific and change rapidly with age (Table 4.6). It is difficult to combine these dimensions. Secondly, appropriate child feeding practices are defined within narrow age ranges. Therefore, key feeding practices within a continuum of child feeding are used as an indicator of nutritional care practices (Arimond & Ruel 2002 & 2003). There is a need to create a child feeding summary index to avoid bias that results due to the co-existence of both good and bad nutritional care practices in the same household on the one hand, and the clustering of nutritional care practices on the other. Basically, optimally fed infants and young children should be recipients of all the key nutritional care activities mentioned in the above table for their age category. If one of them is not fulfilled, the child will be identified as sub-optimally fed. The data can be collected using 24-hour recall or repeated visit methods. At the population level, the following indicators can be used for assessing nutritional care practices. • Rate of timely initiation of breastfeeding. • Exclusive breastfeeding rate. • Rate of timely complementary feeding. • Rate of continued feeding during diarrheal episodes. • Rate of increased feeding after diarrhea. Optional indicators include: • Rate of continued breastfeeding at 12 months. Table 4.6: The continuum of child feeding. 0- 6 months 6-9 months 9-12 months 12-24 months • Initiate breastfeeding soon after birth. • Continue breastfeeding. • Continue breastfeeding. • Continue breastfeeding. • Avoid prelacteal feeds. Feed colostrum. • Exclusively breastfeed (no teas, water, other milks). • Avoid bottle-feeding. • Gradually introduce a variety of complementary foods, including animal foods. • Feed complementary foods 2 to 3 times a day + snacks. • Increase amount, variety, and frequency of complementary foods, including animal-source foods. • Feed complementary foods 3 to 4 times a day + snacks. • Continue to give variety of foods and gradually complete the transition to the family diet. • Feed complementary foods 3 to 4 times a day + snacks. • Avoid bottle-feeding. • Avoid bottle-feeding. • Avoid bottle-feeding. Source: Ruel & Menon 2003 124
• Rate of continued breastfeeding at 24 months. • Never breastfed rate. • Bottle-feeding rate. 4.7.1.2. Indicators for monitoring of hygienic child care practices. A variety of both qualitative and quantitative methods have been adopted to assess hygienic child care practices. Many studies used mixed survey methods including in-depth key informant interview, focus groups and other participatory rapid assessment methods, and semi-structured and structured observations involving continuous monitoring and spot checks. The dimensions to be measured include five clusters of hygienic practices: disposal of human feces, use and protection of water sources, water and personal hygiene, food preparation and storage, and domestic and environmental hygiene. Indicators to assess personal hygiene include maternal cleanliness and child cleanliness. Indicators for domestic and environmental hygiene include the cleanliness of floor, compound surface and garbage disposal. This information can commonly be gathered using spot check observations. Good and bad practices tend to occur in the same household and therefore, there is a need for using a composite index that combines various dimensions of care practice. Different methods of data collection can be used. Spot check methods, participant observation, and continuous monitoring techniques are some of them. 4.7.1.3. Assessing caregiver-child interaction during feeding Conceptual issues to be considered in assessing caregiver and child interaction during feeding include the transactional nature of care and the role of the caregiver in ensuring adequate dietary intake through active, responsive feeding. In relation to this issue, anorexia should be considered as a factor affected by various intra-household processes. Different maternal and child characteristics affect the level of interaction during feeding. As a result some caregivers are non-interactive and assume that children know when they are hungry and when they are satisfied. Others have strictly controlled feeding involving threats, bribing or forced feeding (common in the rural Ethiopia). Key constructs to measure interactive feeding at the maternal level include: • Adaptation to child’s characteristics: This includes adaptation to psychomotor abilities and physical difficulties (e.g. low birthweight baby with physical suckling difficulties) • Active and responsive feeding: Caregivers ability to feed responsively including encouragement to eat, offering additional foods, offering second helpings, responding to poor appetite and using positive or negative styles of interaction. • The feeding situation: This includes location, organization, regularity, supervision, and distractions during feeding. • At the child level the following characteristics are important • Appetite and hunger. • Food preferences. • Child characteristics preferred by the caregiver e.g. birth order, sex. 4.7.2. Program and policy modifications to enhance caring Malnutrition is a development issue that has to be addressed as such. Good nutrition is both an input and an outcome of development. Without good nutrition development is 125
Page 1:
An assessment of the causes of maln
Page 4 and 5:
• Bantirgu Hailemariam coordinate
Page 6 and 7:
3.4. National and Regional Trends:
Page 8 and 9:
LIST OF TABLES Table 2.1: Child stu
Page 10:
LIST OF ACRONYMS ADLI AGOA AIDS BCC
Page 14 and 15:
Figure 1.1: Stunting among children
Page 16 and 17:
these underlying determinants of th
Page 18 and 19:
experimental body of evidence that
Page 20 and 21:
water can have significant impact o
Page 22 and 23:
2.1. Introduction In the early 1960
Page 24 and 25:
violating the basic tenets presente
Page 26 and 27:
Table 2.3: Regional profile of stun
Page 28 and 29:
A rich food through popularization
Page 30 and 31:
key tenet in the process of identif
Page 32 and 33:
Basic Causes Major Features High im
Page 34 and 35:
commodity trading is the most signi
Page 36 and 37:
Table 2.9: Gross primary enrollment
Page 38 and 39:
following and in alliance with the
Page 40 and 41:
• Accept that agricultural develo
Page 42 and 43:
the other practices that need to be
Page 45 and 46:
CHAPTER 3: FOOD SECURITY AND MALNUT
Page 47 and 48:
Afar in 2000 was 12.6 percent and 5
Page 49 and 50:
3.1. Introduction The economic grow
Page 51 and 52:
In a more technical way, it is diff
Page 53 and 54:
differently, it is important to acc
Page 55 and 56:
households will not be as difficult
Page 57 and 58:
the drought prone areas, the rain f
Page 59 and 60:
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
Page 65 and 66:
Intermediate means of transport suc
Page 67 and 68:
educated, environmentally conscious
Page 69 and 70:
1995-96 revealed that ‘the greate
Page 71 and 72:
works are key instruments to lay do
Page 73 and 74:
due to inappropriate land mismanage
Page 75 and 76:
3.6.3.5. HIV/AIDS This disease is w
Page 77 and 78:
coordinates the different implement
Page 79 and 80:
conception through early pregnancy
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
Page 91 and 92: lack of national nutrition strategy
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
Page 107 and 108: arely provide this kind of benefit.
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 and 116: Figure 4.13: Prevalence of stunting
Page 117 and 118: from poor exposure of children to l
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: International initiative Strengths
Page 139 and 140: Figure 4.17: Community based nutrit
Page 141: There is a strong need for enhancin
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
Page 152 and 153: Although the coverage of ENA traini
Page 154 and 155: Box 5.1: Household and Community In
Page 156 and 157: The interventions that make up this
Page 158 and 159: conferences. To this effect, a nati
Page 160 and 161: with the engineering aspect of wate
Page 162 and 163: Table 5.1: Prevalence of diarrhea a
Page 164 and 165: Figure 5.3: Trends in latrine cover
Page 166 and 167: Institutional arrangements are also
Page 168 and 169: ehavior are integrated and supplied
Page 170 and 171: 5.4.2. Programs and projects 5.4.2.
Page 172 and 173: made by NGOs for the affected child
Page 175 and 176: CHAPTER 6: INSTITUTIONAL FRAMEWORK
Page 177 and 178: interventions in Ethiopia, includin
Page 179 and 180: 6.2. Challenges and Lessons Learnt
Page 181 and 182: Training Post-secondary training is
Page 183 and 184: Table 6.6: (continued) Agency Inter
Page 185 and 186: Table 6.6: (continued) Agency Inter
Page 187 and 188:
Table 6.6: (continued) Agency Inter
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Achievements Challenges Sustainabil
Page 205 and 206:
Berhane G. 1995. Nutrition surveill
Page 207 and 208:
Ethiopian PROFILES Team & AED/Linka
Page 209 and 210:
Middlebrook, P. 2002. Social protec
Page 211 and 212:
Raisin, J. 2001b. Improving food se
Page 213:
Yamano, T., H. Alderman, & L. Chris
show all

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

Create successful ePaper yourself

Delete template?

Save as template?