An assessment of the causes of malnutrition in Ethiopia: A ...
An assessment of the causes of malnutrition in Ethiopia: A ... An assessment of the causes of malnutrition in Ethiopia: A ...
Figure 1.1: Stunting among children under-five, by region. 100% 75% 57% 55% 55% 52% 50% 25% 27% 47% 41% 31% 35% 38% 47% 46% 0% Addis Ababa Afar Amhara Benishangul-Gumuz Dire Dawa Gambella Harari Oromia SNNP Somali Tigray NATIONAL Source: Ethiopia DHS 2000 in our failing to meet the needs of the malnourished among us? To do this, the global conceptual framework of the causes of malnutrition is discussed. Secondly, a case is made for why addressing malnutrition should be an issue of public policy concern. The discussion immediately above is expanded upon to consider both the costs of malnutrition to society and the benefits that accrue if malnutrition is prevented. Turning more directly to the Ethiopian context, in order to identify those objectives and actions that should feature in the nutrition strategy, an assessment and analysis of malnutrition in Ethiopia was undertaken along several of the dimensions identified by the conceptual framework described in the next section. Four teams of Ethiopian experts were employed to undertake research, respectively, into the basic causes of malnutrition and the three underlying causes – food security, health services and a healthy environment, and care. Synopses of the four reports appear as the remaining chapters in this synthesis document. Finally, as an annex to this document, a description of the institutional framework within which nutrition-focused activities are currently being carried out in Ethiopia is presented. 1.1. The Global Conceptual Framework of the Causes of Malnutrition Given that maintaining good nutritional status is both a human right and a necessary component to address effectively the development challenges that Ethiopia faces, what needs to be done to ensure that all Ethiopians are well-nourished? The global conceptual framework of the causes of malnutrition presents a useful generalized understanding of how malnutrition and/or child death are the outcomes of a multisectoral development problem that can be most effectively analyzed in terms of immediate, underlying and basic causes (Figure 1.2). This framework has become one of the most familiar images within the international nutrition community over the past decade and has helped foster improved understandings and dialogue about the nature and causes of malnutrition. In the model, malnutrition is viewed as one important manifestation of a larger development problem that reaches across multiple sectors and social, political, economic, and 2
Figure 1.2: Global conceptual framework of the causes of malnutrition. Malnutrition Malnutritio n & Death Outcome Insufficient Insufficient Dietary Intake Dietary Intak e Disease e Immediate Determinants Inadequate Inadequat Household Household e Food Security Food Inadequate Maternal Maternal && Child Care Care Inadequate Inadequate Health Services Health & Unhealthy Environment Underlying Determinants Inadequate Responsibility, Authority, and Resources Social Processes and Generation of Capacity (Social Trends) ) Social, Economic, Political and Cultural Processes Basic Determinants Potential of Society Social Organization and Relations Source: UNICEF, 1990 cultural institutions. As such, the goal is not only to eliminate the manifestation (i.e. the symptoms) but also to address the larger development problem itself. This is not to diminish the importance of undertaking dedicated efforts to effectively reduce malnutrition and child death, but only to be clear that the way in which these manifestations are addressed is critical to engineering a sustainable solution. The immediate causes of malnutrition and child death are the mutually reinforcing conditions of inadequate dietary intake and infectious disease; the underlying causes are household food insecurity, inadequate maternal and child care, and inadequate health services and health environment; and the basic causes include formal and non-formal institutions, political, economic, and ideological structures and systems—representing the perennial political, economic, and institutional conflicts that public nutrition programs must work within. In the conceptual framework, the degree to which the three underlying determinants are expressed, positively or negatively, is a question of available resources. These include the availability of food, the physical and economic access which an individual or household has to that food, the caregiver’s knowledge of how to utilize available food and to properly care for the individual, the caregiver’s own health status, and the control the caregiver has over resources within the household that might be used to nourish the individual. Additionally, the level of access to information and services for maintaining health, whether curative services are available, and the presence or absence of a healthy environment with clean water, adequate sanitation, and proper shelter all contribute to determining the nutritional status of an individual. The relative importance of each must be assessed and analyzed in each setting in order to define priorities for action. A sustained healthy and active life is only possible when 3
- 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 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
Figure 1.1: Stunt<strong>in</strong>g among children under-five, by region.<br />
100%<br />
75%<br />
57%<br />
55%<br />
55%<br />
52%<br />
50%<br />
25%<br />
27%<br />
47%<br />
41%<br />
31% 35% 38% 47%<br />
46%<br />
0%<br />
Addis Ababa<br />
Afar<br />
Amhara<br />
Benishangul-Gumuz<br />
Dire Dawa<br />
Gambella<br />
Harari<br />
Oromia<br />
SNNP<br />
Somali<br />
Tigray<br />
NATIONAL<br />
Source: <strong>Ethiopia</strong> DHS 2000<br />
<strong>in</strong> our fail<strong>in</strong>g to meet <strong>the</strong> needs <strong>of</strong> <strong>the</strong> malnourished among us? To do this, <strong>the</strong> global<br />
conceptual framework <strong>of</strong> <strong>the</strong> <strong>causes</strong> <strong>of</strong> <strong>malnutrition</strong> is discussed. Secondly, a case is made for<br />
why address<strong>in</strong>g <strong>malnutrition</strong> should be an issue <strong>of</strong> public policy concern. The discussion<br />
immediately above is expanded upon to consider both <strong>the</strong> costs <strong>of</strong> <strong>malnutrition</strong> to society and<br />
<strong>the</strong> benefits that accrue if <strong>malnutrition</strong> is prevented.<br />
Turn<strong>in</strong>g more directly to <strong>the</strong> <strong>Ethiopia</strong>n context, <strong>in</strong> order to identify those objectives<br />
and actions that should feature <strong>in</strong> <strong>the</strong> nutrition strategy, an <strong>assessment</strong> and analysis <strong>of</strong><br />
<strong>malnutrition</strong> <strong>in</strong> <strong>Ethiopia</strong> was undertaken along several <strong>of</strong> <strong>the</strong> dimensions identified by <strong>the</strong><br />
conceptual framework described <strong>in</strong> <strong>the</strong> next section. Four teams <strong>of</strong> <strong>Ethiopia</strong>n experts were<br />
employed to undertake research, respectively, <strong>in</strong>to <strong>the</strong> basic <strong>causes</strong> <strong>of</strong> <strong>malnutrition</strong> and <strong>the</strong><br />
three underly<strong>in</strong>g <strong>causes</strong> – food security, health services and a healthy environment, and care.<br />
Synopses <strong>of</strong> <strong>the</strong> four reports appear as <strong>the</strong> rema<strong>in</strong><strong>in</strong>g chapters <strong>in</strong> this syn<strong>the</strong>sis document.<br />
F<strong>in</strong>ally, as an annex to this document, a description <strong>of</strong> <strong>the</strong> <strong>in</strong>stitutional framework with<strong>in</strong><br />
which nutrition-focused activities are currently be<strong>in</strong>g carried out <strong>in</strong> <strong>Ethiopia</strong> is presented.<br />
1.1. The Global Conceptual Framework <strong>of</strong> <strong>the</strong> Causes <strong>of</strong> Malnutrition<br />
Given that ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g good nutritional status is both a human right and a necessary<br />
component to address effectively <strong>the</strong> development challenges that <strong>Ethiopia</strong> faces, what needs<br />
to be done to ensure that all <strong>Ethiopia</strong>ns are well-nourished? The global conceptual framework<br />
<strong>of</strong> <strong>the</strong> <strong>causes</strong> <strong>of</strong> <strong>malnutrition</strong> presents a useful generalized understand<strong>in</strong>g <strong>of</strong> how <strong>malnutrition</strong><br />
and/or child death are <strong>the</strong> outcomes <strong>of</strong> a multisectoral development problem that can be most<br />
effectively analyzed <strong>in</strong> terms <strong>of</strong> immediate, underly<strong>in</strong>g and basic <strong>causes</strong> (Figure 1.2). This<br />
framework has become one <strong>of</strong> <strong>the</strong> most familiar images with<strong>in</strong> <strong>the</strong> <strong>in</strong>ternational nutrition<br />
community over <strong>the</strong> past decade and has helped foster improved understand<strong>in</strong>gs and dialogue<br />
about <strong>the</strong> nature and <strong>causes</strong> <strong>of</strong> <strong>malnutrition</strong>.<br />
In <strong>the</strong> model, <strong>malnutrition</strong> is viewed as one important manifestation <strong>of</strong> a larger<br />
development problem that reaches across multiple sectors and social, political, economic, and<br />
2
Change language