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

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agents in the community. The issue of sustainability has to be considered and each sector needs to design an inbuilt mechanism of sustaining such an approach. The following key questions need to be answered: How could such networks be established effectively and supported in a sustainable way? Is there sufficient human capacity in communities? If not, how might it be built? • These mobilizers are to be supported by facilitators, with each supporting the efforts of 10 to 20 mobilizers. Could such a system work? Each kebele has approximately 1,000 households, who will require 50 to 100 mobilizers. These mobilizers will need to be supported by 3 to 10 facilitators. Current draft proposals are for two health extension workers, three agricultural extension workers (production, livestock, natural resources), one food security monitor (in selected woredas), and one home economist in each kebele. This totals between 5 to 7 development agents who might serve as facilitators. • How feasible is this? Is there sufficient human capacity? Are there sufficient government resources to manage all of these workers? Will the other obligations of these kebele-level workers permit them also to take on nutrition-oriented activities? • For how long should the volunteers be trained? How will their performance be monitored and mentored? How will they be motivated to sustain their efforts? To address these questions and enable the system to work, in a sustainable way, an integrated approach and careful planning by all sectors using “Triple-A cycle approach” is required. This calls for an institutional framework and mandate to coordinate and organize these efforts. 4.8. Conclusion Regardless of all of the efforts to address malnutrition in Ethiopia, the problems are increasing with time. The victims are the vulnerable groups including children, women, disabled people, people infected with and affected by HIV/AIDS, orphans, street children, Internally Displaced Persons (IDPs) and refugees. Past approaches to addressing nutritional problems in Ethiopia have focused on the food aspect of malnutrition. Poor nutritional status starts during the intra-uterine life due to the poor transfer of nutrients from the mother to the fetus, perpetuating malnutrition across inter-generational cycles. This can only be addressed through interventions focusing on food security, better caring practices for the vulnerable, and adequate healthcare together with a healthy environment. For this reason, the global conceptual framework is based on these three underlying causes of malnutrition. Availability of food alone is not sufficient to address the nutritional security of the most vulnerable segments of the population, as they need someone to feed them, counsel and guide them, and take them to receive healthcare. Additionally, these segments of the population are at great physical and social disadvantage because of poor access to resources. There is a big gap in addressing care for the vulnerable groups by all sectors in Ethiopia. Proper care enables the full utilization of existing food and healthcare services. However, without proper caring practices food and healthcare services will not better the nutrition situation in the country. The reason for the low level of proper caring practices in Ethiopia is that most of the actions that government can take to improve caring practices have to take place at the household and community levels through interactions with caregivers. Moreover, these activities are not as sector specific as those linked to the food security and health determinants. Therefore, efforts to improve care are difficult to assign to a specific sector of government. That is a principal reason nutrition security is not given effective government support in many countries around the world – no single sector is responsible for ensuring the nutritional well-being of a country’s citizens. 128
There is a strong need for enhancing household level caring practices in an integrated way. The experiences in the community from positive deviance cases are real practical issues to be considered in behavior change communication for better caring practices. Community’s own caring practices should be promoted particularly during acute food shocks and emergencies since the level care suffers. Even though there are different care initiatives undertaken both by the government and by NGOs, there is an urgent need for integration and a comprehensive assessment to be undertaken to determine the appropriate caring practices required to confront the state of malnutrition in Ethiopia. If the government of Ethiopia, through the NNS, does put in place a clear accountability framework for the sectors concerned with nutrition, it is still quite possible that nutritional care issues will receive less attention than the other determinants. Nutrition in Ethiopia may move from the current ‘food-bias’ to having a ‘health and food-bias’, while neglecting the importance of good care. Again this will not alleviate nutrition insecurity in Ethiopia. 129
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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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Intermediate means of transport suc
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educated, environmentally conscious
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1995-96 revealed that ‘the greate
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works are key instruments to lay do
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due to inappropriate land mismanage
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3.6.3.5. HIV/AIDS This disease is w
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coordinates the different implement
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conception through early pregnancy
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households who depend on purchased
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• Improve rural radio infrastruct
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3.7.3.6. Improve rural market infra
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CHAPTER 4: CARE AND MALNUTRITION IN
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Page 93 and 94: children between 6 and 24 months. T
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Page 97 and 98: Figure 4.1: Risk of death in infant
Page 99 and 100: Table 4.2: Present discount values
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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
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Page 115 and 116: Figure 4.13: Prevalence of stunting
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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
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Page 137 and 138: • Rate of continued breastfeeding
Page 139: Figure 4.17: Community based nutrit
Page 144 and 145: supplies. The available facilities
Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
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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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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
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Page 179 and 180: 6.2. Challenges and Lessons Learnt
Page 181 and 182: 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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