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

5.1. Introduction
5.1.1. Conceptual framework of the causes of malnutrition
Nutritional status, in its holistic sense, is recognized as an outcome of several
processes in society. The contribution of various developmental sectors is involved in
ensuring adequate nutritional status. The societal processes operate at the different levels of
the conceptual framework of nutritional well-being. During operation, the exertion of the
effects of the processes could be dependent or independent of each other. When these social
processes operate adequately, the nutritional status (outcome) of the given population remains
satisfactory. However, when such processes fail to generate the needed capacity of
stakeholders in order to avert adverse circumstances, the occurrence of malnutrition and its
undesired consequences become inevitable.
According to the conceptual framework shown in Figure 1.2 in the first chapter of
this document, malnutrition is recognized as both an important cause of child deaths and the
result of several causative processes in society (Jonsson 1993). These causes are
conceptualized to operate at three levels: the immediate, underlying, and basic levels. The
effects of health services are considered to operate at the first two levels.
At the immediate level of analysis, the causes of deaths of young children are
primarily malnutrition and disease, the former being usually a combined result of various
diseases and dietary inadequacies interacting in a mutually reinforcing manner. It is at this
level that nutrition and health policies and strategies should be geared toward the achievement
of impact objectives for long-term improvements.
At the underlying level, there may be one or a combination of causes, such as lack of
health services, poor water supplies and sanitary environment, poor food hygiene, or
inadequate child care. The important health-related factors at this level are issues of health
service coverage and actual utilization, especially of preventive and promotive services.
5.1.2. Why is nutrition both a health and a food/diet issue?
In Ethiopia, in any one year, more than four million people face food shortages (both
chronic and transitory) even though the proportion of the rural population under food poverty
has been reported to have declined from 47 percent in 1995/96 to 42 percent in 1999/2000
(the corresponding level for urban areas being 32.5 percent and 46.7 percent respectively).
The consequences of food insecurity are reflected in the high level of malnutrition (stunting
and wasting of children less than five years of age). The major component of the Ethiopian
Sustainable Development Poverty Reduction Program (SDPRP) is the Agricultural Led
Industrial Development (ADLI). Concerning food security, the medium-term target of the
ADLI is to reduce the absolute size of the food insecure rural population substantially,
enabling more people to subsist without food aid. Thereafter, the objective is to rely on fiscal
transfers of resources to support a relatively small number of remaining food-deficit
households. The food security strategy is designed to address both the supply and demand
sides of the food equation: availability and entitlement, respectively within the framework of
the National Agricultural and Rural Development Strategies. The strategy adopted rests on
three pillars: increasing the availability of food through domestic (own) production, ensuring
access to food for food deficit households; and strengthening emergency response
capabilities. Alongside the government's initiatives towards developing alternative income
generation and price support schemes, targeted food and nutrition interventions are also
envisaged in the areas of health and nutrition in rural areas. These include efforts to
strengthen the emergency capabilities of the government; institutional strengthening,
networking, capacity building; and food security assistance (FDRE 2002).
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