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

Nutrition is a cross-cutting issue – contributions from various sectors are necessary to
ensuring adequate nutritional status. Among these sectors are health, agriculture, education,
employment and social services, water and sanitation, as well as environment. However, the
importance of adequate nutrition for good health, and conversely the implication of poor
nutritional status for susceptibility to severity of other common diseases, suggests that
nutrition should be mainstreamed in the child and family health sub-components of health
service delivery. Analysis of longitudinal data in developing countries provides evidence of
the fact that nutrition is not solely a “food issue” and that malnutrition can occur even in
situations of good food availability unless issues related to maternal and child health care as
well as feeding practices; access to basic health care, water and sanitation facilities are
properly addressed (Pelletier & Frongillo 2003).
Nutritional deficiency states are usually associated with increased prevalence of
infections and infestations with parasites. Reductions in the amount of food intake during
acute as well as chronic infection episodes and the persistent catabolic state of individuals
during the period of infections further compromise the nutritional status of such individuals.
5.1.3. Dimensions of the provision of health, water, and sanitation services
5.1.3.1. Disease burden
The major health problems of the country are diseases of a communicable nature that
are due to poor personal hygiene, improper refuse and waste disposal practices, and lack of an
adequate and safe water supply. Significant proportions of other health problems are due to
inappropriate nutritional practices, lack of health awareness, and improper cultural taboos.
Nutritional disorders rank among the top problems affecting the population in general, and
children and mothers in particular. In 1996, nutritional deficiencies in Ethiopia directly
accounted for an estimated 7.8 percent of all deaths and 9.3 percent of discounted life years
lost. The prevalence of micronutrient deficiency in children under the age of five years is
high, with 44 percent of them suffering from sub-clinical vitamin-A deficiency and 22 percent
from iodine deficiency disorders. Iron and folate deficiencies are also common among
children and mothers of childbearing age attending antenatal clinics. Similarly, rickets
because of vitamin-D deficiency due to cultural beliefs that young children must be kept
indoors and due to overcrowded living conditions is common in most urban areas.
Ethiopia is severely affected by the HIV/AIDS pandemic. In 2003, the national seroprevalence
was estimated to be 4.4 percent (MOH 2004a). HIV infection primarily affects the
immune system. Children infected with HIV are afflicted by chronic fungal, bacterial, or other
viral infections that again compromise their nutritional status. As a result, the combined effect
of opportunistic infections and malnutrition is responsible for the high mortality rate of
children afflicted by HIV infection. In addition, it has been shown that malnutrition, even in
its mildest form, increases the likelihood of mortality from a number of different disease
entities, and may be associated with 50 to 60 percent of under-five deaths (Pelletier &
Frongillo 2002).
5.1.3.2. Current status and trends in health service provision
Access to adequate health care, both preventative and curative; water supplies; and
sanitation facilities are critical for a healthy living environment. Malaria, anemia, diarrheal
diseases, and HIV/AIDS are highly prevalent in Ethiopia and have a direct negative impact on
household food security. Access to adequate health care is critical to ensure that the
household will be productive enough to secure sufficient food and thereafter utilize the
nutrients in that food appropriately to ensure the nutritional status of all its members.
Health services in Ethiopia are far from adequate to meet the enormous health care
needs of the population in general and the needs of mothers and children in particular. The
national health policy emphasizes the importance that all segments of the population achieve
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