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

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
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