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

More documents

Recommendations

Info

Integrating nutrition interventions into broader maternal and child health programs can be a doubly effective means of improving child health and survival because it can reduce malnutrition among children and simultaneously lessen the negative impact of illness. Services within the Family Health Department have important implications in improving women’s nutrition. Among these services are postponing first pregnancies, ensuring adequate child spacing and preventing the transmission of HIV/AIDS as well as other sexually transmitted diseases. In line with the mandates of the MOH and the FHD, the nutrition team is primarily engaged with coordinating and directing the development of national strategies and guidelines that will be implemented in nutrition and other child health programs. To do this, the team seeks and utilizes financial and technical assistance from various sources including UNICEF, WHO, other governmental agencies, and NGOs. 5.2.1.2. Capacity for nutrition analysis and nutrition education Historically, the Ethiopian Nutrition Institute (ENI), under the MOH, had been responsible for training in the area of nutrition, the analysis of nutritional problems, and implementation of nutrition interventions nationwide. However, the mandate of the present day Ethiopian Health and Nutrition Research Institute (EHNRI), into which the ENI was later integrated, seems to have exempted the organization from its responsibilities in training and in the implementation of national nutrition programs. The EHNRI has retained its research capabilities in the area of nutrition and other health problems. The EHNRI is among the main governmental organizations with considerable potential in both technical nutrition capabilities and facilities. The present day EHNRI was formed through a merger of three institutions, the ENI, the National Health Institute (formerly known as Pasteur Institute), and the former department on Traditional Medicine under the MOH. The major areas of focus for research at EHNRI include micronutrients, maternal malnutrition, food science and dietetics, clinical nutrition and a new activity on HIV/AIDS and nutrition. The FHD has been able to conduct some nationwide surveys in the area of child health and nutrition through the support of UNICEF and WHO. In this regard, the multipleindicator-cluster-surveys (MICS) have contributed to the monitoring and evaluation of child health programs that are relevant to nutrition. At present, the MOH, through assistance from UNICEF and others, is conducting nationwide surveys on the status of micronutrient nutrition in the country. However, the main national undertakings for the analysis of the magnitude of nutritional problems, and the measurement of the prevalence of protein-energy-malnutrition (PEM) in particular, are accomplished by other sectors outside of the MOH. To this effect, the Central Statistics Authority (CSA) has played a leading role in generating relevant national data on the prevalence of PEM through the 2000 Ethiopian Demographic and Health Survey (DHS) and other national and sub-national surveys. This has been done with little involvement of the MOH (CSA & ORC Macro 2001. The FHD has played an active role in the design of instruments for the 2000 DHS. However, no further attempt was made to analyze the findings of the DHS or the earlier studies to enable a better understanding of the nutritional situation in the country. In general, there is a gap between the sectors that generate information on the extent of malnutrition, such as CSA, and others that are responsible for dealing with the problem, such as MOH, markedly reducing the optimal utilization of such information. The planning and implementation of such large-scale nutrition surveys should give due emphasis to the utilization aspect of the information thus generated. Conducting extensive or expensive studies should not be regarded as a goal on its own. It is rather a means of assessing and analyzing the magnitude and determinants of nutrition problems and can ultimately be used to inform policy and programs. Relevant stakeholders should play active 138
oles in the design and conduct of such surveys, as well as in the dissemination and utilization of the resulting information. Food security is an important underlying determinant of nutrition. However, assessment and intervention in the area of food security is totally handled by yet another organization, the National Disaster Prevention and Preparedness Commission (DPPC). The MOH has little, if any, participation in national efforts towards food security. It is obvious that there is lack of integration between efforts to address the problems of malnutrition in Ethiopia and programs that analyze the problem. Nutrition is not a sector on its own. Rather nutrition depends on the contribution and integration of various sectors of development. The various sectors need to be coordinated in a manner that their efforts are complementary to each other and geared toward a common goal of insuring good nutrition to the nation. Training in the area of nutrition is not well developed in Ethiopia. Very few nutrition curricula exist for training in nutrition. These are found in a handful of health professional training schools in the country. In these universities and colleges, the Medical and Nursing curricula, the Health Officer and the Masters of Public Health (MPH) programs, and a few other related disciplines in the area of public health offer limited credit hours (two to three) of human nutrition or public health nutrition courses. There are no specialized training programs in the country that graduate students primarily in the field of nutrition. The Universities of Jimma and Debub have recently initiated new mid-level training programs in nutrition and Gondar University is in the process of designing a similar training curriculum. The very limited numbers of nutrition experts that function in the country have been trained elsewhere including in other African countries. Moreover, most of the nutrition experts in Ethiopia work for NGOs and UN agencies rather than for government organizations. Thus, the only concentration of nutrition experts in a government institution in Ethiopia to date exists at the EHNRI. Nutrition experts of any kind are not present in the health sector. It is high time that low and mid level nutrition graduates be trained to join health care teams at both management and service provision levels. In the mean time, health professionals need to receive sufficient training through pre-service or in-service programs. Thus, the capacity to analyze nutrition problems at the FHD, in particular, is very limited. The situation calls for an integration of nutrition training across the various organizations, including the health professional training institutions, MOH, and NGOs. In this regard, remarkable efforts have been made through the collaboration of the AED/Linkages program, the Ethiopian Public Health Training Initiative (EPHTI), and the health professional training institutions in the country. Through this collaboration, AED/Linkages has conducted a series of training programs on Essential Nutrition Actions (ENA) that are relevant for both training and service provision. At the service delivery level, clinical capacity and overall management of nutrition related programs, such as growth monitoring and promotion, is weak. Lower and mid-level health workers do not have sufficient theoretical knowledge or practical skills to conduct such programs. In most instances, the growth monitoring and promotion activities are reduced to the measurement and recording of weight of infants and children. There is a lack of understanding in the interpretation and utilization of such data. As a result, there is little communication between health workers and caretakers of children on practical ways of improving nutritional status. The growth monitoring data are compiled and reported through successive higher levels, without being interpreted or used at the respective levels, only, at best, to end up at the MOH in a databank. Rarely is the data analyzed to identify malnourished children at the appropriate levels where action can be taken with the children or their caregivers. Likewise, growth-monitoring reports contribute little to the monitoring of performance by the respective health institutions or personnel. 139
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 14 and 15:
Figure 1.1: Stunting among children
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
Page 65 and 66:
Intermediate means of transport suc
Page 67 and 68:
educated, environmentally conscious
Page 69 and 70:
1995-96 revealed that ‘the greate
Page 71 and 72:
works are key instruments to lay do
Page 73 and 74:
due to inappropriate land mismanage
Page 75 and 76:
3.6.3.5. HIV/AIDS This disease is w
Page 77 and 78:
coordinates the different implement
Page 79 and 80:
conception through early pregnancy
Page 81 and 82:
households who depend on purchased
Page 83 and 84:
• Improve rural radio infrastruct
Page 85 and 86:
3.7.3.6. Improve rural market infra
Page 87 and 88:
CHAPTER 4: CARE AND MALNUTRITION IN
Page 89 and 90:
household allocation; 5) workload a
Page 91 and 92:
lack of national nutrition strategy
Page 93 and 94:
children between 6 and 24 months. T
Page 95 and 96:
Care was recognized as one of the u
Page 97 and 98:
Figure 4.1: Risk of death in infant
Page 99 and 100: Table 4.2: Present discount values
Page 101 and 102: Figure 4.3: Factors that affect the
Page 103 and 104: Box 4.2: Reasons why PLWHA are vuln
Page 105 and 106: Figure 4.7: Risk of mother to child
Page 107 and 108: arely provide this kind of benefit.
Page 109 and 110: Figure 4.8: The extended model of c
Page 111 and 112: 4.3.1.2. Recognizing symptoms of il
Page 113 and 114: the direction of the growth curve i
Page 115 and 116: Figure 4.13: Prevalence of stunting
Page 117 and 118: from poor exposure of children to l
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
Page 135 and 136: International initiative Strengths
Page 137 and 138: • Rate of continued breastfeeding
Page 139 and 140: Figure 4.17: Community based nutrit
Page 141: There is a strong need for enhancin
Page 144 and 145: supplies. The available facilities
Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
Page 148 and 149: access to a basic package of qualit
Page 152 and 153: Although the coverage of ENA traini
Page 154 and 155: Box 5.1: Household and Community In
Page 156 and 157: The interventions that make up this
Page 158 and 159: conferences. To this effect, a nati
Page 160 and 161: with the engineering aspect of wate
Page 162 and 163: Table 5.1: Prevalence of diarrhea a
Page 164 and 165: Figure 5.3: Trends in latrine cover
Page 166 and 167: Institutional arrangements are also
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
Page 177 and 178: interventions in Ethiopia, includin
Page 179 and 180: 6.2. Challenges and Lessons Learnt
Page 181 and 182: Training Post-secondary training is
Page 183 and 184: Table 6.6: (continued) Agency Inter
Page 201 and 202:
Table 6.6: (continued) Agency Inter
Page 203 and 204:
Achievements Challenges Sustainabil
Page 205 and 206:
Berhane G. 1995. Nutrition surveill
Page 207 and 208:
Ethiopian PROFILES Team & AED/Linka
Page 209 and 210:
Middlebrook, P. 2002. Social protec
Page 211 and 212:
Raisin, J. 2001b. Improving food se
Page 213:
Yamano, T., H. Alderman, & L. Chris
show all

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

Create successful ePaper yourself

Delete template?

Save as template?