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

attendance at 35 percent, and institutional deliveries at 10 percent. Utilization of health
services is also low at 27 percent per year.
The proportion of under-fives with diarrhea who received oral rehydration therapy
and continued feeding was 38 percent in 2003 (MOH 2004b). Only 16 percent of those with
acute respiratory infections were taken to a health provider. Similarly, vitamin A
supplementation coverage among children 6-59 months was 16 percent in 2002. About 28
percent of households consumed iodized salt in 2003.
Findings from the nationally representative Ethiopia Demographic and Health Survey
of 2000 revealed that about 50 percent of lactating women initiate breastfeeding within the
first hour following delivery. A similar proportion feed colostrum to their newborn. The
prevalence of exclusive breastfeeding was 47 percent, while continuation of breastfeeding
through the second year of life was reported by more than 80 percent of mothers. Introduction
of complementary feeding was largely delayed, and the quality and frequency of
complementary foods was inadequate. Although breastfeeding is considered a customary
practice in Ethiopia, sub-optimal practices are also widespread.
High prevalence of inappropriate child feeding practices, along with insufficient
knowledge on the part of health care providers regarding optimal feeding practices, has been
documented. The lack of appropriate policies to create an enabling environment for the
promotion of appropriate infant and young child feeding practices has long been a serious
limitation for appropriate infant and young child nutrition in Ethiopia. This prompted the
development of a national strategy for infant and young child feeding in April 2004.
The MCH team under the FHD is currently engaged in two main programs, namely,
immunization (better known as the EPI program) and the Integrated Management of
Childhood Illnesses (IMCI). The IMCI program was initiated in 1997 with a focus on the six
main childhood illnesses and HIV. All of the IMCI components address nutrition directly or
indirectly, and all children coming in contact with the service are evaluated for malnutrition.
All children under two years of age will receive feeding counseling along with other services.
Older children with malnutrition will also receive appropriate counseling on proper feeding
practices.
In addition, the Epidemiology and Diseases Control Department of the Ministry of
Health has launched a strategy for ensuring the availability of Insecticide Treated Nets (ITNs)
through targeted subsidies as well as free provisions with special focus on pregnant women
and children under five living in prioritized economically and geographically vulnerable
highly malarious areas (MOH 2004c). The delivery of ITNs targeted to pregnant women will
be through public health facilities and community based distribution (including attendance of
ANC clinics, community health workers. enhanced outreach activities, immunization
campaigns, etc). Re-treatment of nets to the vulnerable groups in targeted areas will be free of
charge. The other objectives of the ITN strategy include ensuring their availability through the
private sector at affordable prices and encouraging enterprises for their local production. As
malaria contributes significantly to the burden of anemia in Ethiopia, the ITN strategy will
provide important nutritional benefits.
As part of the community component of the IMCI, baseline surveys and focus group
discussions have been conducted. From this research, sixteen key family and household
practices relevant to child health and nutrition have been identified. These are presented in
Box 5.1. Health promoters, also known as community resource persons, have been identified
to provide house-to-house health education on selected key behaviors.
141