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

the training. This time and financial resources needed for the training have been difficult to
meet. Besides, government financial regulations do not allow for attracting the pediatricians
needed to participate in the training. The lack of appropriate training curriculum for trainee
health workers is another problem encountered. The current curricula are limited to the
training of mid and high-level professionals such as nurses, health officers, and medical
doctors. To date, about 45 percent of the eligible health professionals have been trained in
IMCI. Moreover, the current focus of IMCI training has shifted to the pre-service level in the
health professional training schools and universities of the country.
5.2.3. Essential nutrition actions (ENA)
Various studies indicate that the problem of malnutrition in Ethiopia begins early in
life, primarily during the first 12 months, when growth-faltering takes hold due to sub-optimal
infant feeding practices. Following growth faltering, there is little opportunity for catch-up
growth. Stunted infants grow to be stunted children and stunted adults. The ill effects of
malnutrition are not limited to stunted growth. Mental and cognitive development is also
severely hampered following both protein energy malnutrition and micronutrient deficiencies.
The potential learning capability during school age and working capacity during adulthood
are both reduced because of the nutritional insults suffered in early childhood. Thus, it is
imperative to address issues of infant and young child feeding during the first year of life,
particularly promoting proven optimal breastfeeding practices and complementary feeding
practices, both in healthy as well as sick infants.
The nutritional status of women in Ethiopia is also poor, contributing to the high
levels of low birth weight and consequent child malnutrition, hence establishing an intergenerational
cycle of malnutrition. Thus it is imperative than any action taken to improve
nutrition in Ethiopia focus on infant and child nutrition, as well as on the nutrition of
adolescent girls and women of reproductive health (MOH 2004d).
Although the challenges to improve nutrition in Ethiopia are numerous, there are a set
of essential nutrition actions that, when taken together, can make a difference to the wellbeing
and survival of young children and women of reproductive age. Listed in Box 5.2, the
essential nutrition actions (ENA) represent an action-oriented approach that focuses on
promoting seven clusters of nutrition behaviors that have been empirically proven to reduce
morbidity and mortality. The main beneficiaries of these actions would be infants and young
children under the age of two years, as well as women of reproductive age.
The ENA approach aims to consolidate the existing nutrition activities into a holistic
technical package. Although elements of the ENA are not new, their implementation to date
has been uncoordinated and largely vertical. Therefore, the recent initiative of implementing
ENA through the training of health workers may contribute markedly to improvements in the
delivery of maternal and child health services and, ultimately, to the nutritional health and
well-being of mothers and children.
Box 5.2: Essential Nutrition Actions for Ethiopia
1. Exclusive breastfeeding for six months;
2. Adequate complementary feeding starting at about six months with continued
breastfeeding for two years;
3. Appropriate nutritional care of sick and severely malnourished children;
4. Adequate and appropriate nutrition for women;
5. Adequate intake of vitamin A for women and children;
6. Adequate intake of iron for women and children;
7. Adequate intake of iodine by all members of the household.
Source: Guyon & Quinn 2004.
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