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

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The interventions that make up this “essential package” for nutrition are relatively inexpensive and proven to be effective in a range of different settings. They need to be incorporated into both child and maternal health services within the primary health care framework. To date, only a limited number of health facilities and health personnel in Ethiopia have been involved with implementation of ENA. Thus, the effectiveness or costeffectiveness of ENA in the Ethiopian setting is yet to be evaluated. 5.2.4. Nutrition in emergencies The DPPC along with its regional bureaus and district offices are the principal bodies for coordinating health, nutrition, and other interventions during nutritional emergencies within their respective localities. USAID, WFP, and other bilateral and international organizations play an active role in generating surveillance information through the Famine Emergency Warning System (FEWS) and in the provision of food aid and other commodities. The extent of involvement of local health offices and bureaus is largely limited to the provision of curative and preventive health services. Supplementary feeding programs and therapeutic feeding centers are often established and run by NGOs with little involvement or integration with the local health authorities. Likewise, documentation, recording, and reporting activities are rarely channeled to local health offices or to the MOH. Thus, the information and experience of such intervention activities fails to be shared with the health sector. This will further compromise the potential of the health sector to be actively involved in the analysis of nutrition emergencies and in the planning and implementation of nutrition interventions during emergencies. There is an apparent shift of balance by the government in favor of ensuring food security rather than an integrated approach towards ensuring good nutrition for the nation. This is reflected by the levels of attention and resources devoted to the food security program and the policy commitment towards it. While the country has never had a food and nutrition policy, it has had a food security strategy for some time. Nutrition emergency interventions are traditionally limited to the provision of food items and some other commodities. The need for providing appropriate nutritional care for mothers and children in particular, along with the provision of health and sanitation facilities is often considered secondary. This bias is partly revealed in the composition of emergency response teams, which rarely include expertise in the area of health. The protection and promotion of breastfeeding and appropriate infant and young child health and feeding practices are commonly undermined during nutrition emergencies, as both the donors and beneficiary populations focus mainly on food aid. Mothers tend to substitute breastfeeding with the meals and flours that they receive as part of the food aid intervention. However, there have been some encouraging progresses in recent years. Health teams from professional health training institutions have been mobilized along with food aid organizations to serve drought-affected populations in the provision of preventive and curative health services, as well as establishment of water and sanitation facilities. Similarly, in connection with resettlement programs underway in the country, the necessary infrastructure, including water and health facilities, are built prior to deployment of settlers into a new environment. Although the parallel deployment of health professionals in drought and famine interventions could have considerable advantages, there is a need for close communication and integration between the various actors in such settings. The best way to ensure that the care and health aspects of nutrition interventions are properly addressed would be to build-in such interventions in the design of emergency interventions, rather than through a parallel deployment of teams with different expertise. As depicted in the conceptual framework on the causes of malnutrition in Figure 1.2, food security is but one of the three groups of underlying 144
factors needed for proper nutrition. Food security is an essentia l component of the food-carehealth triad, but not sufficient on its own to ensure proper nutrition. Moreover, unless food security strategies are well coordinated with the other nutrition interventions, it is likely that some of such strategies may compete with the care and health objectives. For instance, engaging women in labor-intensive food security activities may put excessive demands on their time and energy requirements. Women’s time is an importance resource needed for providing care for the women themselves and for their children. Women contribute to a significant proportion of the agricultural labor in developing countries. They provide care to their children and the family; seek preventive and curative health services; and utilize water and sanitation facilities. It is obvious that women bear excessive productive responsibilities, both at home and in the field, on top of their reproductive demands. These facts signify the central importance of the care and health aspects of nutrition interventions under emergency conditions. Balanced and coordinated efforts are needed to meet the ultimate goal of improved health and nutritional wellbeing for mothers, children, and the society at large. Finally, with regard to food security interventions, the Ministry of Agriculture has established a technical taskforce, comprising the Food Security Coordination Bureau and concerned international organizations, to coordinate trainings in Community-Based Public Works and Watershed Planning for the Productive Safety Nets Program (PSNP). The objective of this taskforce, among other things, is to contribute towards the achievement of food security. 5.2.5. Micronutrient malnutrition Micronutrient deficiencies are among the nutritional problems of public health importance in Ethiopia. Vitamin A, iron, and iodine deficiencies significantly contribute to the burden of morbidity and mortality and hinder socio-economic development. Other micronutrient deficiencies such as zinc, vitamin B, and folate are also known to have ill health consequences (MOH 2004b). Currently, the MOH is conducting a nationwide micronutrient status survey with the assistance of UNICEF and other bilateral and multilateral organizations. To date, however, data on the scale of the micronutrient problem in the country come from limited pocket studies. It is estimated that about 27 percent of the children under five in Ethiopia suffer from sub-clinical vitamin A deficiency, which increases their risk of morbidity and mortality. UNICEF and the MICAH nutrition project coordinated by the international NGO, World Vision, have reported vitamin A deficiency (Bitot’s spots) levels in parts of the country to be forty fold higher than the 0.5 percent prevalence level that signifies a problem of public health importance. An earlier study by the former Ethiopian Nutrition Institute (ENI) reported that 26 percent of the population had goiter and 62 percent were at risk of iodine deficiency disorders. Some parts of the country had goiter rates varying from 50 percent to 95 percent with estimates that one person out of every 1000 people is affected and about 50,000 prenatal deaths occur yearly due to iodine deficiency disorders. The MICAH project reported a 42.2 percent goiter prevalence rate in four regions of the country in 1997, which in 2000 decreased to 28.6 percent after the project intervention. On the other hand, only 28 percent of households with children use salt with adequate iodine to prevent iodine deficiency disorders. Studies on the prevalence of iron deficiency anemia in Ethiopia are very limited and localized, thus it is difficult to estimate the nationwide prevalence. Data from some regions of the country indicated anemia prevalence of 16 percent among women in the reproductive age group and 42 percent among children 6-60 months of age. International organizations and national governments have repeatedly expressed their commitment to eliminate micronutrient deficiencies. In this regard, the World Summit for Children (1990), and the International Conference on Nutrition (1992) are notable. The Ethiopian government has also reiterated its commitment in the main global summits and 145
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An assessment of the causes of maln
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• Bantirgu Hailemariam coordinate
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3.4. National and Regional Trends:
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LIST OF TABLES Table 2.1: Child stu
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LIST OF ACRONYMS ADLI AGOA AIDS BCC
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Figure 1.1: Stunting among children
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these underlying determinants of th
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experimental body of evidence that
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water can have significant impact o
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2.1. Introduction In the early 1960
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violating the basic tenets presente
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Table 2.3: Regional profile of stun
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A rich food through popularization
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key tenet in the process of identif
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Basic Causes Major Features High im
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commodity trading is the most signi
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Table 2.9: Gross primary enrollment
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following and in alliance with the
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• Accept that agricultural develo
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the other practices that need to be
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CHAPTER 3: FOOD SECURITY AND MALNUT
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Afar in 2000 was 12.6 percent and 5
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3.1. Introduction The economic grow
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In a more technical way, it is diff
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differently, it is important to acc
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households will not be as difficult
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the drought prone areas, the rain f
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insecure, these activities will als
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viewed as a proxy for household foo
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Figure 3.3: Per capita food product
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Intermediate means of transport suc
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educated, environmentally conscious
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1995-96 revealed that ‘the greate
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works are key instruments to lay do
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due to inappropriate land mismanage
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3.6.3.5. HIV/AIDS This disease is w
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coordinates the different implement
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conception through early pregnancy
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households who depend on purchased
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• Improve rural radio infrastruct
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3.7.3.6. Improve rural market infra
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CHAPTER 4: CARE AND MALNUTRITION IN
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household allocation; 5) workload a
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lack of national nutrition strategy
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children between 6 and 24 months. T
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Care was recognized as one of the u
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Figure 4.1: Risk of death in infant
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Table 4.2: Present discount values
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Figure 4.3: Factors that affect the
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Box 4.2: Reasons why PLWHA are vuln
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Page 115 and 116: Figure 4.13: Prevalence of stunting
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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
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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
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Page 139 and 140: Figure 4.17: Community based nutrit
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Page 144 and 145: supplies. The available facilities
Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
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Page 162 and 163: Table 5.1: Prevalence of diarrhea a
Page 164 and 165: Figure 5.3: Trends in latrine cover
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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 203 and 204: Achievements Challenges Sustainabil
Page 205 and 206: Berhane G. 1995. Nutrition surveill
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Ethiopian PROFILES Team & AED/Linka
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Middlebrook, P. 2002. Social protec
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Raisin, J. 2001b. Improving food se
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Yamano, T., H. Alderman, & L. Chris
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