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

More documents

Recommendations

Info

with the engineering aspect of water development. Proper site selection, prevention of cross contaminations, and hygiene education to sustain the use and maintenance of water schemes are cross cutting issues, but mainly overseen by MOH. There is a general understanding that small-scale latrine development is mandated to MOH, while large-scale sewerage activities are handled by the MoWR. The water sector development program of the SDPRP consists of various programs and projects grouped into water supply and sanitation, irrigation, hydropower, etc. The priorities for this program include making clean drinking water available to larger segments of the society, including for sanitation purposes; for livestock in critical areas such as the nomadic areas; expanding irrigated agriculture to the maximum possible extent; meeting hydropower generation capacity needs arising from electricity demand in the economic and social sectors; providing water for the industrial development; and utilization of the resource for fishery, tourism and transportation purposes. According to the targets of the program, water supply coverage of urban, rural, and national was expected to reach at 82.5 percent, 31.4 percent and 39.4 percent, respectively, by the end of 2005 (MOFED 2002). 5.3.3. Does nutrition explicitly feature in justifying resource allocations within the sector? 5.3.3.1. Conceptual framework: malnutrition and sanitation Inadequate sanitation in a household is not always directly related to malnutrition and disease. A number of intervening factors interact with poor sanitation to determine the health status of under-fives. Based on national data on environmental health, the framework presented in Figure 5.1 can be used to relate sanitation, communicable diseases, and Figure 5.1: Framework for the determinants of sanitation in Ethiopia Background factors: Social Economical Cultural Physical Institutional: Responsibilities Coordination Integration Policies, Regulations Organizational behavior Background factors Environmental: toilet facilities, hygiene, waste management, water, housing Personal: education, occupation, residence Behavioralhygiene: Community Individual Underlying factors Communicable diseases; diarrhea, etc. Malnutrition Immediate factors 148
malnutrition. Sanitary conditions, behavioral factors related to sanitation, and the individual personal characteristics affecting the knowledge, attitudes, and practices of caregivers represent the underlying (or proximate) factors, while the overall socio-economic development and institutional arrangements are background factors on which the proximate and immediate factors operate. Environmental determinants – type of housing, number of rooms, whether animals are kept inside a sleeping room, presence of a latrine, type of water source, waste management, and the distance to water sources – were found to have a significant association with childhood diarrhea in a bi-variate analysis. Method of water drawing and residence remained as important predictors of diarrhea after including socioeconomic and behavioral factors in a multivariate analysis (Teklu 2003). Using a hierarchal model approach to a multivariate analysis of DHS data, it was found out that latrine and childhood diarrhea were powerful predictors of malnutrition among under-five children (Shrimpton 2002). However, to be effective, multiple approaches to sanitation should be utilized to reduce the sanitation-related disease burden (Esrey 1991). Educating mothers alone will not bring major changes in the prevalence of child malnutrition in Ethiopia, suggesting the importance of additional strategies like water supply and sanitation (Save the Children Fund UK 2003). A careful review of data in 63 developing countries that achieved a total reduction of at least 5 percent in malnutrition over the period of 1970-1995, indicated that improvements in the health environment (measured by access to safe water) contributed a 19.3 percent reduction in malnutrition. Other basic factors that contributed to this reduction included women’s education (43.0 percent reduction), improvements in per capita food availability (26.2 percent), and improvements in women’s status (11.6 percent). 5.3.3.2. Link between poor sanitation and malnutrition Communicable diseases, malnutrition, and poor sanitation are leading causes of morbidity and mortality in Ethiopia (Kloos & Zein 1993; MOH 1998). Respiratory infections, diarrheal diseases, skin and eye infections are among the top ten leading causes of morbidity in Ethiopia (MOH 2005a). These diseases are related to the prevailing poor access to safe and adequate sanitation under the background of existing poverty, low educational status, and undesirable socio-cultural practices. The link between infections and malnutrition is apparent under conditions where poor sanitation prevails. Existing data indicate that about 75 percent of the causes of outpatient visits are largely due to lack of basic sanitation (MOH 1985). Lack of access to safe drinking water, inadequate latrine provisions, poor housing, and unhygienic behavior are the major environmental factors for the transmission of commonly observed diseases in Ethiopia, in particular among the rural population. Environmental factors act as a proxy determinant for million deaths of children in many developing countries, including Ethiopia. In one rural area of Ethiopia, Butajira, poor housing, as measured by poor hygiene, crowding, and lack of a window, was found to be closely related with under-five mortality (Shamebo et al. 1993). ARI, measles, diarrhea, and malnutrition were found to be the leading causes of morbidity in under-five children in the same study area. Diarrheal disease among under-five children is one known outcome indicator of the lack of basic sanitation. The diarrheal outcome is widely used for the evaluation of poor hygiene, as it is a basic predictor of the disease. Children are sensitive to diarrhea, and diarrhea is easily detected by the caregiver. As shown in Table 5.1, data indicates that the two weeks prevalence of diarrhea did not show much change over the last two decades in Ethiopia. The incidence of episodes of diarrhea for under-five children was estimated to be 4 to 7 per child per annum. It is not difficult to imagine how the nutritional status of a child is severely damaged with such multiple episodes. Children with failure of nutritional status are likely to have diarrhea because of the declined resistance to infections (Nandy et al. 2005). 149
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 150 and 151: Integrating nutrition interventions
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 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 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 ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?