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

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Figure 5.3: Trends in latrine coverage in Ethiopia, 1970 – 2002. Coverage, % 80 70 60 50 40 30 20 10 0 Urban National Rural 1965 1970 1975 1980 1985 1990 1995 2000 2005 person per day for the country as a whole. The minimum guidelines for the provision of safe water are to have basic access to at least 20 liter per person per day when the water source is within 100 to 1000 m of the residence, and 50 liters if the water source is within 100 m of the residence. Clearly, the water consumption of most Ethiopians does not meet these minimum targets. The geographical proximity of drinking water sources is a key factor in determining the amount of drinking water a household consumes. National data for Ethiopia indicates that about 64 percent of the rural population has access within 1 km from any source of water, while only 4 percent had to fetch water from more than 5 km away. The 2000 DHS of Ethiopia indicated 53 percent of urban households, 21 percent of rural households, and 26 percent of all households had access to a safe water sources within less than 15 minutes walking distance. Accessibility for urban centers was found to be less than 200 meters. Although accessibility in rural and urban areas is very different, the average amount of drinking water consumed per day per individual in either location is minimal. The type of water source and preferences, waiting time, service fee, and source functionality could explain the variation in the amount of water collected and consumed. 5.3.3.4. Trends in latrine provision in Ethiopia The indiscriminate contamination of the immediate environment by fecal matter transmits communicable diseases that affect the nutritional status of children. The provision of latrine coverage in Ethiopia is one of the lowest in the world. A time series analysis indicated that the association between time and latrine coverage is very weak to detect any meaningful change in Ethiopia (Figure 5.3). The weakest association was seen for rural areas. The increase rate in the proportion of population coverage in latrine use was less than 0.2 percent per year over the last 30 years at national level. Current latrine coverage for rural, urban, and the country as a whole is 7 percent, 68 percent and 15 percent, respectively. Latrine use coverage is very low with insignificant changes over time when compared to figures for similar countries in East Africa (WHO 2000). 5.3.3.5. Waste management Waste management in its all aspect, whether solid or liquid waste, is very poor in Ethiopia. The situation is much worse in urban areas where a significant amount of waste is produced and improperly handled. Although Addis Ababa and regional state capitals look to be in a better position to access waste management services and infrastructure, there is real concern about the quality of the service. Generally, not more than 5 percent of the entire population has access to organized solid waste collection and disposal. In the capital city, an 152
estimated 65 percent of the city’s solid waste is collected, leaving the rest mainly to pollute the immediate environment. Similar situations exist in urban liquid waste management, although it is worse and sustains ambient water sources pollution. The uncollected waste maintains the continued breeding of disease vectors and is a source of human discomfort due to odor and unsightliness. The situation is a lot worse in crowded areas. Fly breeding is intense in areas where proper waste collection is not performed. Flies, which feed on filth such as cow dung, are mechanical transmitters of diseases such as diarrhea and eye infections. Flies alone in Ethiopia are the major contributor to the transmission of filth-borne diseases such as typhoid fever, dysentery, shigellosis, and many other diarrheal related diseases. One study found that a reduction of the fly population by 64 percent resulted in a reduction of 42 percent in clinic visits for diarrhea and an 85 percent reduction in shigellosis (Cohen et al. 1991). Flies, in the continued presence of poor waste management and household hygiene practice, make a difference in the outcome of infections that affect the nutritional status of under-fives. 5.3.4. Knowledge, attitudes and practices towards sanitation UNICEF, in collaboration with the MOH, conducted studies in 1997 on the knowledge, attitudes, and practices (KAP) on water supply, environmental sanitation, and hygiene education in selected woredas that were involved in the Woreda Integrated Basic Services (WIBS) since 1990. The findings indicate that respondents’ general KAPs were very poor. More than 60 percent of respondents in most rural woredas did not know that diseases could be transmitted through human excreta; 30-75 percent of respondents did not know that diseases are associated with drinking water; and 23 to 87 percent of respondents did not know any method of treatment for drinking water. These findings confirm the prevailing mass ignorance and apparent lack of impact of health education programs in the country, programs that have been active since the establishment of the first Training Institute in Gondar in 1954. Household water handling practice is another major factor that determines possible contamination of drinking water. The rural population uses traditional pots (“Insra”) for the collection and storage of drinking water with an average size of 15-20 liters (Mengistu & Gebre-Emanuel 1992). The proportion of households that covered their stored water was 57 percent, while the proportion using a poured water collection method was 88 percent in a rural study on the determinants of diarrhea. The same study indicated that the method of drawing water from household water containers and its covering status affect the prevalence of diarrhea. Some NGOs promote water handling in 20-25 liter “Jericans” which have a smaller mouth as a means of proper storage that avoids the contamination of drinking cups. The Demographic and Health Survey of Ethiopia in 2000 indicated that the presence of sanitation management infrastructures, such as safe water and latrine, did not alone make a marked difference in the prevalence of diarrheal diseases. This is evidence that factors like sanitation behavior play a decisive role in disease transmission. 5.3.5. Sustainable issues in sanitation development in Ethiopia Human resource development, the institutional framework in sanitation, and the level and use of available resources are the major factors that determine the effectiveness of the provision of environmental services. The traditional health cadres in environmental health, the sanitarians, have played key roles in the promotion of sanitation in both urban and rural areas of Ethiopia. However, these trained cadres have grown so slowly to the extent that their effort have not been sufficiently productive to contribute to the public control of communicable diseases, such as diarrhea, through the provision of improved water supplies and sanitation. The Federal Government of Ethiopia now plans to train and utilize environmental health technicians and Health Extension Package health cadres in order to increase the number of professionals working on water and sanitation activities. 153
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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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Figure 4.7: Risk of mother to child
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arely provide this kind of benefit.
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Figure 4.8: The extended model of c
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4.3.1.2. Recognizing symptoms of il
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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 160 and 161: with the engineering aspect of wate
Page 162 and 163: Table 5.1: Prevalence of diarrhea a
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
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