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

een established at the Federal level, though it has not been institutionalized at the lower
levels of the health system.
In addition to the components in HSDP-I, the main emphasis of HSDP-II, the formal
evaluation of which is still pending, was the accelerated expansion of primary health care
facilities (2004-08). This aims to accelerate physical infrastructure expansion as a base for
improving and expanding basic health care services to rural Ethiopia and enhance the health
care system inputs towards the achievement of the MDGs (MOH 2005b).
During the preparation of HSDP-III, the responsibility of making adequate nutrition
available to the population has been considered as being the role of the Agricultural and Rural
Development Sector (MOH 2005c). The Health Sector’s role in this regard has been defined
to be enhancing good nutritional practice through health education and treatment of severely
malnourished children, in addition to the prevention of nutritional health problems through
provision of micronutrients to the vulnerable group of the population (mothers and children).
The Federal Ministry of Health has developed a guideline for what Essential Nutrition
Actions (ENA) should be taken in the health as well as the other key sectors (such as
agriculture) that impact nutrition. Accordingly, in addition to agricultural sector interventions
to address overall food security, health sector actions to address malnutrition need to focus on
infant feeding as well as nutritional improvements for adolescent girls and women of
reproductive age.
The key interventions for addressing the problems of malnutrition that are outlined
within the Child Survival Strategy are categorized into preventive and promotive and are
targeted towards dealing with specific maternal and child health problems (MOH 2004e).
These include measures targeting pneumonia, neonatal conditions such as low-birth weight,
sepsis and asphyxia, diarrhea, and malnutrition in general.
More specifically, the Child Survival Strategy has also outlined the detailed nutrition
related activities to be performed at each of the various levels of health institutions.
Accordingly, health extension workers are expected to promote exclusive breastfeeding,
improved family practices on complementary feeding, assess and monitor the feeding of
children, carry out growth monitoring and nutritional advice, and provide and record Vitamin
A supplements to children at six-monthly intervals from the age of six months to 59 months.
This may be done through EPI or other child health outreach or through twice-yearly
dedicated outreach programs.
At the Primary Health Care level, the health sector intervention with regard to
nutrition is the package of services referred to as Essential Nutrition Action (ENA) that is
designed as integral part of the Child Survival interventions. The ENA focuses on promoting
seven clusters of nutrition behaviors that have been empirically proven to reduce morbidity
and mortality. Health Centers are expected to promote exclusive breastfeeding through
antenatal and postnatal care, provide feeding assessment, supervise and support community
and health post staff in all aspects of nutrition, and provide practical basic training and
continuing support for HEWs in nutritional assessment and advice. Additionally, health centre
staff is to provide IMCI and ENA training for Health Centre staff, support the community
outreach sessions, provide Vitamin A supplementation through EPI and other child contacts,
and promote exclusive breastfeeding through antenatal and postnatal care.
District hospitals, on the other hand, are expected to promote exclusive breastfeeding
through antenatal and postnatal care, fulfill requirements for the Baby Friendly Hospital
Initiative, provide HEW training, and provide IMCI and ENA training for Health Centre staff.
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