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

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efore a broader set of programs proposed under the NNS can achieve success and substantial, sustained reductions in the prevalence of malnutrition are achieved in Ethiopia. Table 6.5: Lessons learned from past and current efforts to reduce malnutrition in Ethiopia. Integration and focus on nutrition Institutional framework Multisectoriality Communitybased action Implementing agencies Integrated and nutrition-focused interventions result in impact on household-level nutritional status. Conversely, fragmented interventions have limited or no impact relative to the investment necessary to implement them. A coordination mechanism is necessary to create and sustain synergy across sectors and coordination among actors. However, this should be done through relatively simple and flexible procedures. No single sector can comprehensively address all nutrition needs. Nutrition interventions need to be integrated across health, agriculture, education, infrastructure, and several other sectors and agencies. In particular, nutrition should not be “medicalized”, as this will provide only a partial response to the problem and res ult in limited impact. Multi-sectoral approaches are needed to enable simultaneous efforts to address the health, caring, and food security underlying determinants of improved nutrition. Separate vertical programs, while valuable from a limited sectoral perspective, are unlikely to lead to sustainable, significant improvements in nutrition. Services should be brought within the communities through outreach and be implemented by community members. Nutrition action is mostly knowledge-based. Such knowledge should be durably disseminated to improve home-based care. Nutrition programs should be developed based on a context-dependent analysis that identifies the priority problems and their immediate, underlying, and basic causes. Communities should be involved in decision-making, implementation, and oversight of actions, and be empowered through training and poverty-reduction activities. NGOs can implement decentralized nutrition activities. However, an adequate coordination and supervisory framework should be established to provide oversight across the various activities of the NGOs involved. Supervision Any training on nutrition interventions needs to be followed up by on-the-job training or mentoring. Supportive supervision within the health system is also important to ensure that knowledge and skills are translated into improved service delivery. Child growth promotion Essential Nutrition Actions Child growth monitoring and promotion is a key element to ensure that timely corrective action can be taken to prevent infants and young children from become stunted in their growth, both physically and mentally. Moreover, regular monitoring can be an effective entry point for nutrition education, as well as other public health activities. The ENA approach is accepted by all partners. It is a simple approach that is relatively compatible with the technical capacity in place. Micronutrients Micronutrient interventions should be integrated with food security interventions to a larger degree than is presently the case, including through the development of gardening and livestock and poultry enterprises. Diet diversification activities can make a significant contribution towards the prevention of micronutrient malnutrition. Food aid Food aid can be part of an adequate response to nutrition needs in Ethiopia, especially during drought or other emergencies, as long as its provision is appropriately targeted and implemented. However, food aid should not be perceived as the solution to malnutrition. The focus in this addressing malnutrition in Ethiopia must be on nutrition promotion and growth monitoring, which are less visible but have higher and more sustainable impact than does food aid distribution. Poverty It is essential to target vulnerable groups and link nutrition activities to income generation. Nutrition needs can be addressed through knowledge, but it is critically important that such improvements in knowledge be complemented by increasing food security, improving production, and increasing the available resources and assets in a household in general. 168
Training Post-secondary training is needed to create a critical mass of nutrition professionals in the country. Curative nutrition Therapeutic feeding centers often fail to treat severely malnourished children. Moreover, children at such centers are exposed to new diseases, placing an additional burden on their caregivers. Community therapeutic centers, by contrast, have simple protocols: drugs and dietary treatment. They also allow for the prevision of health education to mothers. Source: Compiled by author. As described in Table 6.5, it is clear that the lessons learned from the many efforts to address malnutrition in Ethiopia, as well as lessons learned from elsewhere, have provided a relatively solid understanding of what needs to be done to sustainably reduce malnutrition. Nutrition can be improved and we know the success factors required. Setting aside much of the technical detail of what must be done to combat malnutrition, among the practical considerations that we can draw from all of this evidence is that people, including people who are poor, must develop themselves. They are key actors in their own development. They must be able to make real choices in doing so. Community-led efforts are critically important. Services should be brought within the communities through outreach and be implemented by community members. Communities should be involved in decision-making and in implementing actions and should be empowered through training and poverty reduction actions. Local leaders should be involved in nutrition activity supervision in order to increase ownership, to promote community participation, and to build an understanding of nutrition as a development problem. However, we should also be cautious of both pure top-down and bottom-up approaches. An appropriate mix of both approaches is required. However, past and current nutrition activities in Ethiopia, while many may have been or are locally successful, have not enjoyed the degree of success that the problem of malnutrition in the country demands. There are important complementarities between nutrition actors, programs, and sectors that must be exploited. Opportunities exist for coordinating, scaling-up, and maximizing outputs from existing programs and investments and extending those activities. These must be fully exploited. The National Nutrition Strategy provides an important element for the promotion of such coordinated direct action and for ensuring that where there are gaps in the interventions undertaken – whether human, financial, or institutional – these gaps are effectively filled in a timely manner. Only if this is done can we expect significant and sustained reductions in the numbers of malnourished people in Ethiopia. 6.3. Detailed Overview of Nutrition Interventions in Ethiopia The set of tables below contains a non-exhaustive of nutrition interventions carried out by the government, international development, agencies, and NGOs in Ethiopia. A summary of some of this information was presented earlier in Table 6.2 and Table 6.3. Here more detail is provided. 169
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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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the direction of the growth curve i
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Figure 4.13: Prevalence of stunting
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from poor exposure of children to l
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4.3.3.4. Response to food security
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4.3.6. Time and energy expenditure
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Table 4.3: Care focused initiatives
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together. This demands an integrate
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In an emergency, therefore, care an
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Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
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Page 150 and 151: Integrating nutrition interventions
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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
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Page 179: 6.2. Challenges and Lessons Learnt
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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