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

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Table 6.6: (continued) Agency Intervention Nutrition Unit, Family Health Department, Ministry of Health Micronutrient deficiency control Timeframe since 1995 Main areas Objectives Activities Vitamin A, Iodine, Iron Eliminate micronutrient deficiencies • Currently conducting baseline survey on the three micronutrient deficiencies. • Vitamin A capsule distribution as part of EPI+. Post-partum supplementation within 45 days from delivery. Child (6-59 months) supplementation campaigns twice a year (June and October). Vitamin A food fortification (in stand-by) Assessments conducted to identify most effective food vehicle. Production machineries and fortificants procured (UNICEF). One sugar factory selected for pilot. Diet diversification: IEC brochures and advocacy meetings. Information on Vitamin A included in the HEP training module on nutrition. • Iron: iron/folic supplementation. • Salt iodization: plans underway, 10 machines for fortification (mid-level capacity) distributed to factories and training conducted (in Afar with investors association). Iodization has started. However, producers complain about market – fear of not covering costs. NGOs have offered to buy production. Big producers are ready to start fortification in September 2005. Target Children under 5 Sites Vitamin A supplementation is in all of Amhara. This will be extended to Oromia in September 2005. Roles definition Health personnel (facility-based and Health Extension Agents) Partners Training Tools developed Challenges USAID, UNICEF, MOST (USAID program). National micronutrient committee includes membership of Ministry of Trade, Ministry of Mines, universities, Ethiopian Quality and Standards Authority, UN agencies, NGOs. EHNI (quality control) and food factories (and their research centers) trained in Guatemala. National micronutrition control guidelines for Vitamin A, iodine, and iron. • Vitamin A supplementation: EPI+ covers under-ones, while Vitamin A supplementation targets under-fives. More outreach strategies are needed. • High rickets prevalence, but vitamin D is not included in strategy. • Salt iodization: Until 1992, iodized salt was available through Eritrea. Now using Djibouti salt, which is not totally iodized. Sustainability Vitamin A fortification: There is no legislation to oblige producers to fortify the foods they produce. More legislation and advocacy is needed. Lessons learnt • Sugar identified as most effective food vehicle for Vitamin A supplementation, due to centralized state-owned production, so it is easier to plan/coordinate/supervise. • Poor understanding on food fortification • Concerns were raised on costs of fortification of sugar ($0.02/kg) and on consumption (a CSA report mentioned that only 50 percent pop especially in urban areas consume sugar) so advocacy was conducted by Ministry of Health. • Health Extension Package (HEP) has been identified as most cost-effective delivery strategy for Vitamin A supplementation. 172
Table 6.6: (continued) Agency Intervention Timeframe Main areas Objectives Activities Family Health Department, Ministry of Health Integrated Management of Childhood Illnesses (IMCI) and Community-IMCI (C-IMCI) since 2002 (C-IMCI) Treatment Reduce morbidity and mortality from common childhood diseases • C-IMCI piloting in two woredas (Wukro in Tigray and Dabat in Amhara). • Sick child consultation: training of Health workers to assess common illnesses. • Severe malnutrition cases are referred for appropriate treatment. • Feeding counseling and routine vitamin A supplementation. Target Children under 5 Sites IMCI: 10 woredas. C-IMCI: 2 woredas Roles definition One trained IMCI worker for every 20 households, IMCI workers will receive regular refresher courses. Partners Training Tools developed Challenges UNICEF, WHO Initial and refresher training. IMCI expansion strategy based on training. Training manual • An evaluation of nutrition activities in health centers found that those who receive IMCI training are not those who directly work on child health • In-service training is 2 weeks long. This requires time and additional costs. Problems with government financial regulations have emerged. Training has not been adequate. • IMCI training targets diploma health workers. Available training material is not usable for lower level health workers. Materials now being adapted. • Remote areas have little assistance. Embarking more now on in-service training. Sustainability Voluntary work, selected by community. Selection process is slow, then trained. Monthly reports, mobilize communities on vaccination and water and sanitation activities. Lessons learnt • Considered a success story: indicators have improved, now in an expansion-planning phase. Trained 550 community resource people, now trying to scale up. • C-IMCI: baseline survey and focus group discussions have been completed on child health in order to design interventions. Twenty family and household practices relevant for child health have been identified and appropriate messages developed. 173
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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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• Enhance women’s capacity for
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Table 4.4: Analysis of care conside
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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
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Page 179 and 180: 6.2. Challenges and Lessons Learnt
Page 181 and 182: Training Post-secondary training is
Page 183: Table 6.6: (continued) Agency Inter
Page 187 and 188: 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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