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

More documents

Recommendations

Info

experimental body of evidence that both iodine and iron supplementation or fortification provides economic benefits more than 100 times the cost of the interventions. Similarly, the benefit-to-cost ratio for vitamin A programs is estimated to be more than 40 to one (Behrman et al. 2004). Recently a panel of economists including three Nobel laureates was asked to rank the expected rate of return of 17 possible development investments covering education, health, water and sanitation, trade reform, private sector deregulation and also including nutrition. By this committee’s consensus, only addressing HIV/AIDS was considered as effective an intervention as addressing micronutrient deficiencies. Programs to address child stunting were also ranked as highly effective in economic terms. Few development investments exceed the returns offered from those that accrue from tackling malnutrition. Moreover, the intervention that was deemed to have the highest rate of return – combating HIV/AIDS – has a strong tie with investments in nutrition. Nutrition affects HIV/AIDS since nutritional status will influence the progression of the disease. Conversely, HIV/AIDS adds to the problem of hunger and malnutrition directly by reducing the income and food security of affected households and by interfering with the intergenerational transmission of agricultural skills. In addition, young orphans and children with chronically ill caregivers risk higher rates of malnutrition. HIV also imposes a dilemma in assessing the increased risks of breastfeeding against the risks of not breastfeeding and, therefore, makes the need for proper nutritional education all the more pressing. In addressing malnutrition in society, two nutritionally vulnerable groups should be targeted especially - children under two years of age and pregnant and lactating women. This reflects a coinciding of both biological and economic considerations. In most low-income countries, including Ethiopia, growth faltering begins in the first six months of life; age specific malnutrition rates generally increase until about two years of age and then level off (Shrimpton et al. 2001). Rarely does a child who is stunted at age two catch up more than a portion of the gap from international standards – to a large degree, the stunting is permanent. Thus, the window of opportunity to prevent malnutrition is relatively narrow. This vulnerable age bracket is also the time of peak risk of child mortality, as well as the time that a child’s brain is growing most rapidly. Preventing malnutrition at this age can avoid comparatively ineffective later attempts to reverse health and cognitive impairment. Pregnancy is also a period of higher risk and, correspondingly, a time that preventative measures can be most effective. In particular, folate or iodine deficiency in early pregnancy can cause irreversible defects for the child. Similarly, iron deficiency anemia increases the risk of maternal mortality and of low birthweight babies. High-energy outlay or low food intake in the third trimester of pregnancy can also lead to low birthweight. Prioritization of programs to address the needs of mothers can lead to substantially higher returns to investments. For example, while on a global basis the benefits of reducing iron deficiency is in the range of $40-50 per capita they are $82-$140 per pregnant woman (Behrman et al. 2004). In the former case, the majority of the benefits come from increased productivity stemming from increased work capacity for all age groups as well as a lesser amount from improved learning. In the latter case, the benefits come largely from improved birth outcomes including – but not limited to – reductions in low birthweight births. Not only does failure to address the nutritional needs of pregnant women and very young children generally leads to lasting consequences for a child, these transmit over generations. Firstly, this is because, as mentioned, malnourished children later in life will earn less on average than their well nourished neighbors and, therefore, have fewer resources to provide their children. Secondly, women who were malnourished as children have a higher risk of adverse pregnancy outcomes when they become mothers (Ramakrishnan et al. 1999). Moreover, these women are more likely to give birth to infants with low birthweight who thus will face the effects of malnutrition diminishing their potential from the day they are born. This process is shown in the diagram in Figure 1.3. 6
Figure 1.3: Intergenerational link of malnutrition. Inadequate food, health, & care Reduced physical labor capacity, lower educational attainment, restricted economic potential, shortened life expectancy OLDER PEOPLE Malnourished Reduced capacity to care for child Inadequate infant nutrition WOMAN Malnourished PREGNANCY Low weight gain Higher mortality rate BABY Low Birthweight Inadequate fetal nutrition Impaired mental development ADOLESCENT Stunted Inadequate catch-up growth Increased risk of adult chronic disease Untimely / inadequate feeding CHILD Stunted Frequent infections Inadequate food, health, & care Reduced mental capacity Inadequate food, health, & care Higher maternal mortality Inadequate food, health, & care Reduced physical labor capacity, lower educational attainment Source: ACC/SCN-IFPRI, 2000 1.2.3. Will robust economic growth reduce malnutrition? Economic growth does lead to reduced malnutrition. This has been shown with crosscountry studies as well as comparisons of nutrition among different income groups within countries in every continent. Ethiopia is no exception to the global pattern. However, the rate of improvement with income growth is moderate. It is estimated that 2.5 percent per capita income growth in Ethiopia for 15 years will only reduce malnutrition by 3 or 4 percent (Christiaensen & Alderman 2004). Of course, higher rates of income growth will make even greater inroads into malnutrition, but globally, in the absence of specific programs, malnutrition tends to decline at half the rate that income grows. Thus, it would take a doubling of per capita income to bring the malnutrition rate down to 30 percent. Looking at this from another perspective, given the impact of malnutrition on health and productivity, poor nutrition is an obstacle to accelerated income growth. Moreover, failure to address malnutrition places a long-term drag on the entire economy. If malnutrition is not addressed in early childhood, subsequent interventions or economic prosperity, at best, will only partially reverse the consequences. On a global average, poverty incidence falls at twice the rate that an economy grows (Ravallion 2001). Thus, an economic growth rate of 10 percent would lead to an expected 5 percent decline in rates of malnutrition, but might achieve a 20 percent decline in poverty. One possible reason for the differences in the rates of decline of malnutrition compared to income poverty is that poverty reduction measures growth in private consumption which closely tracks national income growth. In contrast, improvements in malnutrition are induced by public expenditures as much as they are affected by private consumption, even food consumption. For example, it is well known that improved sanitation and access to clean 7
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 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 160 and 161:
with the engineering aspect of wate
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 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
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?