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

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Table 6.6: (continued) Agency Intervention Status Timeframe Main areas Objectives Activities Target Sites Goal Community Therapeutic Center (CTC) Active From 2005 until 2006 (as of now). CTC operational since activities recently. Treatment of severe acute malnutrition • Creating local capacity to manage severe acute malnutrition using existing health institutions. • Prevent and treat acute malnutrition. • Blanket supplementary feeding – under-fives population, regardless of screening outcome plus all pregnant and lactating women. • Capacity building in Ministry of Health at woreda level. • Nutrition education. • Home-based treatment: therapeutic feeding and essential drugs (antibiotics, deworming, folic acid, anti-malarial) Under-fives, pregnant and lactating women. SNNP (Awasa Zuria woreda); Affar (Abala woreda). One more planned in Oromiya, under assessment. Coverage rotational system: NGO implements & builds capacity, then moves to another woreda, around 10 months in each area. Handing over and phasing out depends on capacity. Roles definition • Nurses - physical examination, drug distribution, counseling, verification of admission or discharge criteria. • Public health officers, health assistants, and front line health workers – screening for malnutrition based on weight and height, health and nutrition. Partners Training Tools developed Achievements Challenges Sustainability MOH (federal – MCH dept, regional – MCH, woreda – Head of the Health bureau), UNICEF, WFP, DPPC. At Community Therapeutic Center setting up training provided for 2 days. Topics include basic nutrition, anthropometry, CTC protocols, social mobilization, and defaulter tracing. Participants in the training include nurses, public health officers, health assistants, child health assistants, community nutrition volunteers, and other front-line staff. Community Therapeutic Center protocol, health, and nutrition messages. 400 severely malnourished children admitted in 5 sites. Trained -30 medium level health personnel, 40 grass root level health workers , 400 volunteer health workers • Lack of clear commitment by a government sector. Still no clear mandate for nutrition. Policy gaps. Lack of commitment to nutrition from federal to village levels. • Lack of funding, as a result remains a small-scale intervention. Need trained health workers at grassroots level. Sustainable because capacity is created at grassroots level. Expectation is that health institutions will take over services within their existing primary service delivery systems. Lessons learnt Therapeutic Feeding Centers have failed to treat severely malnourished children. Moreover, TFCs place children at increased risk of infection, increasing the healthcare burden on households. CTCs have simple protocols: drugs and dietary treatment. Health education is included to prevent a relapse into malnutrition through mother-to-mother training. CTC is based on early detection, thereby limiting potentially severe malnutrition. 182
Table 6.6: (continued) Agency Intervention Status Linkages Essential Nutrition Actions active Timeframe since 2003 Main areas Objectives Activities Target Sites Nutrition promotion Improve nutritional status Based on 6 contact points with health services and 7 proven behaviors: The 7 behaviors are: optimal breastfeeding, complementary feeding, feeding during illness, women’s nutrition, Vitamin A deficiency control, anemia control, and iodine deficiency disorders control. Linkages has developed ENA-focused lesson plans and curricula for Addis Ababa, Jimma, Gondar, Alemaya, Awasa, Mekelle, and the Defense Universities. Children under 2, adolescent girls, pregnant and lactating women As per partners ’ sites Roles definition N/A Partners Training Tools developed Achievements Challenges Sustainability Ministry of Health, Food Security Bureau of Ministry of Agriculture and Rural Development (Child growth monitoring component of Food Security Project). MOARD/Pastoral department, NGOs, UNICEF. Five modules: • Decision-making for managers ; • Advocacy; • Behavior Change Communication; • Infant feeding in HIV; and • Lactation m anagement. Trained MOH staff – program managers only at federal level, Family Health Program Managers, i.e. MCH and EPI, in all regions , except Affar and Somali Regions, Health Extension Agents training is planned. Child Growth Promotion animators , under the Food Security Project, is planned. Extension workers of MOARD/Pastoral Department, Training of Trainers with NGO partners, UNICEF, professors from Public Health, pediatrics , Obstetrics -Gynecology, and paramedics . Information, Education, and Communication: posters, audio programs, flip charts for use by academia, teaching institutes, government agencies, NGOs. Curricula standardization – The Ministry of Health adopted, in collaboration with the medical universities, national guidelines on Infant and Young Child Feeding. Monitoring & evaluation tool developed. This is currently being finalized. N/A Limited information on partners ’ implementation of ENA Limited reflection, as have focused on developing tools until now. Need now to assess options for sustainability. Lessons learnt • Lack of coordination in nutrition actions . • Need to create a critical mass of trained personnel. • ENA approach is accepted by all partners . ENA is a very simple approach, addressing available technical capacity and is of use for advocacy and IEC efforts. 183
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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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Sector/ Office Strength Weakness Op
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International initiative Strengths
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• Rate of continued breastfeeding
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Figure 4.17: Community based nutrit
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There is a strong need for enhancin
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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 156 and 157: The interventions that make up this
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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
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 193: 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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