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

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Table 6.6: (continued) Agency Intervention Status World Vision Micronutrient and Health (MICAH) project Ending Timeframe Since 1998. Two phases: 1998-2002 and 2003-2005 Main areas Objectives Activities Target Sites Reduce prevalence of micronutrient deficiencies; prevention and treatment of malaria, anemia, and intestinal worms; IMCI. • Reduce prevalence of micronutrient deficiencies through integrated access to and intake of micronutrients. • Reduce prevalence of diseases that predispose to micronutrient deficiencies. • Build capacity of line ministries, communities, and NGOs • Supplementation and fortification – bi-annual Vitamin A to children 6 months to 14 yrs of age; iron and folic acid to pregnant and lactating women. Deworming. Education through outreach campaigns. Distribution of iodized salt through revolving fund. • Dietary diversification - distribution of vegetable and fruit seeds, agricultural tools, and pullets and cockerels to communities through Rural Development Offices. • Public Health: Water and sanitation support. Immunization support. IMCI and antimalarial drugs supply to health facilities . Distribution of insecticide-treated bed nets . • Capacity building: community training on gardening and poultry in collaboration with Rural Development Office. Training to health workers and community health workers on HIV, gender, and environmental health. • Information, Education, and Communication: nutrition clubs in schools covered by the project; breastfeeding promotion based on Hearth model; community education on construction and utilization of latrines and slabs provision, training on micronutrient deficiencies and health to line ministries staff. All community members, especially children 6 months to 14 yrs of age and pregnant and lactating women. Amhara, Oromiya, SNNP, Tigray, and Benishangul Gumuz regions – in 11 woredas with a total population of 2 million. Roles definition Program is coordinated through the Health and Nutrition Coordination Unit with a MICAH program officer, and implemented with technical support by Branch offices. • Steering committee at each project site: line ministries, woreda & kebele staff, community members, project staff (NGOs). Involved in planning monitoring evaluation. • Health services delivered by MOH staff. MICAH provides financial, supplies, and logistics support; training; per diem for field trips; transportation; cold chain equipment. • MOARD provides seeds, poultry, dairy goats, & small trees , with training. Partners Training Tools developed World Vision coordinates work under the project of six NGOs - CARE, CPAR, Family Health International, Kale Heywet Church (KHC), Feed the Children, and World Vision itself. The project implementers work closely with line ministries - Health, Water Resources, Education, and Agriculture. Training on nutrition, food preparation, agricultural production of nutritious food, and health – IMCI, malaria prevention and control, optimal child feeding practices, Hearth model, micronutrient deficiencies . Training provided to MOARD extension workers, MOARD development agents, and project staff. Posters, leaflets, booklets, videos, t-shirts, caps, drama clips, songs, billboards. Hearth Model manual. Micronutrient teaching aids for child health workers. Micronutrient training guide for project level. 190
Achievements Challenges Sustainability • Bitot’s spot prevalence and night blindness reduced in underfives and school age children. • Vitamin A capsule supplementation coverage increased significantly. • Stunting in underfives in project areas reduced from 64 percent to 41 percent. • Underweight in underfives in project areas reduced from 48 percent to 36 percent. • Women exclusively breastfeeding for 6 months and percentage of women breastfeeding for at least 24 months increased from 11 percent to 28 percent and from 62 percent to 69 percent, respectively. • Access of households to protected water sources increased from 31 percent to 50 percent. • Households with disposal of excreta in latrine increased form 11 percent to 33 percent. • Shortage of Vitamin A capsules for mass supplementation of school age children and lactating mothers. • Lack of policy support for supplementation of school age children with vitamin A. • Inadequate stocks of iron and mebendazole in the domestic market. • Shortage of health workers at the MOH health facilities. • Unfavorable government extension policy to address the poorest of the poor in horticultural and poultry development. • Ethiopia-Eritrea border conflict has resulted in absence of iodized salt in the market and hence poor achievement on fight against iodine deficiency disorders. MICAH is a donor-supported project that is closing soon. However, all activities were planned and implemented with the full participation of the community and line ministries. Capacity building was one of the main strategies during program implementation. Lessons learnt • Need for integration through a comprehensive approach by addressing Health, Caring and Food Security in packages of interventions, instead of through isolated, vertical programs. • Poor nutritional status of children can be prevented through primary health care interventions . • Water and sanitation interventions can significantly reduce the disease burden in the community that results poor nutritional status . • Interventions like development of gardening and poultry have significant contribution towards the prevention of micronutrient malnutrition. • Micronutrient interventions should be integrated with food security interventions in order to effectively tackle the problem . This has been observed during the implementation of Hearth Model. • Vitamin A supplementation to children through campaigns and to lactating mothers through house-to-house visits was found to have resulted in good program coverage. 191
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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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supplies. The available facilities
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5.1. Introduction 5.1.1. Conceptual
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access to a basic package of qualit
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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 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 201: Table 6.6: (continued) Agency Inter
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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