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

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water can have significant impact on malnutrition. Modest increments to a household’s income are, however, unlikely to affect such access to the degree that public investment can. Moreover, increases in income may have an immediate impact on income poverty yet also take a generation or more to affect fully the consequences of poverty. School enrollment, particularly the enrollment of girls, will almost certainly expand as incomes increase. This will eventually lead to improved health and nutrition, but mainly when the current students become parents. Similarly, as mentioned, an important lagged effect of malnutrition in young girls is the influence this has on the birthweight of the children born to them later in life. This lag also slows the response of nutrition to changes is current income and contrasts with the potentially more rapid impact of improvements in nutritional knowledge. It is well known that specific nutritional knowledge and understanding of child care has an important role in child health. While schooling contributes to this knowledge, there is an equally important role of specific programs to impart information relevant to improved health care. These programs are not, however, an automatic and immediate consequence of increased income but reflect investments in health systems, for which the government must take primary responsibility. The SDPRP acknowledges the important of nutrition as a poverty issue in Ethiopia but primarily as a matter of food security and relief (MOFED 2002, pp. 34, 36, & 66). From a broader perspective, nutrition is a development issue, with high economic returns stemming from investments in health and sanitation, in specific programs to convey knowledge about child care, and in measures to improve food security. Much progress in reducing malnutrition can be achieved if existing strategies, such as those regarding health extension and for enhancing food security, achieve their objectives. However, strategies such as the health and food security strategy have multifaceted objectives and given the multifaceted nature of nutrition as outlined in the global framework discussed above, nutrition is often a secondary priority within any sector strategy and does not feature among the regular responsibilities of line ministries. Moreover, as many efforts to improve nutrition involve coordination at the woreda and kebele level in order to communicate effectively with stakeholders and service providers, there is much potential value in achieving harmonization of programs across ministries. This is, indeed, among the goals of the national nutrition strategy. 8
CHAPTER 2: THE BASIC CAUSES OF MALNUTRITION IN ETHIOPIA AN ASSESSMENT AND ANALYSIS OF MACRO AND CROSS-CUTTING ISSUES CONTRIBUTING TO MALNUTRITION Solomon Bellete, PhD Rural Development Consultant Addis Ababa Executive Summary The global framework of the causes of malnutrition has been used as a starting concept for the preparation of this report, which is presented as a contribution to the design of the National Nutrition Strategy for Ethiopia. The framework articulates three levels of analysis to identify and analyze the causes of malnutrition that ult imately results in death or an extremely malnourished child as a negative outcome. This report focuses on the level of analysis dealing with the basic causes or determinants of malnutrition. The basic causes are well known to most people working in the areas of nutrition and agriculture. These causes operate at various levels of society, from international, to national, to community levels, and to households and individuals. They involve a set of complex processes of vertical and horizontal relationships. In addition, one level of analysis (basic causes) may interact with another level (underlying or immediate causes), thus creating difficulties to make precise distinctions of the levels and hierarchies. In the report, major effort is put to identify the most critical basic causes of malnutrition in Ethiopia based on certain criteria, particularly the potential to exert noticeable impact and amenability or bring about desirable change through the provision of public goods and services. Thus, the report starts with the introduction of the conceptual framework and a brief exposition of the historical situation. This is followed by a description of who the malnourished are in Ethiopia and the current trends of malnutrition at national and regional levels. The report is mainly focused on the identification and content of the basic causes of malnutrition at three levels: the international, the national, and the household and community level. Each of these is further subcategorized. The causes under the national level are subcategorized under (a) natural resources, (b) human resources, (c) institutions, and (d) government development commitments and priorities. The report concludes with key implications of the assessment of the basic determinants of malnutrition and future directions. It is felt that further screening of the basic determinants may be required to ensure compatibility and workability that could fit synergistically with other development strategies and to avoid duplication. However, diversification of export products and services are key interventions at the international level to improve nutrition in Ethiopia. The conservation, proper utilization, and management of land and water resources, literacy, and skill development for rural youth and food and nutrition-focused education to women are key determinants at the national level. Developing household livelihood systems that maximize the creation and building of their assets and change in the conventional cultural practices that are detrimental to the nutritional status of children and women should be considered as major determining sets of factors to positively impact nutritional status at the household level. 9
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
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Page 22 and 23: 2.1. Introduction In the early 1960
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Page 26 and 27: Table 2.3: Regional profile of stun
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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
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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
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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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Although the coverage of ENA traini
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Box 5.1: Household and Community In
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The interventions that make up this
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conferences. To this effect, a nati
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with the engineering aspect of wate
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Table 5.1: Prevalence of diarrhea a
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Figure 5.3: Trends in latrine cover
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Institutional arrangements are also
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ehavior are integrated and supplied
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5.4.2. Programs and projects 5.4.2.
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made by NGOs for the affected child
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CHAPTER 6: INSTITUTIONAL FRAMEWORK
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interventions in Ethiopia, includin
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6.2. Challenges and Lessons Learnt
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Training Post-secondary training is
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Table 6.6: (continued) Agency Inter
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Achievements Challenges Sustainabil
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Berhane G. 1995. Nutrition surveill
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Ethiopian PROFILES Team & AED/Linka
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Middlebrook, P. 2002. Social protec
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Raisin, J. 2001b. Improving food se
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Yamano, T., H. Alderman, & L. Chris
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