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

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violating the basic tenets presented above, have also been developed in considering different sorts of nutrition interventions. 2.1.3. Historical Background The science of nutrition emerged in the early twentieth century with the development of scientific research and enquiry in biochemistry and related sciences. With increased depth of research and better capability in the development of instruments for the measurement of objective indicators and outcomes, since World War II the attention of the scientific community as well as the development community has shifted to broader aspects of child survival as a dominant policy goal. In recent years, more attention has focused on attaining adequate micronutrient intake and other selective health interventions as dominant strategies (Pelletier & Frongillo 2002, 2). As pointed out above, serious focus on human nutrition in Ethiopia started in 1960s with the assistance of American and Swedish experts. The Ethio-Swedish Pediatric Clinic, later called the Ethiopian Nutrition Institute (ENI), was established as a semi-autonomous agency in 1968 under the Ministry of Health to deal with serious problems of malnutrition. This was done through training and research and by collecting and disseminating data and information on nutritional status among various groups in Ethiopia. Since the early years, the institution has been technically assisted and nurtured by Swedish bilateral assistance. Various support programs on nutrition were also forthcoming to ENI from UNICEF and WHO in the 1970s and 80s. FAO through its Technical Cooperation Program had been involved in an effort to develop nutrition policy in the 1980s under the auspices of the Ministry of Agriculture and the former National Committee for Central Pla nning. In December 1986, a workshop was held at Alemaya University on the development of a Food and Nutrition Strategy through the participation of local and international experts. The workshop resulted in guidelines for the formulation of the strategy. Preparation continued with a team of multidisciplinary Ethiopian experts and the draft strategy underwent a series of revisions until the change of government in 1991. In the 1990s, there was a major shift of emphasis and ENI was transformed into Ethiopian Health and Nutrition Research Institute (EHNRI), with a narrower focus on micronutrient and health-related clinical investigations. In one of the recent unpublished documents of the World Bank, it is indicated that there has been a decline in the prominence given to nutrition in programs and policy debates in the 1990s, concurrent with the departure of professionals from the Research Institute and due to a fragmentation of nutritional responsibilities to government agencies such as the Ministry of Economic Development and Cooperation, the then Ministry of Agriculture, and the Ministry of Health (MOH). However, drawing in part on earlier work on a Food and Nutrition Strategy, the National Food Security Strategy initially received government approval in 1996. A revised version was approved in March 2002 (FDRE 2002). In November 2003, another attempt was made by the MOH to draft a National Nutrition Policy based on the Essential Nutrition Actions (ENA) (MOH 2003b). A draft proposal for a National Nutrition Policy was presented for discussion at MOH. The underlying causes of malnutrition are outlined in the document and priority areas of interventions are presented in the document. The behavior change communication (BCC) approach is taken as the basis for defining the objectives, priority actions, and strategies for the implementation of those actions, centered on the Essential Nutrition Actions (ENA). It was intended that this document would be implemented as a component of the Health Sector Development Program III and, for cross-sectoral initiatives under the policy, as a component of relevant development programs in other collaborating sectors. However, the document never reached either stakeholders for discussion or higher officials for approval. 12
2.1.4. Institutions Concerned with Nutritional Status There has been a multiplicity of reorganizations of government institutions in the last four years, both at federal and regional levels. Until recently, the nutrition program was housed in two separate institutions: the MOH and Ministry of Agriculture and Rural Development (MOARD). The Nutrition Surveillance Unit under DPPC and UNICEF, the Welfare Monitoring Surveys of MOFED and CSA, and EHNRI under MOH are the major sources of information on nutrition. With particular reference to institutions generally concerned with nutrition in Ethiopia, few have strong records of accomplishment. Many have not been operating long enough to have made a visible impact and/or have not been provided with adequate resources. Some lack a sound conceptual construct to deal with multi-sectoral processes such as nutrition, lack results-based performance evaluation processes, or lack clear guidelines on accountability, authority, and the use of the resources committed to their operation. 2.2. Who are the Malnourished in Ethiopia The demographic, geographic, and socio-economic characteristics of the malnourished are described below. The manifestations of malnutrition outcomes are expressed in internationally accepted measurements that reflect the chronic nature of malnutrition. 2.2.1. Demographic Dimensions Based on nationwide data coverage, the analysis profile of MOFED’s Welfare Monitoring Unit for 1995/96 and for 1999/00, and the results of the Ethiopia DHS 2000 survey, the prevalence rate of stunting (shortness in relation to age) of children up to the age of 5 years was found to be about 57 percent as compared to the figure of 66.6 percent in 1995/96. The prevalence rate of stunted children appeared to be higher for males as compared to the females, particularly in rural areas. A declining trend is shown between the two survey years. Table 2.1 presents the prevalence rate of stunting for children under five years of age. 2.2.2. Geographic Dimensions The regional profile of stunting in children less than 5 years old is shown in Table 2.3 Table 2.1: Child stunting in Ethiopia, percent of children aged 6-59 months. Location 1995/96 1999/00 Male Female Total Male Female Total Ethiopia Rural Urban Stunted 68.1 65.1 66.6 58.1 55.5 56.8 Severely stunted 45.2 42.2 43.7 32.0 30.6 31.3 Stunted 70.0 66.7 68.4 59.4 56.4 57.9 Severely stunted 47.4 43.8 45.6 32.9 31.6 32.3 Stunted 56.6 55.2 55.9 44.0 45.0 45.5 Severely stunted 32.1 31.9 32.0 21.5 20.4 21.0 Source: MOFED 2002a, 55. 13
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 20 and 21: water can have significant impact o
Page 22 and 23: 2.1. Introduction In the early 1960
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Page 30 and 31: key tenet in the process of identif
Page 32 and 33: Basic Causes Major Features High im
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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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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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