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

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A rich food through popularization and educational media campaigns can contribute to significantly reducing VAD. Iron Deficiency Anemia (IDA): IDA is the most common nutritional deficiency in developing countries, although the limited studies carried out in Ethiopia have shown mixed results. For the majority of the studies, the high prevalence rate of anemia (above 40.5 percent) was found to be due to parasitic infection and malaria and was not exclusively of nutritional origin (ibid, 64). Iodine Deficiency Disorder (IDD): Iodine is an essential element of the thyroid hormones, which are basic ingredients for normal growth and physical and mental development in humans and animals. The effect of IDD goes beyond the most familiar one of goiter and is recognized as the greatest cause of preventable brain damage and mental retardation globally, estimated to affect about 30 percent of the world’s population. In Ethiopia, a goiter survey conducted by ENI revealed that about 50,000 prenatal deaths occur annually due to IDD, about 26 percent of the population has acquired goiters, and about 62 percent of the total population is at risk of IDD (ibid, 65). Attempts are being made to establish iodization facilities for the production of iodized salt in Ethiopia. It is reported that at the time of writing about 28 percent of Ethiopian households were consuming iodized salt (MOH 2004b). In Asia, in contrast, iodized salt is used by 60 percent of households (Mason 2000, 64). Breastfeeding and supplementation: It is the tradition and culture of nearly all ethnic groups in Ethiopia to exercise breastfeeding as common practice. While breast-feeding is practiced by nearly 100 percent of mothers of infants in rural areas, it is less common in urban areas, particularly among educated women. The biggest challenge to proper feeding of young children is the unavailability of nutritious and affordable weaning foods for children 6 to 11 months old and above. This is the critical period in the life of the child that determines the physical and mental development over her or his lifecycle. 2.2.5. Trends in malnutrition National Nutrition Surveys were carried out by CSA in 1983, 1992, and 1998, which focused on rural Ethiopia. Based on data collected, the three indicators of protein-energy malnutrition (PEM) include weight-for-age (underweight), height-for-age (stunting) and weight-for-height (wasting) could be computed. As shown in Table 2.6, data collected in 1983 and 1992 indicated that the underweight prevalence rate for rural areas increased from 37.3 percent to 46.9 percent respectively for children 6 to 59 months of age. The prevalence declined to 42 percent in 1998 in children of 3 to 59 months of age. The decline during this period needs to be qualified due to the inclusion of the lower age group. The prevalence of Table 2.6: Trend in prevalence rates of underweight, stunting, and wasting, percent of children under 5 years of age. Status of children CSA Surveys Ethiopia DHS 1983 1992 1998 1999/00 Underweight (weight-for-age) Stunting (height-for-age) Wasting (weight-for-height) 37.3 46.9 42.0 47.2 60.7 64.0 52.0 51.5 8.0 9.3 9.0 10.5 Source: CSA 1999; CSA & ORC Macro 2001. 16
underweight children 6 to 59 months of age is estimated to be 47 percent in the Ethiopia DHS 2000 study (CSA & ORC Macro 2001). This represents a further increase of 5 percent, which is probably due to the drought of 1990/00. The height-for-age (stunting) prevalence for rural Ethiopia increased from 60.7 percent in 1982/83 to about 64 percent in 1992. 3 However, there was a noticeable decline in stunting reported in 1998 with 52 percent of the children 3 to 59 months of age being classified as stunted (CSA, 1999, 226-27). The Ethiopia DHS of 2000 estimated that 51.5 percent of children under 5 years of age were stunted (CSA & ORC Macro 2001, 154). The weight-for-height (wasting) prevalence picked up slightly from 8 percent of children 3 to 59 months of age in 1992 to 9.3 percent in 1992 for rural Ethiopia and then showed a marginal decline to 9 percent in 1998 (CSA 1999, 228). The proportion of wasted children increased to 10.5 percent in the DHS 2000. The higher level in 2000 is probably due to prevailing drought in that year, since wasting is a measure of acute malnutrition. The trend for all measures of malnutrition are found to be among the highest in the world, with figures not showing any significant improvement over the last twenty years, except for the prevalence rate of stunting which shows a decline of about 0.5 percentage points per year. Studies on malnutrition of adults (PEM) are scarce in Ethiopia except in some pocket studies conducted by NGOs (Zewditu et al. 2001, 62) and the Ethiopia DHS of 2000. The body mass index (BMI) is used as an indicator to measure the nutritional status of women and a high prevalence of chronic energy deficiency. The DHS found that 30.1 percent of women 15 to 49 years of age have a low BMI (< 18.5 kg/m 2 ). 2.3. The Macro and Cross-cutting issues (Basic Causes) of Malnutrition in Ethiopia The macro and cross-cutting issues as basic determinants of malnutrition can be viewed from various angles and dimensions. The most important aspect of illuminating and describing these causes of malnutrition is to establish causality within the complex nature of nutrition in the various stages, scales, and hierarchies that lead to the final outcome at the level of the child and his or her nutritional status. Without undue alteration of the global conceptual framework (presented in Figure 1.2), the various dimension of macro-level causes and issues are clustered at (a) the international level, (b) the national level and (c) at the subnational (household and community) level. From a theoretical perspective, the basic determinants of malnutrition are presumed to be part of cause-effect relationships or means-end continuum relationships. In the present analysis, context-specificity is considered paramount in order to sift out the most important determinants and factors that operate towards the achievement of the appropriate nutritional status of the individual and/or of the community in aggregate. Since the global conceptual framework was developed on the premise of field-tested propositions, the hierarchy of basic, underlying, and immediate causes of malnutrition consists of clusters of factors operating at different levels. The operational framework articulated in the triple-A cycle (Assessment, Analysis, and Action) enables the identification and sifting out of the most essential and manageable public and private goods and services to achieve desired nutrition outcomes. The 3 The Central Statistical Authority defines the height - for age measure of protein-energy malnutrition as 'children falling below the cut off point of minus two standard deviation (-2SD) from median of the reference population are classified as stunted or short for age and are chronically malnourished'; while the height - for - weight is an index that measures the current nutritional status and the prevalence rate of 'nutritional deficiency of current incidence falling below minus two standard deviation (-2SD) from the median of the reference population as wasted and -3SD as severely wasted'. 17
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 18 and 19: experimental body of evidence that
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 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
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Page 55 and 56: households will not be as difficult
Page 57 and 58: the drought prone areas, the rain f
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Page 61 and 62: viewed as a proxy for household foo
Page 63 and 64: Figure 3.3: Per capita food product
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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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