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

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key tenet in the process of identifying the macro and cross-cutting issues of malnutrition is to avoid being bogged down with numerous and detailed factors and to focus on those that are broad and manageable. 2.3.1. Content and Operations of the Macro and Cross-cutting (Basic Determinants) Factors In enumerating the relevant factors that affect the nutritional status of the household, the community, or the larger society and that are amenable to change through the provision of public goods or through the application of policy and strategic interventions, a workable approach is needed. The approach taken here is to establish a set of criteria that identify the key basic determinants that include the following: (a) the level of analysis; (b) the level of society; (c) the timing or seasonal variations involved; and (d) the amenability to change through the provision of public goods. 4 For the first criterion, this paper deals primarily with the basic determinants or causes from among the three clusters of causes of malnutrition. However, there are gray areas where the underlying and basic causes overlap and it is found essential that the two clusters – the basic causes and the underlying causes of the global conceptual framework – be considered in a synergetic fashion. The three levels of society identified are the international, national, and household/community. Changes on aggregate (national or community) or individual nutritional status occur due to changes in the basic causes. These changes are envisaged to be of high impact when significant change is anticipated based on experience. In contrast, medium and low impact is expected when the changes in nutritional status are minimal for various reasons. Assessing the level of impact or the amenability to change through the provision of public goods is necessarily a subjective exercise due to the qualitative nature of our understanding of many of the mechanisms involved. 5 In this attempt, 27 basic causes are identified as potentially having a high impact on nutritional status, whereas sixteen are expected to have a medium impact. Categorized by the level of society at which they operate, four of the high impact basic causes operate at the international level, ten at the national level, and thirteen at household and community levels. Details of the selections and classifications are presented in Table 2.7. Table 2.7: Selection of macro & cross-cutting issues (basic determinants), based on likely impact on nutritional status. Basic Causes Major Features High impact * Medium impact * Low impact * Selected Causes International International markets • Export of primary commodities • Import of manufactured goods Few commodities & with declining prices. High priced goods resulting in negative balance of payments. B-I-S-Y B-I-S-Y √ √ Trade agreements • regional COMESA • regional EU – EBA • bilateral US – AGOA Very small inter-regional trade. Restricted due to standards. Stiff competition on textiles. B-I-C-Y B-I-C-Y B-I-C-Y √ √ 4 The analytical approach here is adapted from that of Jonsson 1993. Jonsson argues that a permanent improvement of the condition of children and women cannot be achieved until the basic causes (macro and crosscutting issues) of death of young children (outcome) are attacked or solved. However, much can be accomplished on in the short-or medium -term with immediate and underlying causes (p. 197). 5 One cannot imply the existence of a one-to-one or direct relationship between the changes in the basic factors and changes in malnutrition. In most cases the basic causes operate in relationship with and through the underlying causes or the immediate causes to impact on changes in malnutrition. 18
Basic Causes Major Features High impact * Medium impact * Low impact * Selected Causes Globalization, with liberalization of commodity trade, finance, and investment For all, influenced by market entry restrictions; full participation has not been pursued aggressively. B-I-C-Y National Natural Resources • Agro ecology • Land • Water • Forest • Wildlife • Climate Diverse, but facing degradation. Soil erosion at 1900million ton/yr. Undeveloped irrigation potential. Deforestation. At risk due to farm expansion. Variability increasing. B-N-C-Y B-N-C-Y B-N-C-Y B-N-C-Y B-N-C-Y B-N-C-N √ √ Human Res ources • Population 84 percent rural; early stage of transformation B-N-C-N Institutions Public sector • Executive Branch • Legislative Branch • Judiciary Branch • Administrative services • Public enterprises Day to day administration. At Federal, Regional, & Woreda. At Federal & Regional. Ministries, Commissions, Authorities, Bureaus, & Departments. PESA; Industries; Trade, Service, and Agricultural Enterprises B-N-C-Y B-N-C-Y B-N-C-Y B-N-C-Y B-N-C-Y √ √ Private sector • Agriculture & coops • Industry • Trade services • ICT Peasant farms, Commercial farms, & Cooperatives. Small-scale enterprises, manufacturing. Small-scale petty traders, importer, exporters. Media, advertising, publishing. U/B-N-C-Y B-N-C-Y U/B-N-C-Y U/B-N-C-Y √ √ Non formal NGOs • Local indigenous • Others—donors • Food aid Large no. of small size NGOs. International NGOs. For emergency & productive safety net programs B-N-C-Y B-N-C-Y U/B-N-C-Y Political commitments and priorities • Development policy debates • Review of policies & strategies , including: - SDPRP - Rural Development - Capacity Building - Civil service reform - Industrial strategy - Education SDP - Health SDP - Water SDP - Roads SDP - Disaster Prevention & Preparation Started recently on identifying priorities. Preparation encouraging; limited promotion at Region & Woreda levels. U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y U/B-N-C-Y √ √ √ √ √ 19
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 28 and 29: A rich food through popularization
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
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Page 49 and 50: 3.1. Introduction The economic grow
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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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