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

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• Bantirgu Hailemariam coordinated the efforts of all of the other experts and managed day-to-day relations and logistics with the NNS steering committee and with UNICEF-Ethiopia. Working with Dr. Benson’s supervision, the experts carried out extensive literature reviews and participated in field trips to several regions to meet with NNS stakeholders at regional and woreda levels. Assistance was also received from the World Bank. As part of this effort, a World Bank consultant, Eleonora Genovese, compiled an inventory of nutritionfocused programs and projects in Ethiopia. On 8 August 2005, a half-day workshop was held in Addis Ababa at which the team of experts presented overviews of the initial drafts of the background documents they were preparing. Extensive comments on the papers were received from the approximately 50 participants at the workshop. These were then used by the authors to develop the final versions presented in this volume. By late August 2005, a detailed NNS framework document was submitted to the NNS steering committee. The NNS steering committee used this framework document to draft the Strategy document itself. The framework document was written by Todd Benson working closely with the team of local experts. It is available as a companion document to this edited volume. The NNS steering committee finalized a draft Strategy document by late September 2005. After disseminating it widely for comment at federal and regional levels, a full-day workshop was held in Addis Ababa in mid-November to review the draft Strategy in preparation for its submittal for approval to the Council of Ministers. The work of the experts ended with the successful conclusion of this workshop. In finalizing these papers for wider dissemination, we gratefully acknowledge the editorial efforts of Noora-Lisa Aberman of IFPRI and Kevin Pepper, an intern with UNICEF- Ethiopia. Harold Alderman of the World Bank reviewed early drafts and made important suggestions to strengthen all of them. We also thank the national steering committee for the NNS for the comments its members provided on these papers and the spirited dialogue they provided in discussing the NNS framework document. In particular, we appreciate the leadership provided by Beyene Haile in guiding the NNS formulation process. Finally, these documents could not have been prepared without the financial and logistical resources provided by UNICEF-Ethiopia. In particular, we thank Iqbal Kabir, the Program Officer for Nutrition, and Bjorn Ljungqvist, the Country Representative. While the papers included in this edited volume have been edited extensively and expert comments have been received on them, they have not been subjected to a formal peerreview. They are circulated in order to stimulate discussion and critical comment and as documentation on the effort in 2005 to formulate a National Nutrition Strategy for Ethiopia. Moreover, the findings, interpretations, and conclusions in these documents are those of the author(s) and should not be attributed to the government of the Federal Democratic Republic of Ethiopia, MOARD, FSCB, the NNS steering committee and its members, UNICEF, or IFPRI. ii
TABLE OF CONTENTS Foreword....................................................................................................................................................................i Table of Contents ..................................................................................................................................................iii List of Tables...........................................................................................................................................................vi List of Figures ........................................................................................................................................................vii List of Boxes ...........................................................................................................................................................vii List of Acronyms ................................................................................................................................................. viii Chapter 1: The Importance of Improving Nutrition for Sustainable Development in Ethiopia......1 1.1. The Global Conceptual Framework of the Causes of Malnutrition.................................................. 2 1.2. Nutrition as an Element of Public Policy Concern.............................................................................. 4 1.2.1. The economic consequences of malnutrition..................................................................................4 1.2.2. The benefits that accrue from combating malnutrition .................................................................5 1.2.3. Will robust economic growth reduce malnutrition? ......................................................................7 Chapter 2: The Basic Causes of Malnutrition in Ethiopia..........................................................................9 Executive Summary .......................................................................................................................................9 2.1. Introduction...............................................................................................................................................10 2.1.1. Defining Malnutrition .......................................................................................................................10 2.1.2. Conceptual Framework of the Causes of Malnutrition—The Global Framework.................11 2.1.3. Historical Background......................................................................................................................12 2.1.4. Institutions Concerned with Nutritional Status.............................................................................13 2.2. Who are the Malnourished in Ethiopia................................................................................................13 2.2.1. Demographic Dimensions................................................................................................................13 2.2.2. Geographic Dimensions...................................................................................................................13 2.2.3. Socio-economic Dimension.............................................................................................................14 2.2.4. Micronutrient Deficiencies...............................................................................................................15 2.2.5. Trends in malnutrition.......................................................................................................................16 2.3. The Macro and Cross-cutting issues (Basic Causes) of Malnutrition in Ethiopia.......................17 2.3.1. Content and Operations of the Macro and Cross-cutting (Basic Determinants) Factors ......18 2.4. Key Implications of the Assessment of the Basic Determinants of Malnutrition..........................30 2.5. Future Directions for the Development of a Sustainable National Nutrition Strategy................31 Chapter 3: Food Security and Malnutrition in Ethiopia.......................................................................... 33 Executive Summary .....................................................................................................................................33 3.1. Introduction...............................................................................................................................................37 3.2. Definition and Scope...............................................................................................................................38 3.2.1. Defining food security......................................................................................................................38 3.2.2. Definition of malnutrition ................................................................................................................38 3.2.3. Definitional link between nutrition and food................................................................................39 3.2.4. Food and nutrition security at individual, household, community, and national levels ........39 3.3. Conceptual Framework...........................................................................................................................40 3.3.1. Linkage between malnutrition and food security.........................................................................40 3.3.2. The concept of targeting in nutrition and food security strategies............................................42 3.3.3. Food fortification, standards, and quality......................................................................................43 iii
Page 1: An assessment of the causes of maln
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 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
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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 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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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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