An assessment of the causes of malnutrition in Ethiopia: A ...
An assessment of the causes of malnutrition in Ethiopia: A ... An assessment of the causes of malnutrition in Ethiopia: A ...
• 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
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TABLE OF CONTENTS<br />
Foreword....................................................................................................................................................................i<br />
Table <strong>of</strong> Contents ..................................................................................................................................................iii<br />
List <strong>of</strong> Tables...........................................................................................................................................................vi<br />
List <strong>of</strong> Figures ........................................................................................................................................................vii<br />
List <strong>of</strong> Boxes ...........................................................................................................................................................vii<br />
List <strong>of</strong> Acronyms ................................................................................................................................................. viii<br />
Chapter 1: The Importance <strong>of</strong> Improv<strong>in</strong>g Nutrition for Susta<strong>in</strong>able Development <strong>in</strong> <strong>Ethiopia</strong>......1<br />
1.1. The Global Conceptual Framework <strong>of</strong> <strong>the</strong> Causes <strong>of</strong> Malnutrition.................................................. 2<br />
1.2. Nutrition as an Element <strong>of</strong> Public Policy Concern.............................................................................. 4<br />
1.2.1. The economic consequences <strong>of</strong> <strong>malnutrition</strong>..................................................................................4<br />
1.2.2. The benefits that accrue from combat<strong>in</strong>g <strong>malnutrition</strong> .................................................................5<br />
1.2.3. Will robust economic growth reduce <strong>malnutrition</strong>? ......................................................................7<br />
Chapter 2: The Basic Causes <strong>of</strong> Malnutrition <strong>in</strong> <strong>Ethiopia</strong>..........................................................................9<br />
Executive Summary .......................................................................................................................................9<br />
2.1. Introduction...............................................................................................................................................10<br />
2.1.1. Def<strong>in</strong><strong>in</strong>g Malnutrition .......................................................................................................................10<br />
2.1.2. Conceptual Framework <strong>of</strong> <strong>the</strong> Causes <strong>of</strong> Malnutrition—The Global Framework.................11<br />
2.1.3. Historical Background......................................................................................................................12<br />
2.1.4. Institutions Concerned with Nutritional Status.............................................................................13<br />
2.2. Who are <strong>the</strong> Malnourished <strong>in</strong> <strong>Ethiopia</strong>................................................................................................13<br />
2.2.1. Demographic Dimensions................................................................................................................13<br />
2.2.2. Geographic Dimensions...................................................................................................................13<br />
2.2.3. Socio-economic Dimension.............................................................................................................14<br />
2.2.4. Micronutrient Deficiencies...............................................................................................................15<br />
2.2.5. Trends <strong>in</strong> <strong>malnutrition</strong>.......................................................................................................................16<br />
2.3. The Macro and Cross-cutt<strong>in</strong>g issues (Basic Causes) <strong>of</strong> Malnutrition <strong>in</strong> <strong>Ethiopia</strong>.......................17<br />
2.3.1. Content and Operations <strong>of</strong> <strong>the</strong> Macro and Cross-cutt<strong>in</strong>g (Basic Determ<strong>in</strong>ants) Factors ......18<br />
2.4. Key Implications <strong>of</strong> <strong>the</strong> Assessment <strong>of</strong> <strong>the</strong> Basic Determ<strong>in</strong>ants <strong>of</strong> Malnutrition..........................30<br />
2.5. Future Directions for <strong>the</strong> Development <strong>of</strong> a Susta<strong>in</strong>able National Nutrition Strategy................31<br />
Chapter 3: Food Security and Malnutrition <strong>in</strong> <strong>Ethiopia</strong>.......................................................................... 33<br />
Executive Summary .....................................................................................................................................33<br />
3.1. Introduction...............................................................................................................................................37<br />
3.2. Def<strong>in</strong>ition and Scope...............................................................................................................................38<br />
3.2.1. Def<strong>in</strong><strong>in</strong>g food security......................................................................................................................38<br />
3.2.2. Def<strong>in</strong>ition <strong>of</strong> <strong>malnutrition</strong> ................................................................................................................38<br />
3.2.3. Def<strong>in</strong>itional l<strong>in</strong>k between nutrition and food................................................................................39<br />
3.2.4. Food and nutrition security at <strong>in</strong>dividual, household, community, and national levels ........39<br />
3.3. Conceptual Framework...........................................................................................................................40<br />
3.3.1. L<strong>in</strong>kage between <strong>malnutrition</strong> and food security.........................................................................40<br />
3.3.2. The concept <strong>of</strong> target<strong>in</strong>g <strong>in</strong> nutrition and food security strategies............................................42<br />
3.3.3. Food fortification, standards, and quality......................................................................................43<br />
iii
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