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

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3.4. National and Regional Trends: Assessment and Analysis................................................................44 3.4.1. Natural resources, population, agricultural production and food deficit ..................................44 3.4.2. Food aid and emergency responses ................................................................................................46 3.4.3. Malnutrition and food insecurity: national trend..........................................................................48 3.4.4. Regional variations............................................................................................................................49 3.4.5. Poverty and malnutrition: The rural-urban dimension................................................................51 3.4.6. Marketing, trade and access to food...............................................................................................52 3.4.7. Food prices, food security and malnutrition .................................................................................53 3.5. Food Security Policy, Strategy and Programs: A Review ................................................................54 3.5.1. Policy ...................................................................................................................................................54 3.5.2. Strategies .............................................................................................................................................55 3.5.3. Institutions...........................................................................................................................................57 3.5.4. Core programs and projects .............................................................................................................58 3.6. The Food Security Strategy and Nutrition Gap..................................................................................59 3.6.1. The ‘nutrition lens’ and insufficient nutrition criteria .................................................................59 3.6.2. The “food-bias”..................................................................................................................................60 3.6.3. Cross-cutting issues ...........................................................................................................................60 3.7. The Way Forward: Actions, Interventions and Issues for the National Nutrition Strategy........63 3.7.1. Institution (organization and relationship) related interventions/issues ...................................64 3.7.2. Technical issues .................................................................................................................................66 3.7.3. Capacity building...............................................................................................................................70 Chapter 4: Care and Malnutrition in Ethiopia ........................................................................................... 75 Executive Summary .....................................................................................................................................75 4.1. Why Nutrition Matters in Ethiopia?.....................................................................................................80 4.1.1. The global conceptual framework of the causes of malnutrition ..............................................81 4.1.2. Underlying causes of malnutrition..................................................................................................81 4.1.3. The link between underlying and basic causes of malnutrition.................................................82 4.2. Care............................................................................................................................................................82 4.2.1. What is meant by care?.....................................................................................................................82 4.2.2. Linkage between different types of care and malnutrition .........................................................83 4.2.3. Health Care .........................................................................................................................................86 4.2.4. Psychosocial care ...............................................................................................................................87 4.2.5. Nutritional care and HIV/AIDS ......................................................................................................89 4.2.6. Effect of care on the immediate determinants of malnutrition ..................................................93 4.2.7. Who gives the care within the household?....................................................................................94 4.3. Dimensions of Care as a Significant Determinant of the Nutritional Status of the Young Child in Ethiopia....................................................................................................................................98 4.3.1. Knowledge of the caregiver.............................................................................................................98 4.3.2. Preventative health care ....................................................................................................................99 4.3.3. General education attainment and specific nutrition knowledge of caregiver ..................... 105 4.3.4. Caregiver’s health status and quality of care given .................................................................. 107 4.3.5. Household hygiene practices ........................................................................................................ 108 4.3.6. Time and energy expenditure demands on caregivers ............................................................. 109 4.4. Care-focused Initiatives in Ethiopia by Government Sectors and NGOs ....................................110 4.4.1. Assessment of care focused initiatives in Ethiopia ................................................................... 110 4.4.2. Content of curricula to include consideration of proper care practices ................................. 113 4.4.3. Development of appropriate timesaving technologies for caregivers.................................... 113 4.4.4. Community mobilization for improved nutrition and health care .......................................... 114 4.4.5. Care issues within acute food security and other crises or shocks......................................... 114 4.5. The Ethiopian National Nutrition Strategy and Nutritional Care.................................................115 4.5.1. Key care related issues that should be addressed in the NNS ................................................. 115 4.5.2. What are the advantages of having a NNS in place?................................................................ 117 4.6. SWOT Analysis of the Institutional Arrangements and Policies for Better Nutritional Caring Practices in Ethiopia.............................................................................................................118 iv
4.7. Care Indicators and the Monitoring and Evaluation of the National Nutrition Strategy.........124 4.7.1. Indicators of caring capacity and their assessment................................................................... 124 4.7.2. Program and policy modifications to enhance caring .............................................................. 125 4.8. Conclusion...............................................................................................................................................128 Chapter 5: Health Services, a Healthy Environment, and Malnutrition in Ethiopia.....................131 Executive Summary .................................................................................................................................. 131 5.1. Introduction.............................................................................................................................................134 5.1.1. Conceptual framework of the causes of malnutrition............................................................... 134 5.1.2. Why is nutrition both a health and a food/diet issue?............................................................... 134 5.1.3. Dimensions of the provision of health, water, and sanitation services.................................. 135 5.2. The Health Sector and Nutrition.........................................................................................................137 5.2.1. Official location of nutrition within the government health sector........................................ 137 5.2.2. Nutrition activities in primary health care .................................................................................. 140 5.2.3. Essential nutrition actions (ENA)................................................................................................ 143 5.2.4. Nutrition in emergencies ............................................................................................................... 144 5.2.5. Micronutrient malnutrition............................................................................................................ 145 5.3. The Water and Sanitation Sector and Nutrition...............................................................................147 5.3.1. What are the objectives?................................................................................................................ 147 5.3.2. Current status and trends in provision of healthy environment, water supply, and sanitation............................................................................................................................................... 147 5.3.3. Does nutrition explicitly feature in justifying resource allocations within the sector?....... 148 5.3.4. Knowledge, attitudes and practices towards sanitation............................................................ 153 5.3.5. Sustainable issues in sanitation development in Ethiopia........................................................ 153 5.3.6. Health and sanitation policy issues in Ethiopia. ........................................................................ 154 5.3.7. Safety issues and their link to malnutrition................................................................................ 156 5.4. Strategies and Programs ......................................................................................................................156 5.4.1. Policies ............................................................................................................................................. 156 5.4.2. Programs and projects.................................................................................................................... 158 5.4.3. Broad evaluation of the nutrition oriented strategies and programs...................................... 158 5.5. Conclusions and Recommendations...................................................................................................159 5.5.1. Conclusions...................................................................................................................................... 159 5.5.2. Recommendations .......................................................................................................................... 160 Chapter 6: Institutional Framework of Nutrition Interventions in Ethiopia...................................163 6.1. Nutrition Actors......................................................................................................................................164 6.2. Challenges and Lessons Learnt from Current Nutrition Interventions........................................167 6.3. Detailed Overview of Nutrition Interventions in Ethiopia..............................................................169 References ............................................................................................................................................................192 v
Page 1: An assessment of the causes of maln
Page 4 and 5: • Bantirgu Hailemariam coordinate
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
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
Page 51 and 52: In a more technical way, it is diff
Page 53 and 54: differently, it is important to acc
Page 55 and 56: 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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