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 ...
LIST OF TABLES Table 2.1: Child stunting in Ethiopia, percent of children aged 6-59 months..............................................13 Table 2.2: Comparison and trends in rural and urban levels of stunting, by region, percent of children aged 6 - 59 months.....................................................................................................................14 Table 2.3: Regional profile of stunting by gender (1999/00), percent of children aged 6 - 59 months..........................................................................................................................................................14 Table 2.4: Educational level of mother and the prevalence rate of stunting, percent of children aged 6 - 59 months.....................................................................................................................................15 Table 2.5: Child wasting and stunting prevalence in Ethiopia by expenditure quintile (1999/00), percent of children aged 6 - 59 months..................................................................................................15 Table 2.6: Trend in prevalence rates of underweight, stunting, and wasting, percent of children under 5 years of age...................................................................................................................................16 Table 2.7: Selection of macro & cross-cutting issues (basic determinants), based on likely impact on nutritional status....................................................................................................................................18 Table 2.8: Macro and cross-cutting issues and the expected changes that lead to improved nutritional status.........................................................................................................................................21 Table 2.9: Gross primary enrollment and net primary enrollment ratios, percent.......................................24 Table 3.1: Trends in the agricultural population, output and resources (1960-2000) .................................48 Table 3.2: Poverty headcount (2002), malnutrition indicators (2000), and per capita food production by region..................................................................................................................................50 Table 3.3: National, urban and rural malnutrition indicators of children under 5-years 2000..................52 Table 4.1: Optimal infant and young child feeding practices .........................................................................86 Table 4.2: Present discount values (PDV) of economic benefits associated with reducing the prevalence of low birth-weight................................................................................................................87 Table 4.3: Care focused initiatives in Ethiopia ................................................................................................111 Table 4.4: Analysis of care consideration in the national policies and programs by different sectors and offices....................................................................................................................................119 Table 4.5: Implementation of international conventions, codes, initiatives, and resolutions that are supportive of caring practice and nutrition security, in Ethiopia. ....................................................122 Table 4.6: The continuum of child feeding......................................................................................................124 Table 5.1: Prevalence of diarrhea among under fives in Ethiopia, percentage who experienced diarrhea in the two weeks prior to the survey, various surveys.......................................................150 Table 5.2: Per capita drinking water consumption in Ethiopia, 1980-2003, from various statistical sources........................................................................................................................................................151 Table 6.1: Matrix of distribution of roles across actors involved in nutrition interventions in Ethiopia......................................................................................................................................................163 Table 6.2: Overview of federal-level sectors working on nutrition issues in Ethiopia.............................164 Table 6.3: Overview of selected non-governmental organizations working on nutrition issues in Ethiopia......................................................................................................................................................165 Table 6.4: Challenges to effective and sustainable efforts to reduce malnutrition in Ethiopia. ..............167 Table 6.5: Lessons learned from past and current efforts to reduce malnutrition in Ethiopia.................168 Table 6.6: Overview of nutrition interventions in Ethiopia – government, international development agencies, NGOs................................................................................................................170 vi
LIST OF FIGURES Figure 1.1: Stunting among children under-five, by region..............................................................................2 Figure 1.2: Global conceptual framework of the causes of malnutrition........................................................3 Figure 1.3: Intergenerational link of malnutrition...............................................................................................7 Figure 3.1: Nutrition and food security: two-way linkage...............................................................................42 Figure 3.2: Per capita food production and production gap – 1980/81 to 2002/03. ....................................48 Figure 3.3: Per capita food production by major region – 1996/97 to 2003/04. ..........................................51 Figure 4.1: Risk of death in infants 3 to 12 months of age due to diarrhea by infant feeding method, Brazil. ...........................................................................................................................................85 Figure 4.2: Prenatal and postnatal clinic utilization and chronic energy deficiency among women aged 15 to 49, by region............................................................................................................................87 Figure 4.3: Factors that affect the relationship of the caregiver and the child .............................................89 Figure 4.4: Breastfeeding as a package of care addressing the three underlying causes of malnutrition.................................................................................................................................................90 Figure 4.5: The vicious cycle of HIV/AIDS and malnutrition........................................................................91 Figure 4.6: Virtuous cycle of nutritional care and HIV/AIDS ........................................................................92 Figure 4.7: Risk of mother to child transmission of HIV. ...............................................................................93 Figure 4.8: The extended mo del of care. ............................................................................................................97 Figure 4.9: The Triple-A cycle. ..........................................................................................................................100 Figure 4.10: Model of the stages of behavior change.....................................................................................100 Figure 4.11: Stunting, wasting, and underweight prevalence in preschoolers in Ethiopia, by age. .......102 Figure 4.12: Trends in malnutrition in under-fives in Ethiopia, 1982-2000...............................................102 Figure 4.13: Prevalence of stunting and wasting among under-fives, by region.......................................103 Figure 4.14: Feeding Practices in Ethiopian Infants < 6 mo .........................................................................103 Figure 4.15: Feeding practices of children 6-9 months in Ethiopia. ............................................................104 Figure 4.16: Contributions of underlying determinants to reductions in child underweight, 1970- 95, 16 developing countries...................................................................................................................105 Figure 4.17: Community based nutrition operational nexus .........................................................................127 Figure 5.1: Framework for the determinants of sanitation in Ethiopia ........................................................148 Figure 5.2: Trends in safe drinking water coverage in Ethiopia, 1970 - 2002...........................................151 Figure 5.3: Trends in latrine coverage in Ethiopia, 1970 – 2002. ................................................................152 LIST OF BOXES Box 3.1: Interventions and issues proposed for the formulation and implementation of Ethiopia’s National Nutrition Strategy......................................................................................................................63 Box 4.1: Factors affecting nutritional status at different stages of a woman’s life .....................................83 Box 4.2: Reasons why PLWHA are vulnerable to nutritional insecurity .....................................................91 Box 4.3: Feeding options currently recommended by WHO/UNICEF (2003)............................................93 Box 5.1: Household and Community Integrated Management of Childhood Illnesses ...........................142 Box 5.2: Essential Nutrition Actions for Ethiopia ..........................................................................................143 vii
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LIST OF TABLES<br />
Table 2.1: Child stunt<strong>in</strong>g <strong>in</strong> <strong>Ethiopia</strong>, percent <strong>of</strong> children aged 6-59 months..............................................13<br />
Table 2.2: Comparison and trends <strong>in</strong> rural and urban levels <strong>of</strong> stunt<strong>in</strong>g, by region, percent <strong>of</strong><br />
children aged 6 - 59 months.....................................................................................................................14<br />
Table 2.3: Regional pr<strong>of</strong>ile <strong>of</strong> stunt<strong>in</strong>g by gender (1999/00), percent <strong>of</strong> children aged 6 - 59<br />
months..........................................................................................................................................................14<br />
Table 2.4: Educational level <strong>of</strong> mo<strong>the</strong>r and <strong>the</strong> prevalence rate <strong>of</strong> stunt<strong>in</strong>g, percent <strong>of</strong> children<br />
aged 6 - 59 months.....................................................................................................................................15<br />
Table 2.5: Child wast<strong>in</strong>g and stunt<strong>in</strong>g prevalence <strong>in</strong> <strong>Ethiopia</strong> by expenditure qu<strong>in</strong>tile (1999/00),<br />
percent <strong>of</strong> children aged 6 - 59 months..................................................................................................15<br />
Table 2.6: Trend <strong>in</strong> prevalence rates <strong>of</strong> underweight, stunt<strong>in</strong>g, and wast<strong>in</strong>g, percent <strong>of</strong> children<br />
under 5 years <strong>of</strong> age...................................................................................................................................16<br />
Table 2.7: Selection <strong>of</strong> macro & cross-cutt<strong>in</strong>g issues (basic determ<strong>in</strong>ants), based on likely impact<br />
on nutritional status....................................................................................................................................18<br />
Table 2.8: Macro and cross-cutt<strong>in</strong>g issues and <strong>the</strong> expected changes that lead to improved<br />
nutritional status.........................................................................................................................................21<br />
Table 2.9: Gross primary enrollment and net primary enrollment ratios, percent.......................................24<br />
Table 3.1: Trends <strong>in</strong> <strong>the</strong> agricultural population, output and resources (1960-2000) .................................48<br />
Table 3.2: Poverty headcount (2002), <strong>malnutrition</strong> <strong>in</strong>dicators (2000), and per capita food<br />
production by region..................................................................................................................................50<br />
Table 3.3: National, urban and rural <strong>malnutrition</strong> <strong>in</strong>dicators <strong>of</strong> children under 5-years 2000..................52<br />
Table 4.1: Optimal <strong>in</strong>fant and young child feed<strong>in</strong>g practices .........................................................................86<br />
Table 4.2: Present discount values (PDV) <strong>of</strong> economic benefits associated with reduc<strong>in</strong>g <strong>the</strong><br />
prevalence <strong>of</strong> low birth-weight................................................................................................................87<br />
Table 4.3: Care focused <strong>in</strong>itiatives <strong>in</strong> <strong>Ethiopia</strong> ................................................................................................111<br />
Table 4.4: <strong>An</strong>alysis <strong>of</strong> care consideration <strong>in</strong> <strong>the</strong> national policies and programs by different<br />
sectors and <strong>of</strong>fices....................................................................................................................................119<br />
Table 4.5: Implementation <strong>of</strong> <strong>in</strong>ternational conventions, codes, <strong>in</strong>itiatives, and resolutions that are<br />
supportive <strong>of</strong> car<strong>in</strong>g practice and nutrition security, <strong>in</strong> <strong>Ethiopia</strong>. ....................................................122<br />
Table 4.6: The cont<strong>in</strong>uum <strong>of</strong> child feed<strong>in</strong>g......................................................................................................124<br />
Table 5.1: Prevalence <strong>of</strong> diarrhea among under fives <strong>in</strong> <strong>Ethiopia</strong>, percentage who experienced<br />
diarrhea <strong>in</strong> <strong>the</strong> two weeks prior to <strong>the</strong> survey, various surveys.......................................................150<br />
Table 5.2: Per capita dr<strong>in</strong>k<strong>in</strong>g water consumption <strong>in</strong> <strong>Ethiopia</strong>, 1980-2003, from various statistical<br />
sources........................................................................................................................................................151<br />
Table 6.1: Matrix <strong>of</strong> distribution <strong>of</strong> roles across actors <strong>in</strong>volved <strong>in</strong> nutrition <strong>in</strong>terventions <strong>in</strong><br />
<strong>Ethiopia</strong>......................................................................................................................................................163<br />
Table 6.2: Overview <strong>of</strong> federal-level sectors work<strong>in</strong>g on nutrition issues <strong>in</strong> <strong>Ethiopia</strong>.............................164<br />
Table 6.3: Overview <strong>of</strong> selected non-governmental organizations work<strong>in</strong>g on nutrition issues <strong>in</strong><br />
<strong>Ethiopia</strong>......................................................................................................................................................165<br />
Table 6.4: Challenges to effective and susta<strong>in</strong>able efforts to reduce <strong>malnutrition</strong> <strong>in</strong> <strong>Ethiopia</strong>. ..............167<br />
Table 6.5: Lessons learned from past and current efforts to reduce <strong>malnutrition</strong> <strong>in</strong> <strong>Ethiopia</strong>.................168<br />
Table 6.6: Overview <strong>of</strong> nutrition <strong>in</strong>terventions <strong>in</strong> <strong>Ethiopia</strong> – government, <strong>in</strong>ternational<br />
development agencies, NGOs................................................................................................................170<br />
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