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

health care, and psychosocial care can only be addressed through better caring practices at the
household and community levels.
Proper care includes provision in the household and community of time, attention and
support to meet the physical, mental and social needs of socio-economically deprived and
nutritionally vulnerable groups. These groups include children, women, the elderly, the urban
poor, street children, people infected with and affected by HIV/AIDS, the disabled, and
refugees and Internally Displaced Persons (IDPs).
A strengthening of vital care practices includes ensuring care-giving behaviors such
as breastfeeding and complementary feeding practices, food and personal hygiene, diagnosing
illnesses, stimulating language and other cognit ive capabilities, and providing emotional
support. Care also refers to the support that the family or community provides to members of
the family and to behaviors within the household that determine the allocation of the food
supply to members of the household. In addition, care includes the utilization of health
services and water and sanitation systems to create a healthy microenvironment for family
members.
There were 128,000 HIV positive pregnancies in 2003 in Ethiopia. Hitherto,
breastfeeding has been regarded as an act that fulfills all three underlying conditions of
nutritional security —food, health-hygiene, and care. Mother to child transmission of HIV via
breast milk has become another threat to caring practices like breastfeeding. The use of
alternative breast milk substitutes (commercial infant formulas) has two dangers, the potential
spillover effect to the majority of HIV-free women and safety in terms of nutritional value
and freedom from harmful microorganisms. The enactment of the international code of breast
milk substitute marketing is highly important to protect and promote breastfeeding.
Additionally, making health institutions “baby friendly” is an institutional arrangement
required for better caring.
At the household level, mothers are primary caregivers, particularly during the first
one-year of life. Traditionally, responsibility of caring is given to wives, mothers, daughters,
and sisters— based on the assumption that women are more available for caregiving,
regardless of their age, health, or existing responsibilities. As a result, caregivers have
increased workloads, often with little recognition, little training, no financial compensation,
no protection in case of injury, and no workers' benefits. Studies in Ethiopia have shown that
caring is considered solely the job of the mother. In most regions, one of the most commonly
identified problems associated with child rearing was the lack of child care assistance
experienced by mothers.
Care assumes a very high time demand on both urban and rural caregivers. Physically
demanding agricultural work and an absence of child-care centers make caregiving in the
rural areas difficult. In the urban areas, unpredictable shift changes, night work, and lack of
control over work schedules makes child care strenuous for the urban poor.
However, every member of the household can contribute to caring practices. Fathers,
males, and other non-parental members of the household have important roles to play in
sharing the burden of caring at the household level.
The quality of psychosocial care is influenced by the characteristics of the caregiver,
the support system for the caregiver, and resource constraints. The paper presents four
intervention approaches to enhancing the caring capacity of caregivers: working directly with
the child, improving the caregiver-child relationship, increasing the resources available to the
caregiver, and altering the social support available for the caregiving system.
Caregiver’s access to different household and community resources will affect
caregiving capacities. Six major categories of resources for care include: 1) education,
knowledge, and beliefs; 2) health and nutritional status of the caregiver; 3) mental health, lack
of stress, and self-confidence of the caregiver; 4) autonomy, control of resources, and intra-
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