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

only 43 percent of children 6-9 months are optimally fed. Studies also show that maternal
nutrition during pregnancy is poor due to multiple reasons. About 30 percent of childbearing
women in Ethiopia are undernourished (BMI < 18.5 kg/m 2 ). Lessons learned from Behavior
Change Communications (BBC) on child caring (optimal breastfeeding and complementary
feeding practices) and maternal nutritional care in other countries indicated an improvement
of caring practices after the interventions.
Positive deviant caregivers with success stories of child rearing are models of
caregiving at the household level. The other common models of child caring in the Ethiopian
context are grandmothers and elderly women. Young women in particular learn many of the
caring practices like breastfeeding, complementary feeding, and child washing and caring
during illness from their mothers. This implies that involving grandmothers and other elderly
women who have reared their own children in the community support group will benefit the
household.
An assessment of different care-focused initiatives indicated that “care”- the link
between food availability and nutritional status - is the weakest point of all interventions.
Considering the existing realities of the country and envisaging potential issues in the
future, the National Nutrition Strategy has to draw from the experiences and success stories of
these different initiatives and apply them in an integrated manner at the household level. For
example, community IMCI that is being implemented at a household level using community
mobilizers (health promoters, health animators, community volunteers, etc.) can be integrated
with child growth promotions (CGP) by strengthening the key messages of IMCI through
incorporation of the Essential Nutrition Actions (ENA). Community level child growth
promotion can also be integrated with community therapeutic care or with the regular health
care services. Children screened by this program can be referred to the health care facilities
for Community Therapeutic Care (CTC) or for Outreach Therapeutic Care (OTC). This
requires strengthening the referral chain and feedback systems between health care facilities
and household level caring services.
The activities of the agricultural home economic agents can also be integrated for
improving household caring practices. From experiences in the Tigray region, it is possible to
establish a kebele-level development team approach to improve caring practices at the
household level. This requires an integrated, cross-sectoral approach and careful planning,
implementation and monitoring and evaluation of household-level caring practices using the
“triple A cycle” approach.
Behavior change communications at the community level have resulted in
appreciation by the general community of the vulnerability of children and women to
nutritional stresses and other environmental factors. Currently, the Health Extension Program
(HEP) offers a good opportunity to ensure better caring practices at the household level.
Emergencies and food insecurity situations have implications for care behaviors and
practices in the feeding, health, hygiene, and psychosocial areas. During emergencies, food
intake declines. In conflict situations, children face extreme psychosocial stress. As stress
becomes prolonged, children start to suffer a “crisis of care" as caregivers spend more time
searching for income, water, and food. The importance of care for young children is given
insufficient attention during these emergency interventions as the major focus is on availing
food. Care interventions should improve the effectiveness of health, food, and psychosocial
support and protection from dangers and abuses. There should be program and policy
modifications to enhance the current caring practices and caring capacity across Ethiopian
households and communities when shocks occur.
Caring is a cross cutting issue that cannot be addressed by any one development
sector alone. The interfaces for promoting and enhancing better caring practices by the
different sectors are households. There are gaps in the way policies and programs have been
implemented with respect to caring practices at the household level. This is due partly to a
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