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

children between 6 and 24 months. There are significant potential benefits to addressing
malnutrition through improving care practices. This document reviews how care is essential
to convert food security into nutrition security.
4.1.1. The global conceptual framework of the causes of malnutrition
The last two decades have witnessed dramatic changes in the conceptualization of the
problem of malnutrition. There has been a shift in paradigm, where the problem is looked at
from a more holistic perspective, whereas previous efforts were looking for one magic bullet
solution mainly from the food or health sectors. A broad analysis on the causes of
malnutrition should always precede actions. Such an analysis will result in increasing
cooperation in addressing the problem among various institutions and between various
disciplines and in the recognition that those affected, the poor, are parts of the solution, rather
than part of the problem. (Jonsson 1995; Gillespie & Haddad 2003) Such an approach focuses
on food, care, and health, which are the underlying pillars of nutrition security, comprising a
framework called the “food-care–health framework”. This paper is situated within this
framework, focusing on care.
Referring to this framework, Gillespie and Haddad note, “where nutrition programs
have applied this more comprehensive approach, spectacular improvements in the nutrition
status of populations have been recorded. There is now more understanding of what works,
why and how it works, and in general, there is enough knowledge to substantially address the
problem of malnutrition” (ibid). However, there is still a substantial gap between theoretical
knowledge of the causes and their practical application to solutions on the ground.
The belief that only sufficient food availability results in improved nutritional
outcomes still is prevalent and dictates policy and practice in Ethiopia. As a result, resources
are not allocated and institutional arrangements are not in place for vital caring practices, and
the problem of chronic malnutrition continues to be an embarrassing mark for Ethiopia. The
current effort to develop a National Nutrition Strategy is therefore guided by the global
conceptual framework of the determinants of malnutrition that was presented in Chapter 1.
(See Figure 1.2.)
4.1.2. Underlying causes of malnutrition
The most common causes of malnutrition and poor growth in developing countries at
the immediate level are poor maternal nutritional status at conception, in utero undernutrition,
inadequate breastfeeding, delayed complementary feeding for infants or inadequate quality or
quantity of complementary feeding, impaired absorption of nutrients due to intestinal
infection or parasites, or, more commonly, a combination of these problems. Underpinning
these factors are various inadequacies with respect to household and community level access
to food, health, environmental, and caring resources (ibid; Johnson-Welch 2001).
Household food security, care of the vulnerable segments of the population, and
adequate health services and environmental hygiene are the underlying determinants of
nutrition and are closely interrelated.
Food security exists when all people, at all times, have physical, social and economic
access to sufficient, safe and nutritious food that meets their dietary needs and food
preferences for an active and healthy life (World Food Summit Declaration, 1996). This
definition is based on three core concepts of food security: availability (physical supply),
access (the ability to acquire food), and utilization (the capacity to transform food into the
desired nutritional outcome).
Availability and accessibility of food and health services alone cannot be a guarantee
for nutrition security. Vulnerable segments of the population need someone to provide them
with food, to feed them, to take them to the nearby health institution for preventive and
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