From: Secretary of Health, Ethiopia

KiaraBaginski

Nutrition in Ethiopia

From: Secretary of Health, Ethiopia

To: Minister of Finance, Ethiopia

Introduction

The rates of malnutrition in Ethiopia are some of the highest in Sub-Saharan Africa; 26 percent of women of reproductive age are undernourished and 51 percent of children under-five suffer from the effects of chronic malnutrition.[i] The micronutrients necessary for proper development, especially Vitamin A and Iodine, are lacking within individuals that require them the most, placing a disproportional burden on women and children, the most vulnerable segments of the population. The prevalence of malnutrition and micronutrient deficiencies is imposing severe negative costs on society and the economy, which will continue to affect development if not corrected. Nutrition-related deaths comprise 58 percent of all under-five deaths, making it our greatest cause for child mortality.[ii] Strategies to address the problem include expanding supplementation and fortification efforts, implementing community-based nutrition programs and monthly growth-monitoring sessions, and, in the long-run, improving agricultural and educational infrastructures. These cost-effective methods must be urgently implemented in order to change the nutritional status in Ethiopia.

Nature and Magnitude of the Problem

Ethiopia has one of the highest rates of malnutrition in Sub-Saharan Africa. Among a population of 85 million, 46 percent are undernourished.[iii] One of every four (26%) women of reproductive age suffers undernourishment – twice the Sub-Saharan average of 13.3 percent.[iv] Over half (51%) of children under-five are suffering from chronic malnourishment in the form of stunting.[v] In comparison to 44 percent in Tanzania[vi], 38 percent in Uganda[vii], and 35 percent in Kenya[viii], the magnitude of stunting is much higher in Ethiopia than in neighboring countries.

Micronutrient deficiencies contribute greatly to the problem of under-nutrition. Vitamin A and Iodine are two essential micronutrients for proper physical and mental development, yet there is a significant deficiency of these nutrients among our population. Vitamin A supplementation has shown success, but deficiency still exists in 27 percent of children under-five.[ix] In Ethiopia, about 83,000 people are affected by iodine deficiency disorder (IDD) annually. The most visible manifestation of IDD is goiter, and according to the World Health Organization a goiter rate above 5 percent constitutes a public health emergency.[x] In Ethiopia, the goiter rate is 28.6 percent and 62 percent of the population continue to be at risk.[xi]

Affected Populations

Malnutrition is prevalent among people of all ages and sexes; however, the groups most vulnerable are women of childbearing age and children under the age of five, especially following the first five months. Women and children are inevitably linked; mothers who suffer from malnutrition are more likely to have children who experience being undernourished.[xii] In addition, malnutrition is more rampant in rural regions than urban. For example, children living in Amhara, which is approximately 90% rural, are three times more likely to experience stunting than those in the highly urbanized Addis Ababa region.[xiii]

Risk Factors

The most significant factors for malnutrition and micronutrient deficiencies in Ethiopia are food intake, education level, and breastfeeding practices. Accessibility of meat as a consumption product is very limited and the low intake of meats and the inadequate availability of fruit and vegetables are main causes of vitamin A deficiency along with other vital micronutrients.[xiv] Iodine is usually found in topsoil, but depletion of soil and water sources and small consumption of adequately iodized salt (20%) have caused severe iodine deficiency.[xv] Since 84 percent of the population depends on rain-fed subsistence farming, chronic droughts increase the severity of deficiencies and generate continual food insecurity.[xvi]

Furthermore, education is directly tied to the health status of the population. Eighty-two percent of mothers with children under-five have never attended school.[xvii] Since over a 25 percent point difference exists in stunting rates between children of mothers with no education and those who have received a secondary or higher education,[xviii] the level of education is a decisive factor that critically affects knowledge of fundamental care practices. While most infants are initially breastfed, the introduction of complementary liquids occurs for many much earlier than the recommended age; only 54 percent of infants are exclusively breastfed until six months.[xix] A dramatic effect is seen in nutritional status; during 0-5.99 months only 4.4 percent of children measure underweight but the number rises to 28.0 percent in the 6-11.99 month period.[xx]

Economic and Social Consequences

Malnutrition is having a damaging effect on our population and economic structure; it increases the burden of disease while generating a massive indirect cost to the economy. At the point of conception, the crucial window of opportunity of a child begins to close, finally shutting around the age of two years. It is essential they receive adequate quantity and quality intake during this period in order to achieve proper physical and mental development. The effects of malnutrition during this time include growth retardation, fatigue, visual impairment, learning disabilities, impaired brain functions, decreased IQ, decreased psychomotor skills, as well as an increased likelihood of illness and death.[xxi] Nutrition-related deaths comprise 58 percent of all under-five deaths, making it our greatest cause for child mortality. [xxii] Approximately 17 percent of deaths are attributed to vitamin A deficiency, which means approximately 50,000 children die each year as a result of this shortfall.[xxiii] The physical and mental consequences of under-nutrition results in decreased work capacity, family income, and academic achievements, and increased healthcare and education costs, number of unskilled or unemployed persons, and in a loss of productivity.[xxiv]

Priority Action Steps

The strategies necessary to effectively eliminate malnutrition in Ethiopia include improving nutritional intake through supplementation, fortification, and development, and increasing the knowledge of women, especially mothers and those who are pregnant. These steps can be carried out in a variety of inexpensive methods that are extremely effective.

All women and children must have sufficient micronutrients in their diet, particularly Vitamin A and Iodine, in order to become productive members of society. Current integration of Vitamin A supplements into established immunization services has proven successful, achieving 80 percent coverage in targeted children, and costs only a few cents per capsule. In the short-term, we must expand the reach of such programs and include supplementation services to the families of those immunized. Among populations with endemic iodine deficiency, the distribution of fortified salt and oil with iodine is a sustainable, low cost intervention. In the long run, we must implement Universal Salt Iodization, develop sustainable irrigation systems to address droughts, and support communities in the production of fruit and vegetable gardens which grow foods rich in necessary micronutrients such as gommen –a native dietary plant rich in Vitamin A.[xxv]

In addition to consumption, the importance of women must be addressed. From birth to six months, exclusive breastfeeding can ensure that an infant receives relatively sufficient nutritional intake for health and development. In the short run, we must promote this practice followed by education on hygienic complimentary feeding. Community-based nutrition programs and monthly growth-monitoring sessions are inclusive and effective ways to improve knowledge and subsequent care practices. In the long-term, it is vital we develop the infrastructure necessary to increase access to education and to proper health services for our population.

Bibliography

1

[i] United Nations Children’s Fund (UNICEF). Nutrition. Ethiopia, Statistics. Available at:

[ii]Ethiopian Health and Nutrition Research Institute.Assessment of Human Resources Needs for Nutrition for the National Nutrition Program (NNP) in Ethiopia. Addis Ababa: International Health and Social Affairs Consultancy; 2009:14

[iii]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 20

[iv]Bitew, Fikrewold H., Daniel S. Teleke. United States Agency for International Development (USAID).Undernutrition among Women in Ethiopia: Rural-Urban Disparity. Washington, DC; 2010: 1

[v] United Nations Children’s Fund (UNICEF). Nutrition. Ethiopia, Statistics. Available at:

[vi] United Nations Children’s Fund (UNICEF). Nutrition. Tanzania, Statistics. Available at:

[vii] United Nations Children’s Fund (UNICEF). Nutrition. Uganda, Statistics. Available at:

[viii] United Nations Children’s Fund (UNICEF). Nutrition. Kenya, Statistics. Available at:

[ix]Federal Ministry of Health.National Guideline for Control and Prevention of Micronutrient Deficiencies.Family Health Department. Addis Ababa; 2004: 5

[x]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 33

[xi]Federal Ministry of Health.National Guideline for Control and Prevention of Micronutrient Deficiencies.Family Health Department. Addis Ababa; 2004:12

[xii] Save the Children. Ethiopia National Nutrition Strategy. London; 2009: 11-12

[xiii]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 28

[xiv]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 11-18

[xv]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 33

[xvi]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 18

[xvii]United States Agency for International Development (USAID).Nutrition of Young Children and Mothers in Ethiopia.Africa Nutrition Chartbooks.ORC Macro. Calverton, MD: 50

[xviii]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 28

[xix]United States Agency for International Development (USAID).Nutrition of Young Children and Mothers in Ethiopia.Africa Nutrition Chartbooks.ORC Macro. Calverton, MD: 40-45

[xx]Food and Agriculture Organization of the United Nations (FAO).Nutrition Country Profile Federal Democratic Republic of Ethiopia.Nutrition and Consumer Protection Division. Rome; 2008: 28

[xxi]Federal Ministry of Health.National Guideline for Control and Prevention of Micronutrient Deficiencies.Family Health Department. Addis Ababa; 2004: 1-5, 12-13

[xxii]Ethiopian Health and Nutrition Research Institute.Assessment of Human Resources Needs for Nutrition for the National Nutrition Program (NNP) in Ethiopia. Addis Ababa: International Health and Social Affairs Consultancy; 2009:14

[xxiii]Federal Ministry of Health.National Guideline for Control and Prevention of Micronutrient Deficiencies.Family Health Department. Addis Ababa; 2004: 4

[xxiv]Federal Ministry of Health.National Guideline for Control and Prevention of Micronutrient Deficiencies.Family Health Department. Addis Ababa; 2004: 1-5, 12-13

[xxv]Federal Ministry of Health.National Guideline for Control and Prevention of Micronutrient Deficiencies.Family Health Department. Addis Ababa; 2004: 9