Changing pattern of malnutrition in Ethiopia and lessons learnt
1. Changing pattern of malnutrition
in Ethiopia and lessons learnt
Ferew Lemma [PhD, MPH, MD, DLSHT&M]
Senior Advisor, Office of the Minister
Ministry of Health, ETHIOPIA
4. Nationally, levels of anaemia are decreasing among both children and women
though child anaemia remains a serious public health issue
Anaemia decreasing in under5s &
women of child-bearing age
53.5
30.6
23.9
44.2
22
15.0
0
10
20
30
40
50
60
Children 6-59 mo. Pregnantwomen Non-PLW
2005 2011
Source: DHS (2011); Health Sector Development Programme (HSDP) IV Mid-Term Review presentation, Addis Ababa, 17 May 2013
%
Consequences:
• Reduced immunity
• Increased risk of maternal and perinatal
mortality
• Intrauterine growth retardation
• Premature births
• Reduced cognitive and psychomotor
development
• Reduced ability to concentrate/
scholastic performance
• Fatigue, reduced physical capacity/
activity levels
Assessment:
• Anaemia is a proxy for iron deficiency
• Measuring hemoglobin levels in the
blood is the most common a
biochemical indicator with different cut-
offs established for different sub-groups
and environmental factors (e.g. altitude)
40%
severe
threshold
5. Increases in stunting and wasting occurred in some regions from
2005 to 2011; Deterioration particularly pronounced in Afar
Change in stunting prevalence
(in % points)
Not only did Affar have some of the highest stunting and wasting levels,
it also had the 2nd largest increase in stunting (46.85%* to 50.2%) and
the largest increase in wasting (11.7%* to 19.5%) from 2005 to 2011 .
*Note: Prevalence values for 2005 recalculated using 2006 WHO growth standards
Change in wasting prevalence
(in % points)
Source: DHS (2011); DHS (2005); WHO Conversion tool from NCHS reference into estimates based on the WHO Child Growth Standards
IncreaseDecrease
0 5 5
IncreaseDecrease
05510 10+10+10+15+
6. In 2011, largest numbers of children with chronic (stunting) and
acute (wasting) malnutrition found in the same four regions
Wasted children <5
Source: DHS (2011); Ethiopia Census Report (2007); World Population Prospects, The 2010 Revision, Volume II (2011)
950,000 children
Stunted children <5 in 2011
4.6 million children
≥ 1 million
500,000-999,999
100,000-499,999
50,000-99,999
0-49,999
≥ 200,000
100,000-199,999
50,000-99,999
25,000-49,999
0-24,999
9. 60%
40%
Poorest
Less poor
Poorest = 54%
of population
Poorest = 20%
of population
Population size
20%
2000 2011
Mean stunting
prevalence
Stunting %
Stunting changes 2000-11
From 2000-11 the % of the population estimated as poorest (using
the same indicators) fell from 54% to 20%; the reduction in stunting
was somewhat faster in the poorest group (15.0 vs13.8ppts). Mean
stunting prevalences were 55.2% (2000) and 39.1% (2011).
Ethiopia data from DHSs, for children 0-59
months, national samples, 2000 and2011
58%
43%
53%
38%
Poorest: those with
unimproved water, roof, and
toilet
Source: calculated from DHS 2000-11 data, Potts/Mason,
Tulane SPHTM, 19 Feb 2015
9
Economic development reaching all
10. System Strengthening
Improving access to Primary Health Care
Health Extension Program
38,000 Health extension workers; Government salaried
Throughout the country – 2 per village
Provision of promotive, preventative & basic curative services
Improving access to Agriculture (services, technology)
60,000 Agriculture extension workers (3 per village)
Technologies (fertilizers, improved seeds, etc)
Improved access to Education
Primary Schools: from a thousand to over 32,000
Enrolment (primary) increased from 36% to 83% last 5 years (23-
80%)
11. Policies
Agriculture:
DRM: Control of the impact of emergencies (droughts, etc.) on children
and women [CMAM sites hundreds to 14,000]
Agriculture Growth Program;
Productive safety net program,
Livestock
Education: School Health and Nutrition Strategy
school feeding program, de-worming and nutrition education
Industry:
food fortification; private sector engagement
MoLSA: Social Protection policy
Dedicated nutrition unit/ focal person in the above sector
offices
12. Overall and Specific Objectives for Mainstreaming Nutrition in AGP 2
SO 1: Improved production
and productivity of diverse
foods
SO 4: Increase
awareness about
nutrition
SO 6: Support research
and dissemination of
improved production
and post-harvest
technologies
SO 5: Build capacity of
staff about nutrition/ to
implement the NNP
SO 3: Improved income
generating capacity of
women
Overall Objective:
Improved Dietary
Consumption
SO 2: Improved post
harvest handling and
food preparation,
processing and
preservation
13. Main Challenges being addressed
Equity and quality
Limited (local) evidence in nutrition – sensitive sectors; slow
engagement
Information systems – accountability across sectors and
administrative levels
Resources
Capacity to act at scale
Tools: to guide professionals
Emergence of overweight/ obesity
14. “We have the means; we have the
capacity to eliminate hunger from the
face of the earth in our lifetime. We
need only the will.”
John F. Kennedy, 1963
Six specific objectives (SO) have been proposed that will lead together to this overall objective (Figure): The first SO is aligned closely to the main AGP objective of increased production. The post harvest handling, processing, food preparation is SO 2; this is where nutritional quality, acceptability, seasonal issues are dealt with. Income from production is more likely to have impact on nutrition if it is controlled by women, so women’s income is included as SO 3. SO 3: women's income. Increased awareness about nutrition through nutrition promotion is SO 4. Capacity of AGP to deliver on the various objectives is SO 5. Research support for post harvest is SO 6. For improved dietary consumption, food security and knowledge and resources controlled by women are all necessary, so SO 2, 3, 4 link to the Overall Objective. SO 7 is about coordination so is cross-cutting and is not depicted here