of Nutrition situations in areas selected for interventions in the first phase
Over the past decade, Ethiopia has made encouraging progress in reducing chronic undernutrition children. According to the Ethiopian Demographic and Health Survey (EDHS) reports, stunting among under 5 years old children has declined from 52.2 % in 2005 to 38.4% in 2016 at national level. Over the same period, the areas selected for intervention in the first phase have also experienced reduction in the level of stunting in under 5 years old children- in Afar from 46.8% to 41.1%, in Benishangul Gumuz from 45.8% to 42.7%, in SNNP from 56.8% to 38.6%, in Gambella from 35.5% to 23.5%, which remained above the national average except in Gambella. However, the level of acute undernutrition (wasting) in children increased in Afar and Gambella regions, while it declined in Benishangul Gumuz region and remained almost unchanged in SNNP as in the nation as a whole. On the other hand, underweight, which takes into account both acute and chronic undernutrition, has slightly increased in Afar but declined in the other areas selected for intervention as in the country.
Comparisons & Trends
Percentage of stunting (too short for their age), percentage of wasting (too thin for height) and underweight (too thin for their age) in under 5 years old children in the areas selected for intervention compared with best performing area in the country and national level
Comparison of trends of stunting among children under 5 years of age in the areas selected for intervention in the first phase with the best performing area in the country and national level
Comparison of trends of wasting in under 5 years old children in the areas selected for intervention in the first phase with best performing area in the country and national level
Comparison of trends of underweight among children under 5 years of age in the areas selected for intervention in the first phase with the best performing area in the country and national level
Besides these, EDHS 2016 report indicated that 74.8% of under 5 years old children in Afar, 56.2% in Gambella, 50% in SNNP, and 42.5% in Benishangul Gumuz are anaemic. Anaemia in under 5 years old children has increased in Afar, SNNP, Addis Ababa, and at national level, while it declined in Benishangul Gumuz, Gambella, and Amhara regions between 2005 and 2016 as shown in table 5 below.
Comparison of trends of anemia among under 5 years old children in the areas selected for intervention in the first phase with the best performing area in the country and national level
Despite the progress made in reducing stunting in children under age of 5 years at national and sub-national levels, an estimated 5.2 million children in Ethiopia remain stunted with deleterious lifelong impacts of child undernutrition. Malnutrition affects every walk of life- health, education, and productivity with negative effects on socioeconomic situation of individuals, families, communities, and the society at large. Based on the cost of hunger in Africa (COHA 2013) study report, 67% of the adult population in Ethiopia suffered from stunting as children with negative effects on their productivity. The total annual losses associated with child undernutrition are estimated at 55.5 billion Ethiopian birr which is equivalent to 16.5% of GDP. The same report indicated that the health costs associated with child undernutrition is 1.8 billion birr, out of which 1.6 billion birr (90%) is cost to families and 185 million (10%) is cost to health systems. Undernourished children have increased chance of experiencing anaemia, diarrhea, acute respiratory infection (ARI), and malaria. In addition, the report depicted that 16% of all repetitions in primary schools are associated with stunting and stunted children on average achieve 1.1 years less in school education. The costs of repetitions associated with child undernutrition estimated at 93 million birr, out of which 59 million birr (63%) is cost to families and 34 million birr (37%) is cost to education systems. This study has shown that nutrition is of utmost importance for improved health, education, and productivity of the workforce across sectors, which are needed in attaining national growth and transformation.
Ending child undernutrition is not an issue of a simple fix. It requires adequately addressing the immediate and underlying causes of malnutrition with nutrition specific and nutrition sensitive interventions across multiple sectors. Cognizant of the far reaching effects of child undernutrition, the Government of Ethiopia has issued Seqota Declaration- political commitment to end child undernutrition in Ethiopia by 2030. Also the government has prepared and implementing the 2nd national nutrition programme (NNP –II, 2016-2020) which calls for multisectoral actions by 13 sectors to enable ensuring food security and nutrition security in the country. To have lasting impacts in combating undernutrition, the Government of Ethiopia together with its development partners has launched nutrition in the first 1000 days of life, which covers the period from conception of pregnancy until the child becomes two years of age. To enhance caring in early childhood and promote exclusive breast feeding, Ethiopian parliament enacted a law that extends maternity leave period to 120 days and calls for organizations to establish baby corners at the workplace. Moreover, encouraging progress was attained in iodization of salt for use in the households. According to the EDHS reports, percentage of households using adequately iodized salt has increased from 20% in 2005 to 89% in 2016. Proportion of households with iodized salt is almost similar to the national average in the regions except in Somali (63%) and Afar (74%) which have lowest coverage.
Further look into evidences on infant and young feeding practices in the country shows huge gap as compared to acceptable standards. Only 58% of infants below 6 months of age were exclusively breastfed at national level (EDHS 2016) though it has increased from 49% in 2005. The percentage of children age 6-23 months who received minimum acceptable diet (MAD) with required diversity of food groups and frequency of feeding in a day stands only at 7% at national level. There is significant regional variation in receiving minimum acceptable diet- ranging from 27% in Addis Ababa to as low as 2-3 % in Afar, Somali and Amhara regions. The same report indicated that among children age 6-23 months, only 6% in rural areas and 19% in urban areas received minimum acceptable diet. Despite the expected likelihoods, only 15% of children born to mothers with secondary education and 16% of children in the highest wealth quintile are fed according to minimum acceptable dietary standards. There is small increase in percentage of children fed according to the minimum acceptable diet standards- from 4% in 2011 to 7% in 2016.
Besides these, consumption of foods rich in vitamin A or iron remains low among young children in Ethiopia. Based on EDHS 2016 report, only 38.4% of children age 6-23 months consumed foods rich in vitamin A and 21.9% consumed foods rich in iron at national level. There is variation in consumption pattern in the areas selected for intervention in the first phase as compared to national level and best performing region. Percentage of children consumed foods rich in vitamin A ranges from 11.3% in Afar to 69% in Addis Ababa. Whereas, proportion of children who consumed foods rich in iron ranges from 8.1% in Afar to 42.2% in Addis Ababa.
Comparison of consumption foods rich in Vitamin A and iron by children age 6-23 months in the areas selected for intervention with best performing area and national level
Similarly, coverage of supplementation of vitamin A, iron, and de-worming medication to children age 6-59 months is low at national level and in the areas selected for intervention in first phase.
Comparison of coverage of supplementation of iron, vitamin A and deworming medication to children age 6-59 months in the areas selected for intervention with best performing region and national level
The information shows that infants and young children are prone to vitamin A and iron deficiencies as neither the consumption of foods rich in vitamin A and iron nor the supplementation are to the optimal level. Low coverage of deworming medication coupled with poor sanitation practices aggravates the situations.
On the other hand, improved women’s nutritional status is essential in attaining better health outcomes of mothers and children. However, woman of reproductive age are highly vulnerable to undernutrition due to inequitable distribution of food within households, inadequate intake during times of heightened needs such as puberty, pregnancy and lactation, and dietary taboos. The height of women can be associated with undernutrition during childhood and adolescence. Small stature is often associated with smaller pelvis size and difficulty in delivering a child. Moreover, maternal acute undernutrition results in low birth weight and its associated risks.
According to EDHS reports, only 3.2% of women in Ethiopia have height below the cutoff point (shorter than 145cm) in 2005, which has declined to 2.4% in 2016. Whereas, percentage of women with acute undernutrition measured in body mass index with BMI less than 18.5 kg/M2(too thin), has declined from 26.5% in 2005 to 22.4% in 2016 at national level.
Comparison of trends undernutrition in women who are too thin with BMI less than 18.5 in the areas selected for intervention with best performing region and national level between 2005 and 2016
On contrary, percentage of women overweight or obese with BMI ≥ 25 Kg/M2 has increased from 4.4% in 2005 to 7.6% in 2016 at national level. EDHS 2016 report indicates 21.4% of women in urban area are overweight or obese as compared to 3.5% of women in rural areas. The same report shows 12.4% of men in urban areas and 0.9% of men in rural areas are overweight or obese. At present, the burden of non-communicable diseases is growing due to unhealthy diet as one of the major risk factors.
Anaemia among women may be the underlying cause of maternal mortality, spontaneous abortion, premature birth and low birth weight. EDHS 2016 report indicates that percentage of women aged 15-49 years with anaemia ranged from 16% in Addis Ababa to 44.7% in Afar and 59.5% in Somali regions. Prevalence of anaemia in women declined from 26.6 % in 2005 to 23.5% in 2016 at national level. There is decline in anaemia among women in areas selected for intervention except in Afar.
Comparison of trends of anaemia in women age 15-49 years in the areas selected for intervention with best performing region and national level
Further look into EDHS reports on micronutrient intake by pregnant women highlights it is far below the required level. Percentage of women with a child born in the past 5 years who took iron supplement for 90 days or more has increased from 0.1% in 2005 to 5.1% in 2016. Over the same period, percentage of women with a child born in the past 5 years who did not take any iron supplement has declined from 89.4% to 57.7% at national level.
Comparison of trends of iron supplement to women during pregnancy in the past 5 years in the areas selected for intervention with best performing regions and national level
The ongoing efforts have to be intensified to attain the Seqota Declaration of ending child undernutrition and the Sustainable Development Goal of eliminating malnutrition in all its forms by 2030 in Ethiopia. The cost of failing to end malnutrition has grave consequences on health and economic livelihoods of individuals, families, communities, and the nation as a whole. Taking the remoteness of the areas selected for intervention, malnutrition will hinder realization of equitable socioeconomic development.
The immediate and underlying causes of undernutrition in children and women of reproductive age in these areas need to be unfolded to adequately address problems related to the delivery and utilization of nutrition specific and nutrition sensitive interventions across multiple sectors. These will require bringing change in mindsets, in the intensity and scale of actions tailored to end malnutrition.