Nutrition policy issues in Ethiopia

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

Outline
 Changes in patterns of under-nutrition
 Lessons Learnt
 Way forward

58
12
41
51
12
33
44
10
29
40
9
25
0
10
20
30
40
50
60
70
Stunting Wasting Underweight
2000 2005 2011 2013/4
WHO critical
threshold
WHO critical
threshold
Trends in Nutritional Status of Children under 5 in
Ethiopia, 2000 - 2014

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

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+

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

Decisive Government commitment and leadership
8

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

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%)

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

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

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

“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

Nutrition policy issues in Ethiopia

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Editor's Notes