Changing pattern of malnutrition in Ethiopia

and lessons learnt

Ferew Lemma [PhD, MPH, MD, DLSHT&M]

Senior Advisor, Office of the MinisterMinistry of Health, ETHIOPIA

Outline

Changes in patterns of under-nutrition

Lessons Learnt

Way forward

Stunting Wasting Underweight0

10

20

30

40

50

60

70

58

12

41

51

12

33

44

10

29

40

9

25

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

Anaemia decreasing in under5s & women of child-bearing age

53.5

30.623.9

44.2

2215.0

0

10

20

30

40

50

60

Children 6-59 mo. Pregnant women 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)

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)

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 <5Wasted 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 2011Stunted 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

Lessons Learnt

Decisive Government commitment and leadership

8

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 2000-11From 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

Economic development reaching all

System Strengthening

Improving access to Primary Health CareHealth Extension Program 38,000 Health extension workers; Government salariedThroughout 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

15AMESEGNALEHU!