Combatting Malnutrition in EthiopiaDr. F. Barchi

Global Health Perspectives

By: Isha Tendolkar, Karli Rymer, Tori Simon, Ria Brumant, Sofia Anamuro, Paige Paratore

OutlineWhat is Malnutrition? Ria Brumant: 3-5

Global Burden of Malnutrition Karli Rymer: 6-8

Burden of Disease in Ethiopia Sofia Anamuro: 9-12

Socio-ecological Framework Model of Malnutrition in Ethiopia

Isha Tendolkar: 13-16

Programs implemented in Ethiopia vs. Programs implemented in other countries

Tori Simon: 17-22

Resources Paige Paratore: 23-25

Intervention/Investment 26-27

Mission Statement 28

What is Malnutrition?UNICEF Definition: “Malnutrition can be used for describing undernutrition and overnutrition. People whose diet lacks adequate calories and protein for growth and maintenance or are unable to utilize the food they eat due to illness (undernutrition). They are also malnourished if they consume too many calories (overnutrition).”

Other types of poor nutrition:● -Stunting: failure to reach linear growth-height for age 2-Z scores below international

reference● -Underweight: low weight for age - 2-Z scores● -Undernourished: height for age, weight for age, weight for height

Ria Brumant

Top Ten Countries that is Undernourished: 1. Burundi : 73.4 % 2. Eritrea: 65.4 % 3. Comoros: 70%4. Timor Leste: 38 % 5. Sudan: 25% 6. Chad: 33.4% 7. Yemen Republic: 32.4% 8. Ethiopia: 40.2% 9. Madagascar: 33.4%

10. Zambia: 47.4 % -Globalcitizen.org

Contributions to Malnutrition● Political factors● Environmental factors or natural disasters ● Social factors● Lack of Education● Lack of health services

Consequences of Malnutrition:● Morbidity & early death● Repeated cycle● Loss of economic progress: future income● Lack of school enrollment & performance● Increased school dropout rates

The Problems: Systems Problems & Humanitarian Crisis

The Reality

Ria Brumant

Ethiopia :● 2 out of every 5 children in Ethiopia are stunted● 28% of all child mortality in Ethiopia due to malnutrition● 16% of repetitions of in primary school● Women 15-49, 26% are malnourished while 17% have anaemia

Globally: ● One in nine people do not have enough food to eat● Poor nutrition causes 45% of deaths in children under five (3.1

million per year)● The # of hungry would decrease by 150 million if women had the

resources● 66 million primary school age children attend classes hungry across

the developing world- 23 million in Africa alone.

❖ Most Affected: Women & Children

❖ Where: ● Africa

- 58 million are stunted-1 of 4 people are undernourished

● Asia-more than ½ are stunted

Global Burden of Malnutrition

Karli Rymer

● Very large epidemiological burden worldwide; number one risk to health worldwide

● 795 million people in the world, or one in nine, suffer from chronic undernourishment 2014-2016UNITED NATIONS FOOD AND AGRICULTURAL ORGANIZATION

● Most at risk populations are those impoverished--East Asia, Sub-Saharan Africa and parts of South America

● 1 in 4 people are undernourished in Sub-Saharan Africa and ⅔ of population in Asia are considered hungry

● Populations at risk❖ Poverty stricken populations❖ Displaced people or migrating

populations❖ Global climate change❖ Areas in conflict❖ Areas and populations vulnerable

to natural disasters

Global Burden of Malnutrition

Karli Rymer

Contributions to other global burdens relevant to malnutrition● Cycle of poverty● Risk of infectious diseases● Weakened immune system→ Micronutrient deficiencies that lead to other health problems● Poor nutrition in children leads to cognitive and physical deficits, wasting, stunting, which will in turn

have an effect on the country as a whole● Poor nutrition causes nearly half of deaths for children under the age of five● By battling malnutrition, it can benefit many factors in the country and alleviate other problems that

Ethiopia faces

WORLD SDG End hunger, achieve food security, and improved nutrition, and promote

sustainable agriculture

Sofia Anamuro

ETHIOPIA

Burden of disease in Ethiopia Indicator 2014

Infant mortality rate 55 per 1,000

Maternal mortality 673 per 100,000

Children >5 underweight 25.2%

Children >5 stunted 40.4%

Children >5 wasted 8.7%

Women’s underweight 26.5%

Sofia Anamuro

Other indicators: % of children <5 with anemia 53.5%

% of Woman with anemia 30.6%

% of iodized salt consumption in children 15.4%

Sofia Anamuro

Evaluating the MDGsEthiopia:

● Increased agricultural production & productivity ○ Implement the Productive Safety Net Program provided

assistance to 8 million per year since 2005● Urban food aid at times of extreme rises in food prices● Effective regulation of markets for consumers & labor

intensive construction projects● Fulfill basic needs of those living under the poverty line

○ Reducing poverty amongst the poorest, ensuring food security & reducing the number of poor people

● Reducing gender inequality in employment and youth unemployment

Sofia Anamuro

Socioecological Model of Malnutrition

Isha Tendolkar

1) Environmental Factors:● Drought:

○ worst drought the country has faced in 50 years (humanitarian crisis)

○ more than 10 million people are now in need of emergency food aid to survive, but limited food rations

○ forced more than 1 million children to stop going to school so they can do more to help their families cope (Save the Children)

■ Water Scarcity ● the battle for water has become a part of

everyday life ● shepherds drive their herds over longer

distances to find it, causing trouble for themselves and their animals

● crops adversely affected (agricultural based economy)

● lack of potable water, poor sanitation, and dangerous hygiene practices= vulnerability to infectious and waterborne diseases (direct causes of acute malnutrition)

Photo of mother waiting hours to register for a type of blended food used to fight against malnutrition.

Socioecological Model of Malnutrition2) Societal Factors

● Poverty:○ in 2011, 30.7% of population living under $1PPP a day

● Refugee/Asylum-Seeker Hosting:○ Africa’s largest refugee hosting country (2014), “open-door policy”○ Total refugee and asylum-seeker population: 729,460 (Jan 2015)

■ from South Sudan, Somalia, Eritrea○ increases strain on limited food/water resources○ Provisions under Ethiopian law for refugees' local integration are very limited

● Area of Conflict/Unrest:○ Eritrean-Ethiopian War took place from May 1998 to June 2000 (lasting effects)○ Current Events: 200 people dead, 100 children missing by attackers after cross-border cattle raid

and South Sudanese gunmen have killed at least 140 civilians, including women and children, in a raid in Gambela region, also ISIL presence

○ impacts food security by drastically compromising access to food○ uprooted by conflict= lose access to their farms, businesses, or other means of local food

production and markets. ● Employment:

○ agriculture and government are main employers○ “access to seeds, fertilizers, tools and loans … public sector jobs, educational opportunities and

even food assistance” is often contingent on support for the ruling party.(Human Rights Watch in 2011)

○ widespread urban unemployment, growing youth landlessness and insignificant job creation in rural areas

○ unemployment, lack of economic opportunities, and political persecution lead to excessive outward migration Isha Tendolkar

Socioecological Model of Malnutrition3) Community Factors:

● Health Care System:○ Ethiopia's health care system is among the least developed in Sub-Saharan

Africa ○ Health care spending

■ $44ppp per capita (2012)■ 3.8% of total GDP (2012)

○ Healthcare workers:■ health workforce of 0.7 per 1000 population■ 1 nurse per 5000 population■ In 2002, 17% of nurses and 30% of doctors left the country.

○ Lack of Access to health care services (such as prenatal/family planning)■ 83% of the population is underserved by health workers (rural areas)■ 81% rural population (2014)■ Unmet need for family planning: 26.5%

● Education:○ Women’s education

■ 52% no education■ 41.5% primary■ 3.9% secondary■ 2.3% higher

○ Poor literacy levels■ Youth literacy rates (15-24): female: 47%, male: 63% (2012)■ Total adult literacy rate: 39% (2012)

○ In accessibility to schoolsIsha Tendolkar

Socioecological Model of Malnutrition4) Individual/Interpersonal factors:

Diet:● characteristically consists of vegetable and very spicy

meat dishes, stew based with bread (adversely affected by drought)

Religious Beliefs:● 43.5% Orthodox Christians, 33.9% Muslim, just under

18.6% Protestant, and 2.6% adhered to traditional beliefs (2007)

● in rural areas family planning is not common due to religious reasons

Family Configurations:● families tend to be large with 7 or 8 children being

commonComorbidities:

● Certain illnesses and infections, such as TB, HIV/AIDS, measles, and diarrhoea are directly linked to acute malnutrition

Isha Tendolkar

Current ResponseCommunity-Based Nutrition Program (CBN)

The CBN program began in 2008 and coverers 238 districts throughout Ethiopia.Due in part to the CBN, child stunting rates have dropped from 57% in 2000 to 44% in 2010.

The program teaches mothers how to properly feed their babies. A study done by the World Bank, UNICEF, and Tulane University says that the CBN program has a 3-5% decline of

child stunting per year. The program has positively influenced infant and young child feeding

Tori Simon

Concern Worldwide (NGO)

The CBN program successfully partnered with NGO’s (Non-Governmental Organizations) that work at the ordinary level.

Concern Worldwide is an NGO that has worked in Ethiopia for many years.The group has been executing a community-based approach to manage acute malnutrition and improve feeding

practices.Tori Simon

Japan Social Development Fund (JDSF)

JDSF is a joint initiative of the World Bank and the Government of Japan. They finance the work of Concern Worldwide. The objectives of the JSDF program is to provide grants in support of community-driven development and poverty reduction projects that empower the poorest and most vulnerable groups not reached by other programs

and improve their lives through direct benefits. Grants are made eligible to recipient countries, based on income level classification.

This shows how serious malnutrition is in Ethiopia, bearing in mind they must be considered one of the most poor and most vulnerable groups to receive help from the JDSF. Tori Simon

Best Practices1. Save The Children

In Malawi, Save the Children is working with communities to improve their well-being and livelihoods through improved nutrition, sanitation, and access to savings and credit.

The community has come together to build trenches, dams, and more than 100 meters of canal to protect the town from topsoil run-off, mudslides, and channeling water to the fields of the most susceptible households in the

community.Families in Malawi were also receiving training in nutrition, health, and sanitation.

Save the Children focused on protecting crops, so that families had healthy, clean food to eat, and so they can be sold for money to help families also.Tori Simon

2. UNICEF in Philippines

UNICEF is working on properly educating the people of the Philippines on crops and also providing farming education.Many families in the Philippines rely on harvested crops from their own backyard, but due to weather related hardships,

these families are really struggling.Proper education from UNICEF will help rebuild and strengthen the agriculture economy after natural disasters.

Education is the key to success

Tori Simon

3. Integrated Child Development Services (ICDS)

Rates of malnutrition among India’s children are almost 5 times more than the number of children in China and twice the number in Sub-Saharan Africa

Nearly 50% of India’s children are underweight, 45% are stunted, 20% are wasted, 75% are anemic, and 57% are Vitamin A deficient

ICDS is focusing on a more balanced program by taking care of pregnant mothers, and also promoting the immunization and growth monitoring of children

ICDS is also providing education to children so they can learn about food, health, and childcare, which are all foundations for improving nutritional outcomes

Tori Simon

Agricultural Resources

Ethiopia has a very scarce amount of resources due to the low rainfall and drought conditions. Although they do have huge potential for agriculture development, only about 25% of it is arable land is

cultivated while the other 75% is eroded from poor weather conditions.75% of Ethiopia's population relies on smallholder farmers agriculture

Paige Paratore

Resources: Financial

● USAID Ethiopia’s strongest resource When people cannot support themselves, USAID, provides seed, livestock, and food to try to prevent

malnutrition. Provided 38,000 health extension workers to help reduce the under five mortality rate by more

than 6% each year since 2000. ● UNICEF

○ In June 2013, Ethiopia launched an ambitious and revised National Nutrition Plan, that seeks to transform the economic and development trajectory of millions of children and their mothers, by addressing food and nutrition insecurity in the country.

Paige Paratore

Resources: Political ● Growth and Transformation Plan

○ U.S. assistance capitalizes on a partnership with the government to increase economic growth with resilience, deliver basic public health and education services and promote a governance environment that is conducive for sustainable economic development.

Paige Paratore

Intervention

TargetWomenChildrenFarmers

Time Frame -10 years 2017-2027

-2022 midpoint check & track progress through statistics

Funding Partner with Save the

Children, Government & UNICEF

Nutrition Mission in EthiopiaPrograms to target malnutrition

● Invest in agricultural infrastructure & farming education● Educating women & children (children to complete and obtain a secondary

education and informing women about feeding and caring practices)● Improving health care systems

Sofia Anamuro, Ria Brumant, Paige Paratore, Karli Rymer, Tori Simon, Isha Tendolkar

INtervention resource Investment Allocation

Karli Rymer

The Mission The lasting effects of malnutrition weigh heavily on not only the health of Ethiopia, but also on its productivity as a nation. Our mission is to alleviate the factors that lead to Ethiopia's malnutrition crisis. By investing in education systems, health care systems, and agricultural infrastructure, we can provide sustainable methods for Ethiopians to both meet their basic needs and strengthen their quality of life. The elimination of malnutrition opens a door to reaching full potential, thus fortifying Ethiopia's presence in the global community.The earlier we act, the more likely we can avert a greater humanitarian disaster & the systems

problem

Isha Tendolkar

References● Dr. Barchi’s class notes● Hunger Statistics | WFP | United Nations World Food Programme - Fighting Hunger Worldwide. (n.d.). Retrieved April 26, 2016, from https://www.wfp.org/hunger/stats● Nutrition

http://www.unicef.org/ethiopia/ECO_Nutrition_BN.pdf● The world's 10 hungriest countries. (n.d.). Retrieved May 01, 2016, from https://www.globalcitizen.org/en/content/the-worlds-10-hungriest-countries/ ● UNICEF - Malnutrition definition popup. (n.d.). Retrieved April 27, 2016, from http://www.unicef.org/progressforchildren/2006n4/malnutritiondefinition.html● The Cost of Hunger http://documents.wfp.org/stellent/groups/public/documents/newsroom/wfp263405.pdf● Ethiopia | U.S. Agency for International Development. (n.d.). Retrieved April 24, 2016, from https://www.usaid.gov/ethiopia ● Nutrition. (n.d.). Retrieved April 24, 2016, from http://www.unicef.org/ethiopia/nutrition.html ● Ethiopia | Food Security Portal. (n.d.). Retrieved April 18, 2016, from http://www.foodsecurityportal.org/ethiopia/resources

● Ethnomedorg. (2016). Ethnomedorg. Retrieved 25 April, 2016, from https://ethnomed.org/culture/ethiopian/copy_of_ethiopian-cultural-profile

● Hawking, S. (2000). Professor Stephen Hawking's website. Retrieved 9 February, 2009, from http://www.hawking.org.uk/

● Whoint. (2016). Whoint. Retrieved 25 April, 2016, from http://apps.who.int/nutrition/landscape/report.aspx?iso=eth

● Ethiopia Community-Based Nutrition Program Helps Reduce Child Malnutrition. (n.d.). Retrieved April 04, 2016, from http://www.worldbank.org/en/news/feature/2012/10/16/ethiopia-community-based-nutrition-program-helps-reduce-child-malnutrition

● Fighting Malnutrition in the Philippines - The Borgen Project. (2014). Retrieved April 04, 2016, from http://borgenproject.org/fighting-malnutrition-philippines/● Food. Farming. Future: Breaking the Cycle of Malnutrition and Poverty. (2013). Retrieved April 04, 2016, from

http://www.one.org/international/policy/food-farming-future-breaking-the-cycle-of-malnutrition-and-poverty/● Helping India Combat Persistently High Rates of Malnutrition. (n.d.). Retrieved April 04, 2016, from

http://www.worldbank.org/en/news/feature/2013/05/13/helping-india-combat-persistently-high-rates-of-malnutrition