Nutritional problems of
children in Ethiopia
Mekitie Wondafrash(MD, DFSN)
Jimma University, Ethiopia
Content
1. Introduction
– Background about Ethiopia
– Child health in Ethiopia
2. Nutritional problems of children
in Ethiopia
3. Child Health and Nutrition
project of VLIR-UOS
◦
◦
Justification /Rationale
Expected outcomes of the project
◦
Findings from the baseline survey in
Gilgel Gibe Field Research Center
4. Conclusion
Introduction
• Background about Ethiopia
– Geography
– Demographic characteristics
– Health and Nutritional problems of
children in Ethiopia
• Health problems
• Nutritional problems
Mild, moderate and severe Malnutrition
 Micronutrient malnutrition
Source: Ethiopia DHS, 2004
Introduction…
Background about Ethiopia
Geography:
 Situated at horn of Africa
 Position: 3 -150 N latitude , 33 – 480 E longitude
 Topography: Highest peak at Ras Dashen-4,550 m
above sea level
Lowest point- Affar Depression at 110m
below sea level
 The total area ¬1.1 million km2
 Borders: Djibouti, Eritrea, Sudan, Kenya, and Somalia
 A large part is high plateaux and mountain ranges
Source: CSA, 2000, MOI 2004
Demographic characteristics
Population Pyramid of Ethiopia
Age group
1994
Population percent
2007
Child health problems in Ethiopia
• In general 60 to 80 % of health problems in
Ethiopia are due communicable diseases and
nutritional problems
• Health service coverage is low
(about 64%, 2003)
• The is poor public health infrastructure
contributing to high morbidity and mortality
Source: FMOH, 2003
Causes of childhood morbidity and mortality
• Neonatal problems
– Infection ( congenital, acquired)
– Asphyxia
•
•
•
•
Undernutrition( ranges from mild to severe)
Malaria
Measles
Acute respiratory tract infections
( e.g. pneumonia)
• Diarrhoeal diseases
Child survival in Ethiopia
( source: Ethiopia DHS 2005)
Childhood mortality trends per 1000
Source: Ethiopia DHS, 2000.
Timing of mortality in children in Ethiopia
( source: Ethiopia DHS 2000)
What are children dying from in Ethiopia ?
PROFILES analysis , FMOH 2006
Estimated direct causes of neonatal death for Ethiopia
Infection alone
contributes to 46% of
neonatal death
Diarrhoea
3%
Other
Congenital 7%
4%
Asphyixa
25%
Tetanus
7%
Infection
36%
3/11/2016
Preterm
17%
( Source: Facility based death report, FMOH, 2004)
14
Nutrition in the MDGs
MDG
Relevance of nutrition
Eradicate extreme poverty
and hunger
Contributes to human capacity and productivity
throughout life cycle and across generations
Achieve universal primary
education
Promote gender equity and
empower women
Reduce child mortality
Improves readiness to learn and school achievement
Empowers women more than men
Combat HIV/AIDS, malaria
and other diseases
Reduces child mortality (over half attributable to
malnutrition)
Contributes to maternal health thru many pathways
Addresses gender inequalities in food, care and health
Slows onset and progression of AIDS
Important component of treatment and care
Ensure environmental
sustainability
Highlights importance of local crops for diet diversity
and quality
Develop a global partnership
for development
Brings together many sectors around a common
problem
Improve maternal health
Under 5 Mortality Rate
Reaching MDG4 is feasible?
160
165
153
140
123
120
109
89
80
HSDP I
95
54
II
40
0
1990
1995
Current Trend
2000
2005
Years
2010
2015
MDG Trend
Current U5MR trend versus trend needed to reach MDG for Ethiopia
(FMOH, 2006)
3/11/2016
16
Nutritional problems of children in Ethiopia
• Ethiopia is one of the most food insecure
countries in the world having both chronic and
transitory food insecurity and frequent attacks
of famine in the recent past
– Food insecurity incorporates- low food intake ,
variable access to food, and vulnerability
• Food insecurity is mostly associated with
drought, poor land management practices,
diseases, attack by pests, destruction of crops
by flood, etc..
Current estimated food security conditions: January
to March 2009
Source: FEWS NET and WFP Ethiopia
Nutritional problems ….
• Nutritional problems continue to
be the leading cause of morbidity
and mortality in children
• Manifest by
– Protein Energy Malnutrition ( PEM)
– Micronutrient malnutrition
• Vitamin A deficiency ( VAD )
• Iodine Deficiency disorders (IDDS)
• Iron Deficiency Anaemia (IDA)
Nutritional problems ….
• The plight usually starts during
intrauterine life with maternal
malnutrition
(during and prior to pregnancy)
• Continues to childhood with the
same condition
(Feeding, Health Care,
Environment)
Trends in malnutrition in under-fives in Ethiopia, 1982-2000
( Zewuditu et al ,2001)
Nutritional Status of Children Under Age 5,
2000 and 2005
Source: Ethiopia DHS, 2005
Nutritional status of children under five years of age
Percent
Source: Ethiopia DHS, 2005
Stunting, wasting and underweight by age in
Ethiopia,2005
Source: Ethiopia DHS, 2005.
Global timing of growth faltering in U5 child
Stunting at Age 2- critical period
UNICEF/C-55-34/Watson
(EDHS - 2005)
51%
Source: Ethiopia DHS, 2005.
Percentage of children under age five whose height-for-age is below 2 SD from mean by region
Source: Ethiopia DHS, 2000
Micronutrient deficiencies in Ethiopia
• Micronutrient malnutrition is “hard to see”
• VAD among children under five years :
– Prevalence of Bitot’s spot: 1.7% (1.6% - 1.9%)
– Subclinical VAD (<0.7μmol/l): 37.7% (35.6%39.9%)
– Corneal ulceration: 0.02% (1.7% - 2.0%)
– Corrected child night blindness: 0.7%
Source: Tsegaye Demissie et al, 2008
( Unpublished national survey report )
Micronutrient deficiencies
Vitamin A supplementation
• Vitamin Supplementation is
undertaken routinely in the
health institution and during
NIDs
• However, <50% of U5 children
received it the previous 6ms
(EDHS,2005)
Micronutrient deficiencies
Iodine Deficiency Disorders (IDDS):
– Only about one in five live in households
with adequately iodized salt ( EDHS,2005)
– National total goitre rate: 38%
Iron Deficiency Anaemia (IDA):
• Not documented in Ethiopia , rather over all
anaemia is measured through determination
of Hgb status
• Overall anaemia according to Ethiopia DHS,
2005
– 27% of WRA were anemic
– 54% of children between 6-59 mo had
anemia
Infant and young child feeding practices in
Ethiopia
• Infant and young child feeding is critical for child
growth and development
• 96 % of children are ever breastfed
• 86 % breastfed within 24 hours of birth
• The average length of BF is 26 ms
• Only 49% of children under the age of six months
are exclusively breastfed
• Average length of EBF is only 4 ms
• Only 22 % of children 6-23 ms are fed according
to IYCF guidelines
Infant and Young Child feeding…
100
%
50
Exclusive
Breastfeeding
Complementary
Feeding
49
50
0-6 months
6-9 months
UNICEF/93-COU-0173/Lemoyne
75
25
0
Source: Ethiopia DHS2005
Breastfeeding practice by age in Ethiopia
Source: Ethiopia DHS2005
Trends in breast feeding practices in Ethiopia
Source: Ethiopia DHS2005
Feeding practices for infants under six months,
Ethiopia ( Is it optimal according to IYCF guidelines?)
Source: Ethiopia DHS2000
Feeding Practices in Ethiopian Infants 6-9
months
Source: Ethiopia DHS2000
Dietary diversity of infants and young
children in Ethiopia
• Dietary diversity refers to :
Number of foods or food groups consumed in a
defined period (e.g. per day or week)
• 7 groups: starchy staples, legumes, dairy, other,
flesh foods, VA-rich fruit & veg, other fruits &
veg, fats.
Dietary diversity and child growth: Africa (DHS data sets)
Source: Arimond and Ruel, 2004
Means adjusted for child age, maternal height and BMI, # children < 5 y, and 2
wealth/welfare factor scores
Consequences of Malnutrition
among children in Ethiopia
© 2005 Virginia Lamprecht, Courtesy of Photoshare
Four functional consequences




Mortality
Illness – via increasing susceptibility to
illnesses
Intelligence loss
Reduced productivity
Contribution of malnutrition to U5 Mortality in
Ethiopia
Other 2%
Measles 4%
AIDS 1%
Neonatal 25%
Diarrhea 20%
Malnutrition
57%
HIV/AIDS
11%
Malaria 20%
Pneumonia
28%
«Hidden» death due to malnutrition in
Ethiopia
80% of the death due to malnutrition is contributed
for by Mild and moderate malnutrition
Mild &
moderate
Severe
Only 1 in 5 malnutrition-related deaths
is due to severe malnutrition
Malnutrition and intellectual development
Reduced:
•
Learning ability
•
School performance
•
Retention rates
Nutritional problems associated with brain
development
Prevalence (%)
100
75
54
50
47
38
25
13
0
Goitre
Anemia
Stunting
LBW
Consequence of Stunting
Reduced productivity
1.4% decrease in productivity
for every
1% decrease in height
(Haddad & Bouis, 1990)
Child Health Nutrition Project of
JU-IUC (VLIR-UOS)
Rationale of the project
• Developed in cognizant with the current trend of
health and nutritional problems of children in
Ethiopia
• Much of the studies done malnutrition are
descriptive
• Dietary guidelines formulated for Ethiopian children
are not based on local study of complementary foods
and feeding patterns
• Nutrition rehabilitation for severely malnourished
children are mostly restricted to hospitals where
Primary Health Care Units are appropriate and cost
effective
Expected outcomes from the project
• Development of appropriate complementary
feeding strategy based on locally available foods
and method of preparation ( processing)
• Identifying factors affecting the quality and
safety of complementary foods
• Contributing to household food security through
addressing the problem of post harvest losses
• Development of locally appropriate
rehabilitation strategy ( dietary + psychomotor)
(sustainability and cost effectiveness)
Project partners:
• The project encompasses different disciplines
(sectors) namely, Public Health Nutrition,
Pediatrics and Child Health, Agriculture and
Food Chemistry ( food technology)
• Similar composition of expertise is also
obtained from the Belgium
Overall objective of the project
• Development of human and physical capitals
(academic objective)
◦ Public health nutrition , food technology/food
science ( lacking in Ethiopia at large)
◦ Research capacity in the areas of nutrition and
food science/food technology
• Contribute to the improved child growth and
development ( development objective)
Summary findings from baseline survey on
nutritional status and determinants among
under 5 children in communities around
Gilgel Gibe Hydroelectric dam, Ethiopia
March, 2008
Objectives of the study
– Determine nutritional status of children
Under five years of age
– Assess the feeding pattern of target
children
– Describe the association between feeding
patterns with nutritional status
Methods
• Cross sectional
• Representative sample of children between 6
and 59mo
• Simple random sampling technique was used
• Anthropometry , feeding pattern and general
socioeconomic variables were assessed
• Data was collected by going house to house
Data analysis
• Data was entered into SPSS Vr. 16, and
analysis was done by both SPSS and
Anthro2007 ( WHO, 2007)
• Anthropometric measures were converted in
to z-score values for comparison with a
reference population
• Feeding patterns of children was described in
relation to IYC feeding guidelines (WHO,2003)
• Dietary diversity was calculated for children 623mo old based on the number of food
groups consumed the previous 24hrs
Result: Socio-demographics
Age group (n=364)
Frequency
Percent
6-11
60
16.5
12-23
87
23.9
24-35
109
29.9
36-47
73
20.1
48-60
35
9.6
Total
364
100.0
Male
187
51.2
Female
178
48.8
Sex (n=365)
Background information
• 97% of the respondents are biological
mothers
• 87% of the mothers are unable to read and
write
• Average no. of U5 children 1.6
• Average birth interval for U5 children
(n=314)=2.43 yrs
BMI of mothers of index children , kg/m2) (n=350)
3%
23%
Chronic energy
Deficiency
(BMI<18.5kg/msq)
Normal (BMI b/n 18.524.99kg/msq)
74%
Overweight (BMI
>=25kg/msq)
Nutritional status of children under five years of
age using WHO growth reference (WHO,2007)
45%
23%
13%
stunted
wasted
underweight
Type of malnutrition by age in under five children in
GGFRC area, 2008
Age group of children U5 years
MGRS population ( WHO, 2007) compared with the distribution of malnutrition
in Gilgel Gibe area
Feeding practice of mothers of index
children in the project area
Indicators for assessing IYCF practices (623mo) (source: WHO 2007)
• Core indicators include:
–
–
–
–
–
–
–
–
Early initiation of breastfeeding
Exclusive breastfeeding under 6 months
Continued BF at one year
Introduction of solid, semi-solid or soft foods at 6
months of age
Minimum dietary diversity
Minimum meal frequency
Minimum acceptable diet ( MAD)
Consumption of iron reach and iron fortified foods
Feeding pattern of children U5 years
• Ever breastfed (n=365): 99.2%
• Timing of introduction of the breast
milk(n=355):
– Immediately after birth= 41%
– After the first hour of birth=59%
• Average period of EBF (n=361): 3.35 mo
• Average time of introduction of other foods or
drinks to the child (n=356): 3.37mo
Type of additional foods started for U5 children in
the study area
•
Differs for those breastfed and non breastfed
children
9%
Solid and semi solid
foods
Liquid complementary
foods
91%
Dietary diversity for children between 6-23m
Minimum dietary diversity:
• Proportion of children 6–23 m who receive
foods from 4 or more food groups
• The 7 foods groups used for tabulation of this
indicator are :
– Grains, roots and tubers
–
–
–
–
–
–
Legumes and nuts
Dairy products (milk, yogurt, cheese)
Flesh foods
Eggs
Vitamin-a rich fruits and vegetables
Other fruits and vegetables
DD in relation to stunting ( n=118)
p<001
p<001
Non stunted
Minimum acceptable diet (MAD) for children
between 6&23 mo
• Proportion of children 6–23 months of age who receive
a minimum acceptable diet (apart from breast milk)
– It is a composite indicator consists of two fraction
1. Breastfed children 6–23 months of age who had at least
the minimum dietary diversity and the minimum meal
frequency during the previous day out of total breastfed
children 6–23 months of age
2. Non-breastfed children 6–23 months of age who received
at least 2 milk feedings and had at least the minimum
dietary diversity not including milk feeds and the
minimum meal frequency during the previous day out of
non-breastfed children 6–23 months of age
Minimum acceptable diet (MAD) in relation to
stunting
p<001
p<001
Non stunted
Conclusion
• There is high rate of undernutrition among
infants and young children in Ethiopia and
project area
• There is poor optimal breast feeding and
complementary feeding practices
• The quality of the diet is poor as most infants
and young children were initiated with liquid
CFs
• Some indicators of IYCF practice are
associated with stunting
Conclusion…
• Malnutrition is the major single cause of
death in children in Ethiopia
• Malnutrition usually operates synergistically
with infection ( But both can lead to death
directly)
• Programmatically both should be addressed as
the same time to reduce infant mortality in
Ethiopia
UNICEF/C-55-38/Watson
THANK YOU !!!