Nutritional problems of children in Ethiopia

1. Nutritional problems of children in Ethiopia Mekitie Wondafrash(MD, DFSN) Jimma University, Ethiopia

2. Content • Introduction • Background about Ethiopia • Child health in Ethiopia • Nutritional problems of children in Ethiopia • 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 • Conclusion

3. 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

4. Source: Ethiopia DHS, 2004

5. 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

6. Demographic characteristics

7. Population Pyramid of Ethiopia 2007 1994 Age group Population percent

8. 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

9. 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

10. Child survival in Ethiopia ( source: Ethiopia DHS 2005)

11. Childhood mortality trends per 1000 Source: Ethiopia DHS, 2000.

12. Timing of mortality in children in Ethiopia ( source: Ethiopia DHS 2000)

13. What are children dying from in Ethiopia ? PROFILES analysis , FMOH 2006

14. Estimated direct causes of neonatal death for Ethiopia Infection alone contributes to 46% of neonatal death ( Source: Facility based death report, FMOH, 2004)

15. Nutrition in the MDGs

16. Reaching MDG4 is feasible? Current U5MR trend versus trend needed to reach MDG for Ethiopia (FMOH, 2006)

17. 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..

18. Current estimated food security conditions: Januaryto March 2009 Source: FEWS NET and WFP Ethiopia

19. 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)

20. 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)

21. Trends in malnutrition in under-fives in Ethiopia, 1982-2000 ( Zewuditu et al ,2001)

22. Nutritional Status of Children Under Age 5, 2000 and 2005 Source: Ethiopia DHS, 2005

23. Nutritional status of children under five years of age Percent Source: Ethiopia DHS, 2005

24. Stunting, wasting and underweight by age in Ethiopia,2005 Source: Ethiopia DHS, 2005.

25. Global timing of growth faltering in U5 child

26. Stunting at Age 2- critical period (EDHS - 2005) UNICEF/C-55-34/Watson 51% Source: Ethiopia DHS, 2005.

27. Percentage of children under age five whose height-for-age is below -2 SD from mean by region Source: Ethiopia DHS, 2000.

28. 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 )

29. 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)

30. 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

31. 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

32. Complementary Feeding Exclusive Breastfeeding % Infant and Young Child feeding… UNICEF/93-COU-0173/Lemoyne Source: Ethiopia DHS2005

33. Breastfeeding practice by age in Ethiopia Source: Ethiopia DHS2005

34. Trends in breast feeding practices in Ethiopia Source: Ethiopia DHS2005

35. Feeding practices for infants under six months, Ethiopia ( Is it optimal according to IYCF guidelines?) Source: Ethiopia DHS2000

36. Feeding Practices in Ethiopian Infants 6-9 months Source: Ethiopia DHS2000

37. 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.

38. 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

39. Consequences of Malnutrition among children in Ethiopia © 2005 Virginia Lamprecht, Courtesy of Photoshare

40. Four functional consequences • Mortality • Illness – via increasing susceptibility to illnesses • Intelligence loss • Reduced productivity

41. Contribution of malnutrition to U5 Mortality in Ethiopia Other 2% Measles 4% AIDS 1% Neonatal 25% Malnutrition57% Diarrhea 20% HIV/AIDS 11% Malaria 20% Pneumonia 28%

42. Mild & moderate Severe «Hidden» death due to malnutrition in Ethiopia 80% of the death due to malnutrition is contributed for by Mild and moderate malnutrition Only 1 in 5 malnutrition-related deaths is due to severe malnutrition

43. Malnutrition and intellectual development • Reduced: • Learning ability • School performance • Retention rates

44. Nutritional problems associated with brain development

45. Consequence of Stunting Reduced productivity 1.4% decrease in productivityforevery 1% decrease in height (Haddad & Bouis, 1990)

46. Child Health Nutrition Project of JU-IUC (VLIR-UOS)

47. 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

48. 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)

49. 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

50. 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)