In Ethiopia, Community-Based Approaches Help to Improve Nutrition among Women and Children

By Victor Chinyama and Tiguaded Fentahun

South Gondar Zone, Ethiopia: Enalem Asnakew (40) had no idea why her one-year-old son Misganaw Asmare would not stop vomiting. His arms, legs, and abdomen were swollen and his appetite was failing. After about a month, she had had enough and decided to bring him to the local hospital.

“He was put on blood transfusion for three days,” she says in a barely audible voice.Then, they administered [therapeutic] milk through his nostrils in addition to [intravenous] medicine. The nurses frequently visited my child and now, after nine days, the swelling has disappeared, the vomiting is almost gone, and my child takes therapeutic milk orally.”

Misganaw was diagnosed with severe acute malnutrition, a serious but entirely preventable and treatable condition which the WHO estimates accounts for 35 per cent of deaths among children under five globally. Typically, severe acute malnutrition is treated in a hospital but the advent of ready-to-use therapeutic foods has enabled children like Misganaw to be treated at home if they have no underlying medical complication requiring hospitalization.

In general, Ethiopia has made strides in reducing undernutrition in children, with stunting in particular dropping from 58 per cent in 2000 to 38 per cent in 2016. However, the number of children with severe acute malnutrition spikes up during the ‘lean’ season between June and August, the period when most households will have exhausted their food stocks as they await the next harvest beginning September. Prolonged and chronic humanitarian crises, such as droughts and floods, also contribute to increased malnutrition in children.

Inadequate food however is not the only cause of malnutrition. Multiple factors, such as the child’s size at birth and the mother’s weight, predispose a child to malnutrition. Acute illnesses and poor feeding practices are other contributing factors. The key to preventing malnutrition therefore lies in improving the nutritional status of the mother, ensuring the child has access to an improved and diverse diet, providing safe water and sanitation, improving hygiene, and building a strong and supportive system at community level.

In 2011, with a US$ 50 million grant from the Government of Canada, UNICEF embarked on a project to improve nutrition in children and women in 100 food insecure districts in the Amhara, Oromia, and SNNP regions of Ethiopia. The six-year project, later extended for another year, was to improve the use of health and nutrition services by children, adolescent girls, and breastfeeding mothers, and increase the availability of water and sanitation services. The project focused on the community level, where efforts were made to increase the scope and coverage of nutrition activities. These included multi-media campaigns, education of mothers and caregivers on nutrition, promotion of breastfeeding, and increasing production of local complementary foods. Wells were drilled to supply safe water to communities and households were encouraged to construct their own improved latrines.

To improve service delivery, 2,000 community-based health extension workers responsible for mobilizing people and agriculture development agents were trained in nutrition. Water was supplied to health posts and committees to oversee water, sanitation, and hygiene activities were established at kebele level (smallest administrative unit in Ethiopia).

Students line up to receive deworming tablets at Gurumu Koysha Primary and Secondary School in the SNNP Region of Ethiopia. Deworming of adolescents became a national programme after being introduced through the Canada-funded project.
© UNICEF Ethiopia/ 2016/ Meklit Mersha

In total, the number of community-based nutrition activities doubled and 24 per cent more households cultivated a garden (the largest increase was observed among the poorest households). Nutrition knowledge among health workers and health extension workers increased from 51 to 80 per cent while exclusive breastfeeding increased from 71 to 80 per cent. The proportion of mothers stating that water should not be given to babies under six months of age increased from 61 to 78 per cent.

The project also marked a milestone as the first ever in Ethiopia to target nutrition for adolescents (children aged between 10-18 years). Deworming of adolescents was first introduced under the project as a pilot but was subsequently scaled up to national school deworming campaigns, reaching 3.9 million school children.

These results were achieved against a backdrop of unforeseen challenges, such as the civil unrest of 2016 which limited travel and access and the El Nino drought in 2016 which shifted attention and resources.  Notwithstanding, a survey at the end of the project showed that stunting among children had declined from 40 per cent to 35 per cent and the prevalence of underweight children from 22 per cent to 17 per cent. Put differently, the odds of children in the 100 districts being stunted or underweight had been reduced by 19 per cent and 20 per cent respectively.

The education, mobilization, and support given to the 100 districts in Amhara and the other two regions will ensure that mothers like Enalem will never have to wonder again why their children are vomiting, or why their abdomen and limbs are swollen. They will also ensure that children like Misganaw can grow up healthy and strong, free from dangerous yet preventable conditions like malnutrition.

EU and UNICEF launch a photo book on the success story of reducing malnutrition in Ethiopia

25 April 2018, HAWASSA – Today, the European Union (EU) and UNICEF launched a photo book entitled “Ending malnutrition in Ethiopia – A SUCCESS STORY” which illustrates Ethiopia’s success story in ending malnutrition, through the voices, stories and images of Ethiopians.

The nutrition photo book launch and photo exhibition held in the presence of Dr Abreham Alano, Head of the SNNP Regional Health Bureau, H.E Ambassador Johan Borgstam, Head of the European Union Delegation to Ethiopia, Ms Gillian Mellsop, UNICEF Representative to Ethiopia and other key stakeholders from the Government and other partners is a celebration of the success achieved so far in the reduction of malnutrition in Ethiopia while advocating for continued multi-sectoral efforts since malnutrition among children and women in Ethiopia remains a major concern.

It is also a celebration of how Ethiopia has managed to sustain improvements in nutrition, yet also a reminder of all the work that needs to be done to ensure everyone enjoys optimal nutrition.

On the occasion, Dr Abreham Alano, Head of the SNNP Regional Health Bureau thanked the EU and UNICEF for their support in results gained thus far in reducing stunting and  malnutrition, on the health care utilization as well as maternal and child mortality reduction and urged them to continue their support until the targeted results are achieved.

Ambassador Johan Borgstam, Head of EU delegation to Ethiopia on his part said, “It is an honour for me to open this photo book and exhibition launching event today on a topic of malnutrition which is a priority of both the Government of Ethiopia and of the EU’s development cooperation policy. Malnutrition is not only a major health problem affecting children and adults in partner countries, it also has important economic and social dimensions challenging their development by deteriorating the well-being of their entire population.”

Ethiopia has experienced rapid and sustained improvements in nutrition during the past 15 years. For instance, the country has seen a steady reduction in stunting – the fastest rate of improvement in Africa – as well as a significant decline in the percentage of underweight and wasted children. Yet, Ethiopia remains in a precarious situation, with large absolute numbers of affected children: 5 million children are stunted and 1.3 million children under five suffer wasting.

“I would like to highlight the importance of long-term investments to ensure that progress is sustained in ending malnutrition in Ethiopia. While the achievements we recognize today are indeed a success story, we cannot afford to rest on our laurels. Undernutrition still remains a challenge and it requires us all to redouble our efforts to ensure that every child enjoys better health and nutrition,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. With the Government’s leadership and the strong commitment of partners, this goal is achievable. Let’s walk together with the same single-minded determination, zeal, and focus to end undernutrition in Ethiopia.”

To further reduce these numbers, the EU has provided €10,000,000 to support vulnerable populations in 17 woredas (districts) in Oromia, SNNP and Amhara regions of Ethiopia through a project entitled “Multi-sectoral interventions to improve nutrition security and strengthen resilience.” This joint action plan which is being implemented by UNICEF and FAO aims to contribute to the improvement of nutritional status of children, adolescents, pregnant and lactating women using the life cycle approach.

Canada partners with UNICEF to improve reproductive health and nutrition among adolescent girls in Ethiopia

8 March 2018, ADDIS ABABA – On the occasion of International Women’s Day, the Government of Canada is pleased to provide CDN$ 14.8 million (US$ 12 million) to UNICEF Ethiopia to improve the reproductive health and nutritional status of adolescent girls. The initiative will reach over four million girls in districts with high food insecurity and a high prevalence of child marriage. It will be implemented between 2018 and 2022.

“As part of our feminist approach, Canada is committed to advancing sexual and reproductive health and rights in order to empower women and adolescent girls in Ethiopia and around the world,” says Ivan Roberts, Head of Cooperation at the Embassy of Canada in Ethiopia.

In Ethiopia, 25 per cent of the population is made up of adolescents (aged 10 to 19 years), of which 11 million are girls.  Adolescent girls experience numerous barriers that hinder them from fully realizing their potential. A significant portion of these barriers is related to their sexual and reproductive health and to their nutrition.

Canada’s contribution will help girls access adolescent-friendly sexual and reproductive health services and nutrition facilities by training health workers to clearly understand the physiological and psychological needs of adolescent girls. This initiative will also leverage gender clubs in schools to provide life skills and sexual and reproductive health knowledge to young people. In addition, adolescent-friendly spaces will be created to ensure out-of-school children freely discuss nutrition and sexual and reproductive health issues and practices including family planning.

To improve personal hygiene, the programme will support the local production and supply of sanitary pads, education of girls on pre- and post menstruation, improve sanitary facilities through upgrading and rehabilitation, provide spaces in schools for menstruating girls to rest, enhance counselling and peer-to-peer support, and promote informal discussions among girls on issues that concern them.

“We appreciate the timely support from the Government of Canada which will allow us to address the challenges that Ethiopian adolescent girls face today,” says Gillian Mellsop, UNICEF Representative in Ethiopia. “We believe that this contribution will help adolescent girls break out of discriminatory social and gender norms that hamper their education and hinder their ability to meaningfully contribute to their nation’s development.”

UNICEF will use its strong monitoring and evaluation tools to ensure the success of this programme and invest in regular compilation of health and nutrition data to better understand trends and uptake of services by adolescent girls.

MIND THE GAP – BABYWASH Launched on World Toilet Day to Improve Integrated Early Childhood Development in Ethiopia

By Samuel Godfrey

When you travel in a car through Addis Ababa, you will note that adult women and men vary greatly in height. There are tall people and short people. So which ones of these are actually stunted? And why? Scientifically stunting is defined as a reduced growth rate in human development and is a primary manifestation of malnutrition or more accurately under nutrition. The definition of stunting according to the World Health Organisation (WHO) is for the “height for age” value to be less than two standard deviations of the WHO Child Growth Standards median.

So how does under nutrition occur? Recent scientific evidence suggests that under nutrition is a result of recurrent infections such as diarrhoea or helminthiasis in early childhood and even before birth. In 2016, UNICEF Ethiopia, published a blog entitled BABY WASH – the missing piece of the puzzle[1]?, in which evidence from a paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health[2] highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child faeces. To convert this evidence into action, the Government of Ethiopia, UNICEF and partners have developed a BABYWASH implementation guideline. The guideline aims at contributing to improving Integrated Early Childhood Development (IECD) through improving the baby and child environment.

World Toilet Day 2017: safe disposal of child faeces
Lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. ©UNICEF Ethiopia/2017/Mulugeta Ayene

The 2017 World Toilet Day was a perfect opportunity to launch the BABYWASH guideline. The document includes guidance on how to implement programmes with safe disposal of child faeces, providing protective environments through play mats and similar measures as well as prevention of soil transmitted helminths. The strategy was endorsed for implementation alongside regular safe sanitation and hygiene practices which are already being promoted by health extension workers. In his statement, H.E Dr Kebede Worku, State Minister of Health of Ethiopia said, “In Ethiopia, there is a common misconception that children’s faeces are not harmful while evidence shows otherwise. The current sanitation and hygiene promotion efforts, at times, overlook safe disposal of children’s faeces. In addition, most toilets are not designed keeping children’s special needs in mind. Hence, I am proud to endorse the Baby WASH manual today which was developed by the Federal Ministry of Health with the support of UNICEF and other partners in order to ensure a healthy environment for children’s growth and development especially those under three years of age.”

Ms Gillian Mellsop, UNICEF Representative to Ethiopia on her part said, “UNICEF is pleased to support the Ministry of Health in preparing these excellent guidelines on Baby WASH. We know that a contaminated environment harms infants and young children and puts them at risk of increased child mortality and stunting. Together, we have to ensure that parents and guardians, teachers and community leaders are aware of the importance of Baby WASH.”

According to the Knowledge, Attitude and Practice (KAP) baseline survey on Water, Sanitation, and Hygiene carried out in eight regions of Ethiopia, there is a general misconception about child faeces disposal. The survey showed that a lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. According to the survey, only half (49 per cent) of women knew that child faeces are dangerous to health. Misconception is higher among rural pastoralist women where only 39 per cent said child faeces are dangerous as compared with 50 per cent among rural non-pastoralist women and 54 per cent of women in urban areas. Although it may not be clear who is stunted and who is not just by looking at a child, it’s clear that safe disposal of child faeces helps improve a child’s health. Therefore, UNICEF will continue to support the Government with the implementation of the guideline throughout the country.

[1] https://unicefethiopia.org/2016/05/24/baby-wash-the-missing-piece-of-the-puzzle

[2] https://www.ncbi.nlm.nih.gov/pubmed/27546207

Children Takeover Minister Roles as Ethiopia celebrates World Children’s Day and UNICEF Ethiopia’s 65th Anniversary

20 November 2017, United Nations Conference Centre, Addis Ababa: Today, Ethiopia joined the global World Children’s Day celebrations by giving children high profile roles to become champions of their rights. In line with the event’s theme ‘For children, By children’ child parliamentarians took over the roles of the Ministers of: Women and Children’s Affairs; Health; Education; Water, Irrigation and Electricity; Labour and Social Affairs; and Urban Works and Construction. In addition, children took over the roles of the Attorney General and UNICEF Representative. In their new roles as ‘shadow Ministers’, children shared their ideas on issues that affect their lives.

World Children's Day and UNICEF Ethiopia 65th anniversary
Sara Beshir shadow Minister of Women and Children Affairs. Her message on World Children’s Day: attitudes towards violence angst children and women need to be changed. ©UNICEF Ethiopia/2017/Nahom Tesfaye

At the event, which was truly owned by children, some of the key recommendations proposed by children include:

  • Accelerate efforts to end harmful traditional practices, including child marriage and Female Genital Mutilation/Cutting
  • Provide clean water and sanitation services for all children across the country, no matter where they live
  • Build more hospitals that are focused on child health and ensure health professionals treat children with care and love
  • Involve children in child justice
  • Ensure quality education for all children through skilled teachers, including pre-primary education
  • Ensure that girls stay in school and finish their education
  • Provide more playgrounds and safe spaces, especially in urban and peri-urban settings
  • Include children’s voices when adults and local authorities discuss issues that affect children’s lives.

Child parliamentarians from different regions also had an opportunity to discuss issues relevant to children in Ethiopia with shadow Ministers and dignitaries through a Q&A session.

In her opening remarks, H.E Ms Demitu Hambisa, Minister of Women and Children’s Affairs, stated that this year’s World Children’s Day is a day of action for children by children. She highlighted that decision makers need to ensure that children’s voices are heard and reflected in decisions that affect their lives.

World Children's Day and UNICEF Ethiopia 65th anniversary
Minister of Women and Children Affairs , Ms Demitu Hambisa speaking during World Children’s Day. She says; listening to children’s voices and involving them in decision making is key. ©UNICEF Ethiopia/2017/Nahom Tesfaye

Ms Gillian Mellsop, UNICEF Representative to Ethiopia, emphasising the need for the participation of children said, “Meaningful participation of children is not only a fundamental right – and enshrined as such in the Convention on the Rights of the Child – but is also key to ensuring that decisions made by adults are relevant to the actual needs of children.”

World Children's Day and UNICEF Ethiopia 65th anniversary
Ms Gillian Mellsop, UNICEF Representative to Ethiopia speaking on World Children’s Day. ©UNICEF Ethiopia/2017/Nahom Tesfaye

In addition, UNICEF Ethiopia launched its publication ‘Hulem Lehisanat- Always for children’ depicting its 65 years history serving children and women in Ethiopia.

The event highlighted the importance of including children’s voices by providing children with an opportunity to share their own solutions on how to keep every child in Ethiopia healthy, well-nourished, in school and protected.

‘BABY WASH’ boosted at this year’s World Toilet Day in Ethiopia

Addis Ababa, 15 November 2017 – Today, Ethiopia celebrated World Toilet Day by holding a half-day workshop with the theme “Safe Disposal of Child Faeces.

At the workshop, the national ‘Baby WASH’ strategy, which focuses on hygiene of children under three years, was endorsed by the Federal Ministry of Health. The strategy includes safe disposal of child faeces, providing protective environments through play mats and similar measures as well as prevention of soil transmitted helminths. The strategy will be implemented alongside regular safe sanitation and hygiene practices which are already being promoted by health extension workers.

World Toilet Day 2017: safe disposal of child faeces
At the workshop, the national ‘Baby WASH’ strategy, which focuses on hygiene of children under three years, was endorsed by the Federal Ministry of Health. ©UNICEF Ethiopia/2017/Mulugeta Ayene

In his statement, H.E Dr Kebede Worku, State Minister of Health said, “In Ethiopia, there is a common misconception that children’s faeces are not harmful while evidence shows otherwise. The current sanitation and hygiene promotion efforts, at times, overlook safe disposal of children’s faeces. In addition, most toilets are not designed keeping children’s special needs in mind. Hence, I am proud to endorse the Baby WASH manual today which was developed by the Federal Ministry of Health with the support of UNICEF and other partners in order to ensure a healthy environment for children’s growth and development especially those under three years of age.”

Ms Gillian Mellsop, UNICEF Representative to Ethiopia on her part said, “UNICEF is pleased to support the Ministry of Health in preparing these excellent guidelines on Baby WASH. We know that a contaminated environment harms infants and young children and puts them at risk of increased child mortality and stunting. Together, we have to ensure that parents and guardians, teachers and community leaders are aware of the importance of Baby WASH.”

According to the Knowledge, Attitude and Practice (KAP) baseline survey on Water, Sanitation, and Hygiene carried out in eight regions of Ethiopia, there is a general misconception about child faeces disposal. The survey showed that a lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. According to the survey, only half (49 per cent) of women knew that child faeces are dangerous to health. Misconception is higher among rural pastoralist women where only 39 per cent said child faeces are dangerous as compared with 50 per cent among rural non-pastoralist women and 54 per cent of women in urban areas.

World Toilet Day 2017: safe disposal of child faeces
Lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. ©UNICEF Ethiopia/2017/Mulugeta Ayene

A strong early childhood foundation, which includes a safe and hygienic environment coupled with adequate nutrition as well as nurturing parenting and stimulation for optimal brain development, is critical to ensure toddlers can develop to their full potential. This will facilitate a smooth transition to primary school and a better chance of successfully completing basic education. Therefore, investing in early childhood development through improved hygiene practices and environments is one of the most critical and cost‑effective ways to improve a child’s future health, education and productivity.

The Ministry of Health and UNICEF urge citizens, parents, teachers, health workers, policy makers and government officials to play their role in making sure that every child receives the benefits of Water, Sanitation and Hygiene (WASH) in their homes, communities, schools and health facilities.

The Government of Sweden grants US$ 2.5 million to UNICEF for emergency response

The Government of Sweden provides another US$2.5 million to UNICEF Ethiopia to support Water Sanitation and Hygiene (WASH), health and nutrition programmes in the drought affected regions of Afar, Oromia Somali and Southern Nations Nationalities and People’s regions.

UNI_9757

In Ethiopia, where 8.5 million people are currently in need of relief food assistance due to the recurrent drought emergency, 376,000 children are estimated to require treatment for severe acute malnutrition, 10.5 million people require access to safe drinking water and sanitation services and 1.9 million school-aged children need emergency school feeding and learning material assistance.

The contribution provided by the Government of Sweden will be used to construct and rehabilitate water supply schemes, procure Emergency Drug and Case Treatment Centre kits as well as obtain Community Management of Acute Malnutrition (CMAM) supplies including ready to use therapeutic food (RUTF), tents and Stabilization Centre materials in the four regions highly affected by the drought emergency.

UNICEF is grateful to the Government of Sweden for its continued support for providing life-saving interventions during the current humanitarian situation which continues to affect mostly women and children.

In 2017, the Government of Sweden has contributed more than US$5 million to UNICEF-assisted humanitarian programmes in Ethiopia.