Surviving hard times through therapeutic foods

Story – Bethlehem Kiros

Photos – Meklit Mersha 

SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016- Poverty and drought have left people in many parts of Ethiopia to grapple with food shortage; SNNPR is no different. Children are most affected, as evidenced by a high number of severe acute malnutrition (SAM) cases. Fortunately, the Government of Ethiopia implements the Community-Based Management of Acute Malnutrition (CMAM) programme, supported by UNICEF with generous contribution from ECHO. The programme enables children affected by malnutrition to receive life-saving services at stabilization centres (SC) and health posts, such as 32-year-old Bogalech Boreda’s twin infants.

Bogalech Boreda, 32, has 6 children. Her youngest 10-months-old twins Tegegn and Kibru Elias have both become severely malnourished because she could not nurse them sufficiently.
Bogalech’s 10-month-old twins Kibru and Tegegn have been in the Outpatient Therapeutic Feeding Programme (OTP) for SAM more than once. Since Bogalech has three more children at home, she says feeding the twins has not been easy.

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She gets help from her older children when they return from school, such as Caleb, 12, pictured here holding one of the twins.  Still, taking care of the infants occupies most of Bogalech’s day, making it impossible for her to work. Her husband is unemployed with an additional two children from another wife, his earnings from a small plot of farm land are not enough to provide for them.

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The health extension workers (HEWs) of Morancho Kutela health post have arranged for Bogalech to receive targeted supplementary food multiple times since the twins were born. “I normally had enough milk to nurse my children in the past,” explains Bogalech, “but now, there are two of them and I also do not eat enough at home, so they have been suffering since they were born.”

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Three weeks before the picture was taken, Tegegn suffered from diarrhoea and was referred to the Stabilization Centre (SC) at the kebele’s (sub-district) health centre. After a few days of antibiotics and therapeutic milk treatment, he was referred to the health post for OTP to continue his treatment as an outpatient. Since his brother’s situation was not much better, both were enrolled to receive the RUTF.

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In the two weeks since the boys’ treatment began, Bogalech says she has seen progress on her babies’ health and appearance. “They love the [RUTF], they just cannot get enough of it. And the thought of having something to give them when they are hungry gives me such relief,” she adds. Since she is nursing them and providing additional food in her home, she hopes they will grow strong and healthy.

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Their middle-upper arm circumference (MUAC) and weight is measured every week until they reach their target weight for discharge. Currently at 6.2 kg, Tegegn’s target weight for discharge is 6.9 kg, which is still about 2 kg underweight for an average 10-month-old boy according to World Health Organization guidelines. His MUAC was 10.9 cm when he was first enrolled for treatment and has now reached 11.25 cm.

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Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.

 

KfW provides vehicles to support Mobile Health and Nutrition Teams in Somali region

By Somali Region Mass Media Agency

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Mr. Hassan Ismail, Head of Ethiopian Somali Regional Health Bureau ©2016/Mukhtar Mohamed

JIGJIGA, SOMALI REGION, 13 December 2016– In partnership with UNICEF, the KfW Development Bank, which administers Germany’s financial cooperation in developing countries, provided 15 vehicles to support the Mobile Health and Nutrition Teams (MHNT) across the Somali region.

Regional officials and UNICEF staff attended the handover ceremony in Jigjiga, the capital town of the Somali region. Hassan Ismail, Head of the Ethiopian Somali Regional Health Bureau, emphasizing the benefits of the15 vehicles for MHNT services, said, “The vehicles will contribute for the success of MHNTs to reach vulnerable women and children with basic health and nutrition services in drought-affected pastoralist areas.”

The mobile teams conduct outreach services and targeted campaigns, such as the Enhanced Outreach Strategy (EOS) that provides children vitamin A supplementation, treatment for intestinal worms, and screening for acute malnutrition in far-reaching pastoralist areas.

Fartun Mahdi Abdi, Head of the Water Bureau and representing the Vice President of the Somali region at the ceremony, also reiterated the contribution these vehicles will have to reducing maternal and child mortality as well as strengthening the quality of health services.

 Fartun Mahdi Abdi, left, Head of the Water Bureau, receives keys to the 15 vehicles from Dr. Marisa Ricardo of UNICEF Ethiopia.  ©2016/Mukhtar Mohamed
Fartun Mahdi Abdi, left, Head of the Water Bureau, receives keys to the 15 vehicles from Dr. Marisa Ricardo of UNICEF Ethiopia. ©2016/Mohamed

With the support of donors such as KfW, UNICEF Ethiopia provides the Government of Ethiopia with medicine and other supplies for MHNT operations. As a result, 362,815 medical consultations took place between January and October 2016 across Somali and Afar regions. Forty seven per cent of these are children.

UNICEF Ethiopia, through the generous support of KfW, provided an additional five vehicles to MHNTs in Afar for the same purpose.

Prolonged drought and intermittent flooding has gravely affected these areas in recent years, first caused by the effects of El Niño weather in 2015, and currently from effects of the Indian Ocean Dipole, another climatic phenomena.

New National Nutrition Programme II envisions an Ethiopia free of malnutrition

By Fanna Minwuyelet and Eric-Alain Ategbo

Last week, Ethiopia launched the second National Nutrition Programme (NNP) II focusing on the first 1,000 days of life to eradicate chronic malnutrition by 2030.  State Minister of Health and Chairperson of the National Nutrition Coordination Body (NNCB), Dr Kebede Worku, recognized 13 ministries[1] that represent the Federal Democratic Republic of Ethiopia to support the achievement of the targets laid out in the National Nutrition Programme II.

The ministries have recognised that high malnutrition rate in Ethiopia is unacceptable and have stressed the need for strengthened collaboration to reduce the impact of malnutrition in the country. The findings of ‘The Cost of Hunger in Africa,’ study revealed that Ethiopia loses 55.5 billion birr annually due malnutrition.

Ethiopia launched the second National Nutrition Programme
As malnutrition remains to be the underlying cause of more than one in five child deaths in Ethiopia, the goal of the NNP II is to provide a framework for coordinated and integrated implementation of multisector nutrition interventions.

The NNP II is developed taking into account past experiences and lessons learned from the implementation of the NNP I and integrating new initiatives from the second Growth and Transformation Plan (GTP II).

The updated aims of the NNP II include reducing the prevalence of three crucial indicators for children under five: stunting from 40 per cent to 26 per cent; underweight from 25 per cent to 13 per cent and wasting from 9 per cent to 4.9 per cent.

With the following five strategic objectives, the NNP II envisions Ethiopia free of malnutrition and diet-related non-communicable diseases by 2050.

  1. Improve the nutritional status of women (15 -49 years) and adolescent girls (10 – 19 years)
  2. Improve the nutritional status of children from birth up to 10 years
  3. Improve the delivery of nutrition services for communicable and non-communicable/lifestyle related diseases
  4. Strengthen the implementation of nutrition-sensitive interventions across sectors
  5. Improve multisector coordination and capacity to implement the national nutrition programme

The Government of Ethiopia has demonstrated policy commitment to streamline nutrition efforts by incorporating indicators into the Government’s five-year Growth and Transformation Plan II (GTP II; 2016-20).

UNICEF contributed to this important signing through technical support as a National Nutrition Technical Committee (NNTC) member and played a leading role in supporting the Government of Ethiopia to establish and nurture multisectoral coordination bodies at both federal and regional levels.

The event was attended by representatives from civil society organizations, academia, the Addis Ababa Chamber of Commerce, donors and UN agencies.


[1] Ministry of Health,  Ministry of Education, Ministry of Agriculture and Natural Resources,  Ministry of Livestock and Fisheries,  Ministry of Industry,  Ministry of Water Irrigation and Electricity,  Ministry of Trade,  Ministry of Finance and Economic Cooperation,  Ministry of Labour and Social Affairs,  Ministry of Women and Children Affairs,  Ministry of Youth and Sports, Government Communication Affairs Office as well as National Disaster Risk Management Coordination Commission

Five in six children under two not getting enough nutrition for growth and brain development – UNICEF

 NEW YORK/ ADDIS ABABA, 14 October 2016 – Five in six children under two years old are not fed enough nutritious food for their age, depriving them of the energy and nutrients they need at the most critical time in their physical and cognitive development, according to a new UNICEF report.

“Infants and young children have the greatest nutrient needs than at any other time in life. But the bodies and brains of millions of young children do not reach their full potential because they are receiving too little food, too late,” said France Begin, Senior Nutrition Adviser at UNICEF. “Poor nutrition at such a young age causes irreversible mental and physical damage.”

UNICEF data show that poor nutritional practices– including the delayed introduction of solid foods, infrequent meals and lack of food variety – are widespread, depriving children of essential nutrients when their growing brains, bones and bodies need them the most. The findings reveal that: 

  • Young children wait too long for their first bites. One in five babies hasn’t been fed any solid foods by the age of 11 months.
  • Half of children aged six months to two years are not fed the minimum number of meals for their age, increasing their risk of stunting.
  • Less than one-third of children in this age group eat a diverse diet – meaning from four or more food groups daily – causing deficiencies in vitamins and minerals.
  • Almost half of pre-school aged children suffer from anaemia.
  • Only half of children aged six to 11 months receive any foods from animal sources – including fish, meat, eggs and dairy – which are essential to supply zinc and iron.
  • The high cost of foods from animal sources makes it difficult for the poorest families to improve their children’s diet. In Sub-Saharan Africa and South Asia, only one in six children from the poorest households aged six to 11 months eats a minimally diverse diet, compared to one in three from the richest households.
  • Improving nutrition for young children could save 100,000 lives a year.

Making nutritious foods affordable and accessible to the poorest children will require stronger and more targeted investments from governments and the private sector. Cash or in-kind transfers to vulnerable families; crop diversification programmes; and fortification of staple foods are key to improving nutrition for young children. Community-based health services that help caregivers learn better feeding practices, and safe water and sanitation – absolutely critical in preventing diarrhoea among children – are also vital.

“We cannot afford to fail in our fight to improve nutrition for young children. Their ability to grow, learn and contribute to their country’s future depends on it,” Begin said. 

Ethiopia has experienced rapid, sustained improvement in under-nutrition during the past 15 years. For example, the country has seen a steady reduction in stunting – the fastest rate of improvement in Africa – and a decline in the percentage of underweight and wasted children. Yet, Ethiopia remains in a precarious situation, with large absolute numbers of affected children: 5.3 million children are stunted and 1.2 million children suffer wasting. UNICEF’s nutrition programme collaborates with the Government of Ethiopia to reduce these numbers further, working on multi-sectoral coordination to improve the nutrition of all children, pregnant and lactating women and their families

The Government of Ethiopia recognizes that addressing malnutrition is essential to achieving sustainable development. It therefore has issued the Seqota Declaration to end child malnutrition by 2030. The Declaration lays out a plan to stop the cycle of under-nutrition by bringing together all sectors of the Government, paying particular attention to the importance of nutrition during pregnancy and in the first years of a child’s life. 

Over the past decade, Ethiopia has seen a steady reduction in stunting from 58 per cent in 2000 to 40 per cent 2014, in the percentage of underweight children from 41 per cent to 25 per cent, and in wasting from 12 per cent to 9 percent (Mini EDHS: 2014) 

These trends indicate an improvement in chronic malnutrition over the past 15 years. Yet, 28 per cent of child deaths in Ethiopia is associated with under-nutrition. In addition to this high contribution to the under-five mortality rate, high prevalence of various forms of malnutrition among vulnerable groups in Ethiopia has serious implications for social development and economic growth. In a study conducted in 2009, the total annual cost of under-nutrition was estimated at US$2,775,000, equivalent to 17 per cent of the country’s GDP in 2009.

UNICEF’s strategies for nutrition ensure the achievements of results in four areas: 1) upstream nutrition policy support and multi-sectoral engagement; 2) improved nutrition knowledge and caring behaviours; 3) strengthening of systems for nutrition service delivery; and 4) strengthening partner capacities to respond to nutrition in humanitarian crises.

To accelerate the reduction of chronic and acute malnutrition, UNICEF is working in partnership with sectoral government counterparts, including in health, agriculture, education, social protection, trade and industry, and women, children and youth affairs.

UNICEF also works with United Nations agencies such as the Food and Agriculture Organization (FAO), United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), World Food Programme (WFP) and World Health Organization (WHO); UNICEF National Committees; donors such as the aid agencies of Canada, Ireland, Japan, the Netherlands, Spain, the United Kingdom and the United States, as well as the European Union; civil society organizations; and local and international academic institutions.

Nearly 385 million children living in extreme poverty, says joint World Bank Group – UNICEF study

NEW YORK/ADDIS ABABA04 October 2016 – Children are more than twice as likely as adults to live in extreme poverty, according to a new analysis from the World Bank Group and UNICEF. Ending Extreme Poverty: A Focus on Children finds that in 2013 19.5 per cent of children in developing countries were living in households that survived on an average of US$1.90 a day or less per person, compared to just 9.2 per cent of adults.  Globally, almost 385 million children were living in extreme poverty.

Children are disproportionately affected, as they make up around a third of the population studied, but half of the extreme poor. The youngest children are the most at risk – with more than one-fifth of children under the age of five in the developing world living in extremely poor households.

“Children are not only more likely to be living in extreme poverty; the effects of poverty are most damaging to children.  They are the worst off of the worst off – and the youngest children are the worst off of all, because the deprivations they suffer affect the development of their bodies and their minds,” said UNICEF Executive Director Anthony Lake. “It is shocking that half of all children in sub-Saharan Africa and one in five children in developing countries are growing up in extreme poverty.  This not only limits their futures, it drags down their societies.”

The new analysis comes on the heels of the release of the World Bank Group’s new flagship study, Poverty and Shared Prosperity 2016: Taking on Inequality, which found that some 767 million people globally were living on less than $1.90 per day in 2013, half of them under the age of 18. 

“The sheer number of children in extreme poverty points to a real need to invest specifically in the early years—in services such as pre-natal care for pregnant mothers, early childhood development programs, quality schooling, clean water, good sanitation, and universal health care,” said Ana Revenga, Senior Director, Poverty and Equity at the World Bank Group. “Improving these services, and ensuring that today’s children can access quality job opportunities when the time comes, is the only way to break the cycle of intergenerational poverty that is so widespread today.”

The global estimate of extreme child poverty is based on data from 89 countries, representing 83 per cent of the developing world’s population.

Sub-Saharan Africa has both the highest rates of children living in extreme poverty at just under 50 per cent, and the largest share of the world’s extremely poor children, at just over 50 per cent.  South Asia has the second highest share at nearly 36 per cent—with over 30 per cent of extremely poor children living in India alone. More than four out of five children in extreme poverty live in rural areas.   

In addition, the report reveals that even at higher thresholds, poverty also affects children disproportionately.  About 45 per cent of children are living in households subsisting on less than $3.10 a day per person, compared with nearly 27 per cent of adults.

UNICEF and the World Bank Group are calling on governments to:

  • Routinely measure child poverty at the national and subnational level and focus on children in national poverty reduction plans as part of efforts to end extreme poverty by 2030.
  • Strengthen child-sensitive social protection systems, including cash transfer programs that directly help poor families to pay for food, health care, education and other services that protect children from the impact of poverty and improve their chances of breaking the cycle in their own lives.  
  • Prioritize investments in education, health, clean water, sanitation and infrastructure that benefit the poorest children, as well as those that help prevent people from falling back into poverty after setbacks like droughts, disease or economic instability.   
  • Shape policy decisions so that economic growth benefits the poorest children. 
  • UNICEF and the World Bank Group are working with partners to interrupt cycles of poverty and to promote early childhood development – with programs ranging from cash transfers, to nutrition, healthcare and education.

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 Ethiopia specific information:

  • There are 13 million Ethiopian children who live in poor households, 2 million of whom live in extreme poverty.
  • Children are more severely affected by poverty (32.4 per cent) and extreme poverty (5.2 per cent) than adults (29.6 per cent and 4.5 per cent, respectively).
  • The poorest children are found in households whose head is employed in the informal sector. 13.1 per cent of these children live in extreme poverty.

UNICEF and WFP Regional Directors visit El Niño driven drought response in Ethiopia

Afar Region – Ethiopia Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa, have visited the ongoing government-led drought response where UNICEF-WFP are closely collaborating. The drought is affecting six regions in Ethiopia, and 9.7 million people are in need of urgent food relief assistance including approximately 5.7 million children who are at risk from hunger, disease and lack of water as a result of the current El Niño driven drought.

In Afar Region, where an estimated 1.7 million people are affected by the drought, including 234,000 under-five children, the Regional Directors visited UNICEF/WFP/Government of Ethiopia supported programmes. These included the targeted supplementary feeding programme (TSFP) and an outreach site where one of Afar’s 20 Mobile Health and Nutrition Teams (MHNTs) provides preventive and curative health, nutrition and WASH services to a hard-to-reach community in Lubakda kebele.

Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa in Ethiopia visit

The Mobile Health and Nutrition Team provides Outpatient Therapeutic Programme (OTP) and targeted supplementary feeding programme (TSFP) services to remote communities. The TSFP is integrated with MHNT services that address under five children and pregnant and lactating women with moderate acute malnutrition, and link them to TSFP when they are discharged from OTP. This solves the challenge in addressing the SAM–MAM continuum of care and preventing moderate acute malnourished children deteriorating into severe acute malnutrition.

The Directors also visited a multi-village water scheme for Afar pastoralist communities in Musle Kebele, Kore Woreda (district) which suffers from chronic water insecurity.

“Valerie and I are hugely impressed by the work of the WFP and UNICEF teams in Afar,” said UNICEF’s Pakkala.  “The quality of the work being done in such difficult circumstances – from the mobile health and nutrition teams, to WASH, protection, education and advocacy – is remarkable. We were also immensely impressed with the national level partnership between UNICEF and WFP, and our credibility with government and donors. The relationship and collaboration is a model for other countries to learn from and emulate.”

“Ethiopia is showing us that drought does not have to equal disaster,” said Valerie Guarnieri of WFP.  “We can clearly see the evidence here that a robust, government-led humanitarian response – supported by the international community – can and does save lives in a time of crisis.”

UNICEF and WFP continue to support the Government in responding to the current drought with a focus on the most vulnerable and hard to reach communities by using proven context specific solutions and approaches.

Breastfeeding gives children the best start in life: key for sustainable development

Giving children the best start in life begins with breastfeeding.  Breastmilk is the natural first food for newborns. It provides children with necessary nutrients for their growth and development and protects them from deadly diseases such as pneumonia and diarrhoea.

There is no better substitute food for a breastmilk. A breastfed child is 14 times less likely to die in the first six months than a non-breastfed child, and breastfeeding drastically reduces deaths from acute respiratory infection and diarrhoea, two major child killers. The longer breastfeeding is delayed, the higher the risk of death for children in their first month of life.

This year when the world celebrates breastfeeding week (1-7 August) emphasis has been made on breastfeeding and its importance to achieve Sustainable Development Goals (SGDs).

Here in Ethiopia, when the event was celebrated at the Ministry of Health the State Minister of Health, Dr Kebede Worku, said that breastfeeding has an ‘all rounded’ benefit that keeps children healthy, happy and more productive at later age. He also stressed that mothers need to be supported to breastfeed their children both at home and in the workplace.

World Breastfeeding Week 2016
UNICEF deputy representative to Ethiopia, Shalini Bahuguna, speaking at the World Breastfeeding Week ©UNICEF Ethiopia/2016/Bizuwerk

UNICEF Deputy Country Representative to Ethiopia, Shalini Bahuguna, on her part said “optimum breastfeeding to children under six months is an effective resilience measure.”  She also underscored UNICEF’s commitment to promote early and exclusive breastfeeding by engaging fathers, religious leaders as well as members of the community.

According to UNICEF, early breastfeeding rates in sub-Saharan Africa have increased by 19 per cent from 1995 to 2011. This is the highest rate when compared to other regions.  It is estimated that 41 per cent of children in sub-Sharan Africa are exclusively breastfed. When it comes to Ethiopia, the numbers are encouraging. Ethiopia is one of the leading countries with 52 per cent of children exclusively breastfed within the first six month. But still there is a long way to go as the country has high stunting rate.

Breastfeeding and sustainable development

Early and exclusive breastfeeding helps children to survive. That is a fact. Yet, breastfeeding is also linked with national development. Evidence shows that the benefits of breastfeeding extend into adulthood.  A well breastfed child has good sensory and cognitive development which is associated with better educational achievement. Healthy and better educated children will be more productive and positively impact socio-economic development.

Breastfeeding also contributes to poverty reduction. It is a natural and cost effective way of feeding which do not burden household budget as compared with formula feeding. Thus, supporting breastfeeding is the smartest investment nations can make to ensure the wellbeing of their citizens.

It is, therefore, critical to promote optimal breastfeeding and provide support to mothers who have social and commercial pressures that compromises their decision to breastfeed.

 

World Breastfeeding Week 2016