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.

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.

UNICEF Ethiopia renews its Ambassadorship with Hannah Godefa

12 January, 2015, Addis Ababa: Today, UNICEF Ethiopia renewed its ambassadorship with seventeen year old Hannah Godefa, a citizen of Canada with Ethiopian origin, at a signing ceremony held at its premises. The event was attended by Hannah Godefa, UNICEF National Ambassador to Ethiopia, Hannah’s father Ato Godefa Asegahegn, H.E Roman Gebreselassie, Chief of government whip at the House of People’s Representative, W/ro Tsehay Bahta, Head of Capacity Building and Social Affairs Standing Committee of Addis Ababa City Administration Council, H.E Mr. David Usher, Ambassador of Canada to Ethiopia, Ms. Elizabeth Hailu, Manager Customer Services Ticket Offices, Ethiopian Airlines, Patrizia DiGiovanni, Officer in Charge of  UNICEF Ethiopia, and members of the media.

Hannah Godefa's Ambassadorship renewal ceremony with UNICEF Ethiopia
UNICEF Ethiopia renewed its Hanah Godefa’s national ambassadorship at a signing ceremony held on 12 January 2015, at its premises, Addis Ababa. Left to right Patrizia DiGiovanni, Officer in Charge of UNICEF Ethiopia and Hannah Godefa in the presence of (left to right at the back standing)- W/ro Tsehay Bahta, Head of Capacity Building and Social Affairs Standing Committee of Addis Ababa City Administration Council, H.E W/ro Roman Gebreselassie, Chief of Government Whip at the House of People’s Representative, H.E. Mr. David Usher, Ambassador of Canada and Ms. Elizabeth Hailu, Manager Customer Services Ticket Offices. ©UNICEF Ethiopia/2015/Ayene

Speaking on the occasion, Patrizia DiGiovanni, Officer in Charge of UNICEF Ethiopia said, “I’m delighted to announce that today, UNICEF Ethiopia renews the Ambassadorship of Hannah Godefa as its National Ambassador to Ethiopia for two more years. Hannah is a role model for children, her peers and especially girls. Since her appointment in January 2013, we have been proud of her commitment and dedication to advocate alongside Government for women’s and children’s issue in Ethiopia and globally. She is a testimony to what is possible if one is determined.”

At the signing ceremony, Hannah on her part said, “When I remember my first visit to a UNICEF Ethiopia project over two years ago in Hawassa, I immediately think of the smiling faces of the teenage girls I now more closely resemble. They sat down and had a traditional coffee ceremony with me, explaining the benefits of the alternative income programme they were participating in and their life stories. I was in complete awe of the way they transformed their limitations and hardships in life into opportunities and sustainable success. Most of all, I was amazed at how they credited UNICEF for supplementing their personal achievement in the initiative. It was at that moment I knew, UNICEF is an organization and family I wholeheartedly wanted to be a part of.”

Hannah Godefa's Ambassadorship renewal ceremony with UNICEF Ethiopia
UNICEF Ethiopia renewed Hannah Godefa’s national ambassadorship at a signing ceremony held on 12 January 2015, at its premises, Addis Ababa. Left to right Patrizia DiGiovanni, Officer in Charge of UNICEF Ethiopia and Hannah Godefa. ©UNICEF Ethiopia/2015/Ayene

During her ambassadorship, Hannah has been engaged in numerous advocacy activities representing UNICEF-giving a voice to women and children globally. On these occasions, she has served as keynote speaker, a panellist and a moderator with high level government officials, business leaders and advocates from the non-profit sector. Her participation and contribution at the World Economic Forum in January 2014, with H.E. Mr. Ban Ki-moon, Secretary-General, United Nations, H.E. Mr. Paul Kagame, Co-Chair, MDG Advocacy Group and world leaders that focused on issues very close to her heart – innovation on investing in girl’s education – has been exceptional.

H.E. Mr. David Usher, Ambassador of Canada on his part underscored, “As we celebrate the fifty years diplomatic relations between Canada and Ethiopia, Hannah stands an ambassador not only to UNICEF but also to Ethiopians, Canadians as well as the Ethiopian Diaspora.”

Ms. Elizabeth Hailu, Manager Customer Services Ticket Offices, Ethiopian Airlines said, “As part of our corporate social responsibility, it is our duty to give back to the society. Today, we pledge once more to stand by Hannah to support her by providing free tickets to wherever her destination takes her to undertake her humanitarian functions.”

 

I don’t want a world where all children are healthy, happy and safe to be just a dream. I want it to be reality: Hannah Godefa

Canada mobilizes support for innovation, integrated action for youngest children

#EveryNewborn

Mother and child at Wukro Clinic
Improving newborn and child health also depends on better accountability — and more thorough accounting. Wukro Clinic, Ethiopia ©UNICEF Ethiopia/2009/Tuschman

Toronto/Addis Ababa, 29 May 2014 – Every minute, 10 babies die or are stillborn across the world, a staggering 5.5 million lives ended every year just as they start.  The majority of those deaths are from preventable causes, including prematurity, childbirth complications and newborn infections.

While child death rates have been reduced by almost half since 1990, newborn mortality has increased as a proportion of overall of child mortality, as highlighted by papers published in The Lancet earlier this month.

“We are succeeding in rapidly reducing child mortality because we have made it a global priority, with a commitment to innovation, partnership, and equity,” said UNICEF Executive Director Anthony Lake.   “We need the same global commitment, and the same political will, to reduce newborn mortality — working together to find new ways of reaching every family.”

Poorer families bear the greatest burden of newborn deaths.  If current trends continue, it will take over a century before a baby in the Central African Republic has the same chances of survival as a baby born in Canada.

Lake hailed Canada’s leadership in galvanizing global support to reduce maternal, newborn and child mortality.  The Toronto Summit will explore the most effective ways to speed up progress on newborn, child and health.

“The fact that not all children and young people around the world have access to critical health care is unacceptable. It must change,” said UNICEF Ethiopia National Ambassador, Hannah Godefa, who was the only young person to speak at the Summit. “I hope we can redouble our efforts and be catalysts for change. I urge all of you today to renew your promise to the women and children of the world and commit to taking concrete action to ending the preventable deaths of women and children. Because I don’t want a world where all children are healthy, happy and safe to be just a dream. I want it to be reality.” she added.

Improving newborn and child health also depends on better accountability — and more thorough accounting.

In 2012 alone, around two out of five births worldwide were not registered. Around the world, nearly 230 million children under age five have never been recorded – meaning they do not have the legal identity they need to access health, education and other services. And the numbers will rise unless action is taken.

But increasing the number of children registered at birth enables governments to improve the planning and budgeting of life-saving interventions, and to summon the political will and civil society support that is needed to meet targets.

“This year we will celebrate the 25th anniversary of the Convention on the Rights of the Child.  Millions of children are still being deprived of the most precious right — the right to survive,” said UNICEF Executive Director Anthony Lake.  “We must reach every family, every woman, every child, and every newborn.”

 

In Ethiopia, DFATD support improves community based child and maternal care

By Frehiwot Yilma

Paul Rochon thanks Misa Wondimagen, 25, Health Extension WorkerDERA DISTRICT: AMHARA REGION, 30 October, 2013 – It is early Thursday morning and Gibtsawit Health Post, found in a rural village of Gibtsawit Mariam located 42 kilometres from Bahirdar, is busy with patients. The small room is crowded with mothers who are there to check their babies’ growth; pregnant women having their antenatal care and men and women of the community who are receiving malaria treatment.  Today is a special day, because the health extension workers of the health post are welcoming Mr Paul Rochon, Deputy Minister of International Development, Foreign Affairs, Trade and Development Canada (DFATD) and Dr Peter Salama, UNICEF Representative to Ethiopia.

Misa Wondimagegn, a 25 year old health extension worker, supports the community in Gibtsawit village of Dera district with curative and preventative health and nutrition services.  Misa and her colleagues Meseret and Hagere are supported by the health development army (a network of one volunteer to five Households) attend the 13,366 population of the kebele.

Misa has been working at Gibtsawit Health Post for seven years. “It was just when I finished tenth grade that I had the opportunity to join the training for health extension workers. It was hard convincing people to allow me to monitor the growth of their baby and take my advice about what to feed their children,” she says.  “We travelled long distances to reach as many households in the village as possible.  In each of our visit we tried to improve the health seeking behaviour of the community and eventually encouraged them to go to the health post.”

Growth Monitoring and Promotion is the cornerstone in the Community Based Nutrition Programme.  It creates a platform for the health extension workers to contact the caregivers and check the nutritional status of children, detect growth faltering at early stage and provide counselling on Infant and Young Child Feeding practices (IYCF).

“Now, the situation has changed a lot: we have mothers who bring their children for check-up and pregnant women who come for antenatal care. The support we get from UNICEF and the Canadian Government has increased the variety of treatments we provide for the community. We have outpatient treatment for children diagnosed with severe acute malnutrition and for pregnant women we give antenatal care and supply iron –folate. We promote good Hygiene and sanitation and we also give treatment for common childhood illnesses like pneumonia malaria and diarrhoea for the community,” Misa explains with smile on her face.

Support in Action

Haimanot Andarge, 20, and her daughter Azeb Abraru, 23 month, relax at home in Dera Woreda in Amhara region of Ethiopia

Since 2007, the Canadian Government has been supporting UNICEF Ethiopia’s interventions in Child Survival with Vitamin A and Zinc Supplementation and Integrated Health System Strengthening as well as routine immunization. Dera is one of the 100 UNICEF supported districts implementing the preventive and curative nutrition interventions. It is implementing Community Based Nutrition (CBN), integrated with other Community Maternal New-born and Child Health Interventions (CMNCH) to prevent child malnutrition, focusing on the first 1000 days: the time between conception and when a child turns two years of age.

In August 2013, 1,247 children attended the monthly Growth Monitoring and Promotion session in Dera enabling Misa and the other 78 health extension workers in the district to identify nutritional status of the children, detect early growth faltering, help the caregivers visualize the status and counsel them on appropriate age specific feeding messages using the Family Health Card as a counselling aid and refer children for further care in a timely manner whenever needed.

Haimanot Andarge, a 20 year old mother of baby girl Azeb, is one of the many mothers in the district who got follow ups from Misa and her colleagues during their pregnancy. “Misa used to come to my house regularly ever since she knew I was pregnant. She gave me vaccines and other supplements which was important for my baby. And when my labour began my husband took me to the health post. Misa encouraged me to deliver at Hamusit Health Centre which referred me to Bahirdar Hospital in time as my delivery was complicated. My baby was delivered safely because the health post was in our village to identify my condition,” Haimanot remembered. Her eyes reflect her fear of what might have happened. “ Azeb, is going to be two this year and  Misa still follows up on her  regularly and gives me advice on what to feed her,” adds Haimanot.

Integrating approaches to combat malnutrition

Holding Plumpy'Nut produced in Ethiopia, Misa Wondimagen, 25, Health Extension WorkerOne of the challenges to the health extension workers was what kind of advice to give to families with low income, regarding additional food for their children. “Health Extension Workers usually explain to families to use variety of cereals, animal protein and vegetables. Those who have money would buy and others barter with what they have produced,” explains Ato Worku Endale, Head of the Dera District Health Office. “Recently we have been integrating the health extension programme with the agriculture extension programme to support farmers on what to produce and how they can support their children and family with variety of food items. In addition, the safety net programme that has been implemented in this particular community allows families with low income to be involved in the income generating activities.”

With the integrated multisectoral approach of the government of Ethiopia and the support of UNICEF and partners such as DFATD, the hard work of health extension workers like Misa and colleagues is paying off.

Revolutionizing treatment of Severe Acute Malnutrition (SAM)

The support from UNICEF and the Canada Government that started the preventive nutrition programme of Community Based Nutrition linked with provision of WASH facilities has helped reduce the number of children who are malnourished.  According to Dr. Peter Salama, the collaborative work of all stake holders, the availability of treating health posts within the community have made saving a child easier than ever before.

At the end of the visit the team eagerly waits to hear from Misa and her colleagues on their response to the fundamental question of how many children were lost to malnutrition recently.  “There were 27 children diagnosed with Severe Acute malnutrition in July 2012- August 2013. They were treated with the Out-patient Therapeutic Programme (OTP) and 20 have been cured and seven are still on follow up with good prognosis but we have not lost a single child,” Misa explained boastfully.
Group Photo: Joint visit of UNICEF and DFTAD

“It was not easy to change the attitude of the community. When we started, there was no one before us working with the community reaching every  household door to door. We started from nothing. But with the support of donors like  UNICEF and the Canadian Government, I cannot even remember the last time a child died in the community for the last four years,” Misa reminisces.

“It makes me realise that it was not for nothing that I worked so hard at the beginning. I have brought change in my community.” Misa concludes.