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 European Commission’s humanitarian aid department (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.

Laying the foundation of future generation

A new pre-school programme is helping Ethiopian Children to get ready for school

By Demissew Bizuwerk

Mengi-Benishangul Gumuz- Ethiopia 28 September 2016 – In one of the classes at Mengi Elementary School, in the Benishangul-Gumuz region of Ethiopia, Edidal Abdulkerim, six, and her friends sing about the five senses with melodious tone along with a small tape recorder. Before the next song starts, their teacher Abdulaziz Ahmed asks questions to make sure that the children got the message right.

The children are learning with stories, plays and songs and the expression on their faces says it all. This is their first ever school experience at the age six and seven. Perhaps, just before their critical age of learning passed by.

“It feels great to sing, write and colour,” says Edidal cracking a beautiful smile. “I have many friends here and we play together.”

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Edidal draws with her friends in her class room. She is one of the 30 students in Mengi Elementary School who are enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR) ©UNICEF Ethiopia/2016/Tadesse

Edidal, is one of the 30 students in Mengi Elementary School who are enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR). This new programme is designed to prepare rural children, who have not had the chance to attend any form of early childhood education, for primary education by helping them develop cognitive, behavioural as well as foundational ‘pre’ academic skills.

ASR offers 160-hours of pre-literacy and pre-numeracy learning and helps children to develop social skills.  It is an interim strategy which helps children aged between six and seven make a successful transition from home to school while formal pre-primary classes are gradually introduced across the country.

A daunting task of ensuring quality remains ahead despite Ethiopia’s significant achievement in expanding access to primary education. There are quite a number of children in early primary classes who do not acquire the minimum expected level of skills. And the numbers are alarming. The average mean score for reading skills in grade 4 for instance is found to be only 45 per cent, which is below the minimum passing mark of 50, set in the education policy[1]. And this statistics even goes lower in remote rural villages such as Mengi.

“There are many reasons which can explain this poor performance of children in rural Ethiopia,” says Maekelech Gidey, UNICEF Education Specialist “But the main one has to do with school readiness”. The country lacks adequate pre-school facilities where children can be supported and encouraged to better understand their environment and develop skills, which are vital for success in school and later in their lives.

It is only 48 per cent of Ethiopia’s 7.7 million children aged between three and six who have access to early learning[2], and many young children, especially rural girls like Edidal, were not part of this statistics.

Children who start their formal primary schooling on weak early childhood learning are more likely to fall behind their peers and consequently drop out of school too early.

It is this challenge that prompted the development of the ASR initiative.  In 2015 the programme was introduced and piloted in the Benishangul-Gumuz region after designing a well fitted curriculum and training of teachers.

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Edidal shares a smile with her best friend Narmin in Mengi primary school. They are both enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR) ©UNICEF Ethiopia/2016/Tadesse

How does ASR work?

First, teachers and community leaders identify the village children in the month of May each year.  If the nearby schools have O classes already, then the children will be enrolled for eight weeks in the month of July and August. Otherwise, they will undergo the same programme during the first two month of the academic year in Grade 1.

For the ASR to succeed, it needs a dedicated teacher like Abdulaziz and the children have to attend the programme regularly. Missing even a single day of class means missing a lot in the programme.

“Some children who live far away from school skip class when it rains or when their parents go to the market early,” says Abdulaziz. “So I visit their homes to tell their parents about the advantages of this education to their children and the importance of attending class regularly.”

Intizar Abdulkerim, a seven year old who loves to learn about the environment, says her mother is sometimes reluctant to send her to school when she needs help with the household chores. “I feel sad when I stay in the house during school day,” says Intizar “every time I skip class, I lag behind my friends.”

It looks like old habits do not go away easily. The perception of parents towards the education of their daughters still needs to be worked on. “Boys attend the programme more regularly than girls,” says Abdulaziz. “Yet my best performing students are girls,” he added pointing towards Edidal and Intizar.

Edidal and Intizar will be entering Grade 1 in the coming academic year with a solid base. The combination of play and learning activities of the ASR have inculcated the children with the necessary pre-school skills that they need to succeed further.

A preliminary assessment on the impact of the ASR has revealed that, the programme is effective in having children acquire pre-school skills in mathematics and literacy. This is a good news for experts from the region’s education bureau and UNICEF who have been working on the programme since its inception.

The ASR experience in the Benishangul-Gumuz region is also extended to Oromia region based on its cost effectiveness and impact.

While Edidal wants to become a teacher, Intizar’s dream is to be a doctor. There is still a long way to go until the young girls’ dreams are a reality. Yet, for now, the foundation of their future is laid on fertile grounds. 

[1] Ethiopian Fifth National Learning Assessment (NLA), MoE 2016

[2] MOE, Education Statistics Annual Abstract 2008/ 2015-16

Early Childhood Development- Investing in the seeds of tomorrow’s fruits

Gillian Mellsop, UNICEF Representative to Ethiopia

‘Children are today’s flowers and tomorrow’s fruit’ is a saying in Ethiopia and there is no better investment that cultivates the fruit and speaks to the ‘right in principle and right in practice’ mantra more than early childhood development.

Parents and communities want the best for their children and understand that the early years of a child’s life are crucial. However, they may not have the means or the knowledge on how to ensure their next generation best thrives.

Last week, the latest offering from the world-renowned Lancet, Advancing Early Childhood Development: from Science to Scale, showed that almost one in two – 43 per cent – of children under five in low-and middle-income countries are at risk of not achieving their cognitive potential. No country can risk losing nearly half of the brain potential of its youngest citizens – low- and middle-income countries least of all.

Advances in neuroscience show that experiences in early childhood have a profound impact on brain development and on subsequent learning and health. Children who are poorly nourished and nurtured, or those who do not receive early stimulation, are likely to learn less in school and go on to earn less as adults.

In Ethiopia, over 5 million children are stunted which has a serious impact on human development and economic growth. And currently, the most disadvantaged children in rural and hard to reach communities are either coming to grade 1 without having the necessary preparation or are enrolling late – under 40 per cent of children in Ethiopia have access to pre-school provision. Once in primary education, many are at risk of dropping out of school too early.

The good news is that early childhood development interventions, including parenting and care programmes, cost as little as 50 cents (US$) per child per year, when combined with existing services such as health – according to the Lancet Series. And much of what needs to be done at the community level can be achieved by mothers and fathers, grandparents, siblings and caregivers.

The findings in the Series underscore the importance of increased global dedication to early childhood development. Earlier this year, World Bank Group President Jim Yong Kim and UNICEF Executive Director Anthony Lake signalled a renewed commitment to prioritizing investments in the youngest children when they announced a new alliance urging global and national leaders to step up and accelerate action and funding for nutrition and early childhood development (ECD) programmes. The Lancet estimates that individuals who suffer a loss of about a quarter of average adult income per year, while countries may forfeit up to as much as two times their current GDP expenditures on health or education. Consequences of inaction impact not only present but future generations.

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Zebiba Meher feeds her son Ready to Use Therapeutic Food (RUTF) for the past four months. Now the nutritional status of eleven-month-old Bedru has improved from severe to moderate acute malnutrition. He is a much healthier and happier child now. Dubti health center, Afar region, Ethiopia. 25-August-2016 ©UNICEF Ethiopia/2016/Ayene

When children have the opportunity to develop their cognitive capacity, they will pass similar or even better opportunities to their children when they grow up.  Increasing investment in Ethiopia’s young children can break the vicious cycle of intergenerational poverty.

Therefore, prioritizing ECD at the national level is a way for governments to stimulate economic growth. Evidence suggests that every dollar invested in quality ECD programmes brings a return of between US$6 and US$17. Moreover, research by

Nobel Laureate James Heckman found that the rate of return for investments in quality early childhood development for disadvantaged children is 7-10 per cent per annum through better outcomes in education, health, sociability, economic productivity and reduced crime.

This year, the importance of interventions in early childhood was also recognized by the inclusion of an ECD target in the Sustainable Development Goals – indeed, this is the first time ECD has been explicitly included in global development goals. SDG Target 4.2 aims to increase the percentage of children under 5 years of age who are developmentally on track in health, learning and psychosocial well-being.

For many children, lack of educational support at home is one of the biggest obstacles to reaching their full potential. In light of differing needs of families, a range of early childhood education services are offered in Ethiopia, including kindergarten, pre-primary class (‘O-class’) and several school readiness programmes. Parenting education programmes are also provided so families can learn about the importance of early nutrition, hygiene, care and stimulation.

The evidence presented this past week, combined with the current momentum globally, speaks for itself. We are well versed in the elements that affect the development of children’s brains – good nourishment, stimulated minds, and protection from violence. It is now vital that we use this growing body of evidence to effect real changes for children, at both the community and policy levels.

Early child development has to be put on the agenda for children’s rights. In Ethiopia, UNICEF, with the support from partners, takes an integrated approach to addressing early childhood development within Ethiopia’s Early Childhood Care Education Policy.

We owe it to our future generations to prioritize and invest in young children. It is our moral, economic, and social imperative to enable all children to reach their full potential.