Promotion of Dietary Diversity for the Healthy Growth and Development of Children

By Esete Yeshitla

Sekota, AMHARA, 21 June 2017- Meet Netsanet, a strong and independent 25-year-old mother who is very self-assured; reminiscent of her name, which means ‘freedom’.

When we visit Netsanet in her house, it is a typical morning for her. First, she waters her home garden: cabbage, carrots, tomatoes and other vegetables. The seeds were provided by FAO with funding from the European Union through the woreda (district) agriculture office as a support for her family to have balanced meals. Her next task is feeding her chickens, from which she uses eggs for cooking and as a source of income. She sells eggs on Thursdays at the nearby Hamusit market. She then starts preparing breakfast. She takes fresh vegetables from her garden; a couple of eggs, milk, mixed grains and starts to cook the meal for her daughter.

Netsanet, preparing food as per lessons learned from health extension workers
Netsanet, preparing food as per lessons learned from health extension workers, at the woreda health post. Sekota woreda , Hamusit kebele ©UNICEF Ethiopia/2017/Nahom Tesfaye

Netsanet has two daughters, Mekdes age 5 and in kindergarten; and Tsige age 2. Netsanet explains the difference between her two pregnancies, birth and the girls’ first two years of life. “I had my first child at home, as we did not have awareness. I was lucky that I did not face any complications when I had her. If something bad had happened, I would have regretted it,” says Netsanet.

Back then, even when health extension workers insisted that women give birth at the health centre, it was embarrassing for most women. Netsanet explains, “Nowadays, even the wife of a priest gives birth at the health centre. We lost many of our sisters due to high blood loss during birth. I am grateful for the awareness we are getting now.”

Twice a month, they participate in awareness training at the health post, as part of a UNICEF-supported, European Union-funded programme called EU-SHARE. They also receive education on how to prepare balanced meals for young children under two years old, something Netsanet did not know how with her first child. She says, “I was younger, I only breastfed Mekdes when I had spare time as I was busy with house chores.” For her second daughter, she breastfeeds her 8-10 times per day. Netsanet says, “It makes my child strong and at the same time, it serves as protection against unwanted pregnancy.”

Netsanet has witnessed the results. “My first child was fragile and got sick regularly. I used to spend most of my time at the hospital or pharmacy. She was malnourished and at one point, I thought I would lose her. Thank God she was better after she started taking the [ready-to-use therapeutic foods] that was provided by the health post.”

Netsanet put into practice the education given to her about healthy nutrition with Tsige. She started to feed her food when she was six months old. She says, “We did not know that we can feed different vegetables to our babies.”

Netsanet and her husband have three plots of land allotted by the Government, which they use for harvesting crops. Netsanet says, “We do not sell what we produce. We use it for our consumption.”  In addition to selling eggs, Netsanet buys lambs, raises them and sells the sheep. She also buys grains from retailers and sells it for extra money. Netsanet adds, “So the money I get, I use it to buy other stuff.”

This is not the only work Netsanet has. She is also a member of the health development army (HDA), a strategic network the Government has galvanised to reach rural communities. As part of the Government’s intervention, health extension workers train women from the community to become HDA members and drive health-related behaviour change, including breastfeeding and child feeding practices, within their communities. Netsanet is a leader of five teams that each consist of five women- a ‘network’. Netsanet and five additional network leaders are supervised by a health extension worker.

Netsanet, feeding her tow year daughter porridge made of balance nutritional ingredients based on lessons from the wereda health post.
Netsanet, feeding her two-year-old daughter porridge made of balance nutritional ingredients based on lessons from the woreda health post; Sekota woreda, Hamusit kebele ©UNICEF Ethiopia/2017/Nahom Tesfaye

Mothers meet to discuss twice a month. They meet at the health post to demonstrate how to make food for children. They bring whatever food stuff they can find at home such as eggs, flour and milk, then they cook and feed their children.

The Government of Ethiopia has placed malnutrition high on both the political and the development agenda over the past decade. As a result, bold actions have been taken in health and other nutrition-related sectors, putting in place policies, programmes and large-scale interventions to significantly reduce malnutrition among the most vulnerable groups: young children and pregnant and lactating women.

The EU- SHARE project addresses gaps in implementation of the National Nutrition Programme while strengthening nutrition outcomes of major health, food security and livelihoods Government programmes. The primary focus is on the first 1, 000 days of a child’s life, in order to accelerate the decline in stunting.

Sekota is the woredas targeted by the project and has received support with an aim to enhance quality and uptake of nutrition services being delivered to the community. This is done through building the technical capacity of health workers, improving availability of nutrition supplies and sensitizing community members towards proper infant and young child feeding practices.

These interventions have a significant impact in the overall reduction of child malnutrition, especially through contributing to the improvement of nutrition and dietary diversification practices for adolescent girls, pregnant and lactating women, and children younger than five, just like Netsanet and her girls.

Integrated Nutrition Services for Better Nutrition Outcomes 

By Nardos Birru

BOLOSO SORE, SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION, 26 January 2017 – It was a sunny afternoon at the Chamahinbecho health post and the trees planted by health extension workers 10 years ago provided much needed shade in the compound. A group of mothers were sitting under the trees discussing how to best feed their toddlers and among them was Beyenech.

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Beyenech (middle), waiting for the porridge to feed her baby at a cooking demonstration session at Chamahinbecho health post, Boloso Sore woreda, SNNPR ©UNICEF/2017/Pudlowski

The cheery Beyenech, a mother of three, came to the health post to get her 1-year-old son weighed as part of the growth monitoring and promotion session that they attend on a monthly basis.

“I bring my son here every month and the health extension worker measures his weight and gives me advice,” says Beyenech. “She teaches us how to prepare meals for our children using different foods. I can see that my child is growing healthy and am glad to hear that [confirmed by] the health extension worker.”

Beyenech is among the many mothers in Chamahinbecho kebele (sub-district) who are benefiting from a project supported by the European Union called EU-SHARE. The project aims to contribute to improved nutritional status of children under five, adolescent girls and pregnant and lactating women through strengthening nutrition outcomes of Government health, food security and livelihood programmes. The strategy involves integration of the multi-sector interventions at the household level to create synergetic effects that will maximize programme results.

Nutrition services for adolescents

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Adolescent deworming service. Chamahinbecho health post, Boloso Sore woreda, SNNPR ©UNICEF/2017/Pudlowski

It is not only Beyenech’s son who is benefiting from the nutrition services at the health post; her 15-year-old daughter has participated in the deworming campaign organized for adolescent students in the kebele. Beyenech speaks of her daughter, “Wubalem received a deworming tablet from the adolescent deworming campaign at her school last year. She also told me about the nutrition and hygiene practices that she heard from group discussion sessions during the campaign.”

Deworming of intestinal worms and schistosomiasis is an important service for young students, as both ailments affect the health and education of children and adolescents. A student with worms will be too sick or tired to attend school or will have difficulty concentrating in school. If left untreated over time, they may face stunting or malnutrition due to anaemia, as well as impaired cognitive development.

The Government-led programme, which is supported by EU-SHARE, contributes to the health and nutrition status of adolescents while improving school attendance rates. EU-SHARE project supports the programme through procurement of deworming tablets, provision of information, education and communication as well as behavioural change communication materials that are helpful to create awareness and initiate discussion on nutritional requirements during adolescence. The programme also includes technical support to health workers who carry out the deworming campaigns. Students like Wubalem have a better chance to succeed with their education due to initiatives like these.

Improving dietary diversity through backyard gardening

EU-SHARE also includes nutrition-sensitive agriculture interventions which is implemented by FAO as part of the Government’s commitment to integrate nutrition into the agriculture sector. Promotion of backyard gardening is among the initiatives being implemented in the kebele.

After meeting the eligibility criteria targeting vulnerable families, Beyenech has been selected among the 1,960 beneficiaries targeted for seed supplementation led by the woreda agriculture office. She received vegetable seeds and began growing carrots, cabbage and tomato in her backyard garden. Beyenech explained, “I started preparing a porridge mixed with vegetables from my garden, using what I learned from the cooking demonstrations at the health post. I also prepare roasted vegetables along with shiro wot [chickpea stew] for the rest of my children.”

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Beyenech, a mother of three, showing her backyard garden. Chamahinbecho kebele, Boloso Sore woreda, SNNPR. ©UNICEF/2017/Pudlowski

Beyenech aspires for her children to have a better future. She wants them to be top students and become teachers or doctors so they have the knowledge and skills to impact the next generation in the community.

“Such type of nutrition interventions that consider integration as a cornerstone by addressing the different aspects of nutrition are a key weapon to combat the problem of malnutrition in a sustainable manner,” said Israel Mulualem, the nutrition focal person in Boloso Sore woreda health office.

The four-year EU-Share programme has been operational since 2015 and continues to support children, mothers and their families in seventeen woredas located in SNNP, Oromia and Amhara regions. Together with the Government of Ethiopia and donors such as the European Union, UNICEF is able to support existing initiatives of Government programmes so that children such as Wubalem, Setot and Teketel may have a bright future.

EU Partnership Paves the Way for Better Nutrition for Children and Women in Ethiopia

By Nardos Birru

ADDIS ABABA, September 2016 – Ethiopia has experienced repeated droughts, particularly in the past few years, which have eroded rural livelihoods, causing increased food insecurity and malnutrition among vulnerable communities. The 2015/2016 El Niño-driven drought, for instance, left 9.7 million people in need of emergency food assistance.

In response to recurrent food insecurity, UNICEF has partnered with the European Union (EU) to contribute to building resilience of the most vulnerable groups, which includes children under five, as well as pregnant and lactating women. Resilience, or the ability of a community to withstand, adapt and quickly recover from shocks such as drought, is a cornerstone of the EU’s humanitarian and development assistance.

To this effect, the EU has provided €10 million to UNICEF-assisted programmes as part of its Supporting the Horn of Africa’s Resilience (SHARE) initiative through a project entitled Multi-Sectoral Interventions to Improve Nutrition Security & Resilience. The project is implemented in collaboration with the Food and Agriculture Organization of the United Nations (FAO) in the drought-affected woredas (districts) of Amhara, Oromia Southern Nations, Nationalities and People’s Region (SNNP) regions, benefiting 773,626 mothers and children.

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As part of the community-based nutrition programme, Binti, a Health Extension Worker counsels a mother on best nutrition practices. ©UNICEF/2014/Nesbitt

How does SHARE work?

The project aims for communities to have access to quality nutrition services in their vicinity and a better understanding of the importance of proper infant and young child feeding (IYCF) practices.

It covers a wide range of interventions including the promotion of exclusive breast feeding and adequate complementary feeding, vitamin A supplementation and deworming of children, as well as the promotion of hygiene and sanitation.

This is complemented by a series of nutrition-sensitive agriculture interventions led by FAO in partnership with the Ministry of Agriculture. This component helps build the capacity of women to improve the variation of their diet through livestock and poultry rearing, as well as backyard gardening. It also brings opportunities for women to collaborate as peer support groups to produce nutritionally valuable complementary foods such as cereal mixtures for sale. This stimulates the local economy by creating jobs and empowering women to ensure the healthy growth of their children.

An evidence-based approach

Launch of document entitled “Situation Analysis of the Nutrition Sector in Ethiopia” from 2000-2015
Left to right: H.E Chantal Hebberecht, Ambassador of the European Union; Birara Melese, National Nutrition Programme Team Coordinator; Gillian Mellsop, UNICEF Representative to Ethiopia; at the launch of the 2000-2015 “Situation Analysis of the Nutrition Sector in Ethiopia” in Addis Ababa, Ethiopia ©UNICEF/2016/Tesfaye

One achievement of the project was an initiative to analyze and document the nutrition situation in the country from 2000 to 2015.  The report was launched in March 2016 and highlights critical gaps in terms of existing policies and programmes which need to be addressed urgently to accelerate nutrition results for women and children. Key findings of the situation analysis report include poor water supply and sanitation as high risk factors for child stunting, educating mothers as a key factor for improving nutrition, as well as the need to improve production diversity, nutrition knowledge and women’s empowerment to ensure that diverse and nutritious foods are available and accessible at all times.

The SHARE project also serves as a platform for multiple non-governmental organizations where they can exchange expertise and best practices to improve implementation and follow a harmonized approach in their respective intervention sites. This way, efforts are combined and the impact on the nutrition status of children and women will be maximized.

UNICEF would like to express its gratitude to the EU for the generous financial contribution to UNICEF-assisted programmes and looks forward to strengthening successful collaboration for children and women in Ethiopia. Thanks to EU support, over 225,000 children under five and over 50,000 mothers will have better access to improved nutrition services. This is in line with the efforts of the Government of Ethiopia to realize the Seqota Declaration to make undernutrition, in particular child undernutrition, history in Ethiopia.