Ethiopia Community-Based Nutrition Program Helps Reduce Child Malnutrition
A “model mother” from Gelsha kebele (village) in Ethiopia’s Amhara region, Zenitu Sheperaw is 24 years old with two young children. Her first child was often sick and crying at night as an infant, but after learning about better feeding practices, Zenitu has changed the way she feeds her second baby, now seven months old and doing very well.
“Now with this child, I can sleep well because he is not sick,” Zenitu says. “I gave him colostrum immediately after birth and my breast within one hour of birth. I gave him no other foods for six months… Even when he is sick I will feed him because now I know it is important.”
This is in sharp contrast to Zenitu’s first experience with motherhood, when she fed her infant with boiled sugar, water, and butter. “I often took him to the health centre, with abdominal cramping, diarrhea and vomiting. I would lose money paying for the health centre,” she recalls.
This young mother is now an ambassador for better infant and child feeding practices in her village. Her husband also helps her to ensure that she has the right range of foods to feed their baby.
Significant nutritional improvements in a drought-prone country
Zenitu’s baby is among thousands of young children across Ethiopia whose nutritional status is rapidly improving. Recent results from the Ethiopia Demographic and Health Survey show that overall child stunting rates in the country have declined from 57% in 2000 to 44% in 2010. Stunting is one of the common indicators of chronic malnutrition.
“This is significant progress in a drought-prone country with historically high rates of malnutrition,” said Ritva Reinikka, World Bank Director for Human Development in Africa. “It is a sign that Ethiopia is making progress on reducing vulnerability among poor families, and enabling well-nourished children of today to help drive future economic growth and productivity as adults.”
Many factors could underpin the country’s recent progress: Greater resilience among low-income households thanks to a nationwide social safety net, better access to health, education, water and sanitation services, higher food security, and programs targeted specifically at fighting malnutrition.
Community-based nutrition (CBN) program reaches over a million children
Such programs include the CBN program that trained Zenitu and other mothers in Gelsha kebele. With World Bank, UNICEF and other donor support, the program now reaches over a million children under the age of two.
The CBN began in 2008 and covers nearly 238 woredas (districts) in four regions: Southern Nations, Nationalities, and People’s Region (SNNPR); Oromia; Amhara; and Tigray. It is one component of the Government of Ethiopia’s National Nutrition Program.
With the program, fewer children are held back by poor nutrition
Yesin Kassa, a voluntary community health worker in Gelsha has been regularly visiting sick or malnourished children in her community to see if they need higher-level medical care. Once a month, she has also been weighing children and counseling mothers on good practices related to child nutrition.
“Since I’ve been giving these messages, mothers have been practicing the actions and the weights [of children] have improved,” 38-year-old Kassa says.
An evaluation of the CBN jointly undertaken by the World Bank, UNICEF, and Tulane University, shows that the program, as of September 2012, has indeed contributed to improved feeding and child care and thus to lower rates of stunting than seen earlier in these communities.
Compared to the long-term trend decline in stunting of about 1.3 percentage points a year without the program, the study shows that the CBN Program is associated with a 3 to 5 percentage point decline—a sharp and noteworthy acceleration as Ethiopia tries to rapidly improve child health and survival.
The study also finds that the CBN Program has positively influenced infant and young child feeding, including greater adherence to exclusive breastfeeding for babies younger than six months, minimum acceptable diet between 6 and 23 months, and dietary diversity for older children.
“The evaluation shows that the Ethiopia program is working, and as we move forward to scale-up this model, there are many things we can strengthen further,’’ said Ziauddin Hyder, Senior Nutrition Specialist at the World Bank. “If the improvement in children’s nutritional status continues at this pace, Ethiopia will be among those countries in Africa that have tackled child nutrition problems head-on.”
Partnering with NGOs at the community level
The CBN program has successfully partnered with NGOs that are able to work at the grassroots level.
For example, Concern Worldwide, an NGO that has worked in Ethiopia for many years, has been implementing a community-based approach to manage acute malnutrition and improve feeding practices. This work is financed by the Japan Social Development Fund (JSDF), a joint initiative of the World Bank and the Government of Japan.
“We have seen many successes and some failures and our projects continue to evolve,” said Linda Horgan, Country Director for Concern Worldwide in Ethiopia. “We understand the need to work in partnership and with a multi-sectoral approach if we want to strengthen the resilience of vulnerable Ethiopians and see their lives changed in a sustainable way. We are seeing very positive developments in nutrition due to effective collaboration between NGOs and the government.”
Working with NGOs, the CBN has helped to engage entire communities to foster social change.
“There are big changes in the communities because almost all mothers are practicing better infant and young child feeding and care,” said Hawa Hussein, a Voluntary Community Health Worker in Guguftu kebele.
Because CBN works closely with mothers and infants, and emphasizes rigorous training for health workers, the program also benefits pregnant women.
Nutrition, a key target under the Millennium Development Goals
Community-based programs have been effectively implemented in many low-income countries in Asia and Latin America as a platform for delivering health and nutrition interventions.
“We know that malnourished children are more likely to die,” said Guang Chen, World Bank Country Director for Ethiopia. “By improving nutrition, children are more likely to survive, and achieving the Millennium Development Goal on reducing child mortality comes within reach, as it has in Ethiopia.”
Results from Ethiopia’s CBN could inform policy decisions on sustainable child nutrition across Africa.