Children and their mothers suffer disproportionately from the poor health and nutrition situation in Ethiopia

Behavioral change for Improved Nutrition among Pastoralists in Ethiopia

Pastoralists in Ethiopia

Ethiopia is one of the countries who managed to meet the nutrition target of MDG 1 by reducing the rate of stunting from 58% in 2000 to 40% in 2014 and wasting from 12% in 2000 to 9% in 2014.[1] Currently, the country is working towards the nutrition targets of SDG2. As of 2016, 38% of children in Ethiopia are chronically malnourished and 10% are acutely malnourished. [2]

However, the picture in pastoral areas like Somali Region of Ethiopia shows that the under-served and hard to reach segments of the population of the country need tailored ways to address the still prevailing situation of undernutrition. In Somali Region of Ethiopia, the prevalence of stunting (chronic malnutrition) is 27.4% as of 2016. In addition, the region has the highest proportion of children with acute malnutrition from all regions of Ethiopia having 22.7% wasting rate. Somali Region also has the highest prevalence of anaemia in children with a rate of 82.6% as compared to the national prevalence of 56%. Moreover, 12.8% of children in Somali region have severe anaemia. The highest prevalence of anaemia in women is also seen in Somali Region with 59% prevalence compared to 23% nationally. [3]

Nutrition sensitive interventions by VSF-Suisse in Ethiopia

To contribute to addressing the need to nutrition interventions in pastoral areas as Somali Region of Ethiopia, VSF-Suisse has implemented different nutrition sensitive interventions in the region. Linking agricultural and livestock interventions to community-based nutrition has been a flagship activity of the VSF-Suisse (and of the Ethiopia Programme in particular). Owing to the fact that the nutrition needs of under-served communities cannot be addressed by direct nutrition interventions alone, VSF-Suisse had nutrition sensitive livestock based interventions where animal source foods sourced from local markets like meat and milk were availed to households hosting children recurrently affected by acute malnutrition and recurrently admitted to therapeutic feeding centers. These interventions have proven to show changes on the availability of animal source foods at the household level.

To showcase one of these interventions in Kebriderhar and Shilabo Woredas of Somali region of Ethiopia in 2013, where 9 milking goats were provided to households hosting children affected by recurrent malnutrition, change was observed in the targeted households in terms of acute malnutrition, measured through MUAC (Mid-Upper Arm Circumference). A decreased percentage of children with MUAC <11cm from 33% before the intervention to 0% at 4 months after the provision of milking goats was observed. The percentage of children with MUAC for age <-3 SD, showing signs of acute malnutrition, had decreased from 56.8% before the intervention to 12.3% after the intervention.

Availing Animal Source Food was not Sufficient

In the intervention mentioned above, even though change was observed on one of the nutrition indicator of the targeted children, MUAC for age, it was noteworthy to observe that after they were provided with milking goats, none of the mothers were breastfeeding (from 12% before the intervention). This was one of the signals that availing animal source foods for households does not necessarily ensure the improvement of the overall nutrition situation and optimal nutrition practices. The main lesson drawn was that nutrition sensitive interventions are beyond linking specific livestock relief interventions with nutrition outcomes. This ignited the idea of thinking on optimal behavioral change communication interventions which suits pastoral areas like Somali Region of Ethiopia. The option lies on whether to integrate the conventional nutrition education or IEC/BCC interventions to our nutrition sensitive interventions or to look for other sustainable means of channeling our important message on optimal maternal, infant and young child nutrition practices.

Pastoral Community Platforms

Among the rural pastoral communities of Ethiopia’s Somali Regional State, VSF-Suisse has used the community platforms of Pastoral Field Schools (PFS) and Village Community Banks (VICOBAs) to improve communities’ resilience to recurring episodes of drought and other emergencies. The PFS approach is an adaptation of the interactive Farmer Field Schools (FFS) approach developed by the UN-FAO in Indonesia in 1989.  They are groups of community members who meet periodically to pool their observations on livestock production and on rangeland management and to experiment new production systems. VICOBAs, meanwhile, comprise groups of mainly women who are trained and then meet regularly to organise collective saving and loans for times of emergency or crisis.

Given that both of these pastoral community platforms are now integrated features of their communities, they have shown to have tremendous cumulative benefit by equipping them with critical nutrition-related messages.

The BCIN-Action Research

The action research entitled ‘Behavioral Change for Improved Nutrition among pastoralists in Ethiopia’ (BCIN) thus intended to bridge the knowledge gaps by providing the scientific evidence on the outcome of integrating Behavioral Change Communication (BCC) interventions into the routine activities of the existing pastoral platforms, the PFS and VICOBA groups.

BCIN was a quasi-experimental research conducted in two pastoralist districts, Moyale and Mubarek of Somali Region of Ethiopia. The action research evaluated both intervention communities and comparison communities where the intervention did not take place with the aim of appraising the impact of channeled messages on key nutrition practices. In line with this, a total of 942 mothers having children 0-23 months were interviewed, 471 of them were in each study leg.

As a result, the number of mothers who heard about exclusive breastfeeding, optimal young child feeding practices, food safety and personal hygiene through the PFS and VICOBA were higher for the intervention communities compared to the comparison communities.

One of the main findings of the action research shows that exclusive breast feeding, food safety and hygiene are influenced by the mother’s age, educational status, income, and prior information on the issues. It is also observed that 85.5% of the mothers in the intervention groups reported receiving the information through the community platforms compared to 14.2% from other sources. Also, the action research found out that pastoral- community platforms have potential for channeling messages on key maternal, infant and young-child nutrition practices.

[1] MDG report of Ethiopia, 2014

[2] Ethiopian Demographic Health Survey, 2016

[3] Ethiopian Demographic Health Survey, 2016

2017 Transform Nutrition East Africa symposium report

The Transform Nutrition Research Consortium convened the research symposium ‘Evidence for action in East Africa’ on Thursday 8 June 2017, at the Southern Sun hotel, Nairobi, Kenya. A hundred participants from NGOs and academia working on nutrition, health, child welfare and development gathered together with government ministers from Kenya and Ethiopia, donor agency representatives and journalists to discuss the important issue of tackling undernutrition in East Africa.

Transform Nutrition Learning Journey: Kenaw Gebreselassie, Amref Health Africa, Ethiopia

I am currently working as Communications Manager for Amref Health Africa in Ethiopia, the largest African-led  International NGO which works to ensure health equity by serving women and children and reaching the most disadvantaged and inaccessible communities. Before this, I worked for Save the Children’s Health and Nutrition team  as a Communications and Research Uptake Manager where I disseminated research findings, developed key messages and communications materials on health and nutrition, coordinated the SUN Civil Society Network, and advocated for better health and nutrition services.

However, I wasn’t exposed to nutrition issues until later on in my life. Drought, famine, and the government’s and its partners’ emergency response was all I knew about nutrition issues but I didn’t know about the bigger picture. I started learning more about nutrition at Save the Children, but the first formal training I received was on the Transform Nutrition short course in 2014, where I learnt about the key issues, case studies and country experiences. The short course gave me the confidence I needed to talk about the issues, which had a major impact on my advocacy work at Save the Children and it continues support my communications and advocacy efforts at Amref Health Africa.

For example, I was part of the communications working group at the Ministry of Health so I advised on nutrition advocacy and contributed research uptake materials. As part of this working group, I participated in the development of the nutrition communication section of the National Nutrition Program II, which is currently operational and contributed to Ethiopia’s first 1000 days campaign messaging.  At Save the Children, I coordinated, among other things a radio panel seminar with government representation from the Ministry of Health, Ministry of Agriculture, Ministry of Education, as well as Ministry of Women and Children’s Affair.

I have also used Transform Nutrition course materials to develop a media training programme that I have conducted all around Ethiopia. The media in Ethiopia tend focus on food security when covering nutrition related stories so the course teaches journalists how to spread nutrition related lessons, such as back yard gardening, the importance of diversity in diets, agriculture, and the impact of undernutrition on child development so they can present a more rounded and nuanced message for their audience.


Ethiopia’s Productive Safety Net Programme

A new Transform Nutrition discussion paper is now out The impact of Ethiopia’s Productive Safety Net Programme on the nutritional status of children: 2008–2012. Ethiopia’s Productive Safety Net Programme (PSNP) is a large-scale social protection intervention aimed at improving food security and stabilizing asset levels. In this paper, we examine the impact of the PSNP on children’s nutritional status over the period 2008–2012 and these findings, along with work by other researchers, have informed revisions to the PSNP.

Transform Nutrition Symposium: Evidence from East Africa

From 2011-2017 Transform Nutrition has been strengthening the content and use of nutrition-relevant evidence, to accelerate the reduction of undernutrition. On 8 June Transform Nutrition is hosting a regional meeting Using evidence to inspire action in East Africa in Nairobi, Kenya.

This regional meeting will present experiential learning from other African and South Asian countries on key drivers to improve nutrition status, along with evidence on work works in nutrition-sensitive interventions, to policymakers from Kenya and international donors and NGOs in the East Africa region. It aims to inform and equip them to address the particular challenges of tackling child undernutrition in their current contexts. See agenda and press release.


Pastoral Community Platforms as channels for Behavioural Change for Nutrition

New research just been published by Transform Nutrition and Vétérinaires Sans Frontières Suisse with preliminary findings of a study on Pastoral Community Platforms as Channels for Behavioural Change for Improved Nutrition (BCIN) The research was designed to explore the potential of using pastoral-community platforms for channeling maternal, infant and young-child nutrition messages to community members. We have also published some useful case studies which provide an insight into the perceptions of the participants of the study who live in the study area.

Reducing chronic undernutrition in Ethiopia

On December 5th, 2016, Transform Nutrition Co-Research Director John Hoddinott, gave a seminar on issues surrounding chronic undernutrition in Ethiopia. In addition to reviewing current trends and the factors associated with these, Dr Hoddinott summarized Transform Nutrition research on chronic undernutrition in Ethiopia, conveying key messages and outlining areas requiring attention in the future. The lecture was attended by representatives from civil society organizations, academics, government officials and researchers. His presentation can be viewed here.

Children’s diets and access to markets in Ethiopia

Chronic undernutrition in Ethiopia is widespread and many children consume highly monotonous diets. To improve feeding practices in Ethiopia, a strong focus in nutrition programming has been placed on improving the nutrition knowledge of caregivers. In this new Transform Nutrition/ Ethiopia Strategy Support Programme working paper Children’s diets, nutrition knowledge, and access to markets , the impact of improving nutrition knowledge within households and its complementarity with market access is considered.