User:Hailuhammer/sandbox

 Child Malnutrition in Ethiopia  

Ethiopia experiences malnutrition burden among its under-five child population. The national prevalence of under-five stunting is 38.4%, which is greater than the developing country average of 25%. In 2011, Ethiopia shared 3% of the world stunting burden. Malnutrition in childhood has many adverse consequences for child survival and long term well-being.

Background
Malnutrition refers to inadequate, excesses or imbalances in person’s intake of nutrients. The nutrient includes calories, protein, carbohydrate, fat, vitamins or minerals. Mostly under nutrition occurs due to lack of high quality food which available to eat. The term malnutrition covers three broad groups of conditions. Under nutrition can be described by stunting (Low height for age), wasting (low weight for height) and underweight (low weight for age). Over nutrition can be described by overweight, obesity and diet related non communicable diseases. Micro-nutrient-related malnutrition includes micro-nutrient deficiencies (lack of important vitamins and minerals) or micro-nutrient excess.

Protein energy malnutrition is a type of undernourishment which shows an imbalance between the supply of protein and energy and the body's demand for them to ensure optimal growth and function. Protein–energy malnutrition mostly affects children because they have less protein intake. Protein energy malnutrition has three clinical presentations; kwashiorkor (lack of protein), marasmus (lack of protein and calories) and marasmic-kwashiorkor (protein deficiency and chronic energy deficit). At 2015, protein energy malnutrition was estimated to have resulted in 323,000 deaths worldwide. In sub-Saharan Africa, between 25 and 35 % PEM has been associated with mortality.

In Ethiopia, about 5.8 million children under-five years are suffering from chronic malnutrition (stunting). One in ten children in Ethiopia is wasted and suffer from acute malnutrition, which is the leading cause of death.

Food insecurity is a state or a condition in which people experienced limited or uncertain physical and economic access to safe, sufficient, and nutritious food to meet their dietary needs or food preferences for a productive, healthy and active life. Food insecurity is widespread and severe problem in Ethiopia. In the 2019 Global Hunger Index, Ethiopia ranks 97th out of 117 qualifying countries with a score of 28.9, Ethiopia has a level of hunger that is serious.

Fifty-seven percent of all deaths that occur before age five in Ethiopia are related to malnutrition. Causes of malnutrition are very complex. Malnutrition can be influenced by many factors acting at multiple levels. The most common causes of malnutrition in Ethiopia include dietary intake issues, diseases, food insecurity and inadequate maternal and child health care and sanitation services.

Every month, over 25,000 children with severe acute malnutrition were admitted to hospitals across Ethiopia. Childhood malnutrition has been shown to increase the risk of infection like diarrhea and pneumonia and further increasing the likelihood of under-nutrition. Furthermore, child malnutrition causes premature death, linear growth restriction, and cognitive impairment and has behavioral and social problems.

Government of Ethiopia has developed the National Nutrition Program (NNP) in order to reduce the magnitude of malnutrition, coordinate harmonies and scale up current nutritional intervention with the greater focus on community. The NNP targets the most vulnerable groups that is under-five particularly those under 2 years as well as pregnant women. Also NNP tries to address the expansion of the nutrition program and multi-sectoral linkages.

Child malnutrition in Enset growing areas
Enset (Enset ventricosum) is the second most produced plants which serve as traditional staple food for about 20% of the Ethiopian population. Enset –based farming is common in most dense population located in south and southwest highlands of Ethiopia. The primary hot spot areas of cultivated enset are found in Sidama, Gurage, Gedeo, Keffa, Sheka, Ari,Southern Omo, Benchi Maji, Arsi, and some part of Bale and West Shewa region. Enset is important to the diet and economy of Gurage and Sidama peoples and was first recorded in the seventeenth century. Enset is often intercropped with sorghum, although the practice amongst the Gedeo people is to intercrop it with coffee. The causes, prevalence and incidence of specific nutritional deficiency diseases varied among geographical areas, ecological zones and population groups. Protein Energy malnutrition a form of malnutrition frequently reported during famine in Ethiopia specifically in enset growing areas of Ethiopia. Besides, the major staple in many parts of Ethiopia, most of enset growing areas are prone to malnutrition due to the rich content of carbohydrate (80%) and starch (65%) and low content of protein (4%) in enset. Ethiopia’s history has been periodically marked by major drought incidences in the 1970s and 1980s and drought usually occurred once per decade. About 1.2 million people were affected by drought in Ethiopia between 1972 and 1984. A severe drought was also observed in 2002/2003 that leads to a famine, which affected 13.2 million people and most child mortality observed. Populations who depend on enset food, especially southern Shewa, Bale, Sidamo and Gamo Gofa have suffered from drought, during the period of 1983 and 1985.

Epidemiology malnutrition in Enset growing areas
According the World Bank estimate Ethiopia is one of the highest ranking countries where children suffer from malnutrition. The 2019 Ethiopian Mini Demographic Health Survey shows that 38% of children under 5 are short for their age or stunted and 7% are wasted. Child stunting prevalence in the enset growing region is largely consistent with the national average that is 36%. Kwashiorkor is type protein-energy malnutrition that prominently occurs in enset staple food areas of Ethiopia such as Wolita, Gamo Gofa, Kembata-Hadiya. The prevalence of stunting was highest in south region of Ethiopia.

Health effect
The prevalence of stunting and wasting is high, particularly in developing countries, is attributed to low protein-energy intake and increased exposure to enteric infections as a result of poor sanitation. The most serious health effects of protein-energy malnutrition are stunted growth, body wasting, retarded mental growth, and high mortality in younger children. Children suffer from PEM also have other co-morbid conditions such as diarrhea, pneumonia and malaria. Also, in addition to other conditions that occurred with PEM, includes bronchopneumonia, sepsis, chronic otitismedia, rickets and keratomalacia and which resulted increased hospital stay and likelihood of death.