April 2013: UNICEF correspondent Chris Niles reports on a programme tackling malnutrition in rural Ethiopia.
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Not long ago, it was common for children under the age of 5 to receive treatment for severe malnutrition in this Ethiopian community. Today, a community-based nutrition programme is keeping children strong and healthy, and families resilient.
By Indrias Getachew
MANCHA, Ethiopia, 9 August 2013 – Wudnesh Zebdios is a village health extension worker. Today, she weighs children 2 years old and younger in Mancha, Wolaita zone.
Weighing children monthly is one of the pillars of the Ethiopian Ministry of Health’s Community Based Nutrition Programme (CBN), which is designed to prevent malnutrition by building the resilience of communities to shocks such as food insecurity.
“I am very pleased with the condition of the children who came today,” says Ms. Zebdios. “They have all gained weight, and their weight is good for their age.”
CBN is supported by UNICEF and donors like the European Union.
An army of health
If a child is severely underweight, Ms. Zebdios has the mother bring the child to the village health post to be screened for acute malnutrition and possible admission to the outpatient therapeutic feeding programme.
Wudnesh Zebdios, a health extension worker visits the home of Kumete Alaro, mother of five, who is also caring for her 2-year-old granddaughter Tesfnaesh. Tesfanesh was admitted to the village outpatient therapeutic feeding programme one year ago when Wudnesh discovered she was severely malnourished.
If the child is moderately underweight or has not gained enough weight since previous weigh-ins, she will counsel the mother on possible reasons and on solutions.
If the child is doing well, she congratulates the mother and encourages her to continue feeding her child properly.
Later in the week, with the help of the local health development army leader, Ms. Zebdios will gather parents and other community members to discuss the weighing session. These discussions enable them to analyse problems and agree on actions to improve the nutritional status of children.
Members of the health development army are women selected from the community to assist health extension workers to deliver their integrated health, nutrition, hygiene and sanitation services in the rural community. Each woman is responsible for five families.
A positive impact
CBN has had an impact on malnutrition rates in Wolaita zone, which is prone to periodic drought and food crises.
According to the zone health office, over the past three years, malnutrition rates have dropped from 20 per cent to 5 per cent, and severe malnutrition rates have dropped from 5 per cent to about 1 per cent.
“In the past, the nutrition activities that were being implemented focused largely on treating malnutrition,” says Disease Prevention and Health Promotion Officer at the Wolaita zone health office Haile Bekele. “Children would be treated after they became malnourished. But, this CBN programme is focusing on prevention before children become malnourished.”
Screening further afield
Visiting families in the farming community is part of Ms. Zebdios’ work. Today, she is at the home of Kumete Alaro, a mother of five who is caring for her 2-year-old granddaughter Tesfanesh. One year ago, during a monthly session, Ms. Zebdios discovered Tesfanesh was severely malnourished. The infant was admitted to the outpatient therapeutic feeding programme.
“[She] is doing well now,” says Ms. Alaro. “She was very thin before because she wasn’t breastfeeding. Then, the government helped us; she ate the ready-to-use therapeutic foods, and is now much better.”
Wudnesh Zebdios, a health extension worker weighs children under 2 years of age at the monthly growth monitoring and promotion session in rural Ethiopia. Growth monitoring is one of the pillars of the UNICEF and European Union supported Community Based Nutrition Programme.
Ms. Zebdios asks if Ms. Alaro is feeding Tesfanesh a balanced diet, as she learned at the CBN sessions.
“We prepare eggs for her, and we mix the mango and avocado that we buy from market and feed her,” says Ms. Alaro. “In the past, we would take our milk and butter to sell in the market because we didn’t know its importance. Now, we keep and feed it to the children at home.”
Improvements in water supply, hygiene and sanitation are also contributing to the falling malnutrition rates. Before she leaves, Ms. Zebdios checks the latrine and hand-washing facilities that Ms. Alaro has built, important elements in the Government of Ethiopia’s Health Extension Programme.
Today, CBN reaches 80 per cent of children 2 years old and younger in the Southern Nations, Nationalities and Peoples’ Region (SNNPR). According to UNICEF Nutrition Officer in SNNPR Anteneh Omer, within the next two years, it is expected to cover all districts in the region.
A message for adolescents
Meanwhile, there is a new front in the war against malnutrition – adolescents. Health extension workers are taking health- and nutrition-related messages to their village schools. By convincing adolescents to delay marriage and first pregnancy and promoting healthy habits, they are working to break the generational cycle of malnutrition.
“A girl should not get married until 18 years and should not have a child until she is 18,” Ms. Zebdios tells a room full of seventh and eighth graders. “Why, because her body is not ready to carry a foetus…The children who are born will be weak. Their minds will not be strong for education.”
With the support of UNICEF and the European Union, SNNPR will be streamlining adolescent nutrition as a component of the CBN programme.
Outside Kumete Alaro’s home, children gather in a festive mood. Their energetic song and dance is infectious. Neighbours join in, including Wudnesh Zebdios. Mancha is a community where, not long ago, it was common for children under the age of 5 to receive treatment for severe malnutrition. Today, there are no severely malnourished children. As a matter of fact, all children under 2 have gained weight since the previous month. It is, indeed, cause for celebration.