Community Based Nutrition programme holds off hunger in drought-prone Ethiopia
By Indrias Getachew
Brightly clad mothers with babies strapped to their backs make their way to the centre of Chancho village, located in the Deder district of eastern Ethiopia. There, volunteer community health worker Kasim Jibral is setting up weighing scales for the village’s monthly growth-monitoring session.
|VIDEO: 13 July 2011 - UNICEF correspondent Chris Niles reports on community-based nutrition and health initiatives for children living in drought-prone areas of Ethiopia. Watch in RealPlayer|
“We weigh the children in order to identify malnutrition, which may not be visible to the eye,” says Mr. Jibral.
Growth monitoring is one of the pillars of the UNICEF-supported Community Based Nutrition (CBN) programme, introduced by the Government of Ethiopia in 2008 in drought-prone and food-insecure districts. CBN is designed to prevent malnutrition, an underlying factor in many deaths of Ethiopian children under the age of five.
‘She must continue breastfeeding’
Adise Gezahegn and her three-month-old baby Beza patiently wait their turn in Chancho. Last month, Beza weighed 4.4 kg, and her mother is keen to find out how much weight she has gained since her last visit.
Mr. Jibral helps Ms. Gezahegn remove Beza’s clothing, and they put her in a modified sack that’s used to weigh the babies. Together, they note the results – Beza is now a healthy 4.6 kg – and then sit down for their monthly one-on-one consultation.
“Even if she is not feeling well, she must continue breastfeeding her child. That is the advice that I gave her,” Mr. Jibral says after talking with Ms. Gezahegn. “I told her that she should be drinking the cow milk that she is now feeding the child, so that she herself will have enough breast milk to feed her baby.”
National Nutrition Strategy
While breastfeeding is a common practice in Ethiopia, exclusive breastfeeding from birth – including feeding the colostrum, the nutritious and disease-fighting ‘first milk’ released right after delivery – has been considered unclean in many communities.
Promoting exclusive breastfeeding from birth until six months, and then up to two years or beyond with complimentary feeding, is a key component of Ethiopia’s National Nutrition Strategy. It is implemented at the local level through CBN and the Health Extension Programme, which trains community health workers.
“When I had my first two children, I didn’t have this knowledge and so I didn’t breastfeed them immediately,” says Ms. Gezahegn. “But with the third and fourth child, because I had this knowledge, I started breastfeeding immediately.”
Monitoring children’s growth
Mr. Jibral and his fellow volunteer community health workers weigh each of the 27 children under two years of age who have come for growth monitoring. Then they discuss the results with the mothers.
Monthly growth-monitoring sessions provide a timely measure of how children are faring. They also enable immediate intervention if malnutrition is detected. Those who are found to be at risk are referred to outpatient therapeutic feeding programmes, which serve children who suffer from severe acute malnutrition but don’t have other complications such as fever
With support from UNICEF, the government has extended these feeding programmes to 8,800 health posts, up from almost none in 2004. Using ready-to-use therapeutic foods, trained health extension workers can and do save lives.
The results of the Chancho growth-monitoring session are mixed.
“There are those who have gained weight and some who have lost weight,” says Mr. Jibral. “I have referred three children to the health extension workers for further nutritional evaluation.”
Early the next morning, the community health workers in Chancho village use megaphones to remind the farming community that they will be discussing the results of the growth monitoring in a meeting at the village centre.
At the meeting, health extension workers Mersha Tena and Tigist Imiber present a chart with the previous day’s results, then lead the discussion on challenges affecting children’s nutrition.
Ms. Gezahegn’s husband has accompanied her to the meeting. “Previously, [fathers] would refuse to hold our babies,” he says. “We considered it the work of the mothers. But now, following the community conversation, I have been convinced, and now we are taking care of our children equally.”
Impact of regional drought
Child-survival rates in Ethiopia have improved significantly in recent years, with gains in child nutrition playing a major role. In 1990, more than 20 per cent of the country’s children would not survive to reach their fifth birthday. By 2009, that percentage had been cut in half.
Preventing malnutrition before it becomes severe and life-threatening is the cornerstone of the country’s nutrition strategy. The UNICEF-supported CBN programme is also helping to stave off the impact of the on-going drought emergency affecting Ethiopia and the rest of the Horn of Africa.
With approximately 300,000 children requiring treatment for severe acute malnutrition in 2011, however, the systems that have been put in place to save young lives are stretched. UNICEF is appealing to international donors to increase support for its humanitarian response in the coming months.