Health workers and community members work together to prevent child malnutrition in Ethiopia
By Indrias Getachew
Sartu Abdela, a community health worker in the village of Oda Kebena, holds a meeting for mothers with children under the age of two in a local administration office. The mothers, wrapped in colourful outfits, have come for a monthly nutrition check-up for their children, who will be weighed and have their mid-upper arm circumference measured.
The session is one of the pillars of the UNICEF-supported Community Based Nutrition (CBN) programme that was introduced as a pilot initiative in drought-prone and food insecure areas, including here in Fedis District, in 2008.
It has now been adopted as a national strategy, particularly in rural areas, where approximately 85 per cent of Ethiopians live. The aim is to combat child malnutrition, which causes at least half of all deaths of children under the age of five in the country.
Mothers take the lead
Fetia Sham, 22, a mother of three, is first in line with Isteria, her 6-month old baby. “We have come here to have our children weighed,” says Fetia. “Having them weighed monthly lets us know how they are growing and helps us to take good care of them.”
Isteria has put on weight since her last visit and Ms. Abdela congratulates Fetia for the steady progress. Together they fill out Isteria’s weight chart, and then discuss feeding practices using the family health card that has been distributed to all mothers in the programme.
“Now that her child is 6 months old, I advised her to start complementing her breastfeeding with soft foods like sorghum porridge and other items that are available to her,” says Ms. Abdela. “This way her child will continue to grow strong.”
Ms. Abdela repeats this routine with all 19 mothers present. On this occasion all the children are doing well. If any were to show signs of severe malnutrition, Ms. Abdela would refer them to the village health post for further tests and possible enrolment in the village outpatient therapeutic feeding programme (OTP).
Last year, Ms. Abdela referred two cases of severe malnutrition to the OTP, and both children recovered. So far this year there have been no cases, a sign that the preventative strategies are already working.
The CBN programme is vital in villages such as Oda Kebena, which has suffered from numerous cases of child malnutrition in the past. There are 18 community health workers in Oda Kebena like Ms. Abdela, with each responsible for an average of 50 households.
Ms. Abdela says the drop in cases is a result of better expertise and education. “We counsel the mothers and they all want to do well – no one wants to be seen as doing worse than another – so with this competitive spirit they are all taking better care of their children,” she says.
The following day, Ms. Sham and other mothers in the programme – along with members of the larger village community – gather in the local community hall for a discussion facilitated by Ms. Abdela and the village’s two Health Extension Workers, Haimanot Yimenu and Jemanesh Duressa.
“We have discussions where we ask and identify what the problems in the community are, and then we work with them to identify solutions and assist them to reach a collective decision on action that needs to be taken,” says Ms. Yimenu.
Role of fathers
It’s not long before they identify their first issue. Ms. Abdela initiates the community conversation by reviewing results of the monthly growth monitoring session. Soon talk turns to the important role fathers can play in ensuring proper feeding of children. One father admits the monthly charts have changed his perspective on child malnutrition.
“I didn’t think much about the monthly weighing sessions when my wife first started going,” he explains. “I ask all of us fathers here today to commit to take the children to be weighed ourselves if the mothers cannot go.” His suggestion is met with a round of applause and accepted.
Halting malnutrition before it becomes severe and life-threatening is the cornerstone of the national nutrition strategy in Ethiopia. The impact of UNICEF-supported CBN programmes is helping to ensure that gains in child survival are not only sustained, but continue to improve.