In areas once affected by famine, Ethiopia builds capacity to wipe out malnutrition

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By Indrias Getachew

GETER MEDA, Ethiopia, 24 January 2012 – Seven-month-old Aynadis played with her mother, Seta Temesgen, as they waited to be screened at the Geter Meda Health Post.

Several weeks ago, Aynadis was diagnosed with severe acute malnutrition – a condition that can be deadly if untreated.

VIDEO: UNICEF reports on a nutrition programme that is proving to be a lifeline for children in Ethiopia's Amhara region. Watch in RealPlayer

Ms. Temesgen believes her work as a field labourer contributed to Aynadis’s condition.

“We don’t stay at home to feed them,” she said about mothers in their agrarian community. “We spend our day in the fields, and the babies spend the day on our backs… If we are working, we don’t want to miss the work, so we only feed them when they start crying, and that harms them.”

But Aynadis is fortunate. She was referred to the village’s outpatient therapeutic feeding programme (OTP), where she has been receiving life-saving treatment. Today’s check-up will show how much progress she has made since her diagnosis.

Treating malnutrition at the village level

Geter Meda is located in Lasta District, Amhara Region, an area that was affected by the two great famines of the late twentieth century, those of 1973–74 and 1984–85. A lot has changed since those crises, when there were no government systems in place to adequately respond to droughts or the nutritional needs of affected communities.

In 2004, the Government of Ethiopia, with support from partners including UNICEF, rolled out the Health Extension Programme, which trained more than 30,000 health extension workers to provide an integrated package of health, nutrition and sanitation services to largely rural populations.

The health extension workers – who are mostly women – are assigned to village health posts, where they are supported by volunteer community health workers. Every three months, these health workers and volunteers conduct Community Health Days for children under age 5 and for women who are pregnant or breastfeeding. These children and women receive vaccinations, vitamin A supplements, deworming tablets, malnutrition screenings, as well as counseling on health, nutrition and sanitation issues. Children identified with severe acute malnutrition – but without complications such as fever – are referred to health posts for outpatient therapeutic feeding.

This programme has had major success identifying and treating severe acute malnutrition. National capacity to treat this deadly condition at the community level has grown from almost zero in 2004. Prior to the introduction of village-level OTPs, people with severe acute malnutrition needed to go to the nearest health center or hospital, many hours or even days away. Village-level OTPs now cover an average population of 5,000 people each.

According to the Ministry of Health, more than 300,000 severely malnourished children were treated in eight drought-affected regions of Ethiopia between January and November 2011 – with an 84 per cent cure rate and 0.6 per cent death rate.

Preventing future malnutrition

Habtam Byabel, a health extension worker at the Geter Meda Health Post, is conducting weekly check-ups for children in the OTP.

She counsels the patients’ mothers, then weighs the children and checks their mid-upper arm circumference – a measure of their nutritional status. Before they leave, Ms. Byabel gives them ready-to-use therapeutic foods for the week.

“She told me to prepare porridge made from ingredients that we have available at home,” Ms. Temesgen said after her consultation. “Also give her one and a half of these [ready-to-use therapeutic foods] together with your breast milk.”

And Aynadis will not only receive treatment, she will also get help avoiding malnutrition in the future. Geter Meda’s community-based nutrition programme offers monthly growth monitoring for children under 2 years old, and conducts community discussions at which villagers can identify problems that may result in malnutrition. Then, together with health workers, villagers agree on plans to resolve these problems.

These activities have greatly improved the nutritional status of children like Aynadis. Even during 2011, a drought year, the number of children participating in Geter Meda’s OTP had declined from the year before.

“Last year we had eight children in the OTP. Now we have three. When these children are discharged we don’t expect that there will be any more,” said Ms. Byabel.

“My vision, when it comes to nutrition,” she continued, “is for all the children to be healthy and to grow up to be productive citizens.”