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Changes in nutrition outcomes in Ethiopia, 2000-2016

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Changes in nutrition outcomes in Ethiopia, 2000-2016

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Changes in nutrition outcomes in Ethiopia, 2000-2016

  1. 1. Changes in nutrition outcomes in Ethiopia, 2000-2016 Kalle Hirvonen International Food Policy Research Institute The Future of Ethiopia’s Agriculture: Towards a Resilient System to End Hunger and Undernutrition Addis Ababa Hilton December 15, 2017 Addis Ababa 1
  2. 2. 2 Chronic undernutrition 1. Typically measured using Height-for-Age Z-score (HAZ) • For given age and sex: HAZ measures the distance in height to the median child of a healthy and well-nourished population 2. A child is considered stunted if this distance is -2 standard deviations or more: HAZ ≤ -2. 3. In a healthy and well-nourished population this is rare: about 2% have HAZ ≤-2. 4. Higher stunting prevalence rates imply chronic under-nutrition. 5. According to WHO (1995) stunting rates of o > 40 % = very high malnutrition severity o 30-39 % = high malnutrition severity o 20-29 % = medium malnutrition severity o <20 = low severity malnutrition severity
  3. 3. 3 Why should we care? 1. Stunting is a marker for a number of development outcomes: i. Sufficient nutrition is a critical input for brain development (fastest in the first years of life) ii. Considerable body of research shows that stunted children attain less schooling and score poorly on tests measuring cognitive ability iii. All this is then linked to economic productivity, welfare and poverty 20 years later when these children are adults.  GoE (2015) estimates that child undernutrition reduces GDP by 55.5 billion ETB or 16% of GDP.
  4. 4. 4 Ethiopia since 2000: one of the fastest reductions in stunting rate in the world Source: Demographic and Health Survey (DHS) – Ethiopia 2000, 2005, 2011, 2016 WHO: very high malnutrition severity WHO: high malnutrition severityWHO: very high malnutrition severity WHO: very high malnutrition severity
  5. 5. 5 Stunting-age relationship: Global evidence Born small Intensive breastfeeding Introduction of solid foods Source: DHS data for 65 middle and low income countries; more than 1 million observations. Adapted from Headey, Hoddinott & Menon (2017): “The age dynamics of growth faltering among pre-school children”
  6. 6. 6 Stunting-age relationship: Ethiopia Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016
  7. 7. 7 Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016 Hypotheses Hypothesis 1: Marginal improvements in birth sizes
  8. 8. 8 Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016 Hypotheses Hypothesis 1: Marginal improvements in birth sizes Hypothesis 2: ‘More Intensive’ breastfeeding
  9. 9. 9 Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016 Hypotheses Hypothesis 1: Marginal improvements in birth sizes Hypothesis 2: ‘More Intensive’ breastfeeding Hypothesis 3: Little improvement in CF practices
  10. 10. 10 Marginal improvements in birth sizes? 1. Difficult to verify: few children are born at health facilities 2. Self-reported birth sizes by the mothers suggest little improvement but these data are questionable 3. But we can get clues from women’s BMI (who are in reproductive age) • There’s considerable evidence that (pre-pregnancy) BMI is positively associated with infant birth weight
  11. 11. 11 Marginal improvements in birth sizes ✔ Women’s (15-49 y) Body-Mass Index (BMI) Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016 Rural Urban
  12. 12. 12 ‘More Intensive’ breastfeeding ✔ 2000 2016 Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016
  13. 13. 13 Little improvement in CF practices? 1. Minimum meal frequency (%): Proportion of breastfed and non-breastfed children 6-23.9 months of age who receive solid, semi-solid, or soft foods or milk feeds the minimum number of times or more. 2. Minimum dietary diversity (%): Proportion of children 6-23.9 months of age who receive foods from 4 or more food groups (out of 7). o Problem: only available in 2011 and 2016
  14. 14. 14 Larger share of the younger children achieve recommended meal frequency Source: Demographic and Health Survey (DHS) – Ethiopia 2000 & 2016 % of children achieving recommended meal frequency
  15. 15. 15 Few children consume a sufficiently diverse diet % of children achieving recommended dietary diversity Source: Demographic and Health Survey (DHS) – Ethiopia 2011 & 2016
  16. 16. 16 Summary (so far) 1. Considerable reduction in stunting rates since 2000. o One of the fastest reductions in the world 2. Little improvement in avg birth sizes; 20% are born stunted o Calls for focus on maternal health & nutrition 3. In 2016, growth faltering occurs later – likely due to improvements in ‘intensive’ breastfeeding practices. o Median duration of exclusive breastfeeding increased from 2.5 to 3.6 4. However, growth still ‘collapses’ around the time when complementary foods are introduced (~ 6 mo). o Dietary diversity is alarmingly poor
  17. 17. 17 How is this linked to agriculture? 1. Complementary feeding practices are shaped by two factors: i. Caregiver’s knowledge (Health Extension program, Alive & Thrive) ii. Access to food a. Physical access (e.g. Abay & Hirvonen 2017; Stifel & Minten 2017) b. Financial access (affordability & prices) 2. All these factors are important AND complementary (e.g. Hirvonen et al 2017). 3. Global evidence shows that what young children are consuming is strongly influenced by prices (Headey, Hirvonen & Hoddinott 2017). • e.g. doubling the price of eggs is associated with a 15-percentage point drop in the probability of children 6-23 mo consuming them.
  18. 18. Source: Bachewe, Hirvonen, Minten & Yimer (2017) based on CSA retail price data % change in real prices, 2007-2016, by food group (real) Prices of nutritious foods have risen fast
  19. 19. 19 This is how it’s linked to agriculture • Prices of nutritious foods (fruits, vegetables & animal source foods) are directly shaped by agriculture policy – production, marketing & trade.  Agricultural policy has a major role to play in future reduction in stunting rates in Ethiopia.

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