Bi Annual Nutrition Review Meeting and
Capacity Building Workshop
January 26,2008
Woliso
July 17
1
Why Nutrition Matters?
July 17
2
Contents
Nutrition Status
Globally
National Level
Regional Level
Effects of Malnutrition
Window of Intervention
July 17
3
Under-nutrition Globally
1 billion people Undernourished
162 million children <5 yrs - Stunted,
99 million – Underweight
51 million – Wasted
Lancet MCN series, UNICEF/ WB/ WHO, 2013
July 17
Few countries in the world have highest rate of stunting prevalence
4
Under-nutrition in Sub-Saharan Africa
Stunting in Africa
%
July 17
5
The Problem of Under-nutrition …
• Major causes of malnutrition in Ethiopia are
preventable.These are:
–
–
–
–
–
–
Poor maternal nutrition,
Poor infant and young child feeding,
Childhood illness,
Poor WASH practices
Inadequate health care practices and
Limited availability and access to diversified foods
• In addition, care givers illiteracy and inadequate
maternal economic access and control are the
basic causes
July 17
6
Trends in Nutritional Status of Children under 5
in Ethiopia, 2000 - 2014
70
60
58
51
50
44
41
40
40
33
29
30
25
20
12
12
10
10
9
0
Stunting
Wasting
2000
July 17
2005
2011
Underweight
2013/4
7
Under-nutrition in Ethiopia (EDHS 2011)
70
60
49.2
50
44.4
44.3
42.4
37.5
40
38.4
39.7
29.2
30
21.8
27.4
22.9
20
10
0
July 17
2005
2011
2014
8
Under-nutrition in Ethiopia cont…
Malnutrition by Degree of Food Insecurity
July 17
9
Under-nutrition in Ethiopia cont…
Prevalence of Stunting by Economic Status
July 17
10
Trends in nutritional status of children
under 5 years of age, in the last 4 DHSs
PERCENTAGE
Oromia
50.00
45.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
47.2
41
42.4
41.4
37
34.4
26
Children Stunted
DHS 2000
EDHS 2005
22
Children UW
EDHS 2011
MEDHS 2014
Regional Scenario
• Stunting- 41.4% ( 2,217,325 U5Children) this means
more than2 out of every 5 children are stunted in the
region
• Underweight -26% (1,406,108 U5Children)
• Wasting – 9.7% ( 524,587 U5Children)
• Anaemia in Children – 51.7%
• Anaemia in women 15-49 years – 19.2%
• Households consuming iodized salt – 17.4%
2
• Women BMI <18.5 kg/m (thin) – 26.9%
EDHS 2011
Impacts of Nutrition
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13
Stunting and brain development
Normal
July 17
Typical brain cells
Extensive branching
Source: Cordero E et al, 1993
Stunted
Impaired brain cells
Limited branching
Abnormal, shorter branches
14
Social and Economic Implications
Under-nutrition also lowers cognition and impedes
learning.
45% of the 6.9 million child deaths in 2011 were
related to under-nutrition.
10% of an individual’s life-time earnings
11% of a country’s GDP is lost annually due to high
prevalence of under-nutrition.
Every dollar spent on nutrition-specific interventions has
an average return $15-100.
Copenhagen Consensus, 2008/ 2013; LNS 2013
July 17
15
Effect of Under-nutrition on Health Cost
Estimation of health costs of under nutrition related pathologies on
public and private health costs, 2009
Pathologies
(In millions of Ethiopian birr
Number of
Relative
Cost
(In millions
episodes
risk
birr)
LBW/IUGR
148,173
---------
563
Anemia
365,311
12% more
130
ADS
527,153
5% more
144
ARI
114,300
6% more
61
Underweight
2,991,509
---------------
693
Fever/Malaria
264,232
4% more
231
Total
4,410,678
------------
1,822
Cost to the Cost to the
family(MB system(MB)
)
(90%)
(10%)
1.8 BETB
= 0.54 %
GDP
1,637
185
Source: Model estimations based on DHS 2005/2011, and Demographic information and data provided by the National Implementation Team
July 17
16
Effect of under-nutrition on Education
+3.9%
higher
July 17
Stunted
children have a
3.9% more risk
of repetition
than nonstunted
children
17
Effect of under-nutrition on Education
Retention/dropout
19% of non stunted
population completed
primary school
compared to only 8%
of stunted children
12% of nonstunted
completed
secondary school,
while 4% of the
stunted
population
completed
secondary
school
July 17
18
Cost of under-nutrition associated
repetition to the country EDP
COSTS OF GRADE REPETITION ASSOCIATED TO STUNTED CHILDREN, 2009
Primary
Number of repetitions
Total
152,488
------
Public Costs per student
(ETB)
223
------
Total Public Costs (millions
of ETB)
34
Private Costs per student
(ETB)
390
Total Private Costs (millions
of ETB
59
59 Million
Total (millions of ETB)
93 Million ETB
Equival
ent to
0.03%
of GDP
34 million
------
Source: Estimations based on official education statistics of Ministry of Education (2009).
July 17
19
Effect of under-nutrition on
productivity
• Studies indicates that when a
child is stunted, this will impact
them when they enter the labour
force.
• On the whole, stunted workers
are less productive than nonstunted workers, and are less able
to contribute to the national
economy.
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20
Effect of under-nutrition on Income
625 Million
birr = 0.2%
GDP
July 17
21
Effect of under-nutrition on Manual
Intensive Activities
24.3 million
WAP were
stunted,
represents 67
% of the
working age
population in
ML
12.8 BETB
= 3.8% of
GDP in
2009
Source: Estimations based on data from CSA/ EHICE 2010/2011 and WHO/NCHS Database information and relative risk information.
July 17
22
Productive Losses Due to Child
Mortality
4.8 billion
working
hours lost
Economic
losses due to
mortality are
40 Billion ETB
= 11.9% GDP
Source:
based on data from CSA/ EHICE 2010/2011 and WHO/NCHS Database information and relative risk information.23
JulyEstimations
17
Total costs of Child under-nutrition to
Ethiopia
ETB 55.5
Billion/
USD 4.7 B
July 17
24
ESTIMATED SAVINGS FOR EACH SCENARIO, 2009
Scenarios
Baseline:
The Cost of Inaction by
2025
Stunting = 46.4%
Scenario #1:
Scenario #2.
Halving the Prevalence of The ‘Goal’ Scenario: “10
Child Under-nutrition by
and 5 by 2025”
2025
Stunting = 23.2%
Stunting = 10%
Description
Underweight = 31%
Implications
Estimated
Change in
period
Annual
Average
Savings
July 17
Underweight = 15.5%
Underweight = 5%.
No increase or decrease Reduce stunting of 1.5% Reduction of 2.3% points
but total number of
points annually is
annually is required
stunted children and
required
burden increases
Total cost increase of Accumulated savings of Accumulated savings of
up to 39% for 2025
70.9 billion ETB for the 148 billion ETB for the
compared to the values in period from 2009 to 2025 period from 2009 to 2025
2009
4.4 billion ETB
9.2 billion ETB
None
(USD 376 million)
(USD 784 million)
25
We choose...
To pay the consequences
of having under-nutrition
July 17
Source: Francisco Espejo’s presentation on cost of hunger; Picture design by Jhoram Moya
To pay for eradicating undernutrition
26
Window of opportunity to avert
malnutrition
July 17
27
Harka wal qabannee
Jijjiiramaaf Yaa Hojjannu !!!!!
July 17
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