NSA Lecture Notes (For PLSC)

Course Title: Nutrition Sensitive Agriculture
(Hort3096)
By: Mekonnen Tolasa (MSc.)
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Chapter 1: Introduction
1.1. Definition of terms

Nutrition: is the science of food and the nutrients and other
substances they contain, and of their actions within the body
(including ingestion, digestion, absorption, transport, metabolism,
and excretion).
Foods: edible or potable substance (usually of animal or plant
origin), consisting of nourishing and nutritive components such as
carbohydrates, fats, proteins, essential mineral and vitamins, which
(when ingested and assimilated through digestion) sustains life,
generates energy, and provides growth, maintenance, and health of
the body.
Diet: is the foods and beverages a person eats and drinks
Meal: is an eating occasion that takes place at a certain time and
includes specific, prepared food, or the food eaten on that occasion.
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CONT’D…
• Energy: the capacity to do work. The energy in food is chemical
energy. The body can convert this chemical energy to mechanical,
electrical, or heat energy
• Nutritional requirement: refers to the different nutrients required by
the body for energy, growth and repair & protect us from disease.
– Nutritional requirement differs according to age, gender, physical
activity, height, weight, and health status of the individual.
– Nutritional status of an individual person results from nutrient
intake, nutrient requirements, and the body’s ability to digest, use
and absorb the nutrients that is ingested.
• Nutrition assessment: is a comprehensive analysis of a person’s
nutrition status that uses health, socioeconomic, drug, and diet
histories, anthropometric measurements; physical examinations and
laboratory tests.
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CONT’D…
• Nutrition specific interventions: are interventions or program that
address the immediate determinants of fetal and child nutrition
development. Adequate food and nutrient intake, feeding, care
giving and parenting practices, and low burden of infectious disease
are parts of nutrition specific interventions
• Nutrition Sensitive Interventions: are interventions or program
that address the underlying determinants of fetal and child nutrition
and development. Food security, adequate caregiving, resource at the
maternal, household and community levels; and access to health
services and a safe and hygienic environment are incorporated in
nutrition sensitive goals and actions.
• Nutrition sensitive agriculture: nutrition-sensitive agriculture is a
food-based approach to agricultural development that puts
nutritionally rich foods, dietary diversity, and food fortification at the
heart of overcoming malnutrition and micronutrient deficiencies.
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1.2. Nutrients and their functions
 What are Nutrients?
• Nutrients are chemical substances obtained from food and used in

the body to provide energy, structural materials, and regulating
agents to support growth, maintenance, and repair of the body’s
tissues.
• Nutrients may also reduce the risks of some diseases.
• Examples: Carbohydrate, protein, vitamins, fats, minerals, water
etc.
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1.2. Nutrients and their functions…
 Classification of Nutrients:
• Based on the amount of nutrient our body needs for metabolism,
there are two types of nutrients: macronutrients and micronutrients.
• Macronutrients are nutrients required in a large amount and they
provide the bulk energy an organism’s metabolic system needs to
function. Ex. carbohydrate, protein and fats.
• Micronutrients are nutrients required in a small amount and provide
the necessary co-factors for metabolism to be carried out and include
vitamins and minerals. Micronutrients are very important for normal
growth and maintain health of human body.
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 In general, there are six types of nutrients based on function and

sources. These are:
1. Carbohydrate
2. Protein
3. Fats
4. Vitamins
5. Minerals
6. Water
• Let’s discuss each of these nutrients, their function and sources
one by one.
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 1.2.1. Carbohydrates
 Are what our boy burns most often for fuel like firewood.
 They are use in the body to provide the first source of energy
 Major sources are: cereals, grains, legumes, fruits, vegetables, etc.
 1.2.2. Proteins
 Are building blocks of the body tissue, also serve as fuel source.
 They build the walls of our body (hair, skin, muscles etc.) like
bricks build our home.
 Major sources are: meat, egg, poultry, milk, fish, legumes etc.
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 1.2.3. Fats
• Are like paraffin in our homes, stored in a small jug, and a little
fuel goes a long way; easily stored for later use.
• They are burned for energy give more fuel (twice as many
calories as protein and carbohydrate)
• They also help the body to absorb vitamins.
• Major source are: fish, butter, beef, egg, pork (meat of pig), milk,
avocado, nuts, soya beans etc.
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 1.2.4. Vitamins
• Are like watchdogs which protects us from thieves, while vitamins
protects us from diseases.
• They are required in small quantity in the diet, but they cannot be
synthesized by the body.
• Most common vitamins: Vitamin A, B, C, D, E and K
• Major sources are mostly fruits and vegetables.
• Based on solubility vitamins are classified into two as:
a) Fat-solub1e vitamins
b) Water Soluble vitamins
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 1.2.4. 1. Fat-soluble Vitamins:
• They are digested and absorbed with the help of fats in diet.
• They can be stored in the body for long periods. E.g. Vitamin A, D, E, and K
Vitamins Function Source

Vitamin A - Essential for normal growth, - Fruits: Mango, papaya, Jackfruit, dates etc.
reproduction, maintenance of health. - Veg: cabbage, lettuce, tomato, carrot etc.
- Prevent cold, influenza, night blindness - Butter, eggs, milk, liver of beef, pork,
- Deficiency: cessation of growth, night chicken and fishes
blindness, drying up of tear gland in - Orange flashed sweet potato (OFSP)
eyes, eruption of skin. - Yellow maize
Vitamin D - Helps calcium and phosphorus to form - Sunlight, all green leafy vegetables
straight, strong, bones and teeth. - Deficiency: rickets
Vitamin E - Anti-oxidant activities - Green vegetables, oils, cereals, meat, poultry,
- Promote generative function & fertility
eggs, wheat germ oil.
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Vitamin K - Reduce risk of bleeding/blood clotting - Green leafy vegetables
 1.2.4.2. Water-soluble Vitamins:
• They are water soluble and not stored in the body for long period,
thus, their sources should be eaten every day. E.g. Vitamin B &
C.
• Vitamin B (Vit B1 (Thiamine) and VitB2 (riboflavin) common
 Tones the nervous system, facilitate digestive track (vit B1)
 Sources: chills, fruits, lettuce, tomato, potato, cauliflower etc.
 Deficiency: Beri-beri, paralysis, loss of appetite, cataract etc.
• Vitamin C/Ascorbic acid/:
o It is essential for general health and health of teeth, gums and
blood vessels.
o It also helps the body to absorb iron.
o Major sources: citrus fruits, tomato, strawberry, pineapple
o Vitamin C deficiency results in scurvy (rheumatism).
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 1.2.5. Minerals
• Are nutrients such as iron, calcium, iodine, zinc, magnesium and
phosphorus that are important for normal body growth and health.
Mineral Function Source
Iron - Part of hemoglobin, a protein which - Hem-iron (highly bioavailable)
carries oxygen from our lungs - Animal products like red meat and liver
throughout our bodies. - Non Hem-iron (less bioavailable)
- Deficiency: anemia, pale limps - Plant products (pulses, cereals), carrot, apple
Iodine - Participate in regulation metabolic
rate, reproduction, growth, blood cell - Iodized salt
production, nerve and muscle function. - See foods, vegetables grown near the sea
Zinc - Cofactor for more than 100 enzymes.
- Stabilizes cell membrane, helping to
strengthen their defense against free - Meat
radicals
attacks.
- Assist in immune function and growth and
development
 1.2.6. water: needed for most body functions, including maintenance,

of health and integrity of every cell in the body.
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1.3. Food Groups and Their Sources
There are many food classification: 5, 6, & 10 (based nutritional needs)

FAO classify food into six groups:
1) Staple: food which are basic source of energy. Ex. Cereals, grains (sorghum, millet, maize,
barley, oats, wheat, teff, rice) and starchy roots (inset, cassava, sweet potato, potato).
2) Legumes and nuts: provide mainly protein, oils and fat. Ex. Beans, lentils, peas, chick pea,
ground nut, and soya bean.
3) Animal source foods: provide protein, fats, vitamins and minerals. Ex. Meat, poultry, egg,
fish, milk and its products
4) Vegetables: includes, green leafy, yellow and orange vegetables: cabbage, kale, onion,
tomato, carrot, cauliflower, egg plant, and mushrooms
– They provide mostly vitamins, minerals, and water
– They contains natural indigestible fibers that are necessary for proper digestion and healthy bowl
movement and prevent constipation
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1.3. Food Groups and Their Sources…
FAO classify food into six groups…

5) Fruits: includes citrus fruits (orange, lemons, mandarins), banana, papaya, mango,
avocado, pineapple, apple, guava, melons, grapes, peach, etc.
– Fruits provide mostly carbohydrates, vitamins, minerals and water.
6) Fats: includes fats and oils from plant and animal origin.
– Fats and oils from plants are oil seeds (soya bean, linseed, and ground nut)
– Fats provide additional energy, essential fatty acids and fat soluble vitamins.
Remember:
• There are foods unclassified in these food groups w/c are not desired for diet diversification.
• These are mainly processed foods such as biscuits, sweets, and alcohols
• They are refined or modified food, dense in nutrient, contains undesired nutrients like salt,
sugar, and fats in excess to enhance their flavor and taste.
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1.3. Food Groups and Their Sources…
• Most people with low income, consume one or two types of staple foods.
• Different food groups provide d/t nutritional and health benefits.
• Thus children and adolescents should consume diversified food, Eat diversely! 16
1.4. Food and Nutrition Security
 What is food security, nutrition security, their difference?
• Food security: refers the condition when all people, at all times,
have physical and economic access to
– sufficient, safe and nutritional food to meet their dietary needs
and food preferences for an active and healthy life.
• Nutrition Security: refers the condition when all people, at all
times, have ongoing access to:
– the basic elements of good nutrition, i.e., a balanced diet, safe
environment, clean water, and adequate health care
(preventive and curative), and the knowledge needed to care
for and ensure a healthy and active life for all household
members.
• The overlap between food and nutrition security is shown in
figure below
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1.4. Food and Nutrition Security…
• Food and Nutrition security: Food and nutrition security exists when all people at all times
have physical, social and economic access to food, which is consumed in sufficient quantity and
quality to meet their dietary needs and food preferences, and is supported by an environment of
adequate sanitation, health services and care, allowing for a healthy and active life.
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1.5. Malnutrition
1.5.1. Definition and basic concepts of malnutrition

• Malnutrition refers to abnormal nutrition condition, both under-
nutrition and over nutrition.
• Currently it is a public health problem for both developed and
developing countries.
• Majority of developed countries suffer from problems related
over-nutrition, developing countries suffers from the double
burden of under-nutrition and over-nutrition.
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1.5.1. Basic concepts of malnutrition..
• Malnutrition is currently the leading cause of child mortality.
• The global community is urging for prevention of under-nutrition

in children by focusing on the 1000 days nutrition interventions
– the period from pregnancy to the first two years of life.
• This period is called the’ window of opportunity’ because proper
nutrition during this period has the greatest effect on child health,
growth and development.
• If under-nutrition occurs during this period, the damage on child’s
physical and cognitive development will be irreversible.
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1.5.2. Causes of Malnutrition
 Malnutrition is not caused by a single factor.
The nutritional status of an individual, households, and the

community at large is determined by many different and
interconnected factors.
 UNICEF in 1990 identified malnutrition, children &women death
as the final outcome of a long sequence of interconnected factors.
These factors are classified at three levels of causes as:
a) Immediate Causes
b) Underlying Causes
c) Basic Causes
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1.5.2. Causes of Malnutrition…
a) Immediate Causes of Malnutrition
• Is due to inadequate dietary intake or infection of diseases, or both at the
same time.
b) Underlying Causes of Malnutrition
• The underlying causes for malnutrition are context-specific and
classified in to three interrelated groups as follows.
 Insufficient food availability and access
 inadequate care for children and mothers
 Insufficient health services and inadequate provision of a healthy
environment (e.g. clean water and sanitation).
c) Basic Causes of Malnutrition
 Economic, technological, political, cultural, and institutional
structures and processes, and the level of human development.
 The three categories of causes of malnutrition function synergistically with
each other and there are relationships at all levels b/n vertical and horizontal
causes (see figure 1.3)
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1.5.2. Causes of Malnutrition…
Fig 1.3. Framework for causes of malnutrition and their vertical and horizontal
relationships of the causes at different levels 23
1.5.3. Forms of Malnutrition
• In general there are four form of malnutrition. These are:
1) Under nutrition
2) Over-nutrition
3) Co-existence of under and over-nutrition: “double
burden of malnutrition”
4) Chronic and acute malnutrition
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1.5.3.1. Under nutrition
• Under nutrition is generally a form of malnutrition which are

arise due to inadequate intake of macronutrients and
micronutrients.
Under nutrition due to deficiency of macronutrient viz.

carbohydrate, proteins and fats
Known as protein-energy malnutrition (PEM).
Under nutrition due to deficiency of micro nutrients viz.

vitamins (A,B,C D, E, K) and minerals (iron, iodine, zinc etc.)
Known as Micro-Malnutrition (Hidden Hunger).
Let’s see these two forms of under nutrition one by one 25

1.5.3.1.1. Protein-Energy Malnutrition
 Protein-Energy Malnutrition (PEM) is currently the most

important nutritional problem in developing countries including
Ethiopia.
• It often results from consuming too little food, especially energy,
and is frequently aggravated by infections.
• The term protein energy malnutrition is used to describe both the
moderate and the sever forms of under-nutrition.
• Manifestation:
– Moderate PEM is manifested as poor physical growth in
children.
• This include: stunting, underweight, and wasting
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1.5.3.1.1. Protein-Energy Malnutrition (PEM)…
 Manifestations of moderate PEM and over weight (right)
1. Z-score 2. BMI categories

• Formula: z = (x – μ) / σ • Formula: BMI = weight (Kg)/(height (m))2
• Z-score : below -2 SD wasting; -3SD severe • BMI < 17.0 moderate severe thinness
• Z-score : below -2 SD stunting; -3SD severe • BMI < 18.5 indicates underweight
• Z-score: -1 to 0 Normal • BMI 18.5–24.9 indicates normal weight
• Z-score: =>+2SD overweight • BMI ≥ 25.0 indicates overweight
• Z-Score: => +3 Obesity • BMI ≥ 30.0 indicates obesity
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 Stunting:
• is a malnutrition condition reflected by inadequate linear growth of a

child; stunted children are too short for their age (Fig 1.4).
• Stunting develops over a long period of time as a result of inadequate
dietary intake, and repeated infections i.e. chronic malnutrition
• Stunting is an irreversible physical and cognitive damage, leads to
lower adult productivity and enormous long-term economic loss to
societies.
• Stunted children perform low at schools, sport activities and they are
less innovative and productive at adult stages.
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 Wasting:
• Wasting is reflection of current nutritional status and is measured using
the ratio of a child’s weight to height/length.
• Wasted children are too light for their height/length.
• It is caused by inadequate intake of total calories resulting in rapid
weight loss or failure to gain weight.
• Wasting can be reversed with improved diet and the treatment of
underlying illnesses.
• Wasted children should be identified and treated with nutritious foods at
the community level or at health facilities.
– If not treated on time these children will start to manifest clinical
sign and symptoms of marasmus, kwashiorkor or marasmic
kwashiorkor (Fig 1.5) and they may die.
 Underweight: low weight for their age. Children may become
underweight because of wasting or stunting or both.
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 Sever PEM: is manifested as nutritional marasmus (severe wasting) and

Kwashiorkor (petting oedema) and often lead to death of children (figure 1.5).
Figure 1.5. Manifestations of severe PEM (Marasmus and Kwashiorkor) 30

1.5.3.1.2. Micronutrient deficiency
• Micronutrient deficiency refers to deficiencies in one or more

essential vitamin or mineral, often caused by disease and/or
inadequate intake of micronutrient-rich foods such as fruit,
vegetables, animal products, and fortified foods.
• Micronutrient deficiencies increase the severity and risk of dying
from infectious disease.
• The deficiency of micronutrients is not usually visible, and termed as
“hidden hunger”.
• Deficiency of Iron, Iodine, vitamin A, and zinc are most important in
terms of prevalence and severity.
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1.5.3.1.2. Micronutrient deficiency…
 Vitamin A deficiency (VAD)
• Dietary deficiency of vitamin A most importantly affects the eyes,
and the body immunity (Fig 1.7)
• Vitamin A deficiency in children results risk of infection & death.
• Consumption of vitamin A bio-fortified foods such as
– orange-flashed sweet potato and maize, and vitamin A fortified oils,
are some of the solution for the problem.
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1.5.3.1.2. Micronutrient deficiency…
 Iron Deficiency
• Causes iron deficiency anemia (IDA) a disorder condition related
to red blood cells and shortage of oxygen for cellular respiration.
• This results from lack of sufficient consumption of high-iron
containing foods, such as animal products and legumes.
• The consequences of anemia for children include: increased
morbidity and mortality, stunting, retarded cognitive
development, reduced IQ, lower academic performance.
• Anemic pregnant women are at greater risk of giving birth to
underweight babies, preterm and stillbirths, and increased risk of
maternal mortality associated with bleeding during and after
birth.
• In adults, anemia is associated with weakness and fatigue, lower
productivity in agriculture and any other business.
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1.5.3.2. Micronutrient deficiency…
 Iodine deficiency
• Iodine deficiency in our body leads to enlargement of the thyroid
gland developing a disease condition called goiter (fig 1.6).
• Apart from goiter iodine deficiency causes severe consequences
related to child physical growth and intellectual development.
• Iodine deficiency is termed iodine deficiency disorders (IDD).
• Iodine deficiency during pregnancy may lead to cretinism and
mental retardation, which may be permanent in the child.
• Iodine deficient pregnant mothers will also be at greater risk of
spontaneous abortions and stillbirth.
• Iodine deficiency at early age of the child causes mental
retardation, and poor physiological and neurological development
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1.5.3.2. Micronutrient deficiency…
 Zinc deficiency
• Zinc deficiency is recently recognized as a public health problem.
• Available evidences show that it is most likely to be a serious
problem with diets poor in animal foods.
• Zinc deficiency will contribute for child growth retardations,
impaired immune function, increased child morbidity and
mortality from infectious diseases like diarrhea.
• Zinc deficiency also causes reduced appetite and may expose to
protein-energy malnutrition
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1.5.3.2. Over-Nutrition
1.5.3.2. Over-nutrition is another form malnutrition which is chx’d by
• Too fat for height and age; overweight and obesity
• Health consequences (diabetes, cardiovascular diseases)
1.5.3.3. Double burden of malnutrition:
• Is chx’d by co-existence of under nutrition along with overweight, o besity
within individuals, households, and populations, across the life-course
• Ex. Obesity with nutritional anemia or vitamin or mineral deficiency at individual
1.5.3.4. Chronic and acute malnutrition
• From the perspective of developing countries, malnutrition results
from inadequate intake of nutrients and/or from disease factors.
• Protein energy malnutrition, iron deficiency anemia, vitamin A and
iodine deficiency disorders are the most common forms of
malnutrition.
• Both protein energy malnutrition and micronutrient deficiency can
have serious negative consequences for physical and mental health.
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1.5.4. Status of Malnutrition in Ethiopia
 Under-nutrition is a major public health problem in Ethiopia.
– 38% of children under age 5 are stunted; 10% are wasted; 24% are underweight,
and 1% are overweight (heavy for their height).
• The feeding practices of only 7% of children in Ethiopia age 6-23
months meet the minimum standards with respect to all three infant and
young child feeding (IYCF) practices:
– breastfeeding status,
– number of food groups, and
– times they were fed during the day or night before the survey.
• Regarding the maternal nutrition, 22% of women age 15-49 are thin
(with BMI less than 18.5), while 8% are overweight or obese
– BMI: body mass index, is a person’s weight in Kg divided by his/her
height in meters squared. The national institutes of health (NIH) now
defines normal weight, overweight and obesity according to BMI
– BMI categories: Underweight: =< 18.5, Normal weight: 18.5 – 24.9
Over weight: 25-29; Obesity: BMI of 30 or more
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1.5.4. Status of Malnutrition in Ethiopia…
Figure 1.8. Trend of malnutrition among children in Ethiopia (EDHS, 2016)

EDHS: stands for Ethiopian Demographic and Health Survey 38
1.5.5. Impacts of Malnutrition
 The major impacts of Malnutrition are:

1) Susceptibility to mortality (death)
2) Susceptibility to acute morbidity (disease)
Ex. Diarrhea, respiratory infection
3) Poor cognitive dvt (school performance)

4) Decreased economic productivity
5) Susceptibility to chronic diseases in later life
Figure 1.9. Over all impacts of
Ex. Poor foetal growth = stroke, heart disease, diabetes II malnutrition
 These impacts can be reflected at individual, household & community level.
 Children and mothers usually suffer the most because many nutrients are critical for
normal growth and development.
 Malnutrition in pregnant mothers causes intra-uterine growth retardation of the fetus
leading to low weight at birth and lower chance of survival.
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1.6. Nutrition Intervention Strategies to combat Malnutrition
• Are strategies designed to change nutrient intake, nutrition-related

knowledge, environmental conditions.
• There is no single bullet proof nutrition strategy that can meet the
goal of achieving optimum nutrition for all.
• So, different strategic intervention approaches need based on context
for improvement of nutrition out-come of the population.
• Both nutrition specific and sensitive approaches need to be used to
effectively address the problem of malnutrition.
• In this section, core intervention areas both for nutrition specific and
sensitive approaches will be discussed.
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1.6.1. Life cycle approach to nutrition
• These refers investing in nutrition throughout the life cycle.

• Life cycle of human being originates from a fertilized egg, which develops into a
fetus that eventually born as a baby that develops into a child, w/c transit through
adolescence phase and become an adult.
• Egg >>> Fetus >>> baby >>> child >>> adolescence >>>> adult
• Maximum benefit of one age group come from investment in the earlier stage group
(there is a cumulative effect in next generation).
• Therefore, one of the nutrition intervention strategy to combat malnutrition applying
nutrition specific intervention at the critical stages in the human life cycle which
includes:
a) Pre-conception nutrition
b) Window of opportunity (1000 days)
c) Adolescent nutrition
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1.6.1. Life cycle approach to nutrition…
Figure 1.10. Diagram depicting nutrition throughout the lifecycle

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1.6.1. Life cycle approach to nutrition ….
a) Pre-conception nutrition
• Refers to ensuring diversified diet every day to ensure adequate nutrient
intake for every population particularly for a women planning to be
pregnant. Why???
– Human reproduction is the result of a superb orchestration of complex and
interrelated genetic, biological, environmental and behavioral processes.
– Given favorable states of health, these processes occur smoothly in
females and males and set the stage for successful reproduction.
– However, less than optimal states of health, brought about by conditions
such as acute under-nutrition or high levels of alcohol intake, can disrupt
these finely tuned processes and diminish reproductive capacity.
• Thus, women planning to be pregnant needs to take care of:
– Achieve healthy body weight (critical)
– use of iodine fortified salt,
– consume diversified diet (at least 5 food group),
– take folic acid, stop smoking, and drinking alcohol
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b) Window of opportunity
• Providing optimal nutrition for mother and child during the window of
opportunity i.e. the 1000 days b/n pregnancy and a child’s 2nd birth day.
• This period is critical time for positive impact on a child’s cognitive and
physical development.
• So, during pregnancy and lactation provide
– Iron /folic acid supplementation; Treatment and prevention of malaria,
– Increase food intake (one & two extra meal each day during pregnancy and lactation
respectively)
– De-worming during pregnancy,
– vitamin A supplementation with 45 days of delivery
• Then promote and support optimal infant and young child feeding (IYCF)
– Immediate initiation of breastfeeding (within one hour of delivery
– Exclusive of breastfeeding for the 1 st 6 months (no other food than breast milk)
– Complementary feeding (at lest 4 food group) from 6 months-2 year (increase quantity,
number of feeding with age, insure water, sanitation and hygine practices
– Adequate care and feeding of sick children, frequent breast and complementary feeding
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b) Window of opportunity
45
c) Adolescent nutrition
• Total nutrient needs are higher during adolescence than any other stage in
life cycle.
• Failure to consume and adequate diet at this time can result in delayed
sexual maturation and arrest linear growth.
• The following are key activities, which are important to improve
adolescent nutrition:
– Ensure consumption diverse diet from different group
– Integrate adolescent nutrition service into youth center
– Regular monitoring of the nutritional status of school-age children
– Improving access to school based biannual de-worming
– Improving access to biannual deworming for out of school adolescents
– Ensuring access to iron folic acid supplementation for adolescent girl at school
• Chronically malnourished girls are more likely to remain undernourished during
adolescence and adulthood, and when pregnant, are more likely to deliver low-
birth-weight babies
– Delay first pregnancy
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1.6.2. Nutrition sensitive Agriculture approach
• The 2nd type of intervention program to combat malnutrition is
applying nutrition sensitive agriculture approach.
• Nutrition sensitive agriculture works in three main ways:
– Making food more available and accessible (this means increasing
food production)
– Making food more diverse and production more sustainable
• increasing diversity in food production and making it
sustainable through conservation of agriculture, water mgt and
IPM without depleting natural resource.
• Family farming, home garden, homestead food production
– Making food itself more nutritious (e.g. food fortification)
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1.6.2. Nutrition sensitive Agriculture approach…
 In order to implement intervention of NSA in Ethiopia, the national
nutrition sensitive agriculture strategy (NNSAS) adopted six strategic
objectives:
1. To leverage nutrition into agriculture and livestock sector policies,
strategies, and work plans at all levels
2. To establish/strengthen institutional and organizational structures and
capacity responsible for implementing nutrition sensitive agriculture
3. Increase year-round availability, access and consumption of diverse, safe
and nutritious foods
4. Enhance resilience of vulnerable agrarian, agro-pastoral and pastoral
communities and households prone to climate change and moisture
stress
5. Ensure women and youth empowerment and gender equality
6. establish/strengthen strong multi-sectorial coordination within
agriculture sectors and with signatories of NNP and other development
partners
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1.6.3. Caring practices
• Care practice specifically focuses on the care given to mothers and
children for improved nutritional outcome.
• In the UNICEF conceptual framework, inadequate care and feeding
practice is depicted as an underlying cause for malnutrition.
• Caring practices such as breastfeeding, appropriate complementary
feeding, as well as hygiene and health seeking behaviors support good
nutrition.
• These practices can be severely disrupted in various conditions like during
high burden of work on the mother which could limit the time that she
needs to spend caring for herself and her baby.
• This condition could result in poor dietary intake and increased infection,
both of which are immediate causes of under-nutrition.
• In order to tackle this problem, involvement of other family members
mainly the husband has to be promoted in the caring as well as
participation on other daily household activates specially during times of
pregnancy and lactation of the mother.
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1.6.4. Water, sanitation and hygiene (WASH)
 Worldview:
– In 2014, an estimated 159 million children under five years of age were
stunted, and 50 million were wasted around the world.
– Based on WHO 2015 report 2.4 billion individuals lack access to sanitation
and 663 million lack accesses to a protected water source. So, what??
• These WASH interventions include use of:
– improved water supply,
– safe household water management treatment and storage,
– improved household toilets or latrines, and
– Hand washing with soap.
• Keeping food safe through safe handling, preparation and storage and
prevention of contamination is among the important measures which
need to be addressed all the time.
• In Ethiopia WASH is one of the major areas of intervention for improved
health and nutritional status.
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Ch#2: Diversified Food Production and Consumption
2.1. Definition and concepts of diversified food production
• Diversified food production is the practice of producing a variety
of crops or animals, or both, on one farm.
• The precondition for good nutrition is that a diversity of foods is
available and affordable for all individuals at all times.
• However, currently, the global food system is not meeting this
requirements due to:
– excessive intensification i.e. monoculture.
– Extremely reliance of the poor on only one or two types of staple.
• In Ethiopia, the trends of diversified food production and
consumption is not common; thus there are d/t forms malnutrition
• So, as agriculture experts, we need engage ourselves in promotion
and consumption of diversified food both at urban and rural areas
51
2.2. Importance of Diversified Food Production
• Used as the basic element of food security and dietary diversity.
• Creates opportunity for children and pregnant mother with better
food item preferences which will increase daily food consumption
• More over, diversified food crop production can offer support for
multiple pathways to nutrition, including
 Food access and dietary diversification
 Natural resource management
 Productivity enhancement
 Reduce seasonality and risk (e.g. from mono crop failure due to
biotic or abiotic stresses, price shocks)
 Improved income streams and reduced cost of a nutritious diet
 Adaptation to climate changes
 Women’s empowerment.
52
2.3. Dietary Diversification Strategies
• Is an approach that aims to enhance availability, access and

utilization of foods with high micronutrients throughout the year.
• It involves changes in food production practices, food selection
patterns and method of preparing & processing indigenous foods.
• The different dietary diversification interventions are grouped into
three main strategies as:
1. Producing variety and nutritious agricultural foods,
2. Reducing postharvest loss and improve postharvest processing and
3. Designing nutrition behavior change communication.
53
2.3.1. Producing variety and Nutritious agricultural foods
• Variety and nutritious agricultural foods production interventions

include the following key elements:
1. Promoting home gardening
2. Increasing production and consumption of green-legumes
3. Promoting production and mixed consumption of staple crops
4. Increasing production and consumption of locally available
nutrient-rich underutilized foods
5. Promoting production and utilization of animal-source foods
6. Promoting use of bio-fortified crops
54
2.3.1.1. Promoting home gardening
• Home garden is a small plot/area of land around the home,
– managed by household members (particularly women),
– where a variety of crops such as vegetables, fruits, legumes,
tubers etc. are grown throughout the year and
– often small livestock and fish are also raised.
• Home gardening is important to:
– improves the nutrition of households through increasing
availability, accessibility, and consumption of variety of foods,
– improves micronutrient and food fiber intakes.
– helps to reduce seasonality through year round production using
minimal resources.
• Thus, promotion and scaling up of home gardening crucial through
– assisting growers to have an easy access to improved seeds
– Water harvesting technologies and pest control
55
2.3.2. Increase production and consumption of green legumes
• Legumes are rich sources of proteins, iron zinc and dietary fiber as
equivalent to animal source foods vz. meat, fish and poultry
• Using legumes is a cost effective way to complement the protein
profile of cereal-based staple foods such as rice and maize.
• Mechanism to incorporate legumes in the local diet include:
– increasing awareness via extension service,
– nutrition education on complementary cereal-legume protein
– promoting intercropping methods of production.
• Legumes fix nitrogen into the soil as they grow, replace nutrient lost
during staple crop production and improve soil fertility.
• Legumes are ideal intercropping plants with cereals such as maize,
sorghum, and millet as well as some vegetables.
• So, one of the strategies to dietary diversification is increasing
production and consumption of legumes.
56
2.3.3. Promoting production and mixed consumption
• Staple food crops are necessary for energy intake; income
generation and intervention of food and nutrition security.
• However, relying merely on cereals based-staples is can result in
– Micronutrient deficiency because of their limited ability to
provide dietary diversity and also their anti-nutrient effects
(phytates) that reduce iron and zinc absorption
• Hence appropriate production and mixed consumption of staple
foods is vital for cereals based production areas of Ethiopia.
• For example,
– Corn can be consumed with another staple such as wheat or
with pulse to improve protein status.
– Staple such as rice can also be consumed mixed with different
vegetables to minimize effects of phytates.
57
2.3.1.4. Increasing production and consumption of locally
available nutrient-rich underutilized foods
• Traditional and underutilized indigenous foods crops are often

cheap nutritious food resources.
– They are important in the diet of poor households for food and
nutrition security.
– They have usually superior response against local stress
– In most case their production systems did not require use
intensive mangt. practices; they fit with poor households.
– They are environmentally friendly and easily produced;
– help to achieve good household diet diversity and improved
nutritional status.
• However, traditional nutrient rich foods are usually neglected
because they have low market price; replaced by cash crops
• Promotion, nutrition education, behavior change communication,
creating awareness regarding these crops is important
58
2.3.1.5. Promoting Production and Utilization of Animal
Source Foods
• Foods products obtained from different animal source are

important sources of proteins, fats, minerals and vitamins.
• They are important to increase energy density and micronutrient
absorption and bioavailability.
• They are important components of child and maternal nutrition.
• Animal source foods should make up the substantial proportion of
child and maternal meals.
• The development and extension agent are expected to promote
animal source foods production and utilization through:
– Promoting production of small livestock and fish,
– Improve poultry species,
– Training on livestock management and
– Improving veterinary services.
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2.3.1.6. Promoting use of fortified foods
• Is foods to w/c nutrients (not found in the food ) are added
• Staple produced and consumed by majority of rural communities
are deficient of one or more of the essential micronutrients.
• Fortified foods are important means of improving micronutrient
deficiencies for low income staple food-dependent community.
• Fortification of staple is cost effective and sustainable strategies
of micronutrient deficiencies prevention in a wider community.
• Here are examples of fortified foods
– Grain products with folic acid
– Milk fortified with vitamin D
– Golden Rice and Orange Fleshed Sweet Potato + Vitamin A
– Sweet corn is a corn bio-fortified for a protein.
– Currently there also iron fortified staples such as wheat.
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2.3.2. Reducing postharvest loss and improve processing
• Postharvest loss refers any degradation in both quality and quantity

of a food product from harvest to consumption.
• Roughly, 1/3 (aprox.1.3 billion tones/year) of food produced for
consumption is lost or wasted globally (FAO, 2017).
• So, not only increasing food production, which is constraining with
changing climate, limited land and resource, but also
– reduction of the losses of already produced food is critical
component of ensuring the food and nutritional security.
– Besides processing of produces to products which involves:
• 1° processing (dicing, slicing, freezing, drying)
• 2° processing (mincing, macerating, liquefaction)
• Cooking (boiling, broiling, grilling or frying)
• Pickling, pasteurization, canning etc. are important to reduce loss
• By doing so, availability, accessibility and consumption diversified
food could be achieved.
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2.3.3. Designing nutrition behavior change communication
• The third approach used to ensure dietary diversification is

designing nutrition behavior change communication (NBCC).
• In different societies and culture there are different locally
available, nutrient rich, under utilized foods.
• Nutrition education and behavior change communications
programs including cooking demonstration of these foods.
– will help to increase acceptance, production and utilization of
these groups of foods.
• Nutrition behavior change communication involves the steps:
– Understanding the context and audience-situation
– Focusing and designing the strategy/approach
– Creating activities, materials, tools
– Implementing and monitoring progress
– Evaluation and re-planning.
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2.4. Nutrient enrichment/modification strategies
• Apart from consumption of diversified foods(variety productions)
• There are also d/t methods by w/c a household can enhance or
enrich nutrient content present in foods consumed by the family.
• These are:
– Combination,
– Fermentation,
– Germination,
– Fortification and
– Food supplements.
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2.4.1. Combination
• Combination is the process of combining cheaper and commonly
available foods (mostly at preparation) from different groups to
improve the quality of nutrients.
• These method, of course demands diversified food production,
access and affordable
• Good food combinations
– Protein + non-starchy vegetables or sea vegetables
– Starchy vegetables + non-starchy vegetables or sea vegetables
– Protein fats (nuts and seeds) + acid fruits
– Protein fats + non-starchy vegetables or sea vegetables
– Protein fats + sea vegetables
– Protein + fats or oils
– Leafy greens – anything
• What is benefit of food combination?
• Is it possible to combine any types food group together?
64
2.4.2. Fermentation
• Is a natural process through which micro-organism like yeast and
bacterial converts starch and sugars into alcohol or acids
• The alcohol or acids acts as natural preservative and give
fermented food with distinct test and tartness
• They change nutrients already present in the foods into simpler
and better forms or make other new nutrients
• Fermentation makes the dough rise and become almost double in
quantity.
• During fermentation the micro-organisms use up some of the
nutrients present in the dough and change them into other better
quality nutrients
• Milk, curd, bread, injera etc. are all examples of fermented foods
65
2.4.3. Germination
• Germination is a process in which small shoots come out of the pulse
or cereals when these are kept with small amount of water.
• Germination/sprouting helps to:
1. Increased digestibility of foods:
 some carbohydrates and proteins are broken down into smaller
and easily digestible forms.
 Grains and pulses become soft after sprouting, so they take
less time for cooking and are easy for you to digest.
2. Increase the nutritive value of food with no additional cost.
 Some vitamins and minerals become more when foods are
germinated
 Vitamin B become almost double in quantity while vitamin C
increases almost 10 times.
 When sprouting is followed by fermentation the vitamin content
becomes more improved.
66
2.4.4. Food Fortification
• Food fortification is the practice of deliberately increasing the
content of an essential micronutrients in a food.
• This can be done during the processing or at the point of use
• Why food fortification?
• Food fortification can help to tackle micronutrient deficiencies
through increasing the micronutrient content of staples.
• Types of food fortifications: there are 4 types food fortification:
a) Mass or universal fortification of basic staples or condiments (with folic
acid fortified wheat flours, vitamin A fortified cooking oil, iodized salt).
b) Community fortification of locally available staples (e.g. small scale grain
fortification using village mills).
c) Point-of-use fortification (e.g. sprinkles, micronutrients powders on food)
d) Production of fortified food products (e.g. complementary foods for
children 6-23 months, snacks)
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2.4.5. Bio-fortification
• Bio-fortification is the process of enriching live crops with the
desired micronutrient either through breeding or biotechnology.
• Bio-fortification can increase the macronutrient and micronutrient
content of foods
• Bio-fortification technology primarily targets staple foods which are
accessible to majority of population groups.
• The currently targeted nutrients are zinc, vitamin A, and protein
• Here are the examples of bio-fortified crops in Ethiopia:
– Orange fleshed sweet potato (Vitamin A rich) and
– Quality protein maize (protein rich)
– Iron rich beans is being tested in research centers in Ethiopia.
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2.4.5. Bio-fortification…
• Method of bio-fortification
• Bio-fortification is a complex process involving multiple stages.
i. Discovery: includes identifying target populations, setting and
validating nutritional breeding targets, identifying appropriate
candidate crops, screening crop genes.
ii. Development: includes breeding new locally adapted varieties
that have higher amounts of bioavailable micronutrients than
conventional varieties and agronomic traits which match or exceed
conventional varieties.
iii. Delivery: includes the registration of new varieties and releases to
seed companies or directly to producers. It often includes
leveraging the informal seed sector, as a vast majority of poor
farmers acquire inputs through these systems.
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2.4.6. Agronomic bio-fortification
• Agronomic bio-fortification refers the application of mineral
micronutrient fertilizers to soil or plant leaves to increase
micronutrient contents in edible part parts of crops.
• Soil and foliar application of micronutrient fertilizer can be used
for several different mineral micronutrient to varying
effectiveness
• Agronomic bio-fortification, especially in the case of foliar
application is highly effective for zinc and selenium, while also
effective for iodine and cobalt.
• As an effective strategies for reducing micronutrient deficiency,
zinc provide one of the best and quickest avenues for agronomic
bio-fortification particularly with cereals crops
70
2.4.6. Agronomic bio-fortification…
Application of micronutrients-containing mineral fertilizers to the soil and or plant leaves

71
• Success of agronomic bio-fortification to alleviate micronutrient

deficiencies depend on nutrient bioavailability at different stages:
– Soil to crop: the presence and bioavailability of soil nutrient for
plant uptake,
– Crop to Food: nutrient allocation within the plant and re-
translocation into the harvested food.
– Food to human: bioavailability of nutrients in prepared food
for humans and the physiological state of the human body which
determine the availability to absorb and utilize the nutrients.
72
Schematic overview of micronutrient (MN) pathway from soil to

humans and the factors influence MN bioavailability.
73
• Good soil condition that enhance micronutrient availability for

crop uptake are essential for the success of agronomic bio-
fortification.
• A commonly suggested strategies to optimize soil condition is
Integrated Soil Fertility Management which is defined as:
– a set of soil fertility management practices that necessarily
includes the use of mineral fertilizer, organic inputs, and
improved germplasm
74
2.5. Agriculture Nutrition Impact pathways
• Globally, millions of people suffer from poor nutrition.
– In some parts of the world, the poor have inadequate access to
energy from food to meet their energy requirements.
– In these locations, food shortage is often a seasonal phenomenon
and micronutrients are also generally lacking in the diet.
– Elsewhere, there is a stable supply of energy but the poor have
monotonous diets lacking in essential micronutrients.
– In other places, nutrition transition is under-way in w/c the
poor & other consumers enjoy sufficient access to energy and
– indeed often consume excessive amounts but the quality of
their diets is unhealthy owing to a combination of factors
relating to nutrition and lifestyle.
• Malnutrition remains an urgent global public health concern.
75
2.5. Agriculture Nutrition Impact pathways…
• Yet, the question of how agriculture can mostly effectively
contribute to improved nutrition outcomes remains unanswered.
• It is therefore, time to revisit what is known and what can be done
to improve the linkage between agriculture and nutrition.
• So as to minimize the impact of malnutrition there must be strong
relationship between agriculture and nutrition.
• The agriculture and nutrition linkage pathway of food production
with food consumption and human nutrition can be successfully
considered in terms of three pathways.
– Food production and consumption pathways
– Income-oriented production for sale in markets
– Empowerment of women pathway
76
2.5. Agriculture-Nutrition Impact Pathways…
Diagram of agriculture to nutrition impact pathways 77

2.5.1. Food Production Pathway
• Production of food for home consumption is the most

fundamental and direct pathway.
• by which increased production translates into greatest food
availability and food security.
• The principal purpose of producing food to meet the household's
own food requirements.
78
2.5.2. Agricultural Income Pathway
• Also called income-oriented production for sale in market
• Increases in income can in turn translate into improvements in

household nutrition security and food consumption.
• Staple food producers, for instance, may use the income earned
from the sale of their produce to buy fruits, vegetables, meat and
fish and their households may consume these as substitutes for
some proportion of the staples they consume.
• The extent of the nutritional benefits relies on the nutrient content
of the higher-value substitute food.
79
2.5.3. Women Empowerment Pathway
• The agricultural interventions that increase women’s income and
• their control over resource
– can dramatically increase the potential for positive child

nutrition outcomes and health outcomes.
• Thus, the incorporation of a gender equity dimension in

agriculture programs and the consideration of women’s multiple
roles and constraints must be addressed for agricultural programs
to achieve positive nutrition impacts
80
Ch#3: Basic Principles &Techniques of Safe Handling of Products
3.1. Definition of terms related to Food Safety

• Food Safety is a scientific discipline describing handling,
preparation & food storage in way that prevent foodborne illness.
• Foodborne illness: sickness or injury caused by eating food
containing hazards (pathogens) or foreign materials
• Food hygiene: all measures necessary to guarantee the safety of
food at all stages of the food chain:
– From a process on the farm to practices in the kitchen
– Farm to fork
81
3.1. Definition of terms related to food safety…
• Good Agriculture practices (GAP): refers to production of safe

agricultural products through integrated mgt. and best practices
• Good manufacturing practices (GMP): general procedures to
reduce food safety hazards for manufacture and sale of food.
• Hygiene: condition and practices followed to maintain health
including sanitation and personal cleanliness.
• Good Hygienic Practices (GHP): the basic rules for the clean
and healthy handling, storing, processing, distribution and final
preparation of all food along the production chain.
82
3.2. Basic concept of food safety and its importance
 Impact of unsafe food: Overview

• Unsafe food cause >200 diseases ranging from diarrhea to cancers
• Approx. 600 million people in the world (almost 1 in 10) fall ill after
eating contaminated food and from these, about 420,000 die per year
• The impact is more severe on children (aprox.125,000 die/year)
• Food born disease impede socioeconomic dev’t by straining health care
system and harming national economies, tourism and trade.
• Our people are highly exposed to risk of food contamination. So???
• Hence, in this chapter students will get acquainted with food safety
hazards, their sources of contamination, health risks and mgt options.
83
3.3. Food Safety Hazards and Health Risks
• A food safety hazard, in simple term is something that could

cause harm to the consumers.
• Assessing the potential hazards is necessary to reduce risks of
unsafe food and increase produce safety
• Generally, there are three categories of hazards that associated
with all food, including fresh produce. These are:
1. Biological hazards
2. Chemical hazards and
3. Physical hazards
84
3.3.1. Biological Hazards
• Biological hazards are hazards caused by:

 Invisible (micro-organism): bacteria, yeast, viruses, protozoa, mold
 Macro-organisms (visible to naked eyes): flies, worms,

cockroach, weevils, caterpillars and others
• The major biological hazards w/c are responsible for a large

proportion of food poising incidents are:
a) Food-borne pathogenic bacteria,
b) viruses,
c) parasitic protozoan and parasitic worms
85
3.3.1. Biological Hazards …
A. Bacteria: may cause illness in human either by infection or intoxication

• Bacteria is the major biological hazard causing food poisoning
 Most common food poisoning  Health risk of food poisoned by

pathogenic bacteria are: bacteria/ symptoms:
 Salmonella species  Headache
 Escherica coli 0157:H7,  Muscle pain
 Lysteria monocytogenes,  Nausea (sickness of stomach)
 Clostridium perfringen  Fatigue (extreme tiredness)
 Clostridium botulinum  Chills or fever
 Staphylococcus aureus  Stomach or abdominal pain
 Campylobacter jejeuni  Vomiting and diarrhea
• Bacteria poison mostly animal origin foods (meat, egg, milk etc.), fruits,
and vegetables with their products, low acid canned food, and water
• Infants and elders are highly vulnerable to food poisoned by bacteria
86
B. Viruses: like bacteria, viruses are also the major biological hazard
w/c can result food poisoning.
• The most common viruses known to be food safety hazards are:
– The Hepatitis A and E viruses (cause inflammation of liver),
– The Norwalk group of viruses (cause acute gastroenteritis) and
– Rotavirus (viruses causing gastroenteritis in infants)
• These viruses can cause fever, abdominal discomfort, followed by

jaundice (yellowing of skin or the white of eye ), nausea (sickness
of stomach), vomiting, diarrhea and headache.
87
C. Parasites worm and Protozoa:

• Several human parasites can be transmitted by foods.
• The most common parasites include:
• Parasitic protozoan species • Parasitic worms

• Entamoeba histolytica • Ascaris lumbricoides
• Giardia lambia • Taenia solium
• Cryptosporidium parvum • Trichinella spiralis
88
3.3.2. Chemical Hazards
• There are many compounds that cause harm to people if inhaled,
ingested or by contact with skin, eyes or mucous membranes.
 Common chemical hazards are:  Common health risks are:

• Naturally occurring toxins • Allergen in peanut cause allergies,
• Pesticides, • Mycotoxins (mushroom toxin),
• Rodenticides phytohemoglutinin: toxic effect
• Antibiotics, Animal drugs • Chronic, low level exposure to
• Cleaning residues various chemicals may result
• Food additives, Allergens adverse health outcomes:
• Industrial toxic chemical* • Nervous damage, impairment of
• Heavy metals* reproductive function and
• Mycotoxins* (aflatoxin) development, cancer etc.
89
3.3.3. Physical Hazards
• Physical hazards are foreign objects or extraneous materials
• that inadvertently get into a food and could cause harm to
someone eating that food.
 Common physical hazards are:  Common health risks are:
• Dirt, Jewelry • Digestive tract
• Piece of metal • Respiratory tract
• Piece of wood • Mouth,
• Piece of plastic • Teeth and
• Broken glasses) • Extremities (especially hand)
90
3.4. Sources of food contaminants
• In order to reduce risk of food safety hazards,

– Assessment or identification of potential hazards in production and
– Potential source of produce contamination is paramount important
• Once, the potential sources of produce contamination or hazards

are identified, it will be easy
– to control,
– reduce or
– eliminate them.
91
3.4. Sources of food contaminants…
 Accordingly, the major contamination sources are:

 Contaminated land (soil) by pathogenic or toxic chemicals
 Poor quality water (used during irrigation, cooling, washing (processing)

 Untreated or improperly treated organic fertilizers and inorganic
fertilizer contains heavy metals
 Animals (including domestic ones) harbors biological hazards
 Improperly kept worker’s health and hygiene

 Poor sanitation (from the field production to consumption)
 Use of inappropriate, unclean equipment and tools in food production

chain
92
 Soil or agricultural land used

 Soil can be contaminated by pathogenic or toxic chemicals,
 So, studying the prior use of land i.e.

 What the land intended to be used has being used for
previously, is important to identify potential hazards.
93
 Water
• Water is a carrier or living environment for a number of pathogenic
micro-organism that can pose greatest threats to food safety.
 Poor quality water can be direct source of contamination or vehicle for
spreading contamination in the field and processing chain.
 Severity of hazards resulting from poor water quality depends on:
 the type and amount of microorganism in water,
 their capacity to reproduce and survive on the produce,
 the degree of contact b/n water and produce and
 characteristic of the produce itself
94
 Fertilizers
• Untreated, and/ or improperly treated organic fertilizers derived from
plant material, animal manure or human organic waste, pose multiple
risks for contamination of fresh produce.
• Inorganic fertilizers may also contain heavy metals as by-product that
– can negatively affect soil fecundity and

– result in long-term accumulation, eventually also leading to
uptake by plants.
95
 Animals and pests
• All animals including domestic ones, can be considered as vehicle

for contamination, can pose a biological threat to fresh produce.
• They should therefore be excluded from access to crop fields and
kept away from postharvest processing and packing areas
• The main source of contamination by animals are feces matter
containing pathogenic microbes as well as
– Pathogenic microorganisms that can be harbored by animal skin,
fur and feather.
96
 Workers health and hygiene
• The key element in food safety are :

– Ensuring good and stable worker’s health
– Following proper hygienic procedures in all food chain
• This will result in, a long term, sustainable and successful operation
• However, if the worker’s health is not kept well, and if the hygienic
procedures are not followed, it will probably result in
– Reduction of the operation/production
– Pose contamination to soil, crops, and workers themselves,
– which reduces the food safety.

97
 Field and harvest sanitation
• The issue of safety starts from site selection (for production) and goes to
consumption (field- fork)
• In all stages food chain sanitation is very important
• We have to care of the field, b/se if the field is infested it could affect
quality of produce at end of harvesting
• Use of clean water in dump tanks and hydro-coolers, as a mixing agent for
post-harvest treatments with waxes or fungicides or simply as a washing
and rinsing agent.
• Maintaining safe, high quality produce with an adequate shelf life depends
on both the pre-harvest and postharvest factors
98
 Equipment and tools

• Inappropriate equipment and tools has a direct impact on the nutritional
quality of the produce.
• The material that used for harvesting, packaging, transporting,
transportation and consumption should be free from any contaminants.
• Thus for all agricultural products the equipment and tools have to be
sterilized before and after every usage to minimize contamination.
99
3.5. Food Safety and Nutrition Linkage
• Access to safe and adequate food is a basic human needs.

• Food safety is the assurance that food not to cause harm users.
• Food can be unsafe at different points from farm to plate: production,
distribution, retail/sale, preparation and consumption.
• Unsafe food is not food because contaminated food could cause disease,
immune suppression and stunting.
• If food (produce) is contaminated on field
– the quantum of food is reduced and this will affect
– income and market accessibility of household or community,

– Food accessibility and
– Weill being of household and society at large.
100
3.5. Food Safety and Nutrition Linkage…
• Food safety, nutrition and food security are inseparably linked
• Food safety affects food security pillars:
• If food is contaminated, it reduces the food availability and food
utilization. This will affect food security.
Food safety and food nutrition security linkage

101
3.5. Food Safety and Nutrition Linkage…
• Food safety also related with malnutrition which can indirectly
affect the nutrition. How?
• Unsafe food results illness (foodborne and waterborne disease)
• This reduce food intake interest, loss of productivity, death etc.
• The viscous cycle of disease and malnutrition, particularly
affecting most vulnerable groups affects productivity
Diarrhea malnutrition cycle

102
3.6. Nutrition Sensitive Postharvest Handling
• The postharvest or postproduction operation of agricultural and

horticultural products include a wide range of functions between
production and consumption
• These functions have to be carried out efficiently by different
agencies/individuals in the postharvest chain
– in order to supply food of good quality to keep transaction
costs low and
– to deliver high quality and safe raw materials for further
processing and value addition.
103
3.7. Food Safety Standards
• Currently food safety is the major global public health concern
• Many countries have set regulations and standardization to reduce

risk of unsafe food consumption. Ex: Ethiopian Standard Agency
• There are also international organizations those deals with
regulation, accreditation and certification of food.
• Example: ISO9001 (drink), Iso2200 (food) etc.
• The main role these organization is to check weather the
produced food is produced following the safe way or not.
104
3.7. Food Safety Standards…
• Normally, the regulation or evaluation is based on the food safety

standard set.
• There are different food safety standards which based on the type of
product. The most common safety standards are:
– Good agricultural Practices (GAP)
– Good Manufacturing Practices (GMP) and
– Good hygiene Practices (GHP) with
– Hazard Analysis and Critical Control Point (HACCP)
• These safety standards helpful for producers, traders, processors, and

anyone who wanted to present safe and healthy food.
105
3.7.1. Good Agricultural Practices
• Good Agricultural Practices (GAP) are practices that address

environmental, economic and social sustainability for on-farm processes
and result in safe and quality food agricultural products.
• In simple language, GAP stands on four pillars
– economic viability, (safe food)
– environmental sustainability, Security for the people
– social acceptability and (security for environment)
– food safety and quality. (animal welfare)
• The concept of GAP evolved recently as a result of the big concern about
food safety and quality, and the environmental sustainability of agriculture.
106
3.7.1. Good Agricultural Practices…
Figure 3.4. Four pillars of good agricultural practices

107
3.7.1. Good Agricultural Practices…
• GAP focuses on the best practices to be used for producing
agricultural products to ensure the quality and safety of the final
product.
• GAP is guidelines, which ensure that all agricultural practices, in
particular pest and disease control are in accordance with
Integrated Crop Management (ICM) and Integrated Pest
Management (IPM) practices. Where necessary, this will include:
– avoiding the use of areas where the environment poses a threat to the
safety of food;
– Controlling contaminants, pests and diseases of animals;
– adopting practices and measures to ensure that food is produced
under appropriately hygienic conditions;
– Satisfying conditions for the use of plant protection products, in
particular: dose, maximum number of applications, pre-harvest
interval (PHI) and volume of mixture recommended per hectare.
108
3.7.2. Good Manufacturing Practices
• Good Manufacturing Practices (GMP) is the practices required

– in order to conform to the guidelines recommended by agencies
that control authorization and licensing
– for manufacture and sale of food.
• These guidelines provide minimum requirements that a food product
manufacturer must meet to assure that the products are of high
quality and do not pose any risk to the consumer or public.
• Good manufacturing practices, along with good agricultural practices
and good hygiene practices help growers, food supplier and
industries to provide safe and healthy food to end users.
109
3.7.2. Good Manufacturing Practices …
• There are many reactions occurring during processing and

manufacturing of raw materials that cause changes in
composition, nutritional value, physical structure and sensory
properties.
• The objectives of GMP are to control these changes so as to
develop the desired qualities in the product, to ensure food safety
and to stop or slow down any deterioration in the food.
• Good Manufacturing Practices means understanding, analyzing
and controlling the manufacturing process.
110
3.7.3. Good hygiene Practices
• Good Hygienic Practices (GHP) deal with safety and suitability

requirements along the food value chain.
• Risks related to food hygiene need to be controlled all along the
food supply chain, from production to processing, trade,
preparation and consumption.
• A risk-based rather than a hazard-based approach allows for
better resource allocation, which is particularly important in
poorer countries like Ethiopia.
111
3.7.3. Good hygiene Practices…
• Guidelines for GHP aim at establishing processing, handling,

transport and distribution procedures that are appropriate to
prevent perishing due to micro-organisms, growth of pathogens
on food stuff, contamination with chemical residues or
contaminants (e.g. mycotoxins).
• Basic rules are set out in the ‘Codex General Principles of Food
hygiene.
112
• They include requirements for the design of facilities,

control of operations (including temperature, raw materials,
water supply, documentation, and recall procedures),
maintenance and sanitation,
personal hygiene and training of personnel.
• Hygienic practices form an integral part of all food safety
management systems, as for example within the HACCP system.
113
 The five key principles of food hygiene are:
i. Prevent contaminating food with pathogens spreading from

people, pets, and pests.
ii. Separate raw and cooked foods to prevent contaminating the
cooked foods.
iii. Cook foods for the appropriate length of time and at the
appropriate temperature to kill pathogens.
iv. Store food at the proper temperature.
v. Do use safe water and safe raw materials.
114
Chapter 4. Gender and Nutrition
4.1. Definition of Gender related terminologies

• Sex: refers to biological attributes that identify a person as male
and female.
• Gender: refers to socially constructed role and responsibilities
assigned to men and women in a given culture or location.
Sex Gender
Is a natural attribute that we Social attribute that prescribes different
use to identify men and women roles, responsibilities, expectations, norms
and modes of behavior to male and female
Universal in nature Dynamic in nature, depends on the culture,
level of development, education etc.
Difficult to change Can be changed easily
115
4.1. Definition of Gender related Terminologies…
• Gender roles: the roles of women and men are expected to fulfill in the
society as defined by the virtue of being female or male.
• Gender disparity or gap: inequality b/n men and women on any socio-
economic indicators (e.g. access or benefits from resource).
• Access to resource: means having the opportunity to use resources
without having the authority to decide on the output.
• Control over resource: means having full right (authority to decide) to
use resource and how resources should be used.
• Gender sensitive: properly aware of the d/t needs, roles, and
responsibilities of men and women.
116
4.2. Gender Role in food Production and consumption
• Gender roles: the roles of women and men are expected to fulfill
in the society as defined by the virtue of being female or male.
• Both men and women play multiple roles in the society
• These roles can be broadly categorized into:
– Productive role: tasks which contribute to the economic
welfare of the household through production of goods.
– Reproductive role: activities performed for reproduction and
childcare
– Community management: socio-cultural activities (e.g. Idir).
117
4.2. Gender Role in food Production and consumption
• Women have great contribution in food production and consumption

as they mainly involve in production and preparation.
• However, women’s role as producers is usually undermined and
undervalued, hence, it requires empowerment mechanism.
• These is due to gender relations influence what women and men do
what they have access to and what decisions they can make
concerning food production and consumption
• The gender relations are dynamic and change all the time due to
planned intervention, policy changes, changing behavior and other
influences
118
4.3. Gender Equality and Equity for Nutrition
• Gender equality:
– Treating women, men, boys and girls equally

– regardless of their gender to have equal opportunities/
responsibilities, resources, access to good and service.
• Gender equity:
– refers to fairness of treatment by gender which may be equal
treatment or different treatment
– but which is considered equivalent in terms of rights,
benefits, obligations, and opportunities.
119
4.3. Gender Equality and Equity for Nutrition…
Figure 4.1. Gender equality vs Gender equity 120

• Ensuring gender equality can make a substantial contribution to

country’s economic growth and it is the single most important
determinate of food security (FAO, 2013).
• If there is gender disparity (inequities) regarding to access to
resource and control of assets in household, it will result in:
– Severe impact on women’s ability to provide food, care, health and
sanitation services to themselves and their family members.
– Women with less power within household and community will
unable to guarantee fair food distribution within the house hold.
121
• Substantial evidence shows that more equal access to and control

over assets (if gender equality and equity is ensured)
– raises agricultural output,
– increases investment in child education,

– improves visits to health facilities for infants,
– raises household food security, and

– accelerates child growth and development.
• Even though, women have great contribution to country’s economic

growth, most of the time their role is undermined and undervalued,
hence, it requires empowerment mechanism.
122
4.4. Empowering women in food Production & consumption
• In fact, the role of both men and women is great in food production
and ensuring food security.
• Usually, women’s income has greater impact on child nutrition and
food security than men’s
• However, disparities in food production often exist between men and
women farmers in access to land, security of tenure, education,
credit, extension and other services.
• This makes it harder for women farmers to achieve the same yield
and level of production as men in many developing countries.
• So, to tackle such problems, women empowerment is needed!!
123
4.4. Empowering women in food Production and consumption…
 What is women empowerment mean?

• Women’s empowerment refers to improving the social, economic,
political and legal strength of women so that they gain power and
control over their own lives. Why??
– To ensure nutritional security.
• What are the mechanism used to empower women?
• National nutrition Sensitive Agriculture Strategies of Ethiopia
Recommended two mechanism of women empowerment:
1. Promote women’s access and control over assets
2. Promoting time, energy & labor saving technologies to women
• More over, enhancing women’s socio-economic status, such as
education, nutrition awareness, and knowledge, decision making
power, income, and involving male in feeding and caring
practices can be used to empower women
124
4.5.1. Women’s Access and Control Over assets
• Ensuring asset transfers or asset building interventions which

properly target women can empower women for better nutritional
outcomes.
• It includes women’s access to land and other productive assets,
women’s control over cash from agricultural activities (e.g. intra-
household allocation of income between men and women, or the
extent of women’s ability to make decisions about purchases)
125
4.5.1. Women’s Access and Control Over assets…
• The main policy recommendation by FAO includes:
– Focus on food crops grown by women
– Securing land rights for women
– Policies to increase extension services, financing, access to
inputs and appropriate technologies for smallholders adapted
to reach women and ethnic minorities
– Credit and financial services, including insurance
– Increasing women’s access to markets.
– Increasing access to productive assets such as livestock, seeds
and storage facilities
– Social protection measures such as cash, food transfers and
child care services
126
4.5.2. Labor, time and energy saving technologies for women
• Women perform productive as well as reproductive roles.
• Promoting the adoption of labor-saving technologies & practices

– can reduce women’s workloads and
– free up valuable time for child care, food preparation and
women’s health and leisure.
• What are these practices and technologies?
– Th use of high yielding and resistant crops, no tillage.

– small pounding and dehusking machines (easy processing)
– Fuel-saving and fuel-efficient stoves for food preparation.
127
4.5.3. Involvement of male in feeding and caring practices
• A child health care is ‘mother centric’, and less effective in

participating father.
• As part of the provision of nutritious food, some husbands
monitor their wives’ and children’s diets to make sure they are
eating right.
• Involving male in feeding and caring practices can be used to
empower women.
128
Quiz1 (5%, PLSC)
 Instruction:
• Take out a piece of paper

• Write your name, ID No and Department!
• Here you Go! You have 6 minutes for this quiz.
1. What is the difference between sex and gender? (2pts)

2. What is the difference between gender equality & equity?
(2pts)
3. What is gender disparity mean? (1pt)
129
Ch#5: Social Behavioral Change Communication for Nutrition
5.1. Basic concepts of behavior change communication

• Diets and eating behaviors are influenced by many factors at
individual, family, community and national levels.
• The major factors affecting food production and consumption are
– Culture, societal norms, customs, religion and traditional
knowledge of the society.
• The following table shows cultural and socio-economic factors
affecting the distribution and consumption of foods.
130
5.1. Basic concepts of behavior change communication
Table 5.1. Factors affect eating behavior

Individual Family/group Community/institutional National
Food preferences Cultural and Rules, informal structures Health care system
and enjoyment social practices
Child care organizations Food assistance
Programs
Belief Social support Workplaces, schools
Attitude Networks Neighborhoods Food industry
Values Peer influence Shops Food agriculture system
Perceptions Restaurants Policy
Knowledge Community Political and social
structures
Skills Organizations
Information available Media
Recreational facilities Social and cultural
norms
Parks
131
5.1. Basic concepts of behavior change communication..
 Culture, religion and traditional knowledge affect food and

nutrition security because they can shape community’s
Food production, consumption, diet, food preferences,
Intra-household food distribution patterns, food taboo

Child feeding practices, food processing and preparation
techniques,
Health and sanitation practices, traditional medicine and
accessibility and use of biomedical public health service.
132
• In many countries, including Ethiopia, societies are bound by

culturally oriented food production and consumption.
• The behavior of diversified food production and consumption is
not common, and many society are relying of use of cereals only.
• In general, there are some harmful cultural practices, societal
norms and behavioral factors that can influence food security and
nutrition.
133
 Some of harmful cultural practices and societal norms are:

 Food taboo: restriction of specific food as a result of social or religious
customs (give example of food taboos)
 Disparity of food distribution among the households e.g. ‘Doro wot’
 Food preferences (vary among individual, family & communities) is a

result of socio-economic factor, culture, growth stage, palatability
physiological need etc.
• To ensure nutritional security of individuals, households,

community and national at large, social behavioral change
communication is apparently important
134
5.2. Nutrition Education, Counseling and Communication
 Nutrition education
– is any combination of educational strategies,
– accompanied by environmental supports,
– delivered through multiple avenues,
– designed to make people aware of what constitutes a healthy diet and

ways to improve their diets and lifestyles.
• Effective education is a key factor in improving nutrition and health,
• It enhances the impact of nutrition and food security interventions and is often
critical to their success.
• Long-term nutrition education develops popular capacity to make good dietary
choices and builds self-reliance
135
5.2. Nutrition Education, Counseling and Communication…
 Nutrition counseling:
– is a two-way interaction through w/c a client and a trained counselor

– interpret the results of nutrition assessment, identify individual nutrition
needs and goals, discuss ways to meet those goals and agree on next
steps.
• Nutrition counseling aims:
– to help clients to understand important information about their health &
– focuses on practical actions to address nutritional needs, as well as the benefits
of behavior change.
• Nutrition counselors may be nurses or other facility-based providers or

community health workers or volunteers.
136
5.2. Nutrition Education, Counseling and Communication…
 Nutrition Communication:
• Is two-way process, where participants can freely exchange

knowledge, values and practices on nutrition, food & related issues.
• The ultimate goal of nutrition communication is
– to produce nutritionally literate decision makers
– who are motivated, knowledgeable, skilled and
– willing to choose proper nutrition alternatives.

• Nutrition communication is recognized as a primary form of
intervention in national food and nutrition program.
137
5.3. Nutrition Social Behavioral Change Communication
• Nutrition social behavior change communication (NSBCC) is a set of
interventions that systematically combines:

– elements of interpersonal communication,
– social change and community mobilization activities,
– mass media, and advocacy to support individuals,
– families, communities, institutions, and countries
• in adopting and maintaining high impact nutrition-specific and

nutrition sensitive behaviors or practices.
• Effective NSBCC leverages enablers of behaviors and reduces barriers to
adopting and maintaining behaviors over time.
138
5.3. Nutrition Social Behavioral Change Communication
 How can we Achieve NSBC through communication??

• Following ‘Socio-Ecological Model’
• This model views individual behavior as product multiple overlapping
individual, social, and environmental influences, and
• combines individual change with the aim of influence the social
context in which the individual operates.
• Nutrition behavior change communication involves the steps:
– Understanding the context and audience-situation
– Focusing and designing the strategy/approach
– Creating activities, materials, tools
– Implementing and monitoring progress
– Evaluation and re-planning.
139
5.3. Nutrition Social Behavioral Change Communication…
 How do behaviors change??
• Following ‘Socio-Ecological Model’

• This model views individual behavior as product multiple
overlapping individual, social, and environmental influences, and
• Combines individual change with the aim of influence the social
context in which the individual operates.
• According to this model, at any level of society is surrounded by
different domains the influence them and these components may
facilitate or hinder changes (see figure 5.1 below)
140
Figure 5.1. the Socio-Ecological Model For Change

141
• In this model, levels of analysis are represented by the rings,

which show domains of influence and the people representing
them at each level.
• The “self” ring represents those most affected by the issue.
• The next two rings (Interpersonal and Community) represent
those that have direct contact with those most affected (self) and
influence their attitudes, beliefs, and actions.
• They may shape community and gender norms and/or access to
and demand for community resources and existing services.
142
• The outermost ring includes those that indirectly influence those

most affected by the issue and represent the enabling
environment.
• Components of this ring may facilitate or hinder change and
include government policies and regulations, political forces,
prevailing economic conditions, the private sector, religion,
technology, and the natural environment.
• Each level is influenced by four main cross-cutting factors that
SBCC interventions may be able to modify to generate change.
143
• These factors may act in isolation or in combination and are

discussed below.
 Information:
• People need information that is timely, accessible, and relevant.

• With such information, some individuals, groups, or communities
may be empowered to act.
• For most people, however, information is not enough to ignite
change.
144
 Motivation:
• Motivation, represented by attitudes and beliefs about the issues,

is needed.
• Motivation can be affected by SBCC through effective
counseling, peer education, or radio programs, for example.
• If done well, such communication can foster individual
attitudinal and behavioral change, as well as social norm change.
However, even motivation may not be enough.
145
 Ability to Act:
• In particular circumstances, especially those that may pose a threat or

that involve strong gender or social norms against the behavior, people
need the ability to act.
• Skills needed for the ability to act include:
– problem solving, decision making, negotiation,
– critical and creative thinking and interpersonal communication (IPC),
– Efficacy, the confidence of individuals and groups in their own skills to affect
change, access to services and transportation, and
– the ability to buy a diversity of foods, for example, are important elements in the
ability to act.
146
 Norms: (breaking the norms)
• Finally, norms, as expressed in perceived, socio-cultural and gender norms,

have considerable influence.
• Norms reflect the values of the group and specify those actions that are
expected of the individual by its surrounding society.
• Perceived norms are those that an individual believes others are holding and
therefore are expected of him or herself.
• Socio-cultural norms are those that the community as a whole is following
because of social status or cultural conventions.
• Gender norms shape the society’s view on what is expected of males and
females.
147
5.4. Stages of Behavioral change and Intervention Required
• In order to change their behavior, people go through Six stages in

adopting a new behavior (as shown in below chart).
• The arrows indicate

communication
supports that
Agricultural/rural
extension workers
should give
according to the
stage of the
individual/family
whose behavior they
are trying to change.
Figure 5.2. Stages of Behavioral Change 148

5.4. Stage of Behavior Change and Intervention Required…
Table 5.2. Stages of behavior change and communicative interventions to

encourage the target audience to try a new behavior/practice are given in the table
below.
S/N Steps Appropriate Specific tools
intervention
1 Pre-contemplation Build awareness/ • Drama, fairs
Never heard about the provide • Community groups
behavior information • Radio, individual counseling, mother to mother support
2 Contemplation Encourage/ • Group discussions or talks
Heard about the new discuss benefits • Oral and printed word
behavior or knowing • Counseling cards
what is it • Breastfeeding and Young Child Feeding Support
3 Intention Negotiate and • Home visit use of virus
Perception phase help to overcome • Group of activities for family and community.
Thinking about new obstacle • Negotiate with the husband and mother-in-law or other
behavior to take action influential family members to support the mother
4 Action Praise/reinforce • Congratulate mother and other family members as
Trying new behavior the benefits appropriate
• Suggest support to visit or join to provide
encouragement
• Encourage community members to provide support
5 Maintenance Provide support at • Reinforce (strengthening) the benefits
Continuing to do new all level • Praise
behavior or maintaining • Tell others
149
5.5. Tools for Nutritional Behavioral change communication
• The most common tools used to change people’s behavior

are?
1. Behavior change communication

2. Social Behavioral change communication
3. Nutritional Behavior change Communication.
150
1. Behavior change communication (BCC)

• Refers any communication (e.g. interpersonal, group talks, mass
media, support groups, visuals and print materials, videos) that helps
to foster a change in behavior in individuals, families, or communities.
• It is a multi-level tool for promoting and sustaining risk-reducing
behavior change in individuals and communities by distributing
tailored nutrition message in a variety of communication channels.
• It includes careful and focused listening, understanding and then
negotiating with individuals and communities for long-term positive
nutrition behaviors.
151
2. Social and behavior change communication (SBCC):

• This includes not only communication, but also actions to create an
enabling environment for sustained behavior change.
• The actions may be formulation of policy, provision of needed
systems, services, or measures to sway social norms.
• For behaviors to change on a large scale, certain harmful cultural
practices, societal norms and structural inequalities have to be
taken into consideration.
• Social change approaches, thus, tend to focus on the community as
the unit of change.
152
3. Nutrition Behavior Change Communication (NBCC):

• is used to change nutrition related behaviors in a community.
• It involves not only health related messages but also educating
the community about a wide range of Nutrition sensitive
activities and multi-sectoral collaborations.
153
5.6. Nutrition Extension through SBCC/NBCC
• Nutrition extension through behavior change communication (BCC)

improves household nutrition.
• It influences caregivers’ preferences towards more nutrient-rich foods,
intra-household allocation of food to benefit pregnant and lactating
women and children, and other practices related to child feeding, care
giving, sanitation and hygiene, and use of health services.
• Agriculture & Nutrition SBCC is a strategic package of behavior
centered interventions (activities, programs and policies) aimed at
supporting individuals, households, groups, and communities to adopt
and sustain high impact age & nutrition practices by:
154
5.6. Nutrition Extension through SBCC/NBCC
• promoting specific individual and group behaviors – among

mothers, fathers, caregivers, nutrition and health service
providers, farmers, peer networks, and others
• shifting social attitudes, structures, and norms
• creating enabling environments that promote and provide support
for social change & positive change in agriculture & nutrition
behaviors
• and that above all … aim to DO NO HARM
155
Ch#6 Multi-Sectorial Coordination for Nutrition
6.1. Introduction
• Coordination is one strategic objective focusing on multi-sectorial
coordination and linkages for nutrition.
• The purpose is to enhance the nutritional impact at a grass root level by
concerted action of various sectors
• Evidence indicates that the factors that hinder progress in improving
nutrition are multi-faceted and multi-sectorial.
• Therefore, these need to be counteracted by equally powerful, multi-
sectorial, multi-stakeholder forces that combine nutrition-specific, nutrition-
sensitive and environment enabling actions at all levels across the sector.
156
6.2. Multi-sectorial nature of Nutrition
• Nutrition has multi-dimension and multi-sectorial nature in terms of

both effect and outcome.
• The multi-sectorial nature of nutrition requires individual, institutional and
system-level capacities to operationalize effective interventions through
collaborative engagement across sectors and stakeholders
• Effective implementation further requires coherence both vertically (within
sectors and stakeholders) and horizontally (across sectors and
stakeholders).
• In order to ensure effective multi-sectorial coordination among different
stakeholders in Ethiopia, a common structure was already established by
the government in the national nutrition program II (NNPII)
157
6.3. The Ethiopian National Nutrition Program
• The national nutrition program (NNP) is a national multi-sectorial program

with strategic objective to improve the nutrition condition of the country.
• The NNPI has been implemented during the first growth and
transformation plan (GTPI) and a follow on NNPII is launched in
December 2006 to be implemented during GTP2 and will be in place up to
2020.
• The health sector is assumed the coordination while agriculture and
livestock, education, women and child, water, irrigation and electricity
sectors are main sectors working to achieve the program through both
mainstreaming and direct implementation of the program in their
respective areas.
158
6.3. The Ethiopian National Nutrition Program…
• The strategic objectives of the NNPII

• Improve the nutritional status of women (15-49 years) and adolescence (10-
19 years)
• Improve the nutritional status of infants, young children and children under 5
years,
• Improve nutrition service delivery for communicable, lifestyle related or
non-communicable diseases affecting all age group.
• Strengthen implementation nutrition sensitive interventions in various sectors
• Improve multi-sectorial coordination and capacity to ensure implementation
of the NNP
159
6.4. Roles and Responsibilities of Various Sectors
• The national Nutrition Coordination body remains the main

mechanism for leadership, policy decisions and coordination of the
NNP
• Similar multi-sectorial nutrition coordination framework and
program implementation arrangement are provided at regional,
woreda and kebele levels.
• Ensuring good nutrition requires the contributions of many different
sectors. The ranges of sectors that are involved in efforts to reduce
under-nutrition are in total 3 and presented below in the figure 6.1)
160
6.4. Roles and Responsibilities of Various Sectors…
Majors sectors are:
• Health
• Agriculture an NR
• Fishery and livestock
• Education
• Trade
• Finance and
economy
• Women and children
• Labor and social
affairs
• Disaster and risk mgt
• Youth and sport
• Govt communication
• Water irrigation,
energy
• Industry
Figure 6.1. Different sectors involved in implementation nutrition program 161

• Each sector has a role to play in NNPII and its implementation according to their
mandates (table 6.1.)
• In order to have effective coordination, each sector needs to properly understand the
importance of nutrition and what is expected from them
• Assigning a responsible body is a second step towards implementation of the strategy.
• The agriculture sector serves as co-chair of the NNP II and primarily takes lead in the
provision of food for the household and community.
• It also plays a pivotal role in reaching the rural population through strong extension
system.
• The devt committee of Kebele’s through the technical support of Das and health
workers, plan and execute kebele level nutrition intervention through mobilizing
development army
162
Table 6.1. Major roles and responsibilities of nutrition signatory sectors
Sector Major Responsibility
• Strengthen the community level linkage and capacity of women based
Health structure and association at all levels to promote optimal adolescent,
maternal, infant and young child nutrition and caring practices
 Increase year round availability and access to a and consumption of fruits

and vegetables, nutrient-dense cereals and pulses.
Agriculture  Promote technologies for post-harvest food processing, handling,
prevention and preparation to help that food is both nutritious & diverse
 Improve nutrition-sensitive agriculture knowledge/practices among
farmers
 Promote production and consumption of bio-fortified crops
Livestock and • Increase year-round availability, access to and consumption of animal

fishery sourced foods
Industry • Conduct awareness creation events for the private sector on nutrition
requirement and standards for local manufactured food items
Trade • Ensure the quality and safety of imported food items as per the national
standard
163
Table 6.1. Major roles and responsibilities of nutrition signatory sectors…
Sector Major Responsibility
Water, irrigation • Increase access to safe and clean water, small and large scale irrigation
and Energy schemes, availability of renewable energy
Government • Create public awareness, utilize available media outlets to promote
communication optimal nutrition behavior
Youth and sport • Promote the provision of credit, grants, microfinance service to support
increased access to nutritious food among vulnerable groups
Disaster risk • strengthen and scale up early warning systems for food and nutrition
management information from the community level up to the national level
Labor and • Promote the implementation of gender-sensitive social safety net
social affairs program and other social protection instruments in urban settings to
protect the vulnerable groups from food insecurity and under nutrition
Women and • Mainstream gender equality in all nutrition training programs, promote
children meaningful male involvement in nutrition interventions
Education • Promote and scale up school health and nutrition intervention
Finance and • Mobilize resource for nutrition and making sure public resource
economy allocated for nutrition are properly utilized
164
• The agriculture sector serves as co-chair of the NNP II
• The core responsibility of the sector in terms of nutrition

security is making nutritious food available and accessible
• There are two ways to diversify availability of food
– Developing the marketing system in the local market where
the farmers can sell their produce and by what they don’t have
from others
– The second ways is production of diverse types of food by
households
165
6.5. Strengthening multi-sectorial coordination
• Advancing nutrition in countries requires capable human resource,

effective institutions, and functional systems to plan, manage, and
evaluate program.
• Strong country commitment and government leadership along with
the active engagement of communities, the private sectors, and civil
societies are essential for achieving and sustaining nutrition
outcomes
• The commitment of country leadership to nutrition at all level is
essential to creating and sustaining momentum and for the
conversion of momentum into results on the ground.
166
Ch#7: Planning, Monitoring and Evaluation of Nutrition
Sensitive Interventions
7.1. Introduction
• The Ethiopian agricultural system is at its infant stage to be
explicitly nutrition sensitive.
• This affected the agriculture sector ability to impact fully on the
nutritional situation of the country.
• The idea of nutrition-sensitive agriculture has not yet been
internalized by agriculture project planners and managers.
• With respect to monitoring and evaluation, agriculture project
planners and managers are facing considerable difficulty even with
their existing orientation.
167
7.2. Basic Principle of Planning for NSA Interventions
• The basic principle of planning to make agriculture system

nutrition sensitive can be classified as
1. Program principles and

2. Policy principle.
• The components of each principle are presented as follows
168
7.2.1. Program Principles
• At program level, agricultural programs and investments can strengthen
impact on nutrition if they are designed considering the following.
1. Incorporate explicit nutrition objectives and indicators into design and
track to mitigate potential harms
2. Assess the context at the local level to design appropriate activities to
address the types and causes of malnutrition
3. Target the vulnerable and improve equity
4. Collaborate and coordinate with other sectors
5. Maintain or improve the natural resource base
6. Empower women
7. Facilitate production diversification and increase production of nutrient
dense crops and small-scale livestock
8. Improve processing storage and preservation
9. Expand market and market access for vulnerable groups, particularly for
marketing nutritious food
10. Incorporate nutrition promotion and education
169
7.2.1. Program Principles…
1. Incorporate explicit nutrition objectives and indicators into
design and track to mitigate potential harms:
• NSA investments shouldn’t only seek to improve nutritional outcomes,
• But also, at least ensure that they don’t harm to nutritional status of the
project stakeholders including producers and consumers
• The main gaps identified in Ethiopia from agricultural interventions:
 Employment levels have remained static or deteriorated
 Small producers have been excluded, women are not able to participate
 Labor burden of women increased, change in water borne disease
 Health problem due to chemicals inputs is expanded
• Thus, to minimize such influences, during planning we have to consider
the following questions:
 What is/are the program’s main object(s)?
 Is nutrition considered as part of the objective (s)?
 What nutrition indicator can be used to measure the achievement of these objects?
 What is/are the impact pathway(s) through w/c the program impact nutrition?
170
2. Assess the context at the local level to design appropriate

activities to address the types and causes of malnutrition:
• During designing a nutrition-sensitive intervention, a through
analysis of the context, in particular of the nutritional problems
that affect different parts of population, their multiple causes,
and the social institutional contexts that shape the food and
nutrition security situation is paramount important.
171
3. Target the Vulnerable and Improve Equity:

• During planning of our agricultural intervention, target the
vulnerable groups (women of reproductive age group, children,
youth, the landless, etc.) and improving equity is important.
• Agricultural planners, should address the following questions:
• Who will benefit from the program?
• How is the project or investment expected to reach women of
childbearing age and young children?
• Is it possible that the intervention may benefit one group while
harming others?
172
4. Collaborate and Coordinate with Other Sectors:

• Impact on nutritional status cannot be achieved by agriculture
program; it is important to seek synergies from other sectors.
• So, agricultural planners, should address the following questions:
• Are proposed mechanisms facilitating coordination among
stakeholders available? At what level and who is involved?
• Could agricultural investment take place in the same geographic area
as other sector w/c also important to reduce malnutrition?
• Could the project include alternative income-generating activities or
link with social safety nets for hungry seasons?
173
5. Maintain or Improve the Natural Resource Base:

• During planning, we should think to use natural resource in a
sustainable way (water, soil, climate, air biodiversity)
• We should also consider the following questions:
• Does agricultural intervention include measures to protect soil
quality and biodiversity?
• Is the agricultural intervention likely to affect the quantity and quality of
water available to households with malnourished individuals?
• How will the agriculture activities affect women’s workloads

related to water procurement and use?
174
6. Empower Women:
• Women empowerment is linked to improved nutrition for household
members b/s the role of women plays across cultures as providers and
gatekeepers of household nutrition, child care and health.
• So, our planning should answer the following questions:
• How will women be involved and benefit from the program?
• Are they likely to control income generated by the program?
• Are time demand for women likely to reduce the quality of
childcare?
• Are there labor-saving technologies for women?
175
7. Facilitate production diversification and increase production of

nutrient-dense crops and small-scale livestock:
• Diversified food production system is important to ensure resilience to
climate and price shocks, reduction of seasonal food and income fluctuation
and gender-equitable income generation.
• Hence, during planning we have to consider the following questions:
• Do this program initiated surrounding farmers to practice diversified
production and consumption?
• Are the local resources or under utilized foods could be grown to
improve diets and nutrient intake?
• How can market access to nutritious food be increased ?
176
8. Improve Processing, Storage and Preservations:

• Appropriate processing, storage and preservation are essential to
reduce postharvest losses and improve consumption of micronutrient-
rich foods; can even preserve and increase nutrient (fermentation,
etc.)
• Thus, during planning we have to answer the following questions:
• Does the program change the quality, food safety or nutrient
content of the food(s) targeted by the project?
• What crops might be appropriate for enhanced preservation?
• Are there entry points in the value chain for aflatoxin control?
177
9. Expand markets and market access for vulnerable groups,

particularly for marketing nutritious foods:
• Market opportunities is an incentive for farmers to produce and
potentially consume nutritious foods they otherwise would not.
• An important contribution that investments in agricultural value
chain can make nutrition is by improving market access:
• For producers, processors, retailers, to help them to sell their
products and generate income w/c can be invested in better
health care, food consumption and
• For consumer, to improve affordability of nutritious food.
178
10. Incorporate nutrition promotion and education:

• It is important to include measures in program design to build on
existing local knowledge, attitudes and practices of the
community on nutrition.
• Nutrition knowledge can enhance the impact of production and
income in rural households, especially important for women and
young children, and can increase demand for nutritious foods in
the general population.
179
7.1.2. Policy Principles
• Agriculture program and investments need to be supported by an

enabling policy environment to contribute in improving nutrition.
• Food and agriculture policies can impact nutrition if they:
1. Increase incentives for availability, access and consumption of
diverse, nutritious & safe food, trade and distribution.
2. Monitor dietary consumption and access to safe, diverse &

nutritious food
3. Include measures that protect and empower the poor and women.
4. Develop capacity
5. Support multi-sectorial strategies to improve nutrition 180

7.1.2. Policy Principles…
1. Increase incentives and decrease disincentives for

availability, access and consumption of diverse, nutritious,
and safe food through environmentally sustainable
production, trade and distribution.
• The focus needs to be on horticulture, legumes and small-scale
livestock and fish – food which are relatively unavailable and
expensive, but nutrient-rich and vastly underutilized as source of
both food and income
181
2. Monitor dietary consumption and access to safe, diverse and

nutritious foods.
• The food data could include food prices of diverse foods and
dietary consumption indicators for vulnerable groups.
182
3. Include measures that protect and empower the poor and

women.
• Safety nets that allow people to access nutritious food during
shocks or seasonal times when income is low; and tenure rights,
equitable access to productive resources, market access for
vulnerable producers (including information and infrastructures).
• Recognizing that a majority of the poor women, ensure equitable
access to all of the above for women.
183
4. Develop Capacity.
• Capacitate human resource and institutions to improve nutrition
through the food and agriculture sector, supported with adequate
financing.
5. Support multi-sectorial strategies to improve nutrition:
• Within national, regional and local government
184
7.2. Monitoring and evaluation indicators for NSA activities
 The monitoring data that should be collected for NSA interventions are;
– Basic socio-demographic information
– Information indicating participation and the extent to which
households
– Have been reached/affected by the agriculture project
– Data on household food insecurity levels and on the dietary quality
– Data on child and maternal nutritional status
– Income level of the household
– Information on women’s empowerment (qualitative and
quantitative)
– Information on any harmful effects of the project on food security or
nutrition.
– On-farm availability, diversity, and safety of foods
– Data on natural resource management practices
185
7.2. Monitoring and evaluation indicators for NSA activities
Type of Key Indicators What the indicator measure Mode of
measure collection
Diet- Minimum dietary A measure dietary quality, w/c Household survey
individual diversity for women reflects overall nutrient (individual
level of reproductive age adequacy and dietary diversity. interview with
(MDDW) It does not reflect adequacy of household)
specific target nutrient
Food access Food Insecurity Severity of food insecurity Household or
– household Experience Scale experience with in a individual survey
level (FIES) household. Can also be
measured for individual
On-farm Production of target A measure of availability of Household survey
availability, nutrient – rich foods diverse nutritious food s or farm survey
diversity and Diversity of crops and Nutrition and food safety
safety livestock produce related knowledge and
attitudes at community level
Months of adequate
household
provisioning (MAHFP
186
7.2. Monitoring and evaluation indicators for NSA activities…
Type of Key Indicators What the Mode of
measure indicator measure collection
Food Availability and prices of Useful to track Market/price
environment in targeted nutrient-rich foods in whether nutrient- information when
market local markets rich foods are they exist or rapid
available in market market survey
Income Income, disaggregated by Resource equity Household survey,
gender, to reflect intra- enterprise records
household income control kept by project
Women’s Women’s access and control Women’s Household survey
empowerment over resource (e.g. land owner) empowerment or qualitative
Women’s participation in process
economic activities (e.g. gender
gap in product sales)
Women’s access to and control
over benefits (income)
NRM Practices Access to improved drinking Natural mgt Farm survey
water source practices
187
Summary
• The basic principle of planning to make agriculture system nutrition

sensitive can be classified as program principles and policy
principles
• Agricultural programs and investments can strengthen impact on
nutrition if they are designed with nutrition lenses
• Agriculture programs and investments need to be supported by an
enabling policy environment if they are to contribute to improving
nutrition.
• The monitoring and evaluation of agricultural projects for their
impact on household food insecurity and nutrition is important.
188
Quiz2 (10%, \=/ (5%) PLSC)
 Instruction:
• Take out a piece of paper and write your name, ID No and

Department! You have 6 minutes for this quiz.
1. In Ethiopia the idea of nutrition-sensitive agriculture has not yet been
internalized by agriculture project planners and managers.True/False?
(1pt)
2. Mention the two basic principles we need to consider to make
agricultural system nutrition sensitive during planning?(2pts)
3. Mention the 3 key indicators which reveals whether a certain NSA
interventions brought about women empowerment effect or not (2pts)

189
The End
Thank you very much for all your contribution
Wish you ALL THE BEST for YOUR FUTURE Endeavor
Let’s come together to end malnutrition and hunger through NSA

interventions!!
Always Remember that ‘We are What We eat!!’
190

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Course Title: Nutrition Sensitive Agriculture

By: Mekonnen Tolasa (MSc.)

1.1. Definition of terms

 What are Nutrients?

• Nutrients are chemical substances obtained from food and used in

 In general, there are six types of nutrients based on function and

Vitamins Function Source

 1.2.6. water: needed for most body functions, including maintenance,

There are many food classification: 5, 6, & 10 (based nutritional needs)

FAO classify food into six groups…

1.5.1. Definition and basic concepts of malnutrition

• Malnutrition is currently the leading cause of child mortality.

• The global community is urging for prevention of under-nutrition

 Malnutrition is not caused by a single factor.

The nutritional status of an individual, households, and the

• In general there are four form of malnutrition. These are:

• Under nutrition is generally a form of malnutrition which are

Under nutrition due to deficiency of macronutrient viz.

Under nutrition due to deficiency of micro nutrients viz.

Let’s see these two forms of under nutrition one by one 25

 Protein-Energy Malnutrition (PEM) is currently the most

1. Z-score 2. BMI categories

• is a malnutrition condition reflected by inadequate linear growth of a

 Sever PEM: is manifested as nutritional marasmus (severe wasting) and

Figure 1.5. Manifestations of severe PEM (Marasmus and Kwashiorkor) 30

• Micronutrient deficiency refers to deficiencies in one or more

Figure 1.8. Trend of malnutrition among children in Ethiopia (EDHS, 2016)

 The major impacts of Malnutrition are:

3) Poor cognitive dvt (school performance)

 These impacts can be reflected at individual, household & community level.

• Are strategies designed to change nutrient intake, nutrition-related

• These refers investing in nutrition throughout the life cycle.

Figure 1.10. Diagram depicting nutrition throughout the lifecycle

• Is an approach that aims to enhance availability, access and

• Variety and nutritious agricultural foods production interventions

• Traditional and underutilized indigenous foods crops are often

• Foods products obtained from different animal source are

• Postharvest loss refers any degradation in both quality and quantity

• The third approach used to ensure dietary diversification is

Application of micronutrients-containing mineral fertilizers to the soil and or plant leaves

• Success of agronomic bio-fortification to alleviate micronutrient

Schematic overview of micronutrient (MN) pathway from soil to

• Good soil condition that enhance micronutrient availability for

Diagram of agriculture to nutrition impact pathways 77

• Production of food for home consumption is the most

• Also called income-oriented production for sale in market

• Increases in income can in turn translate into improvements in

• The agricultural interventions that increase women’s income and

• their control over resource

– can dramatically increase the potential for positive child

• Thus, the incorporation of a gender equity dimension in

3.1. Definition of terms related to Food Safety

• Good Agriculture practices (GAP): refers to production of safe

 Impact of unsafe food: Overview

• A food safety hazard, in simple term is something that could

• Biological hazards are hazards caused by:

 Macro-organisms (visible to naked eyes): flies, worms,

• The major biological hazards w/c are responsible for a large

A. Bacteria: may cause illness in human either by infection or intoxication

 Most common food poisoning  Health risk of food poisoned by

• These viruses can cause fever, abdominal discomfort, followed by

C. Parasites worm and Protozoa:

• Parasitic protozoan species • Parasitic worms