SESSION ONE:

BASICS OF NUTRITION

1
 Learning objective

At the end of this session, participants will be able to describe:

• The basic concepts related to nutrition

• Why nutrition matters?

• The economic effects of malnutrition

• Nutrition priority groups.

• The impact of malnutrition

 Brainstorming and Large Group Discussion

 What is Malnutrition?
 Why we are focusing on Nutrition?/ why nutrition matters?
 Who is nutrition Priority Groups?
 Have you ever heard of the First 1,000 Days? If so, explain it?
 Have you ever heard of the under-nutrition cycle? If so, explain it?
 Learning Objective 1 – Basics of Nutrition

What is Malnutrition?
• is a general term that includes under nutrition, over nutrition and
micronutrient deficiency disorders.
• Under nutrition is the lack of adequate amounts and types of
nutrients that result in ill health.
• It can also be due to a situation where our body is unable to
absorb or utilize the nutrients from the food we eat.
• Wasting or thinness: is an indicator of acute (short-
term)malnutrition. Wasting is usually the result of recent food
insecurity, infection or acute illness such as diarrhea.
4
UNDERLYING CAUSES OF NUTRITION
INSECURITY AND MALNUTRITION
1.1 Key Definitions
• Food?
• Nutrition?,
• Nutrient?
• Calorie?
• Micronutrient defficancy?
• Food security?
• Nutrition security?
 …Cont

• Stunting or shortness: is an indicator of chronic (long-term)

malnutrition.
• It is often associated with poor development during childhood
and is one of the harmful effects of poverty.
o Stunting is commonly used as an indicator for development, as it is strongly associated
with poverty.
• Underweight: is an indicator of both acute and chronic
malnutrition.
o Underweight is a useful indicator when examining nutritional trends.

• Micronutrient deficiencies (iodine, iron, vitamin

A, zinc deficiencies, etc…)
6
Causes of Malnutrition
 Why Nutrition Matters?

• Malnutrition affects many people, primarily children, and

consequently impedes the social and economic progress of the
nation
• Food insecurity, both chronic and seasonal, is also a
widespread problem, affecting about 45 percent of the total
population.
• Each year about five million people, particularly from rural
areas, are facing food shortages and 2.8 million people
required food assistance in 2011.

8
Under-nutrition Globally
Nutrition trend (20 yrs )
key indicators
 The national prevalence of Malnutrition
EDHS EDHS 2014/1
Indicators 2006 2012 5
Newborns with low birth weight (<2.5kg) 14 11 10
Micronutrient defficencey
Prevalence of anemia in adolescents aged 10-19 years NA NA 28
Prevalence of anemia among adolescents girls aged 10-19 years NA NA 30
Prevalence of anemia in adolescents aged 15-19 years NA NA 13
Prevalence of anemia amongst women in the reproductive age
group (15–49) 27 17 19.3
Prevalence of anemia among pregnant women 22
Anemia in children 6–59 months of age 54 44 39
Iodine deficiency disorder in children 39.9 NA
Vitamin A deficiency (VAD) (%) 61 NA 33.9
Chronic Undernutrition
Adolescents aged 15-19 years with chronic malnutrition (BMI <18.5)
and 38.4 32.5 36
Maternal malnutrition (BMI<18.5) 30.1 27 27
 Cont…

Food consumption
Percentage of women consuming diversified meal (> 5 food groups)
during pregnancy 27 27 22
National food consumption score 20.3
Proportion of households consumed fruits and vegetables 26
Proportion of households consumed animal source foods 17.5
proportion of children age 6-23 months with minimum dietary
diversity score 21.2
proportion of children age 6-23 months received minimum meal
frequency 5 9.8
proportion of children age 6-23 months received minimum
acceptable diet 67.1
Percentage of HH using adequately iodized salt (>15 ppm) 39.9 NA 36
Optimal breast feeding and complementary feeding
Early initiation of breastfeeding 69 52 52
Exclusive breastfeeding under 6 months 49 52 52
Children aged 6–9 months who receive complementary food 44 51 50
Children aged 6–59 months who received two doses of Vitamin A
supplementation 61 NA
Why nutrition matters?
Trends in under-five, infant and neonatal mortality rates and estimated levels for 2015
Nutrition Priority Groups :The First 1,000 Days of Life
 …Cont

• The first 1,000 days is the period from pregnancy through 2 years of age.
• These 1,000 days offer a unique window of opportunity to shape
healthier and more prosperous futures.
• Proper nutrition during this 1,000 day window can have a profound
impact on a child’s ability to grow, learn and rise out of poverty. It can
also shape a society’s long-term health, stability and prosperity.

• Therefore, pregnant and lactating (breastfeeding) women and children

under the age of 2 years are the priority groups that need attention in
nutrition.
17
When does stunting happen?

• The “1,000 days” population: women , infants and young

children
• Pregnant and lactating girls/women“Under 2’s”
• Infants = 0-11 months
• Young children = 12-23 months

Conception Birth 1 year 2 years

270 days (9 months) 360 days (12 months) 360 days (12 months)

270 + 365 + 365 = 1,000 days

 In 1,000 days, you can change the future

• Investing in better nutrition in the 1,000 day window can also

help families, communities and countries break the cycle of
poverty.
• Evidence shows that the right nutrition during the 1,000 day
window can:
 Reduce the risk for developing various non-communicable diseases such as
diabetes, and other chronic conditions later in life;
 Save more than one million lives each year;
 Significantly reduce the human and economic burden of diseases such as
tuberculosis, malaria and HIV/AIDS;
 Improve an individual’s educational achievement and earning potential; and,
 Increase a country’s GDP annually.

19
 The Under-Nutrition Cycle

• The cycle of poor nutrition is perpetuated across generations.

• Young girls who grow poorly become stunted (low height for
their age) women and are more likely to give birth to low birth
weight infants.
• Those infant girls are likely to continue the cycle by being
stunted in adulthood.
• Adolescent pregnancy heightens the risk of low birth weight
and increases the difficulty of breaking the cycle.
• Good nutrition needs support during all of these stages—
infancy, childhood, adolescence and adulthood—especially for
girls and women.
20
…Cont

Figure 2: The Under-Nutrition Cycle

21
Actions for the child (stage 1)

1.Prevent growth failure by:

 Encouraging early initiation of breastfeeding.
 Providing exclusive breastfeeding from 0 to 6 months (0 to 180 days).
 Promoting optimal complementary feeding practices.
 Feeding a sick child frequently.
1.Non-feeding actions to break the under nutrition cycle at
this stage include:
 Practicing good hygiene.
 Attending immunization sessions.
 Using insecticide-treated bed nets to prevent malaria.
 Deworming.
 Preventing and treating infections.
Actions for the teenage girl (stage 2)

Promote appropriate growth by:

 Eating adequate amounts of nutritious foods. Eating a variety of locally available
foods.
 Delaying the first pregnancy until growth is completed (usually 20 to 24 years).
 Preventing and seeking early treatment of infections.
 Encouraging parents to give girls and boys equal access to education; under
nutrition decreases when girls/women receive more education.
 Encouraging families to delay marriage for young girls.
 Supporting equal access to education for girls and boys.
 Avoiding intake of coffee/tea with meals.
 Practicing good hygiene.
 Using insecticide-treated bed nets to prevent malaria.
Actions for adult women (stage 3) Actions for the developing child/foetus to prevent low
birth weight (stage 4)
Improve women‘s nutrition and Improve women‘s nutrition and health
health by: during pregnancy
 Consuming different types of locally by:
available foods.  Increasing the food intake during pregnancy by
 Preventing and seeking early treatment of eating one extra meal.
infections.  Consuming different types of locally available
 Practicing good hygiene. foods.
 Delaying the first pregnancy until at least  Giving iron, folate, and other recommended
20 years of age and encouraging couples supplementation. Preventing and seeking early
to use appropriate family planning treatment of infections
methods.  Encouraging good hygiene practices.
 Encouraging men‘s participation.  Decreasing energy expenditure by resting more.
 Using insecticide-treated bed nets to  Encouraging men’s participation.
prevent malaria.
The Impact of Malnutrition
Group work
 Learning Objective 2 – The Impact of Malnutrition

• The impact of malnutrition is multifaceted. It does not only affect

the health of women and children.
• It also decreases individual productivity, educational
performance and eventually creates poor economic status for
individuals and societies.
• Malnourished children have retarded mental and physical
development and this affects their educational performance and
critical thinking.
• Malnutrition also weakens the immunity system and causes a
predisposition to various illnesses and even death, particularly
among children.
26
…Cont

Figure 3: The Impact of Malnutrition

27
 How malnutrition Impact?
Arrow-1: How malnutrition decreases Arrow-2: How malnutrition increases
productivity
• When malnourished individuals
are sick, they can’t perform their
daily work (e.g., sick farmer)
• Individuals with iron deficiency
anemia (particularly women)
become tired and can’t perform
their day-to-day activities
• Shortage of iodine decreases IQ
and causes a productivity loss
• Stunting also causes less
productivity
Arrow-3: How malnutrition causes poor
deaths and illness educational performance
• Malnutrition weakens immunity and • Iron deficiency anemia lowers
predisposes individuals to different
infections
IQ by 9 points, mild iodine
• More than half of infant deaths are deficiency by 10 points, sever
associated with malnutrition stunting by 5-10 points, and
• Suboptimal breastfeeding is
accountable for 24% of infant
low birth weight by 5 points
mortality and vitamin A deficiency • High absence and drop-out
for 17% of deaths rates from school due to
Marasmus and kwashiorkor and finally
malnutrition associated illness
death are caused by severe malnutrition
Goiter due to iodine deficiency
Night blindness to complete blindness
from vitamin A deficiency
Anemia from iron deficiency
Diseases from deficiency of vitamins
(scurvy, pellagra, etc.)
Arrow-4: How decreased Arrow-5: How increased deaths Arrow-6: How poor educational
productivity causes poor economy and illnesses cause poor economy performance causes poor economy

• Less productive citizens will have • High number of ill
lower income and this creates
poorer society
• Productivity loss due to iodine
deficiency is estimated at 1,347
million birr each year and this has • Low number of productive
negative economic impact
• Productivity loss due to stunting
(low height for age) is estimated
at 2,992 million birr per year and
this has negative economic
impact
• Increased dependency due to less
productive citizens causes poor
economy
individuals will become less
productive and have low
income
citizens (due to high
number of deaths) can’t
produce adequate income
• High dependency due to
low number of productive
citizens (as a result of high
deaths)
• Illiterate farmers will follow traditional
agricultural practices and this will yield
to poor agricultural productivity
• Illiterate society will have poor access
to modern health care and this will
increase deaths and illness and finally
create poor productivity & economy
• Illiterate society will have less
innovation and creativity & this will
decrease productivity and cause poor
economy
• Illiterate mothers will follow poor
feeding practices and this will
eventually lead to increased deaths and
illness and finally to decreased
productivity and poor economy
 Social and Economic Implications

• Under-nutrition also lowers cognition and impedes learning.

• 45% of the 6.9 million child deaths in 2011 were related to under-
nutrition.

• 10% of an individual’s life-time earnings

• 11% of a country’s GDP is lost annually due to high prevalence of under-

nutrition.

• Every dollar spent on nutrition-specific interventions has an average

return $15-100.
Copenhagen Consensus, 2008/ 2013; LNS 2013
 Effect of Under-nutrition on Health Cost
Estimation of health costs of under nutrition related pathologies on public
and private health costs, 2009
(In millions of Ethiopian birr
Number of Relative Cost Cost to the Cost to the
Pathologies episodes risk (In millions family(MB) system(MB)
birr)
LBW/IUGR 148,173 --------- 563
Anemia 365,311 12% more 130 (90%) (10%)
ADS 527,153 5% more 144
ARI 114,300 6% more 61 1.8 BETB
Underweight 2,991,509 --------------- 693 = 0.54 %
GDP
Fever/Malaria 264,232 4% more 231

Total 4,410,678 ------------ 1,822 1,637 185

Source: Model estimations based on DHS 2005/2011, and Demographic information and data provided by the National Implementation Team
12/08/2023 31
 Effect of under-nutrition on Education

Stunted
children have a
+3.9%
3.9% more risk
higher of repetition
than non-
stunted
children

12/08/2023 32
 Effect of under-nutrition on Education
Retention/dropout

19% of non stunted

population completed
primary school
compared to only 8%
of stunted children
12% of non-
stunted
completed
secondary school,
while 4% of the
stunted
population
completed
secondary
school

12/08/2023 33
 Effect of under-nutrition on Income

625 Million
birr = 0.2%
GDP

12/08/2023 34
 Total costs of Child under-nutrition
to Ethiopia

ETB 55.5
Billion/
USD 4.7 B

12/08/2023 35
End