The role of evidence in nutrition policy‐making in Ethiopia: Institutional structures and issue framing

Abstract

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policy‐making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi‐sectoral nutrition policy‐making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong co‐ordinating infrastructure. In December 2014 we undertook 23 in‐depth semi‐structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy‐making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framework and its progress in achieving terms of nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi‐sectoral issue.

Predictors of Underweight Among Lactating Mothers in Dangila District, North West Ethiopia

“…This nding is similar to other ndings (21)(22)(23). Studies conducted in Ethiopia also showed that women in the youngest age group (15)(16)(17)(18)(19) were more likely to be affected by underweight (22). This may be due to in this stage of life; lactating mothers undergo many physical, emotional, and social changes that increase nutritional demand.…”

“…The Federal Ministry of Health of Ethiopia established a national nutrition program to address malnutrition in the country effectively. This program was designed to diminish the magnitude of malnutrition among pregnant, lactating mothers, and under-ve children in Ethiopia (15). As part of this policy, Ethiopia's health sector has also stepped up its efforts to promote acceptable dietary practices through health education and treatment of severe malnutrition among children and lactating mothers (16).…”

Spatial Variations and Determinants of Acute Malnutrition among Under-Five Children in Ethiopia: Evidence from 2019 Ethiopian Demographic Health Survey

“…This study revealed that 7% of children in Ethiopia had acute malnutrition in the 2019 national survey. The current magnitude of wasted children is also higher than the national target of 3% [17]. There are more than a few factors associated with this at both individual and contextual levels.…”

“…Malnutrition is the most sensitive health indicator that re ects the quality of the health care delivery system and socio-economic progress of a country [2,9]. Acute malnutrition or wasting is a health indicator and a critical measure of children's nutritional status [17]. We examined the nutritional status of children aged 6-59 months in Ethiopia through a spatial and multilevel analysis approach based on the 2019 Ethiopian Demographic and Health Survey.…”

“…In this regard, Ethiopia design the program called "the sustainable undernutrition reduction in Ethiopia (SURE)" which is a government-led multi-sector intervention that helps to integrate the work of the health and agriculture sectors to deliver a complex multicomponent intervention to improve child feeding, diversi ed diet, and nutritional behavioral modi cation to reduce undernutrition [16]. However, under-nutrition remains high and suffers from a very high burden of acute and chronic malnutrition [17], with almost half of Ethiopian children chronically malnourished and 1 in 10 children wasted [18]. According to the Ethiopian Demographic and Health Survey (EDHS) quick list of, 2005, 2011, 2016, and 2019 the prevalence of under-ve wasting was 12.2%, 9.7 %, 9.9%, and 7.0% respectively [18][19][20][21].…”