Endris Seid Plant Biotechnology (M.SC)

1
Endris Seid
Plant Biotechnology (M.Sc)
“Whatsoever was the father of a disease, an ill diet
was the mother” George Herbert
What do you understand from this proverb?

“
Nutrition Sensitive Agriculture

2
Feed The future
Session Outline
 Introduction
 Definitions of Basic Terms
 Nutrient and their functions
 Food groups and their source
 Food and Nutrition security
 Malnutrition, forms of malnutrition and its causes
 Nutrition intervention strategies
 Summary
Nutrition Sensitive Agriculture 3

Objectives
At the end of this chapter participants will be able to:
Explain trends and prevalence of malnutrition in Ethiopia
Define important nutrition related terms
Describe food groups, nutrients and functions of nutrients
Discus food and nutrition security
Discus malnutrition and its different forms
Analyze the causal framework of malnutrition
Discus nutrition intervention strategies to combat malnutrition

4
Introduction
Why Nutrition Matter?
As an agriculture profession, is nutrition

our concern?
How do you decide what to eat in a

restaurant?

5
Introduction…
According to CoHA, 2012,
Today, more than 2 out of every 5 children in Ethiopia are stunted.
81% of all cases of child undernutrition and its related pathologies

go untreated
44% of the health costs associated with undernutrition occur before

the child turns 1 year-old.

6
Introduction…
 28% of all child mortality in Ethiopia is associated with un-
dernutrition.
 16% of all repetitions in primary school are associated with

stunting
 Child mortality associated with undernutrition has reduced

Ethiopia’s workforce by 8%
 67% of the adult population in Ethiopia suffered from stunting

as children.

Introduction…n
 The annual costs associated with child undernutrition are esti-

mated at ETB 55.5 billion
 Which is equivalent to 16.5% of GDP.

8
Nutritional status
Indicator Prevalence's Source
Stunting 38 EDHS 2016
Wasting 10 EDHS 2016
Underweight 24 EDHS 2016
LBW 13 EDHS 2016
Anemia among under 56 EDHS 2016
five children
Anemia women 23.4 EDHS 2016
Overweight women 8 EDHS 2016
BMI <18.5 women 22 EDHS 2016

1
0
Status of stunting prevalence within 5 yrs

Region EDHS 2011 EDHS 2016 remark
Amhara 52 46.3 1st
Oromia 41 36.5 7th
SNNP 44 38.6 6th
Tigray 51 39.3 5th
Afar 50.2 41.1 3rd
Benishangul G. 48.6 42.7 2nd
Gambela 27 23.5 10th
Harari 28.8 32.0 8th
Somali 27.4 9th
Diredawa 36.3 40.2 4th
National 44.4 38.4

Region # U5 children % U5 stunted # U5 stunted
Tigray 766,063 39.3 301,063
Afar 268,176 41.1 110,221
Amhara 2,853,223 46.3 1,321,042
Oromiya 5,816,588 36.5 2,123,055
Somali 1,052,067 27.4 288,266
Benshangul 172,692 73,739
42.7
SNNP 2,990,521 38.6 1,154,341
Gambella 58,859 13,832
23.5
Harari 31,734 10,155
32
Addis Ababa 247,248 36,098
14.6
Dire Dawa 56,386 40.2 22,667
National 13,775,246 38.4 5,289,694

Why these happen?

1
5
CSA
RegionAgricultural production sample survey
Production 2016/17
in quintals
2015/16 2016/17 DD
TIGRAY 15,663,285.10 18,448,000.20 13.7
AFAR 212,258.72 183,744.90 2.6
AMHARA 87,464,267.66 95,282,955.56 3.6
OROMIA 133,285,694.33 143,893,653.61 13.7
SOMALI 1,718,172.71 1, 453,702.76 4.6
BENISHANGUL-GU 4,817,641.94 5,409,168.11 20.6
S.N.N.P.R 23,400,556.99 25,134,237.79 13
GAMBELA 121,441.44 157,977.08 14.2
HARARI 164,372.57 95,291.12 18.1
DIRE DAWA 122,033.48 226,862.08 18.2

Indicator EDHS 2016
Exclusive Breast feeding 58
Complementary feeding 60
minimum acceptable diet among children 6-23 7
months
Minimum dietary diversity 14
Iron Folic acid supplement 90 tab 5
De-worming Pregnant and Lactating Women 6
Vitamin A Supplementation 6-59 months 44.7
PLW not taking Iron tabs 58
De-worming children 12.7
HH with iodized salt 87.9

Definition of Important Nutrition related Terms
Define the Terms: (Individual

Exercise)
Food
Diet
Balanced diet
Nutrients
18 Nutrition Sensitive Agriculture

 Food
 Any product obtained from plants or animals that
can be taken into the body to yield energy and
nutrients for the maintenance of life and the growth
and repair of tissues.
 Includes all foods and drinks acceptable to be
ingested by a certain society.

19
 Diet: is defined as the sequence of meals in a day. It
is concerned with the eating patterns of
individuals or a group.
 Eg: breakfast and dinner; breakfast, lunch, and dinner; and
other may add snack
 Balanced Diet: is a diet that contains all the
nutrients in the proportion that is optimal for long-
term health and survival.

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 Nutrients
 Chemical substances that are essential to life
which must be supplied by food to yield energy
and nutrients for the maintenance of life and the
growth and repair of tissues.

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Quick Exercise: Pair up and define the following
terms:
 Nutrition
 Malnutrition
 Over nutrition
 Under nutrition
 Nutritional requirement
 Nutrition sensitive agriculture

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Nutrition
 The scientific study of food and its nutrients; its functions,

actions, interactions and balance in relation to health and
disease.

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Malnutrition
 Under nutrition: results from inadequate intake of macro and

micro-nutrients or inability to fully utilize the food they eat due to
illness.
 Over nutrition: results from excessive intake and deposit of

nutrients (carbohydrate and fats)
 Micronutrient deficiency: Deficiency in one or more minerals or

vitamins
24 Nutrition Sensitive Agriculture

 Nutritional requirement: refers to the different nutrients re-
quired by the body for energy, growth and repair, as well as
protection from disease.
 It differ according to age, gender, physical activity, height,

weight, and health status of the individual.

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 Nutrition sensitive agriculture: An approach that
seeks to maximize agriculture’s contribution to nutrition
by focusing on the production of nutritious foods, and
entails targeting poor households, promoting gender
equality, and providing nutrition education so that
household resources are used to improve household
members’ nutrition, especially that of women and
young children.

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Nutrient and their functions
Two types of nutrients
Macronutrients: required in a large amount include

carbohydrates, proteins and fats
Micronutrients: required in a small amount and provide the

necessary co-factors for metabolism to be carried out and include
vitamins and minerals

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Nutrients…
Based on function and source there are six different types of
nutrients
Carbohydrates – are what our body burns most often for fuel,
much like firewood: Cereal, grains, legumes, fruits and vegetables
are the main source of carbohydrates.
Proteins - are the building blocks of the body tissue, and can also
serve as a fuel source: meat, egg, poultry, milk, fish and legumes
are main source of protein

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Nutrients…
 Fats - are also burned for energy and they give more fuel and
are easy for our bodies to store for later use: Fish, butter, beef,
egg, pork, milk, fruits such as avocado, nuts and soybeans are
good source of fat
 Vitamins – are essential for normal growth and health: most

vegetables and fruits are good source of vitamins


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Nutrients…
 Minerals – are nutrients that are important for normal body

growth and health. Iron (Fe), Iodine (I), Zinc (Zn), Calcium (Ca)
and Prosperous (P) are some examples of minerals
 Water - is needed for most body functions, including mainte-

nance of health and integrity of every cell in the body.

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Food Groups and their Sources
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Food and nutrition security
 What is the difference between food security and nutrition secur-
ity?
 Food security: 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.
(World Food Summit, 1996).


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 Nutrition security is when all people, at all times,
consume food of sufficient quantity and quality in
terms of variety, diversity, nutrient content and safety
to meet their dietary needs and food preferences for
an active and healthy life, coupled with a sanitary en-
vironment, adequate health and care. (State of Food
Security, 2013).

Food Security Nutrition Security
 Availability  Consumption of balanced
 Access diet to attain adequate nu-
 Utilization tritional status for healthy
and active life
 Sustainability
 NS – can be achieved by nar-

 FS - Can be achieved by
rowing ‘nutrient gap’ - cur-
narrowing the gap b/n
rent food intake pattern and
current & potential
optimal intake in terms of
production yields
macro & micro nutrient con-
tent
F & N Stability
3
5
Conceptual frameworks for food and nutrition security

Malnutrition
Malnutrition refers to abnormal nutrition condition, both

under-nutrition and over nutrition
Causes of malnutrition can be immediate, underlying, and

basic causes of malnutrition

37
Malnutrition ….
 Immediate causes that act on the individual.
 Underlying causes that act on households and com-

munities.
 Basic causes that act on entire societies

Forms of Malnutrition
Under nutrition
Protein-energy malnutrition: arises due to inadequate intake

of calories from macronutrients: Carbohydrates, fats and pro-
teins.
Micro-Malnutrition (Hidden Hunger) refers to mineral and

vitamin deficiency such as iron, iodine, and vitamin A.

40
Forms of ….
Over-nutrition
Overweight and obesity -BMI= Wt/ ht2
 Less than 18.5 under weight
 18.5 - 24.9 kg/m2 is within a healthy weight range
 25.0 - 29.9 kg/m2 overweight.
 Over 30 kg/m2 Obesity
Health consequences (diabetes, cardiovascular diseases, Cancer)

41
Forms of….
Co-existence of under and over-nutrition: “double
burden of malnutrition”
Obesity and protein energy malnutrition (PEM) in the
same family
Obesity and micronutrient deficiencies in the same in-
dividual
Chronic and acute malnutrition

42
Forms of…
 Stunting: chronic : too short for their age
 Wasting: Acute: too light for their height/length
 Underweight: low weight for their age
 Micronutrient Deficiency: “hidden hunger”.

43
Forms of…

44
F
2
3
D
-R
4
E
-
8
Malnutrition trend in Ethiopia
Stunting Underweight Wasting
60 58 51
44 40 38
40 41 33 29 25 23
20 12 12 10 9 10
0
2000 2005 2011 2014 2016
Impacts of Malnutrition

46
Nutrition Intervention Stratégies to Combat Malnutrition
 There is no single bullet proof nutrition strategy that can meet the
goal of achieving optimum nutrition for all
 Nutrition interventions are of two types

 Nutrition specific
 Nutrition sensitive

47
Nutrition specific interventions are interventions
or programs that address the immediate
 Nutrition Specific interventions are interventions or programs that
determinants
address the immediate determinants of fetal and child nutrition
and development
 IYCF and treatment of sever under nutrition
 Micro nutrient supplementation and fortification
 Hygienic practices

48
Nutrition Sensitive interventions
 Agriculture and food security
 Social safety nets
 Early child development; maternal mental health
 Women’s empowerment; child protection; schooling
 Water, sanitation, and hygiene
 Health and family planning services

Core Intervention areas
Life Cycle Approach to Nutrition
Nutritional status is an intergenerational continuum.

Maximum benefits in one age group come from invest-
ments in an earlier age group

Pre-conception nutrition
A women planning to be pregnant needs to take care of:
Achieve health body weight
Use iodine fortified salt
Consume diversified diet from at least five different food groups
Take folic acid supplementation every day
Stop smoking and drinking alcohol

5
3
Windows of opportunity
 1,000 days: between pregnancy and a child's 2nd birthday
 The most critical time for positive impact on a child's cognitive

and physical development
 Optimal nutrition for the mother and for the child during this
time can have a profound impact on the child's growth and
development and reduce disease risk

5
4
Promote and support good maternal nutrition
during pregnancy and lactation
During pregnancy & lactation provide
Iron/Folic Acid supplementation
Treatment & prevention of malaria
 Increase food intake
 one extra meal each day during pregnancy
 Two extra meals each day during lactation
De-worming during pregnancy
Vitamin A supplementation within 45 days of delivery

Promote and support optimal IYCF
 Immediate initiation of breastfeeding after birth (within one
hour of delivery)
 Exclusive breastfeeding for the first 6 months of life (no other
food than breast milk)
 Starting at 6 months appropriate complementary feeding (at
least four food group)
 Adequate care and feeding of sick children to prevent both acute
malnutrition and stunting
 Ensure water, sanitation and hygiene practice

Adolescent nutrition
 Total nutrient needs are higher during adolescence than any
other time in the lifecycle
 Failure to consume an adequate diet at this time can result in

delayed sexual maturation

5
7
 Making food more available and accessible
 Making food more diverse and production more sus-
tainable
 Making food itself more nutritious
 Nutrition-sensitive agriculture focuses on the production of a
variety of affordable, nutritious, culturally appropriate and safe
foods in enough quantities and quality to meet the nutritional
needs of a community in a sustainable manner

5
8
Nutrition Sensitive
Nutrition sensitive interventions or programs address the
underlying determinants of undernutrition
Agriculture and food security;
Social safety nets;
Early child development; maternal mental health;
Women’s empowerment; child protection; schooling;
Water, sanitation, and hygiene; health and family planning ser-
vices

59
National NSA strategy
 SO1: To incorporporate nutrition into agriculture and livestock
sector policies, strategies, programs and work plans at all
level.
 Result 1.1 Integrated nutrition into agriculture sector policy,
strategies, program and work plans at all level

NSA strategy….…
 SO2: To establish/strengthen institutional and organizational
structure and capacity responsible for implementing nutrition
sensitive agriculture.
 Result 2.1: Established/strengthened food and nutrition
structure and its affiliates at all level
 Result 2.2: Built capacity of implementers on nutrition sen-
sitive agriculture at all level
 Result 2.3: Revised curricula of Agriculture learning insti-
tutions with nutrition sensitive agriculture competencies

NSA strategy …
 SO3: Increase year-round availability, access and
consumption of diverse, safe and nutritious foods
 Result 3.1. Increased production of diversified and nutrient
dense foods
 Result 3.2. Increased consumption of safe, diverse and nu-
trient dense foods at household levels

NSA strategy …
 SO4: Enhance resilience of vulnerable agrarian, agro-pastoral

and pastoral communities and households prone to climate
change and moisture stress
Result 4.1 Strengthened resilience of food insecure and

vulnerable households and communities by incorporat-
ing nutrition sensitive agriculture interventions and
practices into the resource transfer programs/projects

NSA strategy …
 SO5: Ensure women and youth empowerment and gender
equality
 Result 5.1 Empowered women and enhanced their role in
nutrition sensitive agriculture
 SO6: Establish/strengthen strong multi-sectorial coordination

within the agriculture sectors and with signatories of NNP and
other development partners
 Result 6.1 Strengthened intra and inter-sectorial nutrition
coordination at all level

Caring Practice
 Underlying cause for malnutrition
 Caring practices such as breastfeeding, appropriate complemen-

tary feeding, as well as hygiene and health seeking behaviors
support good nutrition.

65
Water, Sanitation and Hygiene (WASH )
 In Ethiopia WASH is one of the major areas of intervention for

improved health and nutritional status
 Improved water supply
 Safe household water management treatment and storage
 Improved household toilets or latrines
 Handwashing with soap

66
Exercise
 List all the foods you have consumed within the previous day
(over 24 hours) including drinks, within and outside of your
home.
 Categorize the listed food items in to the six food groups (Use
the provided table for categorization).
 List the nutrients available in the food groups you have con-
sumed in the past 24 hour
 Identify the food groups you missed in the previous day and
list what kind of nutrients do they contain?

Food groups
Staples Legumes/Nuts Vegetables Fruits Animal Source Fats

food

Group exercise
 Look the picture below very carefully

 Assume all of the four children are found within the same age
group.
 Discus the nutritional status of the children

Goitom Zeray Mehari Seyoum

Summary Why nutrition matter ?
Because when.. Children receive
Girls & women are Children
proper receive
nutrition
well-nourished and proper
and nutrition
develop and
strong
have healthy develop
bodies & strong
minds
newborn babies bodies & minds
The world, region, Adolescents learn

Communities & Nations, is a safer, better & achieve
nations are more resilient & higher grades
productive & stable stronger place in school
Families & Young adults are

communities emerge better able
out of poverty to obtain
work & earn more
72

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1

What do you understand from this proverb?

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture 3

Nutrition Sensitive Agriculture

Why Nutrition Matter?

As an agriculture profession, is nutrition

How do you decide what to eat in a

Nutrition Sensitive Agriculture

Today, more than 2 out of every 5 children in Ethiopia are stunted.

81% of all cases of child undernutrition and its related pathologies

44% of the health costs associated with undernutrition occur before

Nutrition Sensitive Agriculture

 16% of all repetitions in primary school are associated with

 Child mortality associated with undernutrition has reduced

 67% of the adult population in Ethiopia suffered from stunting

Nutrition Sensitive Agriculture 7

 The annual costs associated with child undernutrition are esti-

 Which is equivalent to 16.5% of GDP.

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Status of stunting prevalence within 5 yrs

Oromia 41 36.5 7th

SNNP 44 38.6 6th

Tigray 51 39.3 5th

Afar 50.2 41.1 3rd

Benishangul G. 48.6 42.7 2nd

Gambela 27 23.5 10th

Harari 28.8 32.0 8th

Somali 27.4 9th

Diredawa 36.3 40.2 4th

National 44.4 38.4

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Define the Terms: (Individual

18 Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

 The scientific study of food and its nutrients; its functions,

Nutrition Sensitive Agriculture

 Under nutrition: results from inadequate intake of macro and

 Over nutrition: results from excessive intake and deposit of

 Micronutrient deficiency: Deficiency in one or more minerals or

24 Nutrition Sensitive Agriculture

 It differ according to age, gender, physical activity, height,

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Macronutrients: required in a large amount include

Micronutrients: required in a small amount and provide the

Nutrition Sensitive Agriculture

 Vitamins – are essential for normal growth and health: most

Nutrition Sensitive Agriculture

 Minerals – are nutrients that are important for normal body

 Water - is needed for most body functions, including mainte-

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

Nutrition Sensitive Agriculture

 NS – can be achieved by nar-