Federal Democratic Republic of Ethiopia
The Federal Democratic Republic of Ethiopia is a landlocked mountainous country located in the North-eastern horn of Africa. Ethiopia, which is the second most populated country in Sub-Saharan Africa, is experiencing rapid population growth. The population is very young and is one of the least urbanized in the world.
Ethiopia is heavily dependant on the agricultural sector which accounts for almost half of the GDP. About three-quarters of the population are engaged in agriculture, mainly in subsistence and rain-fed farming and livestock production. Since 2000, the economy has been growing steadily. However, Ethiopia remains one of the poorest nations in the world, with almost a quarter of Ethiopians living with less than 1$ a day.
High incidence of infectious diseases and nutritional deficiencies, low immunization coverage, and very low access to improved water sources and sanitation are the major factors contributing to high morbidity. Due to a shortage of skilled health personnel and health facilities, access to basic health care is still very limited. Consequently, infant and under-five mortality rates remain very high, although some progress has been recorded. The maternal mortality ratio also remains unacceptably high.
The Ethiopian diet is mainly composed of cereals (maize, sorghum, teff), tubers and root crops (ensete, potatoes, sweet potatoes), pulses and oil seeds. Despite a large livestock population, the food supply of animal products is very limited, and consumption of these products is especially low in rural areas, except in nomadic areas where milk is a major component of the diet. Environmental and man-made factors cause widespread and severe food insecurity. The dietary energy supply is not sufficient to meet population energy requirements and almost half of the population is undernourished. Besides being quantitatively insufficient, food supplies also lack diversity.
Breastfeeding is widespread and early initiation is common. However, the duration of exclusive breastfeeding remains very short, bottle-feeding is frequent and complementary feeding practices are inadequate. These inappropriate practices, combined with poverty, food insecurity and limited access to health services, are major determinants of the high prevalence of malnutrition among young children. Almost half of underfives are stunted. Although the prevalence of stunting has declined slightly over the last five years, special attention still needs to be given to this silent emergency in order to obtain further reduction in prevalence. More than a quarter of women are affected by chronic energy deficiency.
Although recent data are lacking, it is likely that iodine deficiency disorders are still highly prevalent, especially in the mountainous parts of the country. There is currently no universal salt iodization programme in Ethiopia but a pilot project is envisaged. In the meantime alternative approaches such as iodized oil capsules should be implemented urgently. Vitamin A deficiency is a severe public health problem, affecting young children and mothers and reaching alarming levels in Amhara and Tigray. Vitamin A supplementation coverage remains limited, especially in rural areas. Intensification of vitamin A supplementation and implementation of long-term food-based interventions are needed. Anemia is also a public health problem: more than half of underfives and more than a quarter of women are anemic. Iron deficiency due to low consumption of foods of animal origin is the main cause, compounded by high incidence of malaria and other parasitic diseases. Iron supplementation of pregnant women, which reaches only a limited number of women, and nutrition education are the only interventions that are currently implemented to combat iron deficiency anemia. More efforts are needed to address this public health problem.
Severely affected by poverty, food insecurity and morbidity, rural populations are highly exposed to undernutrition and micronutrient deficiencies. Major efforts are needed to rapidly and sustainably improve the health and nutritional status of the population, which would have a positive impact on economic growth and development of the country.