Official name

Ethiopia: Food-Based Dietary Guidelines–2022

Publication year

Ethiopia’s first dietary guidelines were published in 2022. It is anticipated that the guidelines will be revised between 2027 and 2029.

Stakeholder involvement

The development of the Ethiopian dietary guidelines was led and coordinated by the Ethiopian Public Health Institute (EPHI), the technical arm of the Ministry of Health. Stakeholders from national and international organizations were involved in their development. Government institutions included the Ministries of Health, Agriculture, and Education. The development process was supported by the following international organizations: the Food and Agriculture Organization of the United Nations (FAO), International Livestock Institute (ILRI), Wageningen University and Research (WUR), and the CGIAR Research Program on Agriculture for Nutrition and Health.

Representing the multi-sectoral engagement in their development and implementation, the guidelines have been endorsed by the Ministry of Health, the Ministry of Agriculture, and the Ministry of Education.

Products, Resources and Target audiences

Development process

The guidelines aim to (1) provide dietary recommendations for the Ethiopian population two years and older to increase diet quality, including diversity and food safety, for optimal health, and (2) promote broad food system actions supporting diet quality while being sensitive to sustainability.

The development process started in 2018 and the guidelines were finalized in 2022. The process involved setting up a multisectoral and multidisciplinary technical working group that established the development and methodological framework for the dietary guidelines. Based on recommendations by the technical working group, six priority areas were identified for evidence review and secondary data analysis to inform the development of the guidelines:

• priority diet-related diseases and diet relationship
• dietary intake gaps
• food availability, seasonality and accessibility
• determinants of food choice
• social and behaviour change communication interventions
• Ethiopia’s food treasures (revitalizing Ethiopia’s underutilized fruits and vegetables for inclusion in the guidelines for improved diet diversity, nutrition and health of the population)

Findings from this review informed the identification of technical recommendations, which were then translated into eleven key messages for the public and a visual food guide representing these key messages. Diet modelling was used to determine the proportions for each food group in the visual food guide and to refine the qualitative dietary goals included in the key messages. The diet modelling for various population groups was categorized into three energy level requirements in the non-fasting, continuous fasting, and intermittent fasting diets using individual and population-based diet modelling. The three energy levels in the specific subpopulation diets were characterised as low (1250 kcal/day representative for preschool children, 2-5 years old), medium (2300 kcal/day representative for school-age children, 6-18 years and older people, +65 years old), and high (2700 kcal/day representative for adult men and women 19-64 years old). The key messages, visual food guide and other food graphics were field-tested.

Implementation

The official implementation plan is currently being developed.

Evaluation

An official monitoring and evaluation plan for the guidelines is being developed. EPHI plans to collaborate with the Ministries of Health, Agriculture and Education, research organizations, universities, and other stakeholders to identify appropriate M&E indicators covering short-term, medium-term, and long-term outcomes.

Food guide

The visual representation of the guidelines is a meskel flower (the flower signals the start of the new year and the harvest season, and students and workers start their work with new hope and energy). Six food groups are displayed inside the petals:

1. Cereal, grains, roots and tubers
2. Legumes
3. Nuts and oilseeds
4. Milk and dairy foods; meat, fish and egg
5. Fruits and vegetables
6. Fats and oils

There is a glass of water at the center of the flower as a reminder to drink clean water throughout the day. The mother, father and baby at the bottom indicate the target of the Ethiopian FBDGs, that is, all family members above 2 years old.

Messages

The 11 key messages for the public are:

1. Diversify your diet by selecting at least 4 food groups in every meal and 6 food groups every day.
2. Every day, eat 80–120 grams of legumes such as beans, chickpeas, peas, or lentils
3. Eat 100–200 grams of various fruits and vegetables of different colours every day, such as bananas, papayas, kale, carrots, and tomatoes
4. Diversify your diet with 10–20 grams of nuts and oilseeds such as groundnuts, and sunflower or sesame seeds
5. Add animal-source foods such as eggs and meat (60 grams) and dairy foods (300–400 grams) to your meals every day
6. Drink 8–10 large glasses of clean water every day
7. Take up to 15–20 grams of fats and oils per day
8. Be physically active for at least 30 minutes a day
9. Limit intake of sugar, sweets, and soft drinks to below 30 grams per day
10. Limit salt intake to below 5 grams per day
11. Limit alcoholic drinks, both factory-processed and homemade, to no more than 2 glasses per week.

Sustainability

One of the main objectives of the Ethiopian FBDGs is to promote broad food system actions supporting diet quality and being sensitive to sustainability. For the purposes of the Ethiopian dietary guidelines, the FAO/WHO definition of sustainable healthy diets was considered:

“Sustainable healthy diets are dietary patterns that promote all dimensions of an individual’s health and wellbeing; have low environmental pressure and impact; are accessible, affordable, safe and equitable; and are culturally acceptable.”

The Ethiopian dietary guidelines were developed recognizing the need to address social-cultural, economic, and environmental sustainability through the promotion of (1) diversified, nutrient-dense, and healthy diets that are equitably accessible and affordable to the general population, including vulnerable groups, (2) environmental sustainability and resilience across the entire food system from production to consumption, and (3) economic development and poverty reduction through the agriculture sector.