NATIONAL NUTRITIONAL SURVEILLANCE SYSTEM
113 STATISTICAL BULLETIN May 1993

INTRODUCTION

A. Background

It is widely recognized from earlier national surveys and small-scale studies that malnutrition is a serious problem in Ethiopia. The problem has two distinct aspects: malnutrition resulting from drought in some years and some geographic areas, and chronic malnutrition resulting from poverty-related factors occurring in all parts of the country. Over the years, acute malnutrition has, of necessity, dominated the attention of government and outside organizations. However, there is a growing recognition that the long-term solution to the acute problems is to improve the underlying poverty-related factors which give rise to chromic malnutrition. Based on many years of experience in Ethiopia and other countries, it is known that these underlying factors include household food security, health status and child care and feeding practices. These, in turn, are affected by a wide range of other factors (income, prices, markets, water, sanitation, hygiene, education, female work loads, etc.). In, short, chronic malnutrition is a reflection of the success or failure of development in many sectors, and acute malnutrition caused by drought and other events will continue to plague Ethiopia until chronic malnutrition is significantly reduced through progress in social, as well as economic, development.

Social and economic development generally is a very long-term process requiring the efforts of all sectors, even under favorable conditions. Ethiopia has clearly not enjoyed favorable conditions in recent decades and, indeed, has suffered from stagnation or decline in the overall economy and key sectors. The GDP per capita annual growth rate during the 1980's had fallen below zero. During this same period agricultural output growth rate was much below 0.5% while population growth rate was 2.9% (FAO 1989, Addis Abeba).

The country is currently undergoing widespread reforms to reverse these negative trends, and these are likely to continue and intensify over the foreseeable future. While these reforms are necessary and highly desirable from a long-term perspective, they will also have strong effects on many aspects of human welfare during the transition. These effects may be positive or negative, depending upon the pace and way in which the reforms are pursued (Pinstrup-Andersen 1988). Nutrition is one aspect of human welfare, and is typically not the paramount concern of governments and international agencies as they attempt to redirect the economy. However, as described above, nutritional status is a useful and easily measured indicator of many aspects of human welfare and development processes. Thus, even though government and international policy makers do not base their reform-related decisions on nutrition in its own right or as a public health problem, there is strong justification for using indicators of nutritional status, among others, to assess the overall impact of their actions on human welfare and development processes. Thus, there are strong reasons for the Ethiopian government and international agencies to be concerned about nutrition in its own right, and to be interested in nutritional status as an indicator of development processes during a time of important policy changes. This coincides with efforts over the past three years to devalue a national nutrition surveillance system(NNSS), which began with a workshop held in Addis Abeba in May 1989 (ENI/RRC, 1989). This workshop recommended that a national technical committee be established to develop a plan for the NNSS. Soon thereafter, the committee was established, ¹ start-up funding was obtained from UNICEF, WHO and FAO, a pilot project was undertaken (ENI/CSA, 1990) and a detailed plan for the system was developed (NTCNS, 1991). Most recently, a national survey was undertaken by CSA in March 1992, which is the central component of the overall system. This report presents the results from this survey and recommendations for follow-on activities.

RESULTS

This section of the report focuses on overall findings following the outline provided earlier. In doing so it relies heavily on graphics, maps and tables to summarize key findings. In all cases these graphics are taken directly from the tables found at the end of the report. In, addition, the reader will find further material in those tables, which cannot be adequately covered in this section without overwhelming the reader. Users of this report are urged to go beyond the results summarized in this section, to identify the results which may have particular relevance to their own applications. It would be also important to note that in this report children aged 6 - 11, 6- 23 and 24 - 59 months are referred as infants, young children ad older children respectively. In presenting the findings, present tense has been unused mostly. But the result actually refer to the date of the survey.

A. National and Regional Levels of Malnutrition

For all regions covered in the 1992 survey, 64% of children aged 6 - 59 months are stunted (low height-for-age), 8.0% are wasted (low weight-for-height) and 47% are underweight (low weight-for-age). Figures 3 through 5 and Table 3 show that all three indicators are somewhat lower among infants (6-11 months), highest in the second year of life (12-23 months) and somewhat lower after 24 months.

These overall results have several striking features. First, the level of stunting is among the highest in the world, if not the highest (UNICEF State of the World's Children, 1990). Second, infants (59% for boys and 54% for girls). This suggests that it may be caused by factors affecting mothers during pregnancy and/or factors operating during infancy. This matter is explored further in a later section, A third, related, observation is that stunting in the Ethiopian Children set in earlier and does not continue to increase with the age of the child after infancy as it does in virtually all other populations up to the age of two. This reinforces the importance of the infancy period in the causation of stunting, since it appears that, height does not suffer greatly beyond that period in the Ethiopian case¹. Some related observations from these figures are that wasting is much lower than stunting, but the overall figure of 8.0% is till high by African standards. Moreover, wasting peaks in the period 12-23 months, with prevalence of 13% for boys and 105 for girls. These peaks are largely a reflection of the increased burden of infection and problems during the weaning period. Wasting peaks at such ages are found in most populations, but not to the same extent as those shown here for Ethiopia. As noted earlier, the prevalence of underweight reflects a combination of stunting and wasting, and the values are intermediate.

Table 4 show the level of stunting across the 22 regions covered in the survey. (Note that in this and most other figures, the regions are arranged in ascending order of the variable of interest, to help identify the high-risk areas). The results range from a low of 49% in South Omo to 75% in South Gonder. The regions with the highest rates, in addition to south Gonder, are East and West Gojam, North Welo, Tigray, Sidamo and Ilubabor, North Gonder and South Shewa all with rates above 66%. As shown in Table 5, the stunting rates in most of these high-risk regions are high for young children (6-23 months) as well as older children (24-59 months). In other regions, however, stunting is markedly higher among younger children (North, South and East Shewa, South Welo, Borena, Arsi and Kefa). Since there is normally little or no catch-up growth in height observed in countries like Ethiopia, the apparent decline in stunting with age in these regions may be due to time-dependent factors (e.g. drought episodes of diseases, weaning complications, civil unrest etc.) which affected the younger cohort much more than the older cohort. Table 3- Prevalence of Stunting, Wasting and Underweight by Age [in months) and Sex

Age & sex 

Stunting	Wasting	Underweight
Number	Percent	Numder	Percent	Number	Percent
Boys
1,238	59.0	1,227	6.5	1,244	42.5
11-23	2,358	74.5	2,351	13.0	2.367	59.7
24-35	2,172	65.5	2,161	6.9	2,176	50.4
36-59	4,645	63.1	4,641	7.9	4,662	45.3
All Ages	10,413	65.7	10 380	8.7	10,449	49.3
Girls
6-11	1,188	53.8	1,169	6.1	1,195	36.2
12-23	2,185	70.8	2,178	10.2	2,197	50.0
24-35	2,065	63.1	2,044	7.0	2,074	50.4
36-59	4,359	61.0	4,380	6.2	4,392	44.5
All Ages	9,817	62.7	9,771	7.2	9,858	45.9
Both Sexes
6-11	2,426	56.5	2,396	6.3	2,439	39.5
12-23	4,543	72.7	4,529	11.7	4,564	55.0
24-35	4,237	64.3	4,205	6.9	4,250	50.4
36-59	9,024	62.0	9,021	7.0	9,054	44.9
All Ages	20,230	64.2	20,151	8.0	20,307	47.71

Note: 1- "Number" in this and all Forthcoming Tables, unless described referes to the Number of Children in the Sample. 2- All prevalence are based on -2 Z-Scores Cut-Off Source: 1992 Rural National Nutrition Survey, CSA. Table 4- Prevalence of Stunting, Wasting and Underweight by Region

Region 

Stunting		Wasting	Underweight
Number	percent	Number	Percent	Number	Percent
Arsi	941	62.7	933	4.6	939	41.1
Bale	745	55.0	743	4.4	751	29.2
N.Omo	1,385	60.7	1,384	6.9	1,382	48.5
S.Omo	444	49.2	445	6.6	440	35.9
E,Gojam	1,052	68.9	1,044	13.3	1,063	54.1
W,Gojam	992	73.6	991	8.1	995	53.8
Metekel	483	57.2	482	6.7	482	42.6
N.Gonder	985	66.4	982	7.7	987	52.9
S.Gonder	537	74.5	534	9.9	539	62.0
Ilubabor	1,207	67.1	1,204	9.1	1,217	52.5
Kefa	1,102	60.9	1,097	7.3	1104	38.2
N,Shewa	450	56.7	452	5.1	450	31.1
E,Shewa	768	57.6	767	5.7	770	40.2
W.Shewa	1,122	62.1	1,119	5.3	1,125	39.8
S.Shewa	1.,275	66.1	1,261	6.3	1,285	44.4
A.Ababa	989	55.5	988	5.1	989	33.3
Sidamo	1,346	67.2	1,337	10.2	1,356	55.0
Borena	731	55.9	722	12.8	734	45.4
Tigray	1,272	67.9	1,2681	4.2	1,284	59.9
Welega	854	59.2	853	10.8	856	51.6
N,Welo	867	68.6	805	8.7	811	53.0
S.Welo	746	62.3	743	5.2	751	47.3
Total	20,233	64.2	20,154	8.0	20,310	47.6

The result for Addis Ababa in this and all forthcoming tables refers to surrounding rural areas of the city. Number of children in the sample are slightly different to those tnoted in other simlar Tables. This insignificant discrepancy was due to differences in Not Stated and/or missing cases. Source: 1992 Rural National Nutrition Survey, CSA. Table 5-prevalence of stunting by Region and Child's Age

6-23 Mos 24-59 Mos Region	Number	Percent	Number	Percent
Arsi	346	68.9	594	59.2
Bale	255	57.8	490	53.5
N.Omo	495	58.7	889	61.9
S.Omo	151	50.9	293	48.4
E.Gojam	376	70.5	676	68.1
W.Gojam	350	77.2	642	71.5
Metekel	139	60.1	344	55.8
N.Gonder	352	63.6	633	68.0
S.Gonder	201	75.6	336	73.9
Ilubabor	440	64.0	767	68.8
Kefa	389	65.4	712	58.2
N.Shewa	180	70.2	270	47.9
E.Shewa	281	65.7	487	53.0
W.Shewa	413	60.8	709	62.8
S.Shewa	398	67.8	877	65.4
Addis Ababa		331	59.5	658	53.5
Sidamo	423	64.7	920	68.3
Borena		209	70.0	532	50.2
Tigray	403	71.7	868	66.2
Welega	297	62.1	557	57.7
N.Welo	282	81.4 525	61.7
S.Welo		257	70.1	489	57,9
All Regions	6,968	67.0	13,258	62.8

Note: Same as Table 4. Source: 1992 Rural National Nurtition Survey, CSA.

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