Bi Annual Nutrition Review Meeting and Capacity Building Workshop January 26,2008 Woliso June 161

Why Nutrition Matters? June 162

Contents Nutrition Status  Globally  National Level  Regional Level Effects of Malnutrition Window of Intervention June 16 3

Under-nutrition Globally Few countries in the world have highest rate of stunting prevalence 1 billion people Undernourished 162 million children <5 yrs - Stunted, 99 million – Underweight 51 million – Wasted Lancet MCN series, UNICEF/ WB/ WHO, June 16

% Stunting in Africa Under-nutrition in Sub-Saharan Africa 5June 16

The Problem of Under-nutrition … Major causes of malnutrition in Ethiopia are preventable. These are: – Poor maternal nutrition, – Poor infant and young child feeding, – Childhood illness, – Poor WASH practices – Inadequate health care practices and – Limited availability and access to diversified foods In addition, care givers illiteracy and inadequate maternal economic access and control are the basic causes June 166

Trends in Nutritional Status of Children under 5 in Ethiopia, June 167

Under-nutrition in Ethiopia (EDHS 2011) 8June 16

Malnutrition by Degree of Food Insecurity Under-nutrition in Ethiopia cont… June 169

Prevalence of Stunting by Economic Status Under-nutrition in Ethiopia cont… June 1610

Trends in nutritional status of children under 5 years of age, in the last 4 DHSs Oromia

Regional Scenario Stunting- 41.4% ( 2,217,325 U5Children) this means more than2 out of every 5 children are stunted in the region Underweight -26% (1,406,108 U5Children) Wasting – 9.7% ( 524,587 U5Children) Anaemia in Children – 51.7% Anaemia in women years – 19.2% Households consuming iodized salt – 17.4% Women BMI <18.5 kg/m 2 (thin) – 26.9% EDHS 2011

Impacts of Nutrition June 1613

Stunting and brain development NormalStunted 14 Typical brain cells Extensive branching Impaired brain cells Limited branching Abnormal, shorter branches Source: Cordero E et al, 1993 June 16

Under-nutrition also lowers cognition and impedes learning. 45% of the 6.9 million child deaths in 2011 were related to under-nutrition. 10% of an individual’s life-time earnings 11% of a country’s GDP is lost annually due to high prevalence of under-nutrition. Every dollar spent on nutrition-specific interventions has an average return $ Copenhagen Consensus, 2008/ 2013; LNS 2013 Social and Economic Implications June 1615

Effect of Under-nutrition on Health Cost Pathologies Number of episodes Relative risk Cost (In millions birr) Cost to the family(MB ) Cost to the system(MB) LBW/IUGR148, (90%)(10%) Anemia365,31112% more130 ADS527,1535% more144 ARI114,3006% more61 Underweight2,991, Fever/Malaria264,2324% more231 Total4,410, ,8221, Source: Model estimations based on DHS 2005/2011, and Demographic information and data provided by the National Implementation Team Estimation of health costs of under nutrition related pathologies on public and private health costs, 2009 (In millions of Ethiopian birr 1.8 BETB = 0.54 % GDP June 1616

Stunted children have a 3.9% more risk of repetition than non- stunted children +3.9% higher Effect of under-nutrition on Education June 1617

Effect of under-nutrition on Education Retention/dropout 19% of non stunted population completed primary school compared to only 8% of stunted children 12% of non- stunted completed secondary school, while 4% of the stunted population completed secondary school June 1618

Cost of under-nutrition associated repetition to the country EDP PrimaryTotal Number of repetitions152, Public Costs per student (ETB) Total Public Costs (millions of ETB) 3434 million Private Costs per student (ETB) Total Private Costs (millions of ETB 5959 Million Total (millions of ETB)93 Million ETB Source: Estimations based on official education statistics of Ministry of Education (2009). COSTS OF GRADE REPETITION ASSOCIATED TO STUNTED CHILDREN, 2009 Equival ent to 0.03% of GDP June 1619

Effect of under-nutrition on productivity Studies indicates that when a child is stunted, this will impact them when they enter the labour force. On the whole, stunted workers are less productive than non- stunted workers, and are less able to contribute to the national economy. June 1620

Effect of under-nutrition on Income 625 Million birr = 0.2% GDP June 1621

Effect of under-nutrition on Manual Intensive Activities 12.8 BETB = 3.8% of GDP in 2009 Source: Estimations based on data from CSA/ EHICE 2010/2011 and WHO/NCHS Database information and relative risk information million WAP were stunted, represents 67 % of the working age population in ML June 1622

Productive Losses Due to Child Mortality Source: Estimations based on data from CSA/ EHICE 2010/2011 and WHO/NCHS Database information and relative risk information. 4.8 billion working hours lost Economic losses due to mortality are 40 Billion ETB = 11.9% GDP June 1623

Total costs of Child under-nutrition to Ethiopia June 1624 ETB 55.5 Billion/ USD 4.7 B

ESTIMATED SAVINGS FOR EACH SCENARIO, 2009 Scenarios Baseline: The Cost of Inaction by 2025 Scenario #1: Halving the Prevalence of Child Under-nutrition by 2025 Scenario #2. The ‘Goal’ Scenario: “10 and 5 by 2025” Description Stunting = 46.4% Underweight = 31% Stunting = 23.2% Underweight = 15.5% Stunting = 10% Underweight = 5%. Implications No increase or decrease but total number of stunted children and burden increases Reduce stunting of 1.5% points annually is required Reduction of 2.3% points annually is required Estimated Change in period Total cost increase of up to 39% for 2025 compared to the values in billion ETB Accumulated savings of 70.9 billion ETB for the period from 2009 to billion ETB Accumulated savings of 148 billion ETB for the period from 2009 to 2025 Annual Average Savings None 4.4 billion ETB (USD 376 million) 9.2 billion ETB (USD 784 million) June 1625

We choose... Source: Francisco Espejo’s presentation on cost of hunger; Picture design by Jhoram Moya To pay the consequences of having under-nutrition To pay for eradicating under- nutrition June 1626

Window of opportunity to avert malnutrition June 1627

Harka wal qabannee Jijjiiramaaf Yaa Hojjannu !!!!! June 1628

June 1629