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Increased Production
Product Diversification
Home utilization
TABLE OF CONTENT
BACKGROUND ....................................................................................................................................... 1
2.
3.
4.
5.
3.1.
3.2.
4.2.
4.3.
5.2.
5.2.1.
5.2.2.
5.3.
5.4.
Nutrition Education..................................................................................................................... 20
5.4.1.
5.4.2.
5.4.3.
SOURCES ..................................................................................................................................................... 22
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LIST OF FIGURES
Figure 3-1 Components of food and nutrition security................................................................................. 4
Figure 3-2 Stunting prevalence of the different regional states, Ethiopia .................................................... 5
Figure 3-3 Food balance sheet for Ethiopia, FAO, 2014 ................................................................................ 6
Figure 4-1 Recommended energy shares of the different macronutrients for a healthy life......................... 8
Figure 4-2 Sources of carbohydrates............................................................................................................ 9
Figure 4-3 sources of proteins .................................................................................................................... 10
Figure 4-4 sources of dietary fats ............................................................................................................... 11
Figure 4-5 Foods considered to be rich sources of micronutrients ............................................................ 12
Figure 4-6 Sources of micronutrients (vitamins and minerals) .................................................................. 13
Figure 4-7: Ethiopian traditional: a plate with the different food groups.................................................. 16
Figure 4-7: Food pyramid showing the types and amount of food groups in a healthy diet. ..................... 17
Figure 4-8: Food plate showing the types and amount of food groups for a healthy diet. ......................... 18
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LIST OF TABLES
Table 4-1: Summary of the functions of carbohydrates in humans body .................................................... 8
Table 4-2: Summary of the functions and dietary sources of some vitamins .............................................. 14
Table 4-3: Summary of the functions and dietary sources of important minerals ...................................... 14
Table 4-4: Summary of types and functions nutrients ................................................................................. 15
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LIST OF ABBREVIATIONS
COHA
DDS
EDHS
FAO
FTC
GDP
IDA
IDD
IFPRI
MAD
MDD
NNP
OFSP
PEM
Protein-energy malnutrition
SAM
VAD
vitamin A deficiency
1. BACKGROUND
Malnutrition continues to affect the lives of millions of children and women worldwide. Every
country is affected by some form of nutrition problem1. Malnutrition can be over nutrition
(usually in the developed world) and under nutrition (in developing countries). Under-nutrition
mostly affects hundreds of millions of pregnant women and young children in developing
countries. It is manifested in both macro- (protein-energy) and micro-nutrient (iron, zinc, iodine
and vitamin A) deficiencies in these countries. Chronic under-nutrition is indicated in children by
high prevalence of stunting (too short for their age). Acute forms of malnutrition are indicated by
the prevalence of wasting (too low weight for height). Globally, 19 million new cases of severe
acute malnutrition (SAM) are documented each year, which is responsible for over one million
under-five mortality.
The Global Nutrition Report of 2014 indicated that the burden of under-nutrition is affecting the
economies of the countries in the Easter African, the Caribbean and South -Eastern Asian
regions. The report also indicated that very limited progress in nutrition interventions were made
in these regions. The cost of hunger in Africa (COHA) study, also reported that malnutrition
costs Ethiopia about 55.5 billion birr per year, which is 16% of the total gross domestic product
(GDP) of the country.
The Ethiopian demographic and health survey (EDHS) of 20112, indicated that the prevalence of
stunting, underweight and wasting are 44%, 29% and 10%, respectively. Under-five mortality
was also reported to be about 88 deaths per 1000 live birth, of which over 51% is attributable to
malnutrition. Micronutrient deficiencies are also of public health significance in Ethiopia. The
prevalence of iron deficiency anemia (IDA), iodine deficiency disorder (IDD), vitamin A
deficiency (VAD) and zinc deficiency is very high and is identified as nutritional problem of
public health significance.
International Food Policy Research Institute (IFPRI) (2014), Global Nutrition Report, the words of HE, Dr. Kesetebirhan
Adamsu Birhane, Minister, Federal Ministry of Health, Ethiopia.
2
Ending malnutrition throughout the world requires action on many fronts which the health sector
cannot do alone3. The Ethiopian government launched a 5 years national nutrition program in
2008. The program was revised and re-launched in June 2013. The revision emphasized on a
multi-sectorial implementation approach and 9 line ministries have shown their commitments to
take their part and play a role. Much is expected from the Ministry of Agriculture (MA) in
effective implementation and sustainable improvement of the nutritional status of women in the
reproductive age groups and young children. Other ministries are also expected to play their
roles to realize the long term plans of the Ethiopian government of making the country among
the middle income ones in the near future.
International Food Policy Research Institute (IFPRI) (2014), Global Nutrition Report, the words of Margaret Chan, Director
General, World Health Organizations.
2. TRAINING OBJECTIVES
This training manual is designed for training professionals and students in the fields of
agriculture to:
aware students in the agriculture fields about the impact of under-nutrition on the
wellbeing and economic development of the community
make the agriculture students understand the importance of proper nutrition and its
association with the socio-economic development of the community and the nation
enable students in the agricultural fields to understand the different categories of nutrients
and their roles in the normal functioning of human bodies.
elaborate the concept of balanced and healthy diet for humans depending on different
preconditions and health situations of individuals.
capacitate the agriculture students and professionals to contribute to effective
implementation of nutrition programs at all levels .
sensitize the agriculture professionals on how to make their activities agriculture sensitive
and contribute to accelerated and effective implementation of the National Nutrition
Program (NNP) of the Ethiopian Government.
orient the agriculture sector actors of tomorrow on their roles in the multi-sectorial
implementation approach of the national program.
enable the agriculture sector students and professionals to focus on not only the yield but
also the quality and diversity of crops.
integrate home utilization of nutritious crops and products into the agricultural extension
systems, rather than market oriented production.
promote rearing of small ruminant animals for home consumption, particularly for young
children and pregnant/lactating women.
promote hygiene and sanitation practices in the preparation of foods and feeding children.
3. WHAT IS MALNUTRITION?
Malnutrition is the lack of adequate amounts and types of nutrients that result in ill health. It can
also be due to a situation where our body is unable to absorb or utilize the nutrients from the
food we eat. Malnutrition particularly under-nutrition therefore occurs when sustainable
availability, accessibility and utilization of adequate and quality foods is compromised.
Malnutrition is the opposite of Food and nutrition security.
Availability
accessibility
Utilization
3.1.
Types of malnutrition
3.2.
Malnutrition in Ethiopia
Both protein energy malnutrition (PEM) and micronutrient deficiencies are highly prevalent in
Ethiopia. The average energy intake of the population is about 1980 kilocalorie per person per
day and this is about 10% less than the recommendation (2250 kilocalories per person per day).
Stunting prevalence as an indicator of the PEM among the different regional states in Ethiopia is
summarized in Figure 3-2 below.
As it can be clearly seen in the map (Figure 3-2), the prevalence of stunting is the highest in the
Amhara region, regardless of the high production practices and potentials of cereal staples.
Stunting prevalence of Amhara, Tigray, Affar and Ben-Shangul Gumuz regional states is much
higher than the national average (44%). Figure 3-3 below shows the composition of Ethiopian
diet (kcal proportion), food balance sheet based on the 2011 EDHS.
Cereals
Starcy Roots
Pulses
Vegetable oils
Sugar
Milk
Vegetables
Oil crops
Animal fat
Meat
Fruit
Spices
Alcohol beverages
4.1.
Macro nutrients, which are required in larger quantities, include carbohydrates, fats and proteins.
They are used as a source of energy and for growth and cell repair. It is recommended that the
carbohydrates and proteins contribute larger proportion of the caloric requirements and are
usually obtained from staples. The level of sugars (sweets) and fats in the diets need to be limited
(Figures 4-1 and 4-2) to maintain a healthy life. The energy share of carbohydrates, fats and
proteins is recommended to be 55%, 30% and 15%, respectively for a healthy life (Figure 4-1).
A) Carbohydrates
Carbohydrates are the single most abundant & economic sources of food energy in the human
diet, constituting 4080% of total energy intake in different populations. The food sources of
carbohydrates include: cereals, starchy roots, sugar, honey, sweet fruits and processed foods like
pasta and macaroni. Intakes of optimum amounts of different types of carbohydrates are
associated with good health through effects on energy balance, digestive functions, blood
glucose control, and other risk factors for several chronic diseases. Detail in the functions of
carbohydrates is summarized in Table 4-1.
Fats
Proteins
Macronutrients
Carbohydrates
0%
20%
40%
60%
80%
100%
Figure 4-1 Recommended energy shares of the different macronutrients for a healthy life
B) Proteins
Protein is the most abundant nitrogen-containing compound in the diet and the body. The
simplest units of proteins are amino-acids. Essential amino acids cannot be synthesized by
humans from materials ordinarily available to cells and they have to be obtained from diets. For
infants, children, and pregnant as well as lactating women, requirements would include protein
deposited and secretion of milk proteins. The food sources of proteins include: legume crops
(common beans, faba beans, peas, lentils, chickpeas, soybeans) and animal sources like milk and
milk products, eggs, lean meat, fish and chicken. All animal foods contain better quality proteins
than plants and are therefore usually better sources of body building foods. The better quality of
animal source foods can be explained in terms of their essential amino acid content and
bioavailability for utilization by our body.
Proteins have the following functions in the body:
For growth and development of the body
For body maintenance and the repair as well as replacement of worn out or damaged
tissues
To produce metabolic and digestive enzymes
As an essential constituent of certain hormones, (e.g. thyroxine and insulin).
C) Fats
Fat is an essential nutrient for life. Our bodies require small amounts of several fatty acids from
foods (the so-called essential fatty acids). Dietary fats are obtained both from plants (vegetable
and seed oils) and animals (lard, butter, and eggs). Fats play the following vital functions in the
body:
o skin integrity,
o utilization of body fat and
o maintenance of cell membranes.
4.2.
Micronutrients are those required for our body in tiny amounts, yet failing to get even those
small quantities virtually results in illnesses. Micronutrients include the different vitamins and
minerals. The dietary sources of vitamins and minerals are fruits, vegetables, animal source
foods, grains, seeds, nuts and so on. Benefits of micronutrients include:
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A) Vitamins
Vitamins are organic compounds that are required by humans body in limited amounts.
Vitamins are compounds which cannot be synthesized in the body but obtained from diets.
Vitamins are classified according to their solubility in water and fat soluble groups:
a. The fat soluble vitamins (vitamin A , vitamin D, vitamin E and vitamin K)
Here are some examples of the essential roles these vitamins play:
Some examples of how different water soluble vitamins help us maintain health:
Release energy Several B vitamins are key components of certain coenzymes (molecules
that aid enzymes) that help release energy from food.
Produce energy. Thiamin, riboflavin, niacin, pantothenic acid, and biotin engage in
energy production.
12
Build proteins and cells. Vitamins B6, B12, and folic acid metabolize amino acids (the
building blocks of proteins) and help cells multiply.
13
Table 4-2: Summary of the functions and dietary sources of some vitamins
Vitamins
Functions
Food Sources
Breast milk, Tomatoes, Cabbage, lettuce,
Night vision, healing epithelial
Pumpkins, mangoes, papaya, Carrots,
Vitamin A
cells, normal development of
liver, kidney, egg yolk, milk, butter,
teeth & bones
cheese, cream
Milk, egg yolk, liver, kidney and heart,
Vitamin B
Metabolism of carbohydrates,
whole grain cereals, meat, whole bread,
complexes
proteins and fats
fish, banana
Vitamin C
Vitamin D
Vitamin K
A) Minerals
Minerals have numerous functions in humans body. Sodium, potassium and chlorine are present
as salts in body fluids, where they have a physiological role in maintaining osmotic pressure.
Minerals form part of many tissues. For instance calcium and phosphorus in bones combine to
give rigidity to the whole body. They are also essential constituents of certain hormones. Iodine
for example is important part of the thyroxine produced by the thyroid gland. The principal
minerals in the human body are calcium, phosphorus, potassium, sodium, chlorine, sulphur,
copper, magnesium, manganese, iron, iodine, fluorine, zinc, cobalt and selenium. Minerals that
are of most importance in human nutrition are calcium, iron, iodine, fluorine and zinc.
Table 4-3: Summary of the functions and dietary sources of important minerals
Minerals Functions
Food Sources
Milk, cheese and dairy products, Foods fortified
Gives bones and teeth rigidity &
Calcium
with calcium, e.g. flour, cereals, eggs, fish,
Strength
cabbage
Meat and meat products, eggs bread, leafy
Iron
Formation of haemoglobin
vegetables, pulses, fruits
Iodized salt, sea vegetables, yoghurt, cows
Iodine
Normal metabolism of cells
milk, egg, cheese, fish, plants grown in Iodine
rich soil
For children to grow & develop
Zinc
Maize, fish, breast milk, meat, beans
normally, for wound healing
Fluorine
Helps to keep teeth strong
Water
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4.3.
Eating a balanced diet means choosing a wide variety of foods and drinks from all the food
groups (cereals and starchy roots; legumes and nuts; vegetables; fruits; milk and other dairy
products; meat, poultry, eggs and fish products; fats, oils and sweets). Balanced diet also means
having larger proportion of grains, roots and legume products; fair amounts of fruits, non-starchy
vegetables, meats and poultry products as well as milk products and small portion of fats, oils
and sweets in our daily meals. The levels of the different food groups in our daily meals are
usually demonstrated in a food guide pyramid (Figure 4-8) or in a food plate (Figure 4-9). The
Ethiopian Food culture is more related to the food guide plate and as injera or other flat breads
are prepared in round (circular) shapes and are accompanied by different stews (sauces) prepared
from different food groups (Figure 4-7).
15
Figure 4-7: Ethiopian traditional: a plate with the different food groups.
Including the recommended levels of the different food groups in our daily meals guarantee the
intake of all the macro- and micro-nutrients required by our body for the normal growth and
proper functioning of the various systems. Eating balanced diet and doing physical exercises on a
regular basis will help us have a healthy and productive life.
Individuals or groups eating meals prepared from less than 4 of the various food groups are said
to have poor dietary diversity score (DDS) and are at risk of both macro- and micro-nutrient
deficiencies. A global report on nutrition (IFPRI, 2014) indicated that a small proportion of
young children have been reported to have the minimum acceptable diets (MAD) 15% and
minimum dietary diversity score (MDD)-27%. This is situation is worse in developing countries
like Ethiopia. Food availability, affordability and awareness of the community can be mentioned
as the factors behind lower dietary diversity scores.
16
Figure 4-8: Food pyramid showing the types and amount of food groups in a healthy diet.
17
Figure 4-9: Food plate showing the types and amount of food groups for a healthy diet.
18
Increased Productivity
The agriculture sector needs to make effort to increase the production and productivity of the
food crops to ensure the sustainable availability and affordability of staple and nutritious crops.
Food crops with high nutritional importance need to be selected and made to give high yields
with reasonable resistant to adverse environmental conditions. The agriculture sector needs to
play a role of improving the production and productivity and also work on the awareness of the
community on the importance on new crops for nutrition and health.
5.2.
Diet Diversification
Besides increasing the production and productivity of crops, increasing the diversity of food
crops is crucial to improving nutrition. High quality nutritious crops like fruits and vegetables,
legumes and nuts as well as rearing of small ruminant animals and poultries is very important for
food and nutrition security of the farming community. Production of diversity of foods alone
does not guarantee improved nutrition of the community. The agriculture professionals need to
also educate the farmers on hygienic preparation of the crops and encourage the home
consumption of the nutritious crops, and to take only the surplus to the market. Teaching the
mothers to include these nutritious crops in complementary foods for children under 2 years of
age is also very important.
Legumes (cheap protein sources poor mans meat) need to be grown and used for consumption
at household level. The production (back yard gardens, irrigation) and consumption of fruits and
vegetables, (rich sources of many micronutrients vitamins and minerals), are also required to
be promoted to the farming communities. Orienting the farmers to feed adequate amounts of
fruits and vegetables to their children and women of reproductive ages is expected from the
agriculture sector professionals.
19
Rearing of small ruminant animals (goats, sheep) and poultries (chicken) are among the low cost
agricultural activities. The small animals can be consumed at home or can be used as a source of
income to buy more nutritious foods for the families. Eggs for instance can be fed to children and
lactating or pregnant women to improve their protein requirements. Milk and milk products can
also be used to improve the nutritional status of the families.
Education and demonstration on better management practices for the small animals and poultries
as well as importance of home consumption of animal source foods need to be delivered to the
farming communities by the agricultural professionals and development agents.
5.3.
High quality nutritious crops like the deep colored fruits and leafy vegetables as well as orange
fleshed sweet potato (OFSP) can be promoted to new areas to improve the vitamin A deficiency
problems in young children. Depending on the availability and quality of water, small scale
fishery farms can also be established at farmers training centers (FTC) and demonstrated to the
community. The utilization of fortified foods and their preparations can also be demonstrated to
the community on special events or regular basis. For instance the importance of iodized salt and
its management during storage and cooking can be demonstrated to women groups by the
agriculture professionals and extension workers.
5.4.
Nutrition Education
5.4.1. Complementary feeding
The Agriculture sector should be the major player in promoting complementary feeding of young
children between 6 and 23 months of age for accelerated stunting reduction in Ethiopia. The
agriculture sector needs to promote the production of crops that are important for the formulation
of high quality complementary foods. The agriculture sector should also take the responsibility
of formulating cereal-based local complementary foods with the inclusion of 20-30% legumes
and nuts. The Agricultural extension and development agents need to own the complementary
feeding component of the national nutrition program.
20
The Agricultural extensionists and development agents need to be trained on the consistency
(appropriate thickness) and feeding frequency and amount of the complementary food. They are
also required to get training on the enrichment of complementary foods (adding meet powder,
using milk instead of water, use of oils and fats, use of sugar and iodized salt).
The foods that are consumed by humans are also needed by other organisms like bacterial, molds
and yeasts. They are also important for rodents and other pests. The micro and macro organism
that feed on human foods will reduce its nutritional and functional qualities and compromise its
safety for humans. The agriculture sector needs to make sure that the farming families are aware
of all the food hazards from production through storage and preparation to consumption.
Postharvest management practices and transforming perishable foods to amore storable ones by
using simple and affordable food processing technologies like drying, cooking, packaging,
preserving and so on need to be promoted by the agriculture sector.
Hygienic practices in food storage, preparation and consumption is a crucial issue in maintaining
human health. The sources of water and its quality, the cleanliness of the food handlers and the
sanitation of utensils used for food handling are all important issued. Spoilage of foods by
microbes and other natural processes will drive the nutrients to be unavailable for our body to
readily absorb them. Therefore the hygiene and sanitation issues in food preparation and
consumption are very important. The agriculture sectors need to work in collaboration with the
health sector to ensure proper management of wastes and safety and hygiene of water for
domestic and agricultural consumptions.
21
SOURCES
1. International Food Policy Research Institute (IFPRI), 2014. Global Nutrition Report:
Actions and Accountabilities to Accelerate the Worlds Progress on Nutrition, A
peer reviewed publication
2. Central Statistical Agency [Ethiopia] and ORC Macro, 2012. Ethiopia Demographic
and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA:
Central Statistical Agency and ORC Macro.
3. SUN Compendium Ethiopia, Scaling-up Nutrition, 26 October 2014.
4. Federal Ministry of Health (FMOH) Ethiopia, 2012. The Cost of Hunger in Ethiopia:
Implications for the Growth and Transformation of Ethiopia Social and Economic
Impacts of Child Under-nutrition in Ethiopia. Addis Ababa Ethiopia.
5. UNICEF, 2014. Integrating Agriculture and Community-based Nutrition (CBN) to
Improve Nutrition: A training manual (Draft) for Agriculture Development Agents
and Health Extension Workers, Addis Ababa.
6. School of Nutrition, Food Science, Hawassa University and Center for Development
Innivations, Wageningen University, 2015. Agriculture development agents training
manual linking agriculture and nutrition for healthy and strong Ethiopian families,
Hawassa, Ethiopia.
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