The Ethiopia applied nutrition project

Abstract

The British projects conducted in Ethiopia under the auspices of the I. B. P. have collected a vast amount of information concerning the peoples in Begemedir province, a highland area. This background served well as baseline data to establish the value of an applied nutrition project covering a broad range of activities. In the project township, Debarek, a polyclinic was introduced. Special attention was given to nutrition education for the under-fives by using several approaches. Other activities included nutrition education in the school and polyclinic, investigations into treatment of goitre and vitamin A deficiency, market garden schemes and improvements in poultry keeping. The only input in the control town Adi Arkai was a polyclinic set up by the Ethiopian Ministry of Health. Information about Debarek (the target community) and Adi Arkai (control) was also obtained from government statistics and surveys carried out by the Gondar Public Health College in 1968. The Project carried out censuses in 1970 and again in 1972. The evidence collected in the two communities over this period, while insufficient to establish any long-term trend, showed clearly a similar population structure. The most marked characteristics were the imbalance in the sex-ratio (67 males per 100 females Debarek, 86/100 in Adi Arkai) which reflected mobility, and the employment of about 80 % of the labour force in the tertiary or service sector, which reflected the economic function of the towns. On the other hand, religious groupings appeared to be remarkably stable and were an important aspect of the pattern of authority in the community. The monitoring of births and deaths during the Project gave accurate data for the first time. Crude birth rates in Debarek and Adi Arkai were 42 and 50 per thousand, crude death rates 19 and 35 per thousand, and infant mortality rates 229 and 198 per thousand live births respectively. A number of indicators of nutritional status were employed. Within a stratified sample of families three-day individual food intakes were measured on six occasions during 1969 and again at the conclusion of the Project in 1972. Energy intakes were consistently low, being about 70 % of the 1973 F. A. O./W. H. O. recommendations. Measurements made on these families, and on schoolchildren, of height, mass, skinfold thickness and arm circumference demonstrated that the people are small and underweight, with very little body fat. Clinical examinations revealed few overt signs of nutritional deficiencies, except for vitamin A and goitre. Evaluation was achieved by comparing anthropometric, mortality, and morbidity data from the Project and control towns. The most significant changes observed in the Project town were a 38 % reduction in the infant mortality rate, an improvement in the mass for age data for under-fives, and a reduction in the prevalence of vitamin A deficiency and goitre. Assessment of nutritional knowledge, its application, and effectiveness was attempted on selected groups. The achievements and failures of applied nutrition programmes are discussed in relation to the underlying economic basis of malnutrition, i.e. poverty.

Determinants of iodine deficiency in school children in different regions of Ethiopia

“…Studies carried out in the past have demonstrated that iodine deficiency disorders existed in Ethiopia and that in certain areas the prevalence may be as high as 71% (2,4). In this study, we assessed the total goitre prevalence rate among school children and found a percentage of 53.3% which is regarded as severe according to the classification of WHO/UNICEF/ ICCIDD(5).…”

“…From a national survey conducted among school children and household members, the national goitre prevalence rate ranged from 0.4 to 66.3%, with a mean value of 35% (2,3). Goitre prevalence rates vary significantly from region to region in Ethiopia and in certain areas the prevalence rate may be as high as 71% indicating that a single national estimate many times does not reflect sub-national variability in the prevalence of IDD (4). Identifying such areas of iodine deficiency and determining the iodine status of the population will help in the accurate planning and evaluation of intervention programmes.…”

Macrovascular disease in middle-aged diabetic patients in Addis Ababa, Ethiopia

“…< 18) were of normal weight, or even obese, before the onset of diabetes. Mean body weight for adult men was 54.7 kg and for women 48.0 kg in one survey in Northern Ethiopia where the mean daily energy intake was 1880 Kcal for men and 1375 for women on nonfasting days, and 1680 for men and 1210 for women on fasting days [18]. Although "privileged" pregnant Addis Ababa women had an average energy intake of 2963 kcal daily with 25% of energy from fat, often of animal origin, that of the "nonprivileged" majority was 1539 kcal daily with only 10% of energy from fat, almost all of which was of vegetable origin, mainly safflower oil [19].…”

Observations on syphilis in Addis Ababa. 1. General considerations.

“…The walls are cracking and the roofs are made of corroded sheets of corrugated iron, the same roofing material that is used on most dwellings in Addis Ababa, but without the benefit of a coat of paint. (Miller et al, 1976) and kwashiorkor is seen in the young. The age of first marriage is usually at adolescence.…”