1. Biyyoolessaii Ija
Mukaa
“Fruit of the Land”
Team 2
Devin Broadwater, Karen Hamby, Naomi Chen,
Online Image. 07 November 2009. EthioGardian.com Amanda Hasseltine, Bernice Boursiquot

2. Presentation Outline
 Demographics on Oromiya
 Meet the Adabbos, an Average Oromo family
 Child Malnutrition and Its Factors
 Strategy to Combat Child Malnutrition
 Emergency Food Aid
 Comprehensive Approach
 Allocation of Funds
 Summary

3. Oromiya Region Background
Demographics Current Health Crisis
 27 Million People  34.4% of Children under the
 4.8 People Per Household age of five are underweight
 Estimated 126,000 children are
 Ethnic Groups
in need of urgent therapeutic
 87.8% Oromo care for severe malnutrition in
 7.22% Amhara Ethiopia
 Religion  This number is expected to
climb
 48.2% Christian
 Ethiopia is rated the sixth
 Orthodox and Protestant
worst country in terms of
 47.5% Muslim nutritional outcomes
 88.7% Rural Inhabitants worldwide.
Central Statistical Agency (CSA) of Ethiopia, 2007

4. Meet the Adabbos
The World Factbook 2009. Washington, DC: Central Intelligence Agency, 2009.
https://www.cia.gov/library/publications/the-world-factbook/index.html
Online image. PBS.org

5. Online image. Current food shortages in Ethiopia. (2009) http://news.bbc.co.uk/2/hi/8319741.stm

6. Identifying Cases of Severe Acute
Malnutrition
Children with mid-upper arm circumference (MUAC) <11cm or bilateral leg
pitting edema referred to regional health centers weight for height. Children
with weight for height less than 85% of median national center for health
statistics (NCHS) classified as having Severe Acute Malnutrition
 Advantages:
 Practice currently in use
 Independent of age
 Simple, low cost technology
 Low stress on children and caregivers
 Accurate
 Highly sensitive and specific
Recommendation: increase usage of MUAC measurements
Belachew, T, & Nekatibeb, H. (2007). Assessment of outpatient therapeutic programme for severe acute malnutrition in three regions of Ethiopia. East
African Medical Journal.
Amsalu, S & Tigabu, Z. (2008). Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiop.J.Health Dev.

7. Black. “Framework of the relations of poverty, food insecurities, and
other underlying and immediate causes to maternal and child
malnutrition and its short-term and long-term consequences” Maternal
and Child Undernutrition.

8. Cholera
Outbreak
August 8th 2009
The shaded region indicates the
area of outbreak.
Online image. Zones affected with the cholera are highlighted in red (the current
map of Oromia). Ethiopia: Cholera and Severe Acute Malnutrition Ravage Oromia

9. The Three Sections
West
•Generally Food Stable
•Without Cholera
South
•Highly Food Insecure
•Without Cholera
North
•Highly Food Insecure
•With Cholera

10. Current Trend

11. The 1 million dollar question (USD)?
How can severe acute malnutrition be sustainably reduced in
the Oromiya region of Ethiopia with 1 USD million?

12. The Two-Pronged Strategy
Emergency Food Aid Comprehensive Approach

13. Emergency Food Aid
Ready to use therapeutic foods (RUTFs) are currently distributed in Ethiopia
•High rate of acceptance
•Distributed by government, Doctors Without Borders, and other non-
governmental organizations (NGOs)
Immediate response to current Ethiopia conditions
•Results:
•Point of entry
•Local acceptance
•Requirement:
•Using available infrastructure to deliver RUTFs
•Coordinate with work of NGO’s within the region
Belachew, T, & Nekatibeb, H. (2007). Assessment of outpatient therapeutic programme for severe acute malnutrition in three regions
of Ethiopia. East African Medical Journal.

14. Comprehensive Targeted Approach
 Develop local RUTF’s—”Fruit of the land”
 Local farmers
 Training of CHA’s
 Community members
 Radio Soap Opera
 Mass communication, dissemination

15. Assessment
Time Emergency / Local RUTFs Community Soap Opera Accountability
Imported Health and Evaluation
RUTFs Advisors
1-3 months Evaluate Focus groups Recruit -- Ethics
current CHA’s clearance
partner NGO Identify farmers,
efforts formulas Assess distrib.
Stockpile food- Adapt local
secure area crops RUTF “chain”
3-6 months Start efficacy Start efficacy trial Create -- Baseline
trial with several curriculum statistics
formulas
Local
distribution
feasibility
6-9 months Analyze Analyze results Training -- Intervention
results impact
Plant for next
Discontinue season

16. Implementation
Time Emergency / Local RUTFs Community Soap Opera Accountability
Imported Health Advisors and Evaluation
RUTFs
9-12 months -- Local crop Educating Identify Harvest trends
farming, community radio
production stations, Economic
Local economic recruit stability
initiatives talent indicators
12-18 months -- Same as Same as above Preliminary Same as above
above scripts
Quality Fidelity of CHA
assurance training
Training new Concept
CHA’s testing
18-24 months -- Same as Same as Recording Same as above
above above

17. Replication
Time Emergency / Local RUTFs Community Soap Opera Accountability
Imported Health Advisors and Evaluation
RUTFs
3 years -- Local crop Educating Broadcast Evaluate
farming, community media reach,
production impact
Local economic
initiatives Crop
sustainability
Training new
CHA’s Child nutrition
indicators
5 years -- Same as Same as above Fundraising Same as above
above to record
new
episodes
10 years -- Same as Same as above Syndication Same as above
above

18. Expected Intervention

19. Allocation Of Funds
Short Term – 15%
Import Tax 20-50% of cost
RUFTs $77,700
Cost of RUTFs $77,700
Short Term Internal travel &
$150,000 distribution $20,000
Internal Shipment $22,300
Efficacy evaluation/ research $30,000

20. Allocation Of Funds
Long Term – 85%
Malnutrition screening (bangle)
Local RUTFs
$340,000
Acceptance of paying for
supplements
Education/ CHAs
Long Term $340,000 Sanitation
$850,000
Soap Opera Breastfeeding/ Child feeding
$85,000 practices
Accountability & Family Planning
Evaluation
$85,000
Female Empowerment

21. Summary
 Child malnutrition is a multi-faceted issue
 Requires:
 Comprehensive, long-term approach
 Community involvement
 Four components :
 Initial importation of RUTF’s
 Training Oromiyan farmers to produce local RUTFs
 Training CHA’s to educate mothers on proper feeding practices
 Health soap opera broadcasting