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The Influence of Some Socio-economic Factors on the Nutritional Status of Beneficiaries

It is well known that socio-economic factors have an overwhelming impact on the nutritional status of any population, particularly the young. In this study some of these factors have been selected and their impact on nutritional status of the study children, as measured by the weight-for-age indicator, were analysed at the end of the survey. Tables 15-21 present this information.

TABLE 15. Prevalence of Low Levels of Weight for Age, by Marital Status of Head of Household (Percentages)

TABLE 16. Prevalence of Low Levels of Weight for Age, by Family Size (Percentages)

TABLE 17. Prevalence of Low Levels of Weight for Age, by Number of Children under 6 Years Old in Household (Percentages)

TABLE 18. Prevalence of Low Levels of Weight for Age, by Education of Head of Household (Percentages)

*Able to read and write.

The marital status of heads of households did not appear to influence the prevalence of malnutrition among study subjects (table 15). This is not surprising because all the study children of married heads of households and over 70 per cent of those from single heads of households lived with their mothers, who were primarily responsible for feeding their children. In the control group, however, the prevalence tended to be slightly higher among children of single heads of households.

Household size did not seem to affect the prevalence of malnutrition in any consistent manner (table 16). As opposed to household size, there appeared to be a close relationship between the number of children under six years of age and the prevalence of malnutrition (table 17). The prevalence tended to increase with the number of children in a household. This is to be expected in families with economic constraints, as the limited food available has to be shared among all family members. Data on the controls contrasted with those on study subjects in this measurement.

TABLE 19. Prevalence of Low Levels of Weight for Age by Household Ownership and House Rent (Percentages)

TABLE 20. Prevalence of Low Levels of Weight for Age, by Occupation of Head of Household (Percentages)

Information on the occupation of the heads of households is not available for the control group.

Data on education and the prevalence of malnutrition (table 18) indicated that the magnitude of undernutrition was marked among study subjects from households whose heads had no education or who could only read and write compared to subjects from households where the head had a basic education of grade three and above. This demonstrates the impact of parents' level of education on the nutritional status of their children.

An examination of the prevalence of malnutrition in households owning their own home (table 19) indicated a slightly increased rate of undernutrition for families who owned their home. Analysis of the condition among subjects from families living in rented houses showed higher prevalence values for those paying a monthly rent of Br 10 and less than for those paying Br 11 and more. The relatively high prevalence of undernutrition among those paying a rent of Br 10 and less could be a reflection of their economic status. Why the prevalence was higher among subjects from families owning their own home is hard to explain. The same pattern was observed in the control group.

No clear association was observed between the occupation of the heads of households and the prevalence of malnutrition (table 20). This is presumably because there were no substantial differences in income among the households in various occupational categories. A relatively high prevalence of malnutrition (69.1 per cent) is indicated among subjects from families living on welfare assistance.

TABLE 21. Prevalence of Low Levels of Weight for Age, by Number of Rooms in House (Percentages)

The prevalence of malnutrition according to the number of rooms in the house revealed it to be higher by about 28.1 per cent among subjects of families with a one-room residence and lower by about 15.9 per cent in homes with four rooms (table 21). The size of the residence could be an indicator of a family's economic situation and may explain why the prevalence of malnutrition appeared to be greater among those living in a one-room home.

CONSTRAINTS OF THE SUPPLEMENTARY FEEDING PROGRAMMES

Children in the study sample suffered from longstanding malnutrition both at the start and end of the study. This is indicated by the high prevalence of malnutrition in weight-for-age and height-for-age indicators. Significant improvement in weight for height is not, therefore, to be expected. Moreover, the feeding programmes did not have any impact on changing height that was already short of reference value.

The feeding programmes appear to have had significant impact on the nutritional status of the beneficiaries as shown by the weight-for-age indicator. However, as a comparable value is seen for the same indicator in the control group, factors other than the feeding programmes may have been in operation, resulting in the observed improvement, or it may simply have been an artifact.

Dietary analysis indicates that the total daily food energy the study subjects received from the supplementary foods provided by the different schemes ranged from 25 to 100 per cent of their requirement. This appeared to ensure coverage of most of the food energy requirement of the beneficiaries, which is more than generally expected from a supplementary feeding programme. However, despite the fact that the supplementary foods provided a major portion of the daily energy requirement, the feeding programmes undertaken in Addis Ababa did not result in significant reduction of the prevalence of malnutrition as expected. The following are some of the factors that might have contributed to this.

1. It is unrealistic to assume that food handouts in supplementary feeding programmes are used for feeding beneficiary children only. In families of low socio-economic status, owing to inconveniences imposed by time and economic factors, mothers tend to decline from preparing meals solely for the beneficiary child. In the Ethiopian culture it is customary to prepare family food together and consume it from a common plate. The supplementary foods made available by feeding programmes are likely to be shared among all family members. It is therefore obvious that the beneficiary child gets only a small proportion of the food supplement and that the effect of such an amount on nutritional status becomes negligible.

2. Because of the economic pressure to meet household expenses for immediate requirements, such as clothing, food, rent, etc., foods received by families of beneficiary children may be sold or exchanged. Although mothers declined to confirm the sale of the food-aid commodities, which was not unexpected, some of the foodstuffs were observed to be on sale in the various retail market areas of Addis Ababa. The information on the number of families involved and the proportion of food commodities marketed is sensitive and hard to obtain. With such background information it is not difficult to conclude that supplementary foods given to families are used not only for feeding beneficiary children but also as a source of family monetary income, and consequently significant nutritional impact is not to be expected.

3. Another but less important factor that might have contributed to the lack of significant nutritional impact of the feeding programmes is the concept that mothers have about the role of supplementary foods they receive in the beneficiary child's diet. Some mothers might have understood such commodities as foods on which the child could rely solely, thus leading to total dependence of the child on food handouts, ultimately resulting in inadequate feeding.

RECOMMENDATIONS

Supplementary feeding programmes, whether they are government or voluntary-agency undertakings, follow either the food handout scheme or the on-spot feeding approach, both of which have their merits and demerits. The take home schemes have the advantage of being simple to operate and easy to administer. However, as the system does not guarantee the utilization of supplementary foods by the recipient children, its effectiveness as an intervention strategy is questionable. The on-spot feeding approach is desirable in that it makes certain that the food prescribed is consumed by the subjects in need. This scheme, too, is not free from limitations; the administrative problems it entails, the strong financial support it requires, and the need for increased manpower are but a few.

In view of the problems faced by the feeding programmes evaluated, believed to be a reflection of the take-home scheme, the following general recommendations are made. However, they need to be weighed against the current practice of schemes in operation.

It is felt that a supplementary food handout scheme is likely to operate effectively in communities where there are favourable educational and economic standards. It is, therefore, suggested that in countries like Ethiopia the emphasis be on on-spot feeding despite the constraints mentioned above. If these on-spot feeding programmes are felt appropriate and desirable, they should be carried out through day-care centres and pre-primary and primary schools.

The number of day-care centres currently in operation is too small to be effective as a strategy for intervention programmes. An increase in the number of these centres is desirable, as the reduction in the distance that has to be travelled by mothers and children is likely to result in the participation of more families. This approach is worthy of consideration as it is in harmony with the government's policy to expand day care-centre services in both urban and rural communities.

Pre-primary and primary schools include all those that are run by the government, mass organizations, various religious sects, and voluntary organizations. Priority is to be given to centres serving children from families in the low socio-economic sector of the community.

Some take-home schemes may still be required. Children less than two years old who are not able to attend either preschool or day-care centres because of reluctance on the part of the mother or inconvenience should be given special consideration. For this group of children the only choice appears to be the take-home scheme. Whenever the food-handout scheme is inevitable for these or other reasons, it should be complemented with:

- rigorous teaching of mothers on child nutrition and proper utilization of supplementary foods;

- discouragement of the sale of food handouts by curtailing the distribution of cash-food commodities such as oil and milk and dispensing foods that have less market demand such as faffa, sorghum, and corn-soy-milk (CSM),

- regular home visits to the beneficiary families aimed at strengthening both the teaching of mothers and follow-up of food-handout utilization.

Observation of the current supplementary feeding programmes showed that food handouts are given to children from underprivileged families regardless of their age or nutritional status. It is therefore suggested that supplementary foods be given on the basis of the nutritional needs of children and should not be an economic blanket coverage. More attention should be given to families with large numbers of children under the age of six years, whose household heads are illiterate or poorly educated, who live in a one-room home, or who pay a low monthly rent.

In carrying out a supplementary feeding programme of any type, emphasis must be given to proper training of the staff in simple means of identifying malnourished children, recording data, programme management, interpretation of information, and the like. Differences in some aspects of programme implementation are acceptable, as this provides the opportunity to test different operational strategies to compare effectiveness. However, a general framework to guide the activities of feeding programmes is necessary, particularly for supervision and evaluation purposes.

In addition to its administrative functions, the International Coordinating Committee for Welfare and Development will have to assume the responsibility of supervision and evaluation of feeding programmes under its auspices. This entails the development of staff and the establishment of a special unit to handle the task.

ACKNOWLEDGEMENTS

The authors would like to thank Sister Mulu Belete, Ato Haile Gebru, Ato Yacob Tekle Berhan, members of the data processing unit, the secretarial staff, and data enumerators, without whose help this study could not have been completed. Thanks are also due to Ato Tamrat Ejigu for his interest in the task of editing the final document.

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