Demographic and Health Surveys (DHS) are nationally representative household surveys on health, nutrition, and population in developing countries. The DHS surveys have been regularly conducted in Ethiopia every 5-6 years since 2000. The survey results are an extremely useful tool for tracking national and regional trends in key monitoring and impact indicators. The Ethiopia DHS 2016 Final Report was recently released in the summer of 2017.
On Wednesday, March 14, 2018, Tufts organized a half day internal learning event on the topic “Evidence and Implications from EDHS 2016 for the Growth through Nutrition Activity”. The major discussion points were:
- Stunting trends across EDHS results and implications for Growth through Nutrition stunting target
- What can be done about the low level of ANC and PNC coverage?
- Gender issues and potential solutions
- The role of education related to health and nutrition-related indicators
- Highlights of research gaps in the EDHS
The learning event was attended by project managers and staff from SCI and project implementation partners at the Save the Children Country Office. Rahel Gizaw, Tufts Senior Learning Advisor (SLA), began the presentation on 2016 EDHS findings alongside some results from the Growth through Nutrition baseline study, with the acknowledgment of the important differences between the two surveys including time, sampling methodology, indicator definitions, and geographical coverage, which require caution when comparing results. Following the presentation, Tufts SLA facilitated important discussions on how the findings presented from the EDHS 2016 could inform the Growth through Nutrition activity implementation.
One of the items of discussion was the trend in stunting rates seen in past to recent EDHS results. The team discussed whether based on this trend if Growth through Nutrition’s target of reducing stunting by more than 7 percentage points from the existing 38 percent is a reasonable estimate. The opportunities around the existence of good political will reflected on the NNP and the combined effect of other projects were mentioned in support of the existing target. However, participants also made the suggestion to review regionally and locally disaggregated stunting figures so as to give more attention to areas with higher stunting rates to help achieve project stunting target.
Another key takeaway point from findings of low levels of ANC and PNC coverage was to further understand the quality and coverage of the different components of ANC, including the exchange of learning based on the regional variation using best practices from high performing areas. Tigray region in particular recorded significantly high rates of PNC service utilization. Participants suggested that it could likely be due to the innovative approach they have implemented in creating safe and comfortable delivery place, suitable to the community culture. Advocacy for implementing a similar approach in other regions was suggested as one approach to help address the demand side of low service utilization.
Based on the findings presented, participants also called for making project interventions more sensitive to gender. According to the participants, teenage pregnancy and early marriage are reflections of gender-related issues. They suggested that Growth through Nutrition to collaborate with other institutions to address harmful cultural practices that could be underlining factors affecting adolescent health and nutrition. Since the Tufts Agriculture-Nutrition study showed the strong positive association between women’s role in decision making and household diet diversity, the new Growth through Nutrition SBCC strategy should incorporate messages to improve women’s decision making and use appropriate media to reach the targeted audience. Additionally, using qualitative assessment to better understand the progress in decision-making role of women would be a helpful complement to quantitative indicators, which do not always give a full picture.
DHS 2016 results once again confirmed the positive role of education in health and nutrition related indicators. The audience suggested the use of change agents in the community and at household levels as an entry point to create behavioral changes in this area. For instance, the recent expansion of primary education means that students of beneficiary households could be used as a change agent at the family as well as community levels.
The presentation ended with highlighting some gaps and further research areas in the EDHS including the gap in capturing maternal nutrition indicators and the need for more focus in collecting adolescent related nutrition and health service indicators.The meeting was concluded with a reiteration from participants about the importance of the convergence and layering component of the project to facilitate partnership and coordination with other government activities and projects that implement activities at ground level. This component has the great advantage of helping to cover areas of implementation that are currently beyond the scope of the project but will help in progress toward the project and government targets.