Description of Challenge. EED and Stunting may be your impact indicators, but other outcomes are important if you want to understand your impact pathway. As I have said before it would be very helpful to see your detailed impact pathway – which essentially shows us the how of the project – how will the proposed intervention function to achieve impacts. Response 2: I have addressed this by discussing other outcomes such as feeding and sanitation practices as well as gender and women’s empowerment on Page 76 in Section
Description of Challenge. (in reference to causes of stunting and associations with fecal exposure) add Xxxxxxxxxxx and Xxxxxxxxx’ review Response 3: A description of the Xxxxxxxxxxx and Xxxxxxxxx’ causal pathway for ‘stunting syndrome’ which includes the causal pathways between the outcomes of study has been added as indicated in the first paragraph of Section 5.3 on Page 76
Description of Challenge. The low status of women in Ethiopia (2005 and 2011 Ethiopia DHS) - quantify this in terms of DHS data. The low status of women, as indicated by X, Y, Z Response 4: This has been addressed on Page 76 by referring to DHS report and other resources.
Description of Challenge. (largely linked to a deeply patriarchal society with harmful traditional norms) – “ensure this is properly sited and ensure all references sited in the text are included in the references cited section” Response 5: This section has been properly cited in the last paragraph of Section 5.2 on Page 76. Other references have all been properly cited.
Description of Challenge. Clarify citation on Manoff group publication linking EED with fecal exposure in Ethiopia Response 1: This citation has been corrected, as seen in Section 5.2, in the last paragraph of Page 77. This refers to an evaluation commissioned by the USAID ENGINE project to the Manoff group as the consulting agency. The citation has now been corrected to read as ‘USAID 2014’.
Description of Challenge. Suggested language to convey the impact of lack of gender focus in national nutrition program on outcomes Response 1: Indicated as “Despite women’s primary role of feeding the household, men hold the decision making power and control resources that impact nutrition” in Section 5.2 on Page 74. Comment 2: Proposed Intervention 1 - Will improved practices knowledge be imparted in demo plots? Are we not we moving away from giving inputs- dependency- so they learn at the plots and practice at home--- so the inputs are only for the demo plots?
Description of Challenge. Are the statistics of stunting in relation to children under 5 or under 2? Please make sure you specify
Description of Challenge. With 23% million children stunted and 51 million (Xxxxx et al., 2019) wasted globally, achieving Sustainable Development Goal (SDG) 2 remains a global priority for the development community. At 38%, stunting rates (in children under 5) in Ethiopia are very high and even more alarming in the Amhara region where CARE works, which, at 46%, has the highest stunting rate in Ethiopia (Ethiopia Demographic Health Survey 2016). With far reaching consequences such as poor cognitive development among children and their resulting inability to perform well at school and be gainfully employed as adults, as well as a vicious cycle of stunted mothers giving birth to stunted babies, efforts at economic development and poverty reduction in Amhara may be a mirage, if underlying causes are not addressed. Xxxxxxxxxxx & Xxxxxxxx (2014) identify multiple causes and consequences of stunting in the short-, medium- and long-term and the potential windows of opportunity in this chain, where interventions can be targeted to reduce the problem. These include the pathways between the 4 “interlinked phases of growth” (fetal, infant, childhood and pubertal”), characterized by poor feeding practices and inadequate dietary nutrient intake, poor WASH practices, resulting in EED and maternal factors. (Xxxxxxxxxxx & Xxxxxxxx, 2014) Previous interventions aimed at reducing stunting through infant and young child feeding (IYCF) practices alone, or combined with WASH, (with a focus on EED) have not demonstrated sufficient stunting reduction outcomes. Other interventions that have combined child feeding and women’s empowerment (WE) (USAID, 2015) have shown more significant impacts, but not enough to meet the WHO global target of 100 million stunted children by 2025 (Xxxxxxx, 2014). This proposal suggests that the failure of previous work to yield significant impact on stunting is due to the lack or limited focus of women’s empowerment in nutrition sensitive interventions. As a result, proposal will test the effectiveness of integrating interventions that address the 3 key issues (IYCF; EED; WE). It will answer the question, “Does the addition of women’s empowerment improve sanitation and feeding practices and consequently stunting outcomes (above and) beyond a package of water, sanitation hygiene, food security and nutrition education activities?” In Ethiopia, negative feeding practices such as late initiation and discontinued breastfeeding, (only 58% of children under 6 months are exclusively b...
