Using survey data collected from 996 representative households in Addis Ababa, Ethiopia, this paper documents several insights to help understand urban consumer food purchasing and consumption choices. The findings can be summarized as follows: 1) We find that households face important dietary gaps; a large proportion eats insufficient amounts of nutrient-dense vegetables, animal-source foods, and fruits. 2) The consumption of ultra-processed foods increases with income and may become a pressing health concern as incomes rise. 3) From a purchasing perspective, we find that consumers buy foods for different purposes at different outlets. Nearby kiosks and informal street markets are frequented for small food items and for fruits and vegetables, while formal open markets and consumer cooperatives are used for bulky food items. 4) Respondents make food and food outlet choices based on their health and food safety concerns, but few consider the nutritional value of food when purchasing it. Concurrently, the availability of a wide variety of healthy and safe foods is highly valued by most respondents for outlet choice. Among consumers in lower income categories, they tend to make food and food outlet choices based on prices and location convenience. 5) Although nutrition is not a primary concern when making choices about food, consumers appear to have reasonable nutritional knowledge. Most respondents considered a healthy diet to be primarily plant-based. Most people are aware that they should eat more fruits and vegetables and less sugary, fatty, and salty foods, but they have limited knowledge on the nutrient content of specific foods and the causes of obesity. 6) Labelling would not be an effective way to increase nutritional knowledge; most respondents have limited understanding of the information that labels provide. Rather, most respondents trust the information provided by health professionals over other sources. In sum, these results are potentially relevant for policy and the design of future programs for improving nutritional outcomes through enhanced diets.

Ethiopia has witnessed significant reductions in child mortality, undernutrition, and communicable diseases, but more substantial and faster progress is still needed. The rise in obesity and in noncommunicable diseases, particularly in urban areas, is alarming and requires urgent policy and programmatic attention. Unhealthy diets drive both undernutrition and obesity and are the underlying cause of significant proportion of both communicable and non-communicable diseases. Maintaining the relatively high breastfeeding practices and increasing the diversity of diets will be critical to improving nutrition in Ethiopia. Implementation of effective nutrition messaging that shapes consumer behavior to adopt healthy dietary patterns, while bridging gaps in both the reach and the quality of such messaging is warranted. The health extension program, which is the cornerstone of the transformation of the health sector, may need to be redesigned in a way that improves its reach and the quality of the services it provides and minimizes the risk of burnout of frontline health workers. Interventions focusing on making healthy diets available, affordable, and accessible are urgently needed.

In early June 2020, we called by telephone a representative sample of nearly 600 households in Addis Ababa, Ethiopia to assess income changes and household food and nutrition security status during the COVID-19 pandemic (survey period covering May). This was the second administration of a COVID-19 related survey to these households, following an initial survey conducted in early May 2020 covering the situation of the survey households in April. More than two-third of the households indicated in the second survey that their incomes were lower than expected (up from 58 percent in April) and 45 percent reported that they are extremely stressed about the situation (up from 35 percent in April). Using a pre-pandemic wealth index, we find that less-wealthy households were considerably more likely to report income losses and high stress levels than were wealthier households. Compared to a period just before the pandemic (January and February 2020), indicators measuring food security have significantly worsened but have remained the same since April. During the pandemic, households are less and less frequently consuming relatively more expensive but nutritionally richer foods, such as fruit and dairy products. However, overall food security status in Addis Ababa is not yet alarming, possibly because many households have been able to use their savings to buffer food consumption. As the pandemic is still in an early stage in Ethiopia, it is likely that these savings will not last throughout the pandemic, calling for a rapid scale-up of existing support programs.

Overweight and obesity are rising rapidly in Ethiopia's urban areas, constituting a major public health concern. Dietary choices can be one of the key drivers of adult body-weight. Using data collected from a large household survey in Addis Ababa, we provide a snapshot of dietary patterns in Ethiopia's largest urban area. We find that starchy staples (cereals, roots, and tubers) are prominent in household food baskets, taking up 25 percent of the food budget and providing more than 50 percent of consumed calories, on average. In contrast, the consumption of all kinds of fruits and vitamin A-rich vegetables is very low. For the average household, meat products account for nearly 18 percent of the food budget but provide only 2 percent of total calories. Richer households consume relatively less starchy staples than poorer households, but more animal-source foods and vegetables. However, the importance of fruits in household diets rises very slowly with household incomes. Together, these findings suggest that further income growth will result in drastic changes in the composition of food demand in Addis Ababa. Considering projections for increasing incomes, especially in urban areas, this will have major implications for agricultural production in rural areas connected to Ethiopia’s cities. There is also an urgent need to design cost-effective public health campaigns to reduce the emerging overweight and obesity crisis in urban Ethiopia.

Considering the detrimental environmental impact of current food systems, and the concerns raised about their sustainability, there is an urgent need to promote diets that are healthy and have low environmental impacts. These diets also need to be socio-culturally acceptable and economically accessible for all. Acknowledging the existence of diverging views on the concepts of sustainable diets and healthy diets, countries have requested guidance from the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) on what constitutes sustainable healthy diets. These guiding principles take a holistic approach to diets; they consider international nutrition recommendations; the environmental cost of food production and consumption; and the adaptability to local social, cultural and economic contexts. This publication aims to support the efforts of countries as they work to transform food systems to deliver on sustainable healthy diets, contributing to the achievement of the SDGs at country level, especially Goals 1 (No Poverty), 2 (Zero Hunger), 3 (Good Health and Well-Being), 4 (Quality Education), 5 (Gender Equality) and 12 (Responsible Consumption and Production) and 13 (Climate Action).

The International Food Policy Research Institute (IFPRI) began research activities in Ethiopia in the 1980s to assess the root causes of drought-related food-production shortages and support adoption of appropriate policy responses. IFPRI’s rigorous empirical research contributed to a broader understanding of economic development processes in Ethiopia and built capacity to conduct such research on a national scale. Working with many long-standing partners, IFPRI evaluated strategies for achieving sustainable agricultural growth, investment in agricultural research, the provision of safety nets to strengthen resilience, prioritization of nutrition interventions for women and children, property rights, and management of natural resources, among other goals. Evidence from this and other work informed programs and initiatives to improve food and nutrition security for vulnerable people.

Telescoping errors occur if survey respondents misdate consumption or expenditure episodes by including events from outside the reference period in their recall. Concern about telescoping influenced the design of early Living Standards Measurement Study (LSMS) surveys, which used a two-visit interview format to allow a bounded recall. This design fell out of favor although not for evidence-based reasons. Recent guidelines to harmonize food data collection in low- and middle-income countries by using one-week recall increase the relevance of telescoping because errors spread over a shorter period will loom larger. To provide evidence on telescoping, we conducted a survey experiment in Ethiopia, randomly assigning a balanced sample – either a two-visit bounded recall or a single visit unbounded recall. The average value of reported food consumption is 16 percent higher in the unbounded single visit recall relative to the two-visit bounded recall. Put differently, in this experiment, telescoping errors amount, on average, to an entire extra day worth of consumption being included in the report for the last seven days. Most of the error is explained by difference in reporting of spending on less frequently consumed, protein-rich foods, so apparent diet diversity and dietary quality indicators are likely to be overstated when using unbounded recall.