Appropriate nutrition is crucial for optimal growth and development of children
With two thirds of child mortality attributable to malnutrition, Egypt stands as one of the 36 countries, where 90 percent of the global burden of malnutrition falls. Despite the notable decline in child mortality in Egypt, achieving the Millennium Development Goal 4 of reducing by two-thirds the under-five mortality rate before 2015 remains challenging. Malnutrition rates remain high particularly among children under-five; stunting among under-five children stood at 21 percent in 2014, while child wasting and underweight stood at 8 and 6 percent respectively.
The double burden of malnutrition is characterized by the coexistence of undernutrition along with overweight, obesity or diet-related deficiencies within individuals. Children who are overweight are more susceptible to non-communicable diseases such as diabetes and coronary heart disease and micronutrient deficiencies due to a poor diet. The double burden of malnutrition (DBM) is a major challenge in Egypt especially for overweight/obesity and stunting. Controlling overweight/obesity to reduce the double burden of malnutrition in Egypt requires comprehensive and appropriate measures as; 14.2 percent of under-fives are classed as overweight.
In addition to the double burden of malnutrition, anemia that is a condition in which there is a deficiency of red cells or haemoglobin in the blood, resulting in paleness and fatigue; is also a major challenge in Egypt affecting 27.2 percent of children under-5 and 25 % of women within reproductive age (15-49 years). Anemia during pregnancy is one of the leading causes of anemia in infants and children. A series of cost-effective nutrition interventions during the first 1,000 days from a woman’s pregnancy to the child’s second birthday can increase the child’s ability to grow.
The concern about malnutrition that it has a long series of devastating effects on early childhood growth and development contributing to not only to infant and child mortality but also, to physical, and cognitive developmental impairments among children if children survive. It further presents considerable risks for future mothers and women where child malnutrition, leads to an infinite cycle of malnutrition throughout the life cycle later on. This is especially true looking at stunting, wasting, and micronutrient deficiencies –mainly iron deficiency anemia affecting large numbers of children, adolescent girls, and women within reproductive age. Overweight leads to increased risks of obesity, and consequently to what otherwise preventable non- communicable diseases including heart conditions, and diabetes, The 2015 Egypt Health Issues Survey (EHIS) confirms that non-communicable diseases (NCDs) are on the rise and remain among the leading causes of death in Egypt.
Maternal and Child Nutrition Study Group, Maternal and child nutrition: building momentum for impact, The Lancet (2013) Vol 382, 373-375
Causes of malnutrition in Egypt,
Direct causes of child malnutrition due to inadequate dietary intake are evidenced in poor Infant and Young Child Feeding practices (IYCF), among which the most concerning, is the decline of exclusive breastfeeding rates at 4-5 months of age from 34% to 29% down to 13 % according to the respective DHS surveys of 2005, 2008, and 2014. Early initiation of BF, one of the indicators of adequacy of care, stands at 27% (EDHS 2014). Of the underlying causes of malnutrition also is food insecurity, which in Egypt, is associated with poor access to a balanced diet among the poorest sections of society, as well as poor dietary habits, lifestyle and lack of nutritional awareness across the population, as opposed to issues of food availability”. Furthermore, only 36% of households have appropriate child stool disposal practices, which is an indication of poor environmental conditions, reflecting underlying causes of child undernutrition.
- UNICEF and the Ministry of Health and Population have developed an operational model focusing on the ‘first 1,000 days’ for early detection and prevention of child malnutrition from conception to two years of age. This approach aims at strengthening the capacity of the primary health care system to prevent stunting and to inform decision-makers at the national level for early detection and monitoring of malnourished cases of pregnant women and children. It addresses antenatal care, breastfeeding promotion, and nutrition counselling for pregnant, lactating women, and mothers of children 0-2 years;
- The Ministry of Health and Population in coordination with all the relevant government stakeholders, UNICEF, World Health Organization (WHO), World Food Programme (WFP), are updating the national nutrition policy, strategy and the related governance structure guided by the results of a nutrition stakeholder mapping in 2016. The national nutrition strategy and “The Agenda for Action” conducted by UNICEF will support the implementation of the priority nutrition actions identified by the policy review;
- UNICEF supports the Ministry of Health and population (MoHP) to identify and address the capacity and coordination gaps for the prevention and early detection of malnutrition among children below two years of age through strengthening Infant and Young Child Feeding practices including complementary feeding and hygiene awareness;
- UNICEF is strengthening evidence-based planning and monitoring of nutrition interventions to inform nutrition programmes and policies at implementation and policy level through supporting the update of a nutrition information management system as key to efficient timely monitoring and data generation for nutrition action;
- UNICEF supports the scaling up of the Baby Friendly Hospital Initiative to encourage early initiation of breastfeeding, exclusive breastfeeding for the first six months, strengthen monitoring of the code of Breast Milk Substitutes and improved community awareness through Mother Support Groups;
- UNICEF is strengthening the capacity of communities to raise awareness of mothers on maternal and child malnutrition through, community-based nutrition programmes for improving community awareness, with a focus on the most deprived and vulnerable populations. Awareness activities include building the capacity of community health workers to support in-community awareness and counselling for nutrition;
- UNICEF is investing in developing national communication guidelines to build capacity of health care workers, raise public awareness, address social norms with regards to positive behavioural changes for ‘Infant and Young Child Feeding’ practices. This is done through the development of a National Communication Strategy, as well as partnerships with academic institutions and NGOs to integrate breastfeeding and Infant and Young Child Feeding into medical and nursing academic programmes in universities;
- UNICEF supports the national vitamin A, iron and folic acid supplementation programme for women and children within the primary health care sector to strengthen prevention and treatment of malnutrition and strengthen the efficiency of micronutrient supplementation programs;
- UNICEF in collaboration with the National Iodine Deficiency Disorders Scientific Secretariat, and national partners is supporting the sustainability plan of the national programme to promote universal salt iodization and household consumption of iodized salt. The plan is prioritizing quality control and quality assurance of iodized salt industry at the level of intermediate and small scale salt producers, as well as developing an updated database for iodized salt monitoring in Egypt. In addition, the national nutrition institute and Ministry of Health and population are investing in community awareness and social mobilization campaigns to address low iodized salt consumption targeting the at-risk governorates.