A bakery shop in Cairo, Egypt. Egyptian flatbread, known as Aish baladi or country bread is on the table of all Egyptians, even the poorest, thanks to a smartcard system that assigns certain quantities to each family to avoid unnecessary waste.

By Maged Srour
CAIRO, Apr 18 2019 (IPS)

“Unfortunately the overall nutritional panorama of Egypt does not look well,” says Dr. Sara Diana Garduno Diaz, an expert concentrating on nutrition and biology at the American University of the Middle East. Diaz’s research focuses on dietary patterns and ethnic-associated risk factors for metabolic syndrome.

“While traditionally a country known for its lavish and welcoming food patterns, the quality of eating has been compromised,” she tells IPS.

Her findings are echoed by Oliver Petrovic, Chief of Health and Nutrition at the United Nations Children’s Fund (UNICEF), Egypt: “Unhealthy foods such as sugary biscuits, candy, chips and cakes, make up one-third of the foods consumed daily by Egyptian infants.”

Child consumption of sugary snack foods was associated with a 51 percent higher likelihood of being part of a ‘stunted child and obese mother’ household, Petrovic tells IPS. “Only about half of children under two consume iron rich foods,” he adds.

In a country where one in five children are stunted or too short for their age, malnutrition accounts for 35 percent of the disease burden in children younger than five, warns the Food and Agriculture Organization of the United Nations (FAO).

The definition of stunting, according to UNICEF, “is a measure of chronic malnutrition; it reflects inadequate nutrition over a long period, or effects of recurrent or chronic illnesses.” 

A 2018 UNICEF report on Egypt explains maternal and child malnutrition are influenced by inadequate dietary intake and disease. The report further states that inadequate dietary intake refers to 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.”

It also notes that not being able to optimise breast feeding plays a role in this. In addition, poor sanitation and hygiene are also underlying causes of malnutrition. 

“Traditional eating practices of the entire region relied heavily on seasonal and local foods, slow cooking methods, communal eating and avoidance of food waste but more recently habits such as rushing meals and preference for cheaper sources of energy are becoming the norm,” Diaz points out.

Junk food is on the rise

And the negative consequences of this extends over time.

FAO estimates that between two and six percent of stunted children become stunted adults who are less productive than adults of normal stature. Increased morbidity and mortality; decreased cognitive, motor, language and socio-emotional development; and an increase in non-communicable diseases like diabetes and heart conditions are some of the short- and long-term effects of stunting.

“It is important to be aware of the crucial importance of a proper nutrition in the first years of life. They have a profound effect on a child’s future. These years are a critical early window of opportunity to provide the nutrition, protection, bonding and stimulation that children need to reach their full potential,” Petrovic tells IPS.

“Adequate nutrition, safe environments and responsive adult caregiving are the best ways to support healthy brain development,” he adds.

On the other hand, the undernourishment rate in the total Egyptian population between 2014 and 2016 was less than five percent according to the World Food Programme. Undernourishment, according to FAO, is “an estimate of the proportion of the population whose habitual food consumption is insufficient to provide the dietary energy levels that are required to maintain a normal active and healthy life.” 

The prevalence of five percent is the same as most industrialised countries, showing that the situation is not as critical as in sub-Saharan Africa. In Zambia, Zimbabwe and Malawi, for instance, one in every three people is undernourished.

Egypt and food challenges: high score in ‘food loss and waste’, poor score in ‘dietary patterns’

But the problem lies not only with Egypt. All Arab countries face complex food challenges, as identified by the Food Sustainability Index (FSI), developed by the Economist Intelligence Unit with the Barilla Center for Food and Nutrition (BCFN).

Each country  is ranked according to food loss and waste, sustainable agriculture and nutritional challenges. According to the FSI Whitepaper 2018, Egypt ranked 50th out of 67 countries analysed worldwide for malnourishment, making it one of four countries not from sub-Saharan African that were ranked in the bottom 20.  The other three nations are Saudi Arabia, India and Indonesia.

However, overall Egypt scored moderately for nutritional challenges. The rather good result obtained in the ‘life quality’ category, did not sufficiently offset the very low results obtained in the ‘lifestyle’ and ‘dietary patterns’ categories.

Food loss and waste: the ‘smartcard system’ in Egypt

Arab countries all ranked low in the FSI with regards to food loss and waste. Saudi Arabia and the United Arab Emirates (UAE) were ranked the 29th and 35th performing countries respectively for food loss and waste among 35 high-income countries, while Egypt ranked 10th out of 23 middle-income countries.

Egypt has specifically introduced a measure–a smartcard system–that has limited the problem nationally.

The programme, which impacts about 80 percent of the Egyptian population, establishes the maximum daily amount of subsidised bread that can be requested by each family member.

As a result, food waste has decreased considerably and other countries like Jordan are considering implementing this model to avoid waste on subsidised basic food items.

What can be done?

Egypt certainly lives in a situation of great vulnerability regarding nutritional challenges.

The aridity of the region places pressure on agriculture and the Nile alone is not enough to satisfy the needs of more than 90 million inhabitants. Much of the Nile water is used for agriculture and inefficient water management at local level can lead to scarcity of supply to entire communities. Moreover, climate change amplifies all these challenges.

The rise in prices of foodstuffs has also forced millions of Egyptians to adopt a less expensive but also less healthy lifestyle.

To reverse the current trends of malnutrition (high prevalence of stunting, increasing underweight and increasing overweight at the same time), requires careful consideration of the common causes and a complex, multisector approach to address the underlying causes.

“At the policy level, UNICEF and the World Bank have worked on better understanding of the problem,” Petrovic tells IPS.

“They have supported the Egyptian Ministry of Health and Population (MoHP) in developing an investment case, with in-depth analysis of the situation and with the proposed and costed interventions needed to reduce stunting. UNICEF is also providing technical support to the Ministry of Health and Population in revising the Nutrition Strategy and developing the new and costed action plan for nutrition,” he adds.

Overall, the picture of food security in Egypt appears positive and negative at the same time. The situation must be kept under control by authorities, farmers and all Egyptians themselves.

“In my opinion it is not a question to be addressed exclusively by policymakers,” says Diaz.

“I believe the solution requires changes at an individual and community (home) level. These changes of course require support from policymakers, for example, through nutrition education programmes, micro-loans to boost local farmers and other local food production initiatives and infrastructure to improve food security.

“The policies may exist or be under developed but will remain useless unless they are accepted and implemented by the people.”

A nutritionist assesses the health of a child in the Sahel. Red indicates severe malnutrition. Credit: Kristin Palitza/IPS

By Noel Marie Zagre and Gary Quince
JOHANNESBURG, Sep 24 2014 (IPS)

Eric Turyasingura chases after a ball made from plastic bags outside his mud-brick home in the mountains of southern Uganda.

Yelling in his tribal tongue, Nkore, “Arsenal with the ball! Arsenal with the ball!” he jostles with his younger brothers for possession. 

The fame of the English soccer club has reached even his little ears. Pretending to be a sports star offers a moment of escape from his daily struggles.

At five years old, Eric’s tiny body already tells a story of poverty and lost opportunity. He is six inches shorter than he should be for his age. His arms and legs are pencil-thin and his head is out of proportion to his body.

Because he is stunted, experts say his chances growing up healthy, learning at full potential, and getting a job, let alone play professional soccer, have been greatly diminished.

In 2013, a United Nations Report said one in four children under five years, across the world – a total of 165 million – were stunted, while last year The Lancet estimated that undernutrition contributed 45 percent of all under-5 deaths.

Often beginning in the womb as poverty-stricken mothers live hand-to-mouth, stunting can be a lifelong affliction. Studies show it is linked to poor cognition and educational performance, low adult wages and lost productivity. A stunted child is nearly five times more likely to die from diarrhoea than a non-stunted child because of the physiological changes in a stunted body.

Development agencies say significant progress has been made in ensuring children are properly nourished, and as a result, the incidence of stunting is declining.

However, huge challenges remain and in sub-Saharan Africa, the proportion of stunted under-fives is two in five. With crises in South Sudan, the Central African Republic, Syria and now Iraq displacing millions of people, combating hunger and ensuring stunting rates don’t creep back up has become a top priority.

“We will not eliminate extreme poverty or achieve sustainable development without adequate food and nutrition for all,” said U.N. Secretary General Ban Ki Moon at a meeting of global hunger agencies in Rome.

“We cannot know peace or security if one in eight people are hungry.”

As such, the first “pillar” of Secretary General’s “Zero Hunger Challenge” aims to eliminate stunting in children under two years old.

The United Nations Children’s Fund (UNICEF) is also a partner in the Scaling Up Nutrition (SUN) Movement, another major global push, bringing together more than 50 countries in an effort put national policies in place and implement programme with shared nutrition goals.

One innovative programme – the Africa Nutrition Security Partnership, being implemented by UNICEF and funded by the European Union since 2011- is combating stunting both at the community level and the institution level.

Acutely malnourished children at risk of death are directed to health clinics, and at the same time health institutions and partners are given the tools they need to improve infant and young child feeding practices and hygiene, and better fight hunger and disease. The four-year programme focuses on Ethiopia (with a stunting rate of 44 percent), Uganda (33 percent), Mali (38 percent) and Burkina Faso (35 percent).

The aim is to change behaviour among households, set up systems for effective multisectoral approaches and increase government capacity, enabling these countries to battle against the effects of hunger long after the programme is complete.

In Uganda, for example, community workers have been provided with smart phones, programmed with information about hygiene, postnatal care and proper infant and maternal diet. The workers share the information with household members and then log their location on the smart phone’s GPS to prove they were there.

In Mali’s capital, Bamako, funding has been provided to broaden a master’s degree to provide advanced training to healthcare professionals about how to best design and implements nutrition programmes.

In Ethiopia, schoolgirls are being encouraged to delay marriage and pregnancy until they are at least 18, as a way of preventing intergenerational undernutrition. Older women are better able to carry a baby and rear children with stronger bodies and minds.

The increased focus on stunting by the humanitarian community is telling: its prevalence has become a kind of litmus test for the well being of children in general. A child who has grown to a normal height is more likely to live in a household where they wash their hands and have a toilet; is more likely to eat fruit and vegetables, is more likely to be going to school; is more likely to get a good job; and is less likely to die from disease.

Moreover, tipping the balance in favour of a child’s future isn’t as hard as some might think. The simple act of reinforcing the importance of exclusively breastfeeding a baby for the first six months of his or her life, for example, increases an infant’s chances of survival by six times.

Most of the regions where the partnership is being run have ample food to go around. It is other factors, such as failing to properly wash and dry utensils after meals, selling nutritious homegrown foods at market rather than eating them, and cultural sensitivities to things like vegetables and eggs that are causing problems. As such, simply education programmes can make a real difference and save countless lives.

The other challenge is ensuring there is enough political will to keep those programmes running. If the international community remains focused, the downward trend in stunting will continue. It could only be a few short years before children from modest African communities like the mountains of southern Uganda get to really play for teams like Arsenal. Children just need to be allowed to grow to their full potential and good things will follow.

Edited by: Nalisha Adams

Excerpt:

Sadhana Ghimire, 23, makes sure to give her 18-month-old daughter nutritious food, such as porridge containing grains and pulses, in order to prevent stunting. Credit: Mallika Aryal/IPS

By Mallika Aryal
RASUWA, Nepal, Jul 22 2014 (IPS)

Durga Ghimire had her first child at the age of 18 and the second at 21. As a young mother, Durga didn’t really understand the importance of taking care of her own health during pregnancy.

“I didn’t realise it would have an impact on my baby,” she says as she sits on the porch of her house in Laharepauwa, some 120 kilometers from Nepal’s capital, Kathmandu, nursing her third newborn child.

It is late in the afternoon and she is waiting expectantly for her two older daughters to return from school. One is nine and the other is six, but they look much smaller than their actual age.

“They are smaller in height and build and teachers at school say their learning process is also much slower,” Durga tells IPS. She is worried that the girls are stunted, and is trying to ensure her third child gets proper care.

A recent United Nations Children Fund (UNICEF) report shows that Nepal is among 10 countries in the world with the highest stunting prevalence, and one of the top 20 countries with the highest number of stunted children.

“Reducing stunting among children increases their chances of reaching their full development potential, which in turn will have a long-term impact on families’, communities’ and the country’s ability to thrive.” -- Peter Oyloe, chief of USAID Nepal’s Suaahara (‘Good Nutrition’) project at Save the Children-Nepal
UNICEF explains stunting as chronic under-nutrition during critical periods of growth and development between the ages of 0-59 months. The consequences of stunting are irreversible and in Nepal the condition affects 41 percent of children under the age of five.

“Nepal’s ranking […] is worrying, not just globally but also in South Asia,” Giri Raj Subedi, senior public health officer at Nepal’s ministry of health and population, tells IPS.

A 2013 progress report on the Millennium Development Goals (MDGs) done by Nepal’s National Planning Commission (NPC) says while the number of stunted children declined from 57 percent in 2001 to 41 percent in 2011, it is still high above the 30 percent target set by the U.N..

“Stunting is a specific measure of the height of a child compared to the age of the child, and it is indicative of how well the child is developing cognitively,” says Peter Oyloe, chief of party of USAID Nepal’s Suaahara, or ‘Good Nutrition’ project at Save the Children Nepal.

Oyloe adds, “Reducing stunting among children increases their chances of reaching their full development potential, which in turn will have a long-term impact on families’, communities’ and the country’s ability to thrive.”

Child health and nutrition experts argue that, while poverty is directly related to inadequate intake of food, it is not the sole indicator of malnutrition or increased stunting.

Saba Mebrahtu, chief of the nutrition section at UNICEF-Nepal, says the immediate causes include poor nutrient intake, particularly early in life. Fifty percent of stunting happens during pregnancy and the rest after infants are born.

“When we are talking about nutrient-rich food […] we are talking about ensuring that children get enough of it even before they are born,” says Mebrahtu. The time between conception and a child’s second birthday is a crucial period, she said, one of rapid growth and cognitive development.

Thus it is incumbent on expecting mothers to follow a careful diet before the baby is born.

Basic education could save lives

Sadhana Ghimire, 23, lives a few doors down from Durga. Separated by a few houses, their approaches to nutrition are worlds apart.

Ghimire breast-fed her 18-month-old daughter exclusively for six months. She continues to make sure that her own diet includes green leafy vegetables, meat or eggs, along with rice and other staples, as she is still nursing.

She gives credit to the female community health-worker in her village, who informed her about the importance of the first 1,000 days of a child’s life.

In preparation for her daughter’s feeding time, Ghimire mixes together a bowl of homemade leeto, a porridge containing one-part whole grains such as millet or wheat and two-parts pulses such as beans or soy.

“I was only using grains to make the leeto before I was taught to make it properly by the health workers and Suaahara,” she says.

However, making leeto was not the most important lesson Ghimire learned as an expecting mother. “I had no idea that simple things like washing my hands properly could have such a long term effect on my daughter’s health,” she says.

Even seemingly common infections like diarrhoea can, in the first two years, put a child at greater risk of stunting.

“That is because the nutrients children are using for development are used instead to fight against infection,” says Mebrahtu emphasising the need for simple practices such as proper hand washing and cleaning of utensils.

If children are suffering from infection due to poor hygiene and sanitation they can have up to six diarrhoeal episodes per year, she warns, adding that while “children recover from these infections, they don’t come back to what they were before.”

Fighting on all fronts

Food insecurity is one of the biggest contributing factors to stunting in Nepal. Rugged hills and mountains comprise 77 percent of the country’s total land area, where 52 percent of Nepal’s 27 million people live.

Food insecurity is worst in the central and far western regions of the country; the prevalance of stunting in these areas is also extreme, with rates above 60 percent in some locations.

Thus experts recognise the need to fight simultaneously on multiple fronts.

“Our work in nutrition has proven again and again that a single approach to stunting doesn’t work because the causes are so many – it really has to be tackled in a coordinated way,” says UNICEF’s Mebrahtu.

In 2009 the government conducted the Nutrition Assessment and Gap Analysis (NAGA), which recommended building a multi-sector nutrition architecture to address the gaps in health and nutrition programmes.

“The NAGA study stated clearly that nutrition was not the responsibility of one department, as was previously thought,” Radha Krishna Pradhan, programme director of health and nutrition at Nepal’s NPC, tells IPS.

Nepal is also one of the first countries to commit to the global Scaling Up Nutrition (SUN) movement, which recognises multiple causes of malnutrition and recommends that partners work across sectors to achieve nutritional goals.

Thus, in 2012, five ministries in Nepal came together with the NPC and development partners to form the Multi-Sector Nutrition Plan (MSNP).

Public health experts say MSNP is a living example of the SUN movement in action and offers interventions with the aim of reducing the current prevalence of malnutrition by one-third.

Interventions include biannual vitamin D and folic acid supplements for expectant mothers, deworming for children, prenatal care, and life skills for adolescent girls.

On the agricultural front, ministries aim to increase the availability of food at the community level through homestead food production, access to clean and cheap energy sources such a biogas and improved cooking stoves, and the education of men to share household loads.

MSNP’s long-term vision is to work towards significantly reducing malnutrition so it is no longer an impending factor towards development. The World Bank has estimated that malnutrition can cause productivity losses of as much as 10 percent of lifetime earnings among the affected, and cause a reduction of up to three percent of a country’s GDP.

At present the Plan is in its initial phase and has been implemented in six out of 75 districts in Nepal since 2013.

(END)

Children in northern Pakistan line up for food rations. Credit: Ashfaq Yusufzai/IPS

By José Graziano da Silva
ROME, Jun 13 2014 (IPS)

Continued growth in developing countries, along with poverty-reduction policies, have helped to improve both income and food security globally.

Still, eradicating hunger remains an enormous challenge that has an impact on every other attempt to improve lives.

An estimated 842 million people were found to be chronically hungry between 2011 and 2013. Globally, one in eight people are unable to gain regular access to enough food to be able to study, work, ward off disease, and otherwise live healthy and productive lives.

Malnutrition has a price tag. It could cost as much as five percent of global income – 3.5 trillion dollars, or 500 dollars per person – in terms of lost productivity and healthcare expenses.
Agriculture remains the key pathway to improving both access to food and income for most vulnerable families worldwide. Policies aimed at enhancing agricultural productivity and rural development, especially when smallholder producers are targeted, can help to create employment opportunities and achieve hunger reduction — even where poverty remains widespread.

But the quest for better lives must necessarily address another, often intertwined issue, that of malnutrition in all its forms. 
At least two billion people suffer from various vitamin and mineral deficiencies and related diseases. Malnutrition undermines wellbeing at all ages, and is seen as the underlying cause of death for some 2.6 million children annually.

In some of the world’s most vibrant and influential developing countries, malnutrition is threatening the next generation of parents, teachers, scientists and leaders.

Inadequate nutrition causes stunting, weakened immune systems and difficulties in learning and concentration. If having access to enough food is necessary for a person’s survival, then getting an adequate combination of safe and nutritious foods is fundamental to his or her future, and to the wellbeing, health and development of entire communities and economies.

Some progress has been made in reducing hunger over the past two decades, as measured by the Millennium Development Goal (MDG) objective of halving the prevalence of dietary energy undernourishment by 2015. Already, about 60 countries have achieved the target against 1990-91 benchmarks, or are on track to do so.

There has been progress, too, in combating malnutrition. Child stunting – a key indicator of malnutrition – has declined, but if present trends continue, half a billion more children will still experience stunted growth over the next 15 years.

Meanwhile, around one-and-a half billion people are overweight, with half a billion deemed obese, and hence, more vulnerable to diet-related non-communicable diseases.

Malnutrition has a price tag. It could cost as much as five percent of global income – 3.5 trillion dollars, or 500 dollars per person – in terms of lost productivity and healthcare expenses.

All this makes nutrition a public issue. And the conversation about malnutrition and hunger may be scientific, social and economic, but above all, it is political.

Tackling malnutrition

Good nutrition starts with access to nutritious food. Food systems must be improved in ways that make nutritious foods available and affordable to people throughout their lives, as shown by the Food and Agriculture Organisation’s (FAO) most recent ‘State of Food and Agriculture’ report.

But overcoming malnutrition in all its forms – caloric undernourishment, micronutrient deficiencies and obesity – requires a combination of appropriate interventions in food systems, public health, education and social protection to guarantee availability and access to nutritious food, reduce the vulnerability of poor populations to disease, and improve consumer awareness of the sources of good nutrition.

Food systems must place extra priority on meeting the special needs of mothers and young children. Malnutrition during the critical first 1,000 days from conception can cause permanent physical and cognitive impairment in children and lasting damage to mothers’ health.

In most governments, nutrition lacks a natural home and a responsible official. Nutrition is a public issue and tackling it is a complex task requiring strong political commitment, leadership at the highest levels, as well as unprecedented cooperation and coordination among various ministries and partners.

Turning up the volume

Fortunately, policymakers and community leaders around the world are making some progress in turning up the volume of the conversation on malnutrition and placing the topic, along with food security, at the apex of the international development agenda.

The U.N. Secretary-General’s Zero Hunger Challenge, launched in 2012 at the Rio+20 Sustainable Development Conference, recognised the intrinsic link between development and proper nutrition for all. It calls for a world without hunger, no more stunting, zero food waste and loss, sustainable agriculture and a doubling of poor farmers’ incomes.

Food security and nutrition have also been placed squarely at the center of discussions to define the work of the High-Level Panel on the Post-2015 Development Agenda; and at high-level meetings hosted in London in 2013 by the UK and Brazilian governments.

The volume of the conversation on nutrition is about to be notched up further. On Nov. 19-21, the FAO, World Health Organisation (WHO) and others in the U.N. system will co-organise the inter-governmental Second International Conference on Nutrition (ICN2), 22 years after the first one in 1992.

ICN2 will establish the bases for sustained international cooperation and improved policy coordination to overcome malnutrition. It should also help to ensure that different voices are heard in the debate. While governments have the final say on policy matters, non-state actors have important contributions to make to the multi-dimensional challenge of improving nutrition.

By cooperating more effectively, we have a real chance of ending this blight on humanity within a generation. But only if the conversation turns to concrete, consistent action that reaches every family.

*José Graziano da Silva is the director-general of the United Nations Food and Agriculture Organisation (FAO) in Rome.