Improving Health Outcomes of the Poor – A
Social Justice Agenda for Egypt (2)
While Egypt has
made impressive progress on each of the MDGs especially MDG 4 and 5, it
continues to face challenges with MDG 1 relating to the eradication of extreme
poverty and hunger. Moreover, regional disparities and gender inequalities
continue to persist across governorates.
Malnutrition in Egypt is increasing. In
2008, the prevalence of malnutrition increased than those figures reported in both
2000 and 2005. Nationwide, 29% of
children under the age of five are stunted, 6% are underweight, and 7% are
wasted. The situation is likely to have further deteriorated since the
continuing political instability following Egypt’s revolution at the start of
2011 as recently announced by CAPMAS indicating an increase in unemployment rates
to 11.9% in September 2011 and poverty to 25% in 2012. National averages,
however, obscure vast regional differences in undernutrition prevalence.
Nutrition is central to human and economic development. Malnutrition frequently escapes full attention, and as a result is referred to as
“the silent disaster.” It rarely attracts
the attention of policy and
decision makers and never was on their agenda.
The most affected people are the poor, who lack a political voice
preventing them from
adequately demanding interventions to combat malnutrition, even if they realize that the problem exists. Malnutrition is a barrier for development, and a determinant for
economic development and poverty reduction, health status, and educational
attainment, and its reduction is central to achieving these broader development
goals.
The Window of Opportunity must be sized to avoid irreversible
damage. Children who are
undernourished between conception and age two are at high risk for impaired irreversible
cognitive development and stunting, which adversely affects the country’s
productivity and growth. Interventions outside this window of opportunity would
only provide relief measures but will not be able to reverse the damage that
happened.
The Cost of malnutrition is high for Egypt. Over one-third of child deaths are due to
undernutrition, mostly from increased severity of disease. The economic costs
of undernutrition and overweight include direct costs such as the increased
burden on the health care system, and indirect costs of lost productivity.
Childhood anemia alone is associated with a 2.5% drop in adult wages. The
current economic crisis and its potential impact on the poor make investing in
child nutrition more urgent than ever to protect and strengthen human capital
in the most vulnerable groups in Egypt.
What is Stunting? Stunting implies
long-term undernutrition and poor health among young children, measured as
height-for-age. It is a striking form of social injustice. It means that
stunted children were not allowed to attain their potential height and will be
shorter than their peers. Their IQ could
probably be lower than their peers and will be less able to learn and
accordingly will be less able to compete for jobs.
Three in ten
Egyptian children under the age of five are stunted. Of these three, at least one
is severely stunted. Lower Egypt Governorates have the highest rates of
stunting, where one third of children U5 living in rural areas are stunted, and
four in ten children U5 in urban areas are stunted.
Surprisingly, neither
the mother’s education nor the wealth quintiles, the usual suspects of bad
indicators, affected the prevalence of stunting amongst children U5. The
question remains: “why almost one third of Egypt’s children are stunted and
on the increase, when all other health indicators are improving?” Maybe because it is not a health problem. Unicef
concludes that socioeconomic factors do not seem to have effect on the chronic
malnutrition levels observed amongst Egyptian children and may suggest that
there are a number of complex factors interfering with the proper nutrition of
children.
This means that
more food or cash is probably not the solution, and it might be behavior
related. An intervention is needed that
combines (i) behavior change including promotion of breastfeeding, appropriate
complementary feeding practices (but excluding provision of food), and proper
hygiene, specifically handwashing; and (ii) complementary and therapeutic
feeding for the prevention and treatment of moderate malnutrition among
children 6–23 months of age, and management of severe acute malnutrition among
children under five years of age.
The key demand
side package of service for such a problem is the promotion of optimal Infant
and Young Child Feeding (IYCF) practices and adequate nutrition during
pregnancy. It proved to be of a high
potential to reduce malnutrition at relatively low cost and most effective if
applied during the first 1000 days of life, from conception to 24 months as the
effects of malnutrition are still reversible. However, these programs are difficult
to implement without an adequate incentive for behavior change and usually
better implemented by NGOs at community level.
Beneficiaries
would use existing health services provided by the MOHP for supply side
services for treatment of moderate and severe malnutrition, for which the
poorest districts with good functioning primary health care services would be
selected.
Until we meet again...
thanks a lot for sharing,
ReplyDeleteit's very interesting. I definely saw the link to education so clear.
Dr. Alaa Hamed, Thank you for this invaluable site. It is very useful and interesting. If you don't mind I would like to be in direct contact with you regarding your work. I am Egyptian/American public health expert. My name is Nile El Wardani. Please contact me at www.nileelewardani.org or on FB. Many thanks.
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