77221 Nutrition at a GLANCE Egypt The Costs of Malnutrition Annually, Egypt loses over US$814 million in GDP • Egypt is anticipated to lose a cumulative US$1.3 billion to chronic disease by 2015.5 to vitamin and mineral deficiencies.3,4 • Over one-third of child deaths are due to under- Scaling up core micronutrient nutrition nutrition, mostly from increased severity of dis- interventions would cost US$55 million per year. ease.2 (See Technical Notes for more information.) • Children who are undernourished between con- ception and age two are at high risk for impaired Key Actions to Approximate cognitive development, which adversely affects Return on the country’s productivity and growth. Address Malnutrition: Investment(%):13 • The economic costs of undernutrition and over- Improve infant and young 1400 weight include direct costs such as the increased child feeding through effective Country Context burden on the health care system, and indirect education and counseling services. costs of lost productivity. Achieve universal salt iodization. 3000 HDI ranking: 123rd out of 182 • Childhood anemia alone is associated with a countries1 Fortify staple foods with iron. 800 2.5% drop in adult wages.6 Life expectancy: 70 years2 Ensure an adequate supply of zinc 1370 supplements for the treatment of Lifetime risk of maternal death: Where Does Egypt Stand? diarrhea. 1 in 2302 • 29% of children under the age of five are stunted, 6% are underweight, and 7% are wasted.2 Examine food policies and the Not currently Under-five mortality rate: country regulatory system as they estimable • National averages, however, obscure vast regional 23 per 1,000 live births2 relate to overweight and obesity. differences in undernutrition prevalence. The Global ranking of stunting stunting rate for children in urban Upper Egypt prevalence: 56th highest out of is 22.7% while that for children in urban Lower 136 countries2 Egypt is nearly twice as high at 39.3%.15 As seen in Figure 2, while Egypt performs bet- • 70% of those aged 15 and above are overweight ter than some of its low-income neighbors in the or obese.7 region, some countries with similar per capita in- Technical Notes • More than 1 in 8 infants are born with a low birth weight.2 comes, such as Sri Lanka and Mongolia exhibit lower rates of child stunting. Stunting is low height for age. As shown in Figure 1, the overall prevalence of Figure 2  Egypt has Higher Rates of Stunting than its Underweight is low weight for age. stunting and underweight has not changed significantly Income Peers Wasting is low weight for height. from 1990 levels. Egypt will not meet MDG 1c (halving 70 Prevalence of Stunting Among Current stunting, underweight, and wasting 1990 rates of child underweight by 2015) with business 60 Yemen as usual.8 Children Under 5 (%) estimates are based on comparison of the 50 most recent survey data with the WHO 40 Child Growth Standards, released in 2006. Figure 1  Egypt’s Progress Toward MDG 1 is Djibouti 30 Egypt They are not directly comparable to the Insufficient Mongolia Iraq trend data shown in Figure 1, which are 20 Bolivia Sri Lanka calculated according to the previously-used 30 10 Prevalence Among Children NCHS/WHO reference population. 25 0 0 500 1000 1500 2000 2500 Low birth weight is a birth weight less 20 Under 5 (%) GNI per capita (US$2008) than 2500g. 15 Source: Stunting rates were obtained from the WHO Global Database on Overweight is a body mass index (kg/m ) 2 10 Child Growth and Malnutrition. GNI data were obtained from the World Bank’s of ≥ 25; obesity is a BMI of ≥ 30. World Development Indicators. 5 The methodology for calculating nationwide costs of vitamin and mineral deficiencies, 0 1992 1998 2003 2008 Most of the irreversible damage and interventions included in the cost of Stunting Underweight 2015 MDG Underweight Target due to malnutrition in Egypt happens scaling up, can be found at: during gestation and in the first Source: WHO Global Database on Child Growth and Malnutrition (figures www.worldbank.org/nutrition/profiles based on the NCHS/WHO reference population) 24 months of life.8 Solutions to Primary Causes of Undernutrition Egypt Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Just over one-half (56%) of all newborns receive • 26% of child deaths are due to either diarrhea or • Achieving food security means ensuring quality and breast milk within one hour of birth.2 pneumonia.8 continuity of food access, in addition to quantity, for • Just over one-half (53%) of infants under six • Undernourished children have an increased risk of all household members. months are exclusively breastfed.2 falling sick and greater severity of disease. • Dietary diversity is essential for food security. • During the important transition period to a mix of • Undernourished children who fall sick are much Solution: Involve multiple sectors including agricul- breast milk and solid foods between six and nine more likely to die from illness than well-nourished ture, education, transport, gender, the food industry, months of age, one-third of infants are not fed ap- children. health and other sectors, to ensure that diverse, nutri- propriately with both breast milk and other foods.2 • Parasitic infestation diverts nutrients from the body tious diets are available and accessible to all house- Solution: Support women and their families to and can cause blood loss and anemia. hold members. practice optimal breastfeeding and ensure timely Solution: Prevent and treat childhood infection and and adequate complementary feeding. Breast milk other disease. Hand-washing, deworming, zinc sup- fulfills all nutritional needs of infants up to six plements during and after diarrhea, and continued months of age, boosts their immunity, and reduces feeding during illness are important. exposure to infections. References Undernutrition is not just a problem of poverty. and sugars, as well as a more sedentary lifestyle are 1. UNDP. 2009. Human Development Report. As Figure 3 shows, stunting rates are similar (27– commonly cited as the major contributors to the in- 2. UNICEF. 2009. State of the World’s Children. 31%) across all wealth quintiles. Children are un- crease in overweight and chronic diseases.9 3. UNICEF and the Micronutrient Initiative. 2004. dernourished in over one-quarter of even the rich- Vitamin and Mineral Deficiency: a Global est households. This is not an issue of food access, Progress Report. Vitamin and Mineral Deficiencies Cause but of caring practices and disease. 4. World Bank. 2009. World Development Indicators (Database). Hidden Hunger 5. Abegunde D. et al. 2007. The Burden and Costs Figure 3  Undernutrition Affects All Wealth Quintiles – Although they may not be visible to the naked eye, of Chronic Diseases in Low-Income and Middle- Poor Infant Feeding Practices and Disease are Major vitamin and mineral deficiencies impact well-being Income Countries. The Lancet 370:1929–38. Causes in Egypt. 6. Horton S. and Ross J. 2003. The Economics of Iron Deficiency. Food Policy. 28:517–5. 7. WHO. 2009. WHO Global InfoBase (Database). Richest 27 • Vitamin A: 12% of preschool aged children and 8. UNICEF. 2009. Tracking Progress on Child and 22% of pregnant women are deficient in vitamin A.10 Maternal Nutrition. Fourth 30 • Iron: Current rates of anemia among preschool 9. Popkin BM. et al. 1996. Stunting is Associated with Overweight in Children of Four Nations Middle 27 aged children and pregnant women are 30% and that are Undergoing the Nutrition Transition. 45%, respectively.11 Iron-folic acid supplementa- J Nutr 126:3009–16. Second 31 tion of pregnant women, deworming, provision 10. WHO. 2009. Global Prevalence of Vitamin A of multiple micronutrient supplements to infants Deficiency in Populations at Risk 1995–2005. Poorest 30 WHO Global Database on Vitamin A Deficiency. and young children, and fortification of staple 25 26 27 28 29 30 31 32 11. WHO. 2008. Worldwide Prevalence of Anemia foods are effective strategies to improve the iron Prevalence of Stunting Among Children Under 5 (%) 1993–2005: WHO Global Database on Anemia. status of these vulnerable subgroups. 12. Horton S. et al. 2009 Scaling Up Nutrition: What will it Cost? Source: DHS 2008 (figures based on the WHO Child Growth Standards) • Iodine: While 79% of households consume io- 13. Micronutrient Initiative. 2009. Investing in the dized salt, over 429,000 infants remain unpro- Future: A United Call to Action on Vitamin and tected from iodine deficiency disorders.8 Mineral Deficiencies 14. Bhandari N., et al. 2008. Effectiveness of The Double Burden of Undernutrition and • Zinc: 9% of the population is at risk for insuffi- Zinc Supplementation Plus Oral Rehydration Overweight cient zinc intake.13 Zinc supplementation during Salts Compared With Oral Rehydration Salts Egypt has also seen a recent increase in adult obe- diarrheal episodes can reduce morbidity by more Alone as a Treatment for Acute Diarrhea in a sity. Low-birth weight infants and stunted children than 40%.14 Primary Care Setting: A Cluster Randomized Trial. Pediatrics 121;e1279–e1285. may be at greater risk of chronic diseases such as 15. Egypt DHS 2008. diabetes and heart disease than children who start World Bank Nutrition-Related Activities in 16. Victora, CG et al. Maternal and child undernutrition: consequences for adult health out well-nourished.16 Egypt and human capital. The Lancet 2008; 371: This “double burden� is the result of various The World Bank is currently engaging heavily with 340–57. factors. Progress in improving community infra- Egypt through its analytical and advisory work. A structure and development of sound public health Governorate Health Plan examining areas of child systems has been slow, thwarting efforts to reduce and maternal health was completed, as was a more undernutrition; while the adoption of Western di- recent how-to-guidance on overall health system THE WORLD BANK ets high in refined carbohydrates, saturated fats performance. Produced with support from the Japan Trust Fund for Scaling Up Nutrition