Trends in Child Stunting Egypt 1995-2005 The role of food subsidies and economic change Anne Austin, MPH Child Nutrition Trends (1995-2005) Wasting Year n % <-2 SD %Moderate Wasting %Severe Wasting 1995 10399 6.87 3.85 3.02 2000 6942 3.15 1.62 1.53 2005 12548 5.13 2.8 2.33 Stunting Year n % <-2 SD %Moderate Stunting %Severe Stunting 1995 10452 32.54 17.3 15.24 2000 6923 23.18 13.27 9.91 2005 12510 26.13 13.85 12.28 Obesity Year n % >+3 SD %Overweight %Obese 1995 10441 15.99 9.19 6.8 2000 6984 23.05 14.63 8.42 2005 12635 19.23 9.6 9.63 Underweight Year n % <-2 SD %Moderate Underweight %Severe Underweight 1995 10584 12.22 8.23 3.99 2000 7010 4.35 3.13 1.22 2005 12728 5.91 4.17 1.74 Why focus on Stunting? Indicative of long-term nutritional deprivation Children measured were under the age of five Three surveys were conducted 5 years apart Three separate cohorts of children under the age of 5 who had been exposed to varying economic realities and food subsidy programs Child Stunting as a Health and Development Problem Associated with delays in cognitive development Linked to adult nutritional and metabolic disorders such as hypertension and obesity. Largely attributable to inappropriate feeding or chronic childhood illness. Associated with low socio-economic status (SES) in multiple studies. Sources: Mendez, et. al (1999), Sawaya, et. al (2005) Results Adjusted odds of a child being stunted: 1995 to 2005 (OR 1.32) 2000 to 2005 (OR 0.87) Residence in Upper Egyptian Governorates, rural residence, maternal short stature, low levels of maternal education, male sex and small birth size significant predictors of stunting Higher wealth and maternal obesity protective of stunting Increase in stunting between 2000 and 2005 accompanied by a 67% increase in Child anemia Overall decline in Child nutrition Stunting and Economic Trends In the MENA region, prevalence of child stunting is highly correlated to the level of a country’s economic development Yemen lowest GDP- Highest prevalence of stunting Not unidirectional (Tunisia 1975-1995) Stunting prevalence increased Annual growth in the per capita GDP Aoyoma (1999) attributes this to poorly targeted food programs. Sources:Pongou R, et.al (2006); Soekirman (2001); Thomas D, et. al (1999); Grantham-McGregor SM ., et.al(1993); Super CM, et. al (1990) Lutter, CK et. all (1989)/ Aoyoma, A (1999) Trends in the Egyptian Economy (1995- 2005) Source: EIU Database Economic Declines 2001 Egyptian Stock market collapse Domestic financial scandals Global financial crisis 1997-99 Further negative shocks included: 1999 Luxor terrorist attacks September 11, 2001 Invasion of Iraq (2003) Sources: Dobronogov and Iqbal (2005) The Egyptian Economic Future? Persistent high levels of poverty High vulnerability to external shocks High dependence on external economic aid Sustained demographic growth and pressures Current global economic crisis Continued fragility of the Egyptian economy merits the creation of durable social security nets that will shield the Egyptian population from the negative nutritional outcomes associated with economic declines Food Policy and Nutrition Targeted food policies have been shown to moderate the nutritional impact of economic shocks Evidence that targeted nutritional programs are effective in protecting low-income groups from nutritional declines In the MENA region there “appears to be a negative correlation between stunting prevalence and efficiently targeted food programs Sources: Pongou R, et.al (2006); Soekirman (2001); Thomas D, et. al (1999); Grantham-McGregor SM ., et.al(1993); Super CM, et. al (1990) Lutter, CK et. all (1989)/ Aoyoma, A (1999) Egyptian Food Subsidies Started in 1941 with WWII ration cards 1980’s over 18 foods were subsidized and available in monthly rations to any Egyptian who had a ration card Meat, fish, chicken and other foods consumed by high-income populations were removed from the subsidy system between 1990 and 1992 1996 only four foods subsidized Flour (unfortified) Baladi bread (made with unfortified flour) Edible oil Sugar Limited to high energy, low nutritional value foods Subsidized food as a source of caloric availability Subsidized food as a source of Calorie Availability by Expenditure Quintile for Urban and Rural Egypt1 Total Per Capita Calorie Subsidized Calorie Availability per Day % Subsidized Availablity Per Region (A) (B/A) Capita per Day (B) Urban Egypt 3,306 33.80% 1,117 Lowest Quintile 2,704 43.50% 1,176 Second 3,012 40.40% 1,217 Third 3,302 36.40% 1,202 Fourth 3,533 30.00% 1,060 Highest Quintile 3,664 24.60% 901 Rural Egypt 3,555 31.60% 1,123 Lowest Quintile 2,874 37.90% 1,089 Second 3,058 32.40% 991 Third 3,543 30.50% 1,081 Fourth 3,653 31.80% 1,162 Highest Quintile 4,194 28.50% 1,195 1Source: International Food Policy Research Institute (IFPRI), Egypt Integrated Household Survey (IFPRI, Washington, D.C., 1997) Tables 6 and 9 in Adams (2000) pages 127 and 130 Conclusions The nutritional status of Egyptian children appears to be highly sensitive to economic changes Declines in the nutritional status of Egyptian children is occurring in a context of high caloric availability Subsidized foods provide significant contributions to the calories available Previous Policy Recommendations Focus on distribution, leakage and targeting of food subsidies in Egypt Suggestions have included Reducing leakage/corruption Targeting the most needy Identifying the most “needy” has been difficult Despite distributional issues: Dietary Energy Consumption (kcal/person/per day): 1992: 3,240; 1995: 3390; 2005: 3320 Sources: Adams (2000); Gutner (1999); FAO food statistics Policy Recommendations Focus on the nutritional quality of subsidized foods Cooking oil and sugar High energy, low nutritional value Less politically sensitive than bread and flour Room for substitution with higher nutritive value foods Elimination? Bread and Wheat flour Average annual bread consumption per person in Egypt: 146.5 kilograms Majority of Egypt’s poor subsist on subsidized bread Ensure recent fortification efforts are successful and implemented nationally Best case scenario: Effective and efficient targeting of neediest populations with quality nutrition foods.