Ministry of Health and Population strategies
Health strategies
In order to improve the health status of the Egyptian population, MOHP has developed several strategies, including the following:
Preventive care system: the specific areas of intervention are immunization, quarantine measures, safe water supply, food hygiene, public cleanliness, environmental hygiene and infestation control.
Primary health care: through which medical services are provided to the general population and to vulnerable groups (pregnant and lactating mothers and children under five years of age).
Curative care services: where sick people find medical treatment.
Nutrition strategies
Before 1992, ad hoc programmes addressed the problem of malnutrition. Following the International Conference on Nutrition (ICN), held in Rome in December 1992 and sponsored by FAO and WHO, nutrition programmes in Egypt have been enhanced.
Egypt presented a country paper at the conference and took part in post-ICN condensed nutrition activities. A ministerial decree of 1994 formulated a high-level inter-ministerial committee representing the ministries of agriculture, health, planning, information, supply, education and academia. The outcome was the development of the Egyptian National Strategy for Nutrition, which has nine main policy areas. Each policy area includes a problem statement, a goal, measurable objectives, actions, authorities responsible for undertaking the different activities, resources, legislation (if required), and monitoring and evaluation indicators.
The main policy areas are:
assessing, analysing and monitoring nutrition situations.
Most of the programmes directed at improving the nutritional status of the population fell under the umbrella of this national strategy.
Programmes to improve food security
In addition to health/nutrition care, the availability of food items is also very important in efforts to improve nutrition status. The following are some of the main programmes aimed at increasing food availability in Egypt.
Food ration and subsidy programmes
The main objective of the food subsidy programme was to improve household food security and to prevent malnutrition and chronic energy deficiency. The current food rationing programme was established more than 50 years ago. In addition to price subsidies, specific forms of price intervention include market interventions in the form of subsidized food imports sold through the existing cooperative system. The most recent examples of this are meat imports from the Sudan, which are sold at less than half the price of locally produced meat. According to the present rationing programme, each individual receives - through the family card - a monthly ration of sugar, tea, oil, lentils, broad beans, rice and macaroni that meets a significant proportion of the family’s needs. The subsidy of wheat bread is the most important component of this programme, but the food subsidy programme has several drawbacks and constraints as the cost of food price subsidies represents a serious drain on Egypt’s national economy and constitutes a major block to the development programme.
Programmes to increase food production
As part of a national land reclamation project, the government has initiated projects all over Egypt. These include the Toshka project in Upper Egypt, which was started in January 1997 and aims to double the area of arable land in Egypt within a period of 15 years. The project’s estimated cost was about US$86.5 billion to cover the 20 years from 1997 to 2017.
Programmes to improve nutritional status and to prevent and control malnutrition and morbidity
Programmes to prevent diet-related NCDs
Many programmes have been directed at improving the nutritional status of the Egyptian population and preventing NCDs. These programmes included the following strategies:
Nutrition education: Community nutrition education was carried out through health facilities, schools, non-governmental organizations (NGOs) and the media with the aims of increasing the population’s awareness of the programme, enhancing its knowledge and modifying its nutritional behaviours.
Food-based dietary guidelines: With support from the United Nations Children’s Fund (UNICEF), NNI produced food-based dietary guidelines for Egypt. These guidelines are directed at educated people, nutrition educators in the health sectors, NGOs and others. They include simple practical messages for healthy eating and lifestyles.
Nutrition capacity building: NNI and MOHP are building capacity through training programmes for health providers, physicians, nurses and community workers.
Specialized clinics: NNI has set up specialized clinics for the prevention, early detection and management of nutritional diseases, particularly obesity, its co-morbidities and stunting.
Programmes for improving nutritional status
Many programmes directed at improving the nutritional status of Egyptian populations have been carried out over the last 20 years. The following paragraphs describe some of these.
The national programme for supporting breastfeeding practices: Exclusive breastfeeding for the first six months of age, continuing breastfeeding up to two years of age, and healthy complementary feeding practices were the main thrusts of breastfeeding promotion activities. Among the many activities implemented to achieve these aims were the formulation of a national committee for the promotion of breastfeeding practices, the establishment of a national policy to support and encourage breastfeeding, implementation of the Baby-Friendly Hospital Initiative in 120 maternity health facilities, and implementation of the international code for the marketing of breastmilk substitutes.
Child Survival and Integrated Management of Childhood Illness: MOHP conducted many projects to improve the health and nutrition status of children under five years of age; these included the Control Diarrhoeal Diseases Programme, Child Survival (1985 to 1995) and Integrated Management of Childhood Illness (1995 to 2005).
The national programme for improving the nutritional status of school-age children: The Ministry of Education implemented school feeding programmes to enhance schoolchildren’s physical and mental development. The programmes include the following:
Iron-fortified biscuits: one packet of 80 g biscuits fortified with iron salt is given to each child in primary schools.
The School Pie Programme: the ministries of education and agriculture provide pies on 110 days a year to half a million primary schoolchildren in seven governorates (Fayoum, Monofia, Behaira, Port Said, North Sinai, Damitta and Beni Swef). The World Food Programme (WFP) contributes to this programme by extending the period of meal distributions to 150 days.
Cooked meals: The main target groups for this are handicapped students.
Cold/dry meals: The main target groups for these are students in secondary, industrial, agricultural, technical and sports schools.
The number of students involved in these programmes increased from 3 019 130 in 1991/1992 to 11 210 258 in 2004/2005. Government contributions and external aid increased from LE 35 806 594 in 1991/1992 to LE 353 600 000 in 2004/2005.
Programmes for the prevention and control of micronutrient deficiencies
The National Programme for the Prevention and Control of IDA: Among MOHP’s activities directed at preventing and controlling IDA are:
programmes to prevent and control infection and infestation.
The National Programme for the Prevention and Control of IDD: With support from UNICEF, MOHP and NNI have implemented many programmes to prevent IDD, which is a public health problem in Egypt. These programmes include:
iodized oil supplementation in New Valley governorate (which has the highest IDD prevalence);
formation of the National IDD Committee in1993;
the universal salt iodization programme, launched by MOHP in 1996 with the support of UNICEF;
four social marketing campaigns to promote iodized salt, which were conducted by NNI, MOHP and UNICEF with the aim of increasing household-level use of iodized salt in governorates where this was low - Gharbia, Fayoum, Quena and Assuit. As a result, household-level use of iodized salt rose from 56 percent in 2000 to 79 percent in 2003 (EIDHS, 2003);
early detection of neonatal hypothyroidism through a neonatal screening programme that aims to test every child before it reaches one week of age.
The National Programme for the Prevention and Control of Vitamin A Deficiency: After NNI had conducted its national survey of vitamin A status, a national plan to eliminate VAD was implemented. This plan involved the following activities:
vitamin A supplementation to children at ages nine and 18 months.
Egypt is a developing country that is facing the double burden of malnutrition. Over recent years, annual per capita income has increased from LE 4 822.4 in 1998/1999, to LE 5 537.6 in 2000/2001 and to LE 5 652.8 in 2002/2003.
Health indicators have also improved over the last 25 years. The under-five mortality rate decreased from 102 per 1 000 live births in 1980 to 1985, to 46 in 1998 to 2003. With infant mortality decreasing from 73 to 38 over the same period. These data indicate that childhood mortality is becoming concentrated in early infancy. Overall, 88 percent of children are immunized against all major preventable childhood diseases. Life expectancy has increased, for males from 52.7 years in 1976 to 67.9 in 2003, and for females from 57.7 years in 1976 to 72.3 in 2003.
The changed consumption patterns of the Egyptian population during the last two decades can be explained as reflecting changes in socio-economic status, changes in feeding habits, urbanization and globalization. The dietary changes that have occurred in Egypt have been associated with increasing proportions of energy-dense foods and saturated fat. Food patterns have changed towards increasing intakes of fats and oils, high-fat products, sugar, meat and refined carbohydrates, and decreasing cereal consumption.
The total energy intake declined from 3 057 kcal in 1981 to 2 460 kcal in 2000, and the mean protein intake increased from 88.7 g to 91.5 g. In 1981, cereals contributed 61.2 percent of total energy intake, and animal protein only 8.1 percent. In 2000, cereals’ contribution had declined to 52.0 percent, while animal protein’s had increased to 20 percent. Animal protein’s contribution to total protein intake also increased, from 27.7 percent in 1981 to 35.5 percent in 2000. This represents a significant increase in consumption of animal protein, while the contributions of vegetarian food groups to energy and protein intakes are decreasing; this may play a role in the emergence of diet-related chronic diseases in Egypt.
Although mothers’ total energy intake decreased from 2 602 kcal in 2000 to 1 995 kcal in 2004, this did not seem to have any influence on the prevalence of obesity among females. This can be explained by the complexity of obesity pathogenesis. Most of the mothers - more than 90 percent - did not practice any regular physical activity.
Food prices and availability have influenced the food consumption of Egyptian populations. Increased income leads to people increasing their consumption of meat and animal protein; after prices increased rapidly following devaluation of the Egyptian pound in 2001, the consumption of all food groups decreased in 2004.
The food adequacy data from NNI national surveys show that the percentage of children receiving more than 100 percent of their energy RDAs increased from about 14 percent in 1995 to about 46.9 percent in 2000. These data, when added to the decrease in physical activity, explain the high prevalence of obesity in adolescence.
Although data show that about 90 percent of children and 70 percent of mothers consume more than 100 percent of the RDA for iron, the prevalence of anaemia in Egypt is still very high. This could be because most of the iron consumed is of plant origin, which decreases the bioavailability of iron.
Changing life styles, with more psychological stress, less physical activity and more high-density food, and changing eating habits, such as eating heavy meals late at night, are leading to increased prevalence of overweight and obesity among Egyptian populations. This in turn is leading to increased prevalence of diet-related chronic NCDs - diabetes, hypertension and certain types of cancer. The alarming results are that diet-related diseases are becoming more prevalent among younger age groups.
It is evident that future surveys should standardize their methodologies, have unified guidelines and be implemented regularly. This will make it easier to analyse, compare and track changes over time.
Changing the conceptual framework for implementing nutrition education programmes so that more attention is paid to raising Egyptians’ nutrition awareness could help the prevention of diet-related diseases and their consequences. Such programmes must target adolescents and young adults, especially females, in order to reduce the high prevalence of NCDs in Egypt. Micronutrient deficiencies, especially IDA, still need strategies such as food fortification and nutrition education to increase the bioavailability of iron in foods. It is also recommended that distribution and application of the existing food-based dietary guidelines be strengthened.
Obstacles and constraints faced by this report
The following challenges were encountered during the preparation of this report:
Raw data from most NNI and ARC surveys were not available, so data had to be obtained from the published reports.
The NNI and ARC surveys used different types of analysis as regards RDAs, food composition tables and use of the truncated method (removing data pertaining to consumption of > 100 percent RDA). Differences in methodology made it very difficult to compare both sets of data.
The dietary consumption surveys conducted by NNI had differing objectives and target groups, making it difficult to derive trends in food consumption patterns.
Institutional needs
National nutrition policy
There is a great need to implement a national nutrition policy with objectives that are modified according to changes in food patterns and food habits. Healthy eating and healthy lifestyles should be addressed in all health facilities and school curricula.
New component in primary health care to address obesity and diet-related NCDs
The role of the primary health care unit in preventing and treating obesity and NCDs must be addressed over the coming years, as the prevalence of diet-related diseases is increasing.
Strengthening of the nutrition surveillance system
A nutrition surveillance system was established in Egypt between 1995 and 1997. There is a great need to redesign and strengthen this system for the early detection and proper management of malnutrition disorders.
Capacity building and training needs
Improving nutrition status requires a well-trained health staff who are capable of communicating with communities to spread information about healthy food and to educate people on the prevention of NCDs. There should be continuous training programmes for health staff, with emphasis on intra- and intersectoral collaboration.
Communication, education and advocacy activities
Communication programmes are important in supporting strategies to prevent nutrient deficiencies. Information on causes, consequences and measures to control and prevent IDA, IDD and VAD should be disseminated through mother-and-child health centres, primary and secondary schools and the mass media.
Education and communication programmes are needed to raise awareness of the risks of obesity and diet-related NCDs and to change the health and nutrition behaviour of women. Such programmes should be implemented for adolescent girls in schools and at mother-and-child health centres.
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[7] This section was
investigated by A. Gohar and I. Ismail. [8] This section was investigated by A. Gohar and I. Ismail. |
