The rise in stunting in relation to avian influenza and food consumption patterns in Lower Egypt in comparison to Upper Egypt: results from 2005 and 2008 Demographic and Health Surveys

Abstract

BackgroundA 2006 avian influenza (AI) outbreak resulted in mass removal of chickens in Lower Egypt, which decreased the household supply of poultry. Poultry, a key animal-source food, contains nutrients critical for child growth. This paper examines determinants of stunting between 2006 and 2008 in children 6 to 59 months of age within the context of the AI outbreak.MethodsThe 2005 and 2008 nationally representative Egypt Demographic and Health Surveys (EDHS) were used to analyse anthropometric data from 7,794 children in 2005 and 6,091 children in 2008. Children, 6–59 months of age, with length for age Z-score < −2 S.D. were categorized as stunted. Predictors of stunting were examined by bivariate and multivariable analyses, focusing on Lower Egypt, where a rise in stunting occurred, and Upper Egypt, where stunting declined.ResultsBetween 2005 and 2008, Upper Egypt experienced a significant decline in stunting (28.8 to 21.8%, P < 0.001). Lower Egypt experienced a significant rise in stunting (16.6 to 31.5%, P < 0.001), coinciding with the 2006 AI outbreak. In Lower Egypt (2008), households owning poultry were 41.7% less likely to have a stunted child [aOR 0.58; 95% CI (0.42, 0.81) P = 0.002], and 12–47 month old children were 2.12-2.34 times [95% CI (1.39 – 3.63) P ≤ 0.001] more likely to be stunted than 6–11 month old children. Older children were likely affected by AI, as these children were either in-utero or toddlers in 2006. In Upper Egypt, stunting peaked at 12–23 months [aOR 2.62, 95% CI (1.73-3.96), P < 0.001], with lowered risk (22-32%) of stunting in 24–47 month old children [aOR1.65, 95% 1.07-2.53, P = 0.022, 24–35 month old] and [aOR 1.57, 95% CI 1.01-2.43, P = 0.043 36–47 months old]. A two-fold increase in child consumption of sugary foods between 2005 and 2008 was found in Lower Egypt (24.5% versus 52.7%; P < .001).ConclusionsDecreased dietary diversity, reduced poultry consumption, substitution of nutritious foods with sugary foods paralleled a reduction in household raising of birds, following the AI outbreak in Lower Egypt and not Upper Egypt. Increased feeding of sugary foods due to fear of illness or greater penetration of these foods may be related to stunting. Advice on infant and young child feeding is needed to improve dietary intake and reduce sugary food consumption.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1627-3) contains supplementary material, which is available to authorized users.

Program considerations for integration of nutrition and family planning: Beliefs around maternal diet and breastfeeding within the context of the nutrition transition in Egypt

“…Although processed foods are more expensive than locally available foods, these foods are within economic reach for most families who choose to consume these foods, based on recent evidence from Egypt (Kavle, Mehanna et. al., ), which may have contributed to the nutrition transition. Inadequate dietary intake of energy, protein, and micronutrients during pregnancy can subsequently put infants and young children at increased risk of adult obesity, which would be of particular concern in Egypt, where prevalence of maternal overweight and obesity is high (Christian & Stewart, ; Ludwig, Rouse, & Currie, ).…”

“…Nearly one in five women recalled eating sugary foods during this time period. Similarly, nutrient-poor diets and consumption of low-nutritive, high fat "junk" foods has been documented as a feeding problem among Egyptian infants and young children, and evidence-based recommendations have recently been put forth to address this issue (Huffman, Piwoz, Vosti, & Dewey, 2014;Kavle, El-Zanaty, Landry, & Galloway, 2015;Kavle et al, 2014;Kavle, Mehanna, et al, 2015;Kavle et al, 2016).…”

Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition

“…Recent analyses revealed decreased dietary diversity, reduced poultry consumption and substitution of nutritious foods with sugary foods as a consequence of the AI outbreak (Kavle et al . ). During the same time period, a similar increase in stunting prevalence did not occur in Upper Egypt, a rural, agricultural area, in the southern part of the country.…”

“…An increase in the prevalence of stunting from 2005 to 2008 was documented in Lower Egypt, a semi-urban area in northern Egypt, near the capital city of Cairo (El-Zanaty & Way 2006;El-Zanaty and Way 2009), which coincided with an AI outbreak. Recent analyses revealed decreased dietary diversity, reduced poultry consumption and substitution of nutritious foods with sugary foods as a consequence of the AI outbreak (Kavle et al 2015b). During the same time period, a similar increase in stunting prevalence did not occur in Upper Egypt, a rural, agricultural area, in the southern part of the country.…”

Infectious Diseases and Agriculture

“…Widespread animal diseases reduce the availability of animal source food. But control of ZEIDs can also reduce animal source food available with likely nutritional consequences (Kavle et al, 2015). If people become ill their health and nutrition are obviously affected.…”