Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Justine A Kavle, Fatma El-Zanaty, Megan Landry, Rae Galloway

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

A 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.

Methods

The 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.

Results

Between 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).

Conclusions

Decreased 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.
Appendix
Available only for authorised users
Literature
1.
de Onis M, Garza C, Onyango AW, Martorell R. WHO child growth standards. Acta Paediatr. 2006;450 (Suppl.):1–101.
2.
Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473–80.CrossRefPubMed
3.
Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013;9 Suppl 2:27–45.CrossRefPubMed
4.
World-Bank. Repositioning nutrition as central to development: a strategy for large-scale action. Washington, DC: World Bank; 2006.
5.
Food and Agriculture Organization. The double burden of malnutrition: Case studies from six developing countries. In: Food & Nutrition Paper. Rome, Italy: Food and Agriculture Organization; 2006.
6.
El-Zanaty F, Way A. Egypt demographic and health survey 2008. Cairo, Egypt: Ministry of Health and Population, National Population Council, El-Zanaty and Associates, and ORC Macro; 2009.
7.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.CrossRefPubMed
8.
World Food Programme. Cost of hunger in Egypt: implications of child undernutrition on the social and economic development in Egypt. In: The social and economic impact of child undernutrition in Egypt. Cairo, Egypt: Egyptian Cabinet Information Decision Support Center; 2013.
9.
Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370(9603):1929–38.CrossRefPubMed
10.
11.
Krebs NF, Mazariegos M, Tshefu A, Bose C, Sami N, Chomba E, et al. Meat consumption is associated with less stunting among toddlers in four diverse low-income settings. Food Nutr Bull. 2011;32(3):185–91.CrossRefPubMedPubMedCentral
12.
Leroy JL, Frongillo EA. Can interventions to promote animal production ameliorate undernutrition? J Nutr. 2007;137(10):2311–6.PubMed
13.
Alders R, Awuni JA, Bagnol B, Farrell P, de Haan N. Impact of avian influenza on village poultry production globally. Ecohealth. 2014;11(1):63–72.PubMed
14.
World Food Programme. Status of poverty and food security in Egypt: analysis and policy recommendations, Preliminary summary report. Egypt: World Food Programme; 2013.
15.
Ismail NA, Ahmed HA. Knowledge, attitudes and practices related to avian influenza among a rural community in Egypt. J Egypt Public Health Assoc. 2010;85(1–2):73–96.PubMed
16.
Hawkes C, Ruel M. From agriculture to nutrition: pathways, synergies, and outcomes. 40th ed. Washington DC: The World Bank and Agriculture and Rural Development (ARD); 2008.
17.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.CrossRefPubMedPubMedCentral
18.
Bwibo NO, Neumann CG. The need for animal source foods by Kenyan children. J Nutrit. 2003;133(11 Suppl 2):3936S–40S.PubMed
19.
Murphy SP, Allen LH. Nutritional importance of animal source foods. J Nutr. 2003;133(11 Suppl 2):3932S–5S.PubMed
20.
de Beer H. Dairy products and physical stature: a systematic review and meta-analysis of controlled trials. Econ Hum Biol. 2012;10(3):299–309.CrossRefPubMed
21.
Iannotti L, Roy D. Nutritional impact of highly pathogenic avian influenza in Kenya. Food Nutr Bull. 2013;34(3):299–309.CrossRefPubMed
22.
United Nations Development Program (UNDP), Institute of National Planning Egypt. Egypt human development report: youth in Egypt 2010. Cairo, Egypt: UNDP; 2010.
23.
El-Zanaty F, Way A. Egypt demographic and health survey 2005. Cairo, Egypt: Ministry of Health and Population, National Population Council, El-Zanaty and Associates, and ORC Macro; 2006.
24.
WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Scandinavica Suppl. 2006;450:76-85.
25.
Way A, El-Zanaty F, R H, Ismail I. Undernutrition among young children in Egypt, Prepared for Expert Consultation. Calverton, Maryland: Measure DHS project, USAID and El-Zanaty and Associates; 2012. p. 21.
26.
Filmer D, Pritchett LH. Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography. 2001;38(1):115–32.PubMed
27.
Rutstein SO, Rojas G. Guide to DHS Statistics. Calverton, MD: Macro International, Demographic and Health Research Division; 2006.
28.
O’Brien RM. A caution regarding rules of thumb for variance inflation factors. Qual Quantity. 2007;41(5):673–90.CrossRef
29.
Kandeel A, Manoncourt S, Abd el Kareem E, Mohamed Ahmed AN, El-Refaie S, Essmat H, et al. Zoonotic transmission of avian influenza virus (H5N1), Egypt, 2006–2009. Emerg Infect Dis. 2010;16(7):1101–7.CrossRefPubMedPubMedCentral
30.
Vergne T, Grosbois V, Jobre Y, Saad A, El Nabi AA, Galal S, et al. Avian influenza vaccination of poultry and passive case reporting, Egypt. Emerg Infect Dis. 2012;18(12):2076–8.CrossRefPubMedPubMedCentral
31.
Lohiniva AL, Dueger E, Talaat M, Refaey S, Zaki A, Chisholm Horton K, et al. Poultry rearing and slaughtering practices in rural Egypt: an exploration of risk factors for H5N1 virus human transmission. Influenza Other Respi Viruses. 2013;7(6):1251–9.CrossRef
32.
Lambert V, Radwan H. Gender assessment of avian influenza in Egypt. Washington, DC: USAID; 2010.
33.
Kavle J, Mehanna S, Saleh G, Foaud M, Ramzy M, Hamed D, et al. Examining factors associated with stunting in Lower Egypt in comparison to Upper Egypt: bridging the gap between cultural beliefs and feasible feeding practices through Trials for Improved Practices (TIPs). USAID Report. Washington DC; 2014.
34.
Arimond M, Ruel MT. Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr. 2004;134(10):2579–85.PubMed
35.
PAHO/WHO. Guiding principles for the complementary feeding of the breastfed child. Washington, DC: Pan American Health Organization; 2003.
36.
Geerlings H. Highly pathogenic avian influenza: a rapid assessment of the socio-economic impact on vulnerable households in Egypt. Cairo, Egypt: Food and Agriculture Organization; 2007.
37.
World Food Program. Status of food security and vulnerability in Egypt, 2009. Cairo, Egypt: World Food Programme; 2011.
38.
Calloway DH, Murphy SP, Beaton GH, Lein D. Estimated vitamin intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. Am J Clin Nutr. 1993;58(3):376–84.PubMed
39.
Murphy SP, Beaton GH, Calloway DH. Estimated mineral intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. Am J Clin Nutr. 1992;56(3):565–72.PubMed
40.
Siekmann JH, Allen LH, Bwibo NO, Demment MW, Murphy SP, Neumann CG. Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. J Nutr. 2003;133(11 Suppl 2):3972S–80S.PubMed
41.
Dror DK, Allen LH. The importance of milk and other animal-source foods for children in low-income countries. Food Nutr Bull. 2011;32(3):227–43.CrossRefPubMed
42.
Darapheak C, Takano T, Kizuki M, Nakamura K, Seino K. Consumption of animal source foods and dietary diversity reduce stunting in children in Cambodia. Int Arch Med. 2013;6:29.CrossRefPubMedPubMedCentral
43.
John Snow Inc., Arabic Software Engineering (ArabSoft), Clark Atlanta University, The Manoff Group and TransCentury Associates. Healthy Mother/Healthy Child Project. Completion Report, USAID Report; Boston, MA; 2005.
44.
Rogol AD, Clark PA, Roemmich JN. Growth and pubertal development in children and adolescents: effects of diet and physical activity. Am J Clin Nutr. 2000;72(2 Suppl):521S–8S.PubMed
45.
Baumgartner RN, Roche AF, Himes JH. Incremental growth tables: supplementary to previously published charts. Am J Clin Nutr. 1986;43(5):711–22.PubMed
46.
Kavle J, Mehanna S, Khan G, Hassan M, Saleh G, Galloway R. Cultural beliefs and perceptions of maternal diet and weight gain during pregnancy and postpartum family planning in Egypt. USAID Report. Washington DC; 2014.
47.
Asfaw A. Micronutrient deficiency and the prevalence of mothers’ overweight/obesity in Egypt. Econ Hum Biol. 2007;5(3):471–83.CrossRefPubMed
48.
Asfaw A. Do government good price policies affect the prevalence of obesity? Empirical evidence from Egypt. World Dev. 2007;35:687–701.CrossRef
49.
Austin AM, Hill AG, Fawzi WW. Maternal obesity trends in Egypt 1995–2005. Matern Child Nutr. 2013;9(2):167–79.CrossRefPubMed
50.
McPhie S, Skouteris H, Daniels L, Jansen E. Maternal correlates of maternal child feeding practices: a systematic review. Matern Child Nutr. 2014;10(1):18–43.CrossRefPubMed
51.
Fabunmi T, Onabanjo O, Oguntona O, Keshinro O, Onabanjo J, Obanla OO, et al. Nutrient intakes and nutritional status of mothers and their under-five children in a rural community of Oyo state, Nigeria. Int J Child Health Nutr. 2013;2:39–49.
52.
Saha KK, Frongillo EA, Alam DS, Arifeen SE, Persson LA, Rasmussen KM. Household food security is associated with infant feeding practices in rural Bangladesh. J Nutr. 2008;138(7):1383–90.PubMedPubMedCentral
53.
Rutstein SO. Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries: evidence from the demographic and health surveys DHS working papers. Calverton, MD: Macro International, Demographic and Health Research Division; 2008.
54.
Dewey KG, Cohen RJ. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr. 2007;3(3):151–73.CrossRefPubMed
55.
Zottarelli LK, Sunil TS, Rajaram S. Influence of parental and socioeconomic factors on stunting in children under 5 years in Egypt. East Mediterr Health J. 2007;13(6):1330–42.PubMed
56.
Mora JO, Nestel PS. Improving prenatal nutrition in developing countries: strategies, prospects, and challenges. Am J Clin Nutr. 2000;71(5 Suppl):1353S–63S.PubMed
57.
Merchant K, Martorell R. Frequent reproductive cycling: does it lead to nutritional depletion of mothers? Prog Food Nutr Sci. 1988;12(4):339–69.PubMed
58.
Huffman S, Piwoz E, Vosti S, Dewey K. Babies, soft drinks and snacks: a concern in low- and middle-income countries. Mat Child Nutr. 2014. doi:10.1111/mcn.12126. [Epub ahead of print]
59.
Kavle J, Mehanna S, Saleh G, Foaud M, Ramzy M, Hamed D, et al. Exploring why junk foods are ‘essential’ foods and how culturally tailored recommendations improved feeding in Egyptian children. Mat Child Nutr. 2014. doi:10.1111/mcn.12165.
Metadata
Title
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
Authors
Justine A Kavle
Fatma El-Zanaty
Megan Landry
Rae Galloway
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1627-3

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Detection of influenza-like illness aberrations by directly monitoring Pearson residuals of fitted negative binomial regression models

Study protocol

Activation of persons living with HIV for treatment, the great study

Research article

Viral transmission risk factors in an Egyptian population with high hepatitis C prevalence

Research article

Effectiveness of a problem-solving based intervention to prolong the working life of ageing workers

Research article

Vitamin D levels and status amongst asthmatic and non-asthmatic adolescents in Cyprus: a comparative cross-sectional study

Research article

Awareness of female malignancies among women and their partners in Southern Sri Lanka and implications for screening: a cross sectional study