Menu ENN Search

Regional nutrition strategies to address the double burden in the Eastern Mediterranean

Dr Ayoub Al Jawaldeh has been the Regional Adviser for Nutrition in the WHO Regional Office for Eastern Mediterranean Region since 2009, leading the Regional Nutrition Strategy.

Introduction

The burden of disease associated with inadequate nutrition continues to grow in countries of the Eastern Mediterranean Region (EMR), comprising 22 countries and territories in the Middle East, North Africa, the Horn of Africa and Central Asia. Similar to many developing countries, the region suffers from problems of both undernutrition and overweight, obesity and diet-related non-communicable diseases (NCDs), which are all increasing. This ‘double burden’ of malnutrition negatively impacts EMR health systems. Several micronutrient deficiencies are still being reported from many countries in the region, particularly iron, iodine and vitamin A.

In response to these challenges, the World Health Organization (WHO) Regional Office in the EMR developed the first regional Nutrition Strategy (2010-2019) and Action Plan in coordination with other UN agencies and stakeholders to scale up nutrition1. The overall goals of the regional strategy are to encourage countries to reposition nutrition as central to their development agenda; support them in establishing and implementing action on nutrition according to their national situation and resources; and provide a framework for prioritising nutrition actions in each country context. The plan has been updated to include recent initiatives such as the World Health Authority (WHA) global targets 2025 to improve maternal, infant and young child nutrition and the Sustainable Development Goals (SDGs)2; most states within the EMR have now developed or reviewed national action plans in line with these.

Nutrition situation for key indicators

According to the most recent estimates3, rates of stunting, wasting and underweight in children under five years of age (CU5) in the region are 28 per cent, 8.69 per cent and 18 per cent, respectively. Yemen, Pakistan, Afghanistan, Sudan and Djibouti have the highest burden of stunting (>30 per cent). Due to political unrest and food insecurity in these countries, as well as in Syria, Iraq and Libya, the total number of wasted CU5 is estimated at 9.1 million (7.3 per cent); out of which nearly half (3.1 million or 3.8 per cent) are severely wasted. Over half of pregnant women have anaemia in the Sudan (58.4 per cent), the Syrian Arab Republic (57.3 per cent) and Pakistan (51 per cent).

Of particular concern is the increasing trend in overweight and obesity among adults and children. Average prevalence of overweight and obesity in the region is 27 per cent and 24 per cent in adults and 16.5 per cent and 4.8 per cent in school-aged children respectively3. The highest levels of obesity were reported in Kuwait, Qatar, Bahrain and the United Arab Emirates (UAE). In 2016, an estimated 5.4 million CU5 (6.7 per cent) in EMR were overweight, an increase from 3.5 million in 1990. Half the region’s adult women and more than two out of five men are overweight or obese.

As in other regions, high rates of overweight and obesity are closely linked to physical inactivity and unhealthy diets. The EMR has the highest global prevalence of physical inactivity in adults (approximately one third), with data consistently showing higher levels of inactivity in women than men (compared with an overall global prevalence for both sexes of 23 per cent4. There have also been marked changes in the region’s dietary patterns consistent with global food consumption, shifting towards higher-energy diets dominated by increased intakes of fats and sugar.

Bakers use fortified flour to make bread as part of a programme in Afghanistan

Key priorities

The following key actions are taking place to support strategic priorities:

  1. Maternal, infant and young child nutrition: interventions including infant and young child feeding (promotion of breastfeeding and complimentary feeding), food fortification and supplementation programmes, growth monitoring and nutrition surveillance and treatment of severe acute malnutrition (SAM).
  2. NCD-diet related risk factors: promoting healthy diet through cost-effective interventions identified within the Regional Framework for Action to address NCDs, including: promoting breastfeeding and implementing the International Code of Marketing of Breast-milk Substitutes (‘the Code’); reducing salt intake at population level; developing food-based dietary guidelines; food labelling; product reformulation, including replacing trans fats with polyunsaturated fats and sugar reduction; and restricting marketing of unhealthy food to children.
  3. Emergency nutrition: screening cases for SAM.

Progress and achievements to date

More than 17 countries have developed full or partial legal documents relating to the Code, but implementation remains a challenge. In 2017, development of food-based dietary guidelines was expanded in the region to include Afghanistan, Egypt, Islamic Republic of Iran, Lebanon, Oman, Qatar and Saudi Arabia. Salt reduction in bread is also progressing in Kuwait, Qatar, Oman, Iran, Bahrain, Morocco, Tunisia and Jordan. Elimination of trans fats is a priority for action in Iran, Saudi Arabia and Tunisia. Adding taxes to sugar-sweetened beverages to reduce sugar consumption is being implemented in Saudi Arabia, United Arab Emirates, Iran and Jordan.

Afghanistan Pakistan, Somalia, Sudan and Yemen have all become members of the Scaling Up Nutrition (SUN) Movement, providing a great opportunity to galvanise action to ensure country progress in efforts to reach SDG targets.

Challenges in implementation

The EMR is a very complex region and countries have different nutrition problems and challenges with different socioeconomic profiles. There is a double burden of malnutrition and at least 16 countries are experiencing internal conflicts and political instability, making the most vulnerable inaccessible to nutrition services that are in high demand. Many countries still face challenges in the formulation and implementation of nutrition strategies and action plans that are holistic in their approach to addressing nutrition issues, including Pakistan, Yemen, Sudan, Djibouti and Somalia.

Other challenges in the region include:

  1. Weakness of clear political commitment to nutrition action and/or failure to turn the political commitment towards nutritional problems into tangible action;
  2. The absence of a policy framework and institutional capacity to plan, implement and monitor nutrition programmes that respond to the multi-sector dimensions of nutrition problems;
  3. Recurrent conflicts and natural disasters;
  4. The disproportionate allocation of health budgets, often at the expense of preventive strategies such as nutrition;
  5. The abandonment of traditional diets, which are often more nutritious, in favour of western diets that feature more refined foods, resulting in the reduction of dietary diversity; and
  6. The absence of nutrition expertise in related sectors and inter-sector coordination.

The Regional Strategy has helped countries to set strategic priorities of key activities with clear outcomes and measurable deliverables and enabled states within the EMR to monitor progress towards meeting achievable global targets. Close follow-up and technical support from UN/NGOs is helping to scale up nutrition programmes and focus on cost-effective interventions. 

Read more...

More like this

NEX: Regional nutrition strategies to address the double burden in the Eastern Mediterranean

Dr Ayoub Al Jawaldeh has been the Regional Adviser for Nutrition in the WHO Regional Office for Eastern Mediterranean Region since 2009, leading the Regional Nutrition...

NEX: A regional nutrition strategy for West Africa

West Africa has a population of close to 372 million, of which 62.3 million are children under five years of age (CU5). Over one third of these - 19 million CU5 - are stunted,...

en-net: Nutrition and NCDs

I work as a Principal Nutritionist in Lusaka province in Zambia. There has been an increase in morbidity of hypertension and diabetes in the hospitals in the province. I...

NEX: Championing nutrition in Gabon

An interview with Yves Fernand Manfoumbi, Gabon's Minister of Agriculture, Livestock and the GRAINE Programme1 from October 2016 to February 201). As Minister, Manfoumbi...

FEX: Tackling the double burden of malnutrition in low and middle-income countries: response of the international community

Research By Alexandra Rutishauser-Perera Alexandra Rutishauser-Perera is a Humanitarian Nutrition Adviser with Save the Children. She has ten years of experience of public...

NEX: Stratégies régionales de nutrition visant à alléger le double fardeau qui pèse sur la Méditerranée orientale

Le Dr. Ayoub Al Jawaldeh est conseiller régional pour la nutrition au sein du Bureau régional de l'OMS pour la région de la Méditerranée...

NEX: Nourishing the Sustainable Development Goals: Global Nutrition Report 2017

In this fourth Global Nutrition Report (GNR), significant burdens of three key forms of malnutrition (child stunting, anaemia in women of reproductive age and overweight in...

NEX: Editorial

Listen to an interview with the editors on the ENN podcast channel We're proud to introduce this tenth issue of Nutrition Exchange! The publication has grown from a digested...

FEX: Double Burden of obesity and malnutrition in Western Sahara refugees

Summary of published research1 There is growing recognition of a ‘double burden’ of malnutrition among populations in both affluent and less-affluent countries, i.e. the...

NEX: Moving towards multi-sector programming in Mauritania

Moving towards multi-sector programming in Mauritania Mohamed Ould Saleck is the coordinator of the National Nutrition Programme at the Ministry of Social Affairs,...

en-net: Impact evaluations of urban food policy and project interventions

I am looking for empirical analyses of urban-focused, policy and project interventions to address urban food insecurity and malnutrition.

Recent statistics based on...

NEX: A catalyst for scale-up in SUN countries: Experiences of technical assistance for Tajikistan and the Philippines

ENN's SUN Knowledge Management team with contributions from Nutrition International (NI) and Maximising the Quality of Scaling Up Nutrition Plus (MQSUN+) Click here and...

NEX: Developing the second National Plan of Action for Nutrition in Bangladesh

Dr Md. M. Islam Bulbul is the Deputy Programme Manager with National Nutrition Services and a technical specialist in the Public Health and World Health Wing of the Ministry of...

FEX: Contribution of six risk factors to achieving the 25x25 non-communicable disease mortality reduction target

Summary of study1 Location: Global What we know: Non-communicable diseases (NCDs) cause more than 35 million deaths every year and account for more than half of the deaths...

NEX: Providing district-level coverage for nutrition programming in Balochistan, Pakistan province

Hassan Hasrat is the Chief Executive Officer of the Society for Community Action Process (SCAP-Balochistan), a local NGO. He has ten years' experience in health, nutrition and...

NEX: Mapping multi-sector actions in Burundi and Myanmar: Towards more effective coordination

Ernest Niyokindi is Deputy Chief of Cabinet in the Second Vice President's Office for the Republic Burundi and the SUN Movement Government Focal Point. Dr Célestin...

NEX: Tackling overweight and obesity in Ecuador : Policies and strategies for prevention

Angélica Ochoa-Avilés is a professor/researcher at the Food Nutrition and Health Unit, Department of Biosciences, Cuenca University, Ecuador. Gabriela...

NEX: Editorial

Listen to an interview with the editors (podcast) on ENN's MediaHub Welcome to this eighth issue of Nutrition Exchange (NEX), in which we have widened our geographical...

NEX: What's new at ENN?

Nutrition Exchange: Preliminary results from user survey ENN conducted an impact survey in late 2017 with the aim of understanding how our global network of practitioners and...

NEX: Tracking progress for breastfeeding policies and programmes

Breastfeeding (BF) is reported to be one of the most effective investments a country can make in nutrition programming. It not only provides protection against child morbidity...

Close

Reference this page

Dr Ayoub Al Jawaldeh (2018). Regional nutrition strategies to address the double burden in the Eastern Mediterranean. Nutrition Exchange 10, July 2018. p16. www.ennonline.net/nex/10/regionalnuteasternmed