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Background:
The Regional
Nutrition Research Group was formed during the first Regional
Workshop on Nutrition Capacity Building and Development for
countries of North Africa and the Middle East. The workshop was
organized in Cairo by the National Nutrition Institute (NNI,
Egypt, 14-15 July 2004) in collaboration with the International
Union of Nutritional Sciences (IUNS) and the United Nations
University (UNU). It was during that meeting that the
participants, representing 10 countries, adopted a decision to
establish the Middle East and North Africa Nutrition
Association (MENANA), and to seek affiliation status
with the IUNS. (The report of the First Regional Workshop can
be obtained through the National Nutrition Institute, Cairo).
The request for MENANA to be affiliated to IUNS has been granted
during the IUNS Council meeting in Cape Town, South Africa in
August 2004. The Research Group, which is an open ended group,
operates as such pending the creation of the Association’s
Research Committee to be appointed by the elected MENANA
Council, following the formal establishment of MENANA at the
Regional Founding Members’ Meeting planned for towards the end
of 2005.
Objectives of the Meeting:
The purpose of this first meeting was to follow up on the
implementation of two of the activities set out in the action
plan produced during the July Workshop (above-mentioned report
refers), which include:
The
meeting will also serve to review and agree on steps to be taken
in preparations for the MENANA Founding Member’s meeting to be
held in Oman towards the end of 2005.
The participants:
(The List of participants is
attached as
Annex 1.)
The meeting was organized and hosted by the National Nutrition
Institute (NNI, Egypt). 31 participants representing six
countries, namely; Egypt, Tunisia, Jordan, Iraq, Kuwait, and
Libya were present. In addition the Nutrition Capacity Building
Task Force of Egypt, and other Nutrition Research Institutions
were represented and attended the meeting. Representatives of
IUNS, the Food and Agriculture Organization FAO, UNICEF, UNU and
were among the participants. HE Dr Mamdouh Gabr, (Egypt) Former
Minister of Health, Head of the Supreme Nutrition Committee of
the Academy of Sciences, Former President of IUNS was able to
participate during the second day. Apologies were accepted from
KSA Saudi Arabia), Oman Bahrain and Lebanon who were unable to
attend due to last minute
force
majeur.
The WHO- EMRO Regional Nutrition Adviser could not attend as he
was away on duty travel. FAO Regional Advisor Dr Yassine Wahelie
and UNICEF Regional Advisor also could not attend so agenda
adjustments (cancellations of their presentations) were made
accordingly.
Opening Session of
the meeting:
(The revised Agenda is attached
as
Annex 2.)
Prof Dr. Hoda
Hassan (Egypt), Director of the National Nutrition Institute
delivered the opening and welcoming remarks at the start of the
meeting. She stressed the importance of capacity building and
development in Egypt and the region. She stressed the potential
role of NNI in supporting the Nutrition Capacity Building
Initiative.
Dr. Azza Gohar presented an update of MENANA activities
summarizing the steps which led to its establishment during the
1st Regional Workshop for Nutrition Capacity Development held in
July / 2004 including the formation of core are a working group
and also the purpose of the 1st Meeting of MENANA Research
group.
Dr. Azza Gohar emphasized that the present research group
was the first to call for a meeting to discuss the design,
implementation and support of steps necessary to establish a
Regional Nutrition Monitoring project which will be published on
the MENANA website.
Dr. Galal and Dr Azza explained reasons for including the
Libya Food Fortification and Bahrain Medical Students Nutrition
Curriculum in the present agenda. They demonstrated that this
event demonstrates how MENANA can work collaboratively in
accelerating nutrition capacity building within the endigineos
human resources and capabilities.
Both Drs. Galal and Gohar stressed the fact that MENANA
established steps and detailed action plan for capacity building
in the Region. Due to the request from Libya for support of
MENANA to its advocacy conference on food fortification which is
scheduled and the request from Bahrain to assist in
establishing a nutrition curriculum for Bahrain Medical School
that were given priority due to their importance and direct link
to Regional Nutrition Capacity Developing goals.
The agenda was then approved after agreeing on a few
changes to accommodate the absence of three of the speakers, and
a change in the title of the presentation to be made by Dr.
Khatib (Jordan). Dr Zahra S. Ahmad (Egypt) and Dr Afaf Abdel
Fattah (Egypt) were designated as Reporters for the Meeting.
Session I.
Dr
Ibrahim El-Madfaa (IUNS), Chairperson, introduced the recently
produced European Nutrition and Health report and the list of
indicators used for monitoring public health nutrition in
European countries. Dr Fatima Hachem (FAO) then spoke about
Food Security and highlighted the difference between food
security and food self sufficiency (a policy taken by many ME
countries). A review was made of the potential role of food
security in the region. Dr Hachem emphasized the importance of
designing and implementing efficient food security systems that
target the vulnerable groups in the community. She introduced
the work of FAO in establishing a global Food Insecurity and
Vulnerability Information and Mapping System (FIVIMS) that aims
to promote the development of a national and international
network of systems that can assemble, analyze and disseminate
information about the problems of food insecurity and
vulnerability and support improved action.
It
was suggested by Dr. Wafaa Moussa / Egypt using the term
"household food security" instead of just food security to be
more accurate while Dr. Ibrahim El Madfaa commented that in
Yemen they were working these days on a food security system and
this could be shared later with the group. Dr. Galal was also
involved in creating a Food Security Information Center in the
West bank.
The
following presentation on,
"Nutrition related challenges in the Middle East and North
Africa region"
was
given by Dr Ibrahim Khatib (Jordan).
The speaker brought to the floor the common features of the
nutrition situation that are shared by countries of the region,
and the manifestations of diseases of malnutrition, including
from Protein Energy Malnutrition (PEM) to osteoporosis and
obesity that are common to MENANA countries. He described the
problem dimensions, the overlooked nutrition problems in women &
adolescent girls, the obstacles, the importance of clinical
nutrition in our region to practicing physicians, the
significance of community nutrition community pan-malnutrition
risk & outcomes and current nutrition concerns in the region
He explained that the main difference lies in the
magnitude and evolution of the problems. The impact of
malnutrition on the immune system, on child growth, cognitive
development, school performance and on the whole life span was
detailed. Dr Khatib proposed to confront the challenge by
evolving multidisciplinary systems and building partnerships
among government, industry, health professions, media, civil
society and international agencies.
Dr Ridha Mokni (Tunisia) presented
"The
Nutrition Situation in Tunisia".
After giving a brief historical background about evolution of
Tunisia's dietary habits Tunisia’s initiatives in the domain of
nutrition, he provided some statistical information on infant
mortality rate, life expectancy at birth, total fertility rate
and some demographic parameters. He went on to present tables
showing the household food consumption structure, evolution of
mean nutrient intake, and the trends in the evolution of food
consumption. Dr Mokni explained the organization of the
nutrition surveillance system in Tunisia and briefed the meeting
on the elaboration of the causal model and its usefulness in
identifying the etiology of nutrition problems and hence
improving the ability to identify and plan solutions for
overcoming them. He listed some current intervention programs in
the sector of health and nutrition.
Issues and the outcome of the discussion
were summarized as follows:
-
Indicators to monitor the nutrition situation
The
importance of choosing sensitive and simple indicators from
available data like the food consumption data base could be used
for that purpose. It was stressed that those indicators after
selection, are not static and have to be thoroughly and
regularly evaluated and modified or changed if needed.
-
Nutrition should not solely be treated as a clinical issue
problem.
Treating nutrition as a clinical issue only hampers efforts that
can be deployed to prevent and control nutrition related
problems. The discussion indicated also that building
partnerships among all stakeholders could lead to more effective
solutions for those persistent nutritional problems.
-
Nutrition is the foundation for development
The
discussion made it clear that nutrition is a strong predictor
for socio-economic development. Desegregation of the human
development parameters down to the village and the urban
neighborhood or
haļ
in
the 2003 Egypt Human DevelopmentReport enabled the subsequent
Interim Health and Demographic Survey (2003) to demonstrate that
link.
Bioavailability studies are necessary in our Region to
accurately identify our causes of micronutrient deficiencies.
Session II.
The
second session was chaired by Dr Wafaa Moussa (Egypt) and the
first speaker was Dr Osman Galal (UNU/IUNS) who introduced the
“Nutrition Monitoring System Concept”. He drew attention to
the importance of changing the conceptual framework for
designing a monitor system for nutrition, and stressed the
importance of creating a multidisciplinary environment that can
enable solving accumulated nutrition and nutrition related
problems. He called for integrating nutrition programs with
national development policy, and for overcoming the dichotomy
between nutritionists and policy makers. Dr Galal went on to
discuss the use of indicators in monitoring the nutrition
situation regionally and differentiated between three types of
indicators, which can all reflect nutritional status. These
three types are 1) indicators for status of nutrition, 2)
indicators for causes of malnutrition or deficiency disorders,
3) indicators for identifying risk factors. The use of such
indicators would strengthen the efforts mobilized for prevention
of nutritional diseases instead of solely relying on treatment.
He explained that the use of both the status and risk factor
indicators are more prevention oriented while using causal
indicators lead us to treatment orientation which takes us more
to the medical side.
We should choose simple indicators already used in our countries
and collect them regularly while improving the system as we go
along, then we should meet after around 6 months to analyze
what we've done – start discussions and decide what we need e.g.
(training – workshops – etc) until the system is strongly
established He highlighted the importance of the use of the
forthcoming MENANA website for sharing of information on
nutrition status indicators as well as for disseminating the
results of country food consumption surveys.
Dr
Afaf Abdel Fattah (Egypt) gave the second intervention which
reviewed,
"Egypt's Experience in Nutrition Surveillance".
She described the nutrition surveillance system and gave details
of the different partners involved in implementing the system,
namely, the mother and child health units, primary health care
units, and the rural and urban health centers. The system was
boosted by the generalization of the use of the home-based
child’s card which bears the health history of the child since
birth and provides a record of the anthropometric parameters for
each child. She listed some selected indicators derived from
existing records of the mother and child health program. She
also explained that the sustainability of this system is based
mainly on cooperation and partnership building among the
involved sectors and the active community participation.
Dr
Ezzat Khamis (Egypt) and Dr Samir Mustafa (Egypt) gave a joint
presentation entitled,
" The
possible role of countries represented in the meeting and of
different institutions in Egypt as represented by
EgyptNutritionCapacityBuilding Task Force”.
The presentation of Dr Khamis was based on the fact that there
is ample data on the nutritional problems of the region.
However, there is a deficient effort to exploit such a valuable
pool of available data and to use it in drawing effective
strategies that can improve the persistent and pressing
nutritional problems and their economic impact. He stressed the
importance of MENANA to build institutional and individual
capacity in the Region
Dr Mustafa addressed the need to disaggregate the data in order
to identify the pockets where the nutritional problems are
concentrated. He also highlighted the economic implications of
overlooking the nutritional dimensions of development when
drawing up national polices. He also stressed the importance of
developing case studies to study the cost of malnutrition and
its relation to annual growth rates in our Region.
The highlights of the discussions that followed are summarized
as follows:
-
The
need to evaluate and validate the data available in the
region
It
was clear from the discussion that there was a real need to
study the quality of the available data and to prepare it in a
format that can lend itself to a more advanced statistical
analysis. The suggestion was made to entrust this task to the
MENANA Research Group who will have to work on evaluating the
data and identifying the most simple and sensitive indicators.
-
Drawing on this pool of data for designing and implementing
Food Based Dietary Guidelines (FBDG)
The
group raised the issue of adopting FBDG as an educational and
cost affective tool recommended by FAO and WHO. This
recommendation is based on the fact that most countries in the
region have substantive data that can allow them to start
designing and implementing FBDG. Moreover, almost all countries
in the region are undergoing a nutrition transition and
suffering from both over and under nutrition. This requires an
effective nutrition education program that disseminates a clear
message that enables the community to deal with this
transition. Each country has to identify which group will be
responsible for producing its national FBDG. For Egypt it was
suggested to use the FBDG developed by the National Nutrition
Institute around ten years ago as a baseline for developing an
updated unified guideline by the selected national team
-
The
need to strengthen the cooperation and coordination among
concerned parties, both nationally and regionally
It
was fully agreed, by all participants, that without cooperation
and coordination it will be impossible to come up with
measurable improvement in the nutritional status. In addition,
the market influence on the food intake and food habits should
be counter balanced by disseminating clear messages to the
community to help create the discriminating consumer.
Session III:
The third session, chaired by Dr
Ibrahim Khatib (Jordan), continued the discussions, focusing on;
"The necessary steps
to design, implement, and support a monitoring system"
A suggestion was made to collect information on the nutrition
status in MENANA countries through completing a form designed
for that purpose. The methods of data collection have to be
well defined so that the methodology for nutrition and nutrition
related data collection adopted by the responsible institutions
in the MENANA countries can be ultimately harmonized.
Guidance could be drawn from the outcome of the consultation
held in Rome 2002 by FAO which had concluded that the no single
indicator can alone reflect the nutrition situation in a
country. The consultation suggested the use of at least five
different indicators, drawing attention to the value accorded to
the evolution of a trend over time than to absolute values that
are often difficult to compare between countries due to
differences in collection methodologies. It was suggested to
make use of this experience in selecting and assessing the
nutrition indicators.
It was agreed to follow up on the possibility of holding a
meeting for the Research Group next May 2005 in tandem with the
planned Libya meeting on food fortification.
Session IV:
The second day started with the
fourth session which was chaired by Dr Ridha Mokni (Tunisia).
The first speaker was Dr Yousef Elshrek (Libya), who presented
the
"Health and
nutritional situation in Libya".
He started with a brief socio-geographical presentation of the
country, going on to review the food situation in terms of
production, importation, and per capita income. He also provided
some statistical data on the health situation. An account was
given of the field studies conducted in Al-Fattah University in
the year 2000, and which showed that the diets of the surveyed
population were low in the vitamin and mineral content for
vitamins B1, B2, C and for calcium, potassium and sodium.
He also explained all the steps taken in preparation for
fortification starting with official government approvals,
completion of committees etc…
The second speaker was Dr Ibrahim El-Madfaa (IUNS) who gave a
presentation on
"Safety aspects of
food fortification".
He explained the global
consideration of micronutrients status and of their impact on
public health, giving a review of the occurrence and causes of
nutrient deficiencies. Special emphasis was placed on the
importance of risk assessment of food fortification on a
national level.
Dr. Osman Galal (UNU/IUNS)
presented the subject of, "Design
for a Fortification Study".
He stressed the importance of creating the conceptual framework
for any fortification study and the need to pre-determine the
scope of the fortification. Dr Galal focused on the need to
define the expected level of improvement in relation to the
baseline data, and to correctly estimate the time interval
needed to reach this aspired nutritional improvement before
proceeding into implementing a fortification plan.
Dr Mohamed El Guindi (Egypt) gave a
short presentation titled,
"The story of
Micronutrients Bioavailability".
The
presentation focused on the importance of bioavailability
studies and the benefits to be gained from conducting research
in this area. Dr El Guindi called for the creation of a central
regional laboratory capable of conducting such advanced
research. He concluded that such studies would help in defining
the causes of the nutritional problems and in identifying
solutions.
The Chairperson opened the discussion and the outcomes could be
summarized as follows:
- It
was agreed that distinction should be made between food balance
sheets and the information obtained from household food
consumption surveys. All fortification interventions should be
based upon an extensive and updated household food consumption
survey of the targeted population. The analysis of the survey
results would serve to assess and confirm the need for
fortification and contribute towards a cost effective design of
the intervention(s).
- The
risk assessment of food fortification should be undertaken
before implementing the fortification program especially for
nutrients with a narrow safety range.
- Bio-fortification might prove to be a better approach if
compared with resorting to GMOs in dealing with nutrient
deficiencies.
- Special attention should be taken when adopting a co-nutrient
fortification program since there could be incompatibility that
might adversely affect the respective bioavailability of the
involved nutrients.
- Other alternate food based intervention strategies
namely: dietary diversification, nutrition education, and FBDGs
should be also given due consideration.
-
For advocacy purposes of the fortification conference it was
suggested by Dr Azza to include presentations on; foods already
fortified and bought by consumers in Libya (market shelf survey)
- consumers perceptions and opinions on food fortification
(qualitative studies)- presentations from other countries of the
Region with successful fortification experiences
Session V:
The
fifth session was chaired by Dr.Yousef Shrek (Libya) and was
allocated to the
discussion of three issues, namely,
-
The draft By-Laws for MENANA.
As a
follow up to this meeting, the participants agreed on the
formation of the following three working groups:
-
A first working Group for monitoring the
nutritional status in the region and the selection of
sensitive indicators. (Members: Dr.El-Madfaa, Dr Khatib, Dr.
Mokni, Dr Nabih and Dr. Zahra)
-
A second working Group to assist Dr.Yousef
Shrek in assessing the need and in designing a food
fortification program in Libya. (Members: Drs El-Madfaa, Dr
Galal, Dr El Guindi, Dr Mokni , Dr Fahmy and Dr Khatib)
-
A third working Group to respond to the
request made by Bahrain to assist the Medical School in the
development of a syllabus for undergraduate medical
students. (Members: Drs El-Madfaa, Dr. Khatib Dr. Galal,
Dr. El Guindi, Dr. Mona El Tobgy. The names of Drs El-Gasmy
and El-Gazaeery were brought forward and could be integrated
in the group pending their consent)
It
was agreed that any of the members from the Region could join in
one or more of the working groups of interest to them and it was
accepted by everyone for the sake of the work outcome that any
of the names on any of the working group lists would be removed
if that member does not actively participate in email
discussions with his/her colleagues for more than 15 days
A
draft proposed for the MENANA By-Laws which was based - in great
measure - on the MENANA Constitution presented to the IUNS
earlier in the year, was presented to the Meeting by Dr Habiba
Hassan (Egypt). A careful reading was made of the By-Laws, and
issues needing agreement were discussed. Some key alterations
were suggested and agreed upon. On the issue of the hosting
country, it was agreed to follow the example of the IUNS where
the hosting country, providing managerial and administrative
support is the country of origin of the elected President who is
currently in office. Country fees were suggested to be 100$/year
It
was also agreed that the period prior to the First general
assembly of MENANA will not be counted since it is the period of
preparations and establishment, meaning that Egypt can be
nominated during that assembly for presidency like the other
countries.
Dr
Hassan was entrusted with producing a final draft of the By-Laws
based on the outcome of the discussions.
Until Next Meeting:
As
the acting coordinator of MENANA Dr Azza Gohar was assigned to
do the following;
-
Circulate the meeting report to all regional
members
-
Initiate the assigned working groups email
contact and follow-up on each of their activities for
coordination, facilitation and reporting
-
Begin discussions and preparations for the
General Assembly Meeting with the hosting country
(Oman/other) including accommodation and hosting expenses
It
was also agreed by the participants that the National Nutrition
Institute would continue to be the site of MENANA Secretariat
until the elections , and Dr Azza may seek the assistance of any
of the members in following up of her duties as coordinator.
The general Assembly meeting must follow the IUNS Assembly
Meeting in Durban South Africa /Sept/2005 and cannot be held as
suggested by some of the group during the Fortification
Conference in Libya/ may/2005.
The Closing Session
The
meeting ended with a closing ceremony during which Dr Hoda
Hassan, Director of the hosting National Nutrition Institute,
delivered a closing message. The participants expressed their
sincere appreciation to the organizers and to the administrative
support team for their hospitality and the smooth organization
of a fruitful and pleasant meeting. A special vote of thanks
went to Dr Azza Gohar (NNI, Egypt) who is entrusted with the
task of MENANA Coordinator. Her commitment, dedication and
untiring support to MENANA, combined with a commendable
efficiency were acknowledged by all the participants.
The
Regional guest participants were invited by Dr. Ashraf Shaalan,
Head of Health & Nutrition Department, National Research Center
and Organizer of the 3rd International Conference to attend the
opening session of the conference which was one day prior to the
MENANA Meeting and also to the closing celebration on Thursday
16 December,5-7 pm for a Traditional Arabic Musical Concert.
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