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Background and Summary
of Activities:
The Middle East and North
African Nutrition Association (MENANA) was founded in July 2004
as one of the regionally driven Nutrition Capacity Building
Initiatiatives spearheaded by UNU / FNP / IUNS.
In Mid July /
2004 a two day workshop was organized and hosted by the National
Nutrition Institute in Egypt, funded by UNU and attended by two
IUNS representatives Dr. Osman Galal (Secretary / IUNS) and Dr.
Ibrahim El-Madfaa. 33 participants (Nutrition Scientists,
Authorities and Professionals) attended, 14 countries endorsed
the meeting & 10 countries were, officially represented. (Egypt,
Sudan, Jordon, Oman, Palestine, Libya, Kuwait, KSA, Lebanon,
Yemen attended while Iran, Tunisia, Morocco & Bahrain apologized
but supported the meeting objectives & outcomes).
Representatives from WHO, UNICEF, FAO, WFP were invited and only
UNICEF and FAO representatives could attend.
A 10-year plan for regional
capacity building in nutrition was developed by the July / 2004
the workshop participants based on a “Planning Model and
Capacity Development Conceptual Framework” developed and
presented by Dr. Azza Gohar / Egypt (Head of the Egyptian Task
force for NCD). The Bylaws of MENANA were developed (adapted
from IUNS bylaws by Dr. Osman Galal) and revised by the
representatives. Dr. Azza Gohar was nominated as MENANA
Coordinator until official status of the Association was
established.
Another two day meeting was
conducted in Dec. 2004 to launch the activities of one of the
working groups of MENANA in Research. The meeting was hosted by
National Nutrition Institute / Egypt attended by 7 countries.
(Egypt, Tunisia, Jordon, Iraq, Kuwait, Yemen, Libya) and two
IUNS members (Prof. Osman Galal & Prof. Ibrahim El- Madfaa). All
costs were shared between NNI and country representatives
themselves (NNI Beared workshop & accommodation cost while
participants beared Travel cost).
In Sept. 2005/ Durban, South
Africa during the 19th ICN, IUNS officially approved
& acknowledged the affiliation of MENANA to IUNS.
MENANA was represented by Dr.
Gohar in the 32nd Session SCN, Brazilia 2005 and 33rd
Session SCN, Geneva 2006, and also in May 2005 at the Budapest
kick- off Meeting of the Eastern European Region Nutrition
Capacity Building Initiative. Dr Gohar shared with the meeting
participants the Conceptual Planning Model developed and used by
MENANA members to plan a 10- year action plan for the regions
capacity Development activities.
GA & Scientific Meeting Dec. 2006
The General Assembly &
Scientific Meeting of MENANA and was financially supported by
UNU and hosted by NNI, Cairo, Egypt 21st - 22nd
Dec. 2006.
The meeting
was attended by 33 participants (endorsed by 14 countries and
attended by 9 country representatives) (Egypt, Jordon, Sudan,
Kuwait, Morocco, Lebanon, Palestine, Iran and Libya (attended),
Bahrain and KSA (last minute cancellations) Oman, Tunisia and
Yemen (apologized) while Iraq could not attend due to political
disturbance.
The meeting was held at CairoTel
Hotel Maadi on the 1st day and at NNI on the 2nd
day.
All guest
country representatives were accommodated at the same hotel.
The Meeting started at 10 am by
opening & welcome remarks from Prof. Mamdouh Gabr / Egypt
(previous IUNS president), Dr. Osman Galal (IUNS Secretary), and
Dr. Azza Gohar (MENANA coordinator and host of the meeting.
Participants were introduced by
Dr. Gohar; IUNS Policy was presented by Dr. El- Madfaa
(President elect / IUNS). Objectives of the meeting were
highlighted by Dr. Galal and Dr. Gohar.
A Chairman was elected (Dr. El
Madfaa) and two reporters (Dr. Nagat Sarhani (Morocco) & Dr.
Malek El- Batal (Lebanon).
The Agenda was adopted with some
rearrangement in the sequence of events to accommodate for
Council elections to be finalized as early as possible.
Summary of
Meeting Outcomes:
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The
Bylaws of MENANA were reviewed, modified & adopted followed by
the Council Elections which were done on the 1st day
of Meeting.
-
Their
were 8 countries (voting) Egypt, Libya, Jordon, Lebanon,
Palestine, Sudan, Morocco, Kuwait),Iran was excluded from
elections upon request of its member (Dr. Siassi) until he went
back to discuss with his society to join MENANA since the
adopted MENANA bylaws included government representatives & was
not exclusively for nutrition societies. After his return home
and within 2 weeks he replied by e-mail that Iran would like to
be a member of MENANA and he would be representing it.
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The
election was conducted & supervised by Dr. El-Madfaa (IUNS
President Elect) & Dr. Malek (Lebanon).
Results of
MENANA Council Elections:
|
President of MENANA |
: |
Dr. Azza
Gohar (Egypt). |
|
President Elect. |
: |
Dr. Ibrahim
El- Khatib (Jordon). |
|
Treasurer |
: |
Dr. El-
Guindi (Egypt). |
|
Secretary |
: |
Dr. Rekia
Belhasan (Morocco). |
|
Active Member |
: |
Dr. Sediga
Washi (Sudan). |
-
The
participants agreed to change the name of the working groups on
the different disciplines & core areas from “Committee” to “Task
Force” e.g. Task Force on Advocacy Communication, Task force on
Research……etc.
-
The
Participants also suggested adding two other separate Task
Forces one on Food Industry (to coordinate Private / Public
cooperation) led by Dr. Galal & Dr. Fahmy Seddik and the other a
Dietetics Task Force (to coordinate Dietetic Accreditation
Activities (led by Dr. Nahla Hawala lebanon).
-
In
addition to the already existing Task Force on Research
coordinated by Dr. Siassi (Iran) after confirming Iran’s
membership otherwise Dr. Khatib will be this TF coordinator.
Advocacy & Communication TF coordinated by Dr. Osama Salah
(Palestine) and Training TF coordinated by Dr. Yousif Shrek
(Libya).
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The
participants agreed that Dr. Abdel Hady (Egypt) who was
responsible for development & design of MENANA website will act
as website Administrator & Dr. Yousif (Libya) will translate the
Arabic version when necessary.
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They
also agreed that Dr. El-Guindi (Egypt) will continue
coordinating the work on monitoring Nutritional Status in the
Region which will later be a part of MENANA website.
|
Training Task force coordinator |
Dr. Yossef Shrek (Libya). |
|
Research Task force coordinator |
Dr. Siassi (Iran). |
|
Advocacy and Communication Task force coordinator |
Dr. Ousama Salah (Palestine). |
|
Dietetics Task force coordinator |
Dr. Nahla (Lebanon). |
|
Nutrition Status Indicators Task force coordinator |
Dr. El- Guindi & Dr. El- Madfaa. |
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MENANA
website Administrator Dr. Abdel Hady Abbas.
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Nutrition Friendly School Initiative (NFSI) Dr. May Mattar.
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Food
Industry / Public- Private Cooperation Task force Dr. Galal &
Dr. Fahmy.
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Fund
Raising groups TBD.
Summary of
Presentations:
On the 1st day:
1.
Dr. Azza
Gave a brief report on MENANA activities since its establishment
in July 2004 and during the period which she was acting as
MENANA coordinator.
2.
Dr.
Mohamed El- Guindi presented the Middle East Nutrition Profile &
Data Base which he and analyzed form the available country data
sent by some of the member countries (Bahrain - Egypt – Sudan –
Jordon – Libya – Kuwait – Lebanon – Yemen). A few Simple
available indicators were found to be common among most
countries & the participants gave their feedback to Dr. El-
Guindi. Further work will be led by Dr. El- Guindi who will work
with (Dr. Abdel Hady & Dr. El Khatib & Dr. Galal).
3.
Dr.
Abdel Hady Abbas (Egypt) presented the MENANA website &
demonstrated the options & facilities which it includes for its
members and requested that any further suggestions from the
participants to be sent to him through E-mail communications.
On the 2nd day:
The Theme:
Flour Fortification Experiences within the Region
The
participants were requested Prior to the Meeting to prepare
brief presentations on their countries experiences in flour
fortification especially focusing on (the date of initiation,
the fortificant, the reasons for fortifying flour, the positive
results or impact (if any) the obstacles & constraints faced &
the current situation.
Summary of Presentations on Country
Flour Fortification Programs:
Lebanon:
No flour fortification program – IDA is not a problem.
Palestine:
IDA among adults > 35%, and in children / school children (50%).
In July 2006
Flour Fortification started without a baseline survey with the
support of UNICEF (fortificant: Vit. A – B1 – B6 – Zn –
Fe – Folic acid). A monitoring system was also established.
Morocco:
IDA among children <5 y is 52%. FF started as part of a
Micronutrient Prevention Program in 2001 in cooperation with
GAIN. Flour was fortified with (Fe - folic acid – Vit. B).
Salt was also
iodized & Oil was fortified with Vit. A within the same program
Lessons learned: Civil society involvement is very
important, nutrition awareness is essential and political
commitment is crutid.
In July 2006
an evaluation study was conducted (Report not finalized yet).
Iran:
Restoration of lost iron during processing is supported but
Flour fortification is not encouraged by nutritionists in Iran
since bread is the staple food in Iran (as in many Regional
countries).
In Iran Bread is cheap (10
cents/ loaf) workers may consume daily > 1 Kg / day which may
lead to iron overload if bread is fortified.
·
Iran
representative confirmed that Bioavailability studies are
deficient in our region and we should activity consider them.
Kuwait:
Kuwait National Surveillance system (KNSS) showed in 1995 a
range of IDA (20-40%). Kuwait & GCC countries decided to fortify
flour starting from year 2000 with 60 mg reduced iron. There is
one mill in Kuwait.
The Swiss federation together
with IAEA are currently conducting a study on the type of iron
used & its efficiency. Also Encapsulated FeSo4
is being studied for trial among citizens 18 – 30 years of age.
Libya:
In 1987 a trial was made to launch FF but failed.
In 2002 the standards of
Fortified flour were modified & Fe fortification was omitted
from the National Standards.
In Dec/ 2006 just before the GA
Meeting of MENANA a 3-day National Fortification Conference was
hosted and conducted in Tripoli by Libyan National Standards
Organization to advocate for food fortification (focusing on
FF).
This conference was supported by
two IUNS members (Prof. Galal & Prof. El- Madfaa) and also by
MENANA members (Dr. Gohar – Prof. EL- Khatib – Prof. El- Guindi
and Prof. Fahmy Seddik).
They all participated in the
conference with presentations relevant to flour fortification
and also in the active discussions.
Prof. Yousef Shrek (Libya) has
sent a proposed plan of action to launch FF in Libya & he is
seeking GAIN support & WHO/ FAO cooperation.
Jordon:
In 2002 a pilot flour fortification project was implemented with
Fe & folate. It continued successfully until it was further
expanded in 2006 with the addition of 7 more micronutrients
(Vit. A – Zn – B1 – B2 – B3 – B6 – B12 niacin) Prof. El- Khatib
had strongly recommended that Vit. A be added to improve IDA
status.
MOH / Jordon takes the lead
while WHO and CDC are advisors to the program in Jordon.
Sudan:
IDA is a very serious public health problem affecting almost 90%
of the vulnerable population
(23 – 24 million are persons
affected).
In 2005 a proposal was submitted
to GAIN, for Iron Fortification of flour and a National Alliance
has been formulated. There are 2 large mills (and also 37 small
mills in Sudan).
One of these large mills (Whita)
has started FF in Jan. 2006 while the other mill (Sega) is
still waiting for government legislations on wheat & flour
fortification as they have taxation & cost coverage problems in
addition to lack of potential governorate resources & wheat is
imported .
Egypt:
IDA is a rising problem in Egypt reaching up to 50% of children
<5y, 45% of females, > 50% of elders and around 50% of school
children.
In the late 90s Egypt was one of
the EMR countries working with WHO / EMRO & UNICEF to fortify
flour.
A proposal was submitted in 1999
and a FF Trial was done in collaboration with WHO in Fayoum City.
A feeder was installed in Fayoum
Mill and training workshops were conducted. A Social Marketing
campaign accompanied the trial which was successful and went
smoothly without problems. Balady Breadflour was fortified with
FeSo4 & folic acid and continued successfully for 6 months.
Unfortunately the trail did not continue and was not expanded as
planned due to financial problems & cessation of WHO funds and
support (among other problems facing the expansion).
In Sept 2005 WFP together with
National Nutrition Institute / Egypt collaborated to revive the
Flour fortification program and Food fortification in general).
A literature Review on micronutrient malnutrition in Egypt in
last 2 decades was conducted (by Dr. Habiba Wassef – Dr. Sahar
Khairy). Advocacy meetings with leaders and Key person in Egypt
were done by Dr. Osman Galal / NNI / WFP and an advocacy
workshop was conducting and hosted by NNI in Nov. 2005. MOH
Committee meetings were also organized and conducted by NNI for
approval of the FF program.
Another Advocacy workshop was
conducted by National Research Center & NNI in Dec. 2005.
MOSS was persuaded to take the
role as the leading Ministry in FF in Egypt as it is responsible
for flour distribution and Bakeries. A proposal was submitted by
WFP / NNI and Ministry of Social Solidarity / Egypt to GAIN in
March 2006. A mission from GAIN met with the FF Alliance & all
partners and mission evaluation approved GAIN Support to FF in
Egypt (to be implemented in 3 years covering all 27 Governorate
165 mills & 75 million population. NNI will be a major partner
in the program & will work in all areas especially Social
Marketing – Quality control & M & E.(Monitoring & Evaluation)
The FF will be launched in April 2007, Balady Bread flour (82%
extraction) will be fortified by FeSo4
/ 30ppm & folic acid / 1.5 mg).
Sumary 2nd Day Presentations:
1.
“EU Experiences in Nutrition”
was given by Dr. El- Madfaa desculing the Data Base on Food
intake in EU (Which includes Food supply – Food availability –
Food intake). He also demonstrated its multiple uses.
Dr. El- Madfaa also suggested
using (Dafne – software) which is used in Europe for our
Regional data base.
2.
“Window of Opportunity / World
Bank” was
presented by Dr. Galal who introduced the topic by saying that
50 years ago malnutrition prevalence was around 40% now in 2006
its more or less the same & even worse, despite the Alma Atta
Declaration “Health for All” and “Education for All by 2015”
Protocal which includes in 15 Volumes on how to improve
education will all factors included the plan except Health &
Nutrition.
Nutrition is actually the most
important factor for social economic development. MDGs will
never be reached without workable solutions for nutrition
problems.
During intrauterine period &
during 1st two years of life malnutrition affects
body function during this stage. It will lead to incurable
(lower intelligence – reduced physical activity & productivity –
slow economic growth – perpetuate poverty) & malnutrition will
run on from one generation to the other
Why we must invest in Nutrition;
because .
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Returns
from nutrition program overweighs costs.
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Malnutrition causes us high cost in total GDP.
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Nutrition & human rights – Nutrition & MDGs.
Therefore the Window of
Opportunity for investment is actually from pregnancy throughout
the 1st two years of life. The pregnancy outcome is
not at birth but starting from fetus to 9 m at least. Nutrition
trauma during growth of any organ leads to permanent damage, for
example the brain develops by age 3 years, anemia at age 2 years
leads to irreversible damage but at 14 years will not. It was
also found that 85% of nutrition traumas during early childhood
have chronic diseases as adults.
The members of the meeting
agreed on the importance of taking advantage of this “Window of
opportunity” and to focus future efforts more on this age.
“Nutrition Friendly School
Initiative” presented
by Dr. May Mattar / Egypt. She started by saying that it was
developed by many international partners WHO / UNICEF – as part
of the global prevention of childhood obesity.
One out of every 4 children are
affected later in life by double burden of malnutrition which is
the greatest nutrition challenge (obesity & malnutrition) &
happens in some countries NFSI is an integrated - school
based approach to overcome the double burden of malnutrition and
prevent obesity within an enabling, healthy, nutrition friendly
school environment.
Participants comments on this
logic included to also try the nutrition curricula developed by
FAO as part of this Future trial. They also agreed that MENANA
should support Regional countries in this experience. Iran
representative offered to Share with colleagues the Ministry of
Education of Iran experiences, results & constraints faced in
this issue.
Some suggested that each country
that will implement NFSI could be in charge of a different
school age group and countries could complement each other in
this experience.
Final Discussions outcome:
The participants agreed on:
1.
Endorsing the Nutrition Friendly School Initiative NFSI.
2.
Taking advantage of the window of opportunity in regional
programs.
3.
Continuing work on the Regional database and nutrition
indicators.
4.
Each
Task force coordinator should take the initiative to start
planning & working on each core activity with task force members
and send progress reports to the council members every 3 months.
5.
MENANA 1st Scientific Conference Should be conducting
before the end of the 4 years. The Hosting Country should be
able to cover travel & accommodation of Council members and some
of the country members – IUNS might be able to Support 5-10
thousand dollars. Other Funds should be seeked Countries
offering to host the meeting were: Iran in 2009 – Sudan or Egypt
in 2010 and Libya might also be able to (TBD).
6.
Members will try to meet in the Morocco “Fauns Conference” in
May 2007.
7.
Members were encouraged to attend the Feb. SCN 34th
Session
The meeting ended at 4 pm Friday
and members thanked Dr. Gohar for hospitality & organization and
thanked UNU & IUNS for support, Dr. Gohar invited them to a
Social dinner on a Nile Cruise later the same evening.
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