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Most large countries monitor national food consumption - what and how much is imported, exported and grown domestically. But reliable data about what people actually eat in the home is practically nonexistent. According to UCLA School of Public Health professor Gail Harrison, that is a crucial oversight, because such information is the only way to assess the nutritional status of a population. Egypt's Ministry of Agriculture agreed. In 1993, concerned about obesity and malnutrition in the general population, the country turned to Harrison for help. In purely economic terms, the Egyptian government had a major interest in knowing what its people were eating. It imports a significant share of its food supply and, until recently, had spent a great deal on untargeted consumer subsidies, enabling the population to purchase basic food staples at minimal cost. Beset with rapid population growth and relatively low per capita income, however, that safety net became prohibitively expensive and was largely discontinued several years ago as part of the nation's economic restructuring. But, notes Harrison, the Ministry of Agriculture "had the foresight to believe it needed to get a handle on how changes in food subsidies, as well as inflation and other economic changes, were affecting the population." With funding from the U.S. Agency for International Development and the Egyptian Ministry of Agriculture through the National Agricultural Research Program, Harrison, UCLA faculty members Osman Galal and Joanne Leslie, a technical-support team and an Egyptian team of scientists and field staff under the direction of Drs. Ahmed Khorshid and Nabih Ibrahim of the Ministry's Food Technology Research Institute, set out to develop an ongoing system to monitor food consumption. From December 1993 to October 1994, the group surveyed approximately 7,000 households, sampled to be representative of the rural and urban populations of five of Egypt's 24 governorates: greater Cairo, Ismailia, Dakahlia, Aswan and New Valley. The interviewing was conducted over a one-year period in order to account for seasonal food-intake patterns and included information on household food utilization, individual food intakes of women and children and heights and weights of preschool children and adult women. A household was defined as "food insecure" if it spent more than three-fourths of its income on food and would apply additional income to more food. The prevalence of households meeting these criteria ranged from a low of approximately 5 percent in urban Ismailia to a high of 21 percent in rural Dakahlia. In each local area, the researchers quantified "market baskets" - the minimum cost of purchasing an adequate diet for an average family. Among their more remarkable findings: A minimal-cost diet for a family of 4.7 (the average in one of the governorates) would require the entire incomes of two full-time, minimum-wage adult workers, leaving nothing left over for other family needs. "We documented a real crunch for a very large proportion of households," Harrison says. |
The prevalence of underweight children had increased from the numbers found in large surveys conducted two and four years earlier, while at the same time 30 percent of adult women were found to be obese. "It's the typical situation of a lot of large developing countries: emerging adult chronic illness coupled with persistent undernutrition, particularly in children and pregnant women," Harrison observes. "When undernutrition isn't extremely visible and you see that the markets are full of fruits and vegetables, it's easy, in the absence of information, to miss what's happening to the more vulnerable parts of the society, and certainly not to have an appreciation of the changing prevalence of undernutrition." After completing its survey, Harrison's team adapted the U.S. Department of Agriculture's ingredient-based database: Modifications included accounting for the absence in Egypt of enrichment and fortification requirements and differences in the way foods are prepared, and adding region-specific foods and recipes. But just as important as the findings was the speed with which Harrison and the group were able to deliver their conclusions. Prior to recent advances in the electronic manipulation of large databases, it could take years for researchers to issue a final report after the conclusion of a survey. This time, the information was available to Egyptian policy-makers and researchers just eight months after completion of the fieldwork so policy-makers could consider the most efficient and effective course of action. "The information had to be timely," Harrison explains. A major stumbling block to such a system in Egypt, as well as in many developing countries, had been the lack of an adequate food-composition database. Harrison's project not only created such a reliable database, but, even better, a system that lends itself to a continuous process. A second survey round has recently been completed. As Harrison notes: "It looks to us that with a fairly quick set of screening questions, one could identify households that are having trouble meeting their nutrient needs and develop targeted programs." - D.G.
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Fruit of the Nile
Gail Harrison
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