NEAR EAST AND NORTH AFRICA

Underweight prevalences are around 10% in the Near East and North Africa group of countries, having improved steadily prior to 1990. The largely static trend in the '90s is likely to be due in part to several countries having reached levels similar to industrialized countries so that no further reduction can be achieved; but others like Egypt still have some distance to go, in terms not only of nutrition but of child survival - the IMR in Egypt was reported as 61 deaths per 1000 live births in 1995.

Economies vary greatly in the region, with several high income oil-exporting countries such as Saudi Arabia and Libya, others with middle income like Algeria and Morocco ($750-2000 per caput per year), with Egypt and Yemen the poorest countries (around $700). On average poverty levels, already relatively low, are considered to have fallen slightly 1987-90-93 (4.7% to 4.1%).

Oil prices have great influence on the economies in the region, not only for the oil exporting countries. In part in response to this, GNP growth overall faltered in the 1980's although Egypt's economy is reckoned to have grown during this period. After some recovery in the early '90s, economic growth fell again on average (see Panel 2D), due to several factors. Recession elsewhere in the world affected the region through oil prices; political and civil unrest, and economic sanctions hit levels of living and hence nutrition. Iraq in particular reported a substantial increase in child malnutrition in the general population. Structural adjustment programmes in several countries affected public services, prices, and no doubt nutrition.

Food availability is higher here than elsewhere in the developing world, averaging over 3000 kcals/head/day. In Egypt the extensive food subsidy contributes to a kcal availability of around 3300 kcals/head/day (contrast with, for instance, less than 2000 kcals/head/day for many Sub Saharan African countries). Household food insecurity must be relatively uncommon, and the persistence of malnutrition is known to be related to infectious disease (notably diarrhea), as well as caring practices.

Access to health services and safe water are relatively good, estimated to have reached more than 80% in the '80s. Immunization rates for infants reached a plateau of around 80% in the '90s, and tetanus immunization for mothers also stabilized, in this case at the inadequate level of about 50%. Indicators of safe water access showed some decline in the '90s, and this is in line with concerns about cutbacks in health expenditures, for example in Egypt.

Secondary school enrollment for girls has continued to rise, on average being around 50%, substantially higher in Egypt at more than 80%. The total fertility rate has been falling now being approximately four births per woman.

Overall, the population in many of the countries in this groups is approaching the nutritional levels of the industrialized countries. While continued progress in bringing underweight prevalences down is needed, at the same time attention should begin also to be paid to diet-related chronic diseases which are associated with obesity and which can emerge rapidly under the conditions in the Near East and North Africa.

PANEL 2. NEAR EAST AND NORTH AFRICA

NEAR EAST AND NORTH AFRICA