title: The rise in stunting in relation to avian influenza and food consumption patterns in Lower Egypt in comparison to Upper Egypt: results from 2005 and 2008 Demographic and Health Surveys.
abstract: BACKGROUND
  A 2006 avian influenza (AI) outbreak resulted in mass removal of chickens in Lower Egypt, which decreased the household supply of poultry. Poultry, a key animal-source food, contains nutrients critical for child growth. This paper examines determinants of stunting between 2006 and 2008 in children 6 to 59 months of age within the context of the AI outbreak.
  
  
  METHODS
  The 2005 and 2008 nationally representative Egypt Demographic and Health Surveys (EDHS) were used to analyse anthropometric data from 7,794 children in 2005 and 6,091 children in 2008. Children, 6-59 months of age, with length for age Z-score < -2 S.D. were categorized as stunted. Predictors of stunting were examined by bivariate and multivariable analyses, focusing on Lower Egypt, where a rise in stunting occurred, and Upper Egypt, where stunting declined.
  
  
  RESULTS
  Between 2005 and 2008, Upper Egypt experienced a significant decline in stunting (28.8 to 21.8%, P < 0.001). Lower Egypt experienced a significant rise in stunting (16.6 to 31.5%, P < 0.001), coinciding with the 2006 AI outbreak. In Lower Egypt (2008), households owning poultry were 41.7% less likely to have a stunted child [aOR 0.58; 95% CI (0.42, 0.81) P = 0.002], and 12-47 month old children were 2.12-2.34 times [95% CI (1.39 - 3.63) P ≤ 0.001] more likely to be stunted than 6-11 month old children. Older children were likely affected by AI, as these children were either in-utero or toddlers in 2006. In Upper Egypt, stunting peaked at 12-23 months [aOR 2.62, 95% CI (1.73-3.96), P < 0.001], with lowered risk (22-32%) of stunting in 24-47 month old children [aOR1.65, 95% 1.07-2.53, P = 0.022, 24-35 month old] and [aOR 1.57, 95% CI 1.01-2.43, P = 0.043 36-47 months old]. A two-fold increase in child consumption of sugary foods between 2005 and 2008 was found in Lower Egypt (24.5% versus 52.7%; P < .001).
  
  
  CONCLUSIONS
  Decreased dietary diversity, reduced poultry consumption, substitution of nutritious foods with sugary foods paralleled a reduction in household raising of birds, following the AI outbreak in Lower Egypt and not Upper Egypt. Increased feeding of sugary foods due to fear of illness or greater penetration of these foods may be related to stunting. Advice on infant and young child feeding is needed to improve dietary intake and reduce sugary food consumption.
authors.affiliation: Maternal and Child Health Integrated Program (MCHIP), 1776 Massachusetts Ave NW, Suite 300, Washington DC, USA. jkavle@path.org.|PATH, Maternal, Child Health and Nutrition (MCHN), 455 Massachusetts Ave NW, Suite 1000, Washington DC, 20001, USA. jkavle@path.org.
authors.forename: Justine A
authors.initials: JA
authors.lastname: Kavle
authors.affiliation: El-Zanaty and Associates, Cairo, Egypt. fzanaty@elzanaty.com.
authors.forename: Fatma
authors.initials: F
authors.lastname: El-Zanaty
authors.affiliation: Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington DC, USA. mmlandry@gwmail.gwu.edu.
authors.forename: Megan
authors.initials: M
authors.lastname: Landry
authors.affiliation: Maternal and Child Health Integrated Program (MCHIP), 1776 Massachusetts Ave NW, Suite 300, Washington DC, USA. rgalloway@path.org.|PATH, Maternal, Child Health and Nutrition (MCHN), 455 Massachusetts Ave NW, Suite 1000, Washington DC, 20001, USA. rgalloway@path.org.
authors.forename: Rae
authors.initials: R
authors.lastname: Galloway
mesh_terms: D000818:Animals; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004534:Egypt; D005191:Family Characteristics; D005260:Female; D006130:Growth Disorders / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D053124:Influenza A Virus, H5N1 Subtype; D005585:Influenza in Birds / Q000150:complications*; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D009752:Nutritional Status; D011200:Poultry