NUTRITION COUNTRY PROFILE REPUBLIC OF ALBANIA (cid:1)(cid:2)(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:3)(cid:4)(cid:5)(cid:7)(cid:8)(cid:9)(cid:10)(cid:11)(cid:12)(cid:13)(cid:11)(cid:8)(cid:14)(cid:4)(cid:2)(cid:8)(cid:7)(cid:5)(cid:6)(cid:9)(cid:15)(cid:5)(cid:13)(cid:9)(cid:2)(cid:6)(cid:4)(cid:2)(cid:1)(cid:4)(cid:13)(cid:16)(cid:14)(cid:4)(cid:11)(cid:6)(cid:9)(cid:13)(cid:14)(cid:3)(cid:4)(cid:6)(cid:5)(cid:13)(cid:9)(cid:2)(cid:6)(cid:17)(cid:4) Acknowledgments This profile was prepared by Adrian Berisha, PhD, Senior Lecturer in Nutrition and Food Chemistry, Agrofood Department, Agricultural University of Tirana, Albania, in collaboration with Estelle Bader and Chiara Deligia, Consultants, and Marie Claude Dop, Nutrition Officer, Nutrition Planning, Assessment and Evaluation Service, Food and Nutrition Division, Food and Agriculture Organization of the United Nations. Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 2 Summary Albania is a country of Eastern Europe with a relatively young and predominantly rural population. Agriculture accounts for an important share of the gross domestic product (GDP), but the level of mechanization is low and the size of farms is small. Agricultural exports are limited and production is mostly for subsistence. After the end of the communist regime in 1991, Albania experienced a difficult economic transition and suffered two economic shocks due to the financial collapse of the so-called “pyramid schemes” in 1997 and to the Kosovo crisis in 1999. While the GDP has been growing substantially, poverty still affects a large proportion of the population, particularly in rural areas and among the newly urbanized, and causes problems of access to food and health services. Another consequence of poverty is the increase in child labour and a subsequent decrease in school enrolment in rural areas during the last decade. Health services remain underdeveloped and of poor quality. However, infant, child and maternal mortality rates have progressively decreased and immunization coverage is good. Since the 1990s, the supply of many food groups has increased, particularly for dairy products and eggs, and fruit and vegetables. Consequently the diet has become more diversified, especially in urban areas. Presently, at national level, the dietary energy supply is largely sufficient to meet the population’s energy requirements. Overall the prevalence of undernourishment is low. However, Albania is increasingly dependent on imports of cereals. Infant and young child feeding practices are inadequate. Although a very large majority of infants are breastfed, initiation of breastfeeding after birth is late and exclusive breastfeeding is rarely practiced. These inadequate practices, together with poverty and lack of access to health services of quality are reflected in the poor nutritional status of preschool children, which appears to have worsened in the last few years. In 2000, about a third of children under five years were stunted and one out of ten was wasted. At the same time, the population is undergoing a nutrition transition and the prevalence of overweight and obesity is high among adults in the capital Tirana. Iodine deficiency disorders are common among children, particularly in mountainous areas which represent a large part of the country. Less than half of rural households consume adequately iodized salt. Although data on vitamin A deficiency are not available, it seems unlikely that this deficiency is widespread because of the high dietary supply of dairy products and eggs. Limited data on iron deficiency suggest that it is an important public health problem affecting a large proportion of children under 2 years of age. Supplementation with iron has been conducted in some areas but is not generalized. Major improvements in health care and efforts in nutrition education are needed to reduce the high prevalence of undernutrition, while preventing the transition to obesity and chronic diseases. In particular promotion of better infant and young child feeding practices, promotion of diets rich in fruit and vegetables for all, and programmes to alleviate rural and urban poverty to ensure better access to nutritious foods, are the main actions that could improve the nutrition situation. Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 3 Summary Table Basic Indicators Year Population Total population 3.062 million 2000 Rural population 58 % 2000 Population under 15 years of age 30 % 2000 Annual population growth rate 0.44 % 2000/05 Life expectancy at birth 74 years 2000/05 Agriculture Agricultural area 42 % 2002 Arable and permanent cropland per agricultural inhabitant 0.5 Ha 2002 Level of development Human development and poverty Human development index 0.781 [0-1] 2002 Proportion of population living with less than 1$ a day (PPP) MDG1 17 % 2002 Population living below the national poverty line MDG1 25 % 2002 Education Net primary enrolment ratio MDG2 97 % 2000 Youth literacy (15-24 years) MDG2 99 % 2002 Ratio of girls to boys in primary education MDG3 1.0 girl per 1 boy 2001/02 Health Infant mortality rate MDG4 18 ‰ 2003 Under-five mortality rate MDG4 21 ‰ 2003 Maternal mortality ratio (adjusted) MDG5 55 per 100 000 live births 2000 Tuberculosis prevalence MDG6 33 per 100 000 people 2003 Environment Sustainable access to an improved water source in rural area MDG7 95 % of population 2002 Nutrition indicators Year Energy requirements Population energy requirements 2 275 kcal per capita/day 2001 Food supply Dietary Energy Supply (DES) 2 880 kcal per capita/day 2001 Prevalence of undernourishment MDG1 6 % 2000/02 Share of protein in DES 14 % 2000/02 Share of lipids in DES 26 % 2000/02 Food diversification index 53 % 2000/02 Food consumption Average energy intake (per capita or per adult) n.a. Percent of energy from protein n.a. Percent of energy from lipids n.a. Infant and young child feeding Age Exclusive breastfeeding rate <6 months 7 % 2000 Timely complementary feeding rate 6-9 months 24 % 2000 Bottle-feeding rate 0-11 months n.a. Continued breastfeeding rate at 2 years of age 6 % 2000 Nutritional anthropometry Stunting in children under 5 years 32 % 2000 Wasting in children under 5 years 11 % 2000 Underweight in children under 5 years MDG1 14 % 2000 Women with BMI<18.5 kg/m² n.a. Micronutrient deficiencies Prevalence of goitre in school-age children n.a. Percentage of households consuming adequately iodized salt 57 % 2000 Prevalence of vitamin A deficiency in preschool children n.a. Prevalence of vitamin A supplementation in preschool children 7 % 2000 Prevalence of vitamin A supplementation in mothers 3 % 2000 Prevalence of anemia in women n.a. Prevalence of iron supplementation in mothers n.a. MDG: Millennium Development Goal; n.a.: not available Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 4 TABLE OF CONTENTS Acknowledgments..................................................................................................................................2 Summary.................................................................................................................................................3 Summary Table.......................................................................................................................................4 List of tables and figures.......................................................................................................................6 Acronyms................................................................................................................................................7 Part I: Overview and basic indicators..................................................................................................8 I.1 Context...........................................................................................................................................8 I.2 Population......................................................................................................................................8 Population indicators.......................................................................................................................8 Population pyramid for 2001............................................................................................................9 I.3 Agriculture.....................................................................................................................................9 Land use and irrigation statistics.....................................................................................................9 Main crops, agricultural calendar, seasonal food shortage...........................................................10 Livestock production and fishery...................................................................................................10 I.4 Economy......................................................................................................................................10 I.5 Social indicators.........................................................................................................................11 Health indicators............................................................................................................................11 Water and sanitation......................................................................................................................12 Access to health services..............................................................................................................13 Education.......................................................................................................................................13 Level of development, poverty.......................................................................................................13 Other social indicators...................................................................................................................14 Part II: Food and nutrition situation...................................................................................................15 II.1 Qualitative aspects of the diet and food security...................................................................15 Food consumption patterns...........................................................................................................15 Food security situation...................................................................................................................15 II.2 National food supply data.........................................................................................................16 Supply of major food groups..........................................................................................................16 Dietary energy supply, distribution by macronutrient and diversity of the food supply..................17 Vegetable/animal origin of macronutrients....................................................................................18 Dietary energy supply by food group.............................................................................................18 Food imports and exports expressed as percentage of DES........................................................19 Food aid.........................................................................................................................................20 II.3 Food consumption.....................................................................................................................20 National level surveys....................................................................................................................20 II.4 Infant and young child feeding practices................................................................................21 II.5 Nutritional anthropometry.........................................................................................................22 Anthropometry of preschool children.............................................................................................22 Anthropometry of school-age children and adolescents...............................................................25 Anthropometry of adult women......................................................................................................25 Anthropometry of adult men..........................................................................................................25 II.6 Micronutrient deficiencies.........................................................................................................26 Iodine deficiency disorders (IDD)...................................................................................................26 Prevalence of goitre and urinary iodine level............................................................................26 Iodization of salt at household level..........................................................................................27 Vitamin A deficiency (VAD)............................................................................................................28 Prevalence of sub-clinical and clinical vitamin A deficiency......................................................28 Vitamin A supplementation........................................................................................................28 Iron deficiency anemia (IDA).........................................................................................................28 Prevalence of IDA......................................................................................................................28 Interventions to combat IDA......................................................................................................29 II.7 Policies and programmes aiming to improve nutrition and food security..........................29 Reference list........................................................................................................................................30 Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 5 List of tables and figures List of tables Table 1: Population indicators.................................................................................................................8 Table 2: Land use and irrigation..............................................................................................................9 Table 3: Livestock and fishery statistics................................................................................................10 Table 4: Basic economic indicators.......................................................................................................11 Table 5: Health indicators......................................................................................................................12 Table 6: Access to safe water and sanitation........................................................................................12 Table 7: Access to Health Services.......................................................................................................13 Table 8: Education.................................................................................................................................13 Table 9: Human development and poverty...........................................................................................14 Table 10: Other social indicators...........................................................................................................14 Table 11: Trends in per capita supply of major foods groups (in g/per day).........................................16 Table 12: Share of the main food groups in the Dietary Energy Supply (DES), trends........................19 Table 13: Initiation and duration of breastfeeding.................................................................................21 Table 14: Type of infant feeding by age................................................................................................21 Table 15: Anthropometry of preschool children....................................................................................23 Table 16: Anthropometry of adult women.............................................................................................25 Table 17: Anthropometry of adult men..................................................................................................26 Table 18: Prevalence of goitre and level of urinary iodine in school-age children................................27 Table 19: Iodization of salt at household level......................................................................................27 Table 20: Vitamin A supplementation of children and mothers.............................................................28 List of figures (cid:1) Figure 1: Dietary energy supply (DES), trends and distribution by macronutrient.......................17 (cid:1) Figure 2: Vegetable/animal origin of energy, protein and lipid supplies.......................................18 (cid:1) Figure 3: Dietary energy supply by food group.............................................................................18 (cid:1) Figure 4: Major food exports as percentage of Dietary Energy Supply (DES), trends.................19 (cid:1) Figure 5: Major food imports as percentage of Dietary Energy Supply (DES), trends.................20 Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 6 Acronyms BMI Body mass index CWF Committee on Women and Family DES Dietary energy supply DPT3 Diphtheria, pertussis (whooping cough) and tetanus vaccine – three doses FAO Food and Agriculture Organization of the United Nations FAOSTAT FAO Statistical Databases FIVIMS Food Insecurity and Vulnerability Information and Mapping Systems FNAP Food and Nutrition Plan Action FSS Faculty of Social Sciences GDP Gross domestic product GNP Gross national product GOA Government of Albania Hb Hemoglobin HIV/AIDS Human immunodeficiency virus/ acquired immuno deficiency IDA Iron deficiency anemia IDD Iodine deficiency disorders ILO International Labour Organization IPH Institute of Public Health ITU International Telecommunication Union MICS Multiple Indicator Cluster Survey NCHS National Center for Health Statistics NGOs Non Governmental Organizations PPP Purchase power parity SOFI The State of Food Insecurity in the World SuRF Surveillance of chronic disease Risk Factors TGR Total goitre rate UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children’s Fund UNPD United Nations Population Division UNSTAT United Nations Statistics Division VAD Vitamin A deficiency WB World Bank WHO World Health Organization Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 7 Part I: Overview and basic indicators I.1 Context The Republic of Albania is a small, very mountainous country on the western side of the Balkan Peninsula, bordered by the Adriatic Sea to the west, Greece to the south, the former Yugoslav Republic of Macedonia to the east, and Serbia and Montenegro to the north and north east. Its total land area is of 28 750 km2. About 70 % of the territory is above 300 m. The land rises steeply from the coastal plain to elevations of more than 2 400 m. The most rugged mountains are in the north. The mountains become gentler to the south, eventually merging with the Pindus Mountains of northern Greece. The coastal lowlands have a Mediterranean climate with hot, dry, almost cloudless summers with mild, rainy winters. In the mountains, there is more summer rainfall and higher humidity, especially in the north. Temperatures in the mountains have much larger diurnal variation. The average temperatures in August, the hottest month, range from 17°C to 31°C. January, the coldest month, ranges from 2°C to 12°C. December, the wettest month, has an average rainfall of 211 mm while the driest months, July and August, receive only 32 mm. On the coast, annual rainfall averages 1 200 mm, but it may range up to 4 060 mm in the mountains, often occurring as snow (FAO, Forestry Division; FAO, 2004a). I.2 Population Population indicators The Albanian population is relatively young, with 30% of the population under 15 years. It is estimated that about 900 000 people have emigrated in that period, representing about 35% of the work force of the Albanian population. Urbanization has increased rapidly since 1991, together with emigration (IMF, 2000). In 2003, the unemployment rate was about 15% (GOA & UNDP, 2004). Table 1: Population indicators Indicator Estimate Unit Reference Period Source Total population 3 062 thousands 2000 UNPD Annual population growth rate 0.44 % 2000-2005 UNPD Crude birth rate 17.2 ‰ 2000-2005 UNPD Population distribution by age: 2000 UNPD 0-4 years 9 % 5-14 years 21 % 15-24 years 17 % 60 and over 11 % Rural population 58 % 2000 UNPD Agricultural population 48 % 2000 FAOSTAT Population density 107 inhabitants per km2 2000 UNPD Median age 27 years 2000 UNPD Life expectancy at birth 74 years 2000-2005 UNPD males per 100 Population sex ratio 98.9 2000 UNDP female Net migration rate -6.5 ‰ 2000-2005 UNPD Total dependency rate 60 % 2000 UNPD Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 8 Population pyramid for 2001 Source: UNAIDS, 2002 I.3 Agriculture Agriculture in Albania is still the main activity, employing about half of the labour force. The average agricultural land per capita (less than a hectare) is one of the smallest in Europe, even though agricultural land more than doubled from 1950 to 1990 due to drainage of marshland, terracing and cultivation of forest and pastures, and establishment of new irrigation schemes. Agriculture in Albania has a low level of mechanisation and is considered as subsistence agriculture. Production is dominated by cereals, forage, vegetables, fruits and olive production. Agriculture still provides the income base for most of the population and serves as an employment safety net (FAO, 2004a; INSTAT, 2005). Land use and irrigation statistics Table 2: Land use and irrigation Type of area Estimate Unit Reference period Source Total Land Area 2 740 1000 Ha 2002 FAO Agricultural Area 42 % 2002 FAO Arable lands & Permanent Crops 26 % 2002 FAO Permanent Crops 4 % 2002 FAO Permanent Pasture 16 % 2002 FAO Forested land areas 36 % 2002 FAO Irrigated agricultural land 12 % 2002 FAO Arable & Permanent cropland in Ha per 0.5 Ha 2002 FAO agricultural inhabitant N.B. Percents are calculated on the total land area. Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 9 Main crops, agricultural calendar, seasonal food shortage The 5 major food and agricultural commodities produced in Albania in 2002 were cow milk, wheat, watermelons, fresh vegetables and maize (FAO, Statistics Division). All these commodities were mainly used for local human consumption (FAO, FAOSTAT Database). Source: GIEWS/FAO Based on the seasonality, fresh vegetable shortage might occur from November to May. Livestock production and fishery Livestock breeding in Albania is still done on extensive pasture during the summer while livestock is fed forage during the winter. Livestock breeding is dominated by cattle, pigs (especially in the catholic areas such as Lezha, Shkodra, Mirdita region) with approximately 2~5 heads per family. Sheep breeding is concentrated in some mountain areas such as Peshkopi (Luma), Tepelena, Gjirokastra and Vlora area and nomadic breeding is occasional. Poultry production is limited, and is mainly a family type production (INSTAT, 2005). Consumption of fish is increasing with the fisheries’ production, amounting to 4.6 kg per capita per year in 2003 (FAO, 2004b). Table 3: Livestock and fishery statistics Livestock production and Estimate Unit Reference period Source fishery Cattle 700 000 number of heads 2004 FAO Sheep and Goats 2 825 000 number of heads 2004 FAO Poultry Birds 5 355 thousands 2004 FAO Fish catch and aquaculture 700 000 tons 2004 FAO I.4 Economy The agricultural sector contributes 29% of GDP. Among the non-agricultural activities, services represent 46% of GDP, industry represents 10%, transport 10% and construction 9% (Luçi, 2004). The transition from a centrally planned economy to a market system, witch started after the collapse of the Union of Soviet Socialist Republics (USSR) in 1991, has been marked by a steady growth, but also by increased poverty, underemployment and gender inequality. The financial disaster and civil unrest triggered by the implosion of the pyramid schemes in 1997 and the inflow of refugees caused Albania Nutrition Profile – Food and Nutrition Division, FAO, 2005 10