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Easing Heartbreak for Central Asia's MothersAlmaty Forum 2001 launches a subregional program to improve nutrition for poor mothers and children
By Ian Gill (igill@adb.org)
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Saylaugul Begalieva’s three children romp noisily around their home on the outskirts of Taraz, a city in southern Kazakhstan. Their playfulness belies a family tragedy that has become increasingly common in Central Asia in the decade since the breakup of the Soviet Union.
Her 13-year-old son, Hany, and her 12-year-old daughter, Dana, are healthy. But her 7-year-old daughter, Jayna, is mentally retarded and does not go to school.
Jayna suffers from an enlarged thyroid gland because her mother did not consume enough vital nutrients, such as iodine, during pregnancy.
At the time Saylaugul was pregnant with her first two children, almost all the salt consumed in the former Soviet Union was iodized. Following independence in 1991, the centralized production and distribution system collapsed. Currently, less than one in three Kazakhs has access to iodized salt. The same is true for many other countries of the former Soviet Union.
Saylaugul, 40, is clearly a strong and devoted mother, but she weeps as she points to a sack of salt standing in a corner.
“I had no idea the salt had changed,” she says. “During my pregnancy with Jayna, I was anemic and suffered from a kidney ailment. But I was shocked after Jayna was born to find that she could not move or even cry. I had no idea what was wrong.”
She took Jayna to the regional children’s hospital, where endocrinologist Dr. Roza Bitimbayeva examined her. The doctor diagnosed iodine deficiency disorder (IDD).
 INNOCENT VICTIM. Dr.Roza Bitimbayeva and a child affected with iodine deficiency disorder |
“It’s very sad,” says Dr. Bitimbayeva. “Most of the population consumes noniodized salt, and there has been a sharp increase in IDD cases in this province.” Pointing to a chart, she notes that severe IDD cases among children rose to 3,201 in 2000 from 1,802 in 1998. However, such severe cases are only the tip of the iceberg. While doctors face extreme cases, such as cretinism, iodine deficiency during pregnancy impairs mental development across a population. Even the brightest are denied their full potential.
“The problem starts in the first three months in the womb. If a child lacks vital micronutrients such as iodine and iron from the start, this produces an average loss of 13 IQ points as well as stunted physical development,” says Joseph Hunt, a senior health and nutrition economist with the Asian Development Bank (ADB). “The deficiency also lowers the IQ of potential geniuses.”
Since independence in 1991, Central Asian economies have gone through a painful transition from controlled to market economies, aggravated by the Asian financial crisis. As budget deficits have ballooned and social services declined, poor mothers and children have suffered the most.
As a result, while most of the world is progressing toward universal salt iodization, much of Central Asia has fallen behind. The problem includes a lack of iron too. Half the women of reproductive age and 70 percent of children under three are affected by iron deficiency anemia, according to Mussa Aidjanov, laboratory chief at the Kazakh Academy of Nutrition in Almaty. “This has profound effects on health and development,” he says. “The consequences for infants and children include impaired psychomotor development and decreased physical activity.”
The cost to the subregion is staggering. ADB estimates that the annual economic loss for a country is 5 percent of its gross domestic product.
But all this is changing.
At the groundbreaking Almaty Forum 2001 to Improve Nutrition for Poor Mothers and Children held in Kazakhstan on 10–12 October 2001, Central Asian governments and ADB forged a landmark subregional agreement to boost production, distribution, and consumption of iodized salt and iron- enriched wheat flour. In addition, participating countries agreed on country investment plans with low-cost schemes to address their priority nutrition needs.
The countries participating in the program are Azerbaijan, Kazakhstan, Kyrgyz Republic, Mongolia, Tajikistan, and Uzbekistan. The program is sponsored by ADB, United Nations Children’s Fund, and Kazakh Academy of Nutrition. It is backed by a $6.85 million grant from ADB’s Japan Fund for Poverty Reduction - JFPR.
Each country delegation—representing the public and private sectors, civil society, and nongovernment organizations — agreed to:
“The subregional framework will facilitate the movement of fortified salt and wheat flour into, and between, the countries by creating a more favorable legal and trade environment. It is also a significant step toward building new partnerships, not only between the countries but also between the public and private sectors and NGOs, to solve a common problem,” says William Fraser, Manager of ADB’s Education, Health and Population (East) Division.
“This is a health event of major significance that will enable Central Asia to fully participate in an increasingly globalized economy because children’s capacity to learn and earn will be dramatically increased,” says Mr. Hunt, who is coordinating the subregional program.
The Almaty Forum 2001 was attended by public health service agency personnel, private salt producers, flour millers, and bakers; and representatives of NGOs, external assistance agencies, and central and local governments.
A major outcome of the Forum is the Almaty Declaration, which outlines a set of principles, strategies, and actions to tackle micronutrient deficiency in the sub- region. The JFPR will support the efforts through 2002.
 HIDDEN HUNGER. Many children in Central Asia have not been getting the micronutrients needed to build healthy brains and bodies |
One of Central Asia’s problems is that some countries, like the Kyrgyz Republic, produce no salt and rely on imports from neighboring Kazakhstan and Uzbekistan. Kazakhstan, on the other hand, has vast deposits of natural sodium chloride, but only one of its three major salt producers regularly iodizes its product.
On the supply side, the subregional program will provide more incentives for salt producers to iodize their product and reduce barriers to trade in fortified products. Significantly, cost is not a major problem for salt producers. “Iodizing salt is technically simple and adds only a fraction to production costs,” notes Mr. Hunt. “It costs only five cents a year to meet a child’s iodine needs and less than 10 cents for the iron requirement.”
On the demand side, the program will promote awareness, especially among poor mothers, of how to ensure their children’s normal development. “NGOs will play a critical role in generating demand for fortified products as well as monitoring their delivery,” says Gary Gleason, Progamme Director of the International Nutrition Foundation, who is in charge of ADB’s communications strategy for the program.
One NGO at the meeting was the Forum of Women’s NGOs of Kyrgyzstan, which includes 57 women’s NGOs. “We can help with communicating information, monitoring delivery, and training trainers. We have contacts with women teachers in the villages,” says Nurgul Djanaeva, President of the Women’s Forum.
Relatively small investments can have a huge impact on enabling Central Asia’s children to reach their potential.
But for little Jayna, this help is coming too late.
Although her condition has improved with treatment—and, at seven, she can run, talk, and sing—she will never recover the ground that she lost before she was born. The battle to fortify the next generation before birth is one that can, and must, be won.
____________________________Learn more about Manila Forum 2000: Strategies to Fortify Essential Foods in Asia and the Pacific
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