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Brain Gain
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BISHKEK, KYRGYZ REPUBLIC
You see? asks Artur Buiuklianov delightedly as he points to the telltale stain.
“The salt is iodized.”
We are visiting a small market in Kara-Balta, a town once famed for gold and uranium production. He has purchased a bag of salt and tested it by adding a drop of reagent. The salt has turned purple, showing the presence of iodine. More importantly, it shows that the battle against iodine deficiency disorder (IDD) is being won in Central Asia.
It is an important battle, for human beings need to ingest the right balance of micronutrients for healthy living, and micronutrients like iodine play a vital role. Regular iodine intake is particularly important for the development of healthy children, and if a woman has insufficient iodine in her body during pregnancy— especially in the first trimester—this can seriously damage the fetus.
According to the United Nations Children’s Fund (UNICEF) Executive Director Carol Bellamy, speaking at the International Meeting for the Sustained Elimination of Iodine Deficiency Disorders in Beijing in October 2003, 46 million children were born in 2002 unprotected from iodine deficiency, the world’s single greatest cause of preventable mental retardation. “There is no reason for so many children to be compromised by a disorder that can be prevented with only a few grains of iodized salt,” she said.
Even mild iodine deficiency can result in a significant loss in learning ability. According to UNICEF, IDD can lower the intelligence quotient of a population by as much as 13 points, with serious implications for human and economic development. Other effects include goiters, stillbirths, and miscarriages.
In the former Soviet Union, the connection between micronutrients and health and child development was well recognized, and almost all salt was iodized. But after the breakup of the Soviet Union in 1991, many linkages between Russia and the newly independent countries of Central Asia were sundered and, during the latter’s difficult period of transition from controlled to market economies, iodized salt generally ceased to be available.
In Central Asia, the poor eat little seafood, which is a good source of iodine, and their diets are generally iodinedeficient. With the collapse of systematic iodization of salt, half a generation of poor women and children —especially children—have suffered.
The problem is not limited to iodine. Toregeldy Sharmanov, President of the Kazakh Academy of Nutrition (KAN) in Almaty, Kazakhstan, says half the women of reproductive age in Central Asia are affected by iron deficiency anemia. This can be overcome simply by fortifying flour with iron; but in most parts of Central Asia, fortified flour has never been available.
The World Bank has estimated the cost of micronutrient deficiency to the Central Asia subregion at about 5% of gross domestic product—an enormous price to pay for the absence of tiny amounts of inexpensive micronutrients.
Recognizing the challenge, the governments of Azerbaijan, Kazakhstan, Kyrgyz Republic, Mongolia, Tajikistan, and Uzbekistan reached an agreement in October 2001 to increase the consumption of iodized salt and iron-enriched flour. With a grant of $6.85 million from the Japan Fund for Poverty Reduction (JFPR), a project has been put in place aimed at increasing awareness, mobilizing communities, promoting legislation and regulation, fostering production of iodized salt and fortified flour, and monitoring bioavailability of iron and iodine in people.
Throughout the subregion, information ministries, health authorities, and nongovernment organizations (NGOs) have been mobilized to make people aware of the importance of micronutrients in diet. A whole range of dissemination techniques is being deployed: pamphlets, TV advertisements, billboards, comics, children’s art competitions, wall paintings, and lectures.
The campaigns are succeeding. In Kazakhstan and the Kyrgyz Republic, for example, near universal awareness of the need for iodization and fortification exists in target areas. These are those—like the city of Shimkent in southern Kazakhstan— that have a high incidence of IDD among women and young children, goiters among schoolchildren, and iron-deficient anemia among infants and pregnant women.
Nurzhamal Kuderova is the Director of the Shimkent Center for Healthy Lifestyles, one of 205 centers that have recently been set up as the Government of Kazakhstan has come to recognize the cost of lifestyle diseases. A throat surgeon who is well acquainted with goiters and the danger that iodine deficiency presents, she stresses the need for continuing public information campaigns, not only about micronutrients but also about exercise and lifestyle generally.
She works closely with Kalima Kulbatchaeva, who heads the Federation of Business Women of South Kazakhstan, one of the NGOs recruited under the project to foster awareness and undertake monitoring. Ms. Kulbatchaeva underscores the importance of available supplies of “healthy foods” in the market, and points to the healthy food logo designed by KAN and adopted throughout the region as the campaign symbol.
Children’s Park, a government-funded newspaper aimed at children in the Shimkent area, frequently carries articles about diet and tells children about the importance of iodization and iron fortification. The newspaper even sponsored a graffiti day on the general theme of healthy living. The idea came from five teenage activists who helped organize a daylong event where students from 23 schools created artwork on a wall at the Mendeleev Science School.
“It attracted considerable media coverage and greatly increased awareness of the significance of micronutrients,” says Olga Zorina, Editor of Children’s Park. Similar promotional efforts are being made throughout the subregion.
The fundamental aim of the project is to make iodized salt and fortified flour available to the poor.
To improve supply, iodizing and fortifying equipment is being given to producers. In the Kyrgyz Republic, for example, seven salt packaging companies have been given equipment, as well as being provided with subsidized supplies of potassium iodate.
An association of salt producers has been formed with project assistance, and a further seven processors are joining the scheme. No salt is produced in the Kyrgyz Republic, and most is imported from Kazakhstan. Illegal noniodized imports and counterfeit products are a problem and require strict enforcement of laws and regulations, says Sarpek Eshaliev, President of the Salt Enterprises Association of the Kyrgyz Republic.
In fact, throughout the subregion, legislation is being enacted, regulations established, and surveillance measures adopted to help improve and standardize supply. KAN is leading the subregion in setting standards, ensuring information disseminated is technically correct, and monitoring progress.
Equipment for flour fortification is also being provided free of charge to flour millers, and they are receiving subsidized supplies of a premix developed by KAN. This fortification additive provides iron and five other important micronutrients—zinc, folic acid, and vitamins B1, B2, and B3. A US firm is supplying the premix.
Micronutrient deficiency is estimated to cost the Central Asia subregion about 5% of gross domestic product
As a result of these ongoing efforts, awareness of the need for micronutrients has greatly increased, and the availability of iodized and fortified flour has improved, with prices mostly being held at reasonable levels. It is too early to accurately evaluate the effect on the health of Central Asia’s women and children. What is certain, however, is that continuing commitment and support are needed to ensure that the poor children and mothers of Central Asia get the micronutrients they need. Let us hope Mr. Buiuklianov, and others like him, do not need to test salt for much longer.
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