Nutrition of children and women : achieved progress in the Kyrgyz Republic

1. Nutrition of children and women: achieved progress in the Kyrgyz Republic Professor M.M. Karataev, PhD Deputy Minister of Health of the Kyrgyz Republic,

2. Main problems of health, related to nutrition -Iodine deficiency diseases-Vitamin A deficiency-Iron deficiency anemia-Folic Acid deficiency-Low coverage by exclusive breastfeeding-Exclusive breastfeeding during first 6 month-Stunting (chronic nutrition disorders)

3. Prevalence of stunting (MICS, 2006)

4. Dynamics of stunting(MICS, 2006)

5. Achieved progress in liquidation of iodine deficiency disorders • Salt iodization • Legislative base is prepared • Association of Salt Producers is functioning successfully • Since 2005, KIO3 have been purchasing by the producers at their own expenses • Capacity of production and import of iodized salt covers needs of population of the Kyrgyz Republic • The system of external and internal quality control of iodized salt • 96,5% of respondents prefer to use iodized salt (Marketing Service Bureau, 2006)

6. Quality of iodized salt in trading network (standard tests)

7. Availability of iodized salt in shops, %(at the time of controlin 131 shops)

8. Consumption of iodized salt at household level

9. Main achievements: The results of monitoring, conducted by NC of MCH, RHPCand supported by UNICEF (2007), show that in 77,9% of households, salt with sufficient content of iodine (≥15ppm) is used. 20% of families consider that the content of iodine in salt (< 15ppm) is not sufficient. 96,5% of respondents prefer to consume iodized salt.

10. Liquidation of vitamin A deficiency. Achievements: 8 rounds of vitamin A supplementation, coverage is 97-98% All the medical workers have been trained locally Health officials have been trained at the local level Activities on improvement of population’s awareness is being implemented constantly At present, the issue on supplementation of vitamin A during routine immunization or as a component of “sprinkles”, is being solved

11. Youth component(Demand Side) Iron deficiency anemia • The programme “Prophylaxis of iron deficiency anemia among the population of the Kyrgyz Republic was approved by the Decree of the Government of the Kyrgyz Republic, dated 29.01.1996” • The programme is aimed at flour fortification

12. Youth component(Demand Side) The number of mills, which have possibilities to fortify the flour is increased • 1996- 3 mills • 2003 – 10 mills • 2005- 18 mills • 2006- 22 mills • 2007 - 27 mills

13. Availability of fortified flour in shops in regions, %

14. Availability of fortified flour in shops in oblasts, %

15. Main achievements: • The essential legislative base on fortified flour (standards 918:2004 «Wheat flour, fortified by vitamin-mineral or mineral additives”,КМС 990:2005 “Wheat flourof general purpose”). • Project of the Law «About fortification of flour by baking industry» was presented on approval to the Parliament of the country

16. Main achievements: • The external quality control of fortified flour – SES, Independent Bread Inspection • Internal quality control is established. Most of the enterprises have technical possibilities on control of fortified flour. • Laboratory personnel and technologists of all mills have been trained on fortification technology and quality control of fortified flour.

17. Main achievements: • Only fortified flour and iodized salt are used for preparation of food in pre-schools and schools of the republic according to the order (prikas) of the Ministry of Education and Science, 2007

18. Iron supplementation • Clinical trial on acceptability of “sprinkles” supplementation has been finished • Anemia prevalence among children of early age decreases from 71% to 52% in a group that received “sprinkles” • At present, the issues, related to expansion of experience at country level are studied • Evidence-based clinical guideline on treatment and prophylaxis of iron deficiency anemia among reproductive age women and children is approved.

19. Exclusive breastfeeding • Study situation on Marketing of breastmilk substitutes has been finished • The Law “Protection of Вreastfeeding and marketing of breastmilk substitutes”is being developed at present. During the second quarter of 2008 the Law will be presented to Parliament of the country.

20. Problems • Prevalence of anemia among women and children is still remain high • Prevalence of stunting among children under 5 is remain high (MICS, 2006) • Low coverage by exclusive breastfeeding (MICS, 2006) • Lack of sustainability of flour fortification programme

21. Planned actions • Prophylaxis of anemia: • Sprinkles’ supplementation, as anemia prevalence is more than 72% among children, and more than 50% among women • Flour fortification – approval of the Law «Flour Fortification by bakeries” will allow to achieve sustainability of the programme • To increase population’s awareness • It is planned to conduct survey in Talas on anemia among children under 2 with UNICEF (April-May 2008) • Study on prevalence of helminth among children and women is being conducted

22. Planned actions (continuation) • “Project on improvement of nutrition and care practice of children in families” • Curricula and modules on nutrition of children, pregnant and lactating women for medical workers are being renewed • Training, taking into account the results of MICS, quality study of child nutrition at household level and discussions with medical workers, is planned

23. Planned activities (continuation) • At present, only maternity houses are being certified as BFHI. There are no criteria on certification of FMC and children hospital as baby-friendly hospitals. In this, we need assistance of international experts.

24. Thank you!