Asian Development Bank
Project in Central Asia: Making Progress
Against Micronutrient Deficiency
Two years after its launch, the ADB-backed project to Improve Nutrition
for Poor Mothers and Children in Central Asia is making significant progress
in fighting widespread micronutrient deficiencies.
Following the break-up of the Soviet Union in the early 1990s, and the
collapse of the system for producing and distributing iodized salt, there
was a sharp rise in mentally retarded and physically stunted new-born
babies in Central Asia as a result of iodine deficiency disorder (IDD).
A lack of vital micronutrients such as iodine and iron in the diet of
a pregnant woman can impair the development of her unborn child.
Where IDD is prevalent, children lose 13 IQ points at birth that can never
be recovered. Salt iodization is the best way to eliminate IDD, but less
than one household in four in Central Asia and nearby countries has access
to iodized salt, the lowest consumption rate in the world. The ADB project
is changing all this.
At the Almaty Forum in October 2001, the governments of Central Asia forged
a landmark subregional agreement to boost production, distribution, and
consumption of iodized salt and iron-enriched wheat flour.
Participating countries are Azerbaijan, Kazakhstan, Kyrgyz Republic, Mongolia,
Takijistan, and Uzbekistan.
The effort is backed by a partnership of international advisors consisting
of ADB, the United Nations Children's Fund (UNICEF) and the Kazakh Academy
of Nutrition (KAN). It was financed by a US$6.85 million grant from ADB's
Japan Fund for Poverty Reduction (JFPR).
The project's ambitious scope includes significant institution building
both of the private and public sectors, including the quality control
system, supporting legislation, food safety and trade regulations, providing
incentives for fortification, and promoting an active civil society to
monitor the quality of fortified food in the market.
In the two years since the project was launched, its key achievements
- Legislation: three out of the six countries now have universal salt
iodization legislation, and the other three have drafted legislation for
discussion in parliament
- Flour fortification: all six countries have started flour fortification
that is expected to reduce anemia, and other mineral and vitamin deficiencies
- Quality control: all countries except Tajikistan plan a quality assurance
- Public awareness: major progress has been made in public information
campaigns and social mobilization in all countries except Azerbaijan and
- Regulations: Kazakhstan and the Kyrygz Republic have introduced regulations
to ensure that wheat flour provided to public social service entities
such as hospitals and schools are fortified
- Cost-sharing for wheat fortification by the public and private sectors
for most of the countries
- Blood sampling: the first round of blood sampling was done by KAN in
At a recent project review meeting in Bishkek, Kyrgyz Republic, nutrition
advisor, Dr. Nevin S. Scrimshaw, Professor Emeritus of the Massachusetts
Institute of Technology, noted that "progress was significant even
by global standards."
"After overcoming many political, technical and logistic obstacles,
substantial progress toward implementation has been achieved in all countries
and the pace toward full implementation is accelerating," he said.
"By providing leadership and approximately US$1 million per country
in the region plus Mongolia, legislation requiring iodization of salt
and multiple fortification of wheat flour has been approved and both procedures
are being implemented in all participating countries."
The review meeting concluded that more effort is needed to
- Implement the quality assurance system
- Grant tariff and tax exemption on fortificants and fortification equipment
- Monitor and evaluate outputs and outcomes of activities.
Evaluation studies to determine the impact of the project will be carried
out next year, says Rie Hiraoka, an ADB Social Protection Specialist.
"We expect this will show a significant reversal of past trends,"
she says. One expected trend in decline is the death rate of infants from
neural tube defects and of adults from cardiovascular disease, due to
the folic acid added to the flour along with iron.
At one time, half of Central Asia's women of reproductive age and 70%
of its children under three were affected by iron deficiency anemia. Apart
from the tragic human cost, the economic cost of micronutrient deficiencies
in developing countries is at least a staggering 5% of gross domestic
product (GDP), according to World Bank estimates.
But now Central Asia is steadily closing the gap with most of the world
in the move toward universal salt iodization and flour fortification.
"This will address a promise made at the United Nations General Assembly
Special Session on Children in 2002 to bring lagging regions where children
face a nutrition crisis back into the global community," says Joseph
Hunt, ADB's health and nutrition advisor. "This project is helping
to do just that."
Source: Ian Gill, Nutrition Project in Central Asia:
Making Progress Against Micronutrient Deficiency, ADB On-Line Media Centre,
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