Asian Development Bank

Nutrition 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 include:
- 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 system
- Public awareness: major progress has been made in public information campaigns and social mobilization in all countries except Azerbaijan and Uzbekistan
- 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 all countries
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, 2003

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