Micronutrient Status Survey in Tajikistan, 2009
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Ministry of Health Republic of Tajikistan Micronutrient Status Survey in Tajikistan, 2009 Assisted by the Swiss Centre for International Health of the Swiss Tropical and Public Health Institute The opinions expressed in the report are those of the authors and do not necessary reflect the positions, policies and views of UNICEF Ministry of Health Republic of Tajikistan Micronutrient Status Survey in Tajikistan, 2009 September 2010 Abbreviations AAH Action Against Hunger ACC/SCN Administrative Committee on Coordination/Subcommittee on Nutrition AKHS Aga Khan Health Services BMI Body mass index CED Chronic energy deficiency CRP C-reactive protein DQA Data quality audit DRD Direct Rule District (former Rayons of Republican Subordination) ECCD Early Childhood Care and Development ELISA Enzyme-linked immunosorbent assay GAM Global acute malnutrition (low weight-for-height) GBAO Gorno-Badakhshan Autonomous Oblast GCM Global chronic malnutrition (low height-for-age) Hb Haemoglobin ICF Informed consent form IDA Iron deficiency anaemia IDD Iodine deficiency disorders IMCI Integrated Management of Childhood Illnesses INRAN National Institute for Research on Food and Nutrition MICS Multi Indicator Cluster Survey MNSS Micronutrient Status Survey MoH Ministry of Health NCHS National Centre for Health Statistics QA Quality assurance QC Quality control PPM parts per million RFP Request for proposals SCIH Swiss Centre for International Health SD Standard deviation SHL Survey household list SPMU Systems Performance and Monitoring Unit SPSS Statistical Package of Social Sciences sTfR Serum transferrin free receptor STI Swiss Tropical Institute TLSS Tajikistan Living Standard Survey TMB Tetramethylbenzidine ToR Terms of reference UI Urinary iodine UIE Urinary iodine excretion UNICEF United Nations Children’s Fund USI Universal salt iodization WFP World Food Program WHO World Health Organization WRA Women of reproductive age (15-49 yrs) Table of Contents Summary ................................................................................................................................. 5 1. Introduction ........................................................................................................................ 10 2. Objectives ........................................................................................................................... 13 3. Methodology ....................................................................................................................... 14 3.1 Study area, study design and sampling ..............................................................................14 3.2 Sample size .........................................................................................................................16 3.3 Field Data Collection ..........................................................................................................17 3.4 Laboratory analysis ............................................................................................................20 3.5 Data entry and analysis ......................................................................................................22 4. Results ................................................................................................................................ 24 4.1 Study population ...............................................................................................................24 4.2 Demographic characteristics of households and individuals .............................................25 4.3 Women’s nutritional status ................................................................................................26 4.4 Children’s nutritional status ...............................................................................................31 4.5 Knowledge, attitude and practice ......................................................................................39 5. Discussion ........................................................................................................................... 40 5.1 Quality assurance and quality control procedures .............................................................40 5.2 Limitations and bias ...........................................................................................................41 5.3 Women’s nutritional status ................................................................................................41 5.4 Children’s nutritional status ...............................................................................................44 5.5 Anaemia .............................................................................................................................46 5.6 Iodine .................................................................................................................................49 5.7 Breastfeeding .....................................................................................................................52 5.8 Early Childhood Care and Development (ECCD) .................................................................53 6. Conclusion .......................................................................................................................... 54 References .............................................................................................................................. 58 Appendix 1. Estimated population in 2009 per administrative divisions of Tajikistan .............. 60 Appendix 2. Selected clusters list per Oblast ........................................................................... 61 Appendix 3. Estimates of sample size ...................................................................................... 68 Appendix 4. Research consent form ........................................................................................ 70 Appendix 5. Questionnaire ...................................................................................................... 72 Appendix 6. Cut-off values for haemoglobin and urinary iodine .............................................. 82 Appendix 7. Detailed results in table format ............................................................................ 84 Appendix 8. Socio-economic information ................................................................................ 113 Appendix 9. Salt iodization ...................................................................................................... 117 Appendix 10: Infant and child health, care and development .................................................. 119 Appendix 11. Breastfeeding and infant feeding ....................................................................... 123 Contacts .................................................................................................................................. 126 4 Micronutrient Status Survey in Tajikistan, 2009 Foreword Good nutrition is key to helping children stay healthy, productive, and able to learn. Thus, good nutri- tion benefits families, communities, and the country as a whole. Over the last years Tajikistan has made significant progress in nutrition related areas. The most re- markable achievement is the decrease in the proportion of anaemic women – a good indicator of the nutrition status of mothers – from 41.2 per cent in 2003 to 24.2 per cent in 2009. Another notable achievement is the reduction in stunting among children from 36 per cent in 2005 to 28.9 per cent in 2009. In addition, the number of households consuming adequately iodized salt has increased from 28 per cent in 2003 to 61.9 per cent in 2009. Despite considerable progress made in these areas, undernutrition and micronutrient deficiencies re- main significant public health problems in Tajikistan. This report shows that one in three, or almost 300,000 under-five children in the county are still stunted, a consequence of chronic nutritional dep- rivation that begins in the period before birth if the mother is undernourished. More than eight per cent of Tajik children under five are underweight and only 23 per cent of children under six months are exclusively breastfed. More than half of the country’s children have low iodine levels and almost one third of them have iron-deficiency anaemia. Undernutrition is the largest independent cause of child mortality. It steals children’s strength and makes illness more dangerous. An undernourished child struggles to withstand an attack of pneumo- nia, diarrhoea or other illness – and illness often prevails. Undernutrition is caused by poor feeding and care, aggravated by illness. The children who survive may become locked in a cycle of recurring illness and faltering growth – diminishing their physical health, irreversibly damaging their development and cognitive abilities, and impairing their capacities as adults. Undernutrition among mothers affects a woman’s chances of surviving pregnancy as well as her child’s health. Women who were stunted as girls, whose nutritional status was poor when they conceived or who didn’t gain enough weight during pregnancy may deliver babies with low birthweight. These infants in turn may never recoup from their early disadvantage. Today in Tajikistan more than 50 per cent of women suffer from iodine deficiency and one in four women is anaemic. UNICEF believes that good nutrition is critical in ensuring that every child has the best start in life. UNICEF in Tajikistan has been working on nutrition programmes aimed at fulfilling every