Kyrgyzstan is having problems feeding its children, according to a recent UNICEF/World Bank report, which indicates that 22 percent of deaths among Kyrgyz under 5 years of age are the result of poor nutrition.
The report also shows that malnutrition during the early years of a child's life causes developmental and cognitive delays. Nationally, the growth of 14 percent of children under the age of 5 is stunted, and in three provinces that number rises to 20 percent.
Such figures will come as no surprise to many Kyrgyz mothers like Chynar Mamatbekova, who claims she can barely afford to feed her nine children.
"It is truly difficult now," she says. "Just look at how expensive a kilogram of meat is. Families with many children like mine cannot say we eat meat regularly. Sometimes we have it, sometimes we don't. Our food is not rich with vitamins. Mainly we eat pasta and rice. How can I hide it? We eat what we can find."
Tamer Rabie, a senior health specialist at the World Bank and the lead author of the report, says malnutrition is much more prevalent in rural regions of the country, with 15.7 percent of children under 5 experiencing stunted growth compared to 10.8 percent in urban areas.
The total cost of undernutrition to the economy is $32 million each year, with $4.5 million coming from deaths that are lost to the labor force and the rest due to lost productivity, mainly from stunting and iodine deficiency, which can cause mental retardation.
The report also states that $6.25 million of the country's losses could be prevented through behavioral changes, such as exclusive breast-feeding for the first six months of life, and scaling up existing nutrition programs.
Rabie says that the 2008 food and financial crises had profound effects on Kyrgyz diets. Food prices, for example, rose nearly 30 percent by the end of that year. Since then, the population -- including children and pregnant women -- is eating less nutrient-rich food.
The reports identifies educating mothers on breast-feeding and appropriate complementary feeding as a priority.
He also maintains that the high rate of iodine deficiency also has a profound effect on the nation's health and productivity.
"By far, iodine deficiency is the world's single greatest cause of preventable mental retardation, and it's especially damaging during the early stages of pregnancy and early childhood," he says.
"And with iodine deficiency, normally it's associated with lifelong consequences of brain damage that affect a child's ability to learn, and later on in life to earn...thereby preventing the nation from fulfilling its potential."
Low Academic Achievement
According to Rabie, the lack of proper salt iodization is the main cause of iodine deficiencies. He says that, in addition to the problem of not all salt being iodized, some iodized salt does not have an adequate amount of iodine in it. The World Bank has provided the Kyrgyz government with kits for testing iodine levels in salt.
Rabie says that other conditions caused by undernutrition, such as anemia, have also been shown to cause a loss of IQ points in children and lost productivity in adults.
He maintains that, while the Kyrgyz government has been making strides in fighting undernutrition, meeting the Millennium Development Goals related to maternal and child health still remains a challenge and more needs to be done to achieve them.
UNICEF report author Rajae Msefer Berrada says that out of the five Central Asian countries, only Tajikistan appeared to fare slightly worse than Kyrgyzstan. She adds, however, that there wasn't enough data available on nutrition in other countries in the region to do a proper comparison.
In Berrada's opinion, low academic achievement in Kyrgyzstan is likely linked to undernutrition.
"It is clear that the education achievements and learning achievements among children in Kyrgyzstan is quite low," she says. "So, of course, it is also linked to the poor quality of education, but it is clear that because children at an early age are not fed properly...it should have an impact also at a later stage when the child starts to go to school [and] starts to learn."
The report recommends education on exclusive breast-feeding for the first six months of life, followed by appropriate complementary feeding, and providing women with a protein supplement as the highest priority interventions.
National figures from 2006 showed that 65 percent of woman breast-feed exclusively once a baby is born, but the numbers drop to 40 percent at 3 months and 32 percent at 6 months.
In addition to poor maternal nutrition, health problems including preeclampsia, or high blood pressure during pregnancy, and other various infections often go untreated due to women not seeking proper antenatal care or not taking prescribed medication, as well as doctors not doing sufficient screening.
Rabie points out that preeclampsia can lead to children having low birth weight and birth defects. He says infections that cause diarrhea can also lead to undernutrition, especially in children under the age of 5.
The rest of the report's recommendations -- apart from introducing a zinc-dispensation program to prevent diarrhea -- are already in place and need to be scaled up.
These recommendations include improving programs to provide mothers with multiple micronutrients or iron folic acid to prevent anemia; universal salt iodization (only 76 percent was adequately iodized in 2006); and fortifying flour with vitamins and minerals (only 10 percent is currently fortified, although government programs are rapidly working to improve that).
The report also suggested expanding programs that provide multiple micronutrient powders for children, and scaling up the current deworming program.
It also recommends beginning a community-based feeding program for children with severe acute malnutrition. The report states that the current program only takes place in medical facilities, and increasing its impact by also bringing it to the community level could prevent the deaths of hundreds of thousands of children.