77199 Nutrition at a GLANCE Tajikistan The Costs of Malnutrition Annually, Tajikistan loses over US$60 million • The Europe and Central Asia region is anticipat- ed to lose a cumulative US$7 billion to chronic in GDP to vitamin and mineral deficiencies.3,4 disease by 2015.5 Scaling up core micronutrient nutrition • Over one-third of child deaths are due to under- interventions would cost US$4 million per year. nutrition, mostly from increased severity of dis- (See Technical Notes for more information.) ease.2 • Children who are undernourished between con- ception and age two are at high risk for impaired Key Actions to Address cognitive development, which adversely affects Malnutrition: the country’s productivity and growth. Improve infant and young child feeding, including • The economic costs of undernutrition and over- exclusive breastfeeding for 6 months, through effective weight include direct costs such as the increased education and counseling services. burden on the health care system, and indirect Support vitamin A supplementation of young children. costs of lost productivity. Country Context • Childhood anemia alone is associated with a Increase coverage of iron supplementation for pregnant HDI ranking: 127th out of 182 2.5% drop in adult wages.6 women. countries1 Achieve universal salt iodization. Life expectancy: 67 years2 Where Does Tajikistan Stand? Improve dietary diversity through increased market • 39% of children under the age of five are stunted, access, diversified agricultural production, and national Lifetime risk of maternal death: 15% are underweight, and 7% are wasted.2 food policies that align with public health nutrition. 1 in 1602 • Over 40% of those aged 15 and above are over- weight or obese.7 Under-five mortality rate: • 10% of infants are born with a low birth weight.2 FIgure 1  Tajikistan has Higher Rates of Stunting than 64 per 1,000 live births2 • Tajikistan has achieved high rates of vitamin A its neighbors and Income Peers Global ranking of stunting supplementation: 87% of children 6–59 months of prevalence: 38th highest out of age receive the recommended two doses of vita- 45 Prevalence of Stunting Among 40 136 countries2 min A approximately six months apart.2 Full cov- Tajikistan Children Under 5 (%) 35 erage can decrease the risk of mortality by 23%.8 30 Haiti 25 Ghana Albania As seen in Figure 1, Tajikistan has much higher 20 Technical Notes rates of stunting than countries in the same region and income group. Neighboring Kyrgyzstan (not 15 10 Turkey 5 Stunting is low height for age. displayed below), with a similar per capita income, 0 has a stunting prevalence of 18%, illustrating that 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Underweight is low weight for age. stunting is not dependent on GNI alone. GNI per capita (US$2008) Wasting is low weight for height. Source: Stunting rates were obtained from WHO Global Database on Child Current stunting, underweight, and wasting The Double Burden of Undernutrition and Growth and Malnutrition. GNI data were obtained from the World Bank’s World Development Indicators. estimates are based on comparison of the most recent survey data with the WHO Overweight Child Growth Standards, released in 2006. Though Tajikistan is currently on track to meet undernutrition; while diets high in refined carbo- MDG 1c (halving 1990 rates of child underweight hydrates, saturated fats and sugars, combined with Low birth weight is a birth weight less by 2015), it has seen a recent increase in adult obe- a more sedentary lifestyle are commonly cited as the than 2500g. sity. Low-birthweight infants and stunted children major contributors to the increase in overweight Overweight is a body mass index (kg/m2) may be at greater risk of chronic diseases such as and chronic diseases.11 of ≥ 25; obesity is a BMI of ≥ 30. diabetes and heart disease than children who start The methodology for calculating nationwide out well-nourished10. This “double burden� is the result of various Most of the irreversible damage due costs of vitamin and mineral deficiencies, and interventions included in the cost of factors. Progress in improving community infra- to malnutrition in Tajikistan happens scaling up, can be found at: structure and development of sound public health during gestation and in the first 24 www.worldbank.org/nutrition/profiles systems has been slow, thwarting efforts to reduce months of life.9 Solutions to Primary Causes of Undernutrition Tajikistan Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 39% of all newborns do not receive breast milk • Undernourished children have an increased likeli- • 1 in 4 households are food insecure9, although this within one hour of birth.2 hood of falling sick and experiencing a severe figure may have decreased slightly since the 2008 • Three-quarters of infants under six months are course of disease. food crisis. not exclusively breastfed.2 • Undernourished children who fall sick are much • Households often cope with food insecurity by re- • During the important transition period to a mix of more likely to die from illness than well-nourished ducing the number of meals consumed per day, and breast milk and solid foods between six and nine children. relying on less-preferred and cheaper foods. months of age, 85% of infants are not fed ap- • Parasitic infestation diverts nutrients from the body • Achieving food security means ensuring quality and propriately with both breast milk and other foods.2 and can cause blood loss and anemia. continuity of food access, in addition to quantity, for Solution: Support women and their families to • Poor sanitation is the major determinant of diarrheal all household members. practice optimal breastfeeding and introduction disease in Tajikistan. • High rates of micronutrient deficiencies, concurrent and use of appropriate complementary food. Breast Solution: Prevent and treat childhood infection and with obesity in the population, indicate that dietary milk fulfills all nutritional needs of infants up to six other disease. Hand-washing, deworming, oral rehy- quality is not optimal. months of age, boosts their immunity, and reduces dration salts and zinc supplements during and after Solution: Involve multiple sectors including agriculture, exposure to infections. diarrhea, and continued feeding during illness are education, transport, gender, the food industry, health important. and other sectors, to ensure that diverse, nutritious diets are available and accessible to all household members. References Vitamin and Mineral Deficiencies Cause • Iodine: Two-thirds of households do not con- sume iodized salt.14 1. UNDP. 2009. Human Development Report. 2. UNICEF. 2009. State of the World’s Children. Hidden Hunger • Zinc: One-half of the population is at risk for 3. UNICEF and the Micronutrient Initiative. 2004. Vitamin Although they may not be visible to the naked eye, insufficient zinc intake.15 Zinc supplementation and Mineral Deficiency: a Global Progress Report. 4. World Bank. 2009. World Development Indicators vitamin and mineral deficiencies impact well-being, during diarrheal episodes can reduce morbidity (Database). and are highly prevalent in Tajikistan as indicated by more than 40%.16 5. Abegunde D et al. 2007. The Burden and Costs of Chronic Diseases in Low-Income and Middle-Income in Figure 2. • Adequate intake of micronutrients, particularly Countries. The Lancet 370: 1929–38. 6. Horton S and Ross J. 2003. The Economics of Iron • Vitamin A: 26% of preschool aged children iron, vitamin A, iodine and zinc, from concep- Deficiency. Food Policy 28:517-5. and 18% of pregnant women are deficient in tion to age 24 months is critical for child growth 7. WHO. 2009. WHO Global InfoBase (Database). 8. Beaton G., et al. 1993. Effectiveness Of Vitamin A vitamin A.12 and mental development. Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries. ACC/SCN State- • Iron: Current rates of anemia among preschool of-the-Art Series, Nutrition Policy Paper No. 13. 9. FAO. 2009. The State of Food Insecurity in the World: aged children and pregnant women are 38% and World Bank Nutrition-Related Activities in Economic Crises – Impacts and Lessons Learned. 46%, respectively.13 Iron-folic acid supplementa- Tajikistan 10. Victora CG, et al. 2008. Maternal and Child tion of pregnant women, deworming, provision Projects: The World Bank is currently supporting the Undernutrition: Consequences for Adult Health and Human Capital. The Lancet 371:340-57. of multiple micronutrient supplements to infants US$25 million Community and Basic Health Project, 11. Popkin BM. et al. 1996. Stunting is Associated and young children, and fortification of staple which directs resources to improve delivery of ma- with Overweight in Children of Four Nations that are Undergoing the Nutrition Transition. J Nutr foods are effective strategies to improve the iron ternal and child health services. Of the total, $4 mil- 126:3009–16. status of these vulnerable subgroups. lion was allocated with the specific aim of improving 12. WHO. 2009 Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995-2005. WHO Global nutritional outcomes for pregnant and breastfeeding Database on Vitamin A Deficiency. 13. WHO. 2008. Worldwide Prevalence of Anemia FIgure 2  High Rates of Vitamin A and Iron Deficiency women, and infants and children under age five. Fol- 1993–2005: WHO Global Database on Anemia. Contribute to Lost Lives and Diminished Productivity lowing from these activities, the Tajikistan health/ 14. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition. social protection team received preliminary approval 15. Micronutrient Initiative. 2009. Investing in the Future: 50 in 2010 to implement a Crisis Response grant which A United Call to Action on Vitamin and Mineral 45 Deficiencies. 40 aims to focus on community based nutrition activi- 16. Bhandari N., et al. 2008. Effectiveness of Zinc 35 ties in the most food-insecure region in Tajikistan. Prevalence (%) Supplementation Plus Oral Rehydration Salts Compared 30 With Oral Rehydration Salts Alone as a Treatment for 25 Acute Diarrhea in a Primary Care Setting: A Cluster 20 Analytic Work: Several policy notes and reports Randomized Trial. Pediatrics 121;e1279-e1285. 17. Horton S. et al. 2009 Scaling Up Nutrition: What 15 have been produced in the last year examining the will it Cost? 10 status of Tajikistan’s health system, and evaluating 18. Bakilana M and Mshisha W. Tajik Child Health: All 5 Hands on Deck. 2009. World Bank. 0 the effectiveness of a multi-sectoral approach to Preschool Children Pregnant Women 19. Tajikistan Poverty Assessment 2009. World Bank. health and nutrition-related issues.18, 19 An ongoing Vitamin A Deficiency Anemia Regional Nutrition Situation Analysis for Central Source: 1995–2005 data from the WHO Global Database on Child Growth and Asia (including Tajikistan) is scheduled for delivery Malnutrition. this fiscal year. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition