Malnutrition remains source of concern

Despite an improvement in the rate of acute malnutrition among children under five, chronic malnutrition among Tajik children in the same age group remains problematic. "Tajikistan is entering a transition phase but the success of this transition depends on many factors which should be monitored closely, and great risks remain," Anne Pater, head of mission for Action Against Hunger (AAH), told IRIN from the Tajik capital, Dushanbe, on Thursday. Of the two different types of malnutrition recognised, acute malnutrition (severely under weight), is known as the global acute malnutrition rate (GAM), while chronic malnutrition, so called because it takes much longer to develop, is known as the chronic malnutrition rate. Within GAM, two groups can be identified: severe acute malnutrition (SAM) and moderate acute malnutrition, which are measured by weight and height. This rate weight/height is then compared to the weight/height rate of a healthy child. SAM is life threatening; if nothing is done, the child will die. According to Paten, on an overall level, global acute malnutrition (GAM) among Tajik children under five years of age had decreased to 4.7 percent, citing recent years of peace and stability in the former Soviet republic, coupled with solid efforts by UN agencies, NGOs and ministries to improve the situation. And while that spells good news for the impoverished Central Asian state, where over 83 percent of the population lives below the poverty line, she noted that chronic malnutrition of children in the same age group was still alarming at 36.2 percent (37.1 percent in 2001). Pater's comments coincide with the release earlier this week of Tajikistan's National Nutrition and Water & Sanitation Survey for 2003 (NNWSS), a collaborative work involving 15 organisations led by AAH (UK) and the US-based NGO Mercy Corps. According to Tuesday's survey, 4.7 percent of the sample population suffered from GAM and 0.64 percent suffered from severe acute malnutrition (SAM). GAM and SAM was highest in the southeast Kulob area of Khatlon province at 7.1 and 1.4 percent respectfully, followed by the western Kurgan Teppe area at 5.4 and 0.9 percent. The lowest GAM rates were in the northwestern Sughd region (3.3 percent) and the lowest SAM rates were in Gorno Badakshan Autonomous province at 0.1 percent. Funded by the European Commission Humanitarian Aid Office (ECHO), the survey found that younger children (six to 29 months of age) faced a significantly higher risk of developing acute malnutrition than the older group (30 to 59 months). Since the first national nutrition survey (NNS) in 1999, acute malnutrition rates have dropped throughout the country, dramatically decreasing since 2001 when a sharp increase in malnutrition was recorded. The GAM in 2001 was 17.4 percent, almost four times higher than the GAM reported this year, while the SAM at 4.2 percent was over six times higher than this year's results, the report said.

A young Tajik child is treated for severe acute malnutrition at an AAH therapeutic feeding center

But though acute malnutrition rates have reduced in 2003, the 'at risk population', those children who would potentially become malnourished in the event of any kind of shock such as disease or food shortage, etc, remained high at 6 percent. "The group of children 'at risk' is alarming and needs close monitoring. These children identified as 'at risk' are not identified as acutely malnourished due to being at just the cut-off point," Pater observed. This population, however, was at a very high risk of developing malnutrition should there be any food security incidents (food shortages, decrease food and/or water access, or poor quality water), she warned. Southwest Khatlon province remained of great concern with the highest rates of malnutrion. "The risk factors in Khatlon are definitely significant in terms of poor water quality and poor access to health," she maintained. In 2003, AAH treated 900 children under five years of age for severe acute malnutrition and 20,000 children under five suffering from moderate acute malnutrion. "If any shock should happen, it could be suddenly more than 50,000 children in Khatlon alone who should receive urgent supplementary feeding to prevent further deterioration to life threatening malnutrition." And while Pater emphasised that the country of seven million was now entering a transition phase, she noted assistance should only be withdrawn step by step, whilst ensuring the protection of those groups at risk. "Despite a more stable political environment and the presence of humanitarian assistance for several years, many basic rights are still denied to the poorest populations, especially access to health, safe drinking water, and food security," the aid worker said. "The economic situation remains very weak and the most vulnerable run out of new coping mechanisms." The NNWSS for 2003 complements four previous NNS conducted 1999-2002. The survey combines an analysis of the nutritional survey of children aged six to 59 months and their caregivers in five regions of the country with a water and sanitation survey assessing the relationship between water quality, quantity and hygiene practices as causal factors that might contribute to malnutrition. With a sample size of 4,653, the survey was conducted throughout the country. As part of the exercise, 8 percent had their drinking water analysed and approximately 1,500 people participated in focus group discussions.