OSH/ASHGABAT, 4 May 2008 (IRIN) - Islam, 13, does not differ much from his friends. But he is definitely short for his age and looks younger than most of the children in his age group in the southwestern Kyrgyz city of Osh. He is at least 10 cm shorter than most of his classmates.

"I feel a bit sorry, particularly when playing games because I am shorter and also I get tired very quickly," he said.

Islam's parents divorced about 10 years ago and his mother has been suffering from tuberculosis for a long time and is unable to work. With no income or job, she had to rely on support from her relatives.

"We have been living not just from hand to mouth. Sometimes we didn't have even a loaf of bread and I used to cry at my desperation when I couldn't find food for my children," Islam's mother said. "That's why my son is short and weak, he gets sick very easily, and he is not doing particularly well at school."

The problem of malnutrition is similar in many Central Asian countries, said an expert from the UN Children's Fund (UNICEF).

"There are definitely specific nutritional problems here, especially among children. There is still a high percentage of children with chronic malnutrition; you still find acute malnutrition," Arnold Timmer, a nutrition specialist with UNICEF's Regional Office for Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS), told IRIN in the Turkmen capital, Ashgabat.

The prevalence of chronic malnutrition in Central Asian countries among children under five is highest in Tajikistan - 27 percent, according to UNICEF's Child Nutrition Situation in CEE and CIS Strategic Direction report.

"Chronic malnutrition is when children are too short for their age, but there are also hidden issues - what you call hidden hunger - a lack of minerals and vitamins in the food that leads to micronutrient deficiencies," Timmer explained.

Anaemia

A large proportion of the population in the region is affected by micronutrient deficiencies which are not easily seen, for example anaemia. "It [anaemia] presents itself as general fatigue, lower work output, but it is not something that you can see, it is not visible," Timmer said.

"That is also a serious problem for young children. It happens largely among children under two because of lack of exclusive breast feeding - in the first six months a child should receive only breast milk - and after six months up to two years the child's food is not exactly the family diet, yet it has to have enough energy and protein, and also enough vitamins and minerals," Timmer said.

"Those two components - breast feeding and complementary feeding - are insufficient not only in Central Asia, but in many countries around the world," Timmer said.

Anaemia is a major public health problem among children under five in CEE/CIS, according to UNICEF. According to the World Health Organization, Kyrgyzstan is in the severe category with regard to anaemia.

Iodine deficiency

"Iodine deficiency is a specific micronutrient issue for children in Central Asia because there is no iodine in the soil any more. There used to be but because of the formation of the mountains the iodine leaks out of the soil because of erosion and rainfall," Timmer said.

Iodine deficiency increased after the collapse of the Soviet Union as iodised salt was no longer produced. Since the 1990s efforts have been revitalised to implement universal salt iodisation (USI), which gained momentum after 2001 when UNICEF, with support from donors, started advocating USI.

Most Central Asian countries have tackled the problem of iodine deficiency. "We don't see iodine deficiency in Turkmenistan any more, also in Kazakhstan all salt is iodised," the UNICEF expert said.

The impact of the lack of iodine on brain development is quite severe, particularly during pregnancy when the brain cells of children are formed, according to Timmer. "We see the clinical effects in goitre - an extreme state of iodine deficiency and a visible one. But an invisible effect is reduced intelligence among the population. That's why we want the entire population to consume only iodised salt," he said.

Iodine deficiency is decreasing throughout the region, but work still needs to be done in Kyrgyzstan, Tajikistan and Uzbekistan. "They are getting there - about 70-80 of salt is iodised. The issue is to make it sustainable on the supply side, and make sure that producers self-maintain it. And also that there is a monitoring system that the population is aware of, and that it accepts iodised salt, and national leaders are committed, but also maintain oversight of the process," Timmer said.

Iron deficiency

Timmer said the best sources of iron are animal products, especially meat: "If that's not there, if people cannot afford it - which is often the case because meat is expensive - that leads to iron deficiency."

Echoing that view, Islam's mother said she could not afford to buy meat, as a kilo of beef cost about US$4.5, while lamb was more than $5. "I cannot buy it for my children. It is too expensive for us."

"Women and young children have a higher requirement for iron - women because of pregnancy and menstruation, higher loss of blood. As for young children, they are growing, so they need a lot of iron to build their body system," Timmer said.

In Central Asia iron deficiency can be detected in 50-60 percent of women and children, according to Timmer.

Vitamin A

Vitamin A deficiency is also related to poverty and the lack of animal-based food products. "This has serious implications as it is directly related to mortality and death. That's why we start providing vitamin A supplements to children under five and women after delivery - so that vitamin A comes in the breast milk," Timmer said.

Sources of Vitamin A include most vegetables and liver.

About 50-60 percent of women and children have Vitamin A deficiency in the region, while in some of the countries it is 40-50 percent, Timmer said. "In Turkmenistan they have not done a study on Vitamin A deficiency so we don't know what the situation is," he added.

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