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Tajikistan seeks to reduce child mortality
Over 7,500 children under 5 reportedly die in country annually
By Dilafruz Nabiyeva
DUSHANBE – Although Dushanbe acknowledges the problem of child mortality in Tajikistan, it says international organisations overestimate its prevalence.
Nevertheless, on the heels of a recent World Bank (WB) and UNICEF report detailing the high rate of child mortality, the Tajik government is considering ways to combat the problem.
Education and assistance to the needy are key, the Tajik Health Ministry and international organisations agree.
A WB/UNICEF April statement on their Situation Analysis on Improving Economic Outcomes by Expanding Nutrition Programming in Tajikistan estimated that an average of 7,500 children under 5 years old die in Tajikistan annually and pointed to malnutrition as a major reason.
The study analysed malnutrition’s damage to public health in terms of shortening life expectancy. It also estimated potential gains for the population and the economy through increased investment in nutrition programmes in the country.
“Although child mortality in Tajikistan has declined in the last decade ... 35% of the 7,676 deaths of Tajik children under the age of 5 that occurred in 2011 were due to undernutrition,” the WB and UNICEF said in their joint statement.
“I’m very glad this theme has come up for discussion at long last,” Azim Dzhaborov, head of the Akson NGO for assistance to children, said. “Children are our future, so we must take good care of them to ensure this future is healthy.”
She questioned the breadth of the study, though.
“If the study was carried out in remote districts and villages, where life is very poor, it’s clear why the (WB/UNICEF’s child mortality) estimates are so high,” Dzhaborov said. “The situation in big cities is much better.”
Tajikistan points to improved numbers
Overall, year-over-year mortality statistics have improved, Sherali Rakhmatulloyev, head of the Health Ministry Administration for Organising Mother-and-Child Medical Services and Family Planning, said.
“The Health Ministry jointly with UNICEF researched the level of physical development of children under 5 and women of child-bearing age in 2009,” he said. “The study showed that the number of children with stunted growth and persons suffering from anaemia and iodine deficiency had significantly shrunk since the previous survey. But we are still not satisfied with those figures.”
The number of deaths among small children has dropped by half in 2011 since the end of 1990s, he added. Another survey will be carried out next year, Rakhmatulloyev said.
Malnutrition is not unique to Tajikistan, said Marsha Olive, WB country manager in Tajikistan, according to the April 2 WB/UNICEF statement.
“This hidden disease is prevalent in many countries, yet easily preventable through proven, cost-effective interventions,” she said in the statement. “By taking timely action to meet the nutrition needs of pregnant women and young children, such as … providing micronutrient supplements, nutrition education and promoting breastfeeding in 10 districts in Khatlon, it is possible to save lives and reduce economic, health and development losses.”
Rakhmatulloyev acknowledged the assistance extended to Tajikistan by the WB, UNICEF, Asian Development Bank and different embassies to solve the malnutrition problem. In January and February, about 20 countries sent US $6m (28.6m TJS) worth of relief to Tajikistan, and Russia March 31 pledged to help the Tajik needy.
Such assistance, as well as education and family planning programmes, has helped greatly in knocking down child mortality, Rakhmatulloyev added.
“Today, there are 20 deaths per 1,000 children – less than half of the Soviet-era 42 deaths per 1,000 live births,” he said. “By our own estimates, 3,500 to 4,000 children on average die in this country every year. But they don’t starve to death – there are hundreds of other factors fuelling child mortality.”
Shamigul Rakhmatova, mother of 1-year-old Subkhon, said she had a very difficult time nursing her son, who was born prematurely. “I suffered from anaemia throughout my pregnancy,” the young mother said. “Subkhon was born at 7 months; he was so weak, and still worse, he refused to nurse. So I had to buy expensive milk formulas to feed him.”
For all his parents’ efforts, by the end of his first year of life, the boy was diagnosed with rickets, which he is being treated for now.
“Doctors told me at once all this is because of my improper diet during pregnancy,” Rakhmatova said.
Mothers’ unawareness of the need to eat a healthy diet is one cause of child mortality, Mekhrabon Dzh. of the Tajik Health Ministry said.
“In Khatlon and Sughd oblasts, international organisations and the Health Ministry have been holding campaigns to educate mothers at hospitals, local government agencies and NGOs,” he said. “We plan to cover the whole of Tajikistan and involve media and NGOs. City dwellers appear to be more educated, whereas in remote villages, the education problem is pressing indeed.”
The diets of pregnant women and babies were studied, economist Firuz Makhmadov said. “But we city dwellers can’t see what it’s really like across the country. It is more complicated in remote mountainous regions, where women are guided more by instinct than by approved dietary norms for pregnant women and children. Mixed feeding of babies is virtually non-existent in rural regions.”
The government is considering a draft bill defining “the Minimum Consumer Basket” that “clearly stipulates that children under the age of 5 need, above all, calories and vitamins for full-fledged development,” Makhmadov said.
Combating poverty, disease
Other contributing factors to child mortality are poverty and disease. Poverty impedes the purchase of food, Mekhrabon noted.
“This problem, too, remains severe in the provinces,” he said. “International organisations and (Tajik) government authorities have helped us distribute food rich in calcium, iodine, micronutrients, etc.”
To combat the effect congenital diseases have on child mortality, hospitals are being modernised and medical personnel are being better trained, Mekhrabon said.
The Saudi Development Bank in March allocated US $8m (38.1m TJS) for maternity centres and paediatric medical centres in northern Tajikistan to receive state-of-the-art medical equipment.
The equipment has already been delivered to Khudzhand, said Dzhafar Mamatov, chief specialist at the Sughd Oblast administration’s health department.
“The new equipment will help reduce baby mortality within seven days after birth,” said Indira Akmalkhodzhayeva, chief specialist of the mother-and-child services unit at the Sughd Oblast administration’s health department. About 50% of infant mortality occurs in the first week of life, she said.
The most widespread congenital diseases are lung underdevelopment and intra-uterine infections, Mokhira Saidnasulayeva, chief physician at the Khudzhand maternity hospital, said.
“Of course, the new equipment will improve the situation,” she said. “We’ll receive, among other things, modern blood-testing equipment. Today, we have to take 3mg blood samples from babies for tests, apply chemical agents and waste time. The new equipment will allow us to drop all those practices – it’ll be enough to attach a sensor to a baby’s skin to get the test results immediately.”
Maks Maksudov contributed to this report.