NATIONAL NUTRITION SURVEY IN TAJIKISTAN

RESULTS

NATIONAL NUTRITION SURVEY

IN TAJIKISTAN 2016

MINISTRY OF HEALTH AND SOCIAL PROTECTION OF THE REPUBLIC OF TAJIKISTAN

RESULTSRESULTS


IN TAJIKISTAN 2016


IN TAJIKISTAN 2016

MINISTRY OF HEALTH AND SOCIAL PROTECTION OF THE REPUBLIC OF TAJIKISTAN

Table of Contents 1 Introduction ................................................................................................................................................... 4

2 Objectives ..................................................................................................................................................... 5

3 Results and discussion ................................................................................................................................ 5

3.1 Number of individuals included ......................................................................................................... 5

3.2 Household characteristics .................................................................................................................. 7

3.2.1 General characteristics, income and food production ...................................................................... 7

3.2.2 Water, sanitation and hygiene ....................................................................................................... 10

3.2.3 Birth certificates and household with a disabled child ................................................................... 11

3.2.4 Salt iodization ................................................................................................................................ 11

3.3 Nutritional status and food habits of women .................................................................................. 15

3.3.1 Body Mass Index (BMI) ................................................................................................................. 15

3.3.2 Anaemia and iron status ................................................................................................................ 19

3.3.3 Vitamin A status ............................................................................................................................ 24

3.3.4 Folate status .................................................................................................................................. 25

3.3.5 Iodine status .................................................................................................................................. 26

3.3.6 Food habits.................................................................................................................................... 28

3.3.7 Food supplements and nutritional status of women ...................................................................... 29

3.4 Nutritional status of 6-59 month old children ................................................................................. 30

3.4.1 Anthropometric assessment (underweight, stunting, wasting)....................................................... 30

3.4.2 Anaemia and iron status ................................................................................................................ 42

3.4.3 Vitamin A status ............................................................................................................................ 47

3.4.4 Vitamin D status ............................................................................................................................ 50

3.4.5 Iodine status .................................................................................................................................. 53

3.5 Nutritional status of children less than six months of age (stunting, wasting and underweight) ...................................................................................................................................... 55

3.6 Breastfeeding and infant feeding of children under 24 months of age ........................................ 57

3.6.1 Breastfeeding ................................................................................................................................ 57

3.6.2 Infant feeding ................................................................................................................................. 60

3.7 Child health and child care ............................................................................................................... 60

3.7.1 Child care and development of children under two years of age ................................................... 60

3.7.2 Child health 6 to 59 months ........................................................................................................... 63

4 Study limitations ......................................................................................................................................... 66

5 Conclusions and recommendations ......................................................................................................... 69

5.1 Salt iodization .................................................................................................................................... 69

5.2 Nutritional and micronutrient status of women .............................................................................. 69

5.3 Nutritional and micronutrient status of children ............................................................................. 71

5.4 Recommendations ............................................................................................................................. 73

Annex 1: Detailed results – Household characteristics ................................................................................. 75

Annex 2: Detailed results – Nutritional and micronutrient status of women ................................................ 80

Annex 3: Detailed results - Nutritional and micronutrient status of children aged 6 to 59 months ........... 90

Annex 4. Detailed results - Nutritional status of children below six months of age .................................. 106

Annex 5: Detailed results – Breast- and infant feeding .................................................................................107 Annex 6: Detailed results – Child care and development ............................................................................ 109 Annex 7: Detailed results – Maps of time-trends in iodine deficiency ........................................................ 114

NATIONAL NUTRITION SURVEY IN TAJIKISTAN 2016

RESULTS

1 Introduction The purpose of the 2016 National Micronutrient Status Survey in Tajikistan (NMSS) was to

perform a national and regional representative survey to obtain valid and reliable data on

the anthropometric status, levels of anaemia, iron status, vitamin A deficiency and iodine

intake in non-pregnant women of reproductive age (15-49 years) and in children aged 6-59

months. In addition, the survey assessed Vitamin D levels of children aged 6-59 months

and folate levels in non-pregnant women of reproductive age.

The 2016 survey was intentionally closely modelled on the 2009 Micronutrient Status

Survey in Tajikistan conducted by UNICEF and Tajikistan’s Ministry of Health with support

from the Swiss Tropical and Public Health Institute (Swiss TPH). The survey covered the

whole of Tajikistan in order to collect representative data at national and regional level

(dividing the country into five regions: Khatlon, Districts of Republican Subordination

(DRS), Sughd, Gorno-Badakhshan Autonomous Oblast (GBAO) and Dushanbe). A total of

2,145 children aged six to 59 months and 2,149 non-pregnant women aged 15-49 were

finally included in the survey analysis, in representative numbers for each of the regions.

Data collection took place in November 2016. Research methods included respondent

interviews, household observations, anthropometric assessments (weight and height

measurements) of all study participants, and the laboratory testing of blood and urine

samples to determine anaemia and micronutrient content. A detailed methodology is

presented in a companion publication to this one.

This 2016 report is intended to make a contribution to informing policy and decision-makers

on progress to combat malnutrition and improve early childhood care and development in

Tajikistan, so as to shape future interventions in a way that will ensure equal opportunities

for all children to reach their full development potential.

4

NATIONAL NUTRITION SURVEY IN TAJIKISTAN

2016

RESULTS

2 Objectives

The 2016 NMSS was designed to assess the nutritional and micronutrient status of the

women and children, determine risk factors for deficiencies, and compare the findings with

the 2009 survey. The specific objectives of the survey were:

To identify levels of anaemia, iron status, vitamin A (retinol binding protein (RBP))

deficiency and iodine intake (urinary iodine concentration) in non-pregnant women of

reproductive age (15-49 years) and in children (6-59 months);

To assess vitamin D levels in children 6-59 months;

To assess folate levels in non-pregnant women of reproductive age;

To evaluate feeding patterns among infants and young children (0 to 24 months); and

To conduct anthropometric measurements among children 0-59 months and non-

pregnant women of reproductive age.

3 Results and discussion 3.1 Number of individuals included

Against the planned sample size of 2,160 children aged 6 to 59 months and 2,160 non-

pregnant women aged 15-49 years outlined in the study methodology, a total of 2,145

children and 2,149 women were finally included in the survey analysis. In addition, 232

children below six months of age living in the 1,524 households retained for the study were

included for anthropometric measurements and to investigate their feeding practices.

In other words, 99.3 per cent and 99.4 per cent of the originally planned sample could be

collected and included in the analysis. Information relating to 15 women and 11 children,

corresponding to less than 1 per cent of the initially planned sample, could not be collected

for various reasons.

Table 1 shows the total number of individuals included in the survey and the percentage of

individuals with anthropometric measurements taken and laboratory examinations

performed. As shown in this table the haemoglobin and anthropometric measurement were

done for nearly all the children and women (98 to 99 per cent).

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RESULTS

TABLE 1:

Number of individuals included in the survey and % of individuals

with anthropometric and biochemical measurement

Total number included

% with Hb

measurement

% with anthropo

metric measure

ment

% with ferritin

measurement

% with TfR

measurement

% with CRP

measurement

% with RBP4

measurement

% with vitamin D measure

ment

% with folic acid measure

ment

% with iodine

measurement

Women of reproductive age (15-49 years)

Dushanbe 431 99% 100% 94% 83% 90% 95% 88% 88%

Khatlon 425 99% 100% 89% 89% 88% 89% 77% 82%

Sughd 431 99% 98% 97% 98% 97% 97% 96% 87%

DRS 429 100% 99% 93% 93% 92% 91% 89% 93%

GBAO 429 99% 100% 95% 90% 92% 95% 94% 87%

Total 2,145 99% 99% 94% 90% 92% 93% 89% 87%

Children aged 6-59 months

Dushanbe 432 98% 100% 92% 95% 86% 94% 90% 76%

Khatlon 425 96% 99% 88% 86% 89% 88% 86% 75%

Sughd 431 98% 99% 93% 93% 90% 93% 86% 80%

DRS 431 99% 100% 98% 89% 92% 97% 95% 85%

GBAO 430 96% 99% 90% 81% 88% 88% 87% 85%

Total 2,149 98% 99% 92% 89% 89% 92% 89% 80%

Children under 6 months

Dushanbe 53 100%

Khatlon 29 100%

Sughd 44 100%

DRS 65 100%

GBAO 41 100%

Total 232 100%

It was not possible to conduct blood and urine analysis for all the individuals responding to

the questionnaire and the anthropometric measurement. Around 90 per cent of individuals

were included in the various types of laboratory analysis. There are various reasons that

not all the measurements could be done. An important reason was that in the first days of

data collection, most of the field teams reported difficulties collecting enough blood (400 µl),

particularly among children. In addition, some blood samples had missing or unreadable

labelling, so the unique identifier of the blood sample could not be matched to a given

person. At 80 per cent, the percentage of children who had iodine levels measured is

comparatively low. This is because collection of urine was not possible for all children,

especially for children unable to control urination, typically those aged two years and under.

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2016

RESULTS

3.2 Household characteristics

3.2.1 General characteristics, income and food production

The women and children included in the survey lived in a total of 1,524 households.

Dushanbe was the only region with an entirely urban population: the other regions were

composed of populations living primarily in rural areas with the weighting varying between

73 per cent of households in Sughd and 86 per cent in Khatlon (Annex 1, Table 1.1).

At national level, a mean of 8.3 household members was living in the same household

(Annex 1, Table 1.3). Men headed 82.3 per cent of the households (Annex 1, Table 1.5).

The highest proportion of women-headed households was found in Sughd (27.1 per cent)

and the lowest in GBAO (13.6 per cent) (Annex 1, Table 1.5). Most household heads in all

regions had completed their education at secondary school, with the exception of

Dushanbe, where slightly over half had been to university (Annex 1, Table 1.6).

Remittances are an essential source of income in Tajikistan, and 31 per cent of households

indicated this as their main source of cash income (Table 2). The next most frequent main

sources of cash income were official salaries (21.4 per cent), farming/livestock (19.3 per

cent) and private business (12.8 per cent). Farming (along with remittances) was an

important cash income source in all the regions with the exception of Dushanbe, where

regular salaries, private business and remittances were most important.

TABLE 2: Main source of cash income of households

Number Private business

Salary Pension / social aid

Farming / livestock

Remittances

no cash income

Other

Dushanbe 304 19.4% 48.7% 6.3% 0.3% 12.5% 5.3% 7.6%

Khatlon 264 8.0% 19.7% 4.5% 23.5% 31.1% 10.2% 3.0%

Sughd 313 19.8% 19.2% 2.9% 19.8% 30.0% 4.8% 3.5%

DRS 253 9.5% 16.6% 2.8% 20.9% 42.3% 4.7% 3.2%

GBAO 381 8.4% 34.4% 16.5% 8.1% 17.3% 5.5% 9.7%

National (weighted) 1,502 12.8% 21.4% 4.0% 19.3% 31.0% 6.9% 3.7%

Rural 981 9.6% 20.6% 8.1% 20.4% 30.1% 5.7% 5.6%

Urban 534 19.5% 43.3% 5.8% 1.7% 17.2% 6.6% 6.0%

Around two in three households (63.7 per cent) were growing food crops to complement

their own consumption, with exception of Dushanbe where only 1.3 per cent of households

grew their own food (Table 3). The most common products were green leafy vegetables

(54.1 per cent) followed by other vegetables and yellow/orange vegetables and fruit

including vitamin C rich products (oranges, apricots, carrots, pumpkins). Tubers (potatoes

and other root vegetables) were grown by almost half the interviewed households (47.2 per

cent). Cereals (wheat and rice) were produced by a quarter of the households (25.7 per

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RESULTS

cent), predominantly in Khatlon (42.8 per cent). Pulses (beans, peas, lentils, nuts) were

grown by every fifth household (21.5 percent), and most often in Khatlon and GBAO (34.2

per cent and 28.1 per cent respectively).

TABLE 3: Households with the production of food crops for own consumption

Number Household growing

own food

Cereal (wheat,

rice)

Pulses (beans, peas, lentils, nuts)

Potatoes or other routs or tubers

Yellow / orange

vegetables and fruits

(e.g. pumpkins,

carrots)

Green leafy

vegetables

Other vegetabl

es

Dushanbe 306 1.3% 0.0% 0.0% 0.0% 0.0% 1.0% 1.3%

Khatlon 269 71.4% 42.8% 34.2% 63.2% 56.9% 59.9% 50.2%

Sughd 314 65.9% 20.4% 13.7% 29.9% 37.9% 55.1% 58.9%

DRS 254 73.6% 16.5% 21.3% 61.4% 51.6% 65.0% 61.8%

GBAO 381 70.1% 36.7% 28.1% 68.8% 67.2% 57.7% 50.7%

National (weighted) 1,524 63.7% 25.7% 21.5% 47.2% 44.9% 54.1% 51.1%

rural 986 80.8% 35.3% 28.3% 66.6% 63.8% 68.4% 63.2%

urban 538 11.2% 2.4% 3.2% 4.6% 5.6% 8.9% 9.5%

Animal breeding for meat and milk production was practised by 62.3 per cent of all

households (Table 4). This type of farming is very widespread in all regions (between 66.9

per cent and 75.6 per cent), except Dushanbe (1.0 per cent). Most popular was cattle

breeding, practised by 55.2 per cent of households. Poultry and sheep farming were

practised by more than a quarter of households (30.2 per cent and 27 per cent,

respectively).

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2016

RESULTS

TABLE 4: Households keeping animals for meat and milk production for their own consumption

Number Household with

animals

Cows Sheep Goats Poultry Horse

Dushanbe 306 1.0% 0.3% 0.3% 0.3% 0.3% 0.0%

Khatlon 269 72.9% 67.7% 31.6% 33.5% 43.9% 2.6%

Sughd 314 70.1% 52.2% 31.5% 8.9% 17.5% 1.0%

DRS 254 66.9% 60.2% 22.8% 21.3% 37.8% 3.5%

GBAO 381 75.6% 67.5% 59.6% 61.7% 25.7% 0.8%

National (weighted) 1,524 62.3% 55.2% 27.4% 20.8% 30.2% 2.1%

Rural 986 81.2% 72.9% 45.4% 40.7% 35.5% 1.9%

Urban 538 10.4% 7.1% 4.1% 1.3% 3.3% 0.6%

Half of the households reported having had problems satisfying the food needs of

household members since the beginning of 2016 / last winter (Table 5). Significant

differences were observed between regions (χ2=133.7, P=0.000) with the highest

frequencies of households facing problems in Khatlon (71.7 per cent) and DRS (64.9 per

cent).

TABLE 5: Proportion of households reporting having had problems satisfying the food needs

of household members since the beginning of 2016 / last winter

Total number of households

Never Sometimes (1-2 times per month)

Often (more than 2 times / month)

Dushanbe 306 58.8% 39.5% 1.6%

Khatlon 269 28.3% 60.6% 11.1%

Sughd 314 56.1% 41.8% 2.8%

DRS 254 35.1% 60.2% 4.7%

GBAO 381 63.4% 32.1% 4.5%

Total 1,524 50.0% 45.2% 4.8%

Pearson chi2(8) = 133.7080; Pr = 0.000

Coping strategies for problems related to food security varied and included, among others

(Table 6): borrowing food or relying on help from friends or relatives, decreasing the

amount of food consumption, increasing production of food products for their own

consumption, decreasing purchases of non-food products, selling more animals,

decreasing expenditure on health and drugs, withdrawing from or postponing admission to

school, seeking alternative employment, and increasing the number of household members

out of the village in search for work. The most often reported coping strategies in recent

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RESULTS

months were alternative employment and migration (42.5 per cent and 30.0 per cent

respectively) along decreased purchase of non-food products (36.5 per cent). The search

for alternative work was highest in Khatlon and Sughd (47.2 per cent and 46.2 per cent of

households respectively) alongside reported migration (38.7 per cent and 29.9 per cent

respectively). Almost every third household reported borrowing food or relying on help from

relatives or friends (national level: 29.9 per cent; Khatlon: 40.5 per cent). One out of four

households reported decreasing expenditure on healthcare and drugs (nationally: 26.5 per

cent; Khatlon: 37.2 per cent).

TABLE 6: Coping strategies for problems related to food security reported by head of households

Total number

Borrowed food

Decreased food consum

ption

Increased food producti

on

Decreased

purch ase of non-food

produc ts

Sold more

animals than usual

Decreased

healthcare and drug

expenditure

Withdrew or

postponed

children's school admissi

on

Sought alternative work

Increased

number of

household

members out of village

in search

for work

Dushanbe 306 18.6% 8.2% 2.6% 17.3% 0.3% 16.3% 0.3% 21.6% 8.5%

Khatlon 269 40.5% 21.6% 27.5% 41.3% 14.1% 37.2% 4.5% 47.2% 38.7%

Sughd 314 23.6% 11.8% 29.0% 36.6% 19.7% 25.5% 1.6% 46.2% 29.9%

DRS 254 26.8% 14.6% 10.2% 37.4% 11.8% 17.3% 2.0% 41.7% 28.0%

GBAO 380 28.9% 9.5% 6.6% 16.6% 26.6% 4.2% 0.8% 13.9% 10.8%

National (weighted) 1,523 29.9% 15.5% 20.8% 36.5% 14.5% 26.5% 2.6% 42.5% 30.0%

3.2.2 Water, sanitation and hygiene

Around half the interviewed households (51.1 per cent) rely on public tap water as their

main source of drinking water (Annex 1, Table 1.7). The percentage of households with

access to public tap water was highest in Dushanbe (64.0 per cent) and lowest in Khatlon

(39.4 per cent). Other important sources for households are piped-into-dwelling (13.7 per

cent) and pond/rivers (15.6 per cent). Most households with piped water as the main

source of drinking water have constant access (83.6 per cent, Annex 1, Table 1.8).

A total of 85.4 per cent of households indicates that they had access to clear (non-turbid)

water (Annex 1, Table 1.9). The percentage is highest in GBAO (93.2 per cent) and lowest

in Khatlon (66.5 per cent).

With regard to type of toilet facility used by households, most households indicate relying

on pour flush latrines (85.4 per cent at national level) except for Dushanbe (10.5 per cent)

(Annex 1, Table 1.10). In rural areas 99.2 per cent of households use pour flush latrines,

regrouping pit latrines and ventilated improved pit latrines. Meanwhile, 88.9 per cent of

households in Dushanbe rely on flush to sewage systems.

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2016

RESULTS

Nearly all interviewees (96.7 per cent) indicated having used soap on the day of the

interview or the day before (Annex 1, Table 1.11). Soap was most frequently used for

washing clothes (82.1 per cent), washing the hands of a child of the interviewee (80.4 per

cent) and washing hands before eating (80.2 per cent).

3.2.3 Birth certificates and household with a disabled child

Interviewees were asked if their children aged six to 59 months had birth certificate (Table

7). The national weighted average was 90.5 per cent. The highest frequencies of birth

certificates are observed in GBAO (96.1 per cent) and the lowest in Dushanbe and DRS

(84.0 per cent). Differences were statistically significant between the regions (χ2=97.37,

P=0.000), and a higher proportion of children had birth certificates in rural areas (χ2=19.28,

P=0.000) There was no difference between boys and girls.

TABLE 7: Percentage of children 6 to 59 months with a birth certificate by region

Number of answers

Yes No

Dushanbe 432 84.0% 16.0%

Khatlon 425 88.9% 11.1%

Sughd 431 99.3% 0.7%

DRS 431 84.0% 16.0%

GBAO 430 96.1% 3.9%

National (weighted) 2,149 90.5% 9.5%

Pearson chi2(4)=97.3685, P=0.000

Rural 1,409 92.5% 7.5%

Urban 740 86.6% 13.4%

Pearson chi2(1) = 19.2765 Pr = 0.000

Boys 1,133 91.0% 9.0%

Girls 1,015 89.9% 10.1%

Pearson chi2(1) = 0.6823 Pr = 0.409

Less than 1 per cent of households had a child with a disability below five years of age.

One household reported including a blind child while another had a deaf child (Annex 1,

Table 1.13). Another nine households stated that they had a child with a motor disability

living in the family, and four households mentioned a child with a mental disability.

3.2.4 Salt iodization

Interviewees were asked if they had ever heard about iodization of edible salt (Table 8).

The nationally weighted percentage that had was 78 per cent, with the figure highest in

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RESULTS

Dushanbe (87.6 per cent) and lowest in Khatlon (71.4 per cent). The knowledge of

respondents was significantly different between the regions (χ2=28.7713, P=0.000).

TABLE 8: Percentage of interviewees who had ever heard of iodization of edible salt

Number Yes No

Dushanbe 306 87.6% 12.4%

Khatlon 269 71.4% 28.6%

Sughd 314 75.2% 24.8%

DRS 254 73.6% 26.4%

GBAO 381 80.3% 19.7%

National (weighted) 1,524 78.0% 22.0% Pearson chi2(4)=28.7713, P=0.000

Rural 986 74.5% 25.5%

Urban 538 84.4% 15.6%

Nearly all (99.0 per cent) of those who were aware about iodization of edible salt agreed

that it was important for health reasons to use iodized salt (Annex 1, Table 1.14). The most

common reason given by respondents was to prevent goitre (97.5 per cent) (Annex 1,

Table 1.15). Knowledge of the relationship between iodized salt, foetal development and

childhood mental development was substantially lower, with a nationally-weighted

prevalence of 20.6 per cent of respondents indicating a relationship with foetal

development and 28.1 per cent a relationship with mental development.

TABLE 9: Type of salt used by households according to interviewees by strata

Number Unknown Iodized salt Not iodized salt

Dushanbe 306 21.2% 78.4% 0.4%

Khatlon 269 38.3% 60.6% 1.1%

Sughd 314 14.0% 85.7% 0.3%

DRS 254 27.6% 70.4% 2.0%

GBAO 381 5.5% 92.9% 1.6%

National (weighted) 1,524 19.9% 79.1% 1.0%

Pearson chi2(8) = 129.8164 Pr = 0.000

Rural 986 18.9% 79.8% 1.3%

Urban 538 21.8% 77.7% 0.5%

Pearson chi2(2) = 3.5728 Pr = 0.168

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RESULTS

The interviewees were also asked whether their households use iodized salt (Table 9).

Around 19.9 per cent, or 303 respondents, did not know, while 79.1 per cent said they are

using iodized salt and only 1.0 per cent said that their households used non-iodized salt.

The MBI rapid test kit was used to test whether the salt used by households is fortified with

potassium iodate. Samples from a total of 1,523 households were tested and the nationally

weighted proportion was 74 per cent of tested salts being iodized (Figure 1). The highest

percentage of household salt iodized was found in Sughd (88.9 per cent), while in Khatlon

and DRS regions 35.7 per cent and 34.3 per cent of households respectively used salt

containing no iodine.

FIGURE 1 Prevalence of households using no iodine or iodized salt according to MBI rapid test

Figure 2 shows trends over time in the proportion using iodized salt. It should be noted that

in 2003 Dushanbe was not counted separately, and the national proportion was not

weighted. This said, it can be seen that overall there was a positive evolution between

2003 and 2009. Between 2009 and 2016, however, the percentage of households using

iodized salt decreased in all regions except DRS.

In Table 10, we cross-tabulate the responses given by the interviewees with regard to the

types of salt used with the results of the MBI test kit. It can be seen that among households

reported the use of iodized salt, about a fifth (19.9 per cent) used salt that was not actually

iodized according to test kits. This percentage was particularly high in Khatlon and DRS.

Therefore, even though these households had intended to use iodized salt, availability of

high quality iodized salt seems a bottleneck in some cases.

35.7%

18.0%

82.0%

64.3%

88.9%

65.7%

74.5% 74.0%

11.1%

34.3%

25.5% 26.0%

Dushanbe(n=306)

Khatlon(n=269)

Sughd(n=314)

DRD(n=254)

GBAO(n=380)

National (weighted)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0% no iodineiodized

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RESULTS

FIGURE 2 Time trends 2003 to 2016 in households using iodized salt

TABLE 10: Type of salt used by households according to interviewees and MBI rapid test kit result

Interviewee reported use of iodized salt (n=1204)

Interviewee reported non-use of iodized salt (n=16)

Salt status not known by interviewee

(n=303)

MBI test positive

MBI test negative

MBI test positive

MBI test negative

MBI test positive

MBI test negative

Dushanbe 86.3% 13.7% 100.0% 0.0% 66.2% 33.8%

Khatlon 66.3% 33.7% 33.3% 66.7% 32.1% 37.9%

Sughd 91.8% 8.2% 0.0% 100.0% 72.7% 27.3%

DRS 74.3% 25.7% 60.0% 40.0% 44.3% 55.7%

GBAO 76.2% 23.8% 0.0% 100.0% 66.7% 33.3%

National (weighted) 80.1% 19.9% 31.3% 68.7% 60.7% 39.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2003 2009 2016

21.0%

90.0%

82.0%

64.0%

77.0%

89.0%

97.0%

78.0%

65.0% 66.0%

74.0%

81.0% 82.0%

74.0%

48.0%52.0%

Dushanbe Khatlon Sughd DRD GBAO National (weighted)

97.0%

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2016

RESULTS

3.3 Nutritional status and food habits of women

3.3.1 Body Mass Index (BMI)

Figure 3 and Table 11 show both underweight and overweight prevalence among non-

pregnant women in Tajikistan. Both these issues are concerns in the country and will be

discussed in the sub-sections below.

FIGURE 3 Distribution of BMI among women aged 15-49 years by region

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

7.5%7.4%

43.0%

39.2%37.5% 37.6%

34.7%

8.3% 8.0% 8.0%

21.0%

13.1%


BMI<18.5BMI 25≥

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RESULTS

TABLE 11: Distribution of BMI of women aged 15-49 years

Low BMI Normal BMI High BMI

Number

% < 16 % 16-16.9

% 17-18.4

% 18.5–24.9

% 25-29.9

% 30.0-34.9

% 35.0-39.9

% > 40

Chronic energy

deficiency - Grade ΙΙΙ (Severe

thinness)

Chronic energy

deficiency - Grade ΙΙ

(Moderate thinness)

Chronic energy

deficiency - Grade Ι (Mild

thinness)

Pre Obese

Obese class

I

Obese class

II

Obese class

III

Dushanbe 430 0.5% 1.9% 5.1% 49.5% 25.6% 13.0% 4.0% 0.5%

Khatlon 424 0.5% 0.9% 6.1% 53.3% 26.4% 9.0% 2.8% 0.7%

Sughd 424 0.9% 0.5% 6.8% 54.2% 26.2% 6.4% 3.8% 1.2%

DRS 426 0.5% 1.6% 5.9% 57.3% 20.0% 11.0% 3.1% 0.7%

GBAO 428 0.9% 3.7% 8.4% 65.9% 15.2% 4.9% 0.9% 0.0%

National (weighted) 2,132 0.6% 1.1% 6.3% 54.4% 24.5% 8.9% 3.2% 0.9%

BMI: ≤ 17 = severe to moderate malnutrition;

17.0–18.4 = at risk;

18.5 – 24.9 = normal;

25.0 – 29.9 = overweight (pre-obese); ≥ 30 obese

3.3.1.1 Underweight

Maternal underweight places both mothers and foetuses at risk. There is substantial

evidence linking low birth weight and intrauterine growth retardation to maternal

undernutrition. Maternal malnutrition is also associated with both maternal morbidity and

mortality.

A low BMI (<18.5kg/m2) at national level was observed among 8 per cent of the examined

women.

The highest prevalence of underweight women was observed in GBAO (13.1 per cent). In

all other regions prevalence ranged between 7.4 per cent and 8.3 per cent. The prevalence

of severe thinness (< 16kg/m2) was 0.6 per cent at national level and below 1 per cent for

all five regions. There was no statistically significant difference between the rates of women

with BMI <18.5 in rural and urban areas (8.6 per cent for rural areas, 9.4 per cent for urban

areas).

In line with the WHO technical report on low BMI interpretation (WHO, 1995; low

prevalence: 5%-9%) the findings of the present survey indicate that the proportion of

underweight or Chronic Energy Deficiency (CED) in Tajikistan was low in 2016.

Nevertheless WHO recommends careful monitoring of this situation, as this prevalence is

considered a warning sign at population level.

16


2016

RESULTS

The results for 2016 showed that the current prevalence of underweight women (8.0 per

cent including all CED Grad) has remained in a similar range to the 2009 National

Micronutrient Status Survey in Tajikistan (2009 NMSS) and the 2012 DHS. Regional

disparities remained similar (Figure 4) with underweight remaining highest in GBAO. It

should be noted that in 2003 no separate data was available for Dushanbe, as women and

children in the city were included for that survey in the DRS figures.

FIGURE 4 Time trends in prevalence of underweight (BMI<18.5 kg/m2) in women aged 15-49 years

3.3.1.2 Overweight

Overweight and obesity among women in low- and middle-income countries, as well as in

high-income countries, are an increasingly recognised public health problem. Obesity is the

condition of excessive fat in the body, and has significant health consequences. The most

significant health consequences of overweight and obesity include non-insulin dependent

(type-2) diabetes, coronary heart disease, hypertension and stroke, gallbladder diseases,

and certain types of cancer (endometrial, ovarian, breast, cervical and prostate).

More than a third of the examined women (37.6 per cent) were overweight or obese (BMI >

25 kg/m2) (Figure 5). The highest prevalence of overweight or obesity was found in

Dushanbe (43.0 per cent) and the lowest in GBAO (21.0 per cent). Prevalence of obesity

(BMI>30kg/m2) at national level was 13 per cent, with the highest figure in Dushanbe (17.5

per cent). The prevalence of obesity among women was 5.8 per cent in GBAO and in other

Sughd

7.9 9.05.6

10.0 8.3

DRS

5.5 6.9 5.110.0 8.0

GBAO

20.2 18.3

9.413.3 13.1

Khatlon

10.3 9.2 7.911.6

7.5

Dushanbe

no

da

ta

no

da

ta

8.1 9.6 7.4

UNDERWEIGHT (BMI<18.5)

WOMEN 15-49 YEARS 8.611.0

6.710.6 8.0

2003 2005 2009 2012 2016

National level

17


RESULTS

regions ranged between 11 per cent and 15 per cent (DRS 14.8 per cent; Khatlon 12.5 per

cent; and Sughd 11.3 per cent).

Obesity class ll (>35–39.99kg/m2) was 3.2 per cent at national level. Dushanbe showed the

highest prevalence (4.0 per cent) followed by Sughd (3.8 per cent). Obesity level lll

(>40kg/m2) was very rare at national level (0.9 per cent), with 1.2 per cent of women in this

category in Sughd.

The prevalence of BMI ≥25 among women was significantly higher in urban areas (41.2 per

cent) than rural areas (31.9 per cent) (Pearson χ2=21.3, P<0.001) (Tables 7.1 and 7.2 in

Annex 7).

A statistically significant difference (χ2=110.82, P>0.001) was observed between age

groups and BMI classes. As the age of women increased, the prevalence of overweight

and obesity was also found to increase, with 60.5 per cent of women above 40 years

overweight or obese (Figure 6; Table 7.3 in Annex 7).

FIGURE 5 Time trends in the prevalence of overweight and obesity (BMI>25.0 kg/m2) in women aged 15-49 years

National level

25.6

2003 2005 2009 2012 2016

23.028.2 29.7

37.6

Sughd

25/1 23.4 25.6 26.0

37.5

DRS

36.330.9 32.2 32.7 34.7

GBAO

12.016.1 18.1

22.0 21.0

Dushanbe

no

da

ta

no

da

ta

42.2 40.4 43.0

OWERWEIGHT (BMI>25)

WOMEN 15-49 YEARS

Khatlon

16.423.2 25.0

28.5

39.2

18


2016

RESULTS

FIGURE 6

BMI class distribution according to age (women aged 15-49 years)

A marked increase over the past years in overweight and obesity has been observed in

recent years, with the 2016 figure nearly 8 percentage points higher than the DHS 2012

figure of 29.7 per cent (see Figure 5). To conclude, the prevalence of overweight and

obesity is gradually increasing, particularly in older age groups. This is a matter of concern

from a public health perspective.

3.3.2 Anaemia and iron status

3.3.2.1 Anaemia

Anaemia is a condition in which the number of red blood cells or their oxygen-carrying

capacity is insufficient to meet physiological needs. Iron deficiency is thought to be the

most common cause of anaemia globally, although other conditions, such as folate, vitamin

B12 and vitamin A deficiencies, chronic inflammation, parasitic infections, and inherited

disorders can all cause anaemia. In its severe form, it is associated with fatigue, weakness,

dizziness and drowsiness.

The mean haemoglobin level of the 2,125 women examined nationally was 12.7g/dl (SD

±1.5) (Annex 2, Table 2.4). A significant difference was observed between regions

(Bartlett's test for equal variances: χ2=21.68; degrees of freedom [df]=4; P<0.001). Women

from Dushanbe and Sughd oblast showed a significantly higher mean haemoglobin

concentration than women from other oblasts (Sughd and Dushanbe: 13.0±1.4g/dl;

Scheffe’s test P<0.05).

15-24(n=632)

25-40(n=1277)

41-49(n=223)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

14.7%17.7%

7.0%

39.2%

3.1%

60.5%

age category (years)

BMI<18.5BMI 25≥

19


RESULTS

TABLE 12: Prevalence of different Hb ranges among women aged 15-49 years by region

Region Number Hb<7g/dl Hb 7-9.9g/dl Hb 10-11.9g/dl Hb≥12g/dl Hb<12g/dl

Dushanbe 425 0.2% 2.1% 17.6% 80.0% 20.0%

Khatlon 420 1.2% 3.8% 29.3% 65.7% 34.3%

Sughd 428 0.2% 2.6% 16.6% 80.6% 19.4%

DRS 427 0.2% 4.7% 17.3% 77.8% 22.2%

GBAO 425 0.2% 5.4% 26.1% 68.2% 31.8%

National (weighted) 2,125 0.6% 3.5% 21.7% 74.2% 25.8%

Uncorrected Pearson chi2 (12)= 54.5415, P= 0.000 *weighted; design-based Pearson F(6.89, 1177.79) = 4.7340; P = 0.0000

The survey indicated an overall prevalence of mild anaemia (Hb 10-11.9g/dl) of 21.7 per

cent (Figure 7). An additional 3.5 per cent of women had moderate anaemia (Hb 7-9.9g/dl)

and another 0.6 per cent severe anaemia (Table 12).

FIGURE 7 Prevalence of anaemia among women aged 15-49 years by region

The highest prevalence rates of mild, moderate and severe anaemic women were found in

Khatlon and GBAO (34.3 per cent and 31.8 per cent respectively). Sughd and Dushanbe

showed the lowest prevalence of anaemia (19.4 per cent and 20.0 per cent respectively).

Regional variations were statistically significant (Pearson χ2=54.54, df=12, P<0.001).

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%Hb<10g/dlHb 10-11.9g/dl

2.8%

16.6%

4.9%

17.3%

4.1%

26.1%

21.7%

5.6%

Sughd DRD GBAO National

2.4%

17.6%

29.3%

Dushanbe Khatlon

5.0%

20


2016

RESULTS

Significant differences were observed in mean haemoglobin levels between women in

urban and rural areas (12.9 g/dl for urban, 12.6 g/dl for rural). Similarly, women with

severe, moderate and mild anaemia were significantly more frequent in rural areas (24.9

per cent for urban and 27.2 per cent for rural) (Annex 2, Tables 2.5 and 2.6).

The prevalence of anaemia was with higher in older women (25 to 40 years: 27.7 per cent;

41 to 49 years: 27.6 per cent) compared to women and girls aged 15 to 24 (20.4 per cent).

The differences were statistically significant, (Pearson χ2=24.89, df = 6, P<0.001) (Annex

2, Table 2.7)

FIGURE 8 Time trends in the prevalence of anaemia in women 15-49 years

Figure 8 indicates that both mild and moderate/severe anaemia have not decreased between

2009 and 2016. Indeed the national weighted prevalence stood at 19.9 per cent (mild anaemia)

and 4.3 per cent (moderate and severe anaemia) in 2009 and at 21.7 per cent (mild) and 4.1

per cent (moderate and severe anaemia) in 2016. Prevalence rates increased substantially in

Khatlon and remained comparatively high in GBAO. In other words, the results from the 2016

NMSS reveal that the overall prevalence of anaemia (haemoglobin (Hb) <12 g/dl) in non-

pregnant women aged 15–49 years was similar to that in 2009, with considerable geographical

variation.

Khatlon

49.6

13.4

19.1

5.8

29.3

5.0

DRS

21.0

8.0

23.7

4.4

17.3

4.9Sughd

26.3

6.7

16.7

2.3

16.6

2.8

GBAO

29.9

6.5

24.5

5.83

26.1

5.6

Dushanbe

22.0

4.7

17.6

2.4no

da

ta

32.0

9.2

19.9

4.3

21.7

4.1

2003 2009 2016

National levelANAEMIA

WOMEN 15-49 YEARS

10-11.9g/dl (mild) 10 (moderate/severe)<

21


RESULTS

3.3.2.2 Anaemia and iron status

Concentration of haemoglobin should always be measured, and preferably concomitantly

with other iron status indicators. Haemoglobin concentration can provide information on the

severity of iron deficiency (WHO/CDC, 2004). The most severe consequence of iron

depletion is iron deficiency anaemia (IDA), which is still considered the most common

nutrition deficiency worldwide.

Inflammation: A high level of C-reactive protein (CRP) in the blood is a marker of

inflammation. When using a cut-off 5 μg/ml, the prevalence of inflammation varied

between 76.9 per cent in Sughd and 88.9 per cent in Dushanbe, with a national

weighted average of 82.5 per cent of women having a CRP >5μg/ml (Annex 2,

Table 2.8). The prevalence of inflammation among the study population has to be

considered very high, and causes and possible explanations for this pattern warrant

further investigation.

Iron stores: Serum ferritin concentration is a marker for total body iron stores and can

indicate an iron deficiency or an iron overload. Its concentration increases during

inflammation. The values of the ferritin concentration were not normally distributed,

so log transformed data and the geometric mean are presented. The national mean

ferritin concentration among women corrected for inflammation was 22.7 ng/ml (SD

±1.0ng/ml) (Annex 2, Table 2.9). The mean values were lowest in Sughd (19.3

ng/ml) and highest in Dushanbe (27.3 ng/ml), and thus differences between regions

were significantly different (Bartlett's test for equal variances: χ2=11.70; degrees of

freedom [df]=4; P<0.02). Significant differences were also observed between

women in urban and rural areas (25.9 ng/ml for urban, 31.7 ng/ml for rural) (Annex

2, Table 2.10).

Tissue iron needs: Serum transferrin receptors (TfRs) are the conventional pathway by

which cells acquire iron for physiological requirements. Under iron-deficient

conditions, there is an increased concentration of TfR. The national geometric

mean for serum transferrin receptor (TfR) concentration was 1.9 µg/ml (+/- SD 1.1

µg/ml) and varied considerably between the regions. Women living in DRS showed

the highest concentration of TfR (2.3 µg/ml), followed by women from GBAO (2.2

mg/L). This reflects a higher need for iron in these regions compared to the other

three. The lowest TfR concentration was observed in Khatlon and Sughd (1.8

µg/ml). Differences in mean TfR concentration were statistically significant between

regions (Bartlett's test for equal variances: χ2=202.9; degrees of freedom [df]=4;

P<0.001). Differences were also statistically significant between women living in

urban and rural places.

Body iron stores: Body iron stores are a quantitative assessment (mg iron / kg body

weight) of storage iron. At national level, 89.6 per cent of women have positive body

iron stores (mg iron/ kg body weight) (Annex 2, Table 2.12). The body iron stores of

women do not significantly differ between regions.

22


2016

RESULTS

3.3.2.2.1 Iron deficiency

The prevalence rate of iron deficiency is more sensitive than body iron stores, and is the

WHO-suggested method to assess iron deficiency and iron deficiency anaemia. The

prevalence of iron deficiency shows iron needs and iron stores in combination, and

therefore a person can already be iron deficient before body iron stores are negative. High

rates of iron deficiency - defined as either a low serum ferritin or elevated transferrin

receptor (TfR) value – among women aged 15-49 years were observed, with a national

weighted prevalence of 38.0 per cent of women being iron deficient. The highest

frequencies were found in Sughd (45.4 per cent) followed by DRS (41.2 per cent) and

GBAO (40.4 per cent) (Figure 9).

FIGURE 9 Prevalence of anaemia, iron deficiency (ID) and

iron deficiency anaemia (IDA) among women aged 15-49 years

3.3.2.2.2 Iron deficiency anaemia

Figure 9 also shows women with anaemia and iron deficiency anaemia (IDA). It can be

seen that in most regions at least 50 per cent of anaemia is attributable to iron deficiency (a

national level of 25.8 per cent anaemia and 13.8 per cent IDA) with the exception of

Khatlon where anaemia prevalence rates are explained in less than 50 per cent of cases by

iron deficiency (34.3 per cent of women have anaemia and 15.2 per cent IDA).

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

10.1%

32.2%

20.0%

34.4%

15.2%

30.3%

11.2%

31.8%

45.4%

22.2%

14.8%

17.9%

40.4%

25.8%

13.8%

41.2%

38.0%


19.4%

iron deficiency anaemia iron deficiency anaemia

23


RESULTS

The figures show that the urban population has significantly lower prevalence rates of iron

deficiency and IDA than rural residents, and therefore a better overall iron status than the

rural population (Table 13). Differences in iron deficiency, anaemia and IDA are statistically

significant (ID: χ2,

: 7.45, p=0.006; anaemia: χ2:11.204, p<0.001; IDA χ

2: 7.3, p=0.007). A

possible explanation for this may be that meat consumption is higher in urban areas.

TABLE 13: Prevalence of ID, anaemia and IDA among women 15-49 years stratified by rural/urban

Number Prevalence Pearson χ2 P-Value

Iron deficiency National weighted 2,023 34.5%

Rural 1,325 40.2% 7.450 0.006

Urban 698 34.0%

Anaemia National weighted 2,126 25.8%

Rural 1,398 27.8% 11.204 0.000

Urban 728 21.2%

Iron deficiency anaemia National weighted 2,015 13.8%

Rural 1,320 15.3% 7.303 0.007

Urban 695 10.9%

3.3.3 Vitamin A status

Vitamin A is important for healthy vision, immune function and foetal growth and

development. Vitamin A deficiency can cause visual impairment in the form of night

blindness and, in children, may increase the risk of illness and death from childhood

infections, including measles and those causing diarrhoea.

Geometric mean values of Retinol Binding Protein (RBP) per region adjusted for

inflammation are shown in Annex 2, Table 2.13. The mean was lowest in Khatlon (1.0

µmol/l) and highest in Dushanbe (2.0 µmol/l). Differences were statistically significant

between the regions (Bartlett's test for equal variances: χ2= 66.3; degrees of freedom [df] =

4; p<0.000. Differences in the mean between women living in rural and urban areas were

not statistically significant (P-Value (ttest) =0.11, Annex 2, Table 2.14).

Cut-off values for vitamin A deficiency among women of reproductive age are values of

less than or equal to 0.70 µmol/l. Accordingly the national weighted prevalence of vitamin A

deficiency among women between 15 and 49 years old was 46.5 per cent, with 37.6 per

cent showing severe vitamin A deficiency (Annex 2, Table 2.15). Based on this prevalence,

vitamin A deficiency has to be considered as a serious public health problem among

women of reproductive age in Tajikistan, as typically a prevalence rate above 20 per cent is

24


2016

RESULTS

considered the threshold for such a rating (WHO 2011). Prevalence rates were highest in

Khatlon with two in three women (66.6 per cent) deficient.

Severe vitamin A deficiency is most frequent in Khatlon with 57.4 per cent of women

classified in this category (Annex 2, Table 2.15). Differences between regions are

statistically significant (Pearson’s χ2:97.79, p<0.001).

FIGURE 10 Prevalence of Vitamin A deficiency (RBP ≤0.70 µmol/l) among women by region*

* RBP is corrected for inflammation (CRP ≥5 μg/ml) using a correction factor of 1.14 in the case of elevated CRP (Thurnham 2003)

3.3.4 Folate status

Folate deficiency can cause anaemia, and folate is particularly important for women of

reproductive age as a deficiency during pregnancy can lead to birth defects. Mean folate

levels are shown in Annex 2, Table 2.16. The weighted national geometric mean was 6.3

ng/ml. The lowest folate levels were observed in GBAO (5.2 ng/ml) and the highest in

Dushanbe (7.1 ng/ml). Differences were statistically significant between the regions

(Bartlett's test for equal variances: χ2= 113.54; degrees of freedom [df] = 4; P < 0.000.

Similarly differences in the mean folate level between women living in rural and urban

areas were also statistically significant (P-Value (t-test) =0.0001, Annex 2, Table 2.16).

The nationally weighted prevalence of folate deficiency stands at 20.5 per cent of women

between 15 and 49 years of age (Table 14). Prevalence rates are highest in GBAO (35.3

per cent of women) and lowest in Sughd (14.6 per cent of women) and Dushanbe (15.6 per

cent of women). Differences between regions are statistically significant (Pearson’s

χ2=6480, p<0.001). Conversely, no significant differences were found between age groups

(Table 15).

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

38.5%

66.6%

36.4%

46.5%44.4%

47.7%


25


RESULTS

TABLE 14: Prevalence of folate deficiency among women by region

Region Number Folate deficiency (<3ng/ml)

Dushanbe 379 15.6%

Khatlon 329 22.8%

Sughd 412 14.6%

DRS 381 25.7%

GBAO 402 35.3%

National (weighted) 1,903 20.5%

Pearson chi2(8) = 64.7996 Pr = 0.000

TABLE 15: Prevalence of folate deficiency among women by age group

Age group (years) Number Folate deficiency (<3ng/ml)

15-24 557 21.2%

25-40 1,149 23.9%

41-49 197 20.8%


3.3.5 Iodine status

The most common indicator assessing the impact of universal salt iodization programmes

is urinary iodine. Because more than 90 per cent of ingested iodine is excreted in the urine,

urinary iodine is an excellent indicator of current iodine intake in the diet.

A total of 1,874 urine samples were collected from women and analysed for urinary iodine

concentration (UIC). Because there is high variation in an individual’s daily iodine intake

and diurnal (within each day) variation in iodine excretion, single spot urine samples do not

reflect individual habitual intake of iodine. As such, it is not appropriate to use UIC values to

estimate individual intake, nor to assess the percentage of the population that is deficient.

However, where the sample size is large enough, the median UIC represents the overall

iodine intake of that population.

The weighted national median value for UIC was 75.0 µg/l (Table 16). A threshold of 100

µg/l is considered as the minimal iodine concentration in urine and is therefore an indicator

of adequate iodine intake. The observed median indicates iodine deficiency among the

studied population. Sughd was the only region with adequate iodine levels (113.9 µg/l). The

lowest median concentrations were found in GBAO and Dushanbe (61.5 µg/l and 61.6 µg/l

respectively).

26


2016

RESULTS

TABLE 16: Median urinary iodine concentration among women aged 15 to 49 years old

Region Number Median (μg/l) 25th percentile (μg/l)

75th percentile (μg/l)

Dushanbe 378 61.6 28.9 102.4

Khatlon 348 94.9 40.2 185.8

Sughd 377 113.9 50.4 214.1

DRS 397 73.0 34.4 133.2

GBAO 374 61.5 33.2 101.9

National (weighted) 1,874 75.0 35.5 143.0

Rural 1,227 79.7 37.0 159.6

Urban 647 68.9 32.9 123.4

The median urinary iodine levels nationally in 2003 and 2009 were 93.6 µg/l and 107.8 µg/L

(Figure 11). Therefore, the situation seems to have significantly worsened at national level

since the previous surveys. The potential factors contributing to these changes need to be

further investigated.

FIGURE 11 Time trends in median iodine values (µg/L) in women aged 15-49 years

Khatlon

65.7 61.8

94.9

DRS

77.5 76.6 73.0

Sughd

105.1

178.5

113.9

GBAO

126.7

96.3

61.5Dushanbe

103.8

61.6

no d

ata

National level

93.6107.8

75.0

2003 2009 2016

MEDIAN IODINE CONCENTRATION (µg/l)

WOMEN 15-49 YEARS

27


RESULTS

3.3.6 Food habits

A 24-hour recall questionnaire was used to record the food intake of the women. Of the

2,145 women responding, the most commonly consumed foodstuffs were “wheat, bread,

rice, pasta, biscuits”, “potatoes or other roots or tubers” and sweets such as sugar, honey,

candies, chocolate, etc. (Annex 2, Table 2.22). More than 90 per cent of the respondents

indicated having consumed all three of these food categories. Consumption of the food

groups “fats and oil” and “Vitamin A rich vegetables roots, tubers and fruits” were also very

high (80.7 per cent and 81.9 per cent, respectively). Two thirds reported having consumed

milk or milk products and other vegetables such cabbage or cauliflower (67.0 per cent and

67.7 per cent respectively). Consumption of “‘meat, liver, kidney, chicken, fish” within the

24 hours prior to the interview was at a similar level (72.6 per cent). Eggs had been eaten

by around a third of the women (34.0 per cent). In addition, consumption of beans (39 per

cent), as well as nuts and seeds (38 per cent) is low. The most common drinks were black

or green tea (98.8 per cent) and ‘plain water’ (90.8 per cent).

One out of ten women (10.9 per cent) indicated having consumed “Vitamins, mineral

supplements and/or any medicine” within the past 24 hours.

Significant differences in food consumption patterns are found for a range of items between

women living in urban and rural areas (Table 17). For example women in urban areas

consumed milk or milk products, meat, and eggs more frequently.

TABLE 17: Percentage of women achieving Minimum Dietary Diversity (≥5 food groups yesterday)

Region % achieving MDD (≥5 food groups yesterday)

Dushanbe 87.2%

Khatlon 68.5%

Sughd 88.6%

DRS 74.6%

GBAO 84.2%

National (weighted) 80.7%

Pearson chi2(4) = 83.4430 P = 0.000

Rural 77.5%

Urban 86.7%

Pearson chi2(1) = 26.7629 P = 0.000

Patterns with respect to the Minimum Dietary Diversity for Women are shown in Table 30

(for mean dietary diversity score please consult Annex 2, Table 2.23). As can be seen, at

national level 80.7 per cent of women between 15 and 49 years of age consumed a

minimum of five food groups in the 24 hours preceding the survey. The percentage of

women consuming at least five food groups was highest in Sughd (88.6 per cent) and

lowest in Khatlon (68.5 per cent). Differences between regions were statistically significant

28


2016

RESULTS

(Pearson χ2=83.44, p< 0.001) as they were between women living in urban and rural areas

(Pearson χ2

=26.76, p< 0.001).

The pattern emerging is thus that there is higher food diversity among women living in

urban areas. This is also underlined by Figure 12, which shows the dietary diversity scores

(out of 10 food groups) by urban and rural residence. Differences in dietary diversity scores

were statistically significant (Pearson χ2

=87.05, p< 0.001) as they were by regions (for

details see Annex 2, Table 2.24).

FIGURE 12 Dietary diversity scores of women (out of 10 food groups)

3.3.7 Micronutrient supplements and nutritional status of women

Women between 15 and 49 years of age were asked if they had taken (1) iron tablets, (2)

iodine supplements, and (3) folic acid tablets in the past six months. As the survey only

covered non-pregnant women, data related to consumption of iron and folic acid is only of

limited value. Of the 2,116 providing a yes or no answer on the consumption of iron tablets,

15.6 per cent indicated that they had taken tablets in the previous months (Figure 13;

Annex 2, Table 2.28). Meanwhile, the weighted national proportion of women who

benefitted from folic acid tablets in the past six months was 9.3 per cent (Annex 2, Table

2.29).

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2.6%2.6%

4.9%

2.0%0.7% 0.1%

16.3%

10.7%

19.6%18.3%

22.9%

3.5%

16.2%

6.2%

12.2% 12.0%

8.3%

3.9%

21.4%

11.1%

1namber of food groups consumed within the previous 24h

2 3 4 5 6 7 8 9 10

ruralurban

29


RESULTS

FIGURE 13 Proportion of non-pregnant women taking iron,

iodine and folic acid tablet intake in the past 6 months

The situation looks similar with regard to iodine supplements in the past six months: 14.9

per cent of those who provided yes/no answers indicated that they had benefited from

iodine tablets (Figure 13). The proportion was highest in Dushanbe (17.9 per cent of

women) and lowest in GBAO (12.9 per cent). No significant differences were observed

between the regions.

Those women who indicated having consumed iodine tablets in the past six months had a

significantly higher median iodine concentration (81.0 µg/l compared to 67.6 µg/l for those

who had not consumed the tablets). However, even the figure for those who had consumed

iodine tablets was still below the WHO recommended level of 100 µg/l (Annex 2, Table

2.21).

3.4 Nutritional status of 6-59 month old children

3.4.1 Anthropometric assessment (underweight, stunting, wasting)

3.4.1.1 Underweight

Undernutrition, as measured by underweight status, has been associated with a

substantially increased risk of childhood mortality worldwide. Underweight was defined for

children aged six to 59 months as low weight for age relative to the National Center for

Health Statistics/World Health Organization (NCHS/WHO) reference median. This is a

measure of both chronic and acute malnutrition.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%


12.4%

7.0%

17.9% 18.5%

15.0% 15.1% 14.7% 14.8%

11.8%

9.9% 9.6% 9.3%

13.9%12.9%

17.6%

8.2%

15.6%

14,9%

ironfolic acidiodine

30


2016

RESULTS

The national weighted prevalence of children aged six to 59 months who were underweight

was 6.2 per cent (Figure 14; Table 18). Meanwhile, severely underweight children (−3SD)

made up 1.6 per cent. Children living in GBAO were most often underweight (13.8 per

cent), and were also most often severely underweight (3.0 per cent). Children from Khatlon

were least often underweight (4.7 per cent). Differences across the regions were however

not statistically significant (Pearson uncorrected χ2= 14.5, P=0.075).

FIGURE 14 Prevalence of underweight among children aged 6-59 months (corrected for extreme values)

TABLE 18: Prevalence of underweight among children aged 6-59 months by region (corrected for extreme values)*

Severely underweight

(<-3 z-score) Moderately underweight

(<-2 z-score and >= -3 z-score)

Underweight combined (<-2 z-score)

Strata Number % 95% CI % 95% CI % 95% CI

Dushanbe 431 1.2% (0.4% - 3.1%) 3.9% (2.3% - 6.7%) 5.1% (3.1% - 8.7%)

Khatlon 424 1.2% (0.5% - 2.6%) 3.5% (2.3% - 5.2%) 4.7% (3.3% - 6.4%)

Sughd 431 2.6% (1.3% - 4.7%) 5.3% (3.6% - 7.9%) 7.9% (5.5% - 11.2%)

DRS 429 1.2% (0.4% - 3.2%) 4.9% (3.2% - 7.8%) 6.1% (4.2% - 9.1%)

GBAO 429 3.0% (1.8% - 5.1%) 10.7% (8.3% - 13.8%) 13.8% (10.9% - 17.3%)

National (weighted) 2,144 1.6% (1.1% - 2.4%) 4.6% (1.1% - 2.4%) 6.2% (5.2% - 7.5%)

WHO flag (Weight-for-age z-score (ZWEI) ZWEI<-6 or ZWEI >5) Uncorrected chi2(8) = 14.4920; Design-based F(5.88, 1005.91) = 1.9261; P = 0.0752

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

5.1% 5.3%

3.9% 3.5%

1.2% 1.2%1.2%

2.6%

4.7% 4.9%4.6%

3.0%

7.9%

10.7%

6.1%

1.6%

6.2%

13.8%


severely underweight moderately underweight underweight (combined)

31


RESULTS

No significant differences are observed in the prevalence of underweight between boys and

girls (Table 19). However the prevalence of underweight is 6.4 per cent among children

living in rural areas, significantly higher than the figure for those living in urban areas (4.4

per cent) (Table 20; Pearson uncorrected χ2= 4.6, P=0.03). No clear tendencies are

observed when analysing prevalence between age categories (Table 21).

TABLE 19: Prevalence of underweight among children 6-59 months by gender (corrected for extreme values)

Number severely underweight (<-3 z-score)

moderately underweight (<-2 z-score and >=

-3 z-score)

underweight combined (<-2 z-score)

Gender % 95% CI % 95% CI % 95% CI Boys 1,131 1.7% (0.1% - 2.8%) 4.8% (3.6% - 6.3%) 6.4% (4.9% - 8.3%)

Girls 1,012 1.6% (0.1% - 2.9%) 4.5% (3.2% - 6.2%) 6.0% (4.6% - 7.9%)


Uncorrected chi2(2) = 0.1518; Design-based F(1.99, 339.65) = 0.0565; P = 0.9442

TABLE 20: Prevalence of underweight among children aged 6-59 months

by area of residence (corrected for extreme values)

Number Severely underweight (<-3 z-score)

Moderately underweight (<-2 z-score and >=

-3 z-score)

Underweight combined (<-2 z-score)

Location % 95% CI % 95% CI % 95% CI Rural 1,405 1.9% (1.2% - 3.0%) 5.0% (3.9% - 6.4%) 6.9% (5.6% - 8.5%)

Urban 739 0.8% (0.0% - 2.0%) 3.5% (2.3% - 5.4%) 4.4% (3.0% - 6.4%)


Uncorrected chi2(1) for underweight = 4.6226; Design-based F(1, 171) = 4.5334 P = 0.0347

TABLE 21: Prevalence of underweight among children aged 6-59 months by age group

Age category Number Severely underweight

Underweight Normal

6-12 months 285 0.4% 5.3% 94.3%

13-24 months 531 2.3% 6.6% 91.1%

25-36 months 518 1.7% 4.8% 93.5%

37-48 months 434 1.2% 5.1% 93.7%

49-59 months 376 3.2% 6.7% 90.1%

Pearson chi2(8) = 11.9114 Pr = 0.155

32


2016

RESULTS

The prevalence of underweight children at national level was lower in 2016 (6.2 per cent)

than the 2009 Micronutrient Status Survey in Tajikistan (2009 NMSS: 8.4 per cent) or the

DHS 2012 (12.1 per cent) (Figure 15).

FIGURE 15 Time trends in the prevalence of underweight among children aged 6-59 months*

* the DHS in 2012, assessed underweight in the age category 0-59 months and not only in the age category 6 to 59 months

3.4.1.2 Stunting

Stunting is defined as “low height-for-age” of a child. It reflects the child’s past and

cumulative nutrition situation and is hence seen as an indicator of chronic malnutrition.

Once established, stunting and its effects typically become permanent. Stunted children

may never regain the height lost, and most children will never gain the corresponding body

weight. It also leads to premature death later in life, because vital organs might not fully

develop during childhood. Stunting is a phenomenon of early childhood and directly results

from poor diet and infection. Poor diet and infectious diseases interact to cause growth

failure in children, physiological damage especially to the immune system, and specific

clinical condition such as anaemia, leading to impaired development and death. Eliminating

malnutrition would cut childhood mortality substantially. Well-nourished children perform

better in school, grow into healthy adults and in turn give their own children a better start in

life.

With regard to the prevalence of stunting among children aged 6-59 months, the weighted

national prevalence of severe stunting is 6.0 per cent (<-3 z-score) with another 14.9 per

Sughd

10.45.9 7.9

Dushanbe

5.19.37.7

National level

8.412.1

6.2

2003 2009 2016

Khatlon

10.513.5

4.7

GBAO

13.813.08.5

DRS

8.612.7

6.1

UNDERWEIGHT

CHILDREN 6-59 MONTHS

33


RESULTS

cent being moderately stunted (<-2 z-score and >=-3 z-score) (Figure 16; Table 22). The

prevalence of severely and moderately stunted children was substantially lower in

Dushanbe than in all other regions with differences across regions being statistically

significant (Pearson uncorrected χ2= 19.75, P=0.01).

FIGURE 16 Prevalence of stunted children aged 6-59 months (corrected for extreme values)

TABLE 22: Prevalence of stunting among children aged 6-59 months by region*

Region Number Severely stunted (<-3 z-score)

Moderately stunted (<-2 z-score and >=-3 z-

score)

Stunted combined (<-2 z-score)

% 95% CI % 95% CI % 95% CI Dushanbe 430 3.5% (2.2% - 5.6%) 7.0% (4.6% - 10.5%) 10.5% (7.3% - 14.7%)

Khatlon 420 6.0% (4.1% - 8.5%) 16.7% (14.0% - 19.6%) 22.6% (18.9% - 26.4%)

Sughd 427 6.1% (4.2% - 8.7%) 13.3% (10.7% - 16.5%) 19.4% (16.1% - 23.2%)

DRS 425 6.8% (4.9% - 9.9%) 17.2% (14.0% - 21.1%) 24.0% (19.5% - 29.7%)

GBAO 420 5.5% (3.5% - 8.4%) 16.9% (13.1% - 21.6%) 22.4% (18.4% - 26.9%)

National (weighted) 2,122 6.0% (4.9%-7.2%) 14.9% (13.4% - 16.6%) 20.9% (19.3%-22.5%)

* WHO flag (Length/height-for-age z-score (ZLEN) ZLEN<-6 or ZLEN >6) Pearson χ2 (8) uncorrected = 19.7501 Design-based F(5.50, 939.74) = 2.9138; P = 0.0102

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

10.5%

13.3%

7.0%

16.7%

3.5%

6.8%6.0% 6.0%6.1%

22.6%

17.2%

14.9%

5.5%

19.4%

16.9%

24.0%

20.9%22.4%

Dushanbe

percentage

Khatlon Sughd DRD GBAO National (weighted)

severely stunted moderately stunted stunted (combined)

34


2016

RESULTS

Children in rural areas were significantly more likely to be stunted (χ2 = 14.1612, P =

0.0002) (Table 24). No significant gender-related differences were observed at national and

regional level (Table 23). When analysing stunting by age category, it is observed that

children in the age categories 13 to 24 months and 25 to 36 months show higher

prevalence rates of stunting than children in the other age categories (Table 25). The

prevalence rates for stunting are significantly different between the age categories (χ2 =

18.67, P = 0.02).

TABLE 23: Prevalence of stunting among children aged 6-59 months

by gender (corrected for extreme values)*

Gender Number Severely stunted (<-3 z-score)

Moderately stunted (<-2 z-score and >=-3 z-

score)


% 95% CI % 95% CI % 95% CI

Boys 1'118 6.2% (4.8% - 8.0%) 15.1% (13.2% - 17.3%) 21.4% (18.8% - 24.1%)

Girls 1'003 5.7% (4.1% - 7.7%) 14.7% (12.5% - 17.1%) 20.3% (17.5% - 23.5%)

National (weighted) 2'121 6.0% (4.9%-7.2%) 14.9% (13.4% - 16.6%) 20.9% (19.3%-22.5%)

Pearson χ2 uncorrected = 0.3323 Design-based F(1, 171) = 0.2804; P = 0.5971

TABLE 24: Prevalence of stunting among children aged 6-59 months

by area of residence (corrected for extreme values)*

Area Number Severely stunted (<-3 z-score)

Moderately stunted (<-2 z-score and >=

-3 z-score)


% 95% CI % 95% CI % 95% CI

Rural 1386 6.6% (5.3% - 8.3%) 16.7% (14.9% - 18.6%) 23.3% (20.8% - 26.0%)

Urban 736 4.1% (2.7% - 6.2%) 10.1% (7.5% - 13.4%) 14.2% (11.0% - 18.1%)

National (weighted) 2,122 6.0% (4.9%-7.2%) 14.9% (13.4% - 16.6%) 20.9% (19.3%-22.5%)

Pearson χ2 uncorrected = 20.7347 Design-based F(1, 171) = 14.1612; P = 0.0002

35


RESULTS

TABLE 25: Prevalence of stunting among children aged 6-59 months by age group (corrected for extreme values)

Age category Number Severely stunted Stunted Normal

6-12 months 284 2.8% 17.8% 82.4%

13-24 months 522 5.9% 14.9% 79.2%

25-36 months 514 5.8% 17.7% 76.5%

37-48 months 430 4.9% 11.2% 83.9%

49-59 months 372 7.5% 11.3% 81.2%

Pearson chi2(8) = 18.6699 Pr = 0.017

The proportion of children who were moderately and severely stunted fell from 29.4 per

cent in the 2009 NMSS to 20.9 per cent in the 2016 NMSS (Figure 17). With the exception

of DRS, the situation improved in all regions between 2009 and 2016. Similarly, the

proportion of children severely stunted was 9.2 per cent in 2009 and fell to 6.4 per cent in

2016 (Figure 17). Again, the situation improved in all regions except DRS.

FIGURE 17 Time trends in moderate and severe stunting in children aged 6 to 59 months*

* the DHS in 2012 assessed “height-for-age” for the age category 0-59 months and rather than 6-59 months

GBAO

24.3 22.425.4

41.3

DRS

26.3 24.022.829.4

Sughd

27.2

19.4

27.9

38.6

Khatlon

26.922.6

36.939.0

Dushanbe

18.9

10.5

21.8

29.5

National level

26.220.9

29.436.0

2005 2009 20162012

LOW HEIGHT-FOR-AGE (STUNTING)


36


2016

RESULTS

FIGURE 18 Time trends in severe stunting among children aged 6-59 months

3.4.1.3 Wasting

Wasting, or ‘low weight-for-height’, is a predictor of mortality among children under five.

Wasting usually results from significant acute food shortage and/or disease. Children with

weight-for-height more than 2SD below the median of the reference population are too thin

for their height, and have a ‘low weight-for-height’ or wasted, while those with weight-for-

height more than 3SD below the reference median population are severely ’low weight-for-

height’, or severely wasted.

The prevalence of moderate and severe wasting, <-2 z-score among children aged 6-59

months (corrected for extreme values) was 2.8 per cent (Figure 18, Table 26). Again strong

and significant regional differences are observed in wasting (Pearson uncorrected χ2=

19.98, P=0.01) with frequencies highest in GBAO. A high prevalence of severely wasted

children is observed in Sughd.

Like the pattern found for stunting, children living in rural areas were significantly more

often wasted (χ2 = 5.6, P = 0.01) (Table 28). No significant gender-related differences were

observed (Table 27) at national and regional level. An exception was GBAO, where girls

were more likely to be wasted than boys (χ2 = 7.26, P = 0.027). When analysing wasting by

age category, it is observed that prevalence rates were not significantly different between

the age groups (Table 29).

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%


7.2%

12.3%

3.5%

6.0% 6.1%6.9% 6.8%

5.5%

9.3% 9.2%

6.4%

7.7%

20092016

37


RESULTS

FIGURE 19 Prevalence of wasted children aged 6-59 months (corrected for extreme values)

TABLE 26: Prevalence of wasting among children aged 6-59 months by region*

Region Number Severely wasted (<-3 z-score)

Moderately wasted (<-2 z-score and >=

-3 z-score)

Wasted combined (<-2 z-score)

% 95% CI % 95% CI % 95% CI Dushanbe 431 0.7% (0.2%-2.1%) 1.9% (0.8% - 4.1%) 2.6% (1.3% - 5.0%)

Khatlon 419 0.2% (0.0%-2.7%) 2.1% (1.1% - 4.1%) 2.4% (1.3% - 4.2%)

Sughd 426 2.1% (1.2%-3.7%) 1.9% (0.9% - 3.8%) 4.0% (2.5% - 6.3%)

DRS 426 1.2% (0.5%-2.7%) 0.5% (0.1% - 1.9%) 1.6% (0.7% - 3.7%)

GBAO 425 1.9% (1.0%-3.5%) 4.7% (3.1% - 7.1%) 6.6% (4.7% - 9.2%)

National (weighted) 2,127 1.1% (0.7%-1.6%) 1.7% (1.1%-2.5%) 2.8% (2.1%-3.7%)

WHO flag (Weight-for-length/height z-score (ZWFL) ZWFL<-5 or ZWFL>5) Uncorrected chi2(8) = 19.9803 Design-based F(5.61, 958.92) = 2.7814; P = 0.0129

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%


severely wasted moderately wasted wasted (combined)

1.9% 1.9%

0.7%0.2% 0.5%

2.6%2.1% 2.1%

2.4%

4.0%

1.2% 1.1%

1.7%1.6%1.9%

4.7%

6.6%

2.8%

38


2016

RESULTS

TABLE 27: Prevalence of wasting among children aged 6-59 months by gender (corrected for extreme values)*

Gender Number Severely wasted (<-3 z-score)

Moderately wasted (<-2 z-score and >=

-3 z-score)


% 95% CI % 95% CI % 95% CI

Boys 1,122 0.7% (0.3% - 1.4%) 2.1% (1.3% - 3.2%) 2.8% (1.8% - 4.1%)

Girls 1,004 1.6% (0.9% - 2.6%) 1.3% (0.6% - 2.6%) 2.9% (1.9% - 4.3%)


Pearson χ2 uncorrected = 5.5657 Design-based F(1.98, 337.97) = 2.0000; P = 0.1376

TABLE 28: Prevalence of wasting among children aged 6-59 months by area of residence (corrected for extreme values)*

Area of residence Number Severely wasted (<-3 z-score)

Moderately wasted (<-2 z-score and >=-3 z-

score)


% 95% CI % 95% CI % 95% CI

Rural 1,389 1.3% (0.8%-2.1%) 2.0% (1.3%-3.0% 3.3% (0.8%-2.6%)

Urban 738 0.4% (0.2%-1.1%) 1.0% (1.3%-3.0%) 1.4% (1.9%-4.3%)


Pearson χ2 uncorrected (1) = 5.6410 Design-based F(1, 171) = 6.5294; P = 0.0115

TABLE 29: Prevalence of wasting among children aged 6-59 months by age group (corrected for extreme values)

Age category Number Severely wasted Moderately wasted Total wasted

6-12 months 284 0.4% 1.8% 2.2%

13-24 months 527 1.9% 3.2% 5.1%

25-36 months 515 1.2% 1.9% 3.1%

37-48 months 430 1.4% 0.9% 2.3%

49-59 months 371 0.8% 3.0% 3.8%

Pearson χ2(8) = 11.6678 Pr = 0.167

Comparing wasting rates as revealed by the surveys in 2009, 2012 and 2016, prevalence

fell nationwide (from 4.6 per cent and 9.9 per cent to 2.8 per cent) (Figure 19). Compared

to the 2009 NMSS the wasting rate fell substantially in all regions except GBAO and

Sughd. The rate of severely wasted children remained roughly the same between 2009 and

2016 (Figure 20).

39


RESULTS

FIGURE 20 Time trends in the low and very low “weight-for-height” (wasting and severe wasting)

in children aged 6 to 59 months*

* the DHS in 2012, assessed “height-for-age” in the age category 0-59 months

and not the age category 6-59 months

FIGURE 21 Rate of very low “weight-for-height” (severe wasting) among children aged 6-59 months

Dushanbe

10.3

2.64.09.2

Khatlon

11.1

2.44.9

11.9

GBAO

8.1 6.64.06.3

DRS

9.8

1.67.29.2Sughd

10.32.64.09.2

National level

9.92.84.6

8.8

2005 2009 20162012

LOW WEIGHT-FOR-HEIGHT (WASTING)


0.0%

1.0%

2.0%

3.0%

4.0%

5.0%


1.4%1.6%

2.1%

1.2%

1.9%

1.4%1.1%

2.8%

0.7%

0.2% 0.2%

0.7%

20092016

40


2016

RESULTS

3.4.1.4 Overweight and obesity

Using weight-for-height as the indicator, 4.1 per cent of the children aged six to 59 months

were found to be overweight or obese (Figure 22). The prevalence was highest in Khatlon

with 3.8 per cent of children overweight and 1.0 per cent obese. The lowest prevalence

was observed in GBAO, with 1.7 per cent of children overweight.

Figure 23 indicates time trends in overweight and obesity assessed through “weight-for-

height” among children. Comparing the 2012 DHS prevalence rates (which, it should be

noted, included babies aged below six months) with those from this survey, suggests that

the situation has improved overall, with a fall from 5.9 per cent in 2012 to 4.1 per cent in

2016. Prevalence decreased most notably in Sughd and Dushanbe. FIGURE 22 Prevalence of overweight and obese among children aged 6-59 months using weight-for-height

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%


overweight ( ≤ )weight-for-height > 2SD 3D

obese ( )weight-for-height > 3SD

combined(weight-for-height > 2SD)

0.7%

1.9%

0.7%

3.8%

0.9%

2.6%

1.0%

3.5% 3.5%

4.8%

4.2%

3.3%

0.8%

1.7%1.7%

4.4%

0.0%

4.1%

41


RESULTS

FIGURE 23 Time trends in obesity and overweight (weight-for-height > 2 SD) in children aged 6-59 months

3.4.2 Anaemia and iron status

3.4.2.1 Anaemia

The mean haemoglobin level from the 2,097 children aged six to 59 months examined at

national level was 11.6 g/dl (SD ±1.5) (Annex 3, Table 3.14). A significant difference was

observed between regions (Bartlett's test for equal variances: χ2=14.40; degrees of

freedom [df]=4; P=0.005). Children from Dushanbe, Sughd oblast and DRS showed a

significantly higher mean haemoglobin concentration than children from other oblasts. No

significant difference emerged between girls and boys (Annex 3, Table 3.15).

The survey indicated an overall prevalence of mild anaemia (Hb 10-10.9g/dl) of 17.6 per

cent. A further 8.1 per cent of children had moderate anaemia (Hb 7-9.9g/dl) and another

0.1 per cent severe anaemia (Table 30). Considerable regional variations were observed,

from 41.4 per cent anaemia prevalence in GBAO to 16.2 per cent in Dushanbe. A small

decrease in the overall prevalence of anaemia was observed, from 28.7 per cent in the

2009 NMSS to 25.8 per cent in 2016 (Figure 24). The highest prevalence rates of severely

and moderately anaemic children were found in GBAO and Khatlon (1.0 per cent and 0.3

per cent severe, and 17.7 per cent and 10.5 per cent moderate respectively). Dushanbe

showed the lowest prevalences of severe, moderate and mild anaemia. Regional variations

were statistically significant (Pearson χ2=103.43, df=12, P<0.001).

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Dushanbe

in 2012 DHS assessed “weight-for-height” in the age category 0-59 monthsand not only in the age category 6 to 59 months


5.4%

3.0%2.6%

4.8%4.2% 4.3% 4.4%

1.1%1.7%

5.9%

4.1%

11.8%

20122016

42


2016

RESULTS

FIGURE 24 Time trends in the prevalence of anaemia in children aged six to 59 months

TABLE 30: Prevalence of anaemia among children aged 6-59 months by region

Strata Number Hb<7g/dl Hb 7-9.9g/dl Hb 10-10.9g/dl Hb≥11g/dl Hb<11g/dl

Dushanbe 425 0.0% 4.7% 11.8% 83.5% 16.5%

Khatlon 408 0.3% 10.5% 18.6% 70.6% 29.4%

Sughd 424 0.0% 5.9% 17.5% 76.7% 23.4%

DRS 427 0.0% 7.5% 18.0% 74.5% 25.5%

GBAO 413 1.0% 17.7% 24.7% 56.7% 43.4%

National 2,097 0.1% 8.1% 17.6% 74.2% 25.8%

Pearson: Uncorrected chi2(12) = 103.4301; Pr = 0.000

Significant differences for mean haemoglobin levels were observed between children in

urban and rural areas (12.0 g/dl for urban, 11.5 g/dl for rural). Similarly, anaemia, both

severe and moderate, among children were significantly more frequent in rural areas (31.7

per cent) than in urban areas (19.4 per cent) (Annex 3, Tables 3.13 and 3.14).

National level

18.621.0

10.216.7

17.6

8.2

2003 2009 2016

GBAO

19.4

25.1

20.429.9

24.7

18.7

DRS

21.118.0

10.912.8

18.0

7.5Sughd

17.917.4

11.413.2

17.5

5.9

Dushanbe

16.9

11.5

11.8

4.7no

da

ta

Khatlon

17.8

27.7

7.123.9

18.6

10.8

ANAEMIA



43


RESULTS

FIGURE 25 Prevalence of anaemia among children aged six to 59 months by region

However, there was no significant difference in mean haemoglobin concentration and

anaemia between girls and boys (Annex 3, Tables 3.15 and 3.16).

There was a marked difference in the prevalence of anaemia among children between age

groups: younger children aged 6-12 months and 13-24 months were more frequently

anaemic (45.4 per cent and 42.7 per cent), than children aged 27-48 months and 49-59

months (15.1 per cent and 12.6 per cent). The differences were statistically significant

(Pearson χ2=24.89, df = 6, P<0.001) (Annex 3, Table 3.17). This reveals a need to focus

interventions on the first 1,000 critical days after conception.

3.4.2.2 Anaemia and iron status

Anaemia is multifactorial and can be the result of iron deficiency but also of infections,

blood loss, growth and other cause. This sub-section goes into more detail about iron

deficiency and its links with anaemia.

Inflammation: Like for women, the prevalence of children with elevated CRP was high and

the causes warrant furtuer investigation. Prevalence of CRP ≥5 μg/ml ranged

between 59.5 per cent in Khatlon and 67.6 per cent in Dushanbe with a national

weighted average of 64.0 per cent of children with CRP ≥5 μg/ml (Annex 3, Table

3.18).

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

16.5%

4.7%

11.8%

18.6%

29.4%

10.8%

23.4% 24.7%

5.9%

18.0% 18.7%

25.5%

43.4%

17.6%

25.8%

7.5% 8.2%


17.5%

Hb < 10g/dl Hb < 10-10.9 g/dl combined ( )Hb > 11g/dl

44


2016

RESULTS

Iron stores: Like for women, ferritin values were adjusted due to high rates of

inflammation. The values of the ferritin concentration were not normally distributed,

so log transformed data and the geometric mean are presented. The national mean

ferritin concentration was 19.1 ng/ml (SD ±0.9ng/ml). The highest ferritin values

were observed in Dushanbe and the lowest in Sughd and GBAO (25.4 ng/ml, 14.1

ng/ml and 14.4 ng/ml respectively) (Annex 3; Table 3.20). Differences between

regions are statistically significant (Bartlett's test for equal variances: χ2=44.8;

degrees of freedom [df]=4; P<0.001). However, no significant differences were

observed with regard to gender, apart from in DRS, where girls had a significantly

higher mean (Annex 3, Table 3.22).

Applying the two-sample t test with equal variances, significant differences for

geometric mean serum ferritin levels corrected for inflammation were observed

between children in urban and rural areas (23.0 ng/ml in urban areas and 17.2

ng/ml in rural areas) (Annex 3, Table 3.21).

Tissue iron needs: The national geometric mean for serum transferrin receptor (TfR)

concentration was 3.0 µg/ml: this varied considerably between the regions (Table

33). Contrary to the pattern found among women, children living in DRS showed the

lowest concentration of TfR (2.1 µg/ml), followed by children from GBAO (2.7

mg/L). The highest TfR concentrations were observed in Khatlon and Sughd (3.2

and 3.5 µg/ml respectively). Differences in mean TfR concentrations were

statistically significant between regions (Bartlett's test for equal variances: χ2=38.39

degrees of freedom [df]=4; P<0.001). However, differences were not statistically

significant between children living in urban and rural areas (Annex 3, Table 3.19).

Body iron stores: Among children aged six to 59 months, 84.9 per cent have positive

body iron stores (Annex 3, Table 3.23). The body iron stores of children differ

significantly between the regions with children in Sughd and GBAO having higher

rates of negative body iron storage (Pearson χ2=42.17, df = 7, P=0.0001).

3.4.2.2.1 Iron deficiency

As indicated earlier, prevalence of iron deficiency – defined as either a low serum ferritin or

an elevated transferrin receptor (TfR) value – is more sensitive than body iron stores and is

also the WHO suggested method, as it shows iron needs and iron stores in combination: a

person can already be iron deficient before the body iron stores are negative. Figure 26

presents the prevalence rates of iron deficiency among children aged six to 59 months.

High rates of iron deficiency are observed with a national weighted prevalence of 52.4 per

cent of children being iron deficient. The highest frequencies are found in Sughd (67.2 per

cent), GBAO (59.0 per cent) and Khatlon (54.5 per cent).

45


RESULTS

FIGURE 26 Prevalence of anaemia, iron deficiency (ID) and

iron deficiency anaemia (IDA) among children aged six to 59 months

3.4.2.2.2 Iron deficiency anaemia

Figure 26 also indicates that in all regions except DRS at least 50 per cent of anaemia is

attributable to iron deficiency (nationally 25.8 per cent have anaemia and 16.9 per cent iron

deficiency anaemia (IDA)). Children living in urban areas have significantly lower

prevalence rates of iron deficiency, anaemia, and IDA than those in rural areas, and

therefore a better overall iron status (Table 31). Differences in iron deficiency, anaemia and

IDA were significantly different (ID: χ2: 11.11, p=0.001; anaemia: χ

2: 35.81, p<0.001; IDA

χ2: 26.79, p<0.001). Gender differences were not statistically significant (Annex 3, Table

3.24).

Possible explanations of this situation may be that the meat consumption is higher in urban

areas, and that urban children more frequently consume iron-fortified weaning foods. In

addition, the high rates of anaemia in rural areas may partially be explained by high rates of

infection, for example by helminthic diseases.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


44.0%

54.5%

67.2%

16.5%

25.5%

11.9%

29.4%

23.4%

38.4%43.4%

52.4%

28.7%25.8%

16.9%17.0%

59.0%

18.6%

9.5%

iron deficiency anaemia iron deficiency anaemia

46


2016

RESULTS

TABLE 31: Prevalence of iron deficiency (ID), anaemia and iron deficiency anaemia (IDA)

among children aged six to 59 months by rural/urban residence

Number Prevalence Pearson χ2 P-Value

Iron deficiency (ID) National weighted 2,005 52.4%

Rural 1,309 55.1% 11.112 0.001

Urban 696 47.3%

Anaemia National weighted 2,097 25.8%

Rural 1,377 31.7% 35.813 0.000

Urban 720 19.4%

Iron deficiency anaemia (IDA) National weighted 1,995 16.9%

Rural 1,301 20.1% 26.758 0.000

Urban 694 11.0%

Table 32 shows that iron deficiency, anaemia and IDA are lower with older age categories.

This is partly because children aged 6-24 months often consume nutrient poor weaning

food. Further breast milk contains very little iron so not to increase the risk of bacterial

infection.

TABLE 32: Prevalence of iron deficiency (ID), anaemia and iron deficiency anaemia (IDA)

among children aged 6-59 months by age group

Age group Number ID Number Anaemia Number IDA

6-12 months 271 58.3% 282 45.4% 271 26.6%

13-24 months 494 60.9% 517 42.7% 491 28.3%

25-36 months 482 53.4% 510 23.1% 480 14.6%

37-48 months 408 46.6% 423 15.1% 405 8.4%

49-59 months 350 40.3% 362 12.6% 348 6.3%

National Weighted 2'005 52.4% 2'094 25.8% 1'995 16.9%

Anaemia: Pearson chi2 (4)= 183.4459, P=0.000; ID: Pearson chi2(4)=45.8059, P=0.000; IDA: Pearson chi2(4)=116.1212; P=0.000

3.4.3 Vitamin A status

The carers interviewed were asked if their children had received vitamin A capsules in the

six months prior to the interview. Around four out of five children (78.9 per cent) received

capsules: the percentage was highest in Sughd (91.6 per cent) and lowest in Khatlon (59.7

47


RESULTS

per cent) (Table 33). Differences between regions were statistically significant (Pearson χ2

=138,4, p< 0.001) as they were between children living in urban and rural areas (Pearson

χ2

= 8.29, p=0.004). However, no significant differences were found between boys and

girls.

TABLE 33: Percentage of children aged six to 59 months who received Vitamin A

supplementation in the last 6 months

Number of answers

Yes No

Dushanbe 417 83.4% 16.6%

Khatlon 402 59.7% 40.3%

Sughd 427 91.6% 8.4%

DRS 423 77.1% 22.9%

GBAO 428 81.8% 18.2%

National (weighted) 2'097 78.9% 21.1%

Pearson chi2(4)=138.4480 Pr = 0.000

Rural 1383 77.1% 22.9%

Urban 714 82.5% 17.5%

Pearson chi2(1) = 8.2978 Pr = 0.004

Boys 1102 78.3% 21.7%

Girls 994 79.6% 20.4%

Pearson chi2(1) = 0.5028 Pr = 0.478

Geometric mean values adjusted for inflammation per region of Retinol Binding Protein

(RBP) are shown in Table 3.25 in Annex 3. The mean was lowest in Sughd (1.5 µmol/l) and

highest in Dushanbe (3.2 µmol/l). Differences were statistically significant between the

regions (Bartlett's test for equal variances: χ2= 85.9; degrees of freedom [df] = 4; p< 0.001).

Similarly, the mean RBP adjusted for inflammation between children living in rural and

urban areas was statistically different, with children in urban areas having higher mean

values (P-Value (ttest)<0.0001, Annex 3, Table 3.26). However no significant differences

can be observed in mean RBP values between boys and girls (Annex 3, Table 3.27).

The cut-off value for vitamin A deficiency among children aged six to 59 months is less

than or equal to 0.70µmol/l. Accordingly the national weighted prevalence of vitamin A

deficiency (adjusted for inflammation) among children was found to be 37.0 per cent, with

6.9 per cent showing severe vitamin A deficiency status (Figure 27; Annex 3, Table 3.28).

Prevalence was significantly higher among children living in rural areas (41.0 per cent)

compared to those living in urban areas (29.3 per cent) (χ2=29.77, p<0.001) (Annex 3,

Table 3.30). No significant difference was observed between boys and girls. Prevalence

rates were more than twice as high in Sughd than in Dushanbe. Severe vitamin A

deficiency was also most frequent in Sughd with 42.4 per cent of children classified in this

category. There is significantly different prevalence of Vitamin A deficiency between

regions (Pearson’s χ2: 83.66, p<0.001). No significant differences in Vitamin A deficiency

48


2016

RESULTS

are observed between age groups (Annex 3, Table 3.31). Based on these prevalence

rates, vitamin A deficiency must be considered a serious public health problem among

children in Tajikistan, given that typically prevalence of above 20 per cent is considered the

threshold for such a rating (WHO 2011). High prevalence of vitamin A deficiency despite

the relatively high coverage of Vitamin A supplementation occurs because supplementation

is an intervention to prevent the detrimental effects of vitamin A deficiency (i.e., increased

morbidity and mortality) but not to address the underlying deficiency in the population. As

the survey took place five months after the semi-annual supplementation campaign, any

temporary increase in serum retinol level as a short-term effect of supplementation was

likely to have already diminished.1

FIGURE 27 Prevalence of Vitamin A deficiency among children aged six to 59 months by region

To assess time trends in Vitamin A status the survey results from 2003 were consulted, as

vitamin A was not measured in 2009. It should be noted here that the vitamin A

measurement in 2003 did not use an ELISA test but relied on High Performance Liquid

Chromatography. In addition, a higher cut-off to determine vitamin A deficiency was used in

2003 (≤ 0.97 µmol/l; compared to ≤ 0.70µmol/l in 2016). Consequently time trends in

Vitamin A status of children have to be analysed very cautiously. It is observed that mean

serum retinol values among children aged six to 59 months have increased in all regions.

At national level the mean serum retinol has increased from 0.9 µmol/l in 2003 to 2.3 µmol/l

in 2016. Nevertheless with 37 per cent of children suffering from Vitamin A deficiency, this

remains a serious public health issue.

1 Palmer, A.C., West, K.P., Dalmiya, N., and Schultink, W (2012). “The use and interpretation of serum retinol

distributions in evaluating the public health impact of vitamin A programmes.” Public Health Nutrition: 15(7), 1201-12015

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

21.1%

37.0%41.0%

37.0%

49.7%

36.1%


49


RESULTS

FIGURE 28 Mean serum retinol values (µmol/l) in children aged 6-59 months in 2003 and 2016

3.4.4 Vitamin D status

Geometric mean values adjusted of vitamin D among children 6 to 59 months per region

are shown in Table 3.32 in Annex 3. The mean was lowest in Khatlon (38.9 ng/ml) and

highest in GBAO (65.5 ng/ml). Differences were statistically significant between the regions

(Bartlett's test for equal variances: χ2= 74.29; degrees of freedom [df] = 4; p< 0.000).

Differences in mean vitamin D values between rural and urban areas were also statistically

significant, with children in rural areas having high values (P-Value (ttest)<0.0001: Annex 3,

Table 3.33). However, and like for Vitamin A, no significant differences were seen in mean

Vitamin D values between boys and girls (Annex 3, Table 3.34).

The cut-off value for vitamin D deficiency among children aged six to 59 months is less

than 19.6 ng/ml. The national weighted prevalence of vitamin D deficiency among children

was 12.4 per cent, with 4.6 per cent showing severe vitamin D deficiency (Table 34).

Severe vitamin D deficiency is most frequent in Khatlon, where 14.0 per cent of children

are thus classified. Prevalence rates of vitamin D are significantly different between regions

(Pearson’s χ2: 143.51, p<0.001). Conversely no significant differences were found in

prevalence rates between different age categories of children (Table 35).

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

Dushanbe

* 2003: serum retinol measured through HPLC, Dushanbe not included andnational data not weighted; 2016: serum retinol measure through ELISA

mean serum retinol values (µmol/l)


1.0% 1.0%

3.2%

2.2%

1.5%1.7%

2.8%

2.3%

0.9% 0.9% 0.9%

20032016

50


2016

RESULTS

TABLE 34: Prevalence of Vitamin D deficiency among children aged six to 59 months by region

Region Number Moderate vitamin D deficiency

(10-19.6ng/ml)

Severe vitamin D deficiency (<10ng/ml)

Vitamin D deficiency (combined)

Dushanbe 390 13.8% 5.6% 19.4%

Khatlon 365 8.5% 14.0% 22.5%

Sughd 370 6.2% 2.4% 8.6%

DRS 408 8.1% 1.2% 9.3%

GBAO 376 2.1% 0.5% 2.6%


Pearson chi2(8) = 143.5059 Pr = 0.000

TABLE 35: Prevalence of Vitamin D deficiency among children aged 6-59 months by age group

Age group Number Moderate vitamin D deficiency

(10-19.6ng/ml)

Severe vitamin D deficiency (<10ng/ml)

Vitamin D deficiency (combined)

6-12 months 263 11.4% 4.9% 16.3%

13-24 months 469 8.3% 4.5% 12.8%

25-36 months 457 7.0% 3.9% 10.9%

37-48 months 390 5.6% 5.4% 11.0%

49-59 months 330 7.9% 4.8% 12.7%

Vitamin D def: Pearson chi2(8)=8.9759, P=0.344

The prevalence of Vitamin D deficiency among children aged six to 59 months of age was

found to be 12.4 per cent at national level. This suggests indicates a substantial

improvement since 2009, when prevalence stood at 39.8 per cent (Figure 29). An

improvement of the situation has been found in all regions, and most notably in GBAO and

DRS.

51


RESULTS

FIGURE 29 Time trends in prevalence of Vitamin D deficiency in children aged six to 59 months

TABLE 36: Percentage of children aged six to 59 months receiving Vitamin D supplementation in the previous six months

Number Yes No

Dushanbe 408 31.1% 68.9%

Khatlon 396 25.3% 74.7%

Sughd 405 33.1% 66.9%

DRS 413 29.1% 70.9%

GBAO 424 38.7% 61.3%


Pearson chi2(8) = 32.0446 Pr = 0.000

Rural 1,348 33.2% 66.8%

Urban 698 28.2% 71.8%

Pearson chi2(1) = 5.3492 Pr = 0.021

Boys 1,076 32.3% 67.7%

Girls 969 30.7% 69.3%

Pearson chi2(1) = 0.6759 Pr = 0.411

Less than a third of the children between six and 59 months of age (31.5 per cent) had

received vitamin D supplements in the six-month period prior to the interview. The

percentage was highest in GBAO (38.7 per cent) and lowest in Khatlon (25.3 per cent)

(Table 36).

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


58.9% 59.6%

66.7%

39.8%

19.4%22.5%

25.9%

8.6% 9.3%

2.6%

12.4%

40.7%

20092016

52


2016

RESULTS

3.4.5 Iodine status

A total of 1,720 urine samples were collected from children and analysed for urinary iodine

concentration (UIC). The median value of UIC was 87.5 µg/l (Table 37). A threshold of 100

µg/l is considered the minimal sufficient iodine concentration in urine and is therefore an

indicator for adequate iodine intake. Sughd showed the highest median value (124.4 µg/l),

and was the only region with the median value above the threshold. The lowest median

concentrations were found in GBAO and Dushanbe (73.5 µg/l and 73.9 µg/l respectively).

While variations between regions were strong, no significant differences were observed

concerning median UIC concentration between children living in urban and rural areas or

between boys and girls.

TABLE 37: Median urinary iodine concentration among children aged six to 59 months

Number Median (μg/l) 25th percentile (μg/l)

75th percentile (μg/l)

Dushanbe 328 73.9 39.1 130.8

Khatlon 317 103.1 45.4 183.2

Sughd 343 124.4 53.3 239.3

DRS 367 88.1 45.3 161.3

GBAO 365 73.5 39.8 117.1

National (weighted) 1,720 87.5 43.6 162.8

Rural 1,146 90.4 45.1 170.8

Urban 574 81.4 41.3 146.5

Boys 917 89.6 45.8 163.1

Girls 802 83.3 39.4 162.4

The median urinary iodine levels in 2003 and 2009 were 73.1 µg/l and 116.5 µg/L (Figure

30). This survey cannot reveal the reasons for these time trends, so that the underlying

causes may warrant further research.

53


RESULTS

FIGURE 30 Time trends in median iodine values (µg/L) in children aged six to 59 months

3.4.6 Deworming

Interviewed carers for children aged six to 59 months were further asked if their children

had received de-worming tablets in the previous six months. Around one out five children

aged between six and 59 months (20.7 per cent) had received deworming treatment. The

percentage was highest in Khatlon (31.4 per cent) followed by GBAO (30.0 per cent) and

lowest in Dushanbe (11.1 per cent) (Table 38). Differences between regions were

statistically significant (Pearson χ2

=92.53, p< 0.001), as they were between children living

urban and rural areas (Pearson χ2

= 7.60, p=0.006). However, no significant differences

were found between boys and girls. It should be noted the control efforts for helminths and

the national deworming campaign targets schoolchildren aged five to 14 years. Thus

children aged six to 59 months are not the target of these interventions and most likely

received deworming tablets for treatment purposes.

National level

116.5

73.187.5

2003 2009 2016

Sughd

175.8

75.0

124.4

DRS

72.958.3

88.1

GBAO

93.391.273.5

Khatlon

71.964.5

103.1

Dushanbe

107.7

73.9

no

da

ta



54


2016

RESULTS

TABLE 38: Percentage of children aged six to 59 months

who received de-worming tablets in previous months

Number Yes No

Dushanbe 423 11.1% 88.9%

Khatlon 407 31.4% 68.6%

Sughd 419 18.6% 81.4%

DRS 420 12.6% 87.4%

GBAO 427 30.0% 70.0%


Pearson chi2(4) = 92.5266 Pr = 0.000

Rural 1,370 22.5% 77.5%

Urban 726 17.4% 82.6%

Pearson chi2(1) = 7.5954 Pr = 0.006

Boys 1,103 20.5% 79.5%

Girls 992 20.9% 79.1%

Pearson chi2(1) = 0.0481 Pr = 0.826

3.5 Nutritional status of children less than six months of age (stunting, wasting and underweight)

In addition to children aged six to 59 months, children below six months of age were

included for anthropometric measurement and to investigate their feeding practices. A total

of 232 children were included in the final analysis.

The results revealed have to be taken with caution, as the sample for children below six

months was much smaller than that for the rest of the survey. Of these children, 4.4 per

cent were underweight (low WAZ, -2SD or more) (Figure 31; Annex 4, Table 4.1).

55


RESULTS

FIGURE 31 Prevalence of underweight children below six months of age

A total of 0.4 per cent of children aged under six months were severely stunted and another

2.6 per cent moderately stunted (Figure 32; Annex 4, Table 4.2).

The prevalence of wasting among children under six months of age was 13.7 per cent

(Figure 33; Annex 4, Table 4.3). Pronounced but not statistically significant regional

differences are observed in wasting, with the prevalence highest in GBAO. A high

prevalence of severely wasted children is also observed in Khatlon and DRS regions. The

weighted prevalence of severe wasting among children less than six months of age at

national level is surprisingly higher than among children 6-59 months of age, who are

typically more at risk of wasting. Thus, and given the small sample size, the prevalence

rates have to be interpreted very carefully.

FIGURE 32 Prevalence of stunted children under six months of age

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

severely underweight moderately underweight underweight (combined)

4.4%

3.5%

0.9%

National (weighted)

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

severely stunted moderately stunted stunted (combined)

3.1%

2.6%

0.4%

National (weighted)

56


2016

RESULTS

FIGURE 33 Prevalence of wasted children under six months of age

3.6 Breastfeeding and infant feeding of children under 24 months of age

3.6.1 Breastfeeding

Breastfeeding was assessed among mothers and carers of children between 0 and 23

months of age. As indicated in Table 39, around nine in out of 10 infants under two years of

age were or are breastfed (90.8 per cent). The prevalence was highest in DRS (94.6 per

cent) and lowest in Sughd (87.7 per cent) with generally small and insignificant differences

between the regions.

TABLE 39: Has the child ever been breastfed by region*

Region Number No Yes

Dushanbe 161 8.1% 91.9%

Khatlon 156 9.6% 90.4%

Sughd 171 12.3% 87.7%

DRS 166 5.4% 94.6%

GBAO 166 10.2% 89.8%

National (weighted) 820 9.2% 90.8%

* including those who are still breastfeeding (n=80)

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

severely wasted moderately wasted wasted (combined)

13.7%

9.7%

4.0%

National (weighted)

57


RESULTS

In most instances (76.0 per cent of cases), the mothers indicated that a health professional

helped with breastfeeding in the first week after delivery of the baby (Annex 5, Table 5.1).

Another 21.6 per cent of women indicated that nobody assisted them.

FIGURE 34 ‘Reported’ exclusive breastfeeding in months

Of those 90.8 per cent of mothers who were breastfeeding, 78.0 per cent reported

practising exclusive breastfeeding for at least the first three months, and 62.9 per cent for

the first five months (Figure 35). A large proportion of mothers stopped exclusive

breastfeeding between months five and six. Only 23.9 per cent of the mothers reported

breastfeeding their infant for the first six months and only 1.8 per cent for the first 12

months.

Of the whole sample, 95.2 per cent of women indicated that they breastfed their children on

demand and not at fixed intervals (Annex 5, Table 5.2). Breastfeeding at fixed intervals

rather than on demand was more frequent among women in GBAO (7.4 per cent of

mothers) and Sughd (7.3 per cent of mothers) and less frequent in DRS (1.9 per cent).

Data were collected from the women on feeding practices for infants under two years of

age (self-reported past practice), including breastfeeding, the feeding of solid and semisolid

foods, diversity of foods, and frequency of feeding. To analyse the periods of time that

mothers were exclusively breastfeeding their children, women who at the time of the survey

indicated that they were still breastfeeding were excluded from the analysis. The question

for exclusive breastfeeding was: ‘For how long did you exclusively breastfed your child?’

The information (number of months) provided by the mother stands for the last month.

10 2 3 4 5 6 7 8 9 10 11 12 13-18 19-24

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

DURATION (MONTHS) OF EXCLUSIVE BREASTFEEDING

92.4%

86.0%

78.0%

72.0%

62.9%

23.9%

16.0%11.3%

7.1% 5.4% 5.3%1.8% 1.0% 0%

58


2016

RESULTS

FIGURE 35 Trends in breastfeeding of children under two years (self-reported) (2009 and 2016)

These results are in line with the results of the survey conducted in 2009 (Figure 35), when

64.8 per cent of women indicated exclusively breastfeeding up to month five. The

prevalence of exclusive breastfeeding at month five found by the 2012 DHS was

substantially lower, at 20.6 per cent. This difference is mostly due to the different methods

used for calculation between the DHS and this survey: (i) DHS measures the current

practice of women while this survey measures past practice among those who had already

stopped breastfeeding; ii) DHS measures the actual practice by analysing the 24-hour

recall of the feeding practice, while this survey uses self-reported information on ‘exclusive

breastfeeding’. The latter can be influenced by the interviewees’ definition of ‘exclusive

breastfeeding’, which may include provision of plain water in addition to breastmilk, for

example. In fact, the proportion of infants reported by the DHS to be receiving breastmilk

and plain water only is very similar (63.8 per cent) to that found by this survey for self-

reported ‘exclusive breastfeeding’.

Figure 36 displays results from the questions to mothers: “After how many months did you

stop breastfeeding altogether?” Most of the interviewees (415 out of 661 or 63 per cent) did

not remember when they stopped breastfeeding at all. Of those able to answer, reported

stopping of breastfeeding was gradual and 85 per cent of mothers did breastfeed their

children during month four (thus 15 per cent did not breastfeed any more). At month six, 28

per cent did not breastfeed any longer (72 per cent continued), while at month 12, 65 per

cent did not breastfeed any longer (35 per cent continued).

The main reasons for stopping breastfeeding were not having enough milk any longer (41

per cent) and then a new pregnancy (24 per cent) (Annex 5, Table 5.3).

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%64.8% 62.9%

43.6%48.4%

Exclusively breastfeede at month 5 Breastfeeding and consumingcomplementary food at month 11

20092016

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RESULTS

FIGURE 36 Month when breastfeeding was stopped altogether

In summary, nearly all newborns in Tajikistan are breastfed. Typically, breastfeeding is

initiated promptly after delivery for most children. Exclusive breastfeeding is frequently

interrupted earlier than six months of age, the cut-off recommended by UNICEF and WHO.

Comparing the results in 2016 with the 2009 data, breastfeeding patterns are very similar.

3.6.2 Infant feeding

Table 5.4 in Annex 5 reveals the age of children when they were fed with food or liquids

other than breastmilk for the first time. It can be seen that besides water, infant formula and

milk/milk products are introduced to children below six months of age. Many other food

products such as “food made out of grains” or white roots and tubers are introduced to the

infant’s diet when the children are between six and eight months of age. Other foodstuffs,

such as “meat, poultry” or “other vegetables” are usually first given after the child’s first

birthday.

3.7 Child health and child care

3.7.1 Child care and development of children under two years of age

This subchapter summarizes the ‘Care and Development’ findings among children aged 0

to 23 months. Around nine in 10 (87.3 per cent) of the interviewed caregivers reported

having had contact with health workers (including patronage nurses) to assess child health

and development within the last six months (Table 40). The highest rate was observed in

Sughd (98.3 per cent) and the lowest in Khatlon (76.9 per cent). Regional differences were

statistically significant (χ2=33.9, p<0.001). However the frequency of contact did not differ

by urban/rural residence or gender.

10 2 3 4 5 6 7 8 9 10 11 12 13-18 19-24

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0% 98.0% 96.0%91.0%

85.0%82.0%

72.0%67.0%

63.0%

55.0%50.0% 48.0%

35.0%

9.0%

0%

MONTH WHEN BREASTFEEDING WAS STOPPED ALTOGETHER

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TABLE 39: Contact with health workers for child health and development

in the past six months by region, urban/rural residence and gender

Number Yes No

Dushanbe 161 87.6% 12.4%

Khatlon 156 76.9% 23.1%

Sughd 171 98.3% 1.7%

DRS 166 86.1% 13.9%

GBAO 166 86.8% 13.2%


Pearson chi2(4) = 33.9249 Pr = 0.000

Rural 534 86.5% 13.5%

Urban 286 88.8% 11.2%

Pearson chi2(1) = 0.8853 Pr = 0.347

Boys 433 85.0% 15.0%

Girls 387 89.9% 10.1%

Pearson chi2(1) = 4.4923 Pr = 0.034

TABLE 40: Place of contact with health worker for child health

and development by region, urban/rural residence and gender

Number Health centre/post At home

Dushanbe 141 36.9% 63.1%

Khatlon 120 35.0% 65.0%

Sughd 168 73.2% 26.8%

DRS 143 37.8% 62.2%

GBAO 108 25.0% 75.0%

National (weighted) 716 42.3% 57.1% Pearson chi2(4) = 88.5564 Pr = 0.000

Rural 462 43.5% 56.5%

Urban 254 41.7% 58.3%

Pearson chi2(1) = 0.2106 Pr = 0.646

Boys 368 44.3% 55.7%

Girls 348 41.4% 58.6%

Pearson chi2(1) = 0.6202 Pr = 0.431

Less than half the interviewed caregivers (42.3 per cent) visited a health post or health

centre and in 57.1 per cent of cases the contact with the health worker on child health and

development took place at home (Table 41). The lowest rate of mothers visiting health

workers was reported in GBAO (25.0 per cent). The highest rate of visits to health workers

was in Sughd region (67.9 per cent). Again, frequencies were significantly different for

regions (χ2=88.6, p<0.001), but not for urban/rural residence or gender.

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RESULTS

TABLE 41: Reason for contact with a health worker in the past six months by region,

urban/rural residence and gender

Number Growth monitoring

Child was sick

For prevention

(vaccination)

For advice on care and

development

Dushanbe 141 46.8% 11.4% 26.9% 14.9%

Khatlon 120 44.2% 14.2% 34.2% 7.5%

Sughd 168 33.9% 11.3% 28.0% 26.8%

DRS 143 51.8% 16.1% 20.3% 11.9%

GBAO 144 61.1% 6.2% 6.3% 26.4%

National (weighted) 716 47.2% 11.7% 22.9% 18.2% Pearson chi2(12) = 70.7827 Pr = 0.000

Rural 462 48.3% 11.3% 22.5% 18.0%

Urban 254 45.3% 12.6% 23.6% 18.5%

Pearson chi2(3) = 0.6775 Pr = 0.878

Boys 368 48.6% 12.0% 22.0% 17.4%

Girls 348 45.7% 11.5% 23.9% 19.0%

Pearson chi2(3) = 0.8711 Pr = 0.832

Most frequently the contact with a health worker for children aged 0 to 24 months was for

growth monitoring (47.2 per cent) (Table 42). A quarter (22.9 per cent) of the interviewed

population visited a health worker for their infant for preventive purposes. Preventive visits

were most common in Khatlon (20.8 per cent) and least common in GBAO (6.3 per cent).

Another 11.7 per cent of caregivers had contact with the health worker because the child

was sick. Once more, frequencies were significantly different for regions (χ2=70.8,

p<0.001), but not urban/rural residence or gender.

In Table 6.1 in Annex 6 the areas of advice to caregivers of children aged 0 to 24 months is

indicated. Most caregivers received advice from health workers on types of foods to be

given to the child (90.2 per cent). Slightly fewer (89.2 per cent) received advice on how to

feed a child, and 80.3 per cent were questioned about their infant’s milestones; ability to

walk, talk, and understand. Three quarters (77.3 per cent) of the mothers received advice

on childcare, discipline, and sleeping habits. Receiving advice on how to help the child with

learning was reported from 80.9 per cent of those interviewed. Generally these rates

tended to be lowest in DRS and GBAO.

More than two thirds of caregivers of children between 0 and 24 months of age reported

that their child had been weighed (73.0 per cent) or their height measured (73.0 per cent) in

the previous three months (Annex 6, Tables 6.2 and 6.3). For both weight and height

measurement, rates were lowest in DRS (60.1 per cent) and highest in GBAO (90.3 per

cent). Differences were significant between regions, but not by gender or for rural/urban

residence.

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3.7.2 Child health 6 to 59 months

Reported incidence of diarrhoea among children aged six to 59 months of age for a recall

period of two weeks was 12.1 per cent (Table 43). Significant differences were observed

between regions, with the highest prevalence in Khatlon (21.3 per cent of children had had

diarrhoea in the past two weeks) and the lowest prevalence in Sughd (6.8 per cent)

(χ2=46.82, p<0.001). Prevalence rates between children living in urban and rural areas and

between boys and girls did not differ significantly.

The most common reported drinks and products given to children in cases of diarrhoea are:

sugary water or fruit juices (63.0 per cent) and soup (60.3 per cent) (Annex 4, Table 4.1).

Another observation was that ORS packet solution is typically given to 58.8 per cent of

children. More than half of the caregivers also indicated that they typically give antibiotics

and anti-diarrhoeal drugs if their children have diarrhoea. Generally, 57.2 per cent reported

that their children drank more during diarrhoea episodes, and 4.8 per cent of the mothers

reported that their children were drinking significantly less. Meanwhile, 16.9 per cent

reported normal liquid intake, and 21.1 per cent did not know.

TABLE 42: Children aged six to 59 months with diarrhoea (more than three loose stools per day)

in the past two weeks by region

Number Yes No

Dushanbe 429 10.5% 89.5%

Khatlon 418 21.3% 78.7%

Sughd 428 6.8% 93.2%

DRS 429 10.5% 89.5%

GBAO 430 11.6% 88.4%

National (weighted) 2'134 12.1% 87.9%

Pearson chi2(4)=46.8288, P=0.000

Rural 1400 12.7% 87.3%

Urban 734 10.9% 89.1%

Pearson chi2(1)=1.4927, P=0.222

Boys 1127 13.0% 87.0%

Girls 1006 10.9% 89.1%

Pearson chi2(1) = 2.2312 Pr = 0.135

The reported rate of children aged six to 59 months diagnosed in the past with severe

malnutrition (stunting and/or wasting) was 8.8 per cent, with the highest rates in Khatlon

(19.5 per cent) and GBAO (12.6 per cent) (Annex 6, Table 6.6). Prevalence rates were

significantly different between regions, and significantly higher in rural areas. However, no

significantly different prevalence rates were observed between boys and girls. Those

children who were reported to have suffered in the past from severe malnutrition were

mostly medically treated (Annex 6, Table 6.7). Indeed, carers indicated that 86.2 per cent

of severely malnourished children received medical treatment.

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RESULTS

TABLE 43: Children aged six to 59 months diagnosed in the past with severe malnutrition by region and current stunting rates

Child 6 to 59 months of age

diagnosed in the past with severe malnutrition (as reported by

carers)

Child 6 to 59 months of age diagnosed and medically treated in

the past for severe malnutrition

Number Stunted Number 'Low length-for-

age' (stunted)

No Number 'Low length-for-age'

(stunted)

No

Dushanbe 430 10.5% 22 23.8% 76.2% 20 26.3% 73.7%

Khatlon 420 22.6% 82 30.9% 69.1% 61 29.0% 71.0%

Sughd 427 19.4% 13 23.1% 76.9% 13 23.1% 76.9%

DRS 425 24.0% 17 37.5% 62.5% 15 40.0% 60.0%

GBAO 420 22.4% 54 22.2% 77.8% 50 22.0% 78.0%

National (weighted) 2,122 20.9% 188 27.6% 72.4% 159 27.0% 73.0% Pearson chi2(4) =11.6942; Pr = 0.020

rural 1,386 23.2% 145 26.4% 73.6% 120 34.2% 65.8%

urban 736 13.3% 43 31.7% 68.3% 39 24.8% 75.2%

Pearson chi2(2) = 29.5048; Pr = 0.000

boys 1,118 20.2 108 30.8% 69.2% 91 30.0% 70.0%

girls 1,003 20.2 80 23.1% 76.9% 68 23.2% 76.8%

Pearson chi2(2) = 0.4020; Pr = 0.818

TABLE 44: Children aged six to 59 months of age diagnosed in the past with severe wasting by region and current wasting

Child 6 to 59 months of age diagnosed in the past with severe malnutrition (as reported by care

givers)

Child 6 to 59 months of age diagnosed medically treated in the

past for severe malnutrition

Number Wasted Number 'Low weight-for-

height' (wasted)

No Number 'Low weight-for-height' (wasted)

No

Dushanbe 431 2.6% 22 9.1% 90.9% 20 10.0% 90.0%

Khatlon 419 2.4% 82 6.3% 93.7% 61 6.6% 93.4%

Sughd 426 4.0% 13 0.0% 100.0% 13 0.0% 100.0%

DRS 426 1.6% 17 6.3% 93.7% 15 6.7% 93.3%

GBAO 425 6.6% 54 11.1% 88.9% 50 12.0% 88.0%

National (weighted) 2,127 2.8% 188 7.6% 92.4% 159 8.2% 91.8%

Pearson chi2(4) = 11.6942 Pr = 0.020

Rural 1,289 4.1% 145 7.0% 93.0% 120 7.5% 92.5%

Urban 738 2.2% 43 9.5% 90.5% 39 10.3% 89.7%

Pearson chi2(2) = 6.2090 Pr = 0.045

Boys 1,122 2.9% 108 5.6% 94.4% 91 5.5% 94.5%

Girls 1,004 4.0% 80 10.4% 89.6% 68 11.7% 88.3%

Pearson chi2(2) = 5.1148 Pr = 0.078

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RESULTS

Analysing children aged six to 59 months whose carers indicated that they had been

diagnosed in the past with severe malnutrition against current stunting (Table 44), reveals

that those diagnosed in the past as malnourished are today more frequently stunted: while

20.9 per cent of the whole sample was malnourished, this applied to 27.6 per cent of those

diagnosed in the past as severely malnourished. Similarly, those children who had been in

the past diagnosed and medically treated for severe malnutrition were shown by this survey

to more frequently be stunted (20.9 per cent of all children stunted; compared to 27.0 per

cent of children stunted who were diagnosed and treated for malnutrition in the past). The

same patterns arise when analysing children aged six to 59 months diagnosed in the past

with severe malnutrition against current wasting (Table 45).

The prevalence of reported vision problems among children aged six to 59 months was 0.6

per cent: the figure reached 1.7 per cent in Sughd (Annex 6, Table 6.8).

The interviewed carers reported that 0.6 per cent of their children were currently or had in

the past suffered from goitre (Annex 6, Table 6.9). Prevalence was highest in GBAO (1.7

per cent).

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RESULTS

4 Study limitations

Within this National Micronutrient Status Survey in Tajikistan (NMSS), quality measures

were taken to ensure an acceptable to good quality of field data collection, laboratory

analysis and data management. Various measures were taken to improve the reliability and

validity of the results. These include the following quality assurance measures:

During the pre-survey, the quality assurance was tested. Comprehensive training was

conducted for the field team (interviewers, laboratory technicians and supervisors) covering

interview techniques, sampling procedure, inclusion and exclusion criteria of target

population, sources of errors in taking measurements, standardizing questions in the

questionnaire, the levels of precision required in measurements, handling of equipment and

general courtesy in conducting a survey. In addition, the laboratory technicians received

extensive training from an experienced expert from the Swiss TPH in ELISA on testing

(serum ferritin, TfR, CRP, etc.) as well as on the Sandell-Kolthoff reaction used to measure

urinary iodine concentration.

During field data collection all the field teams were closely supervised by experts from the

MoHSP, UNICEF, and the Swiss TPH to ensure that the field work plan and the procedures

outlined in the field manual were respected and, as much as possible, standardized across

the field teams. All the field teams were contacted on a daily basis in order to address all

upcoming questions or issues immediately. The supervisors from MoHSP, UNICEF and

Swiss TPH also conducted unannounced on-site field visits.

The electronic data capturing through Open Data Kit (ODK) as well as the data analysis

included various quality control measures. During field data collection, the ODK form did

not allow data entry for unusual values. During the analysis all data were checked for

outliers and implausible data were handled as missing data. Using this procedure, any

outliers or mistakes could be detected and consequently not taken into account in the

analysis or replaced, depending on the magnitude of error.

Overall the study team considers the quality of data to be reasonably acceptable given the

prevailing realities in Tajikistan. Nevertheless the TNSS faced various limitations and

biases. Of these, those felt to be the most important are as follows:

Interview quality and translation: Interviewer bias and response bias are possible areas

that could have weakened the strength and quality of the data. On the guidance of

the MoHSP, the questionnaire was only applied in Tajik and not in other vernacular

languages such as Uzbek, the Pamiri languages or Russian. Though the field

teams were closely monitored by MoHSP, UNICEF and the Swiss TPH, there is a

possibility that the interviews were not always conducted at highest standards and

that this could have led to inadequate responses by interviewees, particularly with

regard to general household characteristics, household food security and attitudes

about nutrition (but not with regard to the anthropometric measurement and

biological testing).

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Anthropometric measurement – height: It is well known that measurement of height

under field conditions can pose problems and be of insufficient quality. Though the

field teams were well trained on this before the start of data collection and were

also monitored in the daily execution of their operations; the precision and accuracy

of their measurement skills was not standardized before the survey. During data

analysis data were then checked for plausibility and extreme outliers as defined by

WHO. Overall 18 extreme outliers were spotted. In the course of the analysis their

influence was verified and both frequencies are provided in the report (with and

without the extreme outliers). Thus it is observed that differences are small.

Anthropometric measurement – weight: The deduction of weight due to the fact that

children and women were dressed when they were weighed was handled differently

within and across the twelve field teams: some teams did adjust, but in most

instances this was not consistent over the entire period of data collection. During

data analysis no consistent approach with a good rationale could be identified on

how to deal with this situation. This said the adjustment (if done) by most of the field

teams for children were between 100g and 200g respectively for children and 300g

to 500g for women. This weight corresponds roughly to drinking one or two glasses

of water, and is thus unlikely to substantially influence the results. The study team

therefore considers that no major bias has been introduced at this level, though

some imprecisions in the anthropometric measurements may arise.

Collection of biological samples, labelling, transport and storage: The survey required

several thousand blood and urine samples to be collected, labelled, centrifuged,

frozen, transported, and stored in Dushanbe. In the first days of data collection it

was not always possible to sample enough capillary blood (400 µl), particularly

among children. In addition, the labelling and storage of samples presented major

challenges so that in the course of the sample analysis some batches could no

longer be linked to a unique identifier and thus had to be excluded from the

analysis. Other samples could not be attributed to given persons. However, for the

biological analysis, at least 90 per cent of the samples of women and children could

be included in the study. We consider this to be a high percentage given the

prevailing conditions in Tajikistan. At the same time it is not possible to exclude the

possibility that a bias has been introduced. In which direction such a possible bias

would have distorted the results is, however, impossible to indicate.

Capillary blood and haemolysis: The biological sample analysis relied on a capillary

collection of 400 µl of blood, which was centrifuged and frozen shortly after

collection. It was not in possible all instances to avoid haemolysis, or tissue fluids

entering the collection tubes. Some of the serum samples showed a slightly reddish

coloration, indicating slight haemolysis. All available serum samples were analysed

irrespective of possible haemolysis. All the tests used, and thus the test results, are

however unlikely to have been influenced by haemolysis or tissue fluids (with the

possible exception of CRP).

Laboratory analysis: Overall, around 20,000 ELISA tests had to be conducted in a

relatively short time period by five laboratory technicians who were not familiar with

all the particularities of the procedures and had to be trained before starting. Their

adherence to written standard operating procedures had to be assured over a five-

week period. Meanwhile, some of the infrastructural conditions at the Research

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RESULTS

Laboratory of Preventive Medicine of the Republic of Tajikistan were relatively poor.

So to guarantee to laboratory analysis at the highest possible standards, a

laboratory technician from Swiss TPH assisted the Research Laboratory of

Preventive Medicine and acted as quality assurance expert. Overall the study team,

however, considers that these constraints did not influence the quality of the

biological analysis in a substantive way.

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5 Conclusions and recommendations

5.1 Salt iodization

The MBI rapid test kit used in this survey provides a good qualitative indication of the

presence or absence of iodine, but does not allow the level of iodization to be determined.

Comparing the results of the 2016 National Micronutrient Status Survey in Tajikistan with

the previous two in 2003 and 2009, as well as the 2012 DHS, there has been no progress

with regard to iodization of the salt used by households (Table 46) and an increase in

households relying on non-iodized salt from 17.6 per cent in 2009 to 26.0 per cent in 2016.

TABLE 45: Time trends in use of non-iodized salt by households (2003, 2009, 2012 and 2016)

2003 NMSS

2009 NMSS

2012 DHS

2016 NMSS

Salt non iodized

National: 47.7% max: 78.7% Khatlon min: 19.0% GBAO

National: 17.6% max: 22.8% Khatlon min: 2.7% Sughd

National: 15.9% max: 25.1% DRS min: 8.0 Dushanbe

National: 26.0% max: 35.7% Khatlon min: 11.1% Sughd

The number of households consuming iodized salt increased from 52.3 per cent in 2003 to

74 per cent in 2016. However, the 2012 DHS indicated a higher prevalence, with 84.1 per

cent of household using iodized salt compared to 74.0 per cent in 2016.

Therefore, the goal of 90 per cent of households consuming iodized salt in order to ideally

eliminate iodine deficiency disorder has not yet been reached, and further efforts are

needed.

5.2 Nutritional and micronutrient status of women Underweight among women at national level fell from 8.6 per cent in 2003 to 6.7 per cent

in 2009 but then increased again to 8.0 per cent in 2016 (Table 47). Typically prevalence of

BMI less than 18.5 in between 5 per cent and 9 per cent of the population indicates low

prevalence but is interpreted as a warning sign requiring regular monitoring.

The overall prevalence of overweight and obesity was found to be increasing: 37.6 per

cent of women between 15 to 49 years of age had BMI in 2016 higher than 25 compared to

28.2 per cent in 2009 and 25.6 per cent in 2003. Compared to 2009, a sizeable increase in

overweight/obesity can be seen in Khatlon and Sughd. The prevalence of women with BMI

≥25 was significantly higher in urban areas (41.2 per cent) than rural areas (31.9 per cent).

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RESULTS

These trends indicate that overweight is a matter of concern from a public health

perspective.

While between 2003 and 2009 a remarkable improvement was observed regarding

anaemia (Hb<12g/dl) among women, prevalence remained stable between 2009 and 2016

with 25.8 per cent of women anaemic in 2016. Though there was economic growth in

Tajikistan as measured by GDP between 2009 and 2016, the overall prevalence of

anaemia seems not to have been positively influenced by this.

TABLE 46: Summary of main results relating to women aged 15 to 49 years in 2003, 2009 and 2016

2003 2009 2016

BMI < 18.5 National: 8.6% max: 20.2% GBAO min: 5.5% DRS

National: 6.7% max: 9.4% GBAO min: 5.1% DRS

National: 8.0% max: 13.1% GBAO min: 7.4% Dushanbe

BMI > 25 National: 25.6% max: 36.6% DRS min: 12% GBAO

National: 28.2% max: 42.2% Dushanbe min: 18.1% GBAO

National: 37.6% max: 43.0% Dushanbe min: 21.0% GBAO

Anaemia Hb < 12 g/dl

National: 41.2% max: 62.9% Khatlon min: 29.0% DRS National mean Hb: 12.2 g/dl

National: 24.2% max: 29.8% GBAO min: 19.0% Sughd National mean serum Hb concentration: 12.8 g/dl

National: 25.8% max: 34.3% Khatlon min: 19.4% Sughd National mean serum Hb concentration: 12.7 g/dl

IDA IDA defined in 2003 and 2009 as low Hb (<12.0g/dl) and elevated sTfR IDA defined in 2016 as low Hb (<12.0g/dl) and either low Ferritin or elevated sTfR

National: 29.2% max: 36.1% Khatlon min: 23.2% DRS

National: 4.8% max: 7.5% GBAO min: 3.6% Sughd National mean sTfR: 1.2 µg/ml


Vitamin A deficiency RPB ≤ 0.70µmol/l

Not available Not available

National: 46.5% max: 66.6% Khatlon min: 36.4% DRS National mean: 1.5 µmol/l

Folate deficiency Serum folate <3ng/ml

Not available Not available

National: 20.5% max: 35.3% GBAO min: 14.6% Sughd National mean: 6.3 ng/ml

median Urinary Iodine Concentration

National: 93.6 µg/l max: 126.7 µg/l GBAO min: 65.7 µg/l Khatlon

National: 107.8µg/l max: 178.5µg/l Sughd min: 61.8µg/l Khatlon

National: 75.0µg/l max: 113.9µg/l Sughd min: 61.5µg/l GBAO

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Iron deficiency anaemia (IDA) was defined in 2003 and 2009 as women having an

elevated sTfR. In 2016, IDA was defined as low Hb (<12.0 g/dl) and either low Ferritin or

high sTfR. Given the different definition of IDA, time trends are difficult to judge. This said,

and given the less stringent definition of IDA in 2016, it can be assumed that IDA

prevalence has remained stable since 2009, with 13.8 per cent of women being deficient.

Vitamin A was not measured in 2003 and 2009. In 2016, the national weighted prevalence

of vitamin A deficiency among women was 46.5 per cent. Prevalence rates were nearly

twice as high in Khatlon (66.6 per cent of women) than in DRS (35.3 per cent). Population-

based prevalence rates above 20 per cent typically mean that Vitamin A deficiency is seen

as important public health problem (WHO 2011).

Like vitamin A, folate status was not assessed in 2009. In 2016 the nationally-weighted

prevalence of folate deficiency stood at 20.5 per cent of women between 15 and 49 years

of age. Prevalence rates were highest in GBAO (35.3 per cent) and lowest in Sughd (14.6

per cent).

The median value of urinary iodine concentration (UIC) was 75.0 µg/l, well below the

threshold of 100.0 µg/l. Sughd showed the highest median value (113.9 µg/l) and the

lowest median concentrations were found in GBAO and Dushanbe (61.5 µg/l and 61.6 µg/l

respectively). The median UIC value among women in 2016 was substantially lower than in

2003 and 2009 and corresponds to an increase in the proportion of households relying on

non-iodized salt between 2009 and 2016. 5.3 Nutritional and micronutrient status of children

The nutritional status of children aged 6-59 months living in Tajikistan, as measured

anthropometrically, improved considerably in recent years. The prevalence of underweight children fell from 8.4 per cent in 2009 to 6.9 per cent in 2016. The prevalence of stunted

children fell from 36 per cent in 2003 to 29.3 per cent in 2009 and then 20.9 per cent in

2016. However, this prevalence is still considered high, and stunting remains of public

health importance in Tajikistan. Finally, the prevalence of wasted children continued to

decrease from 8.8 per cent in 2003 to 4.5 per cent in 2009 and then to 3.0 per cent in 2016.

This is below the WHO threshold of 5–9 per cent of children, which would be considered a

severe public health problem.

Anaemia is a common health problem in children under five years of age. The survey

indicated an overall prevalence of anaemia of 25.8 per cent. The highest prevalence of

anaemic children was found in GBAO. Regional variations were statistically significant, as

were variations between children living in urban and rural areas (with prevalence rates

higher among children living in rural areas). Compared to 2009, a slight improvement on

anaemia in children could be reported. Prevalence of anaemia (Hb<11g/dl) fell from 62.3

per cent in 2003 to 28.7 per cent in 2009 and then to 26.4 per cent in 2016.

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RESULTS

TABLE 47: Summary of main results relating to children aged six to 59 months in 2003, 2009 and 2016

2003 2009 2016

Stunting National: 36% max: 41.3% GBAO min: 29.4% DRS

National: 29.4% max: 36.9% Khatlon min: 21.8% Dushanbe

National: 20.9%

max: 24.0% DRS min: 10.5% Dushanbe

Wasting National 8.8% max: 11.9% Khatlon min: 6.3% GBAO

National: 4.6% max: 7.2% DRS min: 2.2% Sughd

National: 2.8% max: 6.6% GBAO min: 1.6% DRS

Underweight National: 8.4 % max: 10.5% Khatlon min: 5.9% Sughd

National: 6.2% max: 13.8% GBAO min: 4.7% Khatlon

Anaemia

National: 62.3% max: 69.4% Sughd min: 45.0% GBAO

National: 28.8% max: 40.1% GBAO min: 25.3% Khatlon National mean serum Hb concentration: 11.6 g/dl

National: 25.8% max: 43.4% GBAO min: 16.5% Dushanbe National mean serum Hb concentration*: 11.6 g/dl

IDA IDA defined in 2003 and 2009 as elevated sTfR (>3.3 µg/ml) IDA defined in 2016 as low Hb (<11.0g/dl) and either low Ferritin or high sTfR

National: 38.8% max: 42.3% GBAO min: 33.0% Sughd

National: 8.6% max: 15.6% DRS min: 5.3% Dushanbe National mean sTfR: 1.6 µg/ml


Vitamin A deficiency

In 2003 analysed through HPLC In 2016 analysed through RPB Vitamin A ≤ 0.70µmol/l

National: 30% max: 35.6% Sughd min: 22.0% DRS National mean: 0.9 µmol/l

National: 37.0% max: 49.7% Sughd min: 21.1% Dushanbe National mean: 2.3 µmol/l

Vitamin D deficiency Vitamin D <19.6ng/ml Not available

National: 39.8% max: 66.7% GBAO min: 25.9% Sughd National mean: 22.5 ng/ml

National: 12.4% max: 22.5% Khatlon min: 2.6% GBAO National mean: 49.2 ng/ml

median Urinary Iodine Concentration

National: 73.1µg/l max: 91.2 µg/l GBAO min: 58.3 µg/l DRS

National: 116.5µg/l max: 176.8 µg/l Sughd min: 71.9 µg/l Khatlon

National: 87.5µg/l max: 124.4 µg/l Sughd min: 73.5 µg/l GBAO

In 2016, the national weighted prevalence of Vitamin A deficiency among children aged

six to 59 months was 37.0 per cent. Prevalence rates were more than twice as high in

Sughd than in Dushanbe, and prevalence rates were significantly higher among children

living in rural areas. Vitamin A measurement was not conducted in 2009, and a different

method was used in 2003 so comparison is problematic. Nevertheless with 37 per cent of

children suffering from vitamin A deficiency, population based prevalence is significantly

higher than 20 per cent, which is considered by WHO to be the threshold for vitamin A

deficiency being an important public health problem (WHO 2011).

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2016

RESULTS

In 2009, the prevalence of vitamin D deficiency among children stood nationally at 39.8

per cent. This prevalence rate has now fallen to 12.4 per cent of children in 2016. Thus,

prevalence has evolved in a very positive way.

The national median urinary iodine for children was 73.1 µg/l in 2003, 116.5 µg/L in 2009,

and 87.5 µg/l in 2016. Thus the median value substantially decreased between 2009 and

2016. Urinary iodine concentration (UIC) above 100 ug/l is the threshold for considering the

iodine status of the population to be adequate.

5.4 Recommendations

Based on the study results the following recommendations emerge:

1. Improvements were reported on anthropometric measurements, but the stunting rate

is still very high at over 20 per cent. Given that the determinants of chronic

malnutrition, including stunting, are multifaceted, continued collaborative efforts are required to scale up programmes that span multiple sectors, especially health, agriculture, education, water, sanitation and hygiene, the environment, social protection, and economy. Such multi-sectoral approaches at multiple levels should

take into account the double-burden of under- and over-nutrition across the life cycle.

2. Under-nutrition is a particularly vital issue during the 1,000 days window of opportunity

between a woman’s pregnancy and her child’s second birthday. Children in this age

category are most affected by stunting (25-36 months and 13-24 months) and

anaemia (6-12 months and 13-24 months). Poor infant and young child feeding

practices are among the main underlying causes. Consider introducing a holistic, innovative, and multi-sectoral first 1,000 days programme in Tajikistan, with an initial focus on infant and young child feeding (IYCF) and maternal nutrition practices.

3. The new prevalence of severe wasting (severe acute malnutrition – SAM) still means

the estimated annual burden of nearly 30,000 among children under five. Given the

low coverage of SAM treatment services at present, there is an urgent need for a

scale-up plan, while longer-term prevention efforts should continue. Before making

decisions about scaling up integrated management of acute malnutrition (IMAM)

programme in the new locations, it is imperative to conduct an active case finding / screening phase and ensure integration of the protocol on SAM management into the routine service package of the secondary and tertiary levels of care

(rather than a stand-alone programme).

4. The prevalence of nutritional disorders among women and children – such as iodine,

iron and Vitamin A deficiency – remains at high levels, indicating continued need for

specific public health measures in Tajikistan. Continued emphasis needs to be given

to multiple approaches: infant and young child feeding promotion, flour fortification, home fortification with micronutrient powders or supplementation of iron drops for children aged 6-24 months, and supplementation with iron/folate tablets or multi-micronutrients for pregnant women.

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RESULTS

5. Food fortification continues to one of the most effective interventions to address

persistent micronutrient gaps in the population, such as iodine, iron and folic

deficiency. Coordinated joint efforts to accelerate these interventions are required.

i) Accelerate the passing of the law on flour fortification to help prevent major

birth defects of the baby’s brain and spine caused by folic deficiency ii) Renew and elevate the commitment toward Universal Salt Iodisation at all

levels, particularly through addressing the supply-side problems such as iodized salt production and quality control and regulation.

6. The survey produced a wealth of information but due to its design does not provide

indications of the effectiveness of existing micronutrient supplementation initiatives.

This may warrant complementary studies on the effectiveness of existing interventions such as micronutrient supplementation programmes – including

sprinkles distribution, the Vitamin A campaign, iron/folate supplementation among

pregnant women. These should include compliance issues, so as to further strengthen

the evidence base for nutritional interventions in Tajikistan.

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2016

RESULTS

Annex 1:

Detailed results – Household characteristics

TABLE 1.1

Number of rural and urban households per region

Total number of households

% rural % urban

Dushanbe 306 0% 100%

Khatlon 269 86% 14%

Sughd 314 73% 27%

DRS 254 83% 17%

GBAO 381 83% 17%

Total 1,524 65% 35%

TABLE 1.2 Type of dwelling of households

Number Communal flat House Other

Dushanbe 306 80.4% 19.6% 0.0%

Khatlon 269 3.3% 96.7% 0.0%

Sughd 314 11.5% 88.2% 0.3%

DRS 254 6.3% 93.7% 0.0%

GBAO 381 11.5% 87.9% 0.5%


Rural 986 0.8% 99.2% 0.0%

Urban 538 63.8% 35.7% 0.6%

TABLE 1.3 Persons per household

Number 1-3 persons per household

4-6 persons per household

7 or more persons per household

Dushanbe 306 7.2% 47.7% 45.1%

Khatlon 269 0.7% 23.4% 75.8%

Sughd 314 2.5% 38.9% 58.6%

DRS 254 1.2% 25.2% 73.6%

GBAO 381 3.9% 48.0% 48.0%

National (weighted) 1,524 2.1% 31.2% 66.8% Rural 986 2.1% 32.9% 65.0%

Urban 538 5.4% 47.2% 47.4%

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RESULTS

TABLE 1.4 Ethnic background of households

Number Tajik Uzbek Russian Kyrgyz Other

Dushanbe 306 95.4% 3.6% 0.3% 0.0% 0.7%

Khatlon 269 79.9% 20.1% 0.0% 0.0% 0.0%

Sughd 314 66.9% 31.5% 0.0% 1.6% 0.0%

DRS 254 79.9% 13.4% 0.0% 6.7% 0.0%

GBAO 381 91.9% 0.0% 0.0% 8.1% 0.0%

National (weighted) 1,524 77.7% 19.9% 0.0% 2.3% 0.1%

Rural 986 77.1% 17.6% 0.0% 5.3% 0.0%

Urban 538 94.8% 4.5% 0.2% 0.2% 0.4%

TABLE 1.5 Gender of household head

Number Male Female

Dushanbe 306 81.7% 18.3%

Khatlon 269 85.5% 14.5%

Sughd 314 72.9% 27.1%

DRS 254 87.8% 12.2%

GBAO 381 86.4% 13.6%


Rural 986 84.6% 15.4%

Urban 538 79.4% 20.6%

TABLE 1.6 Educational attainment of household head

Number None Primary (Grades 1-9)

Secondary (Grades 10-

11)

Vocational / technical education

Higher education

Dont know

Dushanbe 306 1.0% 0.7% 35.3% 11.1% 50.7% 1.3%

Khatlon 269 0.7% 8.9% 56.1% 14.9% 17.1% 2.2%

Sughd 314 0.3% 5.4% 63.4% 15.6% 15.3% 0.0%

DRS 254 0.0% 3.1% 64.2% 12.2% 20.5% 0.0%

GBAO 381 0.0% 1.6% 48.3% 24.1% 26.0% 0.0%

National* 1,524 0.4% 5.5% 58.2% 14.3% 20.7% 0.9%

Rural 986 0.2% 5.3% 59.3% 17.3% 17.2% 0.6%

Urban 538 0.7% 0.9% 40.9% 13.9% 42.8% 0.7%

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2016

RESULTS

TABLE 1.7 Main source of drinking water for household members by region

Number Piped-in dwelling

Public tap

Tube well or

borehole

Protected dug well or

protected spring

Unprotected dug well or spring,

rainwater

Pond, river or stream

Tanker/truck

Bottled water

Other

Dushanbe 306 34.0% 64.0% 0.0% 0.0% 0.0% 0.0% 1.6% 0.3% 0.0%

Khatlon 269 10.8% 39.4% 6.0% 3.4% 4.8% 14.5% 4.8% 9.3% 7.1%

Sughd 314 8.3% 55.7% 22.5% 2.2% 0.6% 13.7% 12.7% 0.0% 1.6%

DRS 254 5.1% 56.3% 2.0% 12.6% 1.6% 11.0% 5.5% 0.0% 5.9%

GBAO 380 9.5% 41.6% 9.0% 6.3% 0.0% 33.4% 0.0% 0.0% 0.3%


Rural 986 6.0% 46.2% 6.8% 6.9% 0.0% 3.2% 4.1% 0.4% 3.0%

urban 537 27.8% 60.2% 0.7% 0.7% 1.9% 22.3% 5.1% 2.4% 2.4%

TABLE 1.8 Regularity of water availability among those households with piped water access by region

Number Constant Once a day Every two or more days

Depends on season

Dushanbe 103 92.2% 5.8% 0.0% 1.9%

Khatlon 29 55.2% 3.5% 0.0% 41.4%

Sughd 26 61.5% 11.5% 11.5% 15.4%

DRS 13 76.9% 7.7% 7.7% 7.7%

GBAO 36 100.0% 0.0% 0.0% 0.0%

National (weighted) 208 83.6% 5.3% 1.9% 9.2%

Rural 59 62.7% 5.1% 6.8% 25.4%

Urban 148 91.9% 5.4% 0.0% 2.7%

TABLE 1.9 Clearness (non-turbidity) of water used by households by strata

Number of answers Yes No Sometimes

Dushanbe 306 86.6% 5.6% 7.8%

Khatlon 269 66.5% 4.8% 28.6%

Sughd 314 88.9% 3.2% 8.0%

DRS 254 88.2% 2.0% 9.8%

GBAO 380 93.2% 5.3% 1.6%

National (weighted) 1,523 85.4% 4.3% 10.3% Rural 986 84.9% 3.5% 11.7%

urban 537 86.4% 5.8% 7.8%

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RESULTS

TABLE 1.10 Type of toilet facility used by household members by strata

Number of answers

Flush to sewage system

Flush to septic tank

Pour flush latrine

Covered by dry

latrine (luft closet)

Uncovered latrine

No facilities

at all

Dushanbe 306 88.9% 0.3% 10.5% 0.3% 0.0% 0.0%

Khatlon 269 3.7% 0.0% 95.9% 0.1% 0.4% 0.0%

Sughd 314 11.8% 0.3% 87.3% 0.3% 0.3% 0.0%

DRS 254 4.9% 0.0% 94.1% 0.0% 0.4% 0.0%

GBAO 380 9.0% 0.0% 90.8% 0.0% 0.0% 0.3%

National (weighted) 1,523 24.2% 0.1% 75.4% 0.1% 0.1% 0.0%

Rural 986 0.5% 0.0% 99.2% 0.1% 0.1% 0.1%

urban 538 67.6% 0.3% 31.7% 0.2% 0.2% 0.0%

TABLE 1.11 Use of soap today or yesterday by interviewee by region

Number of answers

Yes No

Dushanbe 306 96.4% 3.6%

Khatlon 269 93.3% 6.7%

Sughd 314 97.8% 2.2%

DRS 254 96.9% 3.1%

GBAO 380 98.2% 1.8%


rural 986 96.3% 3.7%

urban 537 97.2% 2.8%

TABLE 1.12 Reasons for use of soap by those who used soap today or yesterday by strata

Number Washing clothes

Washing my body

Washing my

children

Washing my

children hands

Washing hands

after defecati

ng

Washing hand

before feeding the child

Washing hand before

preparing food

Washing hands before eating

Other

Dushanbe 295 81.4% 68.8% 68.5% 92.9% 89.8% 82.0% 87.5% 82.2% 6.1%

Khatlon 251 80.5% 83.3% 82.3% 83.7% 65.7% 74.1% 76.1% 72.5% 1.2%

Sughd 307 82.1% 60.9% 68.7% 88.3% 79.5% 81.8% 84.4% 92.2% 16.3%

DRS 246 85.4% 48.8% 45.5% 74.0% 69.1% 68.3% 72.8% 74.8% 3.3%

GBAO 373 83.4% 46.7% 37.0% 66.2% 68.6% 65.4% 69.2% 69.4% 11.0%


rural 950 83.2% 54.4% 53.4% 76.8% 69.4% 71.8% 74.6% 76.5% 8.4%

urban 522 80.3% 72.0% 69.7% 87.0% 84.5% 78.4% 83.5% 86.8% 7.7%

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2016

RESULTS

TABLE 1.13 Number of households with a disabled child below 5 years

Number of households

Blindness Deafness Motor disability

Mental disability

Dushanbe 306 1 1 1 1

Khatlon 269 0 0 0 1

Sughd 314 0 0 1 2

DRS 254 0 0 4 0

GBAO 381 0 0 3 0

National 1,524 1 1 9 4 Rural 986 0 0 6 3

Urban 538 1 1 3 1

TABLE 1.14 Interviewees’ recognition of importance of using iodized salt for health by strata

Number Yes No

Dushanbe 260 100.0% 0.0%

Khatlon 181 97.8% 2.2%

Sughd 229 99.1% 0.9%

DRS 179 100.0% 0.0%

GBAO 291 98.3% 0.7%

National (weighted) 1,140 99.0% 1.0% Rural 698 98.7% 1.3%

Urban 442 99.6% 0.4%

TABLE 1.15 Reasons provided by interviewees for the use iodized salt by strata

Number Prevents goitre

Number Enables foetus to develop normally during

pregnancy

Number Mental development

Number Other

Dushanbe 256 99.2% 187 25.1% 205 32.7% 196 0.5%

Khatlon 169 97.6% 114 17.5% 118 22.0% 118 5.9%

Sughd 226 98.7% 162 45.1% 174 55.2% 157 0.6%

DRS 179 98.9% 150 8.7% 151 13.9% 164 0.0%

GBAO 268 93.7% 242 9.5% 244 16.8% 244 5.7%

National (weighted) 1,098 97.5% 855 20.6% 892 28.1% 879 2.6%

Rural 670 96.3% 538 17.3% 556 26.4% 556 3.6%

Urban 428 99.3% 317 26.2% 336 31.0% 323 0.9%

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RESULTS

Annex 2:

Detailed results – Nutritional and micronutrient status of women

TABLE 2.1 Prevalence of BMI in women, by urban/rural residence

Residence Number BMI < 18.5 BMI 18.5 - 24.9

BMI ≥ 25 Pearson χ2 P-Value

National 21.3 < 0.001

Rural 1,397 8.6% 59.6% 31.9%

Urban 735 9.4% 49.4% 41.2%

BMI: ≤ 17 = severe to moderate malnutrition; 17.0-18.4 = at risk; 18.5-24.9 = normal; 25.0-29.9 = overweight (pre-obese); ≥ 30 obese

TABLE 2.2 BMI level in women by urban/rural residence

Residence Number Mean Standard deviation

95% CI P-Value (ttest)

National

< 0.001

Rural 1,397 23.7 4.7 (23.5, 24.0)

Urban 735 24.7 5.4 (24.3, 25.1)

BMI: ≤ 17 = severe to moderate malnutrition; 17.0–18.4 = at risk; 18.5 – 24.9 = normal; 25.0 – 29.9 = overweight (pre-obese); ≥ 30 obese

TABLE 2.3 BMI classes distribution by age

Age Number BMI <18.5 BMI 18.5-25 BMI ≥25

15-24 632 14.7% 67.6% 17.7%

25-40 1,277 7.0% 53.8% 39.2%

41-49 223 3.1% 36.3% 60.5%

Total (non weighted) 2,132 8.9% 56.1% 35.1%

BMI: ≤ 17 = severe to moderate malnutrition; 17.0–18.4 = at risk; 18.5 – 24.9 = normal; 25.0 – 29.9 = overweight (pre-obese); ≥ 30 obese

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2016

RESULTS

TABLE 2.4 Haemoglobin concentration (g/dl), mean, SD and median in women

Region nb mean (g/dl) SD median (g/dl)

Dushanbe 425 13.0 1.4 13.1

Khatlon 421 12.4 1.7 12.5

Sughd 428 13.0 1.4 13.2

DRS 427 12.8 1.5 13.0

GBAO 425 12.5 1.4 12.6

National (weighted) 2,126 12.7 1.5 Bartlett's test for equal variances: chi

2 = 21.6846 ; degrees of freedom [df] = 4; P= 0.000

TABLE 2.5 Haemoglobin concentration (g/dl) in women by urban/rural residence

Residence Number mean (g/dl) SD 95% CI P-Value (ttest)

National

< 0.001

Rural 1,398 12.6 1.5 (12.5;12.7)

Urban 728 12.9 1.4 (12.8;13.0)

TABLE 2.6 Prevalence of anaemia in women, by urban/rural residence

Residence nb Hb<10g/dl Hb 10-11.9g/dl

Hb≥12g/dl Hb<12g/dl Pearson χ2 P-Value

National

13.21 0.004

rural 1,397 4.9% 22.8% 72.2% 27.8%

urban 728 2.6% 18.5% 78.8% 21.2%

TABLE 2.7 Age categories and anaemia distribution among women

Age category nb Hb<7g/dl Hb 7-9.9g/dl Hb 10-11.9g/dl Hb>12g/dl

15-24 631 0.3% 2.1% 18.1% 79.6%

25-40 1,273 0.4% 3.8% 23.4% 72.3%

41-49 221 0.9% 7.7% 19.0% 72.4%

National (weighted) 2,125 0.6% 3.5% 21.7% 74.2%

Uncorrected Pearson chi2 = 24.8874, df = 6, P = 0.000

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RESULTS

TABLE 2.8 Prevalence of inflammation (CRP >5μg/ml) among women by region

Region Number Inflammation

Dushanbe 388 88.9%

DRS 396 80.8%

Khatlon 373 79.1%

Sughd 416 76.9%

GBAO 393 86.8%


TABLE 2.9 Serum ferritin concentration (ng/ml) overall and corrected

for inflammation among women aged 15-49 years by region

Region Number Geometric mean (ng/ml)

SD Geometric mean (ng/ml) corrected for inflammation*

SD

Dushanbe 405 34.1 1.8 27.3 1.7

Khatlon 379 28.8 1.8 23.6 1.7

Sughd 418 23.2 2.0 19.3 1.9

DRS 400 24.7 1.8 20.3 1.8

GBAO 407 29.4 1.9 23.7 1.8

National (weighted) 2,009 26.5 1.0 22.7 1.0

* SF*0.77 if CRP≥5 (Thurnham 2010) GM: oneway Anova F=12.85; P<0.0000; Bartlett's Test for equal variances: chi2= 11.6978; df = 4, P<0.020; Scheffe's Test p<0.05 for comparison region Dushanbe/DRS, Khatlon/Sughd, Sughd/GBAO. GM corrected for inflammation: oneway Anova F=11.15; P<0.0000; Bartlett's Test for equal variances: chi2= 14.4555; df

= 4, P<0.006; Scheffe's Test p<0.05 for comparison region Dushanbe/DRS, Dushanbe/Sughd, Khatlon/Sughd,

GBAO/Sughd.

TABLE 2.10 Serum ferritin concentration (ng/ml) overall and corrected

for inflammation among women aged 15-49 years by urban/rural residence (CRP ≥5μg/ml)

Residence Number Geometric mean (ng/ml)

SD 95% CI P-Value (Two-sample t test with equal variances)

National not corrected for inflammation 0.0000 Rural 1,316 25.9 1.9 24.7-27.1

Urban 693 31.7 1.9 29.8-33.8

National corrected for inflammation

0.0000 Rural 1,316 21.3 1.8 20.3-22.3

Urban 693 25.7 1.8 24.1-27.3

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2016

RESULTS

TABLE 2.11 sTfR concentration (µg/ml) in women by urban/rural residence

strata Number Geometric mean (µg/ml)

SD 95% CI P-Value (Two-sample t test with equal variances)

National 0.0368 Rural 1,292 2.0 1.1 (2.0, 2.0)

Urban 649 1.9 1.1 (2.0, 2.1)

TABLE 2.12 Body iron stores among women aged 15-49 years by region

Region Number Negative (SF<15ng/ml)

Positive

Dushanbe 355 8.5% 91.5%

Khatlon 374 9.1% 90.9%

Sughd 413 8.7% 91.3%

DRS 395 13.7% 86.3%

GBAO 377 11.9% 88.1%


Pearson chi2 (4)=8.8834 P=0.064

TABLE 2.13 RBP (geometric mean and SD) in women

Region Number RBP (µmol/I) SD

Dushanbe 408 2.0 1.21

Khatlon 380 1.0 1.17

Sughd 419 1.6 1.17

DRS 390 2.0 1.23

GBAO 407 1.7 1.23

National (weighted) 2,004 1.5 1.21

RBP is corrected for inflammation (CRP ≥5μg/ml) using the correction factor of 1.14 in case of elevated CRP (Thurnham 2003)P=0.064 Bartlett's test for equal variances: chi2 = 66.3125; degrees of freedom [df] = 4; P= 0.000

TABLE 2.14 RBP (geometric mean ±SD) in women by rural/urban residence

Residence Number RBP (µmol/l) SD 95% CI P-Value (ttest)

National

0.11 Urban 695 1.8 1.2 1.6 - 1.9

Rural 1309 1.6 1.2 1.5 - 1.7

RBP is corrected for inflammation (CRP ≥5μg/ml) using the correction factor of 1.14 in case of elevated CRP

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RESULTS

TABLE 2.15 Prevalence of Vitamin A deficiency among women by region

Region Number Moderate vitamin A deficiency (>0.48µmol

≤0.70µmol/l)

Severe vitamin A deficiency

(≤0.48µmol/l)

Vitamin A deficiency (combined,

≤0.70µmol/l)

Dushanbe 408 6.9% 31.6% 38.5%

Khatlon 380 9.2% 57.4% 66.6%

Sughd 419 9.8% 34.6% 44.4%

DRS 390 7.2% 29.2% 36.4%

GBAO 407 11.3% 36.4% 47.7%


Pearson chi2(8) = 99.4527 Pr = 0.000

TABLE 2.16 Folate levels (geometric mean and SD) in women

Region Number Folate (ng/ml) SD

Dushanbe 379 7.1 2.11

Khatlon 329 6.5 1.41

Sughd 412 6.5 1.24

DRS 381 6.1 1.36

GBAO 402 5.2 1.35


Bartlett's test for equal variances: chi2 = 113.5447; degrees of freedom [df] = 4; P= 0.000

TABLE 2.17 Folate levels (geometric mean ±SD) in women stratified by rural/urban

Residence Number Folate (ng/ml) SD 95% CI P-Value (ttest)

National 0.0001 Urban 649 6.8 1.3 6.5 - 7.2

Rural 1,254 6.0 1.3 5.7 - 6.2

TABLE 2.18 Prevalence of iodine deficiency among women aged 15-49 years by urban/rural residence

Region Number iodine deficient (UIC<100μg/L) iodine sufficient

National

Urban 647 66.8% 33.2%

Rural 1,227 58.7% 41.3%

Pearson chi2(1)=11.7065, P=0.001

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2016

RESULTS

TABLE 2.19 UIC levels (geometric mean) and prevalence of Iodine deficiency

among women aged 15-49 years by rural/urban residence

Region Number mean (μg/l) SD 95% CI P-Value (ttest)

National 0.00 Urban 647 61.5 2.7 56.2 - 67.1

Rural 1,227 74.1 2.8 69.3 - 79.1

Pearson chi2(1)=11.7065, P=0.001

TABLE 2.20 Prevalence of Iodine deficiency among women aged 15-49 years by strata

Region Number iodine deficient (UIC<100μg/L)

iodine sufficient

Dushanbe 378 72.8% 27.2%

Khatlon 348 51.4% 48.6%

Sughd 377 43.2% 56.8%

DRS 397 65.0% 35.0%

GBAO 374 74.1% 25.9%

National (unweighted) 1,874 61.5% 38.5%

Pearson chi2(4)=115.1488, P=0.000

TABLE 2.21 Median iodine values among women by iodine table intake over last 6 months

Number Median UIC (µg/l) Bartlett's ÷2 P-Value

Consumption of iodine tablets in the past 6 months

Yes 277 81.0 0.60 0.017

No 1,575 67.6

85


RESULTS

TABLE 2.22 Nutritional consumption of women (number = 2,145, recall period: 24 hrs)

Food category %

Wheat, bread, rice, pasta, biscuits 96.6%

Potatoes or other roots or tubers 93.1%

Other fruits (fresh and dried): Apple, banana, lemon, watermelon, mandarin, grapes, pears, melon, muskmelon, berries, raisins, oranges, cherries, figs, plum, pomegranate, prune, quince, raspberries, strawberries, blackberries, mulberries, king mulberries, yellow cherry, plum (orange-color), sinjid, chelon, dulona, kiwi, pineapple, grapefruit, simorodina

76.5%

Fats and oil 80.7%

Nuts and seeds: Sesame seeds, pistachios, almonds, pumpkin seeds, sunflower seeds, walnuts, peanuts, apricot seeds, hazelnuts, pecans

38.0%

Vitamin A rich vegetables roots, tubers and fruits: Yellow or orange coloured vegetables (pumpkins, carrots, red sweet pepper (bulgori), squash) or fruits (yellow plums or apricots)

81.9%

Dark green leafy vegetables: Spinach, checkri, rov, roshak, siyoalaf, bargi salat, dill, coriander, mint, parsley, blue basilica, green garlic, green onion, sorrel

53.6%

Other vegetables: Cabbage, cauliflower, garlic, cucumber, leek, tomato, onion, eggplant, beetroot, mushrooms fresh and dried, anzur, green beans, green pepper

67.7%

Milk or milk products 67.0%

Beans, peas, lentils, nuts 39.0%

Eggs 34.0%

Fish 3.9%

Meat, liver, kidney, chicken, fish 68.7%

Clear broth 58.2%

Tea (black or green), coffee 98.8%

Plain water 90.8%

Fruit juices 13.4%

Sweet soda, sugary water 13.8%

Vitamins, mineral supplements and/or any medecine 10.9%

Sweets: Sugar, honey, candies, chocolate, cakes, biscuits, jam, halva, baklava, obinabot (Crystalised sugar), nishollo, shirim initut (Tajik Snicker, mulberry paste with sugar)

92.1%

Spices, condiments: Black pepper, cumin, ketchup, salt, pripava (adviya), chicken/ beef cubes; Dill, coriander, mint, parsley, blue basilica, green garlic, green onion, sorrel, Jambil (small green leaves)

73.5%

Other 4.8%

TABLE 2.23 Mean (SD) MDD (number of food groups consumed within previous 24h)

Region Mean dietary diversity score for Women of Reproductive Age (MDD-W) SD

Dushanbe 6.8 1.9

Khatlon 5.5 2.0

Sughd 6.8 1.8

DRS 5.9 2.0

GBAO 6.3 1.8

National (weighted) 6.3 1.9 Bartlett's test: chi2(4) = 4.6120 Prob>chi2 = 0.329

Rural 6.0 2.0

Urban 6.7 1.8

Bartlett's test: chi2(1) = 5.1109 Prob>chi2 = 0.024

86


2016

RESULTS

TABLE 2.24 Food group diversity scores of women within the previous 24 hours

Number of food groups

1 2 3 4 5 6 7 8 9 10

Dushanbe 0.2% 1.4% 5.6% 5.6% 11.1% 15.3% 19.0% 24.1% 13.2% 4.4%

Khatlon 1.2% 4.0% 10.8% 15.1% 18.4% 17.7% 17.9% 8.0% 4.5% 2.1%

Sughd 0.2% 0.9% 3.3% 7.0% 12.5% 18.8% 23.0% 14.4% 13.2% 6.7%

DRS 0.5% 3.7% 5.6% 15.2% 16.6% 16.3% 21.2% 10.5% 6.8% 3.3%

GBAO 0.5% 1.9% 5.4% 8.2% 13.3% 24.2% 18.2% 16.1% 10.0% 2.3%

National (weighted) 0.5% 2.4% 6.1% 10.2% 14.4% 18.5% 19.9% 14.6% 9.6% 3.8%

Pearson chi2(40) = 197.1130 Pr = 0.000

Rural 0.7% 2.6% 2.6% 12.2% 16.3% 19.6% 18.3% 11.1% 8.3% 3.9%

Urban 0.1% 2.0% 4.9% 6.2% 10.7% 16.2% 22.9% 21.4% 12.0% 3.5%

Pearson chi2(10) = 87.0556 Pr = 0.000

TABLE 2.25 Nutritional consumption (recall period 24 hours) of women and BMI

Number BMI < 18.5 BMI 18.5–24.9

BMI ≥ 25 Pearson uncorrected

χ2

P-Value

Wheat, bread, rice, pasta, biscuit

2,132 95.8% 96.9% 96.1% 1.196 0.550

Potatoes or other roots or tubers

2,132 93.1% 94.0% 91.7% 3.672 0.159

Beans, peas, lentils, nuts 2,131 32.3% 39.6% 39.9% 5.863 0.210

Milk or milk products 2,132 68.8% 66.4% 68.0% 0.840 0.657

Meat, liver, kidney, chicken 2,132 65.1% 68.7% 69.3% 1.240 0.538

Fish 2,132 3.2% 3.1% 5.2% 5.831 0.054

Eggs 2,132 27.5% 32.3% 38.2% 11.065 0.004

Vitamin A rich vegetables, roots, tubers and fruits

2,132 84.1% 82.3% 80.6% 3.506 0.477

Dark green leafy vegetables 2,131 48.7% 52.9% 55.6% 4.053 0.399

Other vegetables 2,130 68.3% 67.3% 68.6% 1.928 0.749

Other fruits (fresh and dried) 2,132 74.1% 77.9% 75.1% 2.710 0.258

Nuts and seeds 2,132 37.6% 36.7% 39.8% 1.892 0.388

Fats and oil 2,128 84.1% 83.8% 75.1% 31.307 0.000 Tea (black or green) 2,132 98.4% 98.8% 98.9% 0.349 0.840

Plain water 2,132 91.0% 91.7% 89.2% 3.566 0.168

Fruit juices 2,131 11.1% 13.5% 13.8% 1.734 0.785

Soda 2,132 13.8% 13.1% 14.7% 1.062 0.588

Vitamins, mineral supplements 2,129 10.1% 10.2% 12.2% 4.274 0.370

Sweets 2,132 93.1% 92.1% 92.0% 0.290 0.865

87


RESULTS

TABLE 2.26 Nutritional consumption (recall period 24 hours) of women and anaemia

Number Hb <10g/dl Hb 10–11.9g/dl

Hb ≥12g/dl Pearson uncorrected

χ2

P-Value

Wheat, bread, rice, pasta, biscuit 2,125 95.5% 94.5% 97.2% 7.758 0.021 Potatoes or other roots or tubers 2,125 71.4% 94.0% 90.5% 2.828 0.243

Beans, peas, lentils, nuts 2,125 43.2% 35.2% 39.9% 3.834 0.147


Meat, liver, kidney, chicken, 2,125 68.2% 69.6% 68.4% 0.265 0.876

Fish 2,125 5.7% 2.4% 4.3% 3.982 0.137

Eggs 2,125 30.7% 32.2% 34.6% 1.324 0.516


2,125 81.8% 81.5% 82.2% 0.139 0.933

Dark green leafy vegetables 2,125 54.5% 53.5% 53.4% 3.726 0.444

Other vegetables 2,125 61.4% 65.2% 68.8% 15.688 0.003 Other fruits (fresh and dried) 2,125 69.3% 72.5% 78.0% 8.466 0.015 Nuts and seeds 2,125 43.2% 35.5% 38.4% 2.356 0.308

Fats and oil 2,125 79.5% 80.2% 81.0% 0.442 0.979

Clear broth 2,125 42.0% 57.5% 59.3% 10.348 0.006 Tea (black or green), coffee 2,125 95.5% 98.5% 99.1% 10.274 0.006 Plain water 2,125 89.8% 92.7% 90.3% 2.553 0.279

Fruit juices 2,125 10.2% 10.8% 14.2% 4.699 0.320

Soda 2,125 8.0% 11.7% 14.7% 5.240 0.073

Vitamins, mineral supplements 2,125 11.4% 8.8% 11.5% 6.250 0.181

Sweets 2,125 93.2% 91.6% 92.2% 0.313 0.855

TABLE 2.27 Nutritional consumption (recall period 24 hours) and women with deficient/sufficient UIC

Number UIC<100µg/l UIC≥100µg/l Pearson uncorrected

χ2

P-Value

Wheat, bread, rice, pasta, biscuit 2,125 96.5% 97.5% 1.419 0.234

Potatoes or other roots or tubers 2,125 93.7% 93.1% 0.251 0.617

Beans, peas, lentils, nuts 2,125 39.4% 40.2% 0.106 0.745

Milk or milk products 2,125 68.7% 65.2% 2.371 0.124

Meat, liver, kidney, chicken, 2,125 68.6% 69.4% 0.137 0.711

Fish 2,125 5.3% 24.3% 4.861 0.027 Eggs 2,125 34.4% 33.7% 0.102 0.749


2,125 84.1% 80.1% 5.077 0.024

Dark green leafy vegetables 2,125 54.9% 53.6% 0.933 0.627

Other vegetables 2,125 68.1% 68.3% 0.628 0.730

Other fruits (fresh and dried) 2,125 77.3% 76.7% 0.069 0.792

Nuts and seeds 2,125 35.9% 42.0% 7.032 0.008

88


2016

RESULTS

Fats and oil 2,125 81.0% 81.3% 1.027 0.598

Clear broth 2,125 56.9% 61.8% 4.425 0.035 Tea (black or green) 2,125 99.4% 98.6% 2.984 0.084

Plain water 2,125 92.2% 88.1% 8.763 0.003

Fruit juices 2,125 11.7% 16.1% 8.892 0.012 Soda 2,125 13.8% 14.0% 0.013 0.909

Vitamins, mineral supplements 2,125 10.5% 11.4% 0.366 0.833

Sweets 2,125 92.5% 93.2% 0.306 0.580

TABLE 2.28 Prevalence of iron intake of women in the last six months by region

Region Number of women "do not know"

Number "yes or no"

Yes No

Dushanbe 3 428 12.4% 87.6%

Khatlon 14 411 18.5% 81.5%

Sughd 6 425 15.1% 84.9%

DRS 3 426 14.8% 85.2%

GBAO 3 426 17.6% 82.4%

National (weighted) 29 2,116 15.6% 84.4%

Pearson chi2(8) = 7.5628 Pr = 0.109

TABLE 2.29 Frequency of folic acid table intake of women in the last six months by region

Region Number of women "do not know"

Number "yes or no"

Yes No

Dushanbe 2 429 7.0% 93.0%

Khatlon 17 408 11.8% 88.2%

Sughd 7 424 9.9% 90.1%

DRS 2 427 9.6% 90.4%

GBAO 2 427 8.2% 91.8%

National (weighted) 30 2,115 9.3% 90.7%

Pearson chi2(8) = 6.5098 Pr = 0.164

TABLE 2.30 Frequency of folic acid tablet intake and women with folate deficiency

Number FA<3ng/ml FA≥3ng/ml Pearson χ2 P-Value

Consumption of folic acid tablets in the past 6 months 2.63 0.268

Yes 161 10.1% 8.0%

No 1,717 89.9% 92.0%

89


RESULTS

Annex 3:

Detailed results - Nutritional and micronutrient status of children aged 6 to 59 months

TABLE 3.1 Prevalence of underweight among children aged 6-59 months by region (not corrected for extreme values)

Region Number Severely underweight Underweight Normal

Dushanbe 432 1.4% 3.9% 94.7%

Khatlon 424 1.2% 3.8% 95.0%

Sughd 431 2.6% 5.3% 92.1%

DRS 429 1.2% 5.4% 93.5%

GBAO 429 3.0% 11.0% 86.0%


Pearson: Uncorrected chi2(8) = 13.9364 Design-based F(5.84, 998.43) = 1.7994 P = 0.0982

TABLE 3.2 Prevalence of stunting among children aged 6-59 months by region (not corrected for extreme values)

Region Number Severely stunted Stunted Normal

Dushanbe 432 3.9% 6.9% 89.1%

Khatlon 422 6.4% 17.1% 76.5%

Sughd 429 6.3% 13.3% 80.4%

DRS 430 7.7% 17.7% 74.7%

GBAO 427 6.1% 16.9% 77.0%



90


2016

RESULTS

TABLE 3.3 Prevalence of wasting among children aged 6-59 months by strata (not corrected for extreme values)

Region Number Severely wasted Wasted Normal

Dushanbe 432 0.9% 1.9% 97.2%

Khatlon 421 0.2% 2.4% 97.4%

Sughd 428 2.3% 1.9% 95.8%

DRS 429 1.2% 0.5% 98.4%

GBAO 425 1.9% 4.9% 93.2%



TABLE 3.4 Prevalence of underweight in children aged 6-59 months, by urban/rural residence (not corrected for extreme values)

Residence Number Normal Underweight Severe underweight

Pearson χ2 P-Value

National (weighted) 2,135 94.7% 3.9% 1.4% 5.48 0.0699 Rural 1,395 95.7% 2.7% 1.6%

Urban 740 97.7% 1.6% 0.7%

TABLE 3.5 Prevalence of stunting in children aged 6-59 months by urban/rural residence (not corrected for extreme values)

Residence Number Normal Stunted Severely stunted

Pearson χ2 P-Value


Urban 740 85.4% 9.3% 4.3%

TABLE 3.6 Prevalence of wasting in children aged 6-59 months, by rural/urban residence (not corrected for extreme values)

Residence Number Normal Wasted Severely wasted

Pearson χ2 P-Value


Urban 740 97.7% 1.6% 0.7%

91


RESULTS

TABLE 3.7 Prevalence of underweight in children aged 6-59 months by gender and region (not corrected for extreme values)

Region Number Normal Underweight Severe underweight

Pearson χ2 P-Value

Dushanbe

Boys 233 94.0% 3.4% 2.6% 5.473 0.065

Girls 199 95.5% 4.5% 0.0%

Khatlon

Boys 231 94.4% 4.8% 0.9% 1.7607 0.415

Girls 193 95.9% 2.6% 1.6%

Sughd

Boys 224 92.0% 4.9% 3.1% 0.7591 0.684

Girls 207 92.3% 5.8% 1.9%

DRS

Boys 220 93.2% 5.9% 0.9% 0.5053 0.777

Girls 208 93.8% 4.8% 1.4%

GBAO

Boys 224 89.7% 8.0% 2.2% 5.3871 0.068

Girls 205 82.0% 14.1% 3.9%

National (non-weighted) 2,144

Boys 1,132 92.7% 5.4% 1.9% 1.0941 0.579

Girls 1,012 91.8% 6.4% 1.8%

TABLE 3.8 Prevalence of stunting in children aged 6-59 months by gender and strata (not corrected for extreme values)

Region/gender Number Normal Stunted Severely stunted

Pearson χ2 P-Value

Dushanbe 432

Boys 233 88.0% 7.7% 4.3% 0.6811 0.711

Girls 199 90.5% 6.0% 3.5%

Khatlon 422

Boys 229 75.5% 18.3% 6.1% 0.6081 0.738

Girls 193 77.7% 15.5% 6.7%

Sughd 429

Boys 223 80.3% 13.0% 6.7% 0.1673 0.92

Girls 206 80.6% 13.6% 5.8%

DRS 429

Boys 220 73.2% 17.7% 9.1% 1.2688 0.53

Girls 209 76.1% 17.7% 6.2%

GBAO 427

Boys 223 77.1% 17.0% 5.8% 0.0608 0.97

92


2016

RESULTS

Girls 204 77.0% 16.7% 6.4%


Boys 1,128 78.9% 14.7% 6.4% 0.7206 0.697

Girls 1,011 80.3% 13.9% 5.7%

TABLE 3.9 Prevalence of wasting in children aged 6-59 months by gender and region (not corrected for extreme values)

Region/gender Number Normal Wasted Severely wasted

Pearson χ2 P-Value

Dushanbe

0.973 0.615 Boys 233 96.6% 2.1% 1.3%

Girls 199 98.0% 1.5% 0.5%

Khatlon

2.1527 0.341 Boys 229 97.8% 2.2% 0.0%

Girls 192 96.9% 2.6% 0.5%

Sughd

2.2831 0.319 Boys 222 95.5% 2.7% 1.8%

Girls 206 96.1% 1.0% 2.9%

DRS

2.1527 0.341 Boys 220 98.2% 0.9% 0.9%

Girls 208 98.6% 0.0% 1.4%

GBAO

7.2564 0.027 Boys 223 96.0% 3.6% 0.4%

Girls 202 90.1% 6.4% 3.5%


3.328 0.189 Boys 1,127 96.8% 2.3% 0.9%

Girls 1,007 95.9% 2.3% 1.8%

TABLE 3.10 BMI z-score in children aged 6-59 months by region

Region Number Thinness (BMI z-score < −2)

Normal (−2 ≤ BMI z-score ≤ 1)

Overweight (1 < BMI z-score ≤ 2)

Obesity (BMI z-score > 2)

Dushanbe 432 2.8% 76.4% 17.6% 3.2%

Khatlon 425 2.4% 66.6% 23.3% 7.8%

Sughd 431 4.4% 68.7% 20.9% 6.0%

DRS 431 1.9% 72.2% 19.5% 6.5%

GBAO 430 7.0% 75.1% 14.9% 3.0%

National (weighted) 2,149 3.0% 69.7% 21.0% 6.4%

Uncorrected chi2(12) = 24.4757 Design-based F(8.26, 1413.29) = 2.3001; P=0.0177

93


RESULTS

TABLE 3.11 Frequency of BMI z-scores in children 6-59 months, by rural/urban residence and gender

(not corrected for extreme values)

Residence Number Thinness (BMI z-

score < −2)




χ2 P-Value

National weighted 2,148 3.7% 71.8% 19.2% 5.3% 3.2194 0.0341 Rural 1,409 4.3% 70.3% 19.2% 6.1%

Urban 740 2.4% 74.6% 19.2% 3.8%

Residence Number Thinness

(BMI z-score < −2)




χ2 P-Value

National weighted 2,148 3.7% 71.8% 19.2% 5.3% 3.1977 0.362 Male 1,133 3.0% 72.5% 19.3% 5.2%

Female 1,015 4.4% 71.0% 19.1% 5.4%

TABLE 3.12 Haemoglobin concentration (g/dl) in children aged 6-59 months by region

Region Number Mean (g/dl) SD Median (g/dl)

Dushanbe 425 12.0 1.2 12.0

Khatlon 408 11.4 1.2 11.6

Sughd 424 11.9 1.2 12.0

DRS 427 11.7 1.2 11.8

GBAO 413 11.1 1.4 11.2

National (weighted) 2,097 11.6 1.3 NA

oneway Anova F=34.94; P<0.0000; Bartlett's Test for equal variances: chi2 (4) = 14.4018, P=0.006

TABLE 3.13 Haemoglobin concentration (g/dl) in children aged 6-59 months by urban/rural residence and gender

Residence Number Mean (g/dl) SD 95% CI 95% CI P-Value (Two-sample t test with equal variances)

National 2,096 11.6 1.3 11.6 11.7 0.0000 Urban 720 11.9 1.2 11.8 12.0

Rural 1,377 11.5 1.3 11.4 11.5

Gender Number Mean (g/dl) SD 95% CI 95% CI P-Value (t test)

National 2,096 11.6 1.3 11.6 11.7 0.1619 Male 1,102 11.6 1.3 11.5 11.7

Female 994 11.7 1.3 11.6 11.7

94


2016

RESULTS

TABLE 3.14 Prevalence of anaemia in children aged 6-59 months, by urban/rural residence

Residence Number Hb<10g/dl Hb 10-10.9g/dl

Hb≥11g/dl Hb<11g/dl Pearson χ2 P-Value

National 38.02 0.000 Rural 1,377 11.5% 20.3% 68.3% 31.7%

Urban 720 5.6% 13.9% 80.6% 19.4%

TABLE 3.15 Haemoglobin concentration (g/dl) in children aged 6-59 months by gender

Region/gender Number Mean (g/dl) SD 95% CI P-Value (ttest)

Dushanbe

0.2640 Boys 227 11.9 1.1 (11.8, 12.1)

Girls 198 12.1 1.3 (11.9, 12.2)

Khatlon

0.1362 Boys 222 11.4 1.4 (11.2, 11.5)

Girls 186 11.5 1.1 11.4, 11.7)

Sughd

0.2455 Boys 220 11.8 1.3 (11.6, 12.0)

Girls 204 11.9 1.2 (11.8, 12.1)

DRS

0.2634 Boys 218 11.8 1.3 (11.6, 12.0)

Girls 208 11.7 1.1 (11.5, 11.8)

GBAO

0.5621 Boys 215 11.0 1.4 (10.8, 11.2)

Girls 198 11.1 1.4 (10.9, 11.3)

National

0.1619 Boys 1102 11.6 1.3 (11.5, 11.6)

Girls 994 11.7 1.3 (11.6, 11.7)

TABLE 3.16 Prevalence of anaemia in children aged 6-59 months by gender and region

Region/gender Nb Hb<10g/dl Hb 10-10.9g/dl

Hb≥11g/dl Pearsons χ2 P-Value

Dushanbe 0.585 0.747 Boys 227 5.3% 11.0% 83.7%

Girls 198 4.0% 12.6% 83.3%

Khatlon 5.641 0.060 Boys 222 13.1% 21.2% 65.8%

Girls 186 8.1% 15.6% 76.3%

95


RESULTS

Sughd 1.753 0.416 Boys 220 6.8% 19.1% 74.1%

Girls 204 4.9% 15.7% 79.4%

DRS 0.834 0.659 Boys 218 7.8% 16.5% 75.7%

Girls 208 6.7% 19.7% 73.6%

GBAO 0.055 0.973 Boys 215 19.1% 24.7% 56.3%

Girls 198 18.2% 24.7% 57.1%

National 2.889 0.236 Boys 1,102 10.3% 18.4% 71.2%

Girls 994 8.4% 17.7% 73.9%

TABLE 3.17 Prevalence of anaemia in children aged 6-59 months by age group

Age category Number Hb<10g/dl Hb 10-10.9g/dl Hb≥11g/dl

6-12 months 282 18.8% 26.6% 54.6%

13-24 months 517 14.1% 28.6% 57.3%

25-36 months 510 8.0% 15.1% 76.9%

37-48 months 423 4.7% 10.4% 84.9%

49-59 months 365 3.0% 9.6% 87.4%

Uncorrected Pearson chi2 = 24.8874, df = 6, P = 0.000

TABLE 3.18 Prevalence of inflammation (CRP ≥5μg/ml) among children aged 6 to 59 months by region

Region Number Inflammation

Dushanbe 373 67.6%

Khatlon 378 59.5%

Sughd 386 64.0%

DRS 397 63.7%

96


2016

RESULTS

TABLE 3.19 sTfR concentration (µg/ml) among children aged 6-59 months

Region Number Geometric mean (µg/ml) 95% CI

Dushanbe 409 2.7 (2.6 - 2.8)

Khatlon 364 3.2 (2.9 - 3.4)

Sughd 401 3.5 (3.3 - 3.6)

DRS 384 2.1 (2.0 - 2.2)

GBAO 348 2.7 (2.5 - 2.9)

National (weighted) 1,906 3.0 (2.7 - 3.2)

GM: oneway Anova F=38.39; P<0.0000; Bartlett's Test for equal variances: chi2= 365.7564; df = 4, P=0.000; Scheffe's Test p<0.05 for comparison Dushanbe/DRS, Dushanbe/Sughd, Dushanbe/Khatlon, Khatlon/DRS, Sughd/DRS, DRS/GBAO Khatlon/GBAO, Sughd/GBAO.

TABLE 3.20 Serum ferritin concentration (ng/ml) corrected for inflammation among children aged six to 59 months

Region Number Geometric mean (ng/ml) corrected for inflammation*

95% CI

Dushanbe 398 25.4 23.4 - 27.4

Khatlon 373 20.3 18.5 - 22.2

Sughd 400 14.1 12.0 - 16.2

DRS 420 22.7 20.7 - 24.7

GBAO 388 14.4 12.4 - 16.5

National (non-weighted) 1,979 19.1 17.1 - 21.1

* SF*0.77 if CRP ≥5μg/ml (Thurnham 2010)

GM: oneway Anova F=26.36; P<0.0000; Bartlett's Test for equal variances: chi2= 44.8875; df = 4, P<0.000; Scheffe's Test p<0.05 for comparison region Dushanbe/Khatlon, Khatlon/Sughd, Sughd/DRS, Sughd/Dushanbe, GBAO/Dushanbe, GBAO/DRS, GBAO/Khatlon. GM corrected for inflammation ((CRP ≥5μg/ml): oneway Anova F=10.97; P<0.0000; Bartlett's

Test for equal variances: chi2= 13.7032; df = 4, P<0.008; Scheffe's Test p<0.05 for comparison region

Dushanbe/DRS, Khatlon/Sughd.

TABLE 3.21 Serum ferritin concentration (ng/ml) corrected for inflammation

in children aged 6-59 months, by urban/rural residence

strata nb geometric mean (ng/ml)

SD lower 95% CI

upper 95% CI

P-Value (Two-sample t test with equal variances)

National corrected for inflammation

0.0000 Rural 1‘222 17.2 2.0 16.2 18.3

Urban 685 23.0 2.0 21.3 24.8

97


RESULTS

TABLE 3.22 Serum ferritin concentration (ng/ml) corrected for inflammation in children aged 6-59 months by gender and region

Region/gender Number SF geometric mean (ng/ml)

P-Value*

Dushanbe

0.710 Boys 216 25.8

Girls 182 24.9

Khatlon

0.499 Boys 209 20.9

Girls 164 19.6

Sughd

0.759 Boys 206 13.8

Girls 194 14.4

DRS

0.016 Boys 217 20.7

Girls 203 25.1

GBAO

0.196 Boys 204 13.4

Girls 184 15.7

National (not weighted)

0.268 Boys 1,052 18.6

Girls 927 19.6

*Two-sample t test with equal variances

TABLE 3.23 Body iron stores in children aged 6-59 months by region

Region Number Negative Positive

Dushanbe 395 6.6% 93.4%

Khatlon 331 14.5% 85.5%

Sughd 345 22.3% 77.7%

DRS 376 10.1% 89.9%

GBAO 309 24.6% 75.4%


Uncorrected chi2(4)=42.1704, Design-based F(2.81, 470.06)=7.3998, P=0.0001

98


2016

RESULTS

TABLE 3.24 Prevalence of ID, anaemia and IDA among children aged 6-59 months by gender and region

Region/gender ID Anaemia IDA

Dushanbe

Boys 41.1% 16.3% 10.7%

Girls 47.6% 16.7% 8.0%

Khatlon

Boys 52.1% 34.2%* 20.7%

Girls 57.4% 23.7%* 16.0%

Sughd

Boys 68.3% 25.9% 20.3%

Girls 66.0% 20.6% 13.4%

DRS

Boys 41.5% 24.3% 12.4%

Girls

26.4% 10.8%

GBAO

Boys 60.8% 43.7% 28.0%

Girls 57.1% 42.9% 29.4%

National

34.8%

Boys 52.4%

18.2%

Girls 52.2% 26.1% 15.4%

Anaemia in Khatlon: Pearson chi2(1) = 5.4549, p = 0.02

TABLE 3.25 RBP geometric mean ±SD in children aged 6-59 months by strata

Region Number RBP (µmol/l) SD

Dushanbe 404 3.2 1.26

Khatlon 373 2.2 1.23

Sughd 399 1.5 1.18

DRS 419 1.7 1.20

GBAO 380 2.8 1.28

National (non-weighted) 1,975 2.3 1.24

RBP is corrected for inflammation (CRP ≥5μg/ml) using the correction factor of 1.14 in case of elevated CRP (Thurnham 2003) Bartlett's test for equal variances: chi2 = 85.9169 ; degrees of freedom [df] = 4; P= 0.000

99


RESULTS

TABLE 3.26 RBP (geometric mean ±SD) in children aged 6-49 months, by rural/urban residence

Residence Number RBP (µmol/l) SD 95% CI P-Value (ttest)

National 0.00 Urban 685 2.7 1.3 2.5-2.9

Rural 1,290 2.0 1.2 1.9-2.2

RBP is corrected for inflammation (CRP ≥5μg/ml) using the correction factor of 1.14 in case of elevated CRP (Thurnham 2003)

TABLE 3.27 RBP levels among children aged 6-59 months by gender and region

Region/gender Number RBP (µmol/l) SD P-Value (ttest)

Dushanbe

0.779 Boys 220 3.3 1.3

Girls 184 3.2 1.3

Khatlon

0.416 Boys 209 2.3 1.2

Girls 164 2.1 1.2

Sughd

0.017 Boys 206 1.3 1.1

Girls 193 1.7 1.2

DRS

0.953 Boys 214 1.7 1.2

Girls 204 1.7 1.2

GBAO

0.473 Boys 198 2.7 1.3

Girls 182 2.9 1.3

National (not-weighted)

0.596 Boys 1,047 2.2 1.3

Girls 927 2.3 1.2


100


2016

RESULTS

TABLE 3.28 Prevalence of vitamin A deficiency among children aged 6-59 months, by region

Region Number Moderate vitamin A deficiency (>0.48µmol ≤0.70µmol/l)


(≤0.48µmol/l)

Vitamin A deficiency (combined, ≤0.70µmol/l)

Dushanbe 404 5.0% 16.1% 21.1%

Khatlon 373 9.4% 27.6% 37.0%

Sughd 399 7.3% 42.4% 49.7%

DRS 419 7.6% 33.4% 41.0%

GBAO 380 5.3% 30.8% 36.1%

National (weighted) 1'975 6.9% 30.1% 37.0%

TABLE 3.29 Prevalence of Vitamin A deficiency among children aged 6-59 months by age group

Age group Number Moderate vitamin A deficiency (>0.48µmol ≤0.70µmol/l)


(≤0.48µmol/l)

Vitamin A deficiency (combined,

≤0.70µmol/l)

6-12 months 266 7.9% 30.5% 38.4%

13-24 months 485 6.6% 30.7% 37.3%

25-36 months 479 8.6% 28.6% 37.2%

37-48 months 403 4.7% 30.5% 35.2%

49-59 months 342 6.7% 30.4% 37.1%

TABLE 3.30 Prevalence of vitamin A deficiency among children aged 6 to 59 months

by rural/urban residence and gender

Residence Number Prevalence Pearson χ2 P-Value

National 1,975 37.0% 29.768 0.000 Urban 685 29.3%

Rural 1,290 41.0%


Gender Number Prevalence Pearson χ2 P-Value

National 1,975 37.0% 0.774 0.679 Boys 1,047 36.5%

Girls 927 37.4%


101


RESULTS

TABLE 3.31 Prevalence of Vitamin A deficiency among children aged 6-59 months by age group

Age group Number Vitamin A deficiency (RBP* ≤0.70µmol/l)

6-12 months 266 38.4%

13-24 months 485 37.3%

25-36 months 479 37.2%

37-48 months 403 35.2%

49-59 months 342 37.1%

* RBP adjusted for inflammation Vitamin A def: Pearson chi2(8)=5.9228, P=0.656

TABLE 3.32 Vitamin D, geometric mean ±SD in children aged 6-59 months by region

Region Number Mean Vitamin D (ng/ml)

SD

Dushanbe 390 46.2 2.11

Khatlon 365 38.9 2.31

Sughd 370 62.9 2.45

DRS 408 50.8 2.33

GBAO 376 65.5 1.81


Bartlett's test for equal variances: chi2 = 74.2921 ; degrees of freedom [df] = 4; P= 0.000

TABLE 3.33 Vitamin D levels (geometric mean ±SD) in children aged 6 to 59 months by rural/urban residence

Residence Number Mean vitamin D (ng/ml)

SD 95% CI P-Value (ttest)

National 0.00 Urban 664 46.9 2.5 43.6 - 50.4

Rural 1,245 55.0 2.1 52.4 - 57.7

102


2016

RESULTS

TABLE 3.34: Vitamin D levels among children aged 6-59 months by gender and region

Region/gender Number Vitamin D (ng/ml) SD P-Value (ttest)

Dushanbe

0.9325 Boys 207 46.3 1.1

Girls 183 46.2 1.1

Khatlon

0.7528 Boys 205 39.5 1.1

Girls 160 38.2 2.0

Sughd

0.9782 Boys 197 62.9 1.7

Girls 193 63.3 1.1

DRS

0.4993 Boys 210 52.4 1.0

Girls 197 49.6 1.0

GBAO

0.3499 Boys 196 63.7 1.0

Girls 180 67.9 1.0


0.8771 Boys 1,015 51.9 2.1

Girls 893 52.2 2.2

TABLE 3.35 Geometric mean ±SD of urinary iodine concentration among children aged 6-59 months by region

Region Number <ean (μg/l) SD

Dushanbe 328 67.4 2.7

Khatlon 317 84.7 2.9

Sughd 343 102.9 3.1

DRS 367 81.6 2.8

GBAO 365 67.2 2.3


Bartlett's test for equal variances: chi2 = 29.6657; degrees of freedom [df] = 4; P= 0.000

Scheffe's test: Dushanbe/Sughd: P=0.000, GBAO/Sughd: P=0.000

103


RESULTS


among children aged 6-59 months by rural/urban residence

Residence Number Mean (μg/l) SD 95% CI P-Value (ttest)

National 0.19 Urban 574 75.7 2.7 68.9 - 83.1

Rural 1,146 81.8 2.8 76.5 - 87.5


among children aged 6-59 months by rural/urban residence

Residence Number Iodine deficient (UIC<100μg/L)

Iodine sufficient

Urban 574 57.1% 42.9%

Rural 1,146 55.3% 44.7%

Pearson chi2(1)=0.5140, P=0.473


among children aged 6-59 months by gender and region

Gender/region Mean (μg/l)

P-Value (ttest)

Iodine deficient (UIC<100μg/L)

Iodine sufficient

P-Value (chi2)

Dushanbe

0.739

0.804 Boys 68.78 61.6% 38.4%

Girls 65.89 62.9% 37.1%

Khatlon

0.961

0.898 Boys 84.93 48.6% 51.4%

Girls 84.37 49.3% 50.7%

Sughd

0.058

0.284 Boys 115.86 39.9% 60.1%

Girls 89.72 45.6% 54.4%

DRS

0.108

0.019 Boys 74.04 63.3% 36.7%

Girls 89.72 51.1% 48.9%

GBAO

0.011

0.063 Boys 75.82 63.4% 36.6%

Girls 58.42 72.5% 27.5%


0.182

0.684 Boys 82.49 55.5% 44.5%

Girls 76.56 56.5% 43.5%

104


2016

RESULTS

TABLE 3.39 Prevalence of Iodine deficiency among children aged 6-59 months by region

Region Number Iodine deficient (UIC<100μg/L)

Iodine sufficient

Dushanbe 328 62.2% 37.8%

Khatlon 317 48.9% 51.1%

Sughd 343 42.6% 57.4%

DRS 367 57.2% 42.8%

GBAO 365 67.7% 32.3%


Pearson chi2(4)=57.1035, P=0.000

TABLE 3.40 Nutritional consumption of women (recall period: 24 hours) by rural/urban residence

Food category Number % of Women consuming

Rural Urban χ2 for rural-urban

comparison

P-Value

Wheat, bread, rice, pasta, biscuit 2,145 96.6% 96.0% 97.6% 3.481 n.s

Potatoes or other roots or tubers 2,145 93.1% 93.3% 92.6% 0.429 n.s

Beans, peas, lentils, nuts 2,145 39.0% 39.6% 37.9% 2.474 n.s


Meat, liver, kidney, chicken, fish 2,145 72.6% 70.1% 78.2% 47.719 < 0.001

Fish 2,145 3.9% 3.0% 5.7% 9.358 < 0.01

Eggs 2,145 34.0% 28.7% 44.1% 51.543 < 0.001

Vitamin A rich vegetables roots, tubers and fruits

2,145 81.9% 80.2% 85.3% 10.779 < 0.01

Dark green leafy vegetables 2,145 53.6% 48.6% 63.1% 40.776 < 0.001

Other vegetables 2,145 67.7% 66.2% 70.6% 4.639 n.s

Other fruits (fresh and dried) 2,145 76.5% 73.8% 81.6% 16.270 < 0.001

Nuts and seeds 2,145 38.0% 38.8% 36.4% 1.217 n.s

Fats and oil 2,145 80.7% 79.5% 82.8% 11.991 < 0.01

Clear broth 2,145 58.2% 55.9% 62.5% 8.708 < 0.01

Tea (black or green) 2,145 98.8% 99.0% 98.5% 1.021 n.s

Plain water 2,145 90.8% 90.0% 92.4% 3.488 n.s

Fruit juices 2,145 13.4% 11.4% 17.2% 16.080 < 0.001

Soda 2,145 13.8% 11.9% 17.3% 11.751 0.001

Vitamins, mineral supplements 2,145 10.9% 9.6% 13.4% 7.177 n.s

Sweets 2,145 92.1% 91.7% 93.0% 1.102 n.s

105


RESULTS

Annex 4:

Detailed results - Nutritional status of children below six months of age

TABLE 4.1 Prevalence of underweight among children below six months of age by region

Region Number Severely underweight Underweight Normal

Dushanbe 50 2.0% 0.0% 98.0%

Khatlon 28 0.0% 7.1% 92.9%

Sughd 44 2.3% 2.3% 95.5%

DRS 65 0.0% 6.2% 93.8%

GBAO 40 0.0% 2.5% 97.5%

National (weighted) 227 0.9% 3.5% 95.6%

Pearson: Uncorrected chi2(2) = 2.5538 Design-based F(1.98, 251.56) = 2.2182 P =0.1114

TABLE 4.2 Prevalence of stunting among children below six months of age by region

Region Number Severely stunted Stunted Normal

Dushanbe 50 0.0% 0.0% 100.0%

Khatlon 28 0.0% 0.0% 100.0%

Sughd 44 2.3% 4.5% 93.2%

DRS 65 0.0% 0.2% 98.5%

GBAO 41 0.0% 7.3% 92.7%



TABLE 4.3 Prevalence of wasting among children below six months of age by region

Region Number Severely wasted Wasted Normal

Dushanbe 50 4.0% 6.0% 90.0%

Khatlon 28 7.1% 10.7% 82.1%

Sughd 44 2.3% 4.5% 93.2%

DRS 65 1.5% 10.8% 87.7%

GBAO 40 7.5% 17.5% 75.0%



106


2016

RESULTS

Annex 5:

Detailed results – Breast- and infant feeding

TABLE 5.1 Person who helped mother with breastfeeding in the first week

Person Number %

Health professional 566 76.0%

Relative 14 1.9%

Mother's support group 4 0.5%

Nobody 161 21.6%

Total 745 100.0%

TABLE 5.2 How do or did you breastfeed your child by region

Region Number On demand At fixed intervals

Dushanbe 148 96.0% 4.0%

Khatlon 141 96.5% 3.5%

Sughd 150 92.7% 7.3%

DRS 157 98.1% 1.9%

GBAO 149 92.6% 7.4%


TABLE 5.3 Reason for stopping breastfeeding

Number %

Not enough milk 101 41.1%

Mother‘s illness 21 8.5%

Baby’s illness 1 0.4%

Baby was not gaining enough weight 5 2.0%

No time 5 2.0%

Mother became pregnant; 60 24.4%

Health worker’s recommendation 5 2.0%

Relative’s recommendation 1 0.4%

Other 47 19.2%

Total 246 100.0%

107


RESULTS

TABLE 5.4 Age of child when first fed with food or liquids other than breastmilk

Number Not yet given

< 6 months

6 to 8 months

9 to 11 months

12 to 17 months

18 to 24 months

Don't know

Foods made from grains 820 12.9% 3.1% 51.6% 15.0% 15.9% 0.5% 1.1%

White roots and tubers 820 10.4% 2.3% 59.3% 13.7% 13.2% 0.5% 0.7%

Pulses 820 54.3% 0.2% 12.2% 6.5% 22.0% 1.9% 2.2%

Milk and milk products 820 12.1% 13.3% 46.4% 15.2% 11.5% 1.0% 0.6%

Meat, poultry 820 38.7% 0.5% 9.9% 13.9% 33.0% 2.3% 1.7%

Fish 820 79.4% 0.2% 2.1% 2.7% 11.2% 1.7% 2.6%

Eggs 820 37.6% 0.2% 17.3% 18.2% 23.2% 2.0% 1.6%

Vitamin A rich vegetables 820 17.2% 2.1% 38.5% 19.8% 20.1% 1.1% 1.2%

Dark green leafy vegetables 820 65.0% 0.2% 4.9% 7.1% 17.7% 1.3% 3.8%

Other vegetables 820 34.6% 0.7% 14.4% 16.6% 30.1% 2.1% 1.6%

Other fruits 820 11.9% 1.8% 39.5% 23.7% 21.2% 1.0% 0.8%

Nuts and seeds: 820 71.6% 0.1% 0.6% 2.2% 17.8% 5.0% 2.7%

Oils and fats 820 16.6% 5.0% 44.8% 18.8% 12.4% 0.8% 1.6%

Clear broth 820 25.7% 1.9% 42.0% 19.2% 10.0% 0.7% 0.5%

Tea (black or green), coffee 820 28.7% 8.0% 32.9% 17.8% 9.9% 0.6% 1.1%

Plain water 820 2.3% 44.0% 46.1% 4.3% 2.2% 0.2% 0.9%

Fruit juices 820 36.2% 1.9% 24.6% 12.9% 17.9% 1.0% 4.6%

Sweet soda, sugary water 820 76.8% 1.1% 7.3% 4.5% 6.1% 1.6% 2.9%

Infant formula 820 50.7% 18.8% 22.7% 5.1% 1.5% 0.3% 0.9%

Vitamins, mineral supplements, and / or any medicine

820 40.7% 8.8% 27.3% 8.3% 5.6% 0.2% 9.0%

Sprinkles 820 67.2% 0.8% 27.7% 3.3% 5.8% 1.1% 6.7%

Sweets 820 13.1% 7.3% 48.3% 17.3% 12.3% 0.7% 1.0%

Spices, condiments 820 67.4% 0.1% 8.2% 6.9% 13.3% 1.1% 2.9%

108


2016

RESULTS

Annex 6:

Detailed results – Child care and development

TABLE 6.1 Topics of advice by health workers for child health and development for children aged 0 to 24 months by region,


Number Breast-feeding

Foods for child and

type of food

Child ability (e.g., talking,

walking, understanding)

How to feed child

How to help your child to learn more

Child discipline, care and

sleep

Dushanbe 141 72.6% 92.9% 87.2% 95.7% 92.8% 87.8%

Khatlon 117 93.2% 94.8% 89.4% 95.5% 92.6% 90.9%

Sughd 168 82.7% 92.3% 79.2% 92.3% 92.9% 83.3%

DRS 141 80.9% 89.2% 75.9% 88.6% 84.2% 79.1%

GBAO 141 66.7% 82.3% 71.6% 74.5% 42.6% 47.5%

National (weighted) 708 78.7% 90.2% 80.3% 89.2% 80.9% 77.3%

Rural 455 79.6% 89.2% 78.6% 86.0% 77.0% 72.8%

Urban 253 77.1% 92.1% 83.3% 94.8% 87.9% 85.5%

boys 364 78.0% 89.3% 77.7% 88.3% 80.3% 77.3%

girls 344 79.4% 91.2% 83.1% 90.1% 81.5% 77.4%

TABLE 6.2 Weight measurement in the past three months of children aged 0 to 24 months by region,


Number Yes No

Dushanbe 141 64.5% 35.5%

Khatlon 120 61.7% 38.3%

Sughd 168 84.5% 15.5%

DRS 143 60.1% 39.9%

GBAO 144 90.3% 9.7%


Pearson chi2(4) = 58.1291 Pr = 0.000

Rural 462 73.4% 26.6%

Urban 254 72.4% 27.6%

Pearson chi2(1) = 0.0729 Pr = 0.787

Boys 368 72.8% 27.2%

Girls 348 73.3% 26.7%

Pearson chi2(1) = 0.0184 Pr = 0.892

109


RESULTS

TABLE 6.3 Height measurement in the past three months of children aged 0 to 24 months by region,


Number of answers

Yes No

Dushanbe 141 64.5% 35.5%

Khatlon 120 60.8% 39.2%

Sughd 168 85.1% 14.9%

DRS 143 60.1% 39.9%

GBAO 144 90.3% 9.7%


Pearson chi2(4) = 60.5234 Pr = 0.000

rural 462 73.2% 26.8%

urban 254 72.8% 27.2%

Pearson chi2(1) = 0.0088 Pr = 0.925

boys 368 73.1% 26.9%

girls 348 73.0% 27.0%

Pearson chi2(1) = 0.0011 Pr = 0.974

TABLE 6.4 Counselling of care-giver after weight/height measurement for children aged 0 to 24 months by region,


Number of answers

Yes No

Dushanbe 91 94.5% 5.5%

Khatlon 74 93.2% 6.8%

Sughd 143 99.3% 0.7%

DRS 86 100.0% 0.0%

GBAO 130 88.5% 11.5%


Pearson chi2(4) = 22.4837 Pr = 0.000

rural 339 95.9% 93.5%

urban 185 4.1% 6.5%

Pearson chi2(1) = 1.4096 Pr = 0.235

boys 269 94.4% 5.6%

girls 255 95.7% 4.3%

Pearson chi2(1) = 0.4425 Pr = 0.506

110


2016

RESULTS

TABLE 6.5 Drinks and products generally given to children

aged 6 to 59 months in cases of diarrhoea by region

Num ber

Breast milk

Soup Herbal tea

(camomille,

fennel, hibis cus)

Tea (black

or green)

ORS packet

solu tion

Other milk or infant

formula

Water with

feeding during some part of the day

Water alone

Soft drinks (with gas)

Sugary water or fruit juices

Antibiotics/anti diarrhe

al drugs

Dushanbe 422 39.6% 59.6% 9.4% 43.9% 56.7% 33.9% 52.6% 62.1% 3.8% 62.2% 69.9%

Khatlon 413 52.5% 78.9% 15.0% 78.4% 60.2% 34.4% 59.2% 57.7% 6.2% 76.5% 81.2%

Sughd 429 28.0% 42.9% 6.5% 26.3% 49.8% 20.5% 51.6% 45.1% 1.4% 43.3% 36.0%

DRS 424 36.3% 54.7% 13.8% 54.7% 54.5% 28.5% 53.0% 53.5% 1.9% 55.0% 54.1%

GBAO 422 39.3% 65.7% 11.1% 74.2% 72.1% 47.3% 60.1% 61.2% 1.0% 78.5% 44.2%

National (weighted) 2,110 39.1% 60.3% 11.1% 55.4% 58.6% 32.9% 55.3% 55.9% 2.8% 63.0% 57.1%

Rural 1,385 37.9% 60.9% 10.7% 60.0% 58.9% 32.8% 57.0% 52.5% 2.4% 64.2% 53.8%

Urban 727 41.3% 59.0% 11.9% 46.5% 58.0% 33.0% 51.9% 62.3% 3.6% 60.7% 63.4%

TABLE 6.6 Children aged 6 to 59 months of age diagnosed

in the past with severe malnutrition by region

Number of answers

Yes No

Dushanbe 427 5.2% 94.8%

Khatlon 421 19.5% 80.5%

Sughd 427 3.0% 97.0%

DRS 428 4.0% 96.0%

GBAO 430 12.6% 87.4%


Pearson chi2(4) = 104.4705 Pr = 0.000

rural 1396 10.4% 89.6%

urban 735 5.9% 94.1%

Pearson chi2(1) = 12.3187 Pr = 0.000

boys 1122 9.6% 90.4%

girls 1008 7.9% 92.1%

Pearson chi2(1) = 1.8826 Pr = 0.170

111


RESULTS

TABLE 6.7 Children aged 6 to 59 months who were diagnosed in the past

for severe malnutrition who were medically treated by region

Number of answers

Yes No

Dushanbe 22 90.9% 9.1%

Khatlon 82 76.8% 23.2%

Sughd 13 100.0% 0.0%

DRS 17 94.1% 5.9%

GBAO 54 92.6% 7.4%


Pearson chi2(4) = 11.2748 Pr = 0.024

rural 145 84.1% 15.9%

urban 43 93.0% 7.0%

Pearson chi2(1) = 2.1971 Pr = 0.138

boys 108 84.3% 15.7%

girls 80 88.7% 11.3%

Pearson chi2(1) = 0.7777 Pr = 0.378

TABLE 6.8 Children aged 6 to 59 months who have vision problems

at night (vision adaptation to darkness – night blindness) by region

Number of answers

Yes No

Dushanbe 418 0.0% 100.0%

Khatlon 404 0.3% 99.7%

Sughd 424 1.7% 98.3%

DRS 422 0.0% 100.0%

GBAO 413 1.0% 99.0%

National (weighted) 2,085 0.6% 99.4% Pearson chi2(4) = 15.2642 Pr = 0.004

Rural 1,366 0.9% 99.1%

Urban 719 0.0% 100.0%

Pearson chi2(1) = 6.3528 Pr = 0.012

boys 1,103 0.8% 99.2%

girls 981 0.3% 99.7%

Pearson chi2(1) = 2.3603 Pr = 0.124

112


2016

RESULTS

TABLE 6.9 Children aged 6 to 59 months suffering currently or in the past from goitre by region

Number of answers

Yes No

Dushanbe 291 0.3% 99.7%

Khatlon 320 0.3% 99.7%

Sughd 379 0.3% 99.7%

DRS 318 0.3% 99.7%

GBAO 430 1.7% 98.3%

National (weighted) 1,655 0.6% 99.4% Pearson chi2(4) = 9.2691 Pr = 0.055

Rural 1,110 0.4% 99.6%

Urban 545 1.1% 98.9%

Pearson chi2(1) = 3.3379 Pr = 0.068

Boys 869 0.3% 99.7%

Girls 786 0.9% 99.1%

113


RESULTS

Annex 7:

Maps of time-trends in iodine deficiency

Sughd

7.9 9.05.6

10.0 8.3

DRS

5.5 6.9 5.110.0 8.0

GBAO

20.2 18.3

9.413.3 13.1

Khatlon

10.3 9.2 7.911.6

7.5

Dushanbe

no

da

ta

no

da

ta

8.1 9.6 7.4

UNDERWEIGHT (BMI<18.5)

WOMEN 15-49 YEARS 8.611.0

6.710.6 8.0

2003 2005 2009 2012 2016

National level

National level

25.6

2003 2005 2009 2012 2016

23.028.2 29.7

37.6

Sughd

25/1 23.4 25.6 26.0

37.5

DRS

36.330.9 32.2 32.7 34.7

GBAO

12.016.1 18.1

22.0 21.0

Dushanbe

no

da

ta

no

da

ta

42.2 40.4 43.0

OWERWEIGHT (BMI>25)

WOMEN 15-49 YEARS

Khatlon

16.423.2 25.0

28.5

39.2

114


2016

RESULTS

Khatlon

49.6

13.4

19.1

5.8

29.3

5.0

DRS

21.0

8.0

23.7

4.4

17.3

4.9Sughd

26.3

6.7

16.7

2.3

16.6

2.8

GBAO

29.9

6.5

24.5

5.83

26.1

5.6

Dushanbe

22.0

4.7

17.6

2.4no

da

ta

32.0

9.2

19.9

4.3

21.7

4.1

2003 2009 2016

National levelANAEMIA

WOMEN 15-49 YEARS


National level

18.621.0

10.216.7

17.6

8.2

2003 2009 2016

GBAO

19.4

25.1

20.429.9

24.7

18.7

DRS

21.118.0

10.912.8

18.0

7.5Sughd

17.917.4

11.413.2

17.5

5.9

Dushanbe

16.9

11.5

11.8

4.7no

da

ta

Khatlon

17.8

27.7

7.123.9

18.6

10.8

ANAEMIA



115


RESULTS

Khatlon

64.6

84.8

51.4

DRS

60.3

74.365.0

Sughd

48.4

19.7

43.2

GBAO

39.4

55.2

74.1

Dushanbe

42.0

72.8

no

da

ta

56.8 58.6 61.5

2003 2009 2016

National levelIODINE (<100µg/l)

WOMEN 15-49 YEARS

Khatlon

68.2 73.2

48.9

DRS

60.3

74.365.0

Sughd

64.873.3

57.2

GBAO

54.2 57.467.7

Dushanbe

42.0

62.2

no

da

ta

63.852.9 50.9

2003 2009 2016

National levelIODINE (<100µg/l)


116


2016

RESULTS

GBAO

24.3 22.425.4

41.3

DRS

26.3 24.022.829.4

Sughd

27.2

19.4

27.9

38.6

Khatlon

26.922.6

36.939.0

Dushanbe

18.9

10.5

21.8

29.5

National level

26.220.9

29.436.0

2005 2009 20162012

LOW HEIGHT-FOR-AGE (STUNTING)


Dushanbe

10.3

2.64.09.2

Khatlon

11.1

2.44.9

11.9

GBAO

8.1 6.64.06.3

DRS

9.8

1.67.29.2Sughd

10.32.64.09.2

National level

9.92.84.6

8.8

2005 2009 20162012

LOW WEIGHT-FOR-HEIGHT (WASTING)


117


RESULTS

National level

116.5

73.187.5

2003 2009 2016

Sughd

175.8

75.0

124.4

DRS

72.958.3

88.1

GBAO

93.391.273.5

Khatlon

71.964.5

103.1

Dushanbe

107.7

73.9

no

da

ta



Khatlon

65.7 61.8

94.9

DRS

77.5 76.6 73.0

Sughd

105.1

178.5

113.9

GBAO

126.7

96.3

61.5Dushanbe

103.8

61.6

no d

ata

National level

93.6107.8

75.0

2003 2009 2016


WOMEN 15-49 YEARS

118


2016

RESULTS

Sughd

10.45.9 7.9

Dushanbe

5.19.37.7

National level

8.412.1

6.2

2003 2009 2016

Khatlon

10.513.5

4.7

GBAO

13.813.08.5

DRS

8.612.7

6.1

UNDERWEIGHT


119


RESULTS

120

Documents

NATIONAL NUTRITION SURVEY IN TAJIKISTAN