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A programme to improve the nutrition of 6-24 month old children in Talas Province by means of home food fortification using “Gulazyk”

“Secret hunger” or deficit of vitamins and microelements in a human body leads to congenital developmental malformation, delayed physical and intellectual development, an increase in susceptibility to infectious and parasitic diseases, “rejuvenation” of old, and appearance of new diseases and in sum poses a threat to the gene pool of the country.

One of the most widespread manifestations of secret hunger in the whole world is body iron deficiency, which can lead to delays in intellectual and physical development of children, a rise in susceptibility to infections, and aggravation of the consequences of diaorrhea, respiratory and cardiovascular diseases.

Bearing in mind the negative consequences of secret hunger, in July 2008 the Ministry of Health took the decision to fortify the food of all 6-24 month old children in Talas Province with iron and other microelements at home.  The programme is being implemented by the Ministry of Health in close partnership with UNICEF and the Kyrgyz-Swiss-Swedish project.   Funds for realizing the programme were received from the Netherlands National UNICEF Committee and the American Centre for Disease Control.

Why specifically in Talas Province?  According to MICS (2006) the most threatening indicators of stunting among children in the first five years of life are in Talas Province (27.3 percent).  What is more, research carried out in 2008 showed that 71.9 percent of children of 6 months to 3 years of age are anaemic.

It is expected that in the future this programme will be extended to all regions of Kyrgyzstan.  Currently, research is being carried out into the situation at the national level.

Why fortified food for 6-24 month old children?
This age group is critical in the lives of children, as during this period they grow intensively, and there is a high risk of development of iron-deficiency anaemia and other microelement deficiencies because of the high needs of the child’s body.  If a child in this period of life develops iron-deficiency anaemia, the consequences for intellectual and physical development could last a lifetime.  Many foodstuffs used to prepare meals for children do not contain enough iron and other microelements, and many families do not have the chance to buy fortified food for their children.  Therefore it makes sense to fortify the food consumed by 6-24 month old children at home, in order to provide them with the required amount of iron and other micronutrients.

What is Gulazyk?  Gulazyk is a food supplement consisting of iron, zinc, folic acid and vitamins A and C, all of which are essential for child health and development.  Regular intake of Gulazyk meets children’s requirements for these important microelements.

Reasons to use Gulazyk
• Microencapsulated iron in this form has fewer side effects.
• Convenient to take.  Gulazyk is easy to add to any solid food at home.  If mum for whatever reason didn’t give Gulazyk to her child for a few days, she can recommence giving it the next day.
• Convenient packaging.  Gulazyk is distributed in sachets which contain one dose for one time
• Children’s eating habits don’t need to change.  Gulazyk can be added to any food.
• Gulazyk is tasteless, odourless and colourless.
• Gulazyk does not interfere with breast feeding
• Gulazyk is safer than traditional iron preparations.  Overdose is practically impossible.

What is being done to implement this programme?

1. Activities at the political level
On 12 May 2009, in the town of Talas, and on 13-14 May in all 4 districts of Talas Province, orientation meetings were carried out at the Provincial and District Administration levels, with the participation of representatives of all levels of state structures, the heads of the healthcare system, NGO representatives, members of Village Health Committees, religious figures and journalists.  At orientation meetings, the following questions were discussed.
• The composition of children’s food and prevalence of illness connected with lack of or excess food among young children in Talas Province.
• Activities being carried out by the Ministry of Health in partnership with international organizations (UNICEF, Kyrgyz-Swiss-Swedish Health Project) with the aim of improvement of the population’s awareness of rational child nutrition.
• The expediency of improving 6-24 month old child nutrition in Talas Province through food fortification at home using Gulazyk.
• The role of representatives of all levels of the authorities, the health system, NGOs, members of Village Health Committees, religious leaders and journalists for successful realization of the programme

2. At the healthcare system level
• The composition of the vitamin-mineral food supplement Gulazyk has been developed and approved.  The product has been registered by the Department of Medical Provision (DMP) of the Ministry of Health as a biologically active supplement for a period of 5 years.  In accordance with the requirements of registration of biologically active supplements, the DMP has carried out analysis of the quality of the product.
• A Ministry of Health Order has been published to regulate the scheme for distributing, accounting and reporting, the description of what it is for and dosage, the length of period for taking courses of Gulazyk and the duties of medical workers in implanting the programme.
• A special training module has been developed and instructions given for medical workers on the programme, and training has been completed for all medical workers.
• Gulazyk has been provided to all local health centres and clinics in Talas Province.
• Information materials have been developed for mothers with children of under 2 years of age:
 A memo for mothers with children under 2 years of age for monitoring the usage of Gulazyk;
 A booklet for mothers with children under 2 years of age.
• A methodical manual has been developed and printed for КУЗ specialists for promoting Gulazyk at village level,
• A methodical manual has been developed and printed for Village Health Committee volunteers for promoting Gulazyk at village level,
• Training has been carried out for КУЗ specialists (one day seminar),
• Training has been carried out for Village Health Committee heads responsible for issues of nutrition, and members of Village Health Committee (one day seminar),
• Posters have been developed about Gulazyk, its importance in rational nutrition and early training, and bags symbolizing Gulazyk have been produced for medical workers and Village Health Committee members,
• A monitoring and evaluation plan has been developed to influence programmes and the system of mentoring for medical workers and Village Health Committees.

From 25 June 2009, throughout Talas Province, the distribution of Gulazyk to all mothers with children of 6 months to 2 years of age began.



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