Vitamin enriched flour helps prevent birth defects

Families who live in poverty tend to have a diet low in nutrients, negatively affecting the health of the pregnant woman and the development of the child during pregnancy and later.

By Sven G. Simonsen
Абдурахиму два месяца. Через несколько недель ему проведут операцию по устранению спинномозговой грыжи и гидроцефалии.
ЮНИСЕФ Кыргызстан/2016/ Влад Ушаков
01 November 2017

Abdurahim was born with spina bifida and is awaiting surgery. The risk of such birth defects increases when the mother’s diet is low in nutrients. Mills in Kyrgyzstan are bound by law to fortify flour with folic acid. UNICEF is working to help the State enforce the law and raise awareness.

Ever since Abdurahim* was born two months ago, his mother Alima has been struggling to understand why. Why was her boy born with spina bifida, a severe neural defect. Was it because she took antibiotics when she had kidney problems two months into the pregnancy? Was it the tense atmosphere in the household? Was it all the hard physical work back home in the village?

Alima talks about the pregnancy and the questions she has been asking herself in a quiet voice. Sometimes a faint smile passes over her face, but she reveals the tension inside as she continues to squeeze her hands together.

“This was a planned pregnancy, my second one,” she says. “My husband and I had tried for seven years to have a child. Two years ago, we succeeded – our daughter was born. She is a healthy child. One year later, I was pregnant again."

First month of pregnancy

We’re at the neurology unit of the National Centre for Motherhood and Childhood in Bishkek, the capital of Kyrgyzstan. Alima’s daughter is at home in their village in the southeast of the country. The mother has come to Bishkek alone with Abdurahim. They were sent here by a local hospital who could not treat the boy when he fell ill with a serious virus infection.

“We came here with the hope that he will get treatment,” says Alima. Now, 10 days later, the infection has been cured and she and the doctors have their minds solely on the boy’s neural defects.

On a bed next to her lies Abdurahim. As Alima watches, Dr Bakytbek Karachev, head of the neurology unit, gently lifts up Abdurahim’s shirt and releases a bandage that covers much of his spine to expose a thick bulge. The skin is reddish and stretched thin. Inside is fluid that has leaked out of the spine.

Spina bifida is one of the most common neural tube defects, which are defects that affect the brain, spine, or spinal cord. It is a result of the child’s spinal column not closing properly during pregnancy.

Abdurahim also suffers from hydrocephalus, sometimes called ‘water on the brain’. This is a condition where liquid does not properly drain from the brain and can cause severe brain damage.

Доктор Бакытбек Карачев, заведущий неврологическим отделением Национального центра охраны материнство и детства в г. Бишкек объясняет, что спинномозговая грыжа является одним из самых распространенных дефектов нервной трубки.
©UNICEF/Kyrgyzstan/2016/Vlad Ushakov
Doctor of National Centre for Motherhood and Childhood in Bishkek, Kyrgyzstan Bakytbek Karachev explains how neural defects may express themselves in a child’s brain. He operates on some 20 cases of spina bifida and 80 cases of hydrocephalus every year.

Folic acid deficiency multiplies risk

In 2015, 2,938 children under 1 died in Kyrgyzstan. Out of them, 63 children died because of neural tube defects. The defects appear in the very first month of pregnancy when the woman may not even know she is pregnant. It is not known exactly what causes the condition. However, the risk of a child being born with it is dramatically higher if the mother is deficient in folic acid, a type of vitamin B.

Hydrocephalus, too, occurs more frequently when the mother is deficient in folic acid and has also been linked to other nutritional deficiencies.

Among the factors Alima can think of that may have caused Abdurahim’s condition, she does not mention nutrition. It is brought up by Dr. Elmira Kabylova, a paediatrician and nutrition specialist at the Ministry of Health, who has come with us to the hospital.

“When I was pregnant with my daughter I took iodine, because the doctor recommended it. This time, the doctor didn’t say anything, so I just ate normal food,” says Alima.

“People in remote areas are not given good health advice,” says Dr. Karachev. “The good specialists have already left to work elsewhere.”

Fortification is the law – in principle

Families who live in poverty tend to have a diet low in nutrients, negatively affecting the health of the pregnant woman and the development of the child during pregnancy and later. A UNICEF-supported survey in 2009 showed:

As many as 42 per cent of non-pregnant women in Kyrgyzstan suffered from folic acid deficiency and 27 per cent from iron deficiency anaemia; 61.6 per cent of pregnant women were iodine deficient.

Following UNICEF advocacy, large mills in Kyrgyzstan are obliged by law to fortify flour with folic acid since 2009. However, the country has many mills, and the law is difficult to enforce.

A lot of flour is imported from Kazakhstan and Russia where fortification is not done. Alima says that this imported, cheaper flour is what’s on offer in her village and what her family has been using.

Молодая мама с ребенком на приеме в Национальном центре охраны материнства и детства в г. Бишкек. После консультации с врачом она узнала о правильном питании для своего малыша.
©UNICEF/Kyrgyzstan/2016/Vlad Ushakov
Mother and child came to monthly medical check-up to National Centre for Motherhood and Childhood in Bishkek, Kyrgyzstan. After consultation with doctor on proper child diet mother feels more confident.