Quiet” Disease Eats Away at Uzbeks

A medical time bomb is ticking in Uzbekistan where the mental and physical health of an entire generation is under threat because of a lack of dietary iron.

Iron deficiency disorders like anaemia are rampant among Uzbeks with 80 per cent of women and 70 per cent of children under the age of 14 – about 10 million young people.

In one region, Karakalpakstan, doctors interviewed by IWPR say the entire female population is anaemic, resulting in a vicious cycle that sees the women pass the illness on to their children.

Known as the quiet disease, anaemia can be hard to detect since it often lacks the obvious physical manifestations of illnesses like tuberculosis.

Though women are most at risk of anaemia, the general iodine deficiency that causes the sickness affects 60-70 per cent of all Uzbeks, resulting in various thyroid gland diseases.

Goitre, an enlarged thyroid, is the most frequent symptom of insufficient iodine in adults. Because of Uzbekistan’s distance from the sea and general poverty among the population, Uzbeks cannot easily obtain fish, the best food source of iodine along with certain vegetables. It naturally occurs in seawater.

Particularly vulnerable are children.

The World Health Organisation says a serious lack of iodine during pregnancy may result in stillbirths, abortions and congenital abnormalities such as cretinism, a grave, irreversible form of mental retardation.

According to information from Uzbekistan’s Institute of Endocrinology, one in 500 babies born here suffer from cretinism, rising to one in 200 in Karakalpakstan. In developed countries, about one in 5,000 babies is born with the disorder.

According to WHO, iodine deficient people may lose 15 IQ points.

A doctor at an Uzbek paediatric research institute told IWPR that at his granddaughter’s school in Tashkent just two of the pupils receive A grades. Equally poor academic results are common around the country, he said.

“Soon Uzbekistan will be populated by dull, inconspicuous people with no initiative and with limited interests,” said the doctor, who asked not to be named.

Anatoly Bulganov, deputy director of the Institute of Haematology, said Uzbek teachers are told not to punish students who do poorly at school as a result of iron deficiency or anaemia.

Physical education programmes are also being reworked as Uzbek youngsters, who are smaller and lighter than in the past, struggle to keep up.

“In the new instructions for schools, physical exercise is reduced,” said Roza Kamilova, a researcher at the Institute of Endocrinology. “This is because children at schools are not capable of meeting the previous schedule.”

The problem is easily cured by iodising salt, a practice common in the Soviet days, and one, according to WHO, which costs about five US cents, per person, per year.

At the moment, the main work for studying and preventing iodine deficiency and anaemia is being carried out with the financial and technical aid of international organisations like the Asian Bank of Development, which gave 1.2 million dollars this year to tackle the problem.

However, experts says at least 148 million dollars is needed for diagnosis, treatment and prevention programmes.

Senior researcher at the scientific research institute of paediatrics Zulkhumor Umarnazarova said the government is aware of the anaemia and iodine deficiency epidemic among Uzbeks.

When asked what steps it was taking to combat the problem, Umarnazarova showed brochures that were published with the help of the UN children’s agency UNICEF giving recommendations for proper nutrition.

According to the institute, monthly costs for feeding an anaemic two-year-old are about 40 dollars, including treatments this rises to 150-200 dollars per month.

When IWPR approached several women with the brochure containing the list of recommended foods, most said they were unaffordable.

“This list of food like meat, fruit, juice and milk products we only have on [special occasions] like weddings,” said Tashkent resident Nazira.

Zukhra, a mother of five also from Tashkent, knew nothing about iodine deficiency and said she could barely afford the basic necessities her family needs to survive.

“I have completely different worries making sure my children don’t go hungry,” she said.

Doctors say they’ve warned the government about the serious threat posed by mass anaemia and other iron deficiency disorders, but say their complaints are falling on deaf ears.

They say a law should be passed calling for the compulsory iodisation of products like salt.

Omon Mirtazaev, director of the national health institute, said the government is set to declare 2005 “the Year of Health”. He declined to comment on whether this programme includes funds for combating iron deficiency.

There is no clear answer how the anaemic generation will look in 10 or 20 years. Doctors are scared to make predictions, but warn if the Year of Health turns out to be more empty promises, the outlook is grim.

Malik Boboev is an IWPR correspondent in Tashkent.