V.        Nutrition

Low Birth Weight

Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults.

In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant.

In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies.

One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births.

Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.[1]


Table NU.1: Low birth weight infants

Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Kyrgyzstan, 2014

 

Percent distribution of births by mother's assessment of size at birth

Total

Percentage of live births:

Number of last live-born children in the last two years

Very small

Smaller than average

Average

Larger than average
or very large

DK

Below 2,500 grams1

Weighed at birth2

                   

Total

1.7

10.2

71.8

14.8

1.5

100.0

5.9

97.5

1675

Mother's age at birth

                 

Less than 20 years

2.3

16.0

72.1

8.6

1.1

100.0

7.8

97.5

138

20-34 years

1.9

9.6

72.0

15.2

1.4

100.0

5.8

97.7

1340

35-49 years

0.7

10.1

70.1

16.6

2.6

100.0

5.5

96.3

197

Birth order

                 

1

1.7

14.8

73.0

9.4

1.2

100.0

6.6

97.8

473

2-3

1.7

8.5

72.8

15.5

1.5

100.0

5.5

97.6

867

4-5

1.9

7.4

67.7

21.8

1.3

100.0

5.3

97.7

281

6+

3.0

10.2

64.5

15.4

6.9

100.0

9.5

92.1

54

Region

                 

Batken

3.0

9.1

56.3

30.0

1.6

100.0

6.4

98.0

148

Djalal-Abad

0.8

8.6

75.3

14.1

1.1

100.0

4.5

98.1

351

Issyk-Kul

0.6

12.1

78.7

5.1

3.5

100.0

6.4

95.7

97

Naryn

2.6

11.9

72.9

10.2

2.4

100.0

7.3

93.7

56

Osh Oblast

1.3

15.0

70.5

12.3

0.9

100.0

6.6

97.3

366

Talas

0.0

9.1

74.5

14.5

1.9

100.0

4.4

97.7

124

Chui

4.4

6.6

76.8

9.3

2.9

100.0

8.2

97.3

260

Bishkek City

1.6

7.8

68.2

22.3

0.0

100.0

4.6

97.8

197

Osh City

0.7

11.9

69.0

16.3

2.1

100.0

5.4

99.5

76

Area

                 

Urban

1.6

7.8

70.8

18.8

1.0

100.0

4.9

97.9

539

Rural

1.8

11.3

72.2

12.9

1.8

100.0

6.4

97.3

1137

Mother’s education

                 

None/primary

(*)

(*)

(*)

(*)

(*)

100.0

(*)

(*)

15

Basic secondary

2.3

10.4

73.7

11.5

2.1

100.0

6.8

97.7

200

Complete secondary

1.8

9.8

69.7

17.3

1.5

100.0

5.8

97.6

757

Professional primary/middle

2.4

13.8

70.2

12.1

1.5

100.0

7.5

99.6

234

Higher

1.1

7.2

76.4

14.0

1.3

100.0

4.6

97.6

469

Cannot be determined

-

-

-

-

-

100.0

-

-

0

Missing/DK

-

-

-

-

-

100.0

-

-

0

Wealth index quintile

                 

Poorest

2.1

11.5

69.3

15.1

1.9

100.0

6.6

95.7

336

Second

0.9

11.1

70.9

15.8

1.4

100.0

5.2

97.9

372

Middle

2.3

10.0

76.6

10.3

0.7

100.0

6.2

98.0

349

Fourth

2.0

10.8

69.1

15.7

2.3

100.0

6.8

97.9

312

Richest

1.5

7.0

72.6

17.5

1.5

100.0

5.0

98.2

306

Mother tongue of household head

               

Kyrgyz

1.8

9.7

71.4

15.7

1.4

100.0

5.9

97.7

1283

Russian

(3.3)

(3.4)

(81.2)

(12.2)

(0.0)

100.0

(5.1)

(100.0)

63

Uzbek

0.3

11.6

72.4

13.9

1.8

100.0

4.9

97.6

256

Other language

4.3

18.8

68.2

5.1

3.5

100.0

11.3

91.4

73

1 MICS indicator 2.20 - Low-birthweight infants

2 MICS indicator 2.21 - Infants weighed at birth

 
       
             
                     

Overall, 97.5 percent of births were weighed at birth and 5.9 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). There is no notable variation by region. The prevalence of low birth weight also does not vary much by urban and rural areas or by mother’s education.

Nutritional Status

Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished.

Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality.

In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards[2]. Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population.

Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight.

Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness.

Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence.

Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight.

In MICS, weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended[3] by UNICEF. Findings in this section are based on the results of these measurements. 

Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators.


Table NU.2: Nutritional status of children

Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Kyrgyzstan, 2014

 

Weight for age

Number of children under age 5

Height for age

Number of children under age 5

Weight for height

Number of children under age 5

Underweight

Mean Z-Score (SD)

Stunted

Mean Z-Score (SD)

Wasted

Overweight

Mean Z-Score (SD)

Percent below

Percent below

Percent below

Percent above

- 2 SD1

- 3 SD2

- 2 SD3

- 3 SD4

 - 2 SD5

- 3 SD6

+ 2 SD7

                           

Total

2.8

0.6

-0.1

4441

12.9

3.4

-0.7

4412

2.8

0.8

7.0

0.4

4414

                           

Sex

                         

Male

2.9

0.6

-0.1

2269

13.8

3.4

-0.7

2248

2.8

0.8

7.8

0.5

2255

Female

2.6

0.6

-0.1

2172

12.0

3.4

-0.7

2164

2.9

0.9

6.1

0.4

2160

Region

                         

Batken

2.3

0.4

-0.2

402

13.6

1.3

-0.8

402

2.2

0.8

3.4

0.3

401

Djalal-Abad

6.9

1.4

-0.4

945

21.3

7.7

-0.9

931

7.9

2.5

8.7

0.2

934

Issyk-Kul

1.7

1.1

-0.1

262

14.1

2.8

-0.9

258

1.7

0.3

7.8

0.6

261

Naryn

2.9

0.7

-0.1

189

16.4

5.3

-0.9

188

0.5

0.2

6.2

0.5

189

Osh Oblast

1.0

0.2

0.0

1001

10.6

1.8

-0.8

1000

1.1

0.3

4.7

0.5

1001

Talas

2.0

0.3

0.0

352

11.0

2.2

-0.8

352

1.0

0.4

7.3

0.6

352

Chui

1.6

0.0

0.1

637

7.6

1.9

-0.4

631

1.5

0.3

9.0

0.5

628

Bishkek City

1.1

0.5

0.2

467

7.6

2.5

-0.3

467

2.1

0.6

9.5

0.6

467

Osh City

3.9

0.5

-0.2

187

12.1

3.3

-0.7

183

2.4

0.0

4.3

0.3

182

Area

                         

Urban

1.9

0.5

0.0

1310

11.8

3.1

-0.6

1303

2.6

0.6

8.2

0.5

1300

Rural

3.1

0.6

-0.1

3131

13.4

3.5

-0.8

3110

2.9

0.9

6.5

0.4

3114

Age

                         

0-5 months

2.5

0.2

0.2

441

5.3

2.5

0.1

438

6.5

2.7

9.0

0.2

429

6-11 months

2.2

0.7

0.4

528

7.2

2.0

0.0

525

3.1

0.3

11.5

0.6

527

12-17 months

1.4

0.0

0.2

408

11.2

2.4

-0.6

407

2.3

0.4

11.1

0.7

407

18-23 months

2.9

1.1

0.0

456

18.2

6.3

-0.9

453

2.2

0.9

6.8

0.6

453

24-35 months

3.5

1.0

-0.2

907

18.6

5.6

-1.0

897

1.6

0.3

6.8

0.5

900

36-47 months

3.2

0.4

-0.3

878

14.6

3.0

-1.0

874

2.9

0.6

5.0

0.4

877

48-59 months

2.8

0.4

-0.4

823

10.5

1.7

-0.9

818

2.7

1.2

3.3

0.2

821

Mother’s education

                         

None/primary

(0.0)

(0.0)

(-0.2)

56

(26.5)

(8.3)

(-1.4)

56

(1.3)

(0.0)

(8.3)

(0.8)

56

Basic secondary

4.6

0.9

-0.3

519

17.1

4.4

-0.8

514

3.2

0.4

4.9

0.3

512

Complete secondary

2.6

0.6

-0.1

2062

13.5

2.7

-0.8

2052

3.2

0.9

6.7

0.4

2058

Professional primary/middle

3.6

0.8

-0.1

700

11.8

3.6

-0.7

694

2.1

0.7

7.2

0.5

689

Higher

1.8

0.4

0.1

1104

9.8

3.8

-0.5

1096

2.5

1.1

8.3

0.5

1099

Wealth index quintile

                         

Poorest

3.5

0.8

-0.2

971

17.7

4.4

-0.9

970

3.1

1.0

6.2

0.4

970

Second

4.0

0.8

-0.2

1020

14.2

3.8

-0.8

1010

3.6

1.6

4.4

0.4

1015

Middle

2.1

0.5

-0.1

919

10.1

2.6

-0.7

911

2.4

0.3

7.0

0.5

910

Fourth

2.4

0.3

0.1

795

10.7

2.7

-0.6

789

1.6

0.2

9.2

0.6

788

Richest

1.6

0.4

0.1

736

10.7

3.2

-0.4

732

3.3

1.0

9.2

0.5

731

Mother tongue of household head

                       

Kyrgyz

2.4

0.6

0.0

3421

12.0

2.9

-0.7

3405

2.4

0.9

7.0

0.5

3404

Russian

3.4

0.0

0.1

172

11.7

2.4

-0.5

167

2.8

0.0

13.4

0.6

171

Uzbek

4.7

0.6

-0.3

648

17.1

5.9

-0.8

645

5.3

1.2

6.5

0.3

645

Other language

3.1

0.0

-0.3

197

15.8

5.5

-0.8

193

2.4

0.0

2.8

0.3

192

1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe)

2 MICS indicator 2.1b - Underweight prevalence (severe)

3 MICS indicator 2.2a - Stunting prevalence (moderate and severe)

4 MICS indicator 2.2b - Stunting prevalence (severe)

5 MICS indicator 2.3a - Wasting prevalence (moderate and severe)

6 MICS indicator 2.3b - Wasting prevalence (severe)

7 MICS indicator 2.4 - Overweight prevalence


Children whose full birth date (month and year) were not obtained and children whose measurements are outside a plausible range are excluded from Table NU.2. Additionally, children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13, and DQ.14 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, , 3.0 percent of children have been excluded from calculations of the weight-for-age indicator, 3.6 percent from the height-for-age indicator, and 3.6 percent for the weight-for-height indicator.

In Kyrgyzstan, 2.8 percent of children under age five are moderately or severely underweight and 0.6 percent are classified as severely underweight (Table NU.2).  At the same time, 12.9 percent of children are moderately or severely underweight stunted or too short for their age and 2.8 percent are moderately or severely underweight wasted or too thin for their height. More than 7 percent of children are overweight, or too heavy for their height.

Children in Djalal-Abad oblast are more likely to be underweight and stunted than other children.  The percentage of overweight children ranges from 3.4 percent in the Batken oblast to 9.5 percent in Bishkek City. Those children whose mothers have complete secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with no or lower education.

Boys appear to be slightly more likely to be underweight and stunted than girls are. The age pattern (Figure NU.1) shows an increase in stunting and underweight rates approximately at age 18 months at which many children cease to be breastfed and are exposed to risk on unbalanced complimantary feeding, contamination in water, food, and environment.

Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe), Kyrgyzstan, 2014

Breastfeeding and Infant and Young Child Feeding

Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers do not start to breastfeed early enough, do not breastfeed exclusively for the recommended 6 months or stop breastfeeding too soon. There are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of 6 months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life.[4]

UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond.[5] Information on breastfeeding of children under 6 months is provided in Table NU.3. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.[6] A summary of key guiding principles[7], [8] for feeding 6-23 month olds is provided in the table below (see Box NU.1) along with proximate measures for these guidelines collected in this survey.

The guiding principles for which proximate measures and indicators exist are:

  1. continued breastfeeding;
  2. appropriate frequency of meals (but not energy density); and
  3. appropriate nutrient content of food.

Box NU.1 Guiding Principle (age 6-23 months)

Proximate measures

Table

Continue frequent, on-demand breastfeeding for two years and beyond

Breastfed in the last 24 hours

NU.4

Appropriate frequency and energy density of meals

Breastfed children

Depending on age, two or three meals/snacks provided in the last 24 hours

Non-breastfed children

Four meals/snacks and/or milk feeds provided in the last 24 hours

NU.6

Appropriate nutrient content of food

Four food groups[9] eaten in the last 24 hours

NU.6

Appropriate amount of food

No standard indicator exists

na

Appropriate consistency of food

No standard indicator exists

na

Use of vitamin-mineral supplements or fortified products for infant and mother

No standard indicator exists

na

Practice good hygiene and proper food handling

While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple

NU.9

Practice responsive feeding, applying the principles of psycho-social care

No standard indicator exists

na

Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most popula­tions, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber).[10]

These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet in the previous day, a child must have received:

  1. the appropriate number of meals/snacks/milk feeds;
  2. food items form at least 4 food groups; and
  3. breastmilk or at least 2 milk feeds (for non-breastfed children). 

Table NU.3: Initial breastfeeding

Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Kyrgyzstan, 2014

 

Percentage who were ever breastfed1

Percentage who were first breastfed:

Percentage who received a prelacteal feed

Number of last live-born children in the last two years

Within one hour of birth2

 Within one day of birth

           

Total

97.6

82.5

92.5

9.0

1675

           

Region

         

Batken

98.4

83.3

93.1

9.3

148

Djalal-Abad

98.9

80.4

92.1

10.3

351

Issyk-Kul

95.6

82.8

90.2

4.6

97

Naryn

98.4

84.4

95.1

6.2

56

Osh Oblast

97.6

92.3

95.6

5.0

366

Talas

97.7

92.0

93.4

7.6

124

Chui

96.1

67.3

87.9

7.8

260

Bishkek City

96.6

78.8

90.9

20.0

197

Osh City

98.8

87.2

96.7

7.5

76

Area

         

Urban

97.9

82.4

93.6

13.0

539

Rural

97.4

82.5

91.9

7.1

1137

Months since last birth

         

0-11 months

98.7

83.8

93.1

9.8

915

12-23 months

96.2

80.9

91.6

8.0

760

Assistance at delivery

         

Skilled attendant

98.6

83.4

93.4

9.2

1648

Other

(*)

(*)

(*)

(*)

8

No one/Missing

(*)

(*)

(*)

(*)

19

Place of delivery

         

Public sector health facility

98.5

83.5

93.5

9.0

1627

Private sector health facility

(*)

(*)

(*)

(*)

21

Home

(*)

(*)

(*)

(*)

11

Other/Missing

(*)

(*)

(*)

(*)

17

Mother’s education

         

None/primary

(*)

(*)

(*)

(*)

15

Basic secondary

97.2

85.1

93.8

8.5

200

Complete secondary

97.0

81.9

91.2

8.5

757

Professional primary/middle

99.0

82.4

94.1

6.0

234

Higher

98.0

82.2

93.1

11.8

469

Wealth index quintile

         

Poorest

96.5

83.4

92.3

6.0

336

Second

98.2

86.2

94.1

8.6

372

Middle

98.8

83.7

91.1

10.1

349

Fourth

95.0

79.8

92.9

5.3

312

Richest

99.2

78.3

91.7

15.6

306

Mother tongue of household head

       

Kyrgyz

97.5

82.4

92.3

10.0

1283

Russian

(95.2)

(70.9)

(85.7)

(9.6)

63

Uzbek

98.9

87.4

94.9

5.5

256

Other language

96.8

76.2

92.9

3.5

73

1 MICS indicator 2.5 - Children ever breastfed

2 MICS indicator 2.6 - Early initiation of breastfeeding

Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.[11] Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 82.5 percent of babies are breastfed for the first time within one hour of birth;  while 92.5 percent of newborns in Kyrgyzstan start breastfeeding within one day of birth.The findings are presented in Figure NU.2 by region and area.  The difference between urban and rural children who were first breastfed within one hour of birth was very low. Similar percentages are also observed across the wealth index quintiles: 82.2 percent in the richest quintile vs 83.4 percent in the poorest one. The difference between oblasts was much higher: the highest prevalence was in Osh and Talas oblasts (about 92 percent) while in Chui it was the lowest (67.3 percent).

The percentage of mothers who started breastfeeding within one day of birth is 92.5 percent. There is no difference in the percentage of children breastfed within one day by area. The highest percentage of mothers who started breastfeeding within one day of birth was in Osh city (96.7 percent) and the lowest percentage is found in the Chui oblast (87.9 percent)

Figure NU.2: Initiation of breastfeeding, Kyrgyzstan, 2014

The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals.

In Table NU.4, breastfeeding status is presented for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than 6 months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements, and medicine and the latter allowing also plain water and non-milk liquids. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age.

Table NU.4: Breastfeeding

Percentage of living children according to breastfeeding status at selected age groups, Kyrgyzstan, 2014

 

Children age 0-5 months

Children age 12-15 months

Children age 20-23 months

Percent exclusively breastfed1

Percent predominantly breastfed2

Number of children

Percent breastfed (Continued breastfeeding at 1 year)3

Number of children

Percent breastfed (Continued breastfeeding at 2 years)4

Number of children

               

Total

41.1

69.5

455

60.7

284

22.5

311

               

Sex

             

Male

40.5

67.2

245

58.7

163

25.3

150

Female

41.8

72.2

210

63.4

121

19.9

161

Region

             

Batken

48.0

75.1

40

(93.6)

23

(28.0)

22

Djalal-Abad

17.7

58.6

84

(59.1)

59

30.8

77

Issyk-Kul

(34.6)

(81.2)

24

(*)

15

(*)

14

Naryn

(*)

(*)

9

(*)

10

(20.8)

14

Osh Oblast

47.6

68.9

94

48.5

75

19.9

82

Talas

56.5

69.5

34

55.2

25

4.7

20

Chui

(47.5)

(77.4)

80

(*)

32

(*)

45

Bishkek City

(39.2)

(60.3)

66

(*)

31

(*)

24

Osh City

(45.6)

(85.0)

23

(*)

13

(*)

13

Area

             

Urban

39.5

66.7

152

68.3

89

24.4

79

Rural

41.9

70.9

303

57.2

195

21.8

232

Mother’s education

             

None/primary

(*)

(*)

5

(*)

4

(*)

4

Basic secondary

31.1

64.9

55

(45.3)

36

(18.8)

38

Complete secondary

40.7

67.9

201

67.3

128

25.7

159

Professional primary/middle

41.5

79.6

62

(56.7)

39

(23.2)

46

Higher

46.7

71.2

132

62.1

76

17.6

64

Wealth index quintile

             

Poorest

39.5

66.4

79

63.2

58

17.0

72

Second

39.5

65.5

107

62.0

65

29.0

72

Middle

46.4

69.8

93

53.9

59

24.3

61

Fourth

44.7

72.3

79

60.0

55

22.4

68

Richest

36.0

73.9

97

(65.0)

46

(18.0)

39

Mother tongue of household head

           

Kyrgyz

43.4

70.0

362

65.1

219

20.4

234

Russian

(*)

(*)

15

(*)

8

(*)

8

Uzbek

31.5

65.3

59

(50.6)

49

(31.1)

52

Other language

(*)

(*)

17

(*)

8

(*)

18

1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months

2 MICS indicator 2.8 - Predominant breastfeeding under 6 months

3 MICS indicator 2.9 - Continued breastfeeding at 1 year

4 MICS indicator 2.10 - Continued breastfeeding at 2 years

Approximately 41.1 percent of children age less than six months are exclusively breastfed. With 69.5 percent predominantly breastfed, it is evident that water-based liquids are displacing feeding of breastmilk to the greatest degree. By age 12-15 months, 60.7 percent of children are breastfed and by age 20-23 months, 22.5 percent are breastfed.There are no significant urban-rural differences for exclusive breastfeeding (39.5 percent and 41.9 percent, respectively), while by age 12-15 months a higher percentage of urban children are breastfed (68.3 vs 57.2).

Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, many of children are receiving liquids or foods other than breast milk, with plain water being of highest prevalence, even at the early age of 0-1 months. At age 4-5 months old, the percentage of children exclusively breastfed is 25.4 percent. At age 12-13 months old, only 0.8 percent of children are exclusively breastfed. 12.9 percent of children are receiving breast milk at age 2 years.

Figure NU.3: Infant feeding patterns by age, Kyrgyzstan, 2014

Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 15.4 months for any breastfeeding, 1.5 months for exclusive breastfeeding, and 4.5 months for predominant breastfeeding. Rural children are exclusively breastfed nearly 2 times longer than urban children are (1.8 vs 0.7 months).  The longest median duration of exclusive breastfeeding was observed in the Naryn oblast (3.5 months), the shortest in the Batken oblast (0.4 month) and Chui oblast (0.7 month). 

Table NU.5: Duration of breastfeeding

Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Kyrgyzstan, 2014

 

Median duration (in months) of:

Number of children age 0-35 months

Any breastfeeding1

Exclusive breastfeeding

Predominant breastfeeding

         

Median

15.4

1.5

4.5

2807

         

Sex

       

Male

15.5

1.4

4.7

1441

Female

15.3

1.7

4.3

1365

Region

       

Batken

9.1

0.4

3.0

238

Djalal-Abad

16.4

1.3

3.5

594

Issyk-Kul

13.7

1.6

4.1

152

Naryn

16.4

3.5

4.1

103

Osh Oblast

14.4

1.9

4.5

616

Talas

14.3

3.1

4.6

208

Chui

14.4

0.7

5.3

441

Bishkek City

15.7

1.1

3.6

325

Osh City

16.1

1.8

5.7

130

Area

       

Urban

15.6

0.7

4.1

878

Rural

15.2

1.8

4.7

1929

Mother’s education

       

None/primary

(*)

(*)

(*)

29

Basic secondary

14.8

1.7

3.7

328

Complete secondary

15.6

1.6

4.5

1301

Professional primary/middle

14.6

0.5

5.3

419

Higher

15.5

2.2

4.5

729

Wealth index quintile

       

Poorest

15.7

1.8

4.0

567

Second

15.6

1.7

4.6

634

Middle

15.7

2.0

4.6

584

Fourth

15.3

2.2

4.7

512

Richest

14.8

0.6

4.6

509

Mother tongue of household head

     

Kyrgyz

15.7

1.8

4.6

2150

Russian

13.2

0.6

3.7

112

Uzbek

14.8

1.9

4.0

426

Other language

13.0

2.6

5.3

119

Missing

(*)

(*)

(*)

1

         

Mean

16.3

2.6

4.4

2807

1 MICS indicator 2.11 - Duration of breastfeeding

The age-appropriateness of breastfeeding of children under age 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children age 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food.

As a result of feeding patterns, only 54.1 percent of children age 6-23 months are being appropriately breastfed and age-appropriate breastfeeding among all children age 0-23 months drops to 50.9 percent. There is no clear association between feeding patterns and the household wealth or mother’s education level. However, among children age 0-5 months, there looks to be a positive association between exclusive breastfeeding and mother’s education level.

Table NU.6: Age-appropriate breastfeeding

Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Kyrgyzstan, 2014

 

Children age 0-5 months

Children age 6-23 months

Children age 0-23 months

Percent exclusively breastfed1

Number of children

Percent currently breastfeeding and receiving solid, semi-solid or soft foods

Number of children

Percent appropriately breastfed2

Number of children

             

Total

41.1

455

54.1

1414

50.9

1868

             

Sex

           

Male

40.5

245

54.5

745

51.1

990

Female

41.8

210

53.6

668

50.8

878

Region

           

Batken

48.0

40

66.6

109

61.6

150

Djalal-Abad

17.7

84

60.3

313

51.3

397

Issyk-Kul

(34.6)

24

46.2

80

43.6

104

Naryn

(*)

9

52.0

56

53.9

65

Osh Oblast

47.6

94

50.9

334

50.2

428

Talas

56.5

34

44.0

108

47.0

142

Chui

(47.5)

80

51.9

203

50.6

283

Bishkek City

(39.2)

66

55.6

150

50.6

216

Osh City

(45.6)

23

50.4

61

49.1

84

Area

           

Urban

39.5

152

56.7

431

52.2

583

Rural

41.9

303

52.9

983

50.3

1285

Mother’s education

           

None/primary

(*)

5

(*)

15

(*)

20

Basic secondary

31.1

55

54.1

162

48.3

217

Complete secondary

40.7

201

56.5

659

52.8

860

Professional primary/middle

41.5

62

48.5

205

46.9

268

Higher

46.7

132

53.7

371

51.9

503

Wealth index quintile

           

Poorest

39.5

79

51.1

295

48.7

374

Second

39.5

107

54.8

321

51.0

428

Middle

46.4

93

56.0

293

53.7

386

Fourth

44.7

79

53.5

276

51.6

355

Richest

36.0

97

55.1

229

49.4

326

Mother tongue of household head

         

Kyrgyz

43.4

362

53.4

1075

50.9

1437

Russian

(*)

15

(52.3)

54

(43.3)

69

Uzbek

31.5

59

59.8

220

53.8

279

Other language

(*)

17

(46.6)

64

47.6

82

1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months

2 MICS indicator 2.12 - Age-appropriate breastfeeding

Overall, 85.4 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (Table NU.7). Among currently breastfeeding infants, this percentage is 83.6.  There are no clear differences by sex or area.   

Table NU.7: Introduction of solid, semi-solid, or soft foods

Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Kyrgyzstan, 2014

 

Currently breastfeeding

Currently not breastfeeding

All

Percent receiving solid, semi-solid or soft foods

Number of children age 6-8 months

Percent receiving solid, semi-solid or soft foods

Number of children age 6-8 months

Percent receiving solid, semi-solid or soft foods1

Number of children age 6-8 months

             

Total

83.6

216

(*)

29

85.4

245

             

Sex

           

Male

81.5

103

(*)

15

83.9

119

Female

85.5

112

(*)

14

86.7

126

Area

           

Urban

84.8

72

(*)

9

86.4

81

Rural

83.0

144

(*)

21

84.8

164

1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods

Overall, 80.7 percent of the children age 6-23 months were receiving solid, semi-solid and soft foods the minimum number as shown in Table NU.8.The proportions of males and females achieving the minimum meal frequency is similar (79.6 percent  vs. 81.9 percent).  The proportion of children receiving the minimum dietary diversity (50.9 percent), or foods from at least 4 food groups (35.5 percent), was much lower than that for minimum meal frequency (80.7 percent), indicating the need to focus on improving dietary quality and nutrient intake among this vulnerable group. 

A slightly higher proportion of children age 18-23 months (65.8 percent) were achieving the minimum dietary diversity compared to children age 12-17 months (58.6 percent) and to those who are 6-8 months old (22.9 percent). 

The overall assessment using the indicator of minimum acceptable diet revealed that only 35.5 percentof children age 6-23 months were benefitting from a diet sufficient in both diversity and frequency (Table NU.8). 



Table NU.8: Infant and young child feeding (IYCF) practices

Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Kyrgyzstan, 2014

 

Currently breastfeeding

Currently not breastfeeding

All

Percent of children who received:

Number of children age 6-23 months

Percent of children who received:

Number of children age 6-23 months

Percent of children who received:

Number of children age 6-23 months

Minimum dietary diversitya

Minimum meal frequencyb

Minimum acceptable diet1, c

Minimum dietary diversitya

Minimum meal frequencyb

Minimum acceptable diet2, c

At least 2 milk feeds3

Minimum dietary diversity4, a

Minimum meal frequency5, b

Minimum acceptable dietc

                           

Total

39.9

74.8

36.7

812

66.6

89.0

33.8

62.8

573

50.9

80.7

35.5

1414

                           

Sex

                         

Male

41.5

72.1

37.3

429

66.5

90.2

35.6

64.1

303

51.7

79.6

36.6

745

Female

38.0

77.8

36.1

383

66.6

87.7

31.9

61.5

271

50.1

81.9

34.3

668

Age

                         

6-8 months

21.8

68.8

21.0

216

(*)

(*)

(*)

(*)

28

22.9

71.0

19.9

245

9-11 months

34.9

72.2

30.0

249

(69.9)

(95.4)

(43.0)

(94.6)

38

39.8

75.3

31.7

289

12-17 months

52.0

77.5

47.3

233

68.3

88.9

38.8

68.3

171

58.6

82.3

43.7

413

18-23 months

59.9

86.3

59.9

114

68.0

88.4

32.1

55.8

336

65.8

87.9

39.1

467

Region

                         

Batken

39.7

74.6

35.7

76

(79.3)

(95.6)

(23.0)

(41.5)

33

51.6

80.9

31.9

109

Djalal-Abad

40.6

49.3

31.8

193

60.7

61.7

31.3

54.4

113

48.1

53.9

31.6

313

Issyk-Kul

(25.0)

(75.9)

(25.0)

40

(49.6)

(91.6)

(28.1)

(83.5)

38

38.1

83.5

26.5

80

Naryn

46.6

79.8

46.6

32

81.7

100.0

51.5

96.6

24

61.0

88.3

48.7

56

Osh Oblast

32.0

87.3

32.0

181

58.6

94.7

22.0

45.8

149

44.1

90.6

27.5

334

Talas

46.7

89.4

46.7

52

62.1

98.8

40.8

82.2

55

54.5

94.2

43.7

108

Chui

56.7

86.2

53.7

114

(75.5)

(95.0)

(45.8)

(69.8)

81

63.7

89.9

50.4

203

Bishkek City

37.3

86.3

37.3

87

(78.1)

(98.5)

(49.3)

(85.8)

59

53.6

91.2

42.1

150

Osh City

29.7

58.7

24.3

36

(90.6)

(93.3)

(31.7)

(47.9)

23

54.3

72.2

27.2

61

Area

                         

Urban

40.7

74.2

35.7

259

74.9

92.2

44.7

74.1

165

54.1

81.2

39.2

431

Rural

39.5

75.1

37.2

553

63.2

87.8

29.4

58.3

409

49.6

80.5

33.9

983

Mother’s education

                         

None/primary

(*)

(*)

(*)

5

(*)

(*)

(*)

(*)

8

(*)

(*)

(*)

15

Basic secondary

25.5

73.2

22.9

91

66.7

86.8

36.9

64.6

71

43.8

79.2

29.1

162

Complete secondary

38.5

74.6

35.0

393

64.8

85.9

29.6

59.6

248

48.8

79.0

32.9

659

Professional primary/middle

48.8

74.9

45.5

108

70.1

92.5

30.3

54.8

95

58.3

83.1

38.4

205

Higher

43.7

75.2

41.1

214

69.4

92.4

42.0

74.5

150

54.2

82.3

41.5

371

Wealth index quintile

                         

Poorest

31.4

72.2

30.3

158

54.5

74.7

23.3

47.8

129

42.6

73.3

27.1

295

Second

36.3

77.4

34.1

190

68.3

95.0

28.7

58.7

128

49.0

84.5

31.9

321

Middle

37.9

68.8

32.6

175

59.8

90.1

25.4

60.4

113

45.7

77.1

29.8

293

Fourth

50.9

83.7

48.9

157

74.4

95.8

49.6

78.8

106

60.7

88.6

49.2

276

Richest

44.5

71.5

39.2

131

79.5

91.6

47.2

73.5

98

59.4

80.1

42.6

229

Mother tongue of household head

                       

Kyrgyz

39.8

75.8

37.3

613

68.9

91.0

34.1

65.9

443

51.9

82.2

35.9

1075

Russian

(*)

(*)

(*)

30

(*)

(*)

(*)

(*)

21

(67.2)

(86.9)

(52.7)

54

Uzbek

34.1

64.8

27.8

138

57.0

78.1

30.8

48.2

82

42.8

69.8

28.9

220

Other language

(*)

(*)

(*)

31

(*)

(*)

(*)

(*)

27

(49.6)

(89.1)

(38.2)

64

1 MICS indicator 2.17a - Minimum acceptable diet (breastfed)

2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed)

3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children

4 MICS indicator 2.16 - Minimum dietary diversity

5 MICS indicator 2.15 - Minimum meal frequency

a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables.

b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times.

c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while for non-breastfed children it further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds.


The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that bottle-feeding is prevalent in Kyrgyzstan. 29.8 percent of children aged 0-23 months are fed using a bottle with a nipple, even for the younger children (under 6 months) the percentage is 18.3. The prevalence of bottle feeding among children age 0-23 months ranges from 20.7 percent in Djalal-Abad region, to 43.5 percent in Bishkek city

Table NU.9: Bottle feeding

Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Kyrgyzstan, 2014

 

Percentage of children age 0-23 months fed with a bottle with a nipple1

Number of children age 0-23 months

Total

29.8

1868

Sex

   

Male

29.1

990

Female

30.6

878

Age

   

0-5 months

18.3

455

6-11 months

39.5

534

12-23 months

29.8

880

Region

   

Batken

22.5

150

Djalal-Abad

20.7

397

Issyk-Kul

23.2

104

Naryn

31.8

65

Osh Oblast

26.7

428

Talas

39.2

142

Chui

35.6

283

Bishkek City

43.5

216

Osh City

37.1

84

Area

   

Urban

36.4

583

Rural

26.8

1285

Mother’s education

   

None/primary

(*)

20

Basic secondary

30.2

217

Complete secondary

22.8

860

Professional primary/middle

36.7

268

Higher

38.4

503

Wealth index quintile

   

Poorest

19.6

374

Second

23.7

428

Middle

32.0

386

Fourth

39.4

355

Richest

36.3

326

Mother tongue of household head

   

Kyrgyz

30.4

1437

Russian

(41.2)

69

Uzbek

25.3

279

Other language

23.9

82

1 MICS indicator 2.18 - Bottle feeding

Salt Iodization

Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million).

The Government of the Kyrgyz Republic took measures aimed at the prevention of iodine deficiency disorders through the adoption of the Law of the Kyrgyz Republic "On prevention of iodine deficiency disorders” (Governmental Decree N 40, February 18, 2000) and secondary legislation for its implementation. Production of iodized salt has begun in Kyrgyzstan after these legislations. The state Program on reduction of iodine deficiency diseases in the Kyrgyz Republic for 2010-2014 had been developed and implemented to secure progress achieved.

Table NU.10: Iodized salt consumption

Percent distribution of households by consumption of iodized salt, Kyrgyzstan, 2014

 

Percentage of households in which salt was tested

Number of households

Percent of households with:

Total

Number of households in which salt was tested or with no salt

No salt

Salt test result

Not iodized 0 PPM

>0 and <15 PPM

15+ PPM1

                 

Total

98.2

6934

0.4

0.4

6.3

92.8

100.0

6835

                 

Region

               

Batken

99.6

508

0.1

0.7

6.7

92.6

100.0

506

Djalal-Abad

100.0

1235

0.0

0.1

3.1

96.8

100.0

1235

Issyk-Kul

99.7

628

0.3

0.3

4.7

94.8

100.0

628

Naryn

99.1

323

0.5

1.3

16.9

81.3

100.0

322

Osh Oblast

99.7

1028

0.0

0.5

12.2

87.2

100.0

1024

Talas

99.8

270

0.0

1.3

2.5

96.3

100.0

270

Chui

94.3

1393

1.2

0.8

10.0

88.1

100.0

1329

Bishkek City

97.9

1237

0.1

0.0

0.7

99.2

100.0

1212

Osh City

97.4

312

1.5

0.1

1.4

96.9

100.0

309

Area

               

Urban

97.9

2739

0.2

0.1

3.9

95.7

100.0

2688

Rural

98.4

4195

0.4

0.6

7.9

91.0

100.0

4147

Wealth index quintile

             

Poorest

99.7

1198

0.2

0.5

8.8

90.4

100.0

1197

Second

99.1

1193

0.6

0.5

7.0

91.9

100.0

1190

Middle

99.3

1239

0.2

0.5

8.4

90.9

100.0

1232

Fourth

96.9

1401

0.4

0.8

5.2

93.6

100.0

1363

Richest

97.0

1904

0.4

0.1

3.7

95.8

100.0

1853

1 MICS indicator 2.19 - Iodized salt consumption

In 98.2 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. Table NU.10 shows that in 0.4 percent of households, there was no salt available. These households are included in the denominator of the indicator. In 92.8 percent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt was lowest in the Naryn oblast (81.3 percent) and highest in Bishkek city (99.2 percent). 95.7 percent of urban households were found to be using adequately iodized salt as compared to 91 percent in rural areas. Interestingly, the difference between the richest (95.8 percent) and poorest households (90.4 percent) in terms of iodized salt consumption is much less than expected. The consumption of adequately iodized salt is graphically presented in Figure NU.4 together with the percentage of salt containing less than 15 ppm.

Figure NU.4: Consumption of iodized salt, Kyrgyzstan, 2014



[1] For a detailed description of the methodology, see Boerma, JT et al. 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization 74(2): 209-16

[3] See MICS Supply Procurement Instructions: http://mics.unicef.org/tools

[4] Bhuta Z. et al. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013.

[5] WHO. 2003. Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February 2003.

[6] WHO. 2003. Global Strategy for Infant and Young Child Feeding.

[7] PAHO. 2003. Guiding principles for complementary feeding of the breastfed child.

[8] WHO. 2005. Guiding principles for feeding non-breastfed children 6-24 months of age.

[9] Food groups used for assessment of this indicator are 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables.

[10] WHO. 2008. Indicators for assessing infant and young child feeding practices.Part 1: Definitions.

[11] Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life).