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Fill the Nutrient Gap (FNG) Analysis TajikistanSummary of Key Findings and Recommendations

DushanbeJuly 5th - 2018Nitesh Patel, WFP Regional Bureau Cairo

NUTRITIONSITUATIONANALYSIS

Data / grey literature / peer reviewed articles / reports

Secondary data, 200+ sources Cost of the Diet

Market survey food price data(Tajstat, 2016-17)

Analysis and modelling for 4 regions (market price data unavailable for DRS)

Estimate cost of nutritious diet for the household (6 members)

Non-affordability of the nutritious diet using expenditure data (WASH 2017)

How to address economic access issues&

Intervention modelling

Malnutrition characteristics, enabling policy environment, food availability, access, local

practices

Analysis process

Main Findings

1. Stunting is declining, but prevalence of micronutrient deficiencies is high, and overweight/obesity and non-communicable diseases are increasing

Note: 2030 target of 40% decline of # children stunted may be met by 2037

Source: DHS 2003, UNICEF MNS 2009, UNICEF MNS 2016, DHS 2017

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2003 2009, October 2016, November 2017, Aug-Nov

Pre

vale

nce

(%

)

Prevalence of anemia, National average

Women 15-19 years (<12.0 g/dl) Children 6-59 months (Hb < 11.0 g/dl)

WHO - Severe public health problem

WHO - Moderate public health problem

WHO - Mild public health problem

Main Findings

2. Too high consumption of bread and oil, too little diversity; a nutritious diet must be more diverse, and costs 2-3 times more than a diet that just provides sufficient energy

3. Target groups with high needs (1000 days, adolescent girls, elderly) are most at risk of inadequate nutrient intake

Source: CotD analysis 2018

11 11 12 13

3027

30

3943

32

41

51

0

10

20

30

40

50

60

Dushanbe Sughd Khatlon GBAO

Ave

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ost

(TJ

S)

Household cost of diets that meet energy needs, and nutrient needs with or without vegetable oil (2017)

Energy only

Nutritious diet - no fixed amount of vegetable oilNutritious diet - including vegetable oil

0%

20%

40%

60%

80%

100%

Reduced agricultural water Crop pests & diseases Severe weather conditions Landslides/Flooding Harvest failure

% o

f H

ousehold

s

Natural shocks experienced by rural households

May 2016 Dec 2016 May 2017 Dec 2017

Main Findings

4. Major drivers of food security: agriculture, remittances, imported foods and their prices

5. Food security is declining - climate change is a further threat

Source: WFP Food Security Monitoring, draft report December 2017

6. Nutritious diet is unaffordable for 30-55% of households – affordability declines when food security decreases

7. Seasonality of production and incomes is likely to affect nutritional quality of diets throughout the year

Main Findings

8. Prevalence of wasting is high during early infancy (0-5 mo.) and many children receive water in addition to breastmilk - water quantity & quality?

9. Late introduction of complementary foods and low diversity, especially when compared with dietary diversity of women

10. Women’s domestic workload constrains their capacity to care for children; labor migration leads to more female-headed households and increased income-earning responsibilities

0%

10%

20%

30%

40%

50%

60%

70%

80%

1-2 3-4 5-6 6-8 9-11

Pre

vale

nce

(%)

Age (Months)

Breastfeeding status by child's age in months

Not breastfeedingExclusively breastfeedingBreastfeeding and consuming plain water onlyBreastfeeding and consuming other milkBreastfeeding and consuming nonmilk liquidsBreastfeeding and consuming complementary foods

Source: DHS 2017

Main Findings

11. Availability of nutritious foods can be improved through collaboration with:a. collaboration with food producers : increase agricultural diversification and productivityb. collaboration with food processors: fortification (wheat flour, oil, complementary foods

for young children); c. assessing and addressing seasonality to increase availability throughout the year

12. Physical and Economic access to nutritious foods, including for specific target groups, can be improved using existing platforms & delivery channels: e.g. social safety nets, schools, preventive health and nutrition services, and markets

❖ Most cost-effective options for better meeting micronutrient needs:

➢ Household: fortified wheat flour➢ Adolescent girls and lactating women: multi-micronutrient tablets➢ School child: nutritious school meal (fresh foods + fortified flour + beans

+ fortified oil + iodized salt)➢ 6-23 mo old child: fortified complementary food (local / regional)

Health and Nutrition

➢Coordinate through SUN platform and continue Multisectoral engagement

➢Develop, review and promote food-based dietary guidelines

➢Improve national nutrition capacity, including through support to the ongoing initiative to develop and incorporate nutrition training modules into medical curricula

➢Increase local health centre capacity

➢Raise awareness within communities about the importance of exclusive breastfeeding and appropriate, diverse and timely complementary feeding

Recommendations (1 of 4)

Fortification

➢Support passing of fortification law and prepare for implementation of fortification law by involving relevant government and non government agencies

➢Set fortification standards

➢Explore feasibility of development and local/regional production of fortified complementary foods for children 6-23 months old


Social Protection

➢Use Targeted Social Assistance registration system to ensure delivery of services by other sectors

➢Package of support to increase consumption of nutritious foods, including by specific target groups

➢Consider and strengthen capacity of government agencies to deliver services

Education

➢Provision of nutritious meals at school by school kitchens; provide healthy options in school canteens; require sellers to carry nutritious foods

➢Sensitize children to healthy lifestyle and importance of nutritious, healthy, safe foods

Media

➢Use journalists and other television entry points to promote healthy and nutritious diets


Agriculture

➢Promote and support year-round growing of vegetables in greenhouses and tunnels and introduce new varieties to extend the growing season

➢Promote improved food storage and preservation practices

Gaining further insights

➢Conduct qualitative assessment of social and cultural drivers of feeding practices and constraints faced by women to care for young children

➢Better understand provision of water to children

➢Assess non-affordability of a nutritious diet throughout the year

➢Analyse data on Minimum Dietary Diversity in Women for winter and lean seasons


Many thanks for your attention!Any Question?

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Fill the Nutrient Gap (FNG) Analysis Tajikistan – Detailed Key Findings

Dushanbe

May 2018



MALNUTRITION

Inadequate access to food

Inadequate dietary intake

Disease

Inadequate care for

children and women

Insufficient health services and unhealthy environment

Meeting nutrient requirements is a prerequisite for preventing malnutrition


Nutrient needs vary by age, sex and biological state

• More active – Higher energy needs

• Higher body weight – Higher energy needs

• Growth and Development – Higher nutrient needs / 100 kcal:

• Child aged 6-8 mo needs 9x as much iron and 4x as much zinc / 100 kcal than adult man

• Higher need for 'nutrient-dense' foods during

• 1000 days (pregnancy, lactation, 0-24 mo)

• Adolescence

• Chronic illness

• Older age


• Consumption of Adequately Nutritious foods varies and depends on• Availability• Physical Access• Affordability (Food prices & Income)• Preferences, Knowledge, Time, Convenience


➢Specific target groups in a specific context

➢Multi-stakeholder input and involvement

Fill the Nutrient Gap aims to identify the barriers to adequate

nutrient intake:

Recognising need for shared understanding of issues, context and solutions.


➢Children <2 years➢School children

➢Pregnant and lactating women➢Adolescent girls

Life-cycle approach with a focus on:

Linear programming on the

Cost of the Diet

Reviewing secondary data and sources of

information

2 Components of the Analysis


FNG CountryTeam

WFP

National Government

Other UN Agencies

Other Partners

Country Office,Head Quarters Nutrition, Regional

Bureau, Columbia University

Health & Social Protection, TajStat, Agriculture, Education, SUN

Networks

UNICEF, WHO, FAO

World Bank, NGOs, Academia, Private Sector, Development

Partners

Multiple stakeholders, from several sectors, engaged in the process


Fill the Nutrient Gap – Global Partners


Guatemala

El Salvador

Ghana

Pakistan

Madagascar

Tanzania

Indonesia

Cambodia

Laos

Sri LankaQ2 2017

Mozambique

Starting Q2 2018

ZimbabweSudan

Malawi

Armenia

Niger: Q3 2017

Rwanda: Q4 2017

Uganda: Q4 2017

Philippines: Q2 2018

Ecuador: Q1 2018

Pilots – completed 2016

Completed 2017

Ongoing, starting date

Cost of the Diet 2017

Tajikistan: Q1 2018

Around the world


Sourced data / grey literature / peer reviewed articles / reports

Secondary data Cost of the Diet

Market survey data (Tajstat, 2016-17)

200+ sources identified

Analysis and modelling for 4 regions (market price data unavailable for DRS)

Estimate the cost of staple adjusted nutritious diet

for a household of 6 people

Non-affordability of the nutritious diet using expenditure data (WASH 2017)

How to address economic access issues

Intervention modelling

Malnutrition characteristics, enabling policy environment, food availability, access, local

practices

Analysis process


Locally available

food items

Least expensive nutritious

diet

Possible diets meeting all nutrient requirements of the

household

Least expensive nutritious diet

adjusted to include 2 servings of wheat per

day, 3 servings per week of potato and 1 serving per week of

milk (Nutritious Diet /

SNUT)

Wheat flour is the main staple in

Tajikistan

Linear programming (Cost of the Diet, developed by SC-UK) determines the least expensive nutritious diet

using locally available foods


The Nutritious Diet

What it is:

• Based only on foods available in local markets in each area

• Based on lowest cost to meet nutrient requirements

• It includes 2 servings per day of wheat flour (172g per serving for an adult man), 3 servings per week of potato(207g per serving for an adult man) and 1 serving per week of milk (344g per serving for an adult man) in all regions

• Includes 10 servings per week of oil (34g per serving for an adult man) in Khatlon

What it is not:

• Not necessarily what people are actually eating

• Not designed to provide recommendations or guidelines of what people should eat


Standardized household size and composition modelled for all regions

6 person household:

1. Child aged 12-23 months

2. School child aged (6-7 years)

3. Adolescent girl (14-15 years)

4. Lactating adult woman

5. Adult man

6. Older man (60+ years)


Two types of models are analysed

2. Possible ways to improve affordability of nutritious diet- Lower the price of nutritious

foods- Improve nutrient content of foods- Increase availability of nutritious

foods and supplements- Increase income

1. Advocacy around undesirable or suboptimal practices

Informed by secondary data and stakeholder consultation

Source: Cost of the Diet analysis 2018 (WFP)

The average cost of a nutritious diet (2017) does not change much by month or season

NB: Food price data was unavailable for DRS

-

500

1,000

1,500

Jan

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Khatlon

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/mo

nth

Dushanbe

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1,500

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1,500

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GBAO


FO

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Focus of FNG analysis topics – Tajikistan

• Trends for nutritional status

• Dietary intake – Main foods & dietary diversity

• Situation and Drivers of food security: Agriculture, Remittances, Imports

• Cost & Affordability of a nutritious diet

• Further challenges to food security: Climate change and Seasonality of production

• Early life nutrition (0-5 & 6-23 mo): Nutritional status, Feeding practices, Constraints to caring

• Improving availability and access to nutritious foods (approaches, platforms, delivery channels)


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1 Stunting prevalence is slowly declining,

but prevalence of micronutrient deficiencies remains very high

and the burden of overweight and obesity is high and increasing

This indicates that nutritional quality of the diet is inadequate

Nationally, stunting dropped 12 percentage points from 2009 to 2017

Source: MNS 2009, DHS 2012, MNS 2016, DHS 2017

29%

26%

21%

17%

0%

5%

10%

15%

20%

25%

30%

35%

2009, October 2012, July-Sept 2016, November 2017, Aug-Nov

PR

EVA

LEN

CE

(%)

Stunting prevalence (%) by region over time

13,3097,252

54,355

40,003

80,448

Stunting by region, DHS 2017

The most populous regions have lower stunting prevalence, but higher numbers of stunted children

Total: 264,891Total: 195,367

(27% less than 2012)Source: DHS 2012 & 2017, 2010 Census, 2015 Tajstat

15,479

5,022

77,197

64,069

103,125

Stunting by region, DHS 2012

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2003 2009, October 2016, November 2017, Aug-Nov

Pre

vale

nce

(%

)

Prevalence of anemia, National average

Women 15-49 (<12.0 g/dl) Children (6-59 months) Hb ≥11g/dl)

Anaemia affects more than 40% of women and children

Source: MNS 2003, MNS 2009, MNS 2016, DHS 2017

WHO: >40% = severe public health problem

Mild public health problem

Moderate public health problem

High prevalence of iron deficiency. In most regions at least 50% of anaemia is attributable to iron deficiency, in both women and children

Source: MNS 2016

0%

10%

20%

30%

40%

50%

60%

70%

80%

Dushanbe Khatlon Sughd DRD GBAO National

PR

EVA

LEN

CE

(%)

Children (6-59 months )

0%

10%

20%

30%

40%

50%

60%

70%

80%

Dushanbe Khatlon Sughd DRD GBAO National

PR

EVA

LEN

CE

(%)

Women (15-49)

Both women and children living in urban areas have significantly lower prevalence rates of iron deficiency, anemia, and iron deficiency anemia than those in rural areas.

Iodine deficiency is increasing in some regions, and is slightly lower in children than in women

Source: MNS 2009 & 2016

0%10%20%30%40%50%60%70%80%90%

Dushanbe Khatlon Sughd DRD GBAO Nationalaverage

PR

EVA

LEN

CE

(%)

Women (15-49) (Ul <100µg/L)

2009 2016

0%10%20%30%40%50%60%70%80%90%


PR

EVA

LEN

CE

(%)

Children (6-59 months )(Ul <100µg/L)

2009 2016

Households using iodized salt has decreased from 82% nationally in 2009, to 74% in 2016.

Prevalence of Vitamin A deficiency is very high among women and children

Source: MNS 2016

39%

67%

44%

36%

48% 47%

0%

10%

20%

30%

40%

50%

60%

70%


PR

EVA

LEN

CE

(%)

Women (15-49) (RBP ≤0.70 µmol/l)

21%

37%

50%

41%36% 37%

0%

10%

20%

30%

40%

50%

60%

70%


PR

EVA

LEN

CE

(%)

Children (6-59 months) (<0.70µmol/l)

WHO: vitamin A deficiency >20% = severe public health problem

15%

7%3%

8%

18%

39%

61%

38%

0%

10%

20%

30%

40%

50%

60%

70%

15-24 25-40 41-49 National average

PR

EVA

LEN

CE

(%)

BMI class distributionwomen 15-49 years

BMI<18.5 BMI 25

More than one third of women 15-49 yrs are overweight or obese and at increased risk of non-communicable disease

Source: MNS 2009 & 2016

The prevalence of overweight and obesity is

higher in urban (41%) than rural areas (32%).

Cost of nutritious diet are highest for the adolescent girl – her (micro)nutrient needs are difficult to meet

Source: Cost of the Diet analysis 2018 (WFP)

5%

8%

37%

20%

14%

16%

Cost by individual (%) - 2017

Child 12-23 months

School aged child

Adolescent girl

Lactating woman

Man

Elderly man


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The diet in Tajikistan is too high in high-energy,

but low-nutrient foods ('empty calories')

• Typical diet contains too much bread and oil and is not diverse enough

• Agricultural production is centered on staple foods

Source: Tajstat

Agricultural production has been centered on cereals and cotton

-

150,000

300,000

450,000

600,000

750,000

900,000

2012 2013 2014 2015 2016

Cultivated areas by type of crops in Tajikistan (Ha)

Other

Fodder

Potato

Vegetables

Cotton

Rice

Corn (for grain)

Wheat

Source: Tajikistan Food Security Monitoring July 2017

Also households with acceptable food consumption maintain high intake of cereals, oil

and sugar

Frequencies of food group intake (#d/wk)

23.0%

5.0%

1.2%

4.0%

0.6%26.0%

32.5%

1.2%6.5%

Modelled lowest cost nutritious diet*

Source: Cost of the Diet analysis 2018

The current diet contains more grains and fruit, while nutritious diet has more vegetables and dairy

products

37%

10%4%

0%1%

14%

12%

15%

4% 3%

Current diet*Grains

Roots and tubers

Legumes, nuts, seeds

Meat and offal

Fish, seafood, amphibians,

invertebrates

Milk and dairy products

Vegetables

Fruits

Oils and fats

Sugars

Breastmilk

*Percentage weight of food groups

Source: National Food Pricing Policy in Tajikistan


A nutritious diet for the household costs 2.5-3.5 times more than a diet that meets

only energy requirements

10.8 10.9 11.6 12.8

30.427.0

41.339.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Dushanbe 2017 Sughd 2017 Khatlon 2017 GBAO 2017

Ave

rage

dai

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ost

(TJ

S)

Daily Cost (EO) Daily Cost (SNUT)Energy only Nutritious diet


Increased consumption of oil increases cost of a nutritious diet

30.326.9

28.71

39.142.54

32.28

41.2

50.8

0

10

20

30

40

50

60


Ave

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(TJ

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Vegetable oil as a staple food in all regions (not only Khatlon) - 2017

Nutritious diet Add cottonseed oil to other regionsNutritious diet


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Main drivers of food security situation:

Supply & Prices – Agriculture & Food imports

Income – Agriculture & Remittances

Food security has recently decreased,

this also negatively affects the nutritional quality of the diet

Source: Ministry of Economic Development and Trade & World Bank Country Poverty Report, 2017

Currently 29.1% of the population lives below the poverty line

• The national method for measuring poverty in Tajikistan is based on the Cost of Basic Needs approach and a minimum food basket, supplemented by a fixed percentage of expenditures for basic non-food items and services.

• The value of the official poverty line was TJS 146.77/mo in 2013 and 175.2/mo in 2016 after accounting for inflation.

• In 2016, 31.3 percent of the population (2.7 million) fell below this line.

• Agricultural value added to GDP was 25% in 2015, down from a recent high of 27% in 2011 and a thirty year high of 38% in 1996.

• About 40% of households across the country derive more than half of their income from agriculture; one in five obtain more than 70% of their income from agriculture.

• Agriculture accounts for 39% of tax revenues

• Women make up 53% of the economically active population in agriculture

• 86% of women in rural areas are involved in farming

ADB, Sector assessment agriculture and natural resources, World Bank GDP data, Journal of Rural Studies, Feminization of Agriculture ; WFP Climate Risks and Food Security in Tajikistan 2017

Agriculture is the main economic sector responsible for 21% of GDP and 49% of employment

• 36.6% of GDP in 2016

• 15% of the working age population goes abroad

• Shocks to the Russian economy affect the Tajik economy

• Only 43% of the working age population is in the labor force

• Of total employment:

• 13% is formal private sector

• 16% is in the informal sector

• Tajikistan’s cash-based economy is due to high dependence on remittances

Source: WFP Market Environment Assessment Tajikistan

2016; World Bank Slowing Growth, Rising Uncertainties

Remittances are another main contributor to GDP

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2008 2009 2010 2011 2012 2013 2014 2015 2016

GD

P G

RO

WTH

% R

EMIT

TAN

CES

GDP Growth and Net Remittances

Workers net remittances GDP Growth

Source: 2016; World Bank Slowing Growth, Rising Uncertainties, updated with 2015-2016 data

Source: World Bank Listening to Tajikistan Jobs 2017

Agricultural and migratory work dominate, and the number of household heads working fluctuates seasonally

• Household heads work less in the winter

• The percentage of household heads working decreased from 2015 to 2017

Source: Food Security and Poverty No. 3 2017

Consumer prices for foods have been increasing steadily, at a faster rate than prices for non-food products

Among others, consumer prices have been growing due to factors such as poor transport and infrastructure, profiteering, transportation costs, poor storage facilities, poor system of

government intervention in markets, increased costs of renting space in central markets.

• The food component of the Tajik consumer basket was 198.46 Tajik somoni, while the cost of a healthy diet was estimated at 383.24 Tajik somoni

• The share of household spending on food products is over 55%

• Consumer prices for food have been increasing faster than consumer incomes

• 40% of food expenditure is on bread (wheat)

Source: Tajstat Food Security and Poverty No. 4 2016; WFP Tajikistan Food Security Monitoring July 2017; National Food Pricing Policy Case Study 2017

Food expenditure accounts for 50-60% of household expenditure across regions

55%60%

48%

60% 58% 56% 54% 55%

0%

20%

40%

60%

80%

100%

Proportion of food in total household expenditure

Source: WFP Tajikistan Food Security Monitoring July 2017

Food security fluctuates seasonally but has deteriorated in recent years, especially for the most vulnerable

18%31%

22%35%

26%37% 38%

16%

16%16%

20%

20%

23% 22%25%

25%

24%

22%27%

21% 16%

42%29%

38%23% 28%

20% 24%

0%

20%

40%

60%

80%

100%

Dec2014

Apr2015

Dec2015

May2016

Dec2016

May2017

Dec2017

% share food expenditure groups (rural households)

Very high (>75%) High (65-75%)

Medium (50-65%) Low (<50%)

Source: WFP Food Security Monitoring Report December 2017


The cost of a nutritious diet increased, by region, from 2016 to 2017

Cost of nutritious diet without

addition of oil

Source: Cost of the Diet analysis 2018; WASH expenditure data 2017

While nearly all households can afford a diet that meets energy requirements, a nutritious diet is not

affordable for 29% - 56% of households (2017)

2% 2% 1% 2%

35%

29%

42%

56%

0%

10%

20%

30%

40%

50%

60%

Dushanbe Sughd GBAO Khatlon

% o

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ann

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affo

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EO SNUTEnergy only Nutritious diet


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Climate change related events further aggravate food insecurity

and nutritional vulnerability

• Tajikistan is the most climate-vulnerable country in the Europe and Central Asia region

• Repeated climate-related disasters limit coping capacities of populations

• Natural hazards can lead to high economic losses in Tajikistan: estimated loss of >20% of GDP with a 200-year return period

• Climate change impacts include:

• Increase reliance on aging irrigation system

• Increased glacial melt leading to floods

• Droughts and decreased energy production

• Land erosion

• Loss of crops from heat and frostSource: WFP Climate Risks and Food Security in Tajikistan 2017; AdB Tajikistan Country Partnership Strategy 2016

With climate change, natural and environmental shocks are likely to impact increasing numbers of households

Source: WFP Food Security Monitoring Report December 2017

One-third of households are regularly affected by natural shocks that decrease agricultural production

• 74% of rural households have livestock and 71% cultivate their own land making them vulnerable to natural shocks.

• 37% of the households reported that they had been affected by reduced agriculture water in the previous three months, compared to 28% the previous year.

• Crop pests and disease also increased from 34% to 39%.


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Seasonality may further reduce access to a nutritious diet

• Food prices seem relatively stable across seasons, but production varies across seasons, which may particularly

determine consumption by rural households

• Household income, and therefore economic access, varies across seasons

• Dietary diversity among women in winter & lean season?

• 61% of stocks were purchased on the market, and 30% was from own production

• 69% of households that currently have stocks for a few weeks said they would not be able to maintain or rebuild their stocks in the coming month

Source: WFP Tajikistan Food Security Monitoring December 2017

More households have stocks in Dec than in May and they consist mostly of staples

• About 64% of households grow food crops to complement consumption

• Only 1.3% of households in Dushanbe grow food crops

• Rational norm for vegetables and melons: 142 kg/cap/year

Source: Feed the Future Tajikistan Agriculture and Water Activity

Many households grow and consume their own produce, but only in small quantities

Source: Food Security and Poverty No. 3 0217; National Nutrition Survey 2016

0 100 200 300 400 500 600 700

Production

Home consumption

Production

Home consumption

Production

Home consumption average (kg)

Tom

ato

Cu

cum

ber

Pep

per

Kg

Average backyard garden production consumption (May-July)

Cohort 4 Cohort 3

• Crops grown in Feed the Future backyard gardens: tomato, sweet pepper, cucumber, carrots, onions, garlic, herbs, potatoes, cabbage, eggplant, zucchini, and others

• Fresh produce is eaten from May-September, and small quantities are pickled or dried for lean season consumption


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Suboptimal child feeding and nutrition related to several factors:

Low exclusive breastfeeding rates – many receiving water (0-5 mo)

Late introduction of complementary foods

Child dietary diversity, although increasing with age, much lower than among women – related to knowledge / taboos?

Women face time constraints, limiting their ability to care?

DHS 2017

Nutritional status of children by age -Tajikistan

Tajikistan has a high prevalence of wasting <6 months

In 2012, 7% of babies were

reported to have weighed less than

2.5 kg at birth

Source: DHS 2017

64% of children 0-5 months are not exclusively breastfed, but 33% are only receiving water in addition to breastmilk,

late introduction of complementary foods

55%

38%

15%

26%33%

36%

57%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

1-2 3-4 5-6 6-8 9-11

Pre

vale

nce

(%

)

Breastfeeding Status

Not breastfeeding Exclusively breastfeeding

Breastfeeding and consuming plain water only Breastfeeding and consuming nonmilk liquids

Breastfeeding and consuming other milk Breastfeeding and consuming complementary foods

Depending on the volume given –

water might displace breastmilk

The hygiene level of the water could also have

an impact

DHS 2017, Aug-Nov

Very few children aged 6-23 months have a minimum acceptable diet (MAD), 20% in 2012 and only 9% in 2017, diversity is main

issue

The minimum acceptable diet indicator is used to assess the proportion of children age 6-23 months who meet minimum standards with respect to IYCF practices.

3% 3%

10%

13%

9%

0%

5%

10%

15%

20%

25%

30%

6-8 months 9-11 months 12-17 months 18-23 months Total 6-23 months

PR

EVA

LEN

CE

UNICEF MNS 2016

Child gets introduced relatively late to eggs, meat, vegetables

0 10 20 30 40 50 60 70 80 90 100

Fish

Meat/poultry

Eggs

Milk and milk products

Fruits

Other vegetables

Dark green leafy vegetables

Vitamin A rich vegetables

Nuts & seeds

Pulses

Roots & tubers

Oils & fats

Grains

Age of child when first fed with food or liquids other than breastmilk

<6 6-8 9-11 12-17 18-24

Other liquids and sweets are introduced relatively early, encouraging use of

supplements and MNP

UNICEF MNS 2016

0 20 40 60 80 100

Sprinkles (MNP)

Vitamin/mineral supplements

Sweets

Sweet soda/sugary water

Fruit juice

Tea/Coffee

Clear broth

Infant formula

Water

Age of child in months

<6 6-8 9-11 12-17 18-24

Source: UNICEF Micronutrient Survey 2016

Food consumption of women in November (post harvest) reflects high intake of cereals, but also fruits, vegetables and dairy

0%

20%

40%

60%

80%

100%

Grains,white rootsand tubers,

plantains

Pulses(beans,

peas, lentils)

Nuts andseeds

Dairy Meat,poultry, fish

Eggs Dark greenleafy

vegetables

Othervitamin A-rich fruits

andvegetables

Othervegetables

Other fruits

% o

f w

om

en c

on

sum

ed in

pre

vio

us

24

ho

urs

• Daughters-in-law carry out the household chores to “please their mother in laws and husbands”

• The male labor migration has resulted in the feminization of the labor force, especially agriculture

• Both parents of newborn babies can migrate to seek work leaving the babies with their grandparents.

Household decision-making around food in rural Tajikistan, Food & Nutrition Research 2018

Constraints to women’s ability to care for young children

<10%

11-20%

21-30%

31-40%

>41%

Household reliance on remittances by

livelihood zone

Breastfeeding is important for meeting the nutrient needs of the child under 2, whose diet becomes more expensive without breastmilk

1.61.4

1.8

2.12.36

2.012.16

2.92

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


Ave

rage

dai

ly c

ost

(TJ

S)

SNUT No breastfeedingNutritious dietSource: Cost of the Diet analysis 2018

1.6

1.4

1.8

2.1

0.6 0.5

0.80.7

1.6

1.4

1.8

2.1

0.740.65

1.04 1.06

1.3

1.1

1.3

1.7

0.0

0.5

1.0

1.5

2.0

2.5


Ave

rage

dai

ly c

ost

(TJ

S)

SNUT

SC +

Agusha (market price)

Agusha (in-kind)

MNP

Appropriate complementary foods cover many of the child’s nutrient needs, but would not decrease the cost of the child’s diet unless given in-kind because of high current market prices

Nutritious diet



KE

Y M

ES

SA

GE

7

There is a need to increase the availability and affordability of nutritious foods:

more fruits, vegetables, animal source foods

more fortified foods

less flour, oil and (sugary) snacks & drinks

Source: USAID/GAIN Food Fortification in Tajikistan: A Cost-Effective Strategy for Sustainable Economic Growth 2016

Cost-benefit analysis of wheat flour fortification found that it could prevent cumulative economic losses of $878 million

over the next 10 years

0 50 100 150 200 250 300 350 400 450

Neural tube defects

Neonatal mortality

Maternal mortality

Iron deficiency anaemia among children

Iron deficiency anaemia among adults

USD (millions)

Economic consequences of micronutrient deficiencies


Fortified wheat flour would have the greatest impact on the cost of a nutritious diet for a

household in Khatlon

30.326.9

41.239.1

27.224.2

31.435.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0


Ave

rage

dai

ly c

ost

(TJ

S)

SNUT Fortified food (wheat flour Gov specs)Nutritious diet

Important to also add vitamins A and B12

2.8

2.5

1.9

0.0 0.5 1.0 1.5 2.0 2.5 3.0

SNUT

School feeding (current WFP)

School feeding (current WFP) + parentcontribution + add 2 eggs/wk and 200 ml milk…

AVERAGE DAILY COST (TJS)

National Average of intervention for school aged child - 2017

Adding small quantities of animal source foods (eggs and milk) to the school feeding ration would meet more of the child’s nutrient

requirements and decrease the cost to the family of a nutritious diet for the school-going child(ren)

Nutritious diet

0

10

20

30

40

50

60

70

80

90

100

Per

cen

tage

of

RN

I of

the

Sch

oo

l Age

d C

hild

(%

)

Percentage of the RNI covered by the School Feeding Ration + Parent Contribution + 2 eggs + 2x200ml milk in Sughd

Percentage met

0

10

20

30

40

50

60

70

80

90

100

Per

cen

tage

of

RN

I of

the

Sch

oo

l Age

d C

hild

(%

)

Percentage of the RNI covered by the School Feeding Ration

Percentage met

Add-ons to the school meals rations can help cover more of the child’s micronutrient needs

WFP Target for School Feeding Ration

WFP Target for School Feeding Ration

Provision of fortified foods for free reduces the cost of a nutritious diet to the household

Monthly household ration: 40 kg fortified wheat flour, 1.5 kg fortified vegetable oil, 4 kg pulses, iodized salt

0

5

10

15

20

25

30

35

40

45


Ave

rage

dai

ly c

ost

(TJ

S)

Nutritious Diet FFA

Inclusion of fortified foods substantially improves the nutrient content of the ration

0102030405060708090

100

Per

cen

tage

Proportion of the RNI of the household members covered by the ration

No fortification After fortification

Monthly household ration: 40 kg fortified wheat flour, 1.5 kg fortified vegetable oil, 4 kg pulses, iodized salt

Multi-micronutrient supplements for the adolescent girl would help cover many of her nutritional needs, and would have the greatest impact on cost of her diet in Khatlon

8.546.98

18.91

10.66

5.64.7 5.3

7.05.5

4.6 5.26.8

0

2

4

6

8

10

12

14

16

18

20


Ave

rage

dai

ly c

ost

(TJ

S)

SNUT MMT Iron & Folic acidNutritious diet Multiple Micro-nutrient Tablet (MMT)

Supplementation with multi-micronutrient tablets would have the greatest impact on the cost of the diet for a lactating woman

6.4 6.46.9

8.5

5.74.9

5.4

7.0

5.915.27

5.64

7.75

0

1

2

3

4

5

6

7

8

9


Ave

rage

dai

ly c

ost

(TJ

S)

SNUT MMT Iron & Folic acidNutritious diet Multiple Micro-nutrient Tablet (MMT)

An optimized package of interventions for different individuals and the household could maximize benefits

based on existing and proposed platforms

Target Intervention Modality

Household Fortified wheat flour Market

Lactating woman Multi-micronutrient

tablet

In-kind

Adolescent girl Multi-micronutrient

tablet

In-kind

Child under 2 Agusha In-kind

School-aged child School feeding with

parent contribution +

animal-source food

In-kind

This household package could reduce the cost of a nutritious diet by TJS 178-526 per month…

922

744

0

200

400

600

800

1,000

Staple adjusted nutritious diet Best intervention for eachindividualA

vera

ge m

on

thly

co

st (

TJS)

Dushanbe819

632

0

200

400

600

800

1,000

Staple adjusted nutritious diet Best intervention for eachindividual

Ave

rage

mo

nth

ly c

ost

(TJ

S)

Sughd

Nutritious diet Household package Nutritious diet Household package

1,190

952

0

200

400

600

800

1,000

1,200

1,400


Ave

rage

mo

nth

ly c

ost

(TJ

S)

GBAO

1,254

728

0

200

400

600

800

1,000

1,200

1,400


Ave

rage

mo

nth

ly c

ost

(TJ

S)

Khatlon

Nutritious diet Household packageNutritious diet Household package

…And decrease the proportion of households for whom a nutritious diet is not affordable by 12-34%

35%23%

0%

20%

40%

60%

80%

100%


Dushanbe

29%15%

0%

20%

40%

60%

80%

100%


Sughd

42%

20%

0%

20%

40%

60%

80%

100%


GBAO

56%

22%

0%

20%

40%

60%

80%

100%


Khatlon




KE

Y M

ES

SA

GE

8

Public sector programs can improve their contribution to nutrition

School meals and nutrition programs

Social protection for vulnerable groups & specific target groups

Health sector – supplements, nutrition education

In collaboration with – agriculture & private sector

Social protection Programs

Pensions• 400 Somoni per month• Three major social assistance programs (old age, disability and survivor)• Households receiving a pension: national: 38.4% (national); poor households: 42.7%; non-poor households: 33.2%

Targeted Social Assistance (TSA) • Households receive 400 Somoni per year, about 33 per month • Intended to target the poorest 15% of the population

School meals• Government provides for boarding schools• WFP, with government and parent support, provides for first four years of primary school

Between 2009 and 2013, 73% of the social protection sector budget was allocated for social pensions and 12% for social assistance.


MA

IN F

IND

ING

S

1. Stunting is declining, but prevalence of MNDs is high, and overweight/obesity and non-communicable diseases are increasing

2. Too high consumption of bread and oil, too little diversity; a nutritious diet must be more diverse, and costs 2-3 times more than a diet that just provides sufficient energy

3. Target groups with high needs (1000 days, adolescent girls, elderly) are most at risk of inadequate nutrient intake

4. Major drivers of food security: agriculture, remittances, imported foods and their prices

5. Food security is declining - climate change is a further threat


MA

IN F

IND

ING

S

6. Nutritious diet is unaffordable for 30-55% of households –affordability declines when food security decreases

7. Seasonality of production and incomes is likely to affect nutritional quality of diets throughout the year

8. Prevalence of wasting is high during early infancy (0-5 mo.) and many children receive water in addition to breastmilk - water quantity & quality?

9. Late introduction of complementary foods and low diversity, especially when compared with dietary diversity of women


MA

IN F

IND

ING

S

10. Women’s domestic workload constrains their capacity to care for children; labor migration leads to more female-headed households and increased income-earning responsibilities

11. Availability of nutritious foods can be improved through collaboration with food producers and processors: agricultural diversification and productivity; fortification (wheat flour, oil, complementary foods for young children); assessing and addressing seasonality

12. Access to nutritious foods, including for specific target groups, can be improved using existing platforms & delivery channels: e.g. social safety nets, schools, preventive health and nutrition services, and markets

Documents

WFP-0000073380 - Download