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Lack of iodized salt threatens children of Tajikistan


DUSHANBE, Tajikistan -- When the Soviet Union disintegrated into chaos, and the republics of Central Asia began changing governments and patterns of trade, one of the small, seemingly commonplace items that disappeared from the markets of Tajikistan was iodized salt.

It has not reappeared. And the lack of it is threatening to damage one of the last treasures of Tajikistan -- its children.

Iodine is an essential part of the human diet and contributes to the normal mental development of children before they are born, their learning ability as they grow up and, later in life, the regulation of metabolism.

But Tajikistan is suffering an epidemic of iodine deficiency.

It is not a small problem: Experts here warn that if iodine is not soon made available in some form, the results will include a higher number of cases of mental retardation in the young and the mental stunting of their elders.

"The nation is in grave danger," says Dr. Shakarjon Anvarova, head of endocrinology at Tajik Medical University. "We're in desperate need of help."

It is a health crisis that might seem to be of a long-ago age.

American communities began adding iodine to salt in the 1920s. Most of the world has followed their example, and in that way solved a major problem of nutrition.

Iodine is necessary to the proper functioning of the human thyroid gland. And it is the production of thyroid hormone that contributes to the normal mental development of a fetus. Health experts consider iodine deficiency the world's leading cause of mental defects.

One of the most obvious symptoms is goiter, an enlarged thyroid gland. Already, 60 percent of the children examined in Dushanbe were found to have goiters. In an outlying village, the figure is 80 percent.

"Tajikistan has the worst problem in the former Soviet Union," says Dr. Grigori A. Gerasimov, an official of the National Research Center for Endocrinology in Moscow. "The new generation is in big trouble."

In many parts of the world, people obtain the necessary iodine from seafood, plants that grew in iodine-rich soil or salt to which iodine has been added. But the soil of landlocked Tajikistan is iodine-poor, and the country is without the means to add iodine to salt.

Before the collapse of the Soviet Union, Tajikistan obtained salt from other republics, where factories added iodine. Now those supplies have been cut off.

First Tajikistan was consumed in civil war, then by the collapse of its economy. Though the civil war began sputtering to an end by January 1993, the chaos has diverted attention away from public health issues.

According to Dr. Anvarova, the government planned to build a factory to add iodine to salt, but the project has been delayed. "We're hoping it will be put into operation in the year 2000," she said. For this generation, that may be too late.

"The population is growing very quickly in Tajikistan," Dr. Gerasimov said in Moscow. "It's only a matter of several years before the consequences will be felt."

The United Nations Children's Fund (UNICEF), leading a worldwide campaign against iodine deficiency, sent an official to Dushanbe to find a way to add iodine to the local diet. But little progress has been made.

"There now seems to be no iodized salt in the market at all," Johan Fagerskiold, the UNICEF representative here, reported recently.

Most parents here seem unaware of the potential harm; those who are aware of the shortage can do little or nothing to alleviate it.

Barno Safarova, a 36-year-old mother of five, has two children with goiter, the results of iodine deficiency. The family lives in a village about 40 miles north of Dushanbe.

Because of the disruptions through the country, no one in the village has been paid for a year. Mrs. Safarova's husband, a teacher, was forced to leave for Russia, where he does odd jobs and brings home money when he can.

Mrs. Safarova's 8-year-old daughter, Mokchira, had such a severe goiter that she has been hospitalized two weeks. A 13-year-old daughter is being treated as an outpatient.

And Mrs. Safarova is deeply worried. She understands the need for iodine but has no way to obtain it. "If we have any salt at all in the village," she says, "we thank God."

Russia, too, is now without iodized salt, but most people ingest enough iodine from other sources. Dr. Gerasimov, who has a $25,000 UNICEF grant for studying the shortage in Russia, said businesses see no profit for themselves in adding iodine, so they don't do it.

Though Dr. Gerasimov says he was in general not a fan of Soviet medicine, at least it was able to insist on iodized salt. The goiters common before the Bolshevik Revolution began to disappear in the Soviet era.

To remind himself of the past, he keeps a reproduction of two icons on his office wall.

Both Mother and Child have beatific expressions -- and large swellings on their necks. "I have these icons not for religious reasons," he says, "but because I like goiters.

"Look at their necks. Medieval painters painted exactly what they saw."

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