Establishment of a Regional Iodine Resource Laboratory and External Quality Assessment Program at the Kazakh Academy of Nutrition.

Objectives: The need for and lack of iodine resource laboratories in Central and Eastern Europe led to an agreement between the Centers for Disease Control and Prevention (CDC) and UNICEF for developing a regional iodine reference laboratory at the Kazakh Academy of Nutrition (KAN). Objectives included conducting reliable iodine measurements, KAN capacity strengthening, operating an external quality assurance (EQA) program, and self-sustainability. An underlying aim was ensuring quality laboratory data for management and decision-making of iodine disorder elimination programs. Methods: Creation of the laboratory at KAN was undertaken through technical support, training, funding, and material resources from CDC and UNICEF. Initial activities included building a fully-functioning laboratory, developing partnerships, and creating and operating a website and EQA program. Later activities included a landscape analysis, harmonized guidelines, an inaugural workshop attended by 17 regional laboratories, and a business sustainability plan. Results: The KAN reference laboratory was established and an operational plan is being implemented that will ensure sustainability. The plan includes contracts with the Kazakh government for multiple micronutrient analyses in four surveys, and fee-based trainings and assessments for regional laboratories as provided for Serbia, Kyrgyzstan, and Moldova. Participation in at least one EQA round by 78% of regional laboratories and consistent participation from 11/18 labs indicates that KAN assistance was well received. Conclusions: An up-to-date, high-quality reference laboratory and resource center for iodine assessments, led by technical experts capable of managing reliable iodine measurements in salt and urine and coordinating an EQA service for national iodine laboratories, has been established in the region.

The Prevalence of Anemia in women of Childbearing Age in Kazakhstan: Some Causes, Risk Factors and Interventions.

Objectives: An assessment of the causes, risk factors and availability of fortified flour on anemia prevalence among women of reproductive age (WRA) in Kazakhstan. Methods: Results of comparative analysis of the National Nutrition Surveys (NNS) in 2006 and 2011 with randomized sampling of 4089 WRA in 2006 and 1214 WRA in 2011. Hemoglobin levels in blood of WRA measured by HemoCue spectrometry, Serum Ferritin and C-Reactive Protein (CRP) levels - by ELISA, Fortified Wheat Flour (FWF) - by Spot Test For Iron. The WRA were interviewed on risk factors. Results: In 2006 44.5% of women, including 51.8% of Kazakh and 31.6% of Russian, had anemia, and in 2011 these indicators showed reduction anemia 39.0%, 43.6% and 27.5%, accordingly. The prevalence of low ferritin levels with CRP ≤5 mg/L and low ferritin levels with anemia were 43.8% and 57.15%, accordingly. In 2006 FWF was available in 28.4% of households, and the incidence of anemia among women living in these households was lower (41.2%) than in those who hadn't FWF (46.2%). In 2011 in West Kazakhstan Oblast, where 64% of households had FWF, the difference in anemia prevalence (34.6% and 63.3%, accordingly) was more significant. Use of Intrauterine Devices (IUD) increases the prevalence of anemia among women (47.5) than in those, who did not use IUD (36.3%). The influences of some other factors on anemia incidences are also revealed. Conclusions: Iron deficiency, the availability of FWF in households, nationality, use of IUD and some other factors influence on the prevalence of anemia in women.