According to UNICEF, good nutrition is the bedrock of child survival and development. Well-nourished children are better able to grow and learn, to participate in their communities, and to be resilient in the face of disease or disaster.

Yet, globally, proper nutrition during childhood still remains elusive. Malnutrition is linked to nearly half of the world’s childhood deaths under 5 — stealing about 3 million young lives a year. And for millions of children, chronic malnutrition will result in stunting, an irreversible condition that literally inhibits their physical and mental growth and development. Armenia is no exception, and child malnutrition is, unfortunately, a problem, particularly in rural areas.

The results of a recent study conducted by Fund for Armenia Relief (FAR) on the prevalence and determinants of stunting in a border region of Armenia, was recently published in BioMed Central, which is the first serious paper to be published in the preeminent UK-based journal that specifically highlights this problem in Armenia. The study became possible thanks to the longtime cooperation between FAR and Columbia University’s Institute on Human Nutrition, with significant contribution from Columbia Professor Dr. John Bilezikian.

The article in BioMed Central spotlights a severe issue that former FAR Board Vice Chair Dr. Edgar Housepian (1928-2014), shed light on during the early 2010s, when he started conferring with his colleagues from Columbia’s Institute of Human Nutrition.

“Doctor Housepian came to me because he and FAR were concerned about undernutrition and malnutrition in Armenia. After the talk, I said that it’s important that I go to Armenia to actually see the situation. The first trip about seven years ago was organized by FAR and it was a total eye opener,” said Columbia Professor and Director of Columbia’s Institute on Human Nutrition, Dr. Richard Deckelbaum, recollecting his experience in Armenia’s Tavush Province, where he met with numerous elderly and children who had stunting problems, anemia, and high cholesterol levels.

After thorough discussions with representatives from Armenia’s Ministry of Health, USAID, and UNICEF, FAR, together with Columbia University professors in 2011 decided to develop a baseline data collection that could serve to identify the best approaches for combatting malnutrition.

In 2013, FAR initiated one of its biggest and most multifaceted programs, the Breaking the Cycle of Poverty Program (BCPP), which covers 16 communities in Berd, a poor region in Tavush Province near the northeastern border of Armenia that has experienced intermittent military tension for more than 20 years. Since tackling child malnutrition was a high priority, FAR’s healthcare team and Columbia University experts developed a strategy and an activity plan in harmony with the program to advocate for changes amongst both parents and local healthcare service providers. Such initiatives included the elaboration of a nutrition plan for local kindergartens, and continuous outreach and awareness-raising activities, including trainings and seminars targeting both parents and local doctors on childhood malnutrition.

The following year, FAR took the opportunity to host Armenia’s first ever international conference on nutrition, led by Dr. Deckelbaum. The conference focused specifically on the importance of children’s balanced and healthy nutrition, as well as the problem of the “double burden” of malnutrition (being both undernourished and overweight).

“That was a very productive conference because there was a lot of open discussion between the audience, which was packed. At the initial stage of the conference, we could sense some resentment from the audience, as participants/stakeholders thought that we were going to impose on them ready-made templates, and prescribe off-the-rack approaches to the problem. However, when they realized that we were there to listen and hear from our colleagues in Armenia as well, that is when the discussions transformed into a much more constructive mode,” said Dr. Kim Hekimian from Columbia University, who also emphasized the importance of further collaboration to improve interventions in nutrition in the Tavush province and beyond.

The comprehensive study featured in BioMed Central was conducted to assess health and nutrition among preschool-aged children in the Berd Region. Through a cross-sectional study that measured stunting, anemia, soil-transmitted helminthes, and dietary diversity among 6-month to 6-year-old children in 16 communities, researchers found that the prevalence of stunting was higher among the 6- to 24-month-old children (13.3%) than children aged 25 to 72 months (7.8%). In addition, the prevalence of anemia in 6- to 24-month-old children was higher when compared to 25- to 72-month-old children.

Ultimately, the study identified several risk factors associated with the development of stunting among children in this conflict-ridden border region of Armenia. Factors such as minimum dietary diversity and history of previous episodes of diarrhea indicated the necessity of adequately feeding children. The children who consumed at least four food groups during the previous day (minimum dietary diversity) had significantly lower odds of being stunted. Children with reported prolonged diarrhea also had higher odds of being stunted. The prevalence of stunting could have been reduced by the application of appropriate interventions, such as the provision of a balanced and healthy diet.

“In 2015, in collaboration with the renowned Columbia University experts, we elaborated an in-depth and targeted plan of activities focused on combatting child malnutrition and reducing stunting. In the future, I would like to see the holistic summary of our works completed, and the strategy-based program replicated in other communities as well,” said FAR Healthcare Programs Director Hambardzum Simonyan referring to the necessity of further research that could determine the underlying causes of anemia and stunting, and whether or not these are exacerbated by the ongoing conflict in the region.

Currently, the situation of malnutrition has drastically changed in Berd, in part due to FAR’s awareness-raising trainings among community doctors and parents. However, as healthcare experts state, “there is still much to do.”