Ukrainian-American Birth Defects Program

One of the main directions of the Program activities is assistance in implementation of birth defects prevention modern technologies. A great attention was paid to neural tube defects prevention, because the situation with them is considered to be an epidemic in Ukraine. There were held 2 conferences with the participation of foreign specialists, organized by the Academy of Medical Sciences of Ukraine, the Health Care Ministry of Ukraine, the Ukrainian-American Birth Defects Program ("Folic Acid Impact: From Scientific Research to Health Care Practice", June 13, 2001 and "UABDP: Achievements and Perspectives", November 28, 2001). At the conferences there was defined the strategy concerning prevention of such pathology. It was recommended to use the experience of progressive countries concerning fortification of food (flour and baking products) with folic acid to prevent neural tube birth defects.

In November 29, 2001 due to the initiative of the Ukrainian delegation there was a workshop of WHO experts in Minsk where these problems were discussed. The propositions of the Ukrainian delegation were supported and the final document of the conference included "Appeal to the Heads of World Countries" (first of all European Countries) about the necessity of implementation of folic acid food fortification as the highly efficient method of neural tube defects prevention.

According to the decision of the experts group there was prepared an appeal to Vice-Premier of Ukraine Mr. V. Semynozhenko about the necessity of state provision of food fortification. He charged a number of organizations to study this problem and prepare a project of the Ukrainian Cabinet of Ministry regulations.

Main events in chronological order are:

UABDP initiative concerning folic acid fortification of food was supported by Heads of eight Regional State Administrations who signed the Declarations.

Letter of the Volyn Oblast Governor to Health Care Minister of Ukraine Dr. V. Moskalenko concerning flour fortification possibilities in the Volyn Oblast.

Joint recommendations of UNICEF, Center for Disease Control and Prevention (CDC, USA), Rollins School of Public Health (USA), University of South Alabama (USA) concerning folic acid fortification of food were delivered to the President of Ukraine through the Academy of Medical Sciences (June 11, 2001).

International Conference "Folic Acid Impact: From Scientific Research to Health Care Practice" (June 13, 2001, Kyiv, Ukraine). Report of G. Oakley "Folic Acid Revolution" (Visiting Professor, Department of Epidemiology, the Rollins School of Public Health of the Emory University, USA). Prof. Y. Kundiev, M.D., Vice-President of the Academy of Medical Sciences of Ukraine, was chosen as a coordinator of the initiative group on implementation of the folic acid fortification of food in Ukraine.

Preparation of recomendations concerning fortification of food with folic acid. From left to right: Prof. Godfrey Oakley, Dr. Glen Maberly, FRACP - UNICEF Consultant; Dr. O. Radziyevska, Main Specialist for USAID regarding public health programs; Mr. Mikael Aleksanyan, Head, UNICEF Office in Ukraine; Ms. Jacky Knowles, ORISE Fellow, Maternal and Child Nutrition Branch, CDC, Atlanta, USA; Prof. W. Wertelecki, Director of the Ukrainian American Birth Defects Program

Creation of the initiative group on implementation of folic acid fortification of food in Ukraine in November 28, 2001. (International Conference "Ukrainian-American Birth Defects Program: Achievements and Perspectives").

Working Presidium. From left to right: Acad. Y. Kundiyev, Vice-President of the Ukrainian Academy of Medical Sciences; Prof. S. Berezhnov, Deputy Chief Sanitary Physician of the Ministry of Health of Ukraine; Dr. O. Radziyevska, Main Specialist for USAID regarding public health programs; Prof. W. Wertelecki, Director of the Ukrainian-American Birth Defects Program

Meeting of Prof. W. Wertelecki with State Secretary of the Health Care Ministry of Ukraine Dr. S. Shevchuk in December 6, 2001. There were discussed questions of folic acid fortification of food.

Letter of Health Care Minister of Ukraine Dr. V. Moskalenko to Vice-Prime-Minister of Ukraine Mr. V. Semynozhenko about the necessity of flour fortification with folic acid. Orders were given to appropriate ministries and institutions to study this question, give their propositions and in case of necessity to prepare documents concerning implementation of a pilot project of folic acid fortification of food for primary prevention of nervous system birth defects on the basis of the Volyn Oblast Mills.

In June, 2001 President of Ukraine Mr. L. Kuchma got acquainted with UABDP work during his visit to the Volyn Oblast. The President highly appreciated UABDP activities. Particular attention he paid to the fortification of food with folic acid in Ukraine with the purpose of neural tube defects and other diseases prevention. He was given materials concerning this question for studying and preparing to future Special Session of UN General Assembly where the questions of children's health protection should be discussed.

President of Ukraine Mr. L. Kuchma during his visit to the Volyn OMNI-Center

Due to the initiative of the Program and support of the Academy of Medical Sciences of Ukraine there was created the National Fortification Alliance. President of this Alliance is Director of Labor Medicine Institute of the Academy of Medical Sciences of Ukraine Acad. Y. Kundiyev, Vice-President - President of the Ukrainian Grain Association Mr. M. Kompanets, Secretary-Treasurer - UABDP Director Prof. W. Wertelecki. National Fortification Alliance includes partners from different agricultural fields who are interested in fortification project implementation in Ukraine.

Acad. Y. Kundiev (left) and Prof. W. Wertelecki

In January 2003 in Kyiv there was a meeting with representatives of the Health Care Ministry of Ukraine, the Academy of Medical Sciences of Ukraine, representatives of regional and state authorities, leaders of agricultural sector and other Ukrainian strategic partners where the creation of the National Fortification Alliance was approved and the Project "Flour Fortification Proposals in Ukraine" was reviewed. This Project was prepared by the UABDP efforts with the participation of foreign partners: Prof. G. Oakley, Department of Epidemiology, the Rollins School of Public Health of the Emory University, (USA) and Mr. P. Ranum, Consultant in Micronutrient Fortification of Cereal Grain Foods (USA). For effective implementation of fortified flour production on the whole territory of Ukraine the Project foresees the creation of necessary infrastructure, preparation of appropriate legislative basis, creation of a micronutrition center and a national laboratory for quantity control of fortified products, etc. For necessary financial support the propositions concerning flour fortification in Ukraine were presented to the Global Alliance for Improved Nutrition (GAIN) in Geneva (February 2003).

The important step in the successful realization of the National Project of Flour Folic Acid and Iron Fortification is the Pilot Flour Fortification Project which is planned to be started at Lutsk Mill #2. During 2003 there were prepared and approved all necessary technological documents for flour production. In February, the folic acid and iron premix sample "U11" was analyzed by the Institute of Hygiene and Medical Ecology of the Academy of Medical Sciences of Ukraine and it was authorized to use it at mills. In May, there was registered a normative document "Technical Specifications of Wheat Flour Fortification with Folic Acid and Iron" in the Volyn Department of the Technical Regulations and Consume Policy State Committee of Ukraine. Normative document "Bakery Products Fortified with Folic Acid and Iron. Technical Specifications" was registered in November 2003.

In June, 2003 the UABDP delegation consisting of Prof. W. Wertelecki, Program Director, Prof. I. Barylyak, President of the Alliance for the Prevention of Birth Defects, Dr. H. Vashchylin, General Director of the Volyn Regional Children's Territorial Medical Center, Mr. C. Andelin, Consultant on Birth Defects Epidemiology (Atlanta, USA), Mrs. O. Trush, Public Health Consultant, visited the Lutsk Mill #2 and discussed the mill conditions before the Pilot Project's beginning. Later, in Kyiv there was a meeting devoted to technical issues of the Fortification Project implementation. Among the meeting participants there were mills' directors, representatives of the Health Care Ministry and United State Agency for International Development, National Fortification Alliance members.

Mr. P. Ranum (second from the right) during his visit to Lutsk Mill #2

"Flour Fortification in Ukraine Proposal" submitted to GAIN Projects Competition in February, 2003 was not chosen for financing. But Ukraine was proposed to submit a renovated project of the "Proposal" for the second competition stage. The proposal was developed by UABDP efforts and new version was submitted to GAIN in October 1, 2003.

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