Running head: MALNUTRITION IN UKRAINIAN ORPHANAGES 1

Addressing Infant Malnutrition in Ukrainian Orphanages

Laura G. Stewart

Old Dominion University

MALNUTRITION IN UKRAINIAN ORPHANAGES 2

Addressing Infant Malnutrition in Ukrainian Orphanages

Characteristics of the Ukraine

The Central Intelligence Agency (CIA) World Factbook (2016) documents the following

characteristics of the Ukraine:

Geographic

The Ukraine is an Eastern European country slightly smaller than the state of Texas, with

an estimated population of 44,033,874 persons. It shares borders with the Black Sea between

Poland, Romania and Moldova to the west, and Russia to the east. It is of a temperate climate,

with variant summers and winters depending on the proximity to the Black Sea coast.

Population Characteristics

The median age of its’ population is 40.4 years. Out of the 226 countries profiled, the

Ukraine ranks 5th regarding its’ death rate, with an average of 14.4 deaths per 1000 people. As a

comparison, the United States death rate is 8.2/1000. There is a birth rate of 10.3/1000, with

almost 16% of its’ total population falling between the ages of birth and 14 years of age.

Economy

71.2% of the land is agricultural, with significant industry in coal, electric power and

food processing. The Ukraine once provided substantial amounts of meat, milk, grains and

vegetables to surrounding republics, making it the second most important component of the

former Soviet Union behind Russia itself. By 1999, the country had fallen to 40% of this output.

The country once boasted significant production in heavy industry, with the manufacturing of

large-diameter pipe and vertical drilling apparatus. A major part of this industry has been lost

due to the ongoing conflict with Russia. It is characterized by an unemployment rate at 10% (as
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compared to 4.7% in the U.S.), with 24.1% of the population existing below the poverty line

(compared to 15.1% in the U.S.).

Technology

100% of the Ukrainian population has access to electricity. Of its total installed

generating capacity, 63.7% comes from fossil fuels, 23.7% comes from nuclear sources and

9.9% comes from hydro-electric plants. Of significance to this proposal, 128 per 100 inhabitants

have subscriptions to cell service. 52.5% of the population utilize the internet.

The Problem

On-going violent conflict has created a largely unstable situation for the regions’

children, with some estimated 11,00-15,000 children residing in orphanages and other

institutions (Vakulenko et al., 2007). These children can experience neglect on every level.

Institutional malnutrition can affect future growth and development. “While maximizing

nutrition after periods of under-nutrition is crucial to support cognitive recovery, ensuring

adequate and consistent nutrition for vulnerable children with developing minds to prevent

cognitive injury is paramount” (Park et al., 2011, p. 113). One of the 17 sustainable goals as set

forth by the United Nations includes the improvement of good health and well-being with the

goal of promoting this initiative at all ages (United Nations, 2017). To address this issue in the

orphaned Ukrainian child population, the implementation of onsite human milk banks would

improve the overall health and outcomes of infants institutionalized during their first year of life.

There are currently 215 active donor human milk (DHM) banks in Europe, with 16 projects in

development. There are no existing or planned milk banks in the Ukrainian region (EMBA,

2016).

Possible Solutions
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The establishment of on-site DHM banking at Ukrainian orphanages could improve

outcomes for institutionalized infants by providing them with human milk. One consideration is

how the milk will be pasteurized for safe administration. Two popular methods for

pasteurization of DHM are the Holder method and the flash-heat method. Historically, the

Holder method has been the preferred method for larger banks with adequate resources and

funding, but the flash-heat method has proven to be just as effective and more economic for

smaller banks and economically challenged areas and can be accomplished effectively with

common household items (Naicker et al., 2015).

There are two systems currently available for flash-heat treatment of DHM in resource-

limited settings. One system is FoneAstra (Naiker et al., 2015). FoneAstra is a smartphone-

compatible temperature monitoring system which tracks the temperature of the DHM during

each stage of flash-heating and guides the user through the process. Its’ components are simple,

consisting of a mobile phone, a USB cable and bridge, a glass jar and a temperature sensor probe

which connects to the cellular device via USB. These items are utilized alongside common

pasteurization equipment, including a freezer, pot and a source of heat (Naicker et al., 2015). A

second system is PiAstra (PiAstra, 2017), which eliminates the need for a cellular device and

internet use. This system involves 17 pieces of equipment to safely pasteurize DHM. The need

for a cellular phone and internet access is replaced by a touchscreen device that provides power

to the cooker and connects to a printer and temperature probe.

Selected Solution Modification

These two systems could be combined, utilizing some components of each to accomplish

the goal. The battery powered touch-screen cooker provided by PiAstra could be used in

conjunction with the temperature monitoring capability of FoneAstra to save space and reduce
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the amount of equipment required. Having a small, dedicated space for milk preparation and

storage would be possible if combining systems in this manner. This arrangement is feasible

with 100% access to electricity. With 52.5% internet access and a substantial population with

cell phone capability (Central Intelligence Agency, 2017), it could function in the present

conditions.

Implementation

Neither system includes a means of testing post-pasteurized milk for bacteria or

contaminants. Fortunately, in a study of 100 samples of DHM pasteurized utilizing the

FoneAstra system, there were no cases of bacterial contamination post processing (Naiker et al.,

2015), eliminating the need for costly and complicated testing. A simple modification to this

system would be to include a portable battery cellphone charger for continued use during any

power outages. An institution-dedicated cellphone for this purpose would be appropriate with

inclusion of a desktop docking station to house the portable charger, phone and other necessary

equipment. The process can still be performed utilizing the same equipment and a standard

thermometer, and written instructions should always be provided in the case of wireless

interruption. Socially, a pro-breastfeeding culture would be necessary to meet the donation

needs. Social barriers to breastfeeding would hamper the likelihood of a mother donating her

excess milk. According the World Health Organization (WHO), only 25% of women in Eastern

Europe exclusively breastfeed for the first 6 months (WHO, 2017). Education on the donation of

breast milk could be offered to qualified women, including those from local labor and delivery

wards to create a culture where breastfeeding is understood to be the most beneficial for infants

in their first year. This would increase the likelihood of obtaining DHM from that resource as

well.
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Evaluation

Few studies exist providing actual statistical data regarding growth delays in Ukrainian

orphans during the first year of life. One study (Park et al., 2011) took baseline growth

measurements of orphans under 42 months of age. The baselines were then compared to the

2006 WHO Child Growth Standards for children up to 5 years of age (WHO, 2017). This data

found that weight-for-age values classified 90% of the infants studied as under-nourished with z-

scores of -2, and 28% considered in a state of acute malnutrition with z-scores less than -3 (Park

et al., 2011). A measurable goal of this proposal would involve increasing these z-scores to 0,

which would put them at least within the mean standards of weight-for-age as set forth by the

WHO.

Conclusion

From 2002 to 2006, the Ukraine held a special assembly session to commit to the

implementation of “measures to provide welfare for all children and for the protection of the

rights of every child and respect for their dignity” (Vakulenko et al., 2007, p. 1). It sought

improvement of the system of institutional care for orphans and children deprived of parental

care. Instituting on-site DHM milk banks within Ukrainian orphanages would be a useful

contribution to this goal, improving the growth, development, and overall health of

institutionalized infants in the Ukraine.

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References

Central Intelligence Agency. (2017). The World FactBook. Retrieved from

https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html

European Milk Bank Association/EMBA. (2017). Website http://europeanmilkbanking.com/

Naicker,M., Coutsoudis, A., Israel-Ballard, K., Chaudhri, R., Perin, N., & Mlisana, K.

(2015). Demonstrating the Efficacy of the FoneAstra Pasteurization Monitor for Human Milk

Pasteurization in Resource-Limited Settings. Breastfeeding Medicine, 10(2).

DOI: 10.1089/bfm.2014.0125

Park, H., Bothe, D., Holsinger, E., Kirchner, L.H., Olness, K., Mandalakas, A. (2011).

The Impact of Nutritional Status and Longitudinal Recovery of Motor and Cognitive

Milestones in Internationally Adopted Children. International Journal of Environmental

Research and Public Health, 8, 105-116. DOI:10.3390/ijerph8010105

PiAstra. (2017). Website https://piastra.org/

United Nations. (2017). Sustainable development goals: 17 goals to transform our world.

Retrieved from http://www.un.org/sustainabledevelopment/

Vakulenko, O.V., Dorogykh, L.V., Zinchenko, A.G., Leontieva, L.E., Loginova, L.P., Lutsenko,

E.M., Petrochko, Z.V., Silovykh, N.G., & Philipishina, A.A. (2007). National Report of

the UN General Assembly Special Session on Children (2002). State Institute for Family and

Youth Development. Retrieved from UNICEF website:

https://www.unicef.org/worldfitforchildren/files/Ukraine_WFFC5_Report.pdf

World Health Organization. (2017). The WHO Child Growth Standards. Retrieved from

http://www.who.int/en/