A nurse measures the height of a child at a health centre in Kandahar as part of nutrition surveillance. Photo: WHO/S.RamoKabul 15 December 2016 – “Children are the energy for the future of our country,” says Dr. Mohammad Siddiq, head of the paediatrics department at Mirwais Hospital in Kandahar province, while he checks on his hospital’s nutrition surveillance register.
The national sentinel site-based nutrition surveillance system of the Ministry of Public Health has been up and running since 2013 with the support WHO and UNICEF, backed by funding from the Government of Canada. The health facility-based system collects data on key nutrition indicators to improve the planning, implementation, monitoring and evaluation of maternal, neonatal and child health strategies and programmes with the aim to identify and reduce vulnerabilities to achieve better nutrition status for Afghans, especially women and children.
Malnutrition on the rise
Malnutrition is a major contributor to child mortality and morbidity in Afghanistan, causing one-third of all child deaths. According to the 2013 National Nutrition Survey, 25% of children under 5 years of age were underweight and 45% suffered from anaemia. Around 41% of children were reported to suffer from chronic malnutrition (stunting). Wasting, or low weight for height, prevalence was reported at 9.5%.
Inadequate infant feeding and caring practices are a major cause of malnutrition, combined with widespread poverty, low access to basic health services, poor diets, lack of access to food, clean water and sanitation.
Gula brought her 4-month-old baby Rahmat to a health facility for growth monitoring. Photo: WHO/S.Ramo“For many women, accessing health care is also very difficult because their movement is restricted, they need to ask for permission from their family members and often cannot afford transport,” said Sweeta, a midwife providing family planning services for women at Mirwais Hospital.
“We have had an increase in malnutrition cases because of the high poverty level, lack of proper food and low awareness among communities about good infant and young child feeding practices,” said Dr Ali Ahmad Qani, director of the Mirwais Hospital. “We need to invest a lot more in prevention and awareness-raising. Now people often only bring their children into the hospital when they are very sick and there is little we can do to help them if they come here too late.”
Data gathered through the surveillance system shows worrying results, with Global Acute Malnutrition (GAM) proportions showing an upward trend from one quarter to the next, while underweight levels also show signs of increase.
Micronutrient deficiencies are widespread in Afghanistan. Approximately 46% of children under the age of 5 have vitamin A deficiency. Around 23% of women of reproductive age were reported to have zinc deficiency and the majority of women (95%) are deficient in vitamin D.
Stronger surveillance, better nutrition outcomes
A well-functioning nutrition surveillance system is crucial for bringing about better nutrition and health outcomes for women and children.
Currently, there are 175 “sentinel sites” in health facilities in all 34 provinces that gather and register anthropometric nutrition data for children aged 0 to 2 years by measuring their weight, height and mid-upper arm circumference. A total of 953 health posts, community-based sentinel sites, are gathering and reporting data with the support of community health workers.
Nurses check the surveillance system register in Khulm District Hospital in Balkh province in 2015. Photo: WHO/S.RamoSince 2013, WHO has supported the training of over 1500 health workers on accurate nutrition assessment and measurement techniques as well as nutrition counselling. Accurate measurements result in accurate classification of nutrition status, enabling the detection of any growth faltering before it is too late to help the child. Accurate classification of nutrition status also enables health workers to give the right messages to the child’s caregivers to support optimum growth.
Data from all sentinel sites is gathered and analyzed every quarter to inform better practices for nutrition strategies, detailed nutrition assessments as well as humanitarian planning and response. For instance, when nutrition surveillance revealed high levels of neural tube defects in newborns as well as low haemoglobin levels of pregnant women, this was addressed by strengthening iron and folic acid provision to pregnant women during antenatal care visits.
“The nutrition surveillance project helps us get a better picture of the nutrition status in the whole country through data collection and it makes it possible to see the current gaps and take action to correct them,” said Dr Qani from Mirwais Hospital.
Early detection of malnutrition cases and early action to fight severe and acute malnutrition is key.
“Through this surveillance system, we are promoting active case finding and prevention rather than only taking action when it is too late,” said Mr Admire Chinjekure, Nutrition Officer at WHO Afghanistan. “We have supported the Ministry of Public Health to train health workers to provide nutrition counselling to women, advising them on the importance and benefits of exclusive breastfeeding and proper complementary feeding for babies.”
Approximately 15% of severely malnourished children develop complications and are taken to therapeutic feeding units (TFUs) where they receive special emergency nutrition care. WHO supports the mInistry of Public Health in strengthening service delivery in all TFUs in the country through training health workers on the management of acute malnutrition as well as providing medical equipment for sites that are in critical need.
“Our main challenge and focus now is to integrate this surveillance system into Afghanistan’s health management information system to ensure nutrition data is systematically collected, analyzed and used around the country,” said Mr Chinjekure.
With the support from the Government of Canada, and in partnership with UNICEF, WHO will continue to strengthen the nutrition surveillance system to create a sustainable mechanism for the collection and use of nutrition data to generate better nutrition outcomes for all Afghans.
WHO Afghanistan nutrition programme
National Nutrition Survey of Afghanistan 2013
