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Ministry of Public Health
General Directorate of Preventive Medicine
Public Nutrition Department
FEBRUARY 2016
ISSUE 3
Afghanistan National Nutrition
Surveillance System Bulletin
In March 2013 the Afghanistan Ministry of Public
Health, WHO and UNICEF began operationalizing a
sentinel site based national nutrition surveillance sys-
tem (NNSS) in coordination and partnership with the
Basic Package for Health Services (BPHS) and the
Essential Package for Health Services (EPHS) imple-
menters and other service providers. Funded by the
Canadian Department of Foreign Affairs, Trade and
Development (DFATD), the project seeks to estab-
lish a nutrition surveillance system that covers all 34
provinces of the country. A well-functioning nutri-
tion surveillance system provides timely and reliable
information which helps the government and part-
ners to effectively plan and implement maternal, neo-
natal and child health and nutrition programs. Ulti-
mately, the project seeks to increase access to equita-
ble and gender-sensitive health and nutrition services
to mothers and children, while ensuring that their
health needs are met and vulnerabilities reduced.
Key NNSS Objectives and Expected Outcomes:
Progress to date:
34 provinces are re-
porting from health fa-
cility sentinel sites
13 provinces are re-
porting from 356 com-
munity sentinel sites
NNSS has been expand-
ed to the third and last
scale-up phase
175 facility-based senti-
nel sites and 963 com-
munity-based sentinel
sites selected in all 34
provinces
Overview
Objective >>>
To establish a unified
nutrition surveillance
system composed of
sentinel sites and sur-
veys for timely action.
Reporting NSS community-based sentinel sites
Reporting NSS health facility sentinel sites
PAGE 2 ISSUE 3 AFGHANISTAN NATIONAL NUTRITION SURVEILLANCE SYSTEM BULLETIN
Results from Health Facility-based Data Collection:
1. Anthropometric Analysis Results: analyzed using ENA database and WHO-flags
General analysis of the Indicators (Wasting, Stunting and Underweight)
All anthropometric indicators were high compared to the WHO thresholds.
Global Acute Malnutrition (GAM) rates were Q1-14.3 %, Q2-21 % , Q3-26.9% Q4-21.1%
Severe Acute Malnutrition (SAM) rates were Q1-5.5 %, Q2-9.6 %, Q3-12.9% and Q4-8.8%
Stunting rates were Q1-43.8%, Q2-43.1%, Q3-47.1% and Q4-44.9%
Underweight was reported at Q1-33.4%, Q2-37.6%, Q3-45.1% and Q4-40.2%
Key Successes:
175 health facility sentinel sites in 34 provinces are reporting - data reflected in the table be-
low was collected and reported from health facility sentinel sites from all 34 provinces
963 community sentinel sites selected in the 34 provinces, 13 provinces currently reporting
Two quarterly nutrition surveillance bulletins produced and disseminated
14.3 2126.9
21.1
43.8 43.1 47.1 44.9
33.437.6
45.140.2
0
20
40
60
Q1 Q2 Q3 Q4
%
Malnutrition Indicators - 2015
Wasting
Stunting
Underweight
©WHO/R.Akbar
PAGE 3 ISSUE 3 AFGHANISTAN NATIONAL NUTRITION SURVEILLANCE SYSTEM BULLETIN
Anthropometric results: Threshold Analysis
14.3
21
26.9
21.1
0
5
10
15
20
25
30
Q1 Q2 Q3 Q4
%
Wasting Levels-2015
Threshold-cri ticalwasting level
Threshold-poorwasting level
Threshold-Se riouswasting level
43.8 43.147.1
44.9
0
10
20
30
40
50
Q1 Q2 Q3 Q4
%
Stunting levels-2015
Threshold-Veryhigh prevalence
Threshold-Medium
prevalence
Threshold-Highprevalence
33.4
37.6
45.1
40.2
0
5
10
15
20
25
30
35
40
45
50
Q1 Q2 Q3 Q4
%
Underweight levels-2015
Threshold-Very highprevalence
Threshold-Mediumprevalence
Threshold-Highprevalence
Stunting in children is an indicator of growth
retardation. The stunting levels for 2015 were
consistently in the “very high prevalence”
levels (≥ 40%). Children who suffer from
stunting tend to be at greater risk of illness
and death.
Wasting in children is an indicator of acute
malnutrition. The wasting levels for 2015,
with the exception of Quarter 1, were con-
sistently in the critical or “emergency levels”,
(above 15%), which increases the risk of
death for children.
Underweight in children indicates acute
weight loss, stunting, or both. The under-
weight levels for 2015 were consistently in
the “very high prevalence” levels (above
30%). Children who suffer from under-
weight tend to be at greater risk of death.
©W
HO
/R.A
kbar
©W
HO
/S.R
amo
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN
Anthropometric measurements in nutrition surveillance system in Paghman comprehensive health centre. (Photos: WHO/A. Qureshi)
PAGE 4 ISSUE 3
1268 STAFF FROM HEALTH FACILITIES
AND 2498 STAFF FROM COMMUNITY-
BASED SENTINEL SITES HAVE BEEN
TRAINED ON THE NATIONAL
NUTRITION SURVEILLANCE SYSTEM TO
DATE
Severe acute wasting was consistently above emergency levels (above 2%) during the year. SAM levels were
lowest in the first quarter (5.5%) reaching a peak of 12.9% in the 3rd quarter. The 4th quarter recorded 8.8%
whilst the rate was 9.6% in the 2nd quarter.
In 2015 WHO supported the establishment of eight new therapeutic feeding units (TFUs) and the strengthen-
ing of 26 existing TFUs to manage severe acute malnutrition cases. From January to December 2015, WHO
supported the training of 180 health workers from 36 TFUs on the management of severe acute malnutrition.
Milk preparation kits, medicine and medical equipment, TFU files, and bedside chairs were provided and dis-
tributed to 36 TFUs in 13 high-risk provinces.
Severe Acute Malnutrition (SAM)
0
2
4
6
8
10
12
14
Q1 Q2 Q3 Q4
%
SAM Levels
Thresholds
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN
PAGE 5 ISSUE 3
2. Infant and Young Child Feeding (IYCF)
Indicators 52% of infants received breast milk within one hour of
birth
86% of infants were exclusively breastfed during their first six months of life
Proper complementary feeding (introduction of com-plementary foods at 6 months, minimum meal fre-quency and minimum dietary diversity) is still at a low level at 19%
91% children assessed were currently breastfed
Good IYCF practices play an important role in pre-venting stunting
Early initiation of breastfeeding decreases neonatal mortality
IYCF INDICATORS Q1 2015 Q2 2015 Q3 2015 Q4 2015
Children Currently Breastfed (%) 91% 89% 89% 93%
Early initiation
of
breastfeeding
Mean Early. BF (hours) 4 4 3 3
Early. BF at <=1 hour (%) 50% 54% 52% 52%
Early. BF at 1 to < 24 hour (%) 48% 44% 46% 46%
Early. BF at >24 hour (%) 2% 2% 1% 1%
Exclusive
breastfeeding
Mean Exc. BF (months) 2 2 2 2
Exclusive BF 0-5 m (%) 86% 83% 86% 87%
Complemen-
tary feeding
Mean Comp. Feeding (months) 4 4 4 4
Proper Comp. Feeding (%) 20% 16% 21% 20%
91%
52%
86%
19%0%
20%
40%
60%
80%
100%
ChildrenCurrently
Breastfed
Initiation ofBF at <=1
hour
Exclusive BF0-5 m
Proper Compfeeding
mea
n va
lues
Q1-
Q4/%
IYCF Indicators -2015
©WHO/R.Akbar
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN ISSUE 3
3. Birth Outcomes
Low birth weight: The proportion of babies born with low birth weight was consistently at 4% throughout 2015. Low birth weight (< 2500 gr) is an important factor affecting neonatal mortality and a signifi-cant determinant of postneonatal mortality. Low birth weight infants who survive are at an increased risk of health problems ranging from neuro-developmental disabilities to respiratory disorders.
Neural Tube Defects (NTD): The prevalence of NTD’s per 10,000
births ranged from 12 (Quarter 2) to 39 (Quarter 4). The prevalence was
14 in Quarter 1 and 28 in Quarter 3. NTDs (Anencephaly and Spina
Bifida) have a strong association with folic acid deficiency.
January -
March
2015 (Q1)
April - June
2015 (Q2)
July-
Sep
2015
(Q3)
Oct– Dec
2015 (Q4)
Number of children assessed 16,058 20,115 30,947 35,807
Sex
Total Male 8,474 10,785 16,247 17,844
Total Female 7,584 9,330 14,700 17,963
Male/Female Ratio 1.11 1.15 1.10 0.99
Birth weight
Stillbirths per 1,000 births (Birth
Status) 7 9 193 243
Mean birth weight (gr) 3146 3239 3310 3261
Percentage of birth weight less
than 2500 gr 4% 4% 4% 4%
Percentage of birth weight be-
tween 2500 - 4000 gr 93% 92% 91% 91%
Percentage of birth weight more
than 4000 gr 3% 4% 5% 5%
Neural Tube De-
fects (NTD)
Prevalence of NTD per 10,000
births 14 12 28 39
PAGE 6
©WHO/D. Hazrat
©W
HO
/R.A
kbar
Lo
w-
Hb Indicators Q1 2015 Q2 2015 Q3 2015 Q4 2015
Total assessment 4,650 7,747 18,432 20,904
Hb
level
Mean level of Hb (gr) 11 11 11 11
Percentage of pregnant women with
Hb level < 11 gr/dl 37% 40% 32% 34%
Percentage of pregnant women
(pregnancy age ≤ 12 weeks) with Hb
level < 11 gr/dl
38% 41% 36% 36%
Percentage of pregnant women
(pregnancy age 12 to < 24 weeks)
with Hb level < 11 gr/dl
36% 41% 31% 35%
Percentage of pregnant women
(pregnancy age >24 weeks) with Hb
level < 11 gr/dl
38% 40% 32% 32%
4. Results of haemoglobin levels in pregnant women
The mean level of Hb (gr) was 11 throughout the four quarters in 2015
The proportion of pregnant women with haemoglobin level < 11 gr/dl was 36% through Q1-Q4
The proportion of women with Hb<10gdl in the first trimester was 38%
The proportion of women with Hb<10gdl in the second and third trimesters was 36% respectively
CONTACT:
Dr. M. Homayoun Ludin
Acting Director of Public Nutrition Department
Email: [email protected]
Mobile: 0093 700 604 649
Web:
www.moph.gov.af
Facebook:
Ministry of Public Health Afghanistan
PAGE 7 AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN ISSUE 3
0
10
20
30
40
50
Q1 Q2 Q3 Q4
%
% of Pregnant women with Hb level<11g/dl
Threshold-Severe Anemia
Threshold-moderate
anemia
Anaemia:
A low haemoglobin (Hb) level is an
indication of anaemia. The anaemia
levels for 2015 were consistently in the
“moderate” levels (≥20%), with the 2nd
Quarter reporting a severe level
(≥40%). Anaemia is associated with
increased risks of maternal and child
mortality.