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: nutrition.moph@gmail.com

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.