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  • br Although much attention centres on Afghanistan

    2019-04-20


    Although much attention centres on Afghanistan\'s political and security transitions, malnutrition is a foremost concern. Because an absence of adequate nutrition has crucial long-term effects on individuals and on social and economic development, nutrition rates in Afghanistan deserve attention and action, especially during this apexbio calculator time of transition. A national survey from Afghanistan\'s Ministry of Public Health, UNICEF, and Aga Khan University provides the first update in 10 years on the nutritional status of women, children, adolescents, and elderly people in Afghanistan. Nutritional status has well-established, profound effects on health throughout the lifecycle and is closely associated with cognitive and social development, particularly in early childhood. Despite investments in the social sector in the past decade, Afghanistan has been shown to have very low commitment to apexbio calculator tackle hunger and undernutrition, according to the Hunger and Nutrition Commitment Index. Compared with a 2004 nutrition survey, the latest cross-sectional household survey from 2013 shows a fall in estimates of stunting and underweight prevalence, but an almost stagnant level of wasting in children younger than 5 years. It also reports moderate improvement in malnutrition in women of reproductive age, although maternal wasting and micronutrient deficiencies remain widespread. Despite some progress, reported rates of stunting in Afghanistan are still some of the highest in the world, ranging by province from 24·3% in Ghazni to 70·8% in Farah. Afghanistan\'s latest reported rates of stunting in children younger than 5 years are high compared with nearby countries. For example, national estimates are lower for stunting in Uzbekistan at 19·6% and Tajikistan at 26·8% than India at 47·9% and Pakistan at 45·0%. Alarmingly, almost half of figures for stunting (low height for age) and wasting (low weight for height) for children younger than 5 years in Afghanistan are severe (minus three SDs from the median measurement for the reference population). Provinces with high numbers of conflict incidents also show poor indicators of nutrition. Food insecurity is another important factor. The provides an overview of the determinants of child undernutrition in Afghanistan. These data represent the three levels of cause of undernutrition from UNICEF\'s conceptual framework, which the nutrition community has been using for programming for more than two decades. From selected indicators, action is evidently needed in Afghanistan to address causes at all three levels—ie immediate (operating at the individual level), underlying (affecting households and communities), and basic (relating to the structure and processes of societies). Measures should be institutionalised with a national strategy focused on multisectoral action with clear targets. A range of actions is needed to address immediate and underlying causes of hunger and malnutrition. Priority nutrition programmes should be identified, such as promotion of healthy growth, improvement of breastfeeding practices, and addressing of micronutrient deficiencies. Although multisectoral support and coordination is imminently needed, the role of national institutions should be strengthened in promotion of nutrition awareness, technical support, food safety, and regulatory mechanisms; food fortification; and behaviour change communication. Central coordination and oversight mechanisms are needed to support provinces, especially those with a small capacity and serving remote and insecure catchment areas.
    Having read the Editorial (November, p e616), we felt inclined to share our point of view about the recent increase in polio cases in Pakistan and their link to the military operation being conducted in North Waziristan. Since 2012, polio vaccination campaigns have not been undertaken in many districts of federally administered tribal areas (FATA), mainly due to the Taliban\'s ban on polio vaccination in the region and the attacks on health-care workers. Because of this gap, countless residents of FATA were left unvaccinated. Consequently, FATA became a major polio reservoir, with the majority of polio cases in 2014 being reported in FATA and the neighboring Khyber Pakhtunkhwa province (KPK).