Malnutrition in Afghanistan

238 Pages·2010·3.39 MB·English

by  World Bank Group

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c DIRECTIONS IN DEVELOPMENT
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Malnutrition in Afghanistan

Malnutrition in Afghanistan
Scale, Scope, Causes, and Potential Response
Emily Levitt, Kees Kostermans, Luc Laviolette,
and Nkosinathi Mbuya
©2011 The International Bank for Reconstruction and Development / The World Bank
1818 H Street NW
Washington DC 20433
Telephone: [phone]
Internet: www.worldbank.org
All rights reserved
1 2 3 4 :: 13 12 11 10
This volume is a product of the staff of the International Bank for Reconstruction and
Development / The World Bank. The findings, interpretations, and conclusions expressed in this
volume do not necessarily reflect the views of the Executive Directors of The World Bank or the
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All other queries on rights and licenses, including subsidiary rights, should be addressed to the
Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax:
202-522-2422; e-mail: [email protected].
ISBN: 978-0-8213-8441-1
eISBN: 978-0-8213-8442-8
DOI: 10.1596/978-0-8213-8441-1
Cover photo: Emily Levitt
Library of Congress Cataloging-in-Publication data has been applied for.
Contents
Foreword xiii
Preface xv
Acknowledgments xvii
Abbreviations xix
Overview 1
Nutrition Situation in Afghanistan 1
Conceptual Framework 2
Determinants of Undernutrition in Afghanistan 3
Political Economy, Institutional and Implementation
Arrangements, and Capacity to Address
Undernutrition 4
Programs, Gaps, and Opportunities 7
Recommendations 11
References 15
Chapter 1 Introduction 17
Rationale 17
Afghanistan: Country Context 23
Methods and Analytical Approach 26
v
vi Contents
Structure of the Report 26
Note 27
References 27
Chapter 2 The Current Nutrition Situation in Afghanistan 29
Child Undernutrition: Overview 30
Child Undernutrition: Vitamin and
Mineral Deficiencies 32
Maternal Undernutrition: Underweight 36
School-Age Children and Adults: Vitamin
and Mineral Deficiencies 37
Summary of Data and Data Gaps 40
Notes 41
References 42
Chapter 3 The Determinants of Undernutrition
in Afghanistan 45
The UNICEF Framework 45
Food Security: Inadequate Access and
Availability of Food 47
Health and Health Services 51
Health Environment 54
Care for Women and Children 55
Nutrition Awareness 60
Summary 61
Notes 62
References 63
Chapter 4 Political Economy and Capacity to Address
Undernutrition 65
Pillar 1: Nutrition Is Recognized as Foundational
to National Development 66
Pillar 2: Adequate Local Capacity Is Built
and Supported to Design and Execute
Effective Nutrition Policies and Programs 82
References 84
Chapter 5 Current Programs, Gaps, and Opportunities 87
Pillar 3: Cost-Effective, Direct Nutrition
Interventions are Scaled Up, Where Applicable 87
Contents vii
Pillar 4: Determinants of Undernutrition Are
Addressed through Multisectoral Approaches 108
Pillar 5: Coordinated Support for Nutrition
Is Provided by Development Partners 130
Notes 132
References 133
Chapter 6 Recommendations 137
Pillar 1: Nutrition Is Recognized as Foundational
to National Development 137
Pillar 2: Adequate Local Capacity Is Built and
Supported to Design and Execute Effective
Nutrition Policies and Programs 138
Pillar 3: Cost-Effective, Direct Nutrition
Interventions are Scaled Up, Where Applicable 139
Pillar 4: Determinants of Undernutrition Are
Addressed through Multisectoral Approaches 143
Pillar 5: Coordinated Support for Nutrition
Is Provided by Development Partners 145
Notes 145
Reference 145
Appendix A Methodology 147
Network Assessment 147
Synthesis and Analysis of Available Nutritional
Epidemiology Data 149
Analysis of Available KAP Data 149
Review of the BPHS Regarding Nutrition 150
Review of Programs in Other (Nonhealth)
Sectors That Affect or Could Affect Nutrition 150
Capacity Assessment of the MOPH’s
Public Nutrition Department and Other
Institutional Structures to Lead and
Implement Scaled-Up, Effective
Multisectoral Nutrition Interventions 150
Analytical Approach 151
References 151
Appendix B Nutrition Data Collection in Afghanistan 153
Reference 155
viii Contents
Appendix C Cultural Beliefs Relating to Infant and
Young Child Feeding 157
Beliefs about Energy-Rich Foods for Infants
and Young Children 157
Beliefs about Protein-Rich Foods for Infants
and Young Children 158
Beliefs about Fruits and Vegetables for Infants
and Young Children 160
Note 161
Reference 161
Appendix D Summary of Services Provided through the
Ministry of Public Health Basic Package of
Health Services 163
Appendix E Nutrition Components of the Basic Package
of Health Services 165
Appendix F The Afghanistan National Development
Strategy Structure 169
Appendix G Organizational Chart of Ministry of Public
Health’s Public Nutrition Department
(under Preventive Medicine) 171
Appendix H Organizational Chart of the Ministry of
Agriculture, Irrigation, and Livestock 173
Appendix I Job Description for Provincial
Nutrition Officers 175
Appendix J Assessment of Capacity in Government
Entities Responsible for Nutrition 181
The MOPH’s PND 181
The MAIL’s Home Economics Department 186
Reference 189
Appendix K Public Nutrition Partners According to the
Type of Roles and Responsibilities 191