Badakhshan, Jowzjan and Faryab Afghanaid March 1991

Home , Andkhoy (city), Aqcha, Jowzjan Province, Mardyan, Qarqin, Sheberghan

NUTRITION SURVEY REPORT BADAKHSHAN, JOWZJAN AND FARYAB AFGHANAID MARCH 1991

NUTRITION SURVEY REPORT BADAKHSHAN, JOWZJAN AND FARYAB. 25th JULY- 26th NOVEMBER 1990

AFGHANAID EMERGENCY TRAINING UNIT 5B GUL MOHAR ROAD PESHAWAR ACKNOWLEDGEMENTS Afghanaid is grateful to all who contributed to the production of this nutrition survey of three northern provinces of Afghanistan. The United Kingdom Overseas Development Administra- tion (ODA) and UNICEF funded the project. UNICEF, UNIDATA, the Agency Coordinating Body for Afghan Refugees (ACBAR), Save the Children Fund, UK (SCF(UK)), and the Agricultural Survey of Afghanistan (ASA) provided master trainers for the field surveyors' training course and technical assistance in designing the survey questionnaire. Particular thanks must go to Mohammed Daud and his staff at the Afghanaid Emergency Training Unit (ETU), who coordinated the overall training and survey work; to the field personnel themselves, led in Badakhshan by Mohammed Saboor, in Jowzjan by Abdul Mobin, and in Faryab by S. Hedyatullah; to computer programmer Abdul Salam Khan for designing a programme for the analysis of raw data and for producing tables and graphs; and to Mamoona Taskhinud-Din for the difficult task of producing a narrative text from the mass of data brought in by the teams.

Finally, thanks are due to all those, from Afghanaid and other agencies, who contributed to the final appearance of this report; and to the people of Badakhshan, Jowzjan, and Faryab, without whose assistance and co- operation this survey could not have taken place. NUTRITIONAL SURVEY REPORT, BADAKHSHAN, JOWZJAN AND FARYAB

CONTENTS

Glossary of Terms 4

Map 5

I. Executive Summary 6 2. Summary of Results 7 3. Summary of Recommendations 8 4. Introduction 10 5. Objectives of Project and Survey 12 6. Project Development 13 7. Methodology 18 8. Results 21 9. Child Health and Health Services 25 10. Socio-economic Factors 27 11. Discussion 29 12. Conclusion 31 13. Recommendations 32

References 35

Annexe 36 ANNEXE

1) Questionnaires

a) Nutritional Survey field data sheet. b) Bazaar Questionnaire - Food and Beverages Animals c) Fuel Price Questionnaire d) i) Road Transport Service Questionnaire ii) Road Condition Questionnaire e) Population Questionnaire f) Health Clinic Questionnaire.

2) Nutritional Data

a) Number of Children `3creened

b) Nutritional Status -- all provinces, by sex -- by number-

-- by percentage c) Nutritional Status by se<, by Province.

d) Nutritional Status -- all provinces, pooled. e) Nutritional. Status by Province, pooled. f) a). Nutritional Status Badakhshan - by district. b) . Nutritional Status Jowzjan - by district

c). Nutritional Status Faryab -- by district g) Nutritional Status of Children 1-5. Pooled. h) Nutritional Status of Children 1 --5. Badakhshan i) Nutritional Status of Children 1- -5. Jowzjan j) Nutritional Status of Children1 -5. Faryab k) Nutritional Status of Childrent -5. by percentage. 1) Nutritional Status of Children 1- -5. by number, m) Nutritional Status of Children 1 -5. by number. n) Nutritional Survey Comparisons

3) Health Clinic Survey Results

4) Bazaar Prices by Province and District,

a) Commodities b) Animals r_) Fuels a) Diesel b) Kerosene c) Petrol d) Firewood e) Coal f) Charcoal g) Dung

5) Population - Methods of Measurement. a) Population Figures by District b) Population Movement by District

6) Logistics a) Status of Roads in Badakhshan, Jowzian and Faryab. b) Road transport services in Badakhshan, Jowzjan and Faryab. 7) Maps a) Badakhshan b) Jowzjan c) Faryab. B) Geographical Distribution of Malnourishment.

Map 1 Badakhshan- Levels of NormalNourishment by District Map2 Faryab andJowzjan - Levels ofNormal Nourishment by District Map3 Badakhshan- Levels of SevereMalnutrition by District Map4 Faryab andJni-/zjan - Levels ofSevere Malnut- rition byDistrict. Table (a) Provincial and District Ranking of Malnutrition Levels in Badakhshan, Jnwzjan and Faryab.

3 GLOSSARY

ACBAR - AGENCY COORDINATING BODY FOR AFGHAN RELIEF AKRSP - AGA KHAN RURAL SUPPORT PROGRAMME ARI - ACUTE RESPIRATORY INFECTION AVICEN -- AFGHANISTAN VACCINATION /IMMUNIZATION CENTRE EPI - EXTENDED PROGRAMME OF IMMUNIZATION

MCH - MOTHER AND CHILD CARE MSF - MEDEC:INS ;ANS FRONTIERES, FRANCE

ORS/T - -- ORAL RF_HYDRAT I ON SOLUTION/THERAPY SCF(UK)-- SAVE THE CHILDREN FUND' (UNITED KINGDOM) UNFDAC -- UNITED NATIONS FUND FOR DRUG ABUSE CONTROL UNHCR - UNITED NATIONS HIGH COMM I SS I ONER FOR REFUGEES UNICEF -- UNITED NATIONS INTERNATIONAL CH I LDREN ' S FUND UNIDATA --UNITED NATIONS INFORMATION AND DATA SYSTEM RELATING TO AFGHANISTAN UNOCA - COORDINATOR FOR UNITED NATIONS HUMANITARIAN AND ECONOM IC ASSISTANCE PROGRAMMES RELATING TO AFGHANISTAN.

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4-y if y :311 NUTRITIONAL SURVEY REPORT, BADAKHSHAN, JOWZJAN AND FARYAB

1 EXECUTIVE SUMMARY

1.1. During late 1989 and early 1990 reports reaching several aid agencies in Pakistan and Afghanistan suggested that malnutrition in certain areas of Afghanistan was increasing due to food losses arising from drought and pest damage to crops, (Tacon J. 1989) and continuing disruption of local communities due to the civil war. During the latter part of 1990 Afghanaid carried out a nutritional assessment of 10,145 children aged 1 to 5 years in three provinces of Afghanistan over a 12 week period.

1.2 The data was collected by a simple random sampling of villages in the first stage.In the second stage, a rapid nutritional assessment was made of 5 percent of the child population aged 1 to 5 years. The assessment tools included measurements of the mid --upper arm circumference (MUAC) and screening for clinical signs of under- nutrition.

1.3 The findings suggested that just over half of the children were either moderately or severely malnourished in terms of energy intake. Clinical signs of iron deficiency anaemia, vitamin A and vitamin C deficiency were also noted in a significant proportion of the children examined.

1.4 The validity of the results may have been. compromised by an under- representation of females among those children screened; due to the fact that mothers, the primary carers of children, were not interviewed; the impossibility of screening random sample of children; and the inevitability of a subjective element in the observation of clinical signs of under-nutrition. However, in the absence of any other large scale nutritional survey among children in remote areas of Afghanistan, the data that has been gathered constitute a baseline upon which a more carefully designed and control led nutritional survey could rest.

1.5 The availability and price of foodstuffs, domestic fuel and animals together with logistic_ data and health service related information was also gathered. The report concludes with a set of recommendations relating to the need for improved fond distribution, agricultural rehabilitation and a strengthening of basic health services in the areas surveyed.

6 2 SUMMARY OF RESULTS

2.1 10,145 children were screened in 202 villages 26% were moderately malnourished 24% were severely malnourished

2.2 Badakhshan province had the highest rates of malnourished children with 33 severely malnourished and 26% moderately malnourished. Three of the districts had less than 35% normally nourished.

2.3 The survey teams visited 76 health facilitiee, enroute. They found: no facilities for immunization

-- the main diseases are measles, whooping cough and diarrhoea - health facilities range from single-handed clinics to small hospitals with 30 staff 32 out of 36 health facilities complained of insufficient drugs.

2.4 The survey teams visited Z2 bazaars en route.They found:

-- Basic commodities available in every market

- Prices have risen 70% to 50% over a period of one year in Badakhshan. - Prices of grain have fallen in Jotzjan and Faryab ( thought to be due to UN food supplies and Food for Work Projects) - The prices of othercommodities have remained reasona- bly stable in Jowzjan and Far-yab.

2.5 Agricultural production has suffered due to: Sunn- -pest and locust attacks in all 3provinces 3 years of drought in Badakhshan

-- floods which have causedJ. ands l ides and eroded arable land

. -- orrhards damaged by fruit fly - shortage of improvedseed varieties - lack of fertilizers.

7 3 SUMMARY OF RECOMMENDATIONS

3.1 FOOD AND AGRICULTURE

Immediate and urgent food assistance is required to avert the threat of famine with priority to Badakhshan where the depri- vation is the worst. Food for work schemes should be ready for implementation as soon as the passes open.

The Food for Work or cash for work programmes must give priority to agricultural rehabilitation schemes, each as restor- ing damaged irrigation channels.

Adequate pesticides should be pre -positioned well in time in the areas where sun n- -pest and locust attacks have occurred to avoid a repeat of the destruction wrought by infestation.

Investigation should be made' into utilizing local rivers for irrigation purposes so that lalmi (rain fed) land becomes ahi (irrigated) and dependence on rainfall is reduced.

The input of high- -yielding seeds and fertilizer should he continued.

3.2 HEALTH AND NUTRITION

According to UNHCR and WHO criteria, supplementary feeding is recommended when there is more than i_O percent severe malnutrition. However this is not practical in the present context since the malnutrition is extensive and widespread. The following are more pragmatic recommendations:

Food for work schemes in the worst affected areas Immunization facilities in all clinics - Control of diarrhoeal diseases and ORT therapy - Primary health care and community health. worker training for women More emphasis on the gender factors in the training of health workers Health education for all with particular emphasis on non - formal education of women

The high rates of malnutrition call for intensive nutrition education which emphasizes the importance of optimum nutrition of young girls in their own right and as future mothers. Improved nutrition of pregnant and lartating mothers and the early weaning of children combined with encouragement of prolonged breast - feeding for its natural contraceptive effect is also crucial. The role of women as primary carers of children needs more emphasis and the training of female health workers should be a priority.

B 3.3 LOCAL INDUSTRY

Revival of indigenous industries would providethe population with employment, income generation and ahigher standard of living. The traditional mohair and cashmere (pashmina) wool and mining of precious stones in Badakhshan, sericulture and silk manufacture in Jowzjan, carpet weaving in Faryab, should be investigated.

9 4 INTRODUCTION

4.1 Afghanistan is one of the poorest countries in the world when measured against standard indicators of socioeconomic development. In 1991 it stands second in the world in a ranking of under -5 mortality rates, and its per capita income of $US280 is extremely low in global terms: the same is true of its literacy rates (World Bank 1990, UNICEF 1991). Women and female children are particularly disadvantaged. Estimated maternal mortality rates are among the highest in the world and female literacy and contraceptive prevalence rates are among the very lowest (UNICEF 1991). Child mortality, due mainly to passive neglect, remains a problem. Afghanistan has one of the highest infant mortality rates in the world. They last population census carried out in 1979, before the war, revealed the following infant mortality rates:

Overall 102 per 1000 live b i r tt hs Rural 1.88 " Urban 129

(Based on preliminary results of the first Afghan Population Census 1900, Central Statistical Office, Afghanistan).

4.2 In addit.ien to this, over ten years of war has taken a heavy toll of men in their economically most productive years, has created large numbers of unsupported mothers and children, and has disrupted life in many of its most important aspects. At present it is estimated that three and a half million Afghan people are in refugee ramps inside Pakistan. The war has diverted attention and resources from the building up of a socioeconomic .infrastructure in their on country and, in particular, has seriously undermined attempt-, to implement programmes aimed at health promotion and combating preventable disease.

4.3 For several years, the northern part of Afghanistan has apparently suffered falling food production dire to Bunn- -pest and locust infestation. In November 1990. the Northern Afghanistan Food Deficit Survey published by the Agricultural Survey of Afghanistan indicated that an average of 67 percent of the farming population in aine northern provinces had insufficient wheat to feed itself for the year. Significantly, the two worst affected provinces were lowzjan and Oadakhhan, where 01 percent of farmers had to buy wheat to survive, and 90 percent of fami- lies declared them elves below subsistence.

In 1990 repor. :s based on observation on and a nutritional assessment carried out in Faryab province suggested a higher than usual prevalence of moderate to severe malnutrition among young children (Tinsman C. et al. 1990, and Tuffrey V. 1.990). It was indicated in these reports that food shortage as such was not necessarily the main cause of malnutrition. It was suggested rather that poverty and ignorance, coupled with local tradition were probably primary causes. In the past, nutritional surveys have been poorly designed in terms of sampling, demographic

10 information, and supporting evidence such as food prices and health service availability. To this extent they have not formed a credible basis for decision -making as to possible solutions.

4.4 In the middle of 1990 a comprehensive nutritional survey was developed and implemented by Afghanaid in conjunction with UNICEF. It was conducted in three provinces in the north of Afghanistan on the USSR border in areas outside the control of the Afghan government, Badakhl-ian, Faryab and Jowzjan (see maps at Annexe 7)

4.5 The nutrition survey was undertaken by Cfghanaid during the latter part of 1990 and was an attempt to remedy some of the methodological and informational problems identified above. Although not entirely sucra sfr.rlfor reasons that will become apparent in the body of the report, the results do represent a valuable addition to existing knowledge and should form a sounder basis for planning, decision- making and more extensive future investigations. The latter is particularly important with regard to the question as to whether ignorance and tradition or frank food shortages are the key factor inhibiting improvements in child nutrition nr ,indeed, whether, and how, these two factors may interact to the detriment of young children.

4.6 The results of the survey, which was based on screening techniques for the nutritional assessment of a representative sample of children aged ito 5, and on ari evaluation of related health and socioeconomic supporting factors, are shown and dis- cussed below. In the context of this report the terms "survey" and "screening" are used interchangeably although for research purposes they are normally terhnical ly distinct. The long --term and immediate objectives together with the output of the Project are shown below.

il 5 OBJECTIVES OF PROJECT AND SURVEY

5.1 LONG TERM OBJECTIVES OF THE PROJECT To develop and provide assistance to malnourished children in the area depending on locally available food

To improve nutrition /health knowledge nf the Afghan community, especially women, taking local customs and traditions into consideration.

5.2 IMMEDIATE OBJECTIVES OF THE PROJECT

To train J2 individuals' from the .-rreas to he surveyed as surveyors and to educate them on the importance of nutrition and health.

To assess the nutritional status relating to health conditions of children in 32 districts in 3 provinces

To provide information on availability of health services, fond and agricultural products inrlud:i,ng market prices and energy resources

To assess available EFT strurtures: in the

areas and moniter the UNICEF -- supported Er' programmes.

5.3 OUTPUT OF THE PROJECT

Training of 12 Afghan males as surveyors.

Information on malnutriti.onal status relating to health conditions on 12,41.7 children under 5.

Information on the availability of health services, food and agricultural products.

Information nn the availability nf an CPI system

Assessment of UNICEF -- supported CPI

12 6 PROJECT DEVELOPMENT

6.1 Rationale for the Survey Design

Malnutrition, in the context of this report, refers to a deficiency in one or more essential nutrients needed for the growth and development of the child. The major indicators of malnutrition amongst young children include anthropometric, clinical and biochemical measurements; assessment of dietary intake, and morbidity and mortality data. Due totime and logistic constraints, this survey ronf.ined itself to anthropometric measurement, observat_ipn of some clinical signs ofdeficiency and a brief review of mortality data.Thee observations were supplemented by observations as to the price of essential foodstuffs, animals and seed, since there j7 nnrmiiiy a rinse relationship between prices, and the supply and demand for goodsand services. Again because of the relationship between preventiveand curative health care and health status, the availabilitynf ba=sic health services includingi mmun i 7at i nn against childhood diseases and the logistic capability of the three provinces interms of roads and highways were also assessed .(See Annexe 6 for results).

6.1. 1 Malnutrition

Malnutrition, as under-nutrition,is regarded as one of the most common deficiency conditions in the world with some 100 million children affected to a moderate or severe degree.Cameron and Hofvander (1983) snuggestfn;.rr- out of five children in certain developing countries have some degree of malnutritioncaused by a deficient intake nf energy, usually protein, and almost always aggravated by repeated episodes of diarrhoea and other infections.

The first signs of malnutrition are associated with muscle wasting, most easily seen and felt on the upper arm where subcu- taneous fat disappears and the circumference is reduced.In well nourished children, the upper arm circumference increasesrapidly during the first year of life as muscle and fat are laiddown. It then remains fairly constant at around 16 centimetersbetween the ages of one to five years. Therefore, measuring the mid upper arm circumference can be a useful andrapid screening method for The finding malnourished children in the 1. to 5 year age group. method was pioneered by Shakir- for measurement of children in Baghdad. It is also an acceptable alternative to the more accu- rate indicators of protein energy malnutrition (PEN) --- weight for transport height, or weight for age --- when, for logistic reason;, of the necessary equipment is impossible or the risk of damageto scales, etc, is significant and where the age of children is not known or is inaccurate. In accordance with the NCHS /CDC /WHfl Normalized Reference the relationship between the MLJF1C andweight for height is shown below:

13 MUAC of 13.5cms and above = normalor over 80 percent weight for height

MUAC of below 13.5cms and above 12cros= moderately malnourished or approximately equivalent to 70 to 79 percent weight for height.

MUAC of 12cros or below = severely malnourishedor approximately equivalent to under 70 percent weight for height

See Annexe 2, Table 2n for details of other comparisonsin use.

One drawback in using MIIAC relates to the statistical significance of the result. Because of thenarrow range of measurement, usually between 17 and 18cros,any error in the measurement may result in a large statisticalerror in calculating the mean and therefore the significance of any deviation from the mean among different groups of children.

Vitamin A, vitamin C,iron and /or folic acid deficiency are frequently associated with PEM although they may also occur in isolation. Depending on severi ty,the deficiency in any one of these essential nutrients results in relatively clear--cut clinical signs in children.

6.1.2 Vitamin A Deficiency

Vitamin A deficiency is a common condition in developing countries particularly where carotene( -rich foodsare not available or where family poverty or culture precludestheir purchase in sufficient quantities to maintainarega_iJar- source to children under 5. The ultimate result of prolonged vitamin A deficiency in children is xerophthalmia which if untreated eventually results in blindness due to keratomalacia and corneal ulceration. Several clinical signs precede the final stage: these include night blindness and Bitot's spots, the latter beingeasily identified as foamy whitish-grey patches that formon the outer sides of the conjunctiva. Where vitamin A deficiencyis common, certain children are particularly vulnerable to xerophthalmia including those with PEM and those suffering from measles and diarrhoea. Screening for Bitot's spots and night blindness is therefore a useful way of estimating the prevalence of xerophthalmia in a population and is an indication ofmore generalized malnutrition in a (Community.

14 6.1.3 Vitamin C deficiency As with vitamin A deficiency, children vulnerable to infections and PEM may also suffer with symptoms of vitamin C (ascorbic acid) deficiency particularly where fresh fruit and vegetables rich in this nutrient are in short supply. The clinical signs of vitamin C deficiency include loose teeth, bleeding gums and delay in the healing of skin lesions. Because vitamin C is necessary for the absorption of iron from foods, ascorbic acid deficiency is also closely associated with iron deficiency anaemia.

6.1.4 Iron or folic acid deficiency

A deficiency of iron in the child's diet or sadden large or chronic blood loss results in anaemia due to a shortage of haemoglobin in the red blood cells. Most cases of iron -- deficiency anaemia seen among children in developing country are dietary in origin although chronic hookworm infestation may account for persistently low haemoglobin levels. Haemoglobin levels may be accurately measured by biochemical means but anaemia is also suggested by pale mucous membranes and paleness of the inside of the lower eye lid. Folic acid is found as folates in green, leafy vegetables and is required for the formation of red blood cells. As with iron, deficiency in folic acid results in anaemia and is common where access to its source is restricted.

6.2 MUAC Measurements

Given the observations outlined above, the survey design focused on measurement of the MUAC and an estimation of the prevalence of clinical signs suggesting vitamin A, vitamin C and iron /folic acid deficiency.

6.3 Specific criteria and the recording srhodule is set out below in Table la and can be :peen in greater detail in Annexe 2.

15 Table 4a Criteria Measurement Deficiency recorded as:-

Normal Moderate Severe

13.5 to <12.5cros Calories or MUAC >13.5cros 12.5cros Protein Red Pink White Iron Paleness of conjunctiva Present /not present Protein Oedema (O/ -+)

Present /not present Vitamin A Night. Blindness (0 / -r)

Biters spots Present/not present (0/4-)

Vitamin C Bleeding gums Present /not. present. (O / +)

6.4 The Survey Team Afghanaid's Emergency TrainingUnit recruited twelve Afghan into male nationals during the summer of17?0. They were formed team for each of three, four--man nutritional survey teams, one (see map at the provinces of Badakhshan, Faryab and Jowzjan educational Annexe 7). The team members camefrom a variety of backgrounds including civilengineering, agriculture, health and education.

6.5 Training Training of the survey team wascarried out over a six week and by Afghanai.d assisted by UNICEF, SCF(UK), UNIDATA period Specific ACBAR and advised by a UNICEF consultantfrom Kabul. areas of trainingresponsibility were as follows:

Afghanaid Report writing

SCF (UK) Rapid assessment methods of nutritional status Recording of agricultural statistics

ACBAR Agricultural assessment

16 UNIDATA and Questionnaire design, sampling Afghanaid methods, interview techniques and recording of observations

6.6 Questionnaire Design

A questionnaire was developed which combined both open and closed questions and which was designed to be used by the inter- viewer at the time of the investigation rather than being left with the respondent or used as a postal questionnaire. Inevitably open questions create problems for interpretation although they do add to the texture of the response. The questionnaires were pre -tested and the questions rephrased during the pilot stage prior to implementation of the survey.

Field training was provided on the use of the questionnaires, interviewing techniques, and the examination of children for clinical signs of malnutrition. See Annexe 1for the various questionnaires used.

17 7 METHODOLOGY 7.1 It was predetermined by UNICEF random sample of 5 percent and Afghanaid that a of all childrenin rural between 1 and 5years in the three areas, aged The number of children provinces would be screened. needed for arepresentative calculated on thebasis of population sample was estimations already able for the threeprovinces. Although avail- between there wassome the population ofthe various difference the survey districts as estimated by team and thefigures supplied by (see Annexe 5, UNICEF /Afghanaid, Table 7a) the number of screened was closeto the target children eventually as shown in Table 5abelow:- Table 7a

Number of children aged 1 to 5 screenedand number of visited in Badakhshan,Jowzjan and Faryab villages Province Number of Number Children of Villages

Badakhshan 4167 171 Jowzjan 3141 30 Faryab 2837 41

10145 202

7.2 Due to log.isti_c and securityproblems the villages to be surveyedwithin the three percentage of shown in Table 7b below. provinces differed as Pnt.h Badakhshanand Faryab contained districtsnot accessible provinces to the surveyteams. to maintain the samplesize and to In order ences, the proportion of compensate for these differ- children to bescreened in each selected villageswas also adjusted. of the Table 7b

Percentage of villagesand children surveyed in eachprovince:

Province 7, of Villages 7, of children screened in each selected village

Jowzjan 101 501 Badakhshan 207. Faryab 75% 201 251

19 7.3 A simple random sampling method was used to select villages for the nutritional survey from within the districts of the three provinces visited by the survey teams. However as implied above, not all districts were covered, the more remote and war -torn ones being inaccessible. This may be a source of bias.

7.4 Village selection.

Members of the survey teams met with the elders of the various districts of the province assigned to them and obtained from the elders a list of all villages within each district. The names of all the villages in each district were written onto slips of paper, the slips were then folded, thoroughly misted and then drawn out one by one until the required number of villages had been selected.

7.5 Selection of children within the villages

On reaching a randomly selected village, the team members met with the village elders, explained their purpose and obtained from the elders an estimate of the number of households in the village. They then divided the village into three sections and invited the villagers to bring their children aged i to 5 years to a central point within each of the three sections. The age of the children was checked with the father or male guardian and supplemented by observation by the team member. If the child was thought to fall within the age group then she /he was measuredand clinical observations were made and recorded. The children were seen on a first come first seen basis andfor this reason caution is needed in interpreting the results. It is possible that the sickest children were not brought out of the house forscreening. On the other hand it is equally possible that more sick children attended the screening sessions in the hope of receiving treat- ment. It should be noted also that the survey teams didnot have access to the mothers of the children who, as primary carers of the children, could be expected to have a keener observation as to whether the child stumbled in the dark and was possibly night -blind. Unfortunately, the question relating to the presence of Bitot's spots was wrongly interpreted as "skin lesions" and evidence of the latter was sought and recorded rather than additional evidence for vitamin A deficiency. See Annexe .1 for an example of the question schedule.

7.6 As shown in Table 7c below, the survey teams visited the following 24 districts in the course of their work.As mentioned above, for security reasons not all districts could he visited and therefore the districts shown do not comprise the total for each province.

19 Table 7c List of districts visitedwithin each province

Badakhshan Jowzjan Faryab

Fayzabad Sangcharak Pashtoon Kowt Ragh Balkhab Kohestan Shahr-e-Buzarg Kohestanat Almar Khwahan Agchah Belcharagh Jurm Mordyan Darzab Baharak Feyzabad Keran va Menjan Khanaqa Keshem Qargin Khamyab Mangah jek

In Badakhshan most of thetravel was on foot, particu- 7.7 such larly in the remote mountainregions where certain districts Ragh are cut off from othersfor most of the year. as Khuahan and nnre a The people of these districts cometo lower areas only to buy essentials such assalt and cloth. In the past, for year meeeing the most part they havenormally been self- sufficientin their basic needs.

20 B RESULTS

8.1 MUAC Results The results of the MUAC survey,differentiated for age bands and sex of the children, are shownin Table 8a below. A district breakdown of the results can be foundin Annexe 2, tables 2f.

Table ea Mid Upper Arm Circumference* (MUAC) by ageand sex as percentage of total sample: three provinces combined

Normal Moderate Severe

Age Group Male Female Male Female Male Female 56.1 61..0 1 - 2 16.3 12.0 27.6 26.4 2 - 3 32.3 26.8 33.5 35.8 34.2 37.4 3 - 4 57.1 50.0 28.5 30.5 14.4 19.5 6.7 4 - 5 76.2 72.7 18.5 20.6 5.3

Total 52.2 46.2 25.5 27.6 22.6 26.2

*Normal = MUAC 13.5cros and above Moderate = MUAC below 13.5r_ms and above 12.Ocros Severe = MUAC 12.0cm and below

8.2 As Table 8a indicates, well over 50'percent of the children in the 1to 2 age band are severely malnourished on the MUAC criteria and over 25 percent are moderatelymalnourished. In the 2 to 3 age band approximately 70 percent of thechildren are either moderately or severely malnourished on the same criteria. An important contributory factor here is the widespread practice of late and poor weaning among the Afghan population.Only in the later age groups, 3 to 4 years and 4 to 5 years, when children become more demanding of solid food and the continuous breast feeding of the individual child has usually ceased, does some improvement apparently occur. Of the total 1 to 5 age group however, approximately 50 percent are malnourished.

8.3 Provincially, Badakhshan appears to he the worst affected. Table 2c in Annexe 2 shows that overall, only approximately 40 percent of children are considerednormally nourished, and of the 1-2 year old children, almost 70percent are severely malnourished. It is necessary however to look more closely at districts, since better results from some districts overshadow the higher rates of malnutrition in others. Table(a)in Annexe B attempts to rank the various districts according to a weighted percentage of severely malnourished children.According to this, Badakhshan is clearly worst affected.

21 8.4 At the district level, it can be seen that there is variation between the levels of malnutrition within the province. Maps 1 - 4 in Annexe 8 show graphically themost affected districts. The hardest hit districts are mainly in Badakhshan, with Khwahan (35 percent severely malnourished children) and 8aharak (72 percent children malnourished), but Khanaqa and Aqcha districts of Jowzjan also show disturbingly high levels, that are not immediately evident when looking at total provincial figures.

8.5 Fewer female children than males were screened (43 percent of the total). At all ages more female than male children are severely malnourished on the MUAC criteria,but the significance of this difference was not statistically determined from the available data. However, I3huyia et. al 1986, and Koenig et. al 1987, have documented the lower value placed on female children and their disadvantage in terms of equality of access to food in other areas of the world. The outcome of persistent discrimination, although not addressed in this survey, is higher infant and child mortality rates among girl children and higher rates of stunting among the survivors (UNICEF 1990, 1991).

8.6 Evidence of other nutritional deficiencies

Screening for iron /folic acid, vitamin A and C was carried out on each child once the MUAC measurement had been recorded. Children were also checked for oedema as an indicator of Kwa- shiorkor, a condition occasionally seen in severely malnourished children between 1 and 3, who are then subject to diarrhoea or infectious disease such as measles or whooping cough. The repnrt does not differentiate between female and male children nor is it possible from the data available to correlate one set of clinical observations with another. There were wide variations in the number of children seen in different districts and in the number recorded with clinical signs. No attempt has been made to analyse the data and determine whether children generally had a combina- tion of clinical signs, for example, low MUAC measurement + night blindness + anaemia etc.

8.6.1 Iron /folic acid deficiency: Anaemia

A majority of children screened were found to he either moderately or severely anaemic on the criteria used ie. the colour of the conjuctiva under the lower eye lid. This was recorded as Red = normal: Pink = moderately anaemic: white = severe' anaemic. Of the total children seen 58 percent, or 5851. children, were reported as moderately anaemic and 3161 children or 31. percent as severely anaemic. See Table 8b below.

22 e.6.2 Vitamin A Deficiency (a) Night Blindness Given the fact that over half the children were malnourished on the MUAC criteria and a large proportion were reported as clinically anaemic, surprisingly few children were reported to be night blind. The fact that mothers were not interviewed may have resulted in an under -estimation of this condition. The mothers are more likely to notice whether a child stumbles in the dark than are male relatives or friends. Overall, 331 children or three percent of children were reported as night blind.

(b) Bitot's Spots

Instructors and, consequently, members of the survey team misinterpreted the question related to Bitot's spots (see paragraph 7.5 above). Instead the team members searched for evidence of skin disease of which there are numerous varieties and very few of which can be identified specifically as the result of nutritional deficiency. Ten percent of children between 1 and 5 years of age were found to have some type of skin lesion although the specific type and severity is not recorded.

8.6.3 Vitamin C Deficiency: Bleeding Gums

On the indicator used (bleeding gums), 39 percent of children overall were thought to be suffering from vitamin C deficiency. This was more marked in the 1to 2 age group where_ 56 percent of children were reported to have bleeding gums. This may seem surprising in an area where, at the time the survey was undertaken, dark green leafy vegetables and fresh fruit should be plentiful. however, late weaning practices have already been re- ferred to above and vitamin C is also lost if vegetables are boiled. Although vitamin C is present in breast milk the intake of young breast -fed children depends on their mother's intake of this vitamin. As mentioned above there is a close relationship between iron deficiency and vitamin C deficiency because of the biochemical inter -dependence of these two nutrients. It would not therefore be surprising to find that the percentage of anaemic children and the percentage of children with vitamin C deficiency, on the criteria used, were about the same. In fact, the number of children recorded as severely anaemic in less than those recorded with bleeding gums (31 percent and 39 percent) and again, without further analysis of the data, we can not be sure that these two populations are the same. Nevertheless, together they indicate the possibility of severe malnutrition in the communities surveyed.

23 8.6.4 Protein Calorie Deficiency: Oedema The evidence for kwashiokor based on oedema is inconclusive and, as it is but one clinical sign among many in the diagnosis of kwashiorkor it may be misleading if used in isolation. Again, without further analysis of the data, there is no way of corre- lating the various clinical signs of nutritional deficiency found among the children. Isolated cases of oedema by themselves mean little. The highest prevalence rate of oedema was found in Faryab where 8 out of a 100 children were recorded as having oedema. However, this province also recorded the lowest prevalence of anaemia on the criteria used. It also had the lowest percentage of children with moderate or severe malnutrition on the ML!!1C criteria. fladakhshan and Jowzjan each reported 1 percent of children with oedema although the data from fladakhshan, on the basis of other criteria, suggests more children are malnourished there than in the other two provinces. Overall, three percent or 276 children were recorded as having oedema.

Table 8b Nutritional Status: percentage of children with clinical signs of malnutrition: all provinces combined

Age Anaemia* Night Oedema Bleeding R P W Blindness Gums

1- 2 8 39 53 1 2 56 2- 3 11 51 38 3 4 44 3 - 4 11 63 27 4 3 36 4 - 5 13 67 20 4 2 39

Total % 11 58 31 3 3 39

* R = Red = normal P = Pink = moderate W = White = severe

24 9 CHILD HEALTH AND HEALTH SERVICES

9.1 The teams visited 36 health facilities across the three provinces. Their location are shown on the maps at Annexe 7. They ranged from district hospitals through well staffed health centres to singled- handed dispensaries. The questionnaireused to assess the services and resources available is shown at Annexe 1(f). The majority of facilities reported drug shortages regard- less of the usual supplier, ie NGO, or mujahidin. It is not possible from the data to estimate any relationship between the amount of drugs supplied and the population served by the varinus facilities.

9.2 Two of the more remote districts, Khwahan in Badakhshan and Khamyab in Jowzjan (population 10900 and 8900 respectively (Eighmy T 1990)) did not have any health facility. Badakhshan in particular has a sparse population, widely distributed amongst small and remote villages. Surface communications are largely confined to footpaths and mule tracks. Elsewhere facilities are generally reported as inadequate in terms of meeting the health needs of the population served.

9.3 Immunization Against Childhood Diseases At the time of the survey there was no evidence of immunization provision in the three provinces visited. A programme was started in 1989 by MSF (Medecins Sans Frontieres) in a single district in Badakhshan. This was abandoned after the murder of one of their doctors. Health workers interviewed by the survey team emphasized the need for immunization services in thearea, they served. This contrasts with no demand for ORS (sec paragraph 9.6 below).

7.4 Childhood Diseases.

Analysis of the completed questionnaires suggests that the following diagnoses or conditions predominate in children between the ages of I and 5:-

diarrhoea, amoebic dysentery, dehydration, measles, whooping cough, malaria, tuberculosis and malnutrition.

9.5 Food shortages were mentioned as contributory causes to some of the above conditions. At the time of the survey, measles and whooping cough were said to have reached epidemic proportions in several districts of Jowzjan and Faryab. These two infections were also reported as a leading cause of death among children in Badakhshan. The presence of these infectious diseases in an area will increase the clinical signs of under- nutrition among_,t. children.

25 9.6 Main Causes of Child Mortality

Difficulties in recording the cause of death in both developed and developing countries are well known. Circumspection has therefore to be exercised in interpreting this type of data. Amongst children aged O to 15 years, gastrointestinal diseases, including diarrhoea and amoebic dysentery are said to predominate as a cause of death. These are closely followed by measles and whooping cough. No mention has been made of acute respiratory infection (ARI). The survey team report that not a single health worker suggested a need for a supply of Oral Rehydration Salts (ORS). This may reflect a lack of understanding with regard to the importance of ORS in combating dehydration associated with watery diarrhoea.

26 10 SOCIOECONOMIC FACTORS

10.1 As part of the survey, team members looked at various socioeconomic indicators including the role of poppy cultivation and the prices of essential foodstuffs and fuel together with the cost of farm and draught animals. Most of this information is detailed in Annexe 4.

10.1.1 Poppy Cultivation For thousands of years, poppies have been cultivated for opium in at least one of the provinces surveyed (Badakhshan). Opium was used as barter for essential goods or sold for cash and, as such, formed an essential part of the local economy. For a number of reasons, poppy cultivation in large areas of Badakhshan by local farmers has now ceased. However, people of the area report that, in the absence of alternative sources of income they are suffering severe hardship.

10.1.2 Bazaar Prices for Essential Goods As part of their task the survey teams collected information on prices of essential goods from 32 bazaars across all three provinces and measured them against change over time. Their findings are fully set out in Annexe 4 and are differentiated by province and district. The information is inconclusive. In Badakhshan the price of cereals, meat, salt and ghee have apparently risen by between 30 and 50 percent in a year.In the other two provinces prices have in some instances fallen,. It i.., suggested that this is due to the import of food through the (IN agencies and the Food for Work programmes which keep bazaar - prices down.

10.1.3 Petrol, diesel and kerosene were scarce at the time of the survey hut the prices of these fuels are said to he stable in Badakhshan - falling in Jowzjan and Faryab.

10.1.4 Food availability and agricultural production

The survey team received reports of damage to orchards by fruit flies and to cereal crops by locust and sunn --pest attack=; in all three provinces visited. The problem has been madeworse in Badakhshan because of three years of drought. Elsewhere widespread flooding has carried landslides and soil err)si_on of other- wise arable land.

Shortage of fertiliser and of improved vari rit i e -, of seed have also contributed to a slow-- -down in agricultural production and a reduction in local food availability. However, the survey teams do report availahilit.y of basic commodities in the hazaar_ although the price of foodstuffs has risen by between 30 and 50 percent in Badakhshan province in the past. year.

77 10.1.5 Animal Prices.

The prices of both farm anddraught animals have showna marked rise in almost all thebazaars of Badakhshan. Price rises have also been noted in Jowzjanand Faryab although they have not been as marked as in Badakhshan. Detailsof animal prices are shown at Annexe 4 (b).

28 11 DISCUSSION

11.1 Notwithstanding some problemswith interpretation, results tend to confirm that the a majority of children aged 1 to 5 in three northern provincesof Afghanistan are malnourished moderate or severe extent. to a This is consistent with thefact that Afghanistan almost leads theworld in its under -5 mortality which is normally regarded rate as a very sensitive indicator ofchild health and well- being. Itis difficult to establishfrom the data collected, just how far food shortageshave contributed nutritional deficiencies to the identified by thesurvey teams. This is particularly so given the mixedevidence on prices and theavail- ability of foodstuffs in the market.Food availahility market place does not of in hie course mean that individualscan estab- lish their entitlement toit. The phenomenon offamine in the occurring midst of plenty has beenadequately documented (1983), by Sen particularly where populationshave been displaced and their access to ameans of exchange has been curtailed.For reason, this caution is required when looking for explanations widespread malnutrition. of

11.2 Of the three provinces surveyed,fadakhshan shows highest rates of malnutrition the and this coincides withevidence of significant population migrationout of the provinceas a of food shortage. Badakhshan result also reports the highestprice rises for essential commodities over the previous year. This in itself would contribute to fondshortage at the level of the individual family in the absence of an increasedfamily income to meet costs of fond. the

11.3 The claim that locust and otherpests have sources destroyed of food and exchange andthat this hats been exacerbated by adverse climatic factorsmust be accepted as, again, ent consist- with experience elsewhere. Whether or not,in the of the present survey, this context has been exacerbated by the negative effects of tradition and culture isan open question. From a socioeconomic and gender- -relatedviewpoint, extremely low literacy rates, especially among femalesare known to be with associated high child mortality rates.Literacy rates for Afghanistan are expressed as an average for the countryas a whole. It is quite possible that in rural villagesnot a single adult and very few men will be female literate (Hartmann and Royce1.9F33). The health and welfare ofa child in developing countries is insepa- rable from that of its mother.A weakness of thissurvey has been the lack of any assessment of the nutritional status of the mother, on which the nutritionof very young children is dependent, largely and the absence of interviewswith mothers to estab- lish their evaluation ofa child's nutritional status. 11.4 Given the .importance_' of therôle of the woman in child care in Afghan society, recommendations which rentre on the non - formal education of women and the renewaland expansion of nomic eco- activities among women should hegiven serious considera

29 tion as fundamental to long term improvement in the status of women and, consequently, in the health of their children. In implementing any such recommendations due regard should be paid to the accepted norms of Islamic society.

11.5 The relationship between infectious disease, malnutrition and diarrhoea is well established. For this reason an approach which attempts to ameliorate and prevent these conditions together, rather than separately, is preferred. In areas with far-flung populations and where year -round access is not always possible, a comprehensive primary health care approach based on maximum feasible community participation and emphasis of health promotion offers the most cost -effective and logistically sound solution. The survey suggests that neither diarrhoea] control or childhood immunization are at present included in thr basic health services offered in the three provinces surveyed. Remedy- ing this deficiency and making provision for an improved food supply and nutritional education is a basic requirement.

zn 12 Conclusion

The survey described above was the result of a project executed by Afghanaid and partially funded by UNICEF. The field work was carried out by 12 Afghan nationals over a three month period during the latter part of 1990. This followed training carried out by several agencies including Afghanaid, UNICEF, SCF(UK), UNIDATA and ACBAR. The findings, although subject to some problems of interpretation, tend to confirm a marked degree of malnutrition among 1 to 5 year old children in the three provinces. They also confirm widespread damage to fnod crops due to a variety of reasons and suggest that in at least one province (F]adakhshan) inflationary price increases of essential commodities may be a contributory factor in the malnutrition of children aged 1 to 5 years. The survey also confirms a pattern of child disease similar to that of other developing countries with a heavy death toll from diarrhoeai disease and preventable infer- - tious disease.

Due to prevailing social and religious codes, mothers were not interviewed during the survey, no female investigators were employed and girls were under-represented among those children surveyed.It is suggested that these deficiencies be .addressed an far as possible in future work. As it stands, the results of the survey provide a valuable addition to existing knowledge of the area and a basis for further investigation.

3 1 13 RECOMMENDATIONS

13.1 Food Assistance In ideal circumstances, the degree of malnutrition revealed in the survey would warrant the establishment of emergency supplementary and therapeutic feeding centres. This would be in accordance with WHO and UNHCR criteria. Unfortunately, because of the logistical difficulties involved and the fact that the problem is widespread across several hundred square miles, this des not appear feasible.It is recommended that priority he given to Badakhshan in the form of Fond for Work programmes. Tt is suggested that this will serve two purposes by (a) averting the threat of starvation and (b) improving the local infrastructure such as roads, irrigation canals and water and sanitation provision. This in turn would lay the groundwork for a potential increase in agricultural productivity.

13.2 Pest Control

In the short -term it is recommended that farmers he provided with insecticides with which to combat locust and sunn --pe,t infestation.It is argued that the destruction of crnpc by these pests is a major underlying cause of malnutrition in the prnv -. inces. In the long-term it is recommended that all agencies working in the agricultural sector in Afghanistan combine in implementing the solutions put forward in the t1NOCA report UN.AO1 /100.190.(Tacon J. 1990).

13.3 Long-term Planning

It is recommended that a start he made on wide -ranging agricultural rehabilitation of the whole area. The target. should be self- reliant communities, and long -term dependence on aid .should be avoided. Attention is drawn to the success of the Aga Khan Rural Support Programme (AKRSP) operating in northern Paki- stan as a possible model..Tt is noted that ri,.imate, geography and the ethnic character of the population are not dissimilar to those of the provinces reported on here. The programme encourages community participation and uses inrii.genntas resources fur its fulfillment. However, the effect of prevailing political conditions in northern Afghanistan would need to be taken into ac:r urnt when considering possible replication of this programme.

13.1 Fish Farming

Tn Jowzjan province, and in Khamyah and (7/arc-On district=, in particular,it is recommended that thr= possibility of increa protein intake through increased fish production by rational use of the Oxus river be investigated.i f successful, this would not only increase family consumption of fish among people alrr,dy used to it hut would also open up commercial possibilitio and additional opportunities for income generation. 13.5 Sericulture

It is recommended that attention beturned to the possibility of reviving and upgrading the silk production industry in Jowzjan and Faryab provinces her mulberry forests survive. 13.6 Health Services

It is recommended that urgent attent inn be given to the possibility of extending .immunization coverage to Badakhshan, Jowzjan and Faryab provinces. This mighthe accomplished through AVICEN who are already engaged in immuni,ati.on activities in +hn rural areas. Some attempts should bemade to develop MCM activities in existing clinics.

13.7 Drug Supplies

Though health workers are seldom satisfiedwith the amr,rrnt of drugs supplied to their clinics andrnnsi.an t l y request more, organizations supplying drugs to cross border clinics sh.urld investigate complaints of insufficient drugsupplies to determine the precise cause nf any shnrtfal 1. It seems clear that drnrj s are being dispatched from the agenciescnncernr'd; however, sup plies ran be delayed, divertednr lost en route due to fighting, had roads, had weather and similar logistical prehlem .

13.0 Short -Term Health Worker Training /RefresherTraining

It is recommended thatNGCIs at present trainingvarions rategn -- ries of paramedics for work in the provinces bordering Pakistan extend their attention to Badakhshan, Jowzjan andFa.ryah. It is further recommended that basic and refreshertr.aininra should lay emphasis on the control of diarrhoeal diseaseincluding effective case management and the promotion of ORS and home fluids. 13.9 Long-Term Health Measures

13.9.1. Community Health Workers

The development of a long- -term strategy for thetraining nf both female and male health workers to deliver community-based primary health care is strongly recommended.Based on experience elsewhere in the world, it is unlikely thatlasting and fundamental improvements in the health status ofyoung children will he achieved without the involvement of women. The paststratr=gy of training primarily male health workers has resentedin a lark nf involvement of women and may he responsible for the current emphasis on curative care. The absence of requests by health workers for ORS is an indicator of this emphasis. Training ori- ented towards the particular skills and needs ofwomen in the context of child -rearing is needed, along witha commitment to development of more general NCH programmes. As a starting point it is recommended that the gender aspects of health and disease receive greater attention in the training o"f both expatriate and national agency staff.

It is further recommended that the theory and methods of non -formal education be incorporated into health care programmes for women and children. The child -to -child programme with emphasis on the participation of girl children as well as boys is recommended for consideration.

13.9.2 Nutrition education

As in the rural areas of other developing countries prolonged and continuous breast feeding is the norm. This has a positive and natural contraceptive effect thus allowing the mother to build up her biological strength before thn next preg- nancy.In the absence of nutritional education, prolonged breast: feeding, for example up until the age of two years and beyond, has also been associated with late weaning and poor nutritional status among young children. This has heron demonstrated in the present survey by the bulk of malnutrition indicators being concentrated mainly in the lower age bands.It is strongly rernm -- mended that nutritional education programmes he undertaken as an essential part of a primary health care approach. This chnuld emphasize continuation of breast feeding but witht hr introduction of locally available weaning fonds from the age of four to six months. The feeding of equal amounts to both girls and boys should he emphasized in nutritional education programmes.

It is self- evident that the success of nutritional education programmes that utilize local foods depend for their succes-, on the availability of such food in the first ¡lace. To this extent this recommendation is closely related to recommendations of food production and supply made above.

Greater attention needs to be paid to the nutrition of mothers. This is necessary to maintain their- own health and therefore, as far as possible, the quality of their breast milk., particularly its protein, iron, folic acid and vitamin C content :. Similarly, for safe motherhood the nutrition of young girls is extremely important hence the rccommcnd

13.1.0 Further Use of The Data Further valuable points could doubtless he drawn from afurl 1 statistical analysis of the data made available in this report. Other agenc.ie., intere=sted in performing such analysis will hr given access to the data on request.

art References

Tacon J. 1990. Bad Days in Badghis An Assessment of Problems Afflicting Afghanistan's North Western Region Following a UNOCA Mission to the Region During December 1989. UN.A01/100190

Tinsman C, Grobler C, Predja O. and Faliu B.1990. UNICEF Field Mission Report, Shibergan (JIWZJAN Province. Tuffrey.V. 1990. Nutritional Assessment, Faryab Province May 1990 UNICEF Report.

Shakir A. (1975) Arm Circumference in the Surveillance of Pro- tein- Calorie Malnutrition in Baghdad Am.J.Clin.Nutr.1975;2D:66.1 -5 Bhuyia A., Zymicki S. and D'Souza S. Socioeconomic Differentials in Child Nutrition and Morbidity in Rural Areas, J. Trop. Pediat. 32, 17 -23 1986

Cammeron M & Hofvander Y.(1983) Manual on Feeding Infants and Young Children, Oxford Medical Publications

Hartmann B & Boyce J,(1983) A Quiet. Violence, Zed Books

Koenig M & Wojtyniak. B. Excess female mortality during infancy_ and early childhood. Workshop on Female Mortality and Health Care in South Asia. Dhaka, Bangladesh, January 1987

Sen A (1984) Famine: the Politics of Entitlement in Health and Disease: A. Reader ed. Black N. OU Press -^

UNICEF (1991) The State of the Worlds Children, OUP

World Bank (1990) World Development Report, Washington DC

Eighmy, Thomas H.(1990) Afghanistan's Population Inside and put Demographic Data for Reconstruction and Planning, Annexe V Ii A.I.D.

35 ANNEXE 1 ANNEXE 1A

NUTRITIONAL SURVEY

DATE :

VILLAGE :

SURVEYOR'S NAME :

REG M/F AGE MUACNUTRTIONAL ANAEMIA NB BS OED GUMS. NO STUTAS 0/+ O/+O/+ O/+

N M S R P W

NB = NIGHT BLINDNESS N=NORMAL R=RED BS = BITOT'S SPOTS M=MODERATE P=PINK OED = OEDEMA S=SEVERE W=WHITE GUMS=VITAMIN C DEFICIENCY

UNICEFKABUL 1990 1. BAZAAROLESTIC NAIRE

ANNEXE 1E1

FOOD AND EEVERÇGES following ccxivwiditiesin this 1. What ar-o theprices of the ? Woloswali /Alakadarie T 1 ^ ' , LAST YEAR AVAILAE?ILITY UNIT COWEñSION CU=d'EN1' FRICE FER UNIT FRICE FER OF IN1U (IN AFS ) 'MIT ((YS) . CC]hMl"iD I T I ES PEAGLnESTpuUaRll SEERS U - ,rol,r(V*-Z_. . "'/ ',i i sb-1' V % J ÿr/w r ,l__,' f 6 AV/1IlA- 01.Crarley BILITY') ÿ --.- U r: 2.Weat l' 1=-f"tead.i l) Sesame r24/ Ava i-- -_-.-. lab's? 04.Rice &j ' r:iti. Maize/cor''n{/ 2- Ava.i- Vitt__ labte 06.Sugar o// i _ .!', , 07.Salt 2_4 ~~ Avai- lable r:S.Ereef,b

09 . Tea (10. ,

10.Ghee 1,/

animals in thisbazaar? 2. What are theprices of the following

year ago Current Price (AFG) 6 months ago _ ANIMAL cis;. -j c L i J/&- 01. Oxen ; >;a

:,,,L. Sheep,))'

CO. Horse u/

04. Donkey J M FCMJ)EEV . 0.9. Goa t -

06. Camell'

07. Milk Um, JCALLI!,

0 8. Chicken¿- ANNEXE IC

EUEL

What is the price of fuel in this Woloswali /Alakadarie7 n V,f/il -L,TZ FUEL UNIT OFCURRENT LAST AVAILA C.-/. ' MEASURE PRICE YEAR BILITY J - (INAFS) PRICE yñ " ÓJALINAFS)1,2," 1 1. Diesel , fÌ

2. Kerosene 0 . L 3. Petrol /,P- 4. Firewood >v% 5. Coal s A f (G)

6. Charcoal r..y ,. LJ 7. Gas Cylinder

8. Dung ( U`) C.;t ,

1 = not difficult 2 = difficult 3 = v. difficult

! ANNEXE 1D ROAD TRANSPORT SERVICES: What transport services are being operated in this Woloswali /Alakadariet

1- J 1J v. d ',5) . - --'-' r NAME OF NUMBERTYDES INA tTI1990199019891989 TRANSPORT SERVICE PRTO: r' RATERATERATERATE DiILY (IN KMS) PER PER PER PER U FROI1: ;1 SEERPERSSEERPERS ./ 1, (IN k r ) ./Tt. LG-' J>> L !J:-» , 2.¡ , ' 1r : Pre¡a-(- 1

y)/ Type: 1 = private 2 = public 3 = Private @ Public

I ' ROADS - roads connecting this woloswali /alakadarie and their status + C I I1 , /ppr,esent MATERIALL4Jbr",l, COMING FROM GOING TO MAT SIZE CONDITION 1 = PAVED e >2 / f 2 = -PAVEDrgv .t>Le,T/f L 3 = DIRT/

SIZE OF ROAD

= FOR TRUCK:(fai.; = FOR JEEP

3 FOR ANIMAL:- ' 4'. CONDITION`;..?

= DAMAGED6r,...- = MINEZ'&' = OBSTRUCTED J,;,,__.-

= SNOW (m /y) -

=OTHER . I " J ANNEXE 1 E POPULATION ,,,.;,1,,.1/ % <._,,/ 1. What is the estimated population of this woloswali /alakadarie?

Now t Last year

J;,) c;i2LY,-) Breakdown of the population df this woloswali /alakadarie

Age Group numbers nirnbers now last, year

r,,s _ c-/> , (S) /,J`/ ce% r Whether people are having to sell their belonings in,this woloswali/Alaka dari T Yes No

Cf yes, What they are selling?

Refugees Movement in this woloswali /Alakadari 2,1)cJf Cf /br,11/ 1)'((? V. /Corne bac fyompak This year Last year J Vr r Last year Else where inside Afgh this year r L) 1 ~L Left for pak This year Lastyear

Left "Else inside Afgh This year Last year ;--%J - -- 1 Else where explain which place they went or come

... ANNEXE 1F HEALTH Ask from Health worker in Woloswali/Alakadari

?,(-.111 "L,$)-'`'I br3,/

1) What diseases are normally prevalent inthe area?

1. Arb there seasonalV ) Variations?f r-

2)IS there an abnormal prevalence ofany diseases now

What are the probable causes ?

3) What is the mostcammon cause of death in children,

From rJ- 4 Year old ? ,iLI1I -Si/ 5 - 14 Year old 7

4) What health facilities exist f Jlyr (J %a) 1 q How many staff ?

Is there Immuriisation?

5) .What are the sources of Drug suppliesfor the facilities ^r

Is there shartage of Drùgs 7

What are themain needs ?

f / r

6) Are there any trained medical personnelnot working in health care i

( ANNEXE 2 TABLE : 2A

NUMBER OF CHILDREN SCREENED (PROVINCIAL BREAKDOWN)

PROVINCE No. OF CHILDREN No. OF VILLAGES 1 -5 YEARS OF AGE

Badakhshan 4167 131 Jowzjan 3141 30 Faryab 2837 41

Total 10145 202 TABLE : 2B

NUTRITIONAL STATUS - ALL PROVINCES

AGE GROUP M A L E F E M A L E A N A E M I A NB BS DED GUMS TOTAL

N M S TOTAL N M S TOTAL RED PINK WHITE SAMPLE

I - 2 161 272 549 982 90 201 456 747 130 682 916 11 166 41 968 1729 2- 3 424 440 449 1313 211 362 378 1011 258 1191 874 73 254 85 1029 2324 3- 4 699 349 177 1225 518 316 201 1035 243 1413 605 88 225 70 816 2260 4 - 5 1742 423 121 22861124 319 103 1546 496 2565 169 159 387 BO 1121 3832

TOTAL 302614841296 5806200311981138 4339 1127 5851 3164 331 1032 276 3934 10145

AGE L SEI AS PERCENTAGE OF TOTAL SAMPLE BASED ON M.U.A.C.

NORMAL MODERATE SEVERE Age Group Male Female Male Female Male Female

1-2 Years 16 12 28 27 56 61 2-3 Years 32 27 33 36 34 37

3 -4 Years 57 50 28 31 14 19

4 -5 Years 76 13 18 21 5 7

Total 52 46 26 28 22 26

Normal IN) = MUAC 13.5 cm and above Moderate (M)= MUAC below 13.5 cm and above 12.0 co Severe IS) 2 MUAC 12.0 cm and below

NB = Night Blindness BS = Bitot's Spots / Translated as skin disease OED = Oedema GUMS = Vitamin C deficiency TABLE : 2C

NUTRITIONAL STATUS BY PROVINCE

Province : BADAKHSHAN Age and sex as percentage of provincesample based on MUAC

N O R M A L M O D E R A T E S E V E R E Age Group Male Female Male Female Male Female 1 -2 Years 9 6 27 25 64 69 2 -3 Years 18 14. 41 42 41 44 3 -4 Years 46 37 39 44 16 19 4 -5 Years 68 67 27 28 5 5 Total 43 38 32 34 25 28

Province : JOWZJAN Age and sex as percentage of provincesample based on MUAC

N O R M A L M O D E R A T E S E V E R E

Age Group Male Female Male Female Male Female 1 -2 Years 14 12 28 28 58 60 2 -3 Years 37 31 29 36 34 33 3 -4 Years 63 60 24 24 13 15 4 -5 Years 84 82 12 12 4 7 Total 58 54 21 23 21 23

Province : FARYAB Age and sex as percentage of provincesample based on MUAC

N O R M A L M O D E R A T E S E V E R E

Age Group Male Female Male Female Male Female

1 -2 Years 30 21 29 29 41 50 2 -3 Years 43 39 30 28 27 33 3 -4 Years 63 56 23 20 15 23 4 -5 Years 79 74 12 17 9 9

Total 57 51 22 23 21 26

Normal = MUAC 13.5 cm and above Moderate = MUAC below 13.5 cm and above12.0 cm Severe = MUAC 12.0 cm and below TABLE : 2D AgeNUTRITIONAL Group STATUS - ALL PROVINCES Norm. M U A C Number Total ANAEMIA Percentage N. B. Oedema GUMS B.S. 1 -2 Years 251 Mod. Severe473 1005 Red Pink White Red Pink White No. 1 No. No. % No. 4 -532 -4-3Years Years 28661217 695 742665802 224378827 3832226023241729 496243258130 119125651413 682 769605874916 131111 8 67635139 20273853 159 887311 43 80708541 2342 11211029 816968 29364456 387225254166 101110 Percent. Total ; 5029 50 2682 26 2434 24 10145 ;1127 5851 3164 ; 11 58 31 :331 3 :276 3 ;3934 39 ;1032 10 SevereModerateNormal =- MUAC below 13.5cm and above 12.0cm = =MUAC MUAC 12.0cm 13.5 cmand and below above GUMSB.S.N.B. = Vitamin C= deficiencyBitot'sNight Blindness Spots / Translated as skin disease f`a dM a tOaMM d r P tD N r` -N N C) N N O m O - O) O 0) O) m tnNMtO tD hr0c0 O tI) tOCOtAN O N N N M r- M co0)rnm tn Z O O z Z r'r'N r ót tDtOc'9CM t0 ro 0) rn N r- V) u)tndM r be d tO M N .- N cDCoacD N ro M M d d d a) tn t!) f Z N U1 O O C0 O CO Jr O MtOdr O ac0d10 O U O N d M tA C7 to C0 r` N d d M d t n tp 0) O N N .- - C7 OCoO)N O C Z Z Cp O . N N d Z Y tn ro ét - r- r- O r- ro M u)0)O)r r!) E ro 0 ro E ro m E v ro m .-Ou)0) tn U O a r tc) tn ro O M O m t0000t0 O z N O O N tO t0 cO N z N _ro Or-.-.- N r_OMN CV C m rCOO)N 0) ro T m L U m F- C Z COIDCO M a) Z MCMr-01 tO V) \ r O C") z z - O N N u) r`Nr-N N N U z O t0 tO .- d ro Nr- z N C 4- tt) M 0 0) N L7 O m c0 1n M N d 0)10Mr O) Cav a N - r- rnMo)O m rn MMNN. N U 1a fl) - C F) i) r- dtOr-On tOaMd r` t O E Mdt0c0 tn N d N d a) a 0h 0 d d tn tO d 0) ro Z (A'- 4) r V O r- - - a) dOdO) d 11 m V M 0) r` M tr m NNr-N N la tnC/) .

r- M .- t0 Z m C7 - C) r- t0 d01(0 N Q 0) O r 0) r'NMO 10 H aMtO r Q N 0)dmCo O i N HQ -N - - a0 LL t` 0 0 01 u) Q tD00010 IL ^ n r` d 01 u) Q W d dr`N 1` z N C') d M z O 0 tO C0 a n Q .N- N Ndu)m Q N z N M M d M NrCOM Q - N d tO h W tO O d ^ t` O N M o O /0 r M r- N d - r` N d E .- .- N tD U O L n ro m - d r tn L C)MrCO N W N .- st 0 t0 m M tO r tO 1nn0mn r t0 a0 d rom M cO r- M Ó É â an..- .O /- 7 ÓE M 1O r` tO 0) O m Z 1- 7 N > Z 1- Z7 O ro m W > U 3 rr-Mtn c0 tO tn r` O O O C O U - u) d a0 0) N CO N t") O) r` r- O M z tt) M . O h N ro r- N N tO M r NcO c0 N ro > N N r- IO E ñ O UCtn U n. dMtOtO 01f') U U ro C Od Mr- t[) C') cVNCOtO C0 CV ro N M M d M Q CV dCOC'9 O N Q r r M O r N E M m Q -N r- - tO a r d M M N U E r'Nr- tO N Ñ u) _O O S I-- Y C`)rD N Q Q E cOMCMOOOOd N - tOdMa r r r- r- F- O L M ¡.-d E toOOrr1q tnr-tpCO od Cn Q O L N a O) E MOO)O d u) m Z O -M Mr Q Q Q J Z ZLO > > > IL Q iE N z N N N M OH a IA M tJ)tl) L L L L . 7 a d)tr)tA N U rorororo roa, L L L L 7 L L L L LO â)ai W N -. } } } } p m m m m m LO C7 m m m m C }}}} O O >. >. } } a1 C7 O m 1- O NC'MdtO J ~L m I 1 NMdtO L 1 I m iQ O) 1 NMat() ~ L z á 1 1 1 m 0) NMa a Q r-NMd n. 1 1 1 1 m Q -NMa a. TABLE : 2Fa

NUTRITIONAL STATUS DISTRICT -WISE BREAKDOWNOF BADAKHSHAN Page..2

District name : Jurm AGE GROUP NUTRITIONALSTATUS A N A E M IA N NB BS OED GUMS M S TOTAL RED PINKWHITE 1 - 2 15 50 57 122 0 52 2 - 3 69 0 3 2 75 24 62 63 149 0 3 - 4 58 91 0 6 0 94 66 57 15 138 0 93 45 0 3 0 4- 5 175 61 7 243 53 0 188 54 0 6 TOTAL 280 230 142 0 58 652 0 391 259 0 Percentage 43 35 22 18 2 280

District name : Baharak

AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINKWHITE 1- 2 2 20 71 93 0 30 63 0 6 2- 3 9 43 46 98 1 60 1 50 47 3 8 3 - 4 30 52 18 100 2 47 0 65 35 0 5 4 - 5 90 67 16 173 1 33 0 122 '51 0 12 TOTAL 131 182 151 464 1 43 1 267 196 3 Percentage 28 39 33 31 5 183

District name : Keran va Menjan

AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED N M S TOTAL GUMS 1- 2 RED PINK WHITE 0 2 7 9 0 2 7 - 0 0 0 2- 3 0 12 1 8 13 0 7 6 0 3- 4 5 8 0 0 6 1 14 0 9 5 4- 5 0 0 0 5 14 9 1 24 0 19 5 0 0 TOTAL 19 31 10 60 0 5 0 37 23 0 0 Percentage 32 52 17 0 24

District name : Kishim AGE GROUP NUTRITIONAL STATUS A N A E M I A N M NB BS OED GUMS S TOTAL RED PINK WHITE 1 - 2 10 30 85 125 0 44 81 2 - 3 0 1 2 77 13 57 54 124 0 46 78 0 1 0 3 - 4 56 49 25 130 73 0 69 61 0 5 4 - 5 239 118 19 0 49 376 1 238 137 0 TOTAL 318 254 183 11 0 115 755 1 397 357 0 18 Percentage 42 34 24 2 314 Normal (N) = MUAC 13.5cm and above NB = Night Blindness Moderate(M) = MUAC below13.5cm and above 12.0cm Normal (S) = MUAC 12.0 BS = Bitot's Spots cm and below OED = Oedema GUMS= Vitamin C deficiE TABLE : 2Fb

NUTRITIONAL STATUS DISTRICT -WISE BREAKDOWN OF JOWZJAN Page..1

District name : Sangcharak

AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 1 - 2 35 51 89 175 8 95 72 2 6 4 92 2-3 107 97 67 271 17 198 56 3 6 1 68 3- 4 232 49 26 307 17 261 29 6 3 0 39 4 -5 470 59 13 542 38 471 33 6 15 4 35 TOTAL 844 256 195 1295 80 1025 190 17 30 9 234 Percentage 65 20 15

District name : Balkhab

AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINKWHITE 1- 2 7 8 14 29 2 14 13 0 3 0 13 2 - 3 26 24 28 78 13 44 21 0 7 5 34 3 - 4 38 15 14 67 12 40 15 4 4 2 26 4- 5 79 21 9 109 27 69 13 4 4 1 22 TOTAL 150 68 65 283 54 167 62 8 18 8 95 Percentage 53 24 23

District name : Kohistanat

AGE GROUP NUTRITIONALSTATUS A N.A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 3 1- 2 8 23 34 3 13 18 ' 0 6 0 25 2 -3 28 26 50 104 18 45 41 0 4 1 62 3 - 4 57 34 38 129 35 61 33 6 6 3 65 4 - 5 122 24 13 159 93 56 10 8 7 0 34 TOTAL 210 92 124 426 149 175 102 14 23 4 186 Percentage 49 22 29

District name :.Agcha

AGE GROUP NUTRITIONAL STATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 1- 2 0 0 7 7 0 1 6 1 1 0 6 2- 3 4 4 2 10 2 7 1 0 0 0 2 3- 4 2 6 1 9 0 8 1 1 1 0 4 4- 5 10 4 2 16 3 11 2 2 1 0 4 TOTAL 16 14 12 42 5 27 10 4 3 0 16 Percentage 38 33 29

Normal (N)= MUAC13.5cm and above NB =Night Blindness Moderate(M)= MUACbelow 13.5cm and above12.0cm BS =Bitot'sSpots Normal (S)= MUAC12.0 cm and below OED =Oedema GUMS=VitaminC deficit TABLE : 2Fb

NUTRITIONAL STATUS DISTRICT -WISE BREAKDOWN OF JOWZJAN Page..2

District name : Murdian

AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 1- 2 3 3 26 32 1 15 16 0 3 0 24 2 - 3 30 11 33 74 5 54 15 0 0 0 36 3- 4 27 17 9 53 7 38 8 1 1 0 16 4- 5 37 5 7 49 6 37 6 1 2 0 12 TOTAL 97 36 75 208 19 144 45 2 6 0 88 Percentage 47 17 36

District name : Faizabad AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 1- 2 0 18 23 41 0 25 16 0 2 0 19 2- 3 13 11 14 38 0 30 8 0 1 0 11 3- 4 29 11 4 44 1 41 2 0 0 0 3 4- 5 83 3 0 86 2 84 0 0 0 0 0 TOTAL 125 43 41 209 3 180 26 0 3 0 33 Percentage 60 21 20

District name : Khanaga AGE GROUP NUTRITIONAL STATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINKWHITE 1- 2 3 15 34 52 3 17 32 - 0 4 0 36 2 - 3 22 36 27 85 13 49 23 0 6 0 32 3- 4 22 26 7 55 17 32 6 0 2 0 11 4- 5 36 11 9 56 25 23 8 4 2 0 11 TOTAL 83 88 77 248 58 121 69 4 14 0 90 Percentage 33 35 31

District name : Qargeen AGE GROUP NUTRITIONAL STATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINKWHITE 1- 2 1 2 13 16 0 2 14 0 0 0 13 2- 3 5 5 6 16 0 11 5 0 0 0 7 3- 4 18 6 1 25 0 24 1 0 0 0 0 4- 5 42 0 0 42 0 42 0 0 0 0 0 TOTAL 66 13 20 99 0 79 20 0 0 0 20 Percentage 67 13 20

Normal (N)= MUAC 13.5cm and above NB =Night Blindness Moderate(M)= MUAC below 13.5cm and above12.0cm BS = Normal Bitot'sSpots (S)= MUAC12.0 cm and below OED =Oedema GUMS=VitaminC deficit TABLE : 2Fb

NUTRITIONAL STATUS DISTRICT -WISE BREAKDOWN OF JOWZJAN Page..3

District name : Khamyab

AGE GROUP NUTRITIONAL STATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINKWHITE 2 5 1- 2 2 9 0 6 3 0 0 0 3 2- 3 5 1 3 9 0 6 3 0 1 0 4 9 4 3- 4 2 15 0 14 1 0 0 0 1 4- 5 16 0 0 16 0 16 0 0 0 0 0 TOTAL 32 10 7 49 0 42 7 0 1 0 8 Percentage 65 20 14

District name : Mengajek

AGE GROUP NUTRITIONALSTATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 1- 2 2 12 24 38 1 13 24 0 2 0 23 2 -3 24 27 27 78 9 43 26 0 2 0 30 3- 4 49 18 6 73 20 48 5 3 3 0 9 4- 5 79 9 5 93 32 55 6 4 5 0 8 TOTAL 154 66 62 282 62 159 61 7 12 0 70 Percentage 55 23 22 TABLE : 2Fc

NUTRITIONAL STATUS DISTRICT -WISE BREAKDOWNOF FARYAB Page..1

District name : Pushtoonkowt AGE GROUP NUTRITIONALSTATUS A N A E M I A N NB BS OED GUMS M S TOTAL RED PINKWHITE 1 - 2 75 72 112 259 50 128 81 2 - 3 159 98 2 41 11 74 88 345 77 171 97 3 - 4 164 62 31 89 33 102 48 274 57 137 80 4 - 5 299 54 29 67 34 102 36 389 127 192 70 TOTAL 697 286 284 47 107 39 137 1267 311 628 328 109 Percentage 55 23 22 304 117 415

District name : Kohistan /Lolash AGE GROUP NUTRITIONALSTATUS A N A E M I A N M NB BS OED GUMS S TOTAL RED PINKWHITE 1 - 2 8 13 21 42 10 13 19 1 2 - 3 5 . 2 17 22 21 19 62 13 3 - 4 24 25 3 14 6 37 10 14 61 17 29 24 20 6 17 4 - 5 62 6 3 71 3 23 24 35 12 5 23 TOTAL 129 50 57 1 26 236 64 96 76 15 Percentage 55 21 24 59 12 .95

District name : Almar AGE GROUP NUTRITIONALSTATUS A N A E M I A N NB BS OED GUMS M S TOTAL RED PINKWHITE 1- 2 11 19 17 47 28 15 4 -0 9 2 - 3 57 38 33 128 9 2 55 48 25 13 42 3 - 4 74 33 20 127 23 31 28 75 24 13 47 4 - 5 127 24 27 19 53 178 49 81 48 47 TOTAL 269 114 97 74 21 85 480 160 219 101 73 Percentage 56 24 20 17 72 171

District name : Belcheragh AGE GROUP NUTRITIONALSTATUS A N A E M I A N M NB BS OED GUMS S TOTAL RED PINK WHITE 1 - 2 27 34 68 129 17 42 70 0 30 2 - 3 37 39 57 133 3 76 17 48 67 9 42 3 - 4 79 27 37 143 6 86 16 79 48 9 33 4 - 5 150 41 10 201 3 87 37 123 41 10 TOTAL 293 141 172 74 5 135 606 87 292 226 28 Percentage 48 23 28 179 . 17 384

Normal (N) = MUAC 13.5cmand above NB = Night Blindness Moderate(M) = MUAC below13.5cm and above Normal (S) = MUAC 12.0 12.0cm BS = Bitot's Spots cm and below OED = Oedema GUMS= Vitamin C deficie TABLE : 2Fc

NUTRITIONAL STATUS DISTRICT -WISE BREAKDOWN OFFARYAB Page..2

District name : Darzab

AGE GROUP NUTRITIONAL STATUS A N A E M I A NB BS OED GUMS N M S TOTAL RED PINK WHITE 1- 2 14 9 14 37 5 15 17 4 3 0 2 - 3 26 21 22 15 69 8 33 28 6 11 0 3 - 4 41 35 11 8 60. 7 32 21 4 11 1 28 4- 5 70 5 5 80 10 TOTAL 61 9 3 14 0 42 151 46 49 246 30 141 75 17 39 1 120 Percentage 61 19 20 NUTRITIONAL STATUS ALL PROVINCES OF CHILDREN AGE 1 - 5 6080 % Well Nourished 2040 0 1 -2 CHILD 2 -3 AGE GROUPS (Years) 3 -4 4 -5 GRAPH: 2G ___.__ Male SEX Female : :

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0o o o o o o o o o 0 o n d+ o o o NUTRITIONAL STATUS. TABLE 2NI Nutritional Survey Comparisons.

SURVEY NORMAL MODERATE SEVERE PARTICULARS NUMBER OF CHILDREN MUAC measurementsBelow 13.5cm & 12cm & below SCREENED of 13.5cm & aboveabove 12cm (approx equiv (approx equiv to ( approx equiv to under 70% over 80% weight to 70% - 79% weight for for height) weight for height) NCHS /CDC /WHO height)

Afghanaid 1990 MUAC MUAC MUAC 4utrition Survey 49.6% 26.4% 24% Afghanistan 10145 4utrition Survey 1990 afghan Refugees weight/ weight/ weight/ weight/ weight/ weight 30P /CDC /UNHCR height age height age height /age 4WFP 85.7% 67.4% 7.4% 21.8% 1.8% 10.7% 505 3aluchistan 75% 50.4% 26.4% 31.6% 3.1% 18.1% 367

30P National weight for age weight /age weight /age 4utrition Survey 1985 -87 52% 38% 10% 8520

The findings of the surveys givenabove are for referencepurposes. The survey findings cannot becompared since the classification used is different in eachcase. The GOP /CDC /UNHCR survey has used weight- for -height (Waterlow'sclassification) and weight- for -age (Gomez classification). The Government of Pakistansurvey has also used weight- for -age (Gomez classification). Afghanaid has used the simplest screening method Mid Upper Arm Circumference(MUAC). Indicators have been developed by WHO to standardizeresults for children of different weights for heights using data obtainedfrom many countries. This standard is known as the NCHS /CDC /WHONORMALIZED REFERENCE. It is used as the international yardstick for measuringdegrees of malnutrition.

GOP Government of Pakistan CDC Centers for Disease Control USA. UNHCR : UN High Commissioner for Refugees WHO World Health Organisation ANNEXE 3 LCmmOC m mm an 7cCCOC m OCZ7CSa m7CmO.IDC..fCem7C 0.

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BAZAAR LOCATION & PREVAILING PRICKS IN BADAEHSHAN, JOWZJAN, FARYAB (ANIMALS) (In Afghanis) Pg. 1

CODE BAZAAR NAM 1 OXEN SHEEP 1 HORSE DONKEY 1CURNT 6 HON YEAR :CUNT6 MON YEAR :CUNT6 MON YEAR ;CURNT 6 MON YEAR

Province : BADAKHSHAN

1112 District !edit ;100000 60000 ; 20000 150001150000 100000 60000 45000 1106 District June ;100000 80000 1 30000 20000;150000 200000 60000 45000

1103 Shahre Bozarg 1 80000 1 90000 20000 30000;150000 100000 80000 50000

1101 Yaftal -e- Payeen : 80000 1 55000 25000 20000;150000 90000 70000 55000 1107 District Baharat ;150000130000 90000 30000 30000 28000 1 20000 15000 20000 90000 15000 75000

1102 District Ragh 1 70000 60000 ; 15000 20000:100000 100000 60000 60000

Province : JOKZJAN 1702021 Tootzar of Sangcharat 1120000120000120000 ; 32000 32000 32000 ;120000120000120000 1 50000 45000 45000 1702024 Charon of Sangcharat 1120000150000150000 ; 3000040000 40000;120000120000120000 ; 50000 45000 45000

1102050 Otopaz of Sangcharat 1100000120000120000 ; 18000 20000 200001100000100000100000 ; 40000 35000 35000 1102018 Tabir of Sangcharat ;100000100000100000 ;15000 2000020000:100000100000100000 1 40000 45000 45000

1110 Baja of Qargeen 1120000100000100000 ; 18000 16000 16000110000080000 80000 1 70000 50000 49000

1708 District Faizabad 1 9000090000 90000 1 2500025000250001100000100000100000 1 40000 40000 40000 1703 Baltbab (Sub- Distt.) 1150000150000130000 1 28000 25000 200001180000180000140000 ;50000 50000 40000

1711 thatyab (Sub- Diatt.) 1125000110000110000 1 17000 14000 140001120000100000100000 1 50000 45000 40000 1105010 Pasni of Eohistan 1110000110000 70000 1 11000 17000 1 15000 90000 90000 15000 1 40000 40000 30000

1706 District Agcba 1100000100000100000 1 15000 15000 1500011200001200b0120000 1 40000 40000 40000 1709 Ehanaga (Sub- Diatt.) 1130000120000120000 1 2500023000 230001140000130000130000 1 40000 35000 35000

1707 Jangale Aregh (Mardian) 1 80000 80000 80000 1 28000 25000 25000 1120000120000120000 1 50000 5000050000 1712 Mengajet of Qaghan 1120000 11000 11000 1 15000 13000 130001100000 10000 10000 1 4000030000 30000

Province : FARYAB 1 1

1809015 Gowti (Belcheragh) 1 90000 8000070000 1 14000 12000 100001250000200000180000 1 50000 4000030000

1809019 Sarchagan (Belcheragh) 1 90000 89000 78000 1 16000 19000 130001260000250000190000 1 60000 5500050000

1809021 Eollan (Belcheragh) 1 15000 8000085000 1 18000 2000020000:220000140000180000 1 6000055000 65000

1809011 Belcheragh 1 80000 1 82000 85000 18000 20000 200001220000145000200000 1 60000 5000065000

1806014 Ata Khan (Pnshtontowt) 1 90000 80000 70000 115000 14000 120001160000150000 1 60000 50000 45000

1806053 Hiandara (Pnshtontowt) 1 8000076000 60000 1 13000 11000 100001100000 80000 60000 1 50000 40000 30000

1806094 IhujaNatusa (Pu8htontowt)1 80000 70000 60000 1 13000 12000 100001250000140000120000 1 50000 4000035000

1806094 óatagala (Pnahtontowt) 1 90000 80000 70000 1 13000 14000 120001240000120000120000 1 40000 3000025000

1806006 Bandar Itai (Pnshtontowt)1 80000 75000 1 10000 15000 13000 120001240000140000150000 1 60000 65000 65000 1803 Langer in Altar 85000 89000 80000 14000 13000 110001240000220000210000 80000 70000 60000 1808004 éhawaja Gowhr in Altar 90000 8500070000 45000 40000300001250000220000200000 50000 50000 40000 1808 District Altar 80000 7000065000 18000 15000 100001300000250000200000 45000 4000030000

1812 Darzab 1100000120000140000 1 15000 18000200001230000140000140000 1 60000 50000 40000

CURNT = Current price 6 NON = Price 6 Months ago YEAR = Price 1 Year Ago TABLE : 48

BAZAAR LOCATION & PRKVATLTNG PRICKS IN BADAIHSBAN, JOIiZJAN, PARYAB (ANIMALS) (In Afghanis) Pg. 2 CODE BAZAAR NAME 1 GOAT CAMEL 1 MILE COW :CUNT 6 MON YEAR ;CURET 1 CHICHI( 6 HON YEAR :CUNT6 MON YEAR ;CURET 6 NON YEAR Province : BADAIHSHAN 1112 District Ieshl. 1 15000 12000 1 1 60000 1106 District Jura 40000 1 1 20000 1000 500 15000 1 1 80000 1103 Shahre Bozarg 50000 1 1000 1 12000 15000 800 1 1 80000 1101 Yafta1- e- Payeen 40000 1 1000 1 12000 100 8000 : 1 70000 1107 District Baharak 50000 1 1000 1 15000 500 14000 12000 1 1 10000 1102 District Ragh 6000045000 1 1200 1 13000 1000 800 1 15000 1 1 40000 Province : JONZJAN 45000 1 700 1 700 1 1 1 1702021 Tookzar of Sangcharak 1 1 13000 15000 150001120000 1 1300001300001150000150000 1102024 Charoo of Sangcharak 160000 1 1200 1200 114000 16000 16000 1200 11200001300001300001 70000 1102050 Otopaz of Sangcharak 100000100000 1 1000 1 12000 13000 13000 1100 1100 1 1 90000 90000900001 80000 1102018 Tabir of Sangcharat 100000100000 1 1 1000 1100 10000 16000 160001120000 1100 1 1200001200001120000 1710 Baja of Qatgeen 120000120000 1 1000 1 1200 1200 1 11000 9000 90001160000 140000140000 1 80000 1708 District Paizabad 60000 60000 1 1 1000 800 15000 15000 800 1 150001150000150000150000 1103 Balkhab (Sub- Diett.) 1120000130000130000 1000 1 15000 1000 1000 1 15000 12000 1 1 80000 80000 1711 Ihatyab (Sub- Di6tt.) 50000 1 1200 1 1200 800 1 11500 10000 99001140000 1200001200001 90000 75000 1705010 Pant of Iohistan 75000 1 1000 900 1 10000 10000 9000 900 1 1100000100000 900001 50000 1106 District Agcha 50000 45000 1 800 1 800 600 1 10000 10000 100001150000 1500001500001140000140000 140000 1 1200 1709 Ihanaga (S1b- Di8tt.) 1200 1200 1 1 15000 15000 15000 11400001400001400001150000 1707 Jangale Aregh (Mardian) 150000150000 1 1000 1 800 800 1 18000 18000 180001150000 1500001500001120000120000 1712 Hengajet of Qaghan 120000 1 2000 1800 1 1200010000 10000 1800 1 11500001200001200001130000 Province : PARYAB 130000130000 1 1100 1000 1000 1 1 1809015 Govti (Beicheragh) 1 12000 1 11000 100001130000120000 100000 1 8500080000 1809019 Sarchagan (Beicheragh) 75000 1 1000 900 1 14000 800 1 12000 11000 1 1 80000 1809021 Italian (Beicheragh) 70000 70000 1 1000 1 14000 900 800 1 15000 16000 1 1 55000 65000 1809011 Beicheragh 70000 1 1000 1 1100 1200 1 14000 14500 16000 1 1 60000 65000 1806074 Ata Than (Pn8htontovt) 70000 1 8000 1 1000 1200 1 13000 12000 110001120000 90000800001100000 80000 1806053 Hiandara (Pushtontovt) 60000 1 1000 900 1 12000 11000 9000 800 1 1110000100000 700001 70000 1806094 Ihn j aNatnsa (Pnshtonkovt 60000 50000 1 1000 900 700 1 )1 12000 11000 90001120000 100000 800001 80000 70000 1806094 Iatagala (Pushtontovt) 65000 1 1000 1 900 800 1 13000 12000 11000 1 1 70000 1806006 Bandar Inv (Pnehtontovt)1 6000050000 800 700 700 1 11000 10000 10000 1 1 55000 50000 1803 Langar in Altar 50000 1 1000 800 700 1 1 12000 11000 11000 11200001100001000001 80000 15000 1808004 Ihavaja Govhr in Altar 72000 1 900 850 1 12000 12000 800 1 1100012200002000002000001 80000 8000075000 1 1808 District Altar 8000 7000 6000 1 1 14000 13000 9000 12000001800001000001 85000 1812 Darzab 8000060000 1 1000 1 12000 850 500 1 13000 10000 1 1 60000 65000 50000 1 1000 1000 2000 1

CURET : Current price

6 MON : Price 6 Monthsago YEAR: Price 1 Year Ago TABLE : 4Ca

BAZAAR LOCATION& PREVAILING PRICES OF DIESELIN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAME Unit of CODE Current Last Year Measure Price Avail - Price ability

Province : BADAKHSHAN 1112 KESHIM PAO 62 35 2 Province : FARYAB 1809015 GOWKI PAO 80 1809014 SARCHAKAN PAO 60 1809021 KOLIAN 60 80 1809 PAO 60 BELCHIRAGH PAO 50 1806094 KHUJANAMOUSA 60 50 PAO 80 1806053 MIAN DARA PAO 70 1806074 ATA KHAN 80 60 PAO 80 1806094 DATA MLA PAO 70 1806006 BANDAR -E-IMAM 60 80 1808 LITRE 120 LANGAR BAZAR PAO 107 1808 KHAWJA GOWHARI 90 80 1808 PAO 140 ALMAR PAO 160 1812 DARZAB 130 150 LITRE 85 85 Province : JOWZJAN

1702021 TOOKZAR LITRE 1710 BAJA 100 LITRE 200 1708 240 100 FAIZABAD LITRE 1703 80 70 BALKHAB (SUB-DISTI.)LITRE 1711 KHAMYAB 500 120 1705 LITRE 250 PASNIE LITRE 110 1709 KHANAOA (SUB 240 120 1707 -DISTT.)LITRE 100 MARDIAN LITRE 90 1712 MENGAJEK 100 90 1706 LITRE 60 AOCHA LITRE 30 1702024 CHAR00 40 40 LITRE 1702050 OTOPOZ 80 80 1702018 TABIR LITRE 80 LITRE 80 120 125

Units ofMeasurement 1 Pao. = 0.438 Litre Availability 1 Pao = 0.438 Kg 1=Not difficult 1 seer = 7 Kg 2=difficult 1 Bar = 6 Seer 3=very difficult TABLE : 4Cb

BAZAAR LOCATION & PREVAILING PRICES OFKEROSENE IN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAME Unit of Current Last Year CODE Measure Avail - Price Price ability

Province : BADAKHSHAN 1112 KESHIM PAO 120 1106 JURM 80 2 PAO 250 160 1103 SHEHR-E-BOZARG PAO 2 1101 160 90 2 YAFTAL-E-PAYEEN PAO 120 1107 BAHARAK 80 3 PAD 220 180 1102 DISTRICT RAGH PAO 2 120 180 3

Province : FARYAB 1809015 GDWKI PAO 80 90 1809014 SARCHAKAN PAO 2 1809021 KOLIAN 70 90 2 PAO 80 1809 BELCHIRAGH 80 3 PAO BO 80 1806094 KHWAJA NAMOUSA PAO 3 1806053 MIAN DARA 80 60 2 PAO 80 70 1806074 ATA KHAN PAO 3 1806094 OATA DALA 85 ' 60 2 PAO 70 1806006 BANDAR -E -IMAM 90 2 LITRE 130 1808 LANGAR 120 3 PAO 100 1808 90 . 3 KHAWJA GOWHARI PAO 150 1808 ALMAR 180 2 PAO 130 150 1812 DARZAB LITRE 2 60 60 3

Province : JOWZJAN 1702021 TOOKZAR LITRE 140 200 1710 BAJA LITRE 3 1708 140 60 2 FAIZABAD LITRE 150 1703 BALKHAB (SUB -DISTT.) 130 3 LITRE 600 125 1711 KHAMYAB LITRE 3 1705 PASNIE 160 80 2 LITRE 280 1709 KHANAOA (SUB -DISTT.) 140 2 LITRE 120 100 1707 MARDIAN LITRE 3 1712 MENGAJEK 120 100 3 LITRE 120 60 1702024 CHAROO LITRE 3 1702050 OTOPOZ 140 200 3 LITRE 140 200 1702018 TABIR LITRE 3 125 125 3 Units of Measurement Availability 1 Pao = 0.438 Litre 1 Pao 1 = Not difficult = 0.438 Kg 2 = difficult 1 seer = 7 Kg 3 = very difficult 1 Bar = b Seer TABLE : 4Cc

BAZAAR LOCATION& PREVAILING PRICES OF PETROLIN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAME CODE Unit of Current Last Year Measure Price Avail - Price ability

Province : BADAKHSHAN 1112 KESHIM PAO 125 75 3 Province : FARYAB

1809015 GOWKI LITRE 1809014 SARCHAKAN 237 150 3 LITRE 237 1809021 KOLIAN 145 3 PAO 225 1809 BELCHIRAGH 200 3 PAO 225 180 1806094 KHUJA NAMOUSA PAO 3 1806053.MIAN DARA 175 100 3 PAO 150 120 1806074 ATA KHAN PAO 3 1806094 MATA OALA 160 100 3 LITRE 225 1806006 BANDAR -E-IMAM 200 3 LITRE 242 228 1808 KHAWJA GOWHARI PAO 2 260 312 1808 ALMAR PAO 3 1812 250 312 DARZAB LITRE 3 180 120 2 Province : JOWZJAN

1702021 TOOKZAR LITRE 1710 BAJA 400 7400 3 1708 LITRE 280 250 FAIZABAD LITRE 3 1711 250 200 KHAMYAB LITRE 3 1709 300 280 KHANAOA (SUB- DISTT.)LITRE 3 1707 300 250 MARDIAN LITRE 3 1712 MENGAJEK 300 250 3 1706 LITRE 260 200 AOCHA LITRE 3 1702024 CHAROO 300 200 3 LITRE 400 1702050 OTOPOZ 740 3 LITRE 400 740 1702018 TABIR LITRE 3 250 250 3

UnitsofMeasurement 1 Pao = Availability 0.438 Litre 1 = Not 1 Pao = 0.438 Kg difficult 1 seer = 7 Kg 2 = difficult 3 = very 1 Bar - 6 Seer difficult TABLE : 4Cd

BAZAAR LOCATION& PREVAILING PRICES OF FIREWOODIN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAME Unit of CODE Current Last Year Measure Price Avail - Price ability

Province : BADAKHSHAN 1112 KESHIM 1106 JURM BAR BOO BAR 400 1 1103 SHEHR- E- BOZARG 1000 600 1101 BAR 1000 1 YAFTAL -E- PAYEEN 800 2 1107 BAR 1000 BAHARAK BAR 500 2 1102 DISTRICT RAGH 1000 600 BAR 500 1 400 1 Province : JOWZJAN 1702021 TOOKZAR SEER 1710 BAJA 270 350 SEER 100 1 1708 FAIZABAD 60 1 1703 SEER 300 BALKHAB (SUB -DISTT.)40 Kg 300 2 1711 600 400 KHAMYAB SEER 2 1705 120 90 PASNIE 40 Kg 1 1709 500 450 KHANAQA (SUB -DISTT.)SEER 1 1707 200 200 MARDIAN ' 3 SEER 200 1712 MENGAJEK 200 2 1706 SEER 250 AQCHA SEER 200 2 1702024 250 CHAROO SEER 250 2 1702050OTOPOZ 270 350 SEER 270 1 1702018TABIR 350 1 SEER 100 100 1

Units of Measurement Availability 1 Pao = 0.438 Litre 1 Pao = 1 = Not difficult 0.438 Kg 2 = difficult 1 seer = 7 Kg 1 Bar = 6 Seer 3 = very difficult TABLE : 4Ce

BAZAAR LOCATION& PREVAILING PRICES OF COALIN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAM CODE Unit of Current Measure Last Year Avail - Price Price ability Province: JOWZJAN 1703 BALKHAB (SUB-DISTT.)40 Kg 1000 500 2

Units of Measureme 1 Pao = Availability 0.438 Litre 1 = Not difficult 1 Pao = 0.438 Kg 1 seer = 7 Kg 2 = difficult 1 Bar = 6 Seer 3 = very difficult TABLE : 4Cf

BAZAAR LOCATION& PREVAILING PRICES OFCHARCOAL IN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAME Unit of CODE Current Last Year Measure Price Avail - Price ability

Province : BADAKHSHAN 1102 DISTRICT RAGH 63 Kg 500 400 1 Province : JOWZJAN 1702021TOOKZAR 1710 SEER 1100 BAJA SEER 1200 3 1711 KHAMYAB 600 400 SEER 650 1 430 1

Units ofMeasurement 1 Pao = 0.438 Litre Availability 1 Pao = 0.438 Kg 1 = Not difficult 1 seer = 7 Kg 2 = difficult 1 Bar = 6 Seer 3 = verydifficult TABLE : 4Cg

BAZAAR LOCATION & PREVAILING PRICESOFDUNG IN BADAKHSHAN, JOWZJAN,FARYAB (In Afghanis) DIS /VIL BAZAAR NAME Unit of Current Last Year CODE Measure Avail - Price Price ability

Province : BADAKHSHAN 1112 KESHIM 63 Kg 600 1106 JURM 500 1 63 Kg 1000 1103 900 1 SHEHR-E-BOZARG 63 Kg 500 1101 500 1 YAFTAL-E-PAYEEN 63 Kg 1000 1107 BAHARAK 600 1 63 Kg 1000 800 1102 DISTRICT RAGH 63 Kg 1 1000 1000 1

Province : JOWZJAN 1702021TOOKZAR 50 Kg 600 1710 BAJA 600 1 40 Kg 500 1708 500 1 FAIZABAD 50 Kg 1000 1703 1000 1 BALKHAB (SUB-DISTT.)42 Kg 500 1711 400 1 KHAMYAB 50 Kg 500 1705 PASNIE 500 1 50 Kg 500 1709 350 1 KHANAQA (SUB-DISTI.)50 Kg 400 1707 MARDIAN 400 1 50 Kg 400 1712 400 1 MENGAJEK 40 Kg 600 1706 AQCHA 550 1 80 Kg 1000 1702024 1000 1 CHAROO 60 Kg 500 1702050OTOPOZ 500 1 60 Kg 500 500 1702018TABIR 60 Kg 1 500 500 1

Units of Measurement Availability 1 Pao = 0.438 Litre 1 =Not difficult 1 Pao = 0.438 Kg 2=difficult 1 seer= 7 Kg 3=very difficult 1 Bar - 6 Seer ANNEXE 5 Annexe 5 In order to draw a representative number of children between the ages of 1 and 5 years it was first necessary to estimate the population size of villages to be surveyed in the three provinces to be surveyed.

The number of household in a randomly selected village was obtained from the village elders and on the basis of existing demographic estimates for the rural areas of Afghanistan, it was assumed that a household would contain an average of 7 persons. The village population was therefore estimated as:

number of households X 7

The number of children between the ages of 1 and 5 w s r-ialruLitrc! as:- estimated population X19 percent

From the estimated population aged between 1 and 5 a numhc>r representing 5 percent of the total was identified as the required sample size for screening purposes. Table 5a in Annexe shows the combined population numbers for the districts visited. TABLE : 5A

POPULATION : BADAKHSHAN, JOWZJAN, FARYAB

DIST. NAME OF AREA CURRENT LAST YEAR DIFFER- * GAZETEERS/ CODE ENCE USAID FIGURE

Province : BADAKHSHAN

1101 FAIZABAD YAFTAL-E-PAYEEN 34345 36725 -2380 : 1101 FAIZABAD YAFTAL-E-BALA 58450 62790 -4340:--> 138801 1101 FAIZABAD DRAIM 34882 30082 -3200 : 1102 RAGH 84530 101430 -16900 66458 1103 SHAHR-E-BOZORG 60880 67960 -7080 29417 1105 KHWAHAN 7000 7600 -600 8527 1106 JURM 56800 58800 -2000 52623 1107 BAHARAK 21980 22405 -425 49227 1112 KISHIM 87807 96607 -8800 78171

Total 446674, 492399 -45725 423307

Province : JOWZJAN

1702 SANGCHARAK 231000 225456 5544 135233 1703 BALKHAB 35933 35071 862 29766; 1705 KOHISTAN 63210 61692 1518 45634* 1706 AOCHAH 49000 47823 1177 3360 1707 MURDIAN 59500 58072 1428 22014 1708 FAIZABAD 37893 36984 909 22196 1709 KHANAOA 103950 101455 2495 27037 1710 C7ARC7EEN 17149 16737 412 10481 1711 KHAMYAB 7980 7788 192 7844 1712 MENGAJEK 67760 64517 3243 30040

Total 673375 655595 17780 334405

Province : FARYAB

1806 PUSHTOONKOWT 180000 178200 1800 132635 1807 LOLASH 60000 59400 600 20160 1808 ALMAR 60000 59400 600 42296 1809 BELCHERAGH 85000 83150 1850 62956 1812 DARZAB 50000 49500 500 26306

Total 435000 429650 5350 284353

GRAND TOTAL 1555049 1577644 -22595 1042065

* USAID : USAID DEMOGRAPHIC DATA FOR RECONSTRUCTION & PLANNING GAZETEER: AFGHANISTAN IRRIGATION & INTERIOR MINISTRY TABLE : 58

POPULATION MOVEMENT : BADAKHSHAN, JOWZJAN, FARYAB

DIST.DISTRICT NAME THIS LAST PLACE CODE YEAR YEAR

Province : BADAKHSHAN

1101 YAFTAL-E-BALA 1800 580 LEFTFOR 1101 TAKHAR. KUNDUZ, BAGHLAN YAFTAL-E-PAYEEN 2800 1540 LEFTFOR TAKHAR, KUNDUZ, BAGHLAN 1101 DARAIM 500 2700 LEFTFOR TAKHAT, BAGHLAN, KUNDUZ 1102 RAGH 5700 11200 LEFTFOR 1103 TAKHAR, KUNDUZ, BAGHLAN SHAHR-E-BOZORG 4380 2700 LEFTFOR TAKHAR, KUNDUZ, BAGHLAN 1105 KHWAHAN 300 300 LEFTFOR 1106 TAKHAR, KUNDUZ JURM 0 1900 LEFTFOR PAKISTAN 1106 JURM 0 100 LEFTFOR TAKHAR, KUNDUZ, BAGHLAN 1107 BAHARAK 80 345 LEFTFOR 1112 TAKHAR. KUNDUZ, FAIZABAD KISHIM 3300 5500 LEFTFOR TAKHAR, KUNDUZ, BAGHLAN Total Left 18860 26865 Total Came 0 0

Province : JOWZJAN

1702 SANGCHARAK 15742 0 CAMEFROM SHEBERGHAN. SARI -E -PUL 1705 KOHISTAN 350 0 CAMEFROM 1706 AOCHA SHEBERGHAN, AOCHA, SARI -E -PU 1400 0 LEFTFOR NEIGHBOUR VILLAGES 1707 MURDIAN 3150 2400 CAMEFROM AOCHA, AOCHASHAMA, GOWKI 1710 OAROEEN 105 0 LEFTFOR 1711 KHAMYAB KHAMYAB 105 105 CAMEFROM OAROEEN 1712 MENGAJEK 762 0 CAMEFROM SHEBERGHAN. AOCHA Total Left 1505 0 Total Came 20109 2505

Province : FARYAB

1806 PUSHTOONKOWT O 2000 CAMEFROM 1806 BELCHERAGH, SHEREEN TAGHAB PUSHTOONKOWT O 500 LEFTFOR KOHISTAN 1807 LOLASH 0' 6000 CAMEFROM 1808 ALMAR ALMAR, MAIMANA O 1500 LEFTFOR MAIMANA, KOHIKHANA 1809 BELCHERAGH 3000 1000 CAMEFROM 1812 DARZAB SARI-E-HOUZ, GELEEM BAF 2000 0 CAMEFROM DOWLATABAD Total Left O 2000 Total Came 5000 9000 ANNEXE6 TABLE : 6A

STATUS OF ROADS IN BADAKHSHAN,JOWZJAN,FARYAB

Page No. 1 COMING FROM GOING TO MATERIAL ROAD SIZE CONDITION

Province : BADAKHSHAN

JURM SPOJMI DIRT TRUCK SPOJMI CAMPMADAN DIRT TRUCK DAMAGED JURM KHASH DIRT JEEP JURM BAHARAK DIRT TRUCK JURM KHUSTAK DIRT TRUCK JURM SARI HAWZ DIRT TRUCK JURM FARGAMONJ DIRT TRUCK FAIZABAD BAHARAK DIRT TRUCK BAHARAK SERGHILAN DIRT TRUCK DAMAGED BAHARAK SHIWA DIRT TRUCK DAMAGED BAHARAK ZEBAK-ESHKASHIM DIRT TRUCK BAHARAK JURM DIRT TRUCK TALOQAN FAIZABAD DIRT TRUCK DAMAGED KISHIM KARASDEH DIRT TRUCK FAIZABAD DARAIM DIRT TRUCK DAMAGED KISHIM TISHKAN DIRT TRUCK DAMAGED

Province : JOWZJAN

CENTRE OF JOWZJAN AQCHA PAVED TRUCK CENTRE OF JOWZJAN MAZAR-E-SHARIF PAVED TRUCK CENTRE OF JOWZJAN MUROIAN DIRT TRUCK DAMAGED CENTRE OF JOWZJAN MENGAJEK DIRT TRUCK DAMAGED CENTRE OF JOWZJAN FAIZABAD DIRT TRUCK DAMAGED CENTRE OF JOWZJAN QARQEEN DIRT TRUCK DAMAGED CENTRE OF JOWZJAN KHAMYAB DIRT TRUCK DAMAGED SANGCHARAK SHULGAR DIRT TRUCK DAMAGED SANGCHARAK MAZAR-E-SHRIF DIRT TRUCK DAMAGED SANGCHARAK AQCHA DIRT TRUCK DAMAGED SANGCHARAK BALKHAB DIRT TRUCK OBSTRUCTED SANGCHARAK SAR-I-PUL DIRT TRUCK MINED CENTRE OF SANGCHARAK CHAROO DIRT TRUCK DAMAGED CENTRE OF SANGCHARAK SAYAR DIRT TRUCK DAMAGED CENTRE OF SANGCHARAK SUZMAQALA DIRT TRUCK MINED CENTRE OF SANGCHARAK KARIZ DIRT TRUCK DAMAGED CENTRE OF SANGCHARAKAFGHANBAZ DIRT TRUCK DAMAGED CENTRE OF SANGCHARAK TOPKHANA DEHMORDA DIRT TRUCK DAMAGED BALKHAB SANGCHARAK DIRT TRUCK YAKAWOLONG BALKHAB DIRT TRUCK BALKHAB DARZAB DIRT TRUCK KOHISTAN SAR-I-PUL DIRT TRUCK DAMAGED KOHISTAN SANGCHARAK DIRT ANIMAL KOHISTAN FARYAB DIRT ANIMAL KOHISTAN BALKHAB DIRT ANIMAL CENTRE OF AQCHA BISHIREGH DIRT TRUCK DAMAGED CENTRE OF AQCHA SHERAK DIRT TRUCK DAMAGED CENTRE OF AQCHA ALAMLIK DIRT TRUCK DAMAGED CENTRE OF AQCHA SULTAN ARIQ DIRT TRUCK DAMAGED MURDIAN DOWLATABAD DIRT TRUCK DAMAGED MURDIAN AQCHA DIRT TRUCK DAMAGED MURDIAN QARQEEN DIRT TRIirw nPCTRUCTED TABLE : 6A

STATUS OF ROADS IN BADAKHSHAN,JOWZJAN,FARYAB Page No. 2

COMING FROM GOING TO MATERIAL ROAD SIZE CONDITION

MURDIAN MENGAJEK DIRT TRUCK DAMAGED CENTRE OF MURDIAN FAIZABAD DIRT TRUCK DAMAGED CENTRE OF MURDIAN ALAMLEK DIRT TRUCK DAMAGED CENTRE OF MURDIAN PARAQALA DIRT TRUCK DAMAGED FAIZABAD MURDIAN DIRT TRUCK DAMAGED FAIZABAD MENGAJEK DIRT TRUCK DAMAGED FAIZABAD SHIEKHABAD DIRT TRUCK DAMAGED FAIZABAD KUL DIRT TRUCK DAMAGED FAIZABAD MAZAR-E-SHARIF PAVED TRUCK FAIZABAD AQCHA PAVED TRUCK FAIZABAD SHEBERGHAN DIRT ANIMAL DAMAGED YANGI QALA CENTRE OF KHANAQA DIRT TRUCK DAMAGED YANGI QALA QURAPAIN DIRT TRUCK DAMAGED YANGI QALA BAISKAPA DIRT TRUCK DAMAGED YANGI QALA ALIELIWATANI DIRT TRUCK DAMAGED SHEBERGHAN KHANAQA DIRT TRUCK DAMAGED SHEBERGHAN AQCHA DIRT TRUCK DAMAGED SHEBERGHAN MENGAJEK DIRT TRUCK DAMAGED QARQEEN MAZAR-E-SHARIF DIRT TRUCK DAMAGED QARQEEN KHUMYAB DIRT TRUCK DAMAGED QARQEEN AQCHA DIRT TRUCK OBSTRUCTED QARQEEN MURDIAN DIRT ANIMAL OBSTRUCTED QARQEEN MENGAJEK DIRT ANIMAL OBSTRUCTED KHAMYAB MAZAR-E-SHARIF DIRT TRUCK DAMAGED KHAMYAB QARQEEN DIRT TRUCK DAMAGED KHAMYAB AQCHA DIRT TRUCK OBSTRUCTED KHAMYAB MURDIAN DIRT ANIMAL OBSTRUCTED KHAMYAB MENGAJEK DIRT ANIMAL OBSTRUCTED CENTRE OF MENGAJEK SOLIMAN DIRT TRUCK DAMAGED CENTRE OF MENGAJEK ARAB TAGHB DIRT TRUCK DAMAGED CENTRE OF MENGAJEK AMIGALI DIRT TRUCK DAMAGED CENTRE OF MENGAJEK MURDIAN DIRT TRUCK DAMAGED CENTRE OF MENGAJEK QARQEEN DIRT TRUCK DAMAGED CENTRE OF MENGAJEK AQCHA DIRT TRUCK DAMAGED CENTRE OF MENGAJEK KHANAQA DIRT TRUCK DAMAGED

Province : FARYAB

MAIMANA BANDAR -I -IMAM DIRT TRUCK DAMAGED BANDAR-I-IMAM SURHOUZ DIRT TRUCK DAMAGED SURHOUZ KOHISTAN DISTI DIRT TRUCK OBSTRUCTED BELCHERAGH MAIMANA DIRT TRUCK DAMAGED ALMAR BANDAR -I -IMAM DIRT TRUCK DAMAGED QATA QALA DAHUN DURA DIRT JEEP OBSTRUCTED MAIMANA LOLASH DIRT TRUCK DAMAGED GOWKI SURHOUZ DIRT ANIMAL SURHOUZ LOLASH DIRT TRUCK DAMAGED PUSHTOONKOT ALMAR GRAVEL JEEP MAIMANA ALMAR DIRT TRUCK MAIMANA QISAR DIRT TRUCK BELCHERAGH SURCHIQAN DIRT TRUCK BELCHERAGH QURCHI DIRT TRUCK TABLE : 6A

STATUS OF ROADS IN BADAKHSHAN,JOWZJAN,FARYAB Page No. 3 COMING FROM GOING TO MATERIAL ROAD SIZE CONDITION BELCHERAGH DARZAB DIRT TRUCK BELCHERAGH MAIMANA DIRT TRUCK CHERGHAN QURCHI DIRT QURCHI ANIMAL DARZAB DIRT TRUCK DARZAB CHERGHAN DIRT DARZAB TRUCK ANDKHOY DIRT JEEP O 0 0 0 0 C, 0 0 0 0 0 d 0 0 0 C. O O O O d O 0 0 d C. Ó O C. O O O C. O O c. C. 0 0 CÑ h Óíd-. O Ó t0 O Ó Ñ Ñ Ó p O O O p 0 C. Ñ N .ut-' .-. Ó Ó Ñ Oe. N .. Ñ C tiÑ.Oa t) N[.

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CODE DISTRICT BAZAARS ®ßi 1 1702 Sangcharak Tabir . ' 1702 Sangcharak r. . 1 ' Tuzkar . , 1 1702 Sangcharak Charoo 1 \\ ouOwu` / 1702 Sangcharak Otopaz 1 1703 Balkhab Balkhab ...w,\ .\^ ; 1705 Kuhestanat ,;-^^. ^\ Pas Ni 1708 k^'. '..ne ...+° Aqchah Agchah `\ 1 1707 Mardian Jangale Aregh 1708 Feyzabad Feyzabed 11 1709 : i Khanaqa Khanaqa 1 . sr10. 1710 Qarqin Qarqin 1711 Khaoyab Khaoyab ¡ / .+1>.._. .+ ..1.+.'` /. 1712 Hangah Jek 1 Qaghan , :...... Ei CODE DISTRICT HEALTH CLINICS t0.r..1.1 1702 Sangcharak Tebir 1702 Sangcharak Sangoharak 1702 Sangcharak Dol+tao Doaba 1702 Sangcharak Dara Gosphandi ... 1703 0 10 krn Bplkhab Tarkhaj \ 50 am 1703 a Balkhab Hit Syed Murad ^ `\, tom 14.4 . 1703 Balkhab Dara Nazar 2ierat 1705 Kohistan Pea NS .../ 1708 Agchah Nanif Ibn Qaíe `\ 1707 Mardyan Jungle Aregh w 1708 Feyzabad ff Feyzabad . 1 27 . 1709 Khanaga Centre Front Sadaat 1 BAAiYAN 28 1709 Ahaneqa Ahanaga t 1710 Qarqin Qarqin 1712 Hangeh Jek Taghan

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Prorvtce and tads: F

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R 37 00 Y BAZAARS. & HEALTH mLINIC HAP C

1 A PROVINCE FARYAB ,of b.za, B CODE DISTRICT BAZAARS 1806 Pashtunkowt Hiandara 1806 Pushtunkowt Ata Khan Khwaja 18 1806 Pushtunkowt Kata Qala 1)amoosi 1806 Pushtunkowt Kata Qala 1806 Pushtunkowt Bandare Imam 1808 Almar Almar C.a.asS.,I 1808 Almar Langar 1808 Almar Khwajeh Gowhar 1809 Balcheragh Belcheragh 1809 Belcheragh Gawki 1809 Belcheragh Sarchakan 1809 Belcheragh Kowlian 1812 Darzab Darzab

CODE DISTRICT HEALTH CLINICS R 1806 Pashtun Kowt Bandare Imam 1806 Pashtun Kowt Jaba Jamshedi 1806 Pashtun Kowt Dahan Dara 1607 Kohestan Dr Saadat 1807 Kohestan Qadghakh 1808 Almar Almar 1809 Belcheragh Gowki 1809 Balcheragh Sarchakan 1812 Darzab Dr Saeed

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inon l... YaY Auaaa n Lenin; Ninal. C.nv. l., Da.,., N.aman 1111 S., a. Wp.,.Jbpae 0t\1.1.9 (1a1 1G2 oPP') 35 30 _ 1254 o AC0 pal. Ceo. J 1,I11klC1 - . aS1.fl.CS .,GS .1110005. _ BA 'GUIS 19 i°' `\_/N / o!D.t 1 ..... IViDW '17-'05) i.l _ tu-nan. Wal .«I o._i \\ \ 11 IF .lennalm. e n am IN. md- I P10'.. Sawavo Loon... FB /l07 70 +DCNS 0 l.m 50 kmI e0Cnall Dorat I 1 / ' b ` 1 JP;(YSDW'17-'15) i 1 T.w wl.eal t , D.vkt. 1 \ e / 1 .1. / KS0oPJ'7).nda I I L / AID. 1P. 'IS) 1 f".1 :inrtC2. P.«,and {\1 ..apyc.a.n..,. CHOR 27 1/\.. _/ (CSD. 00w 1S req I ANNEXE 8 ANNEXE N.

The accompanying maps of Badakhshan, Jowzjan and Faryab, visually display the level of malnutrition by district. Each map displays the level of malnutrition in each district surveyed in the provinces under study. Maps 1 and 2 show the areas marked according to comparisons with the "normal" nutritional state. Four classifications are made as follows:- 1) Below 35% of children measured considered normally nourished. 2) Between 35% and 50% of children measured considered normally nourished 3) Between 50% and 60% of children measured considered normally nourished 4) More than 60% of children measured considered normally normally nourished.

Maps 3 and 4 show the areas marked according to recorded levels of severe malnutrition. Four classifications are also made here as follows:- 1) 35% or more children measured, considered severely malnourished 2) Between 25% and 35% of children measured considered severely malnourished. 3) Between 15% and 25% of children measured considered severely malnourished. 4) Less than 15% of children measured considered severely malnourished.

It should be noted that low numbers of normally nourished children is not necessarily a reflection of high numbers of severely malnourished children. These two sets of maps should hence be seen in conjunction rather than in isolation. Tables 2f in the Annexe show the data more fully BYMALNUTRITION DISTRICT LEVELS BADAKHSHAN(BY DISTRICT) 1101 FAYZABAD KEY BELOW 35% NORMAL 110311051104 1102SHAHR-E KHWAHAN DARWAZRAGH BOZORG 1106 JURM . 50%35% - 80% - 50% NORMAL NORMAL 1110110911081107 ZEBAK BAHARAKKERANESHKASHEM VA MENJAN ABOVE 601E NORMAL MAP 1 111311121111 WAKHAN KESHEMSHEGHNAN (KHANDUD) 1804180318021801 KHAN-EQORGHAN MEYMANEHANDKHVOY CHAR BAGH FARYAB JOWZJAN 18091808180718061805 BELCHERAGHALMAR KOHESTANPASHTOONQARAMOOL KOWT 170317021701 BALKHAB SANG SHEBERGHAN CHARAK 1813181218111810 DOWLATABADDARZAB QEYSARSHIRIN TAGAB 1708170717061705 1704FEYZABAD MORDJAN KUHESTANATAQCHAH SAR -E POL 1712171117101709 KHAMYABMANGAN QUARQIN KHANAQUA KEY JEK 35%BELOW - 507E 35% NORMAL NORMAL BYMALNUTRITION DISTRICT LEVELS MAP 2 ABOVE50% - 50% 60% NORMAL NORMAL BYMALNUTRITION DISTRICT LEVELS BADAKHSHAN(BY DISTRICT)

KEY 11031105110411021101 SHAHR-E KH RAGHDARWAZ WAHAN BOZORG FAYZABAD . " 11101109110811071106 ZEBAK ESHKASHEM JURMKERANBAHARAK ' VA MENJAN . UNDER 15% SEVERE- 25% SEVERE MAP 3 111311121111 KESHEMSHEGHNANWAKHAN (KHANDUD) 18021801 MEYMANEHANDKHVOY JOWZJAN 18071806180518041803 KOHESTANPASHTOONQARAMQOLQORGHANKHAN-E CHAR KOWT BAGH 17021701 SHEBERGHANSANG CHARAK 18121810180918081811 DARZAB QEYSAR SHIRINBELCHERAGHALMAR TAGAB 17071706170517041703 MORDJAN KUHESTANATAQCHAH BALKHABSAR -E POL 1813 DOWLATABAD 17121711171017091708 KHAMYAB MANGAR QUARQIN KHANAQUAFEYZABAD JEK KEY 25% - 35% SERE UNDER 15% SEVERE- 25% SEVERE MAP 4 BYMALNUTRITION DISTRICT LEVEL! Table (a)

Provincial and District Ranking of Malnutrition Levels in Badakhshan, Joujan and Faryab.

District Score Provincial

NAME NUMBER NORMAL MODERATE SEVERE M + 2S Rant: Score

N M S

BADAKHSHAN FAY/ABAD 1101 48 29 24 76 13

BADAKHSHAN RASH 1102 39 27 35 96 4

BADAKHSHAN SHAR-E-13070R6 1103 36 39 25 89 6

BADAKHSHAN KHWAHAN 1105 30 35 35 105 1

BADAI:HSHAN JURM ' 1106 43 15 22 79 12

BADAK.HSHAN BAHARAK 1107 28 39 33 105 1

BADAKHSHAN KERAN VA MENJAN 1108 32 52 17 85 8

BADAK:HSHAN K1SH1M 1112 42 34 24 82 9 89.625

JO411JAN SANSCHARAK 1702 65 20 15 50 22

JDWiJAN BALKHAB 1703 53 24 23 70 14 JOWiJAN KOH1STANAT 1705 49 22 29 BO 10

JOWIJAN AOCHA 1706 38 33 29 91 5

JOWIJAN MURDIAN 1707 47 17 36 89 6

JOWZJAN FEYZABAD 1708 60 21 20 60 - 19

JOWIJAN KHANAOA 1709 33 35 31 98 3

JOWZJAN OAROEEN 1710 67 13 20 53 21

JOWZJAN KHAMYAB 1711 65 20 14 49 23

JOWIJAN MENGAJEK 1712 55 23 22 67 16 70.7

FARYAB PUSHTOONKOWT 1806 55 23 22 67 16 FARYAB KOH1STAN 1807 55 21 24 69 15 FARYAB ALMAR 1808 56 24 20 64 18 FARYAB BELCHERAGH 1809 48 23 28 BO 10

FARYAB DAR/AB 1812 61 19 20 59 20 17.8

M + 2S = X of Moderately Malnourished Children, + 2 x X of Severely Malnourished Children = District malnutrition score

Rank = Rank cf District Scores

Provincial Score = Average District Score over Province