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 produc- tion 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 survey- ors' 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 them- selves, 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. 4 8. 8 8 4 ,*; : 1 I 1 i I '... 'i I,. ! , 1 1 1 a , z . 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II.1 r I .c. :e1I1-1 tit ':"i1101111r 1.11I-416%170:1 inn' 11 :illLI 'R i, e " - , 4-rim 8 3 '.1dP.' --it_AlAtiita,. f 01/111114111M41411101.11 ti 8 .1111,11r4Ei 7 4 II 1 Ling2161164111111111WrilipPWR 101.439 1112011111tE I -2888: fli; 414114 i! ti 11 Ii 1 I .. 4.1101ThilKINLA 5 st hhl . I\ L:t.r; :n12 7.11111ibelfl 1E; .. ., I ¡P. 4-7.31.11 :8 ''''2 I I 1 ash....4tal'iMiligiMEI IIMIIM.11/0" N V 2I 1 i Î t :th ill aiTi1.4 1 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 nutri- tional 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 signifi- cant 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 relat- ed 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.