Afghanistan National Nutrition Surveillance System Bulletin · Canada (GAC), the project seeks to...
Transcript of Afghanistan National Nutrition Surveillance System Bulletin · Canada (GAC), the project seeks to...
Ministry of Public Health
General Directorate of Preventive Medicine
Public Nutrition Department
AUGUST 2016
ISSUE 5
Afghanistan National Nutrition
Surveillance System Bulletin
In March 2013 the Ministry of Public Health,
WHO and UNICEF began operationalizing a
sentinel site-based national nutrition surveillance
system (NNSS) in Afghanistan in coordination
and partnership with the Basic Package of Health
Services (BPHS) and the Essential Package of
Hospital Services (EPHS) implementers and other
service providers. Funded by the Global Affairs
Canada (GAC), the project seeks to establish a
sentinel site-based nutrition surveillance system
that covers all 34 provinces of the country. A well
-functioning nutrition surveillance system pro-
vides timely and reliable information which helps
the government and partners to effectively plan
and implement maternal, neonatal and child
health and nutrition programs. Ultimately, the
system seeks to increase access to equitable and
gender-sensitive health and nutrition services to
mothers and children, while ensuring that their
health needs are met and vulnerabilities reduced.
Key NNSS Objectives and Expected Outcomes:
Progress to date:
175 facility-based senti-
nel sites and 953 com-
munity-based sentinel
sites selected in all 34
provinces
34 provinces are re-
porting from health
facility sentinel sites
21 provinces are re-
porting from 102 health
facilities and 408 com-
munity sentinel sites
NNSS has been expand-
ed to all 34 provinces
Background:
Objective >>>
To establish a unified
nutrition surveillance
system composed of
sentinel sites and sur-
veys for timely action.
408 NNSS community sentinel sites are reporting
174 NNSS health facility sentinel sites are reporting
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PAGE 2 ISSUE 5 AFGHANISTAN NATIONAL NUTRITION SURVEILLANCE SYSTEM BULLETIN
1. Anthropometric Analysis Results (analyzed using ENA database and WHO-flags)
General Analysis of Key Indicators –GAM,
SAM and Underweight
All anthropometric indicators were high com-
pared to WHO thresholds.
Global Acute Malnutrition (GAM) proportion were
Q2-21%, Q3-26.9% Q4-21.1%, Q 1, 2016-20.2% and
Q2, 2016-21%
Severe Acute Malnutrition (SAM) proportion was
9.6% in Q2-2015, and 8.4% in Q2 2016.
Underweight Proportion was reported at Q2-37.6%,
Q3-45.1% and Q4-40.2%, Q1,2016-40.7% and
Q2,2016-41.9%
The Afghanistan National Sentinel based Nutrition surveillance system has con-
tinued to collect data from 174 health facilities and 408 community sites. Commu-
nity reporting have slightly improved with a total of 21 provinces reporting in
quarter 2, up from 17 provinces in quarter 2 in 2016. Efforts to improve the quali-
ty of data have continued, including joint support visits to sentinel sites and intro-
ducing data quality assurance processes for the team. The general trends from
health facility and community data show consistent malnutrition levels, implying
possible high levels of acute and malnutrition levels in the population that need
further investigation through in-depth surveys. Generally the results were show-
ing similar trends to those of quarter 2 in 2015.
Results from Health Facility-based Data:
Overview of the Health and Community-based Nutrition Surveillance System
Photo
21
26.9
21.1 20.221
9.6 12.98.8 8
8.4
37.6 45.140.2 40.7
41.9
0
5
10
15
20
25
30
35
40
45
50
Q2,2015 Q3,2015 Q4,2015 Q1,2016 Q2,2016
Malnutrition Indicators
GAM % SAM% Underweight (%)
Child receiving treatment at a therapeutic feeding unit in Bamyan Provincial Hospital. Photo: MoPH/
B. Qureshi
PAGE 3 ISSUE 5 AFGHANISTAN NATIONAL NUTRITION SURVEILLANCE SYSTEM BULLETIN
Anthropometric results - National health-facility data:
Wasting in children is an indicator of acute malnutrition.
GAM levels for 2015 and 2016 were consistently in the
“emergency levels” (above 15%) which increases the risk
of death for children. Severe acute malnutrition was con-
sistently above emergency levels (above 2%) during the
last five quarters.
SAM levels were lower in the 2nd quarter of 2016. (8.4%)
as compared to the last year same quarter (Q2,2016) .
Underweight:
Underweight in children indicates acute weight loss, stunt-
ing, or both. The underweight levels for 2015 and 2016
were consistently in the “very high prevalence” levels
(above 30%). Children who suffer from underweight are
at greater risk of death.
Key Successes:
174 health facility sentinel sites (99.4%) from 34 provinces have reported in the 2nd
quarter of 2016
408 community sentinel sites (46%) from 21 provinces reported during the 2nd quar-
ter 2016
Four quarterly nutrition surveillance bulletins released and disseminated to date
NNSS data used in informing in-depth study of Herat province
NNSS data used as a
source in justification
of mobilizing resources for CHF funding
NNSS data analyzed on provincial level and the results
are shared with the stakeholders
Photo
21
26.9
21.120.2 21
9.612.9
8.88 8.4
0
10
20
30
Q2,2015 Q3,2015 Q4,2015 Q1,2016 Q2,2016
National GAM and SAM Trends 2015-2016
GAM % SAM%
37.6
45.1
40.2
40.741.9
32
34
36
38
40
42
44
46
Q2,2015 Q3,2015 Q4,2015 Q1,2016 Q2,2016
National Underweight trends 2015-16
Underweight (%)
A child is examined at a health facility sentinel site in Nuristan province. Photo: MOPH/Dr. Amin
MUAC measurement in Daikundi. Photo: MOPH/Dr. Noor
A child is treated for malnutrition at a therapeutic feeding unit in Parwan. Photo: WHO/S.Ramo
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN
PAGE 4 ISSUE 5
Regional Comparison of GAM and SAM Levels
The Southern Region reported the highest level of GAM (25.5%) during 2nd Q, 2016 as well, whilst the lowest level was reported in
the Northern Region (16.4%) this quarter as well. The Western, Northern and Southern Regions showed decline in GAM proportion
during 2nd quarter 2016 as compared to the first quarter 2016, whilst the Eastern and Central Regions showed an increased level of
GAM during 2nd quarter of 2016 as compared to the first quarter 2016.
The Southern Region reported the highest level of SAM (13..7%) during 2nd Q, 2016 as well, whilst the lowest level was reported
from the Northern Region (6.2%) this quarter . The Western Region showed a decline in SAM proportion during 2nd quarter 2016 as
compared to the first quarter 2016, whilst all other regions showed an increased level of GAM during 2nd quarter 2016 as compared
to the first quarter 2016. Efforts have been made to ensure complementarity of nutrition information systems where the health and
community-based system informs areas for in-depth surveys.
1526 STAFF FROM HEALTH FACILITIES AND 2613
STAFF FROM COMMUNITY-BASED SENTINEL
SITES, INCLUDING 2446 COMMUNITY HEALTH
WORKERS AND 167 COMMUNITY HEALTH
SUPERVISORS HAVE BEEN TRAINED ON THE
NUTRITION SURVEILLANCE SYSTEM TO DATE
Photo
Photo
Monitoring visit to sentinel site at Daikundi district hospital. Photo: MOPH/Dr. Noor
On-the-job training at a health facility sentinel site at Meramor District Hospital focusing on ante-natal and delivery data regis-
tration. Photo: MOPH/Dr. Noor
Refresher training for health facility sentinel site staff at the Nangarhar provincial hospital Photo: MOPH/Dr. Amin
Regional Analysis of NNSS
The results for provinces in the Western, Central, South-
ern, Eastern and Northern Regions have been reported by
health facility sentinel sites during the first and second
quarter of 2016. The results included GAM, SAM and un-
derweight levels. The provincial and regional analysis start-
ed last quarter and the results of the mentioned indicators
have been compared with the 1st quarter of 2016. Reports
were received from health facilities in all provinces during
this quarter.
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN PAGE 5 ISSUE 5
27 26.9
11
32
22.729.3
11.5
28.3
Hirat Badghis Farah Ghor
GAM % West Region
Q1,2016 Q2,2016
14.2
8.9
5
16.5
12.610.9
5.1
11.4
Hirat Badghis Farah Ghor
SAM % West Region
Q1,2016 Q2,2016
35.5 37.4
22
59.1
41.848.4 44.4
57.4
Hirat Badghis Farah Ghor
Underweight % West Region
Q1,2016 Q2,2016
16.411.9
20.4 20.2
33.6
14.3 15.419.4
Nangarhar Kunar Laghman Nuristan
GAM % East Region
Q1,2016 Q2,2016
4.93.1 3.5
7.8
14.6
4.4 4.77.3
Nangarhar Kunar Laghman Nuristan
SAM% East Region
Q1,2016 Q2,2016
36.1 37.1 32.9
51.157.5
40.1
23.5
40.5
Nangarhar Kunar Laghman Nuristan
Underweight % E.Region
Q1,2016 Q2,2016
Photo
Anthropometric measurement at a health facility sentinel site in Nuristan. Photo: MOPH/Dr. Amin
PAGE 6 ISSUE 5 AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN
8.6 8.1
11.414
23
10.9
24.4
0
31.5
12.4
20.2
16.113.3
8.5
12.7 13.4
16.9
34.1
GAM % North Region
Q1,2016 Q2,2016
3.9
1.7
7.7
3.5
6.14.8
3.7
13
4.3
7.2 7.6
4.5 4.73.8 3.6
8.1
12.2
SAM % N-Region
Q1,2016 Q2,2016
12.6
3.5
13
30.936
20.524.1
0
27.8
19.5
31.138.8
24.6
16
2719.3 20.5
49.3
Underweight % N-Region
Q1,2016 Q2,2016
17.9 18.9
30.1 3234.1
21.618.2
22.626.9
38.3
Kandahar Urozgan Nimroz Helmand Zabul
GAM % South Region
Q1,2016 Q2,2016
7.6 8
18.316.2
14.711.3
9.58
12
27.5
Kandahar Urozgan Nimroz Helmand Zabul
SAM% S-Region
Q1,2016 Q2,2016
54 56.1
39
73.281.1
53.8 60
31.5
71.9 66.9
Kandahar Urozgan Nimroz Helmand Zabul
Underweight % S-Region
Q1,2016 Q2,2016
Photo
Photo
MUAC measurement at a community site in Bamyan. Surveillance recording tools at a health facility sentinel site in Bamyan. Photos: MOPH/Dr. Noor
Acute Malnutrition (Community-based data):
The results below were from community-based sentinel sites (HPs) which were reported from 21 provinces. During the first and second quarters of 2016, GAM was reported at 29.7%, 31.1% and SAM at 8.4% and 10%, respectively. Both GAM % and SAM% have increased compared to the first quarter of 2016.
PAGE 7 ISSUE 5 AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN
11.3
17.919.4 19
23.519.7
29.8
3.1
18.120.9 22
37.5
28.5
16.2
20.117.2
24.5
20.9
31.4
21.7
16.6
23.320.2
37.8
GAM % Central-RegionQ1,2016 Q2,2016
6.3 5.9 6.55.1
7.7 7.8
13.8
0.8
5.5 6.1
9.2
18.8
12.9
4.22.3
6.3
8.2
8.2
11 10.5
7 7.96.6
18.2
SAM % C-Region
Q1,2016 Q2,2016
43.1
27.2
54.738.7
38.344.1
52.6
3.5
43.7
34
48.9
29.437.6 37.1
65.4
40.141.6
30.4
49
28.2 32.8
38.3
64.9
47.7
Underweight % C-Region
Q1,2016 Q2,2016
29.7
8.4
31.1
10
GAM % SAM%
GAM & SAM Levels (MUAC)
Q1,2016 Q2,2016
Photo
Visit of community surveillance site in Samangan
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN PAGE 8 ISSUE 5
Infant and Young Child Feeding (IYCF) Good IYCF practices play an important role in preventing
acute malnutrition
Early initiation of breastfeeding decreases neonatal mortal-ity
55% of infants received breast milk within one hour of birth
89% of infants were exclusively breastfed during their first six months of life
Proper complementary feeding (introduction of complementary foods at 6 months, minimum meal frequency and minimum dietary diversity) is still at a low level at 20%.
92% of assessed children under the age of 2 years were breastfed
Results related to IYCF INDICATORS (National Level) Q2,2015 Q2,2016
Total number of assessed children 8,958 24,533
Currently Breastfed
% of <2 children with continued breast feeding 89% 92%
Early initiation
of BF
Early. BF at <=1 hour (%) 54% 55%
Early. BF at 1 to < 24 hour (%) 44% 45%
Early. BF at >24 hour (%) 2% 0%
Exclusive BF Exclusive BF 0-5 m (%) 83% 89%
Complementary feeding
Proper Comp. Feeding (%) 16% 20%
Photo
Anthropometric measurement at a Daikundi district hospital. Photo: MOPH/Dr. Noor
AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN ISSUE 5
Birth Outcomes
Low Birth Weight:
The proportion of babies born with low birth weight was at 6% during the 2nd quarter of 2016. Low birth weight (< 2500 gr) is an important factor affecting neonatal mortality and a significant determinant of post neonatal mortality. Low birth weight infants who survive are at an increased risk of health problems ranging from neuro-developmental disabilities to respiratory disorders.
Neural Tube Defects (NTD):
The NTD rate per 10,000 births was 10 during the 2nd quarter of 2016 . NTDs (Anencephaly, Spina Bifida and encepha-
locel) have a strong association with folic acid deficiency.
PAGE 9
Result of indicators related to birth Outcome Q2, 2015 Q2, 2016
Number of assessed children 20,115 53,980
Sex
Total Male 10,785 28,636
Total Female 9,330 25,344
Male/Female Ratio 1.15 1.12
Birth weight
Stillbirths per 1,000 births (Birth Status) 9 14
Mean weight (gr) 3,239 3,244
Percentage of birth weight less than 2500 gr 4% 6%
Percentage of birth weight between 2500 - 4000 gr 92% 89%
Percentage of birth weight more than 4000 gr 4% 5%
Neural Tube Defect (NTD)
Prevalence of NTD per 10,000 births 12 10
Photo
Photo
Weighing scale at a delivery room in Samangan A child is brought in for growth monitoring at a health facility in Daikundi Photo: MoPH/Noor
Results of Hemoglobin Levels in Pregnant Women
The proportion of pregnant women with hemoglobin level < 11 gr/dl was 26% in the 2nd quarter 2016.
The proportion of women with Hb<11 gdl (have pregnancy age =< 12 weeks) was reported 26% in the 2nd
quarter
The proportion of women with Hb<11 gdl in the second and third trimesters was 26% and 28%, respectively
CONTACT:
Dr. M. Homayoun Ludin Acting Director of Public Nutrition Department, MoPH Email: [email protected] Mobile: 0093 700 604 649
Dr. Abdul Baseer Qureshi National Nutrition Surveillance Consultant, PND, MoPH Email: [email protected] Mobile: 0093 786 56 1156
Web:
http://nutritionmoph.gov.af
Facebook:
Ministry of Public Health
Afghanistan
PAGE 10 AFGHANISTAN NUTRITION SURVEILLANCE SYSTEM BULLETIN ISSUE 5
Anaemia:
A low hemoglobin (Hb) level is an indication of anaemia. The anaemia levels of 26% for 2nd quarter of 2016 were con-
sistently in the “moderate” levels (≥20% - <40%),. Anaemia is associated with increased risks of maternal and child mor-
tality.
Results of hemoglobin levels in pregnant women during first antenatal care (ANC) visit
Q2-2015 Q2-2016
Total assessment 7,747 32,499
Hb level
Percentage of pregnant women with Hb level < 11 gr/dl 40% 26%
Percentage of pregnant women (have pregnancy age =< 12 weeks) with Hb level < 11 gr/dl
41% 22%
Percentage of pregnant women (have pregnancy age 12 to < 24 weeks) with Hb level < 11 gr/dl
41% 26%
Percentage of pregnant women (have pregnancy age >24 weeks) with Hb level < 11 gr/dl
40% 28%