Public health nutrition in Afghanistan-policies, strategies and capacity-building: current scenario and initiatives

Background: Afghanistan is grappling with high burden of malnutrition in women and children and a rising burden of noncommunicable diseases. Aims: A narrative review was conducted with the aim of mapping current nutrition policies and capacity development initiatives to assess policy and the institutional environment and identify gaps and opportunities. Methods: A comprehensive, broad based search was conducted, including databases and websites and policy and programme documents. Results: The policy focuses on multisectoral efforts to address nutrition challenges; however; implementation of nutrition-specific and nutrition-sensitive interventions is not delivered uniformly at the community level due to continued conflic situations and geographic inaccessibility, lack of availability of trained human resources and weak institutions. There is limited evidence on the effectiveness of nutrition programmes in Afghanistan. Limited policy provisions are available to address nutrition issues due to the rising burden of noncommunicable diseases, urbanization and changing dietary patterns. The shortage of skilled nutritional professionals is a critical issue. Lack of institutional capacity, educational standards and accreditation mechanism poses major challenges. Ongoing training programmes are fragmented and fail to meet the requirements of a professional nutrition workforce. Conclusion: The findings highlight that well-structured policies and strategies focusing on maternal and child nutrition provide an enabling policy environment to scale up nutrition interventions. Evidence on the implementation of programmes is needed to aid policy recommendations. The lack of an institutional mechanism for professional nutrition education highlights the great need for action in Afghanistan for public health nutrition and education.

Association between household air pollution and neonatal mortality: an analysis of Annual Health Survey results, India

Background: In India, household air pollution (HAP) is one of the leading riskfactors contributing to the national burden of disease. Estimates indicate that 7.6%of all deaths in children aged under 5 years in the country can be attributed to HAP.This analysis attempts to establish the association between HAP and neonatalmortality rate (NMR).Methods: Secondary data from the Annual Health Survey, conducted in 284districts of nine large states covering 1 404 337 live births, were analysed. Thesurvey was carried out from July 2010 to March 2011 (reference period: January2007 to December 2009). The primary outcome was NMR. The key exposurewas the use of firewood/crop residues/cow dung as fuel. The covariates were:sociodemographic factors (place of residence, literacy status of mothers,proportion of women aged less than 18 years who were married, wealth index);health-system factors (three or more antenatal care visits made during pregnancy;institutional deliveries; proportion of neonates with a stay in the institution forless than 24 h; percentage of neonates who received a check-up within 24 h ofbirth); and behavioural factors (initiation of breast feeding within 1 h). Descriptiveanalysis, with district as the unit of analysis, was performed for rural and urbanareas. Bivariate and multivariable linear regression analysis was carried out toinvestigate the association between HAP and NMR.Results: The mean rural NMR was 42.4/1000 live births (standard deviation [SD]= 11.4/1000) and urban NMR was 33.1/1000 live births (SD=12.6/1000). Theproportion of households with HAP was 92.2% in rural areas, compared to 40.8%in urban areas, and the difference was statistically significant (P < 0.001). HAPwas found to be strongly associated with NMR after adjustment (β = 0.22; 95%confidence interval [CI] = 0.09 to 0.35) for urban and rural areas combined. Forrural areas separately, the association was significant (β = 0.30; 95% CI = 0.13 to0.45) after adjustment. In univariable analysis, the analysis showed a significantassociation in urban areas (β = 0.23; 95% CI = 0.12 to 2.34) but failed to demonstratean association in multivariable analysis (β = 0.001; 95% CI = –0.15 to 0.15).Conclusion: Secondary data from district level indicate that HAP is associatedwith NMR in rural areas, but not in urban areas in India.