Improving nutrition in Afghanistan through a community-based growth monitoring and promotion programme: A pre–post evaluation in five districts

Abstract

In Afghanistan, malnutrition in children less than 60 months of age remains high despite nutritional services being offered in health facilities since 2003. Afghanistan's Ministry of Public Health solicited extensive community consultation to develop pictorial community-based growth monitoring and promotion (cGMP) tools to help illiterate community health workers (CHWs) provide nutritional assessment and counselling. The planned evaluation in the five districts where cGMP was implemented demonstrated that a mean weight-for-age (WFA) Z-score of 414 participant children was 0.3 Z-scores higher than that of matched non-participants who lived outside of cGMP programme catchment areas. The mean change in WFA Z-scores at evaluation was 0.3 (95% CI 0.3, 0.4) Z-scores higher than at entry into the programme. The most influential factor on WFA Z-score changes in participants was initial WFA Z-score. Those with an initial WFA Z-score of less than −2 experienced a mean increase of 0.33 (95% CI 0.29, 0.38) WFA Z-scores per session attended, while those with a baseline WFA Z-score of greater than zero showed a decrease of 0.19 (95% CI 0.22, 0.15) WFA Z-scores per session attended. These results are encouraging since they demonstrate that the cGMP programme in Afghanistan for illiterate women has some potential to contribute to improving nutrition, specifically in underweight children of either sex who enter the programme at less than nine months of age and attend 50% or more sessions.

Pakistan’s Community-based Lady Health Workers (LHWs): Change Agents for Child Health?

“…Households' knowledge and practices for exclusive breastfeeding and weaning were recorded to be poor. Findings from other countries such as Nepal, Mali, and Afghanistan show much higher rates of growth monitoring as well as higher rates in correctly performing growth monitoring (Amano et al, 2014;Mayhew et al, 2014;Alvarez Morán et al, 2018). The third finding from our study relates to LHWs delivery on preparing households for early detection, management and referral of child illness, as well as hygiene counseling for mothers.…”

Overview of community health worker programmes in Afghanistan, Egypt, and Pakistan

“…All three of the programmes reviewed have effected positive change in their respective countries, and have advanced women's engagement in local communities. While not reviewed in this paper, many measurable determinants of health outcomes have been improved through these programmes, such as improved maternal and fetal health outcomes (23)(24)(25)(26), increased reproductive health uptake and education (27)(28)(29), communicable disease control (30,31), and positive impacts on nutrition (32,33). Our goal was to identify strengths and weakness of the CHW programmes in the WHO Eastern Mediterranean Region in order to improve them in the future.…”

Multisector nutrition gains amidst evidence scarcity: scoping review of policies, data and interventions to reduce child stunting in Afghanistan

“…Nutrition awareness is often promoted through campaigns on different topics such as breastfeeding, hygiene, growth monitoring and complementary feeding at group education sessions [63,71,81], training for women and households participating in kitchen gardens and select agriculture activities [81], and other targeted projects. These tend to be topic and agenda specific by project.…”