Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan: An observational study

Nadia Akseer, Zaid Bhatti, Taufiq Mashal, Sajid Soofi, Rahim Moineddin, Robert E Black, Zulfiqar A. Bhutta

Research output: Contribution to journalArticle

Abstract

Background: Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan. Methods: The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother-child pairs using Bayesian spatial and generalised least squares regression models accounting for the complex survey design. Findings: We noted that childhood stunting, underweight, and combined stunting and wasting were consistently highest in districts in Farah, Nangarhar, Nuristan, Kunar, Paktia, and Badakhshan provinces. District prevalence ranged from 4% to 84% for childhood stunting and 5% to 66% for underweight. Child wasting exceeded 20% in central and high-conflict regions that bordered Pakistan including east, southeast, and south. Among mothers, dual burden of underweight and overweight or obesity existed in districts of north, northeast, central, and central highlands (prevalence of 15-20%). Linear growth and weight of children were independently associated with household wealth, maternal literacy, maternal anthropometry, child age, food security, geography, and improved hygiene and sanitation conditions. The mother's body-mass index was determined by many of the same factors, in addition to ethnolinguistic status and parity. Younger mothers (<20 years old) were more underweight and shorter than older mothers (aged 20-49 years). Interpretation: Afghanistan's rapidly changing political, socioeconomic, and insecurity landscape has both direct and indirect implications on population nutrition. Novel evidence from our study can be used to understand these multifactorial determinants and to identify granular disparities for local level tracking, planning, and implementation of nutritional interventions. Funding: None.

Original languageEnglish (US)
JournalThe Lancet Global Health
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Afghanistan
Nutritional Status
Observational Studies
Thinness
Growth Disorders
Mothers
Anthropometry
Weights and Measures
Geography
Sanitation
Food Supply
Nutrition Surveys
Pakistan
Growth
Parity
Least-Squares Analysis
Hygiene
Malnutrition
Body Mass Index
Obesity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan : An observational study. / Akseer, Nadia; Bhatti, Zaid; Mashal, Taufiq; Soofi, Sajid; Moineddin, Rahim; Black, Robert E; Bhutta, Zulfiqar A.

In: The Lancet Global Health, 01.01.2018.

Research output: Contribution to journalArticle

Akseer, Nadia ; Bhatti, Zaid ; Mashal, Taufiq ; Soofi, Sajid ; Moineddin, Rahim ; Black, Robert E ; Bhutta, Zulfiqar A. / Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan : An observational study. In: The Lancet Global Health. 2018.
@article{7155b0220e7a4ec293a87c4cdbbfb7d1,
title = "Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan: An observational study",
abstract = "Background: Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan. Methods: The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother-child pairs using Bayesian spatial and generalised least squares regression models accounting for the complex survey design. Findings: We noted that childhood stunting, underweight, and combined stunting and wasting were consistently highest in districts in Farah, Nangarhar, Nuristan, Kunar, Paktia, and Badakhshan provinces. District prevalence ranged from 4{\%} to 84{\%} for childhood stunting and 5{\%} to 66{\%} for underweight. Child wasting exceeded 20{\%} in central and high-conflict regions that bordered Pakistan including east, southeast, and south. Among mothers, dual burden of underweight and overweight or obesity existed in districts of north, northeast, central, and central highlands (prevalence of 15-20{\%}). Linear growth and weight of children were independently associated with household wealth, maternal literacy, maternal anthropometry, child age, food security, geography, and improved hygiene and sanitation conditions. The mother's body-mass index was determined by many of the same factors, in addition to ethnolinguistic status and parity. Younger mothers (<20 years old) were more underweight and shorter than older mothers (aged 20-49 years). Interpretation: Afghanistan's rapidly changing political, socioeconomic, and insecurity landscape has both direct and indirect implications on population nutrition. Novel evidence from our study can be used to understand these multifactorial determinants and to identify granular disparities for local level tracking, planning, and implementation of nutritional interventions. Funding: None.",
author = "Nadia Akseer and Zaid Bhatti and Taufiq Mashal and Sajid Soofi and Rahim Moineddin and Black, {Robert E} and Bhutta, {Zulfiqar A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/S2214-109X(18)30025-1",
language = "English (US)",
journal = "The Lancet Global Health",
issn = "2214-109X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Geospatial inequalities and determinants of nutritional status among women and children in Afghanistan

T2 - An observational study

AU - Akseer, Nadia

AU - Bhatti, Zaid

AU - Mashal, Taufiq

AU - Soofi, Sajid

AU - Moineddin, Rahim

AU - Black, Robert E

AU - Bhutta, Zulfiqar A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan. Methods: The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother-child pairs using Bayesian spatial and generalised least squares regression models accounting for the complex survey design. Findings: We noted that childhood stunting, underweight, and combined stunting and wasting were consistently highest in districts in Farah, Nangarhar, Nuristan, Kunar, Paktia, and Badakhshan provinces. District prevalence ranged from 4% to 84% for childhood stunting and 5% to 66% for underweight. Child wasting exceeded 20% in central and high-conflict regions that bordered Pakistan including east, southeast, and south. Among mothers, dual burden of underweight and overweight or obesity existed in districts of north, northeast, central, and central highlands (prevalence of 15-20%). Linear growth and weight of children were independently associated with household wealth, maternal literacy, maternal anthropometry, child age, food security, geography, and improved hygiene and sanitation conditions. The mother's body-mass index was determined by many of the same factors, in addition to ethnolinguistic status and parity. Younger mothers (<20 years old) were more underweight and shorter than older mothers (aged 20-49 years). Interpretation: Afghanistan's rapidly changing political, socioeconomic, and insecurity landscape has both direct and indirect implications on population nutrition. Novel evidence from our study can be used to understand these multifactorial determinants and to identify granular disparities for local level tracking, planning, and implementation of nutritional interventions. Funding: None.

AB - Background: Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan. Methods: The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother-child pairs using Bayesian spatial and generalised least squares regression models accounting for the complex survey design. Findings: We noted that childhood stunting, underweight, and combined stunting and wasting were consistently highest in districts in Farah, Nangarhar, Nuristan, Kunar, Paktia, and Badakhshan provinces. District prevalence ranged from 4% to 84% for childhood stunting and 5% to 66% for underweight. Child wasting exceeded 20% in central and high-conflict regions that bordered Pakistan including east, southeast, and south. Among mothers, dual burden of underweight and overweight or obesity existed in districts of north, northeast, central, and central highlands (prevalence of 15-20%). Linear growth and weight of children were independently associated with household wealth, maternal literacy, maternal anthropometry, child age, food security, geography, and improved hygiene and sanitation conditions. The mother's body-mass index was determined by many of the same factors, in addition to ethnolinguistic status and parity. Younger mothers (<20 years old) were more underweight and shorter than older mothers (aged 20-49 years). Interpretation: Afghanistan's rapidly changing political, socioeconomic, and insecurity landscape has both direct and indirect implications on population nutrition. Novel evidence from our study can be used to understand these multifactorial determinants and to identify granular disparities for local level tracking, planning, and implementation of nutritional interventions. Funding: None.

UR - http://www.scopus.com/inward/record.url?scp=85042031012&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042031012&partnerID=8YFLogxK

U2 - 10.1016/S2214-109X(18)30025-1

DO - 10.1016/S2214-109X(18)30025-1

M3 - Article

C2 - 29454554

AN - SCOPUS:85042031012

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

ER -