Author Affiliations: Save the Children–USA, Washington, DC (Ms Assefa and Dr Jabarkhil); International Emergency and Refugee Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Salama and Spiegel).
Section Editor: Annette Flanagin, RN, MA,
Managing Senior Editor.
Context The humanitarian situation in Afghanistan has been deteriorating for
more than 3 years because of civil war and severe drought. Because of recent
events, the international community is predicting a severe worsening of the
country's current situation.
Objective To assess the magnitude and causes of mortality and prevalence of malnutrition
in Kohistan district, Faryab province, Afghanistan.
Design Two-stage, 30-cluster household survey conducted April 4 through 10,
2001, which included anthropometric measurements, assessment of food coping
mechanisms, and retrospective mortality data collection for November 26, 2000,
through April 4, 2001.
Setting and Participants A total of 378 households comprising 3165 people living in Kohistan
district, Faryab province, Afghanistan.
Main Outcome Measures Crude mortality rate, mortality rate among children younger than 5 years,
causes of death, prevalence of wasting and stunting among children aged 6
to 59 months (weight-for-height and height-for-age z
scores <−2, respectively), and food coping mechanisms.
Results The crude mortality rate among the 3165 persons surveyed during the
period of interest was 2.6 (95% confidence interval [CI], 1.7-3.5) per 10 000
per day and the mortality rate among 763 children younger than 5 years was
5.9 (95% CI, 2.0-8.8) per 10 000 per day. Diarrhea (25.0%), respiratory
tract infections (19.4%), measles (15.7%), and scurvy (6.5%) caused most of
the 108 deaths. The prevalences of wasting and stunting among 708 children
aged 6 to 59 months were 7.0% (95% CI, 5.9%-9.0%) and 63.7% (95% CI, 58.6%-68.8%),
respectively. Evidence of late-stage food coping mechanisms and prefamine
indicators existed among the population.
Conclusions These data indicate that, by April 2001, a humanitarian crisis already
existed in Kohistan. Essential humanitarian services, including food aid and
public health programs, are urgently required in such regions of Afghanistan
and will be crucial if a worsening humanitarian crisis is to be avoided. For
these services and programs to be implemented, the international community
needs to create adequate humanitarian space (ie, a secure and accessible location
where humanitarian organizations can provide services to emergency-affected
populations) to ensure that humanitarian organizations have access to populations
within Afghanistan as well as to refugees who flee to surrounding countries.
Assefa F, Jabarkhil MZ, Salama P, Spiegel P. Malnutrition and Mortality in Kohistan District, Afghanistan, April 2001. JAMA. 2001;286(21):2723-2728. doi:10.1001/jama.286.21.2723