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Letter From Afghanistan
December 5, 2001

Malnutrition and Mortality in Kohistan District, Afghanistan, April 2001

Author Affiliations

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.

JAMA. 2001;286(21):2723-2728. doi:10.1001/jama.286.21.2723

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.