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South Asia has the highest rates of malnutrition and the largest number of malnourished women and children in the world. Childhood malnutrition is the main cause of child mortality—one-third of all child deaths are due to the underlying cause of malnutrition. For the children who survive, malnutrition results in lifelong problems by severely reducing a child's ability to learn and to grow to his or her full potential. Malnutrition directly leads to less productive adults and thus to weaker national economic performance. The negative impact of malnutrition on a society's productivity and a nation's long-term development is difficult to underestimate. Malnutrition is a key development priority for the World Bank's South Asia region. The Bank intends to increase its commitment to reducing malnutrition in the region. As a first step, Bank staff are preparing a series of country assessments such as Malnutrition in Afghanistan. These assessments will be useful for governments and development partners committed to scaling up effective, evidence-based interventions to reduce malnutrition in their countries. Conclusive evidence shows that a multisectoral planning approach, followed by actions in the various sectors, is the most successful method to improve a populations' nutrition. Malnutrition in Afghanistan provides the background analysis for the development of a comprehensive nutrition action plan. The timing of this report is propitious. The international communities' interest in the developmental benefits of nutrition programming is high. This analytical report is part of a broader effort by the World Bank South Asia region to increase investments in nutrition, recognizing that good nutrition is important to economic growth and development, and because investing in well-proven nutrition interventions pays high dividends in poverty reduction and national economic development.

Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready‐to‐use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight‐for‐height z‐score ≥ −3 or mid‐upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight‐based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per‐protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (−0.9; 7.2) %] and length‐of‐stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of −10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = −1.5 (−1.8, −1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight‐based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource‐constrained contexts. We conducted a real‐world prospective nonrandomized study assessing the noninferiority of a nonweight‐based daily ready‐to‐use therapeutic food dosage for the treatment of severe acute malnutrition in children under 5, when compared to the standard weight‐based daily dosage. Our results confirm the noninferiority of this dosage as an alternative to the standard dosage. Key messages More evidence supporting the use of the nonweight‐based daily ready‐to‐use therapeutic food (RUTF) dosage for treating uncomplicated severe acute malnutrition (SAM), in specific contexts, is needed. Our real‐world prospective nonrandomized study showed that the fixed nonweight‐based daily RUTF dosage protocol is as effective as the standard weight‐based protocol for treating uncomplicated SAM in children <5 in the Afghanistan context. Our findings support the reflection of a nonweight‐based daily RUTF dosage in resource‐constrained contexts in national and global policies and guidelines to improve coverage of all children in need of treatment.

Background Undernutrition, which includes stunting, wasting, and underweight, is a global problem, especially among children of low- and middle-income countries. To our knowledge, this study is first of its type from Afghanistan. Its main objectives were to estimate the prevalence and associated risk factors of stunting, wasting/thinness, and underweight among urban primary school children in Kandahar city of Afghanistan. Methods This school-based cross-sectional study was conducted among 1205 primary school children aged 6–12 years during a period of six months (October 2022–March 2023). Anthropometric measurements and other data were collected from all the participants. Data were analyzed by using descriptive statistics, Chi square test (using crude odds ratio or COR), and multivariate logistic regression (using adjusted odds ratio or AOR). Results Among the 1205 enrolled government school students, 47.4%, 19.5%, and 25.6% had stunting, wasting/thinness, and underweight, respectively. Statistically significant factors associated with stunting were age group 6–9 years (AOR 1.3, 95% CI 1.1–1.7), being girl (AOR 2.3, 95% CI 1.8–3.0), poverty (AOR 2.2, 95% CI 1.5–3.2), large family (AOR 3.0, 95% CI 2.4–3.9), illiterate mother (AOR 1.6, 95% CI 1.0–2.6), jobless head of the family (AOR 3.3, 95% CI 2.3–4.8), and skipping breakfasts (AOR 1.7, 95% CI 1.2–2.3). Main factor associated with wasting/thinness were age group 6–9 years (AOR 30.5, 95% CI 11.8–78.7), skipping breakfasts (AOR 22.9, 95% CI 13.9–37.8), and history of sickness during the past two weeks (AOR 17.0, 95% CI 6.6–43.8). Also, main factors associated with underweight were age group 6–9 years (AOR 2.6, 95% CI 1.6–4.1), skipping breakfasts (AOR 2.6, 95% CI 1.8–3.6), and poor sanitation (AOR 1.9, 95% CI 1.1–3.2). Conclusions Stunting, wasting/thinness, and underweight are highly prevalent among primary school children (both girls and boys) in Kandahar city. It is recommended that local government (Afghanistan Ministry of Education and Ministry of Public Health) with the help of international organizations and donor agencies should implement comprehensive school-based feeding programs especially for girls. Health and nutrition education programs should be conducted with emphasis on nutrition of children aged 6–9 years as well as importance of healthy breakfast and good sanitation.

Reports about the magnitude of co-existence of under- and over-nutrition is limited in Afghanistan. This study aimed to assess the prevalence of double burden of malnutrition (DBM) at individual and household level in Afghanistan. This study was done based on the Afghanistan National Nutrition Survey 2013, which included a representative sample of 126,890 individuals (including more than 18,000 households) throughout Afghanistan. Intra-individual DBM was defined as the co-existence of \"overweight/obese\" and \"stunting or micronutrient deficiencies\" (including anemia, vitamin A deficiency, vitamin D deficiency and iodine deficiency). At the household level, DBM was considered as having at least one household member as overweight/obese and at least one another member of that household as undernourished (stunted, wasted, underweight or any micronutrient deficiency). SPSS and Stata software were used in the current analysis. Cross-tabulations was used to estimate the prevalence and its 95% confidence interval(CI). This study was ethically approved at Tehran University of Medical sciences. The overall prevalence of intra-individual DBM was 12.5% (95% CI: 12.1; 12.9). Among the whole study participants at individual level of DBM, 11.7% (11.3; 12.1) of individuals had overweight along with stunting simultaneously and 20.5% (18.8; 22.4) had overweight and micronutrient deficiencies at the same time at individual level. The household level of DBM was found among 28.6% (95% CI: 27.9; 29.4) of households; such that 27.3% (26.6; 28.1) of households had at least one member with overweight and another member with stunting or wasting or underweight. Co-existence of overweight and micronutrient deficiencies at the same household was seen in 38.3% (35.5; 41.2). This study demonstrated a high prevalence of DBM at individual and household level in Afghanistan. Therefore, developing appropriate national macro-policies and strategies and designing appropriate programs such as public awareness programs, subsidization, food assistance programs, food fortification and dietary supplementation should be implemented by the ministry of public health, inter- related organs and international health agencies to reduce the burden of this problem in this country.

This research seeks to enhance the understanding of the multifaceted drivers of food and nutrition insecurity in emergency-affected countries within the Eastern Mediterranean region and investigate the dynamics of food and nutrition security in countries facing emerging emergencies. This is a descriptive aim to determine the key factors and challenges affecting food security and nutrition status in ten countries in the Eastern Mediterranean region (Afghanistan, Djibouti, Iraq, Lebanon, Pakistan, Palestine (Gaza Strip), Somalia, Sudan, Syria, and Yemen). The research reveals that all selected countries experienced severe levels of food insecurity, with many reaching Phase 3 or above according to the IPC classification. In 2020, Afghanistan and Yemen were particularly hard-hit, with food insecurity affecting 42% and 45% of their populations; in 2024 in Gaza and Sudan, the same figures were 93% and 54% of the population, respectively, representing worse food insecurity crises in the region. Somalia, Sudan, and Djibouti also faced significant food insecurity rates. Many key drivers of food security are standard in most countries, and the linkage between food insecurity and malnutrition levels has a similar trend in almost all countries. However, none of the countries achieved all the 2025 global nutrition targets, while some reached one or two targets. Reaching sustainable development goals is still challenging in these countries since nutrition and food security levels, included in many goals, have not yet been reached. Food security and malnutrition in emergency-affected countries are driven by conflict, political instability, natural disasters, and socioeconomic conditions, which disrupt agricultural activities and infrastructure, exacerbating these challenges. To address these issues, we recommend a multisectoral approach, conflict resolution, climate-smart agriculture, integration of emergency responses with long-term strategies, and strengthening health and nutrition information systems.

On a planet with a population of more than 7 billion, how do we identify the millions of droughtafflicted people who face a real threat of livelihood disruption or death without humanitarian assistance? Typically, these people are poor and heavily dependent on rainfed agriculture and livestock. Most live in Africa, Central America, or Southwest Asia. When the rains fail, incomes diminish while food prices increase, cutting off the poorest (most often women and children) from access to adequate nutrition. As seen in Ethiopia in 1984 and Somalia in 2011, food shortages can lead to famine. Yet these slow-onset disasters also provide opportunities for effective intervention, as seen in Ethiopia in 2015 and Somalia in 2017. Since 1985, the U.S. Agency for International Development’s Famine Early Warning Systems Network (FEWS NET) has been providing evidence-based guidance for effective humanitarian relief efforts. FEWS NET depends on a Drought Early Warning System (DEWS) to help understand, monitor, model, and predict food insecurity. Here we provide an overview of FEWS NET’s DEWS using examples from recent climate extremes. While drought monitoring and prediction provides just one part of FEWS NET’s monitoring system, it draws from many disciplines—remote sensing, climate prediction, agroclimatic monitoring, and hydrologic modeling. Here we describe FEWS NET’s multiagency multidisciplinary DEWS and Food Security Outlooks. This DEWS uses diagnostic analyses to guide predictions. Midseason droughts are monitored using multiple cutting- edge Earth-observing systems. Crop and hydrologic models can translate these observations into impacts. The resulting information feeds into FEWS NET reports, helping to save lives by motivating and targeting timely humanitarian assistance.

Conflict and war are a part of daily life for Afghan children.1 A 2018 cross-sectional survey of children in Afghanistan revealed that 71% of children had experienced physical violence in the past year, and home was the most likely location of violence.2 There have been decades of economic and security disruptions in the country, and the mental health of Afghan children is in jeopardy as a result.1 The most recent military escalations in the country have further aggravated this psychosocial crisis, and the children of Afghanistan are experiencing acute food insecurity, malnutrition, displacement, loss of family members, and poverty as they face an uncertain future. In a study of school children, 111 (32%) of 350 male students and 74 (18%) of 420 female students disclosed having perpetrated more than one instance of cruelty in the preceding month.4 The type and number of events that resulted in trauma are key factors that influence how mental health issues develop in children.5 Studies on psychotherapeutic interventions in Afghan children and adolescents are rare, and the evidence they have produced is low quality. The emergence of the COVID-19 pandemic has worsened the already fragile health-care system with bed shortages, lack of oxygen, low vaccination rates, and poor diagnostic capacity preventing accurate estimation of the local spread.6 In this context to prevent a mental health catastrophe in children, we call for collaborative support from global establishments.

ObjectivesThe current study aimed to find the distribution and factors associated with undernutrition among children aged 6–36 months in Kabul.DesignCross-sectional study.SettingPublic Ataturk Children’s Hospital, Kabul.Participants385.MethodsA structured questionnaire was used to collect data on sociodemographic conditions and anthropometry of children. Logistic regression was used to find determinants of undernutrition.ResultsThe distribution of stunting, wasting and underweight was 38.7%, 11.9% and 30.6%, respectively. Among the children studied, 54% did not receive breast milk within the first hour of birth, 53.2% were not exclusively breastfed, 21% received complementary feeding before the age of 6 months, 22.1% lacked access to safe water and 44.7% did not practise hand washing with soap. The odds of stunting were lower (p<0.05) in girls (AOR 5.511, 95% CI 3.028 to 10.030), children of educated fathers (OR 0.288, 95% CI 0.106 to 0.782), those from nuclear families (OR 0.280, 95% CI 0.117 to 1.258), those exclusively breastfed (OR 0.499, 95% CI 0.222 to 1.51) and those practising good hygienic practices (OR 0.440, 95% CI 0.229 to 0.847). Boys had high odd of girls (OR 6.824, 95% CI 3.543 to 13.143) while children of educated fathers (OR 0.340, 95% CI 0.119 to 0.973), those receiving complementary food at 6 months (OR 0.368, 95% CI 0.148 to 1.393) and those practising good hygiene (OR 0.310, 95% CI 0.153 to 0.631) had lower odds (p<0.05) of being underweight. Boys (OR 3.702, 95% CI 1.537 to 8.916) had higher odds of being wasted, whereas children of educated mothers (OR 0.480, 95% CI 0.319 to 4.660), those from nuclear families (OR 0.356, 95% CI 0.113 to 1.117), those receiving early breast feeding (OR 0.435, 95% CI 0.210 to 1.341) and those practising hand washing (OR 0.290, 95% CI 0.112 to 0.750) had lower odds (p<0.05) of being wasted.ConclusionThis study demonstrated the sex of the child, illiteracy of fathers, not practising hand washing and not observing hygiene, late initiation of breast milk, complementary feeding timings, and lack of proper exclusive breast feeding as contributing factors to the under-nutrition of the children in the study population.