The first 1,000 days
“In some areas low birth weight can affect up to 20 percent of babies,” Claudia says. “Children are born under 2.5 kg, and it’s very difficult to catch up when they’re born into a situation of deprivation. And so the idea is to prevent low birth weight in the first place, working with a generation to ensure that when a mum gets pregnant that she is well-nourished, to try to prevent the baby from being undernourished, but if the baby is undernourished, to tackle it really quickly so that they get back on track and stay on track.”
Baby Alim Davlatmamadov, from Midenved Village in GBAO, was not eating properly despite the availability of nutritious food and his mother’s best efforts, and was admitted to hospital with acute respiratory infection, rickets, anaemia and mild acute malnutrition. Aged eight months, he was almost a kilo underweight.
AKF offers children who are considerably underweight the ready-to-use supplementary food Acha-Mum. After starting the supplement, Alim began eating again, and drinking his homemade fruit and vegetable juices. By his first birthday, his health had returned to normal and he was gaining weight.
“In addition to working with children and pregnant women we are also focusing on nutrition in adolescent girls. The second decade of children's lives is the greatest chance for catch-up growth. Once they start menstruation, if they are already anaemic that will compound the anaemia, and adolescent girls also tend to get allocated less food within their household than they actually need. In many of our geographies adolescent girls eventually become mums and if well nourished, they can pass on that good nutrition to their newborn children as well as improve the nutrition of the family. It’s a triple benefit,” says Claudia.
Between September 2019 and July 2022, CASI interventions reached almost 65,000 children across the three countries, of which nearly three-quarters were ages 0-4. The 147 project health facilities were given equipment to assess nutritional status in women and babies, measure birth weight and care for low-birth-weight babies. They were provided with nutritional supplements to treat malnutrition, although the stock of supplements in Afghanistan was affected by delays due to the conflict. Over 600 health facility providers and community health workers were trained on growth monitoring, counselling, stunting and acute malnutrition protocols and newborn survival and care, and 89 percent of the 170,000 men and women that CASI targeted attended nutrition training and behaviour change activities.
The programme has achieved an average annual relative reduction in stunting of between two and seven percent (anything over two percent is considered exemplary at global standard), with improvements at the individual and population levels. Not only has the prevalence of stunting decreased, but children who were not clinically stunted are now better nourished than previously.
CASI is in its fifth year. With these stunting reductions and nutrition gains continuing year on year, the team expects increasingly significant improvements in maternal and child health and development. It aims to continue deepening the impact over a generation to break the cycle of undernutrition.
AKDN is also starting to turn its attention to another heavy non-communicable disease burden in Central Asia. One of its nutrition programming objectives is to prevent obesity, caused by poor quality food and built environments that do not encourage exercise.
“It’s expensive to eat healthily, especially given the inflationary environment,” says Claudia. “There's also a loss of historical food types. In the Hunza Valley, there's an amazing history of using healthy apricot oils and soups. But those recipes were in people's great grandmothers’ repertoire, and a lot of that oral history has been lost. So we've moved to this modern food system without having the ability to counteract it with physical exercise. About a third of adults in Kyrgyzstan and Tajikistan are overweight or obese. We’re trying to do more around recreation in schools and on nutrition education. Because it’s hard to lose weight as an adult – where you can change it is in children.”
In their paper How countries can reduce child stunting at scale: Lessons from exemplar countries, Dr Zulfiqar Bhutta of AKU et al concluded that half of stunting reduction could be attributed to non-health interventions. AKDN is able to bring together education, health screening and treatment, food supplement provision, initiatives aimed at increasing household incomes, gender equity education, agriculture and food security programming, and water and sanitation provision to address nutritional objectives. “We have everything under one roof to have a really significant impact in the geographies where we work, because we're working at scale at critical mass in a multisectoral way,” says Claudia. “It's not an easy funding environment, but we've got a proven model now that works.”