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.