A community food system analysis as formative research for a comprehensive anemia control program in Northern Afghanistan

Levitt, Emily; Stoltzfus, Rebecca J.; Pelletier, David; Pell, Alice N.

doi:10.1007/s12571-009-0018-y

Cited by 5 publications

(8 citation statements)

References 26 publications

(25 reference statements)

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“…On average, about 40% of iron content in animal source foods is heme iron, and 60% is non-heme iron, whereas 100% of plant source foods is non-heme iron [ 43 ] The bioavailability of heme iron has been estimated to range between 15 and 35%, while the bioavailability of non-heme iron has been found to vary between 2 and 20% [ 44 , 45 ]. Dairy, tea and phytate-containing foods such as grains and legumes are potentially important non-heme iron absorption inhibitors in this context [ 46 , 18 ], whereas meat and ascorbic acid sources are key non-heme iron absorption enhancers [ 47 ]. The relatively high bioavailability of meat compared to non-heme sources of iron, and its ability, even in small doses, to enhance the bioavailability of non-heme iron [ 47 ] makes it a more important dietary factor in combating anemia than overall dietary contributions might suggest.…”

Section: Resultsmentioning

confidence: 99%

“…Neither the AMICS nor the NRVA survey contains information on iron supplementation, and so this cannot be checked directly. However, Levitt et al [ 18 ] found that just over 50% of women in their sample had received iron-folate supplements during their last pregnancy. The World Bank review of nutrition in Afghanistan [ 15 ] reports that iron and folic acid supplementation is available through prenatal care services, and that care coverage is 36%.…”

Section: Discussionmentioning

confidence: 99%

“…A study of 60 households in Northern Afghanistan by Levitt et al . [ 18 ] reports anemia prevalence amongst women (including pregnant and non-pregnant) of 25% in study households.…”

Section: Introductionmentioning

confidence: 99%

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Reducing Anemia Prevalence in Afghanistan: Socioeconomic Correlates and the Particular Role of Agricultural Assets

et al. 2016

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This research aims to examine the socio-economic correlates of anemia in women, and potential sources of iron in household diets in Afghanistan. It also examines whether ownership of agricultural (particularly livestock) assets and their use in food production has a role in alleviating anaemia, especially where local markets may be inadequate. We analyse data from the 2010/11 Afghanistan Multiple Indicator Cluster Survey, estimating a logistic regression to examine how anemia status of women is associated with socio-economic covariates. A key result found is that sheep ownership has a protective effect in reducing anemia (prevalence odds ratio of sheep ownership on anemia of 0.83, 95% confidence interval (CI): 0.73–0.94) after controlling for wealth and other covariates. This association is found to be robust to alternative model specifications. Given the central role of red meat in heme iron provision and absorption of non-heme iron, we hypothesise that sheep ownership promotes mutton consumption from own-production in a setting where market-sourced provision of nutritious food is a challenge. We then use the 2011/12 National Risk and Vulnerability Assessment household data to understand the Afghan diet from the perspective of dietary iron provision, and to understand interactions between own-production, market sourcing and mutton consumption. Sheep ownership is found to increase the likelihood that a household consumed mutton (odds ratio of 1.27, 95% CI: 1.15–1.42), the number of days in the week that mutton was consumed (prevalence rate ratio of 1.24. 95% CI: 1.12–1.37) and the quantity of mutton consumed (7 grams/person/week). In the subsample of mutton consumers, households sourcing mutton mostly from own production consumed mutton 1.5 days more frequently on average than households relying on market purchase, resulting in 100 grams per person per week higher mutton intake. Thus this analysis lends support to the notion that the linkage between sheep ownership and anemia risk is at least partly due to consumption arising from own-production in the presence of market incompleteness.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reducing Anemia Prevalence in Afghanistan: Socioeconomic Correlates and the Particular Role of Agricultural Assets

et al. 2016

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“…By 2016, 44.6% of the population was food insecure and 30.1% had protein deficiency (CSO, 2018). Levitt et al (2009) conducted formative research in northern Afghanistan to understand iron‐rich food access and consumption by populations living in irrigated and rain‐fed zones. In both zones, summer and winter diets contained some iron‐rich foods, although differences were found between communities in the summer, such as meat consumption no more than once a week in the rain‐fed zone compared with twice a week in the irrigated zone, with the increased consumption tied to larger social occasions as a means of honouring guests.…”

Section: Resultsmentioning

confidence: 99%

Review of policies, data, and interventions to improve maternal nutrition in Afghanistan

Kim

Mansoor²,

Paya³

et al. 2020

Maternal & Child Nutrition

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Malnutrition contributes to direct and indirect causes of maternal mortality, which is particularly high in Afghanistan. Women's nutritional status before, during, and after pregnancy affects their own well‐being and mortality risk and their children's health outcomes. Though maternal nutrition interventions have documented positive impact on select child health outcomes, there are limited data regarding the effects of maternal nutrition interventions on maternal health outcomes globally. This scoping review maps policies, data, and interventions aiming to address poor maternal nutrition outcomes in Afghanistan. We used broad search categories and approaches including database and website searches, hand searches of reference lists from relevant articles, policy and programme document requests, and key informant interviews. Inclusion and exclusion criteria were developed by type of source document, such as studies with measures related to maternal nutrition, relevant policies and strategies, and programmatic research or evaluation by a third party with explicit interventions targeting maternal nutrition. We abstracted documents systematically, summarized content, and synthesized data. We included 20 policies and strategies, 29 data reports, and nine intervention evaluations. The availability of maternal nutrition intervention data and the inclusion of nutrition indicators, such as minimum dietary diversity, have increased substantially since 2013, yet few nutrition evaluations and population surveys include maternal outcomes as primary or even secondary outcomes. There is little evidence on the effectiveness of interventions that target maternal nutrition in Afghanistan. Policies and strategies more recently have shifted towards multisectoral efforts and specifically target nutrition needs of adolescent girls and women of reproductive age. This scoping review presents evidence from more than 10 years of efforts to improve the maternal nutrition status of Afghan women. We recommend a combination of investments in measuring maternal nutrition indicators and improving maternal nutrition knowledge and behaviours.

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“…Ten years ago, Johnecheck and Holland (2007) envisaged a multisectoral approach to improving malnutrition in Afghanistan, while various other research outcomes have identified gaps between the agricultural and nutrition sectors, and highlighted the significance of food-based approaches to improving nutrition (Levitt, Pelletier and Pell 2009a;Levitt et al 2009b;Levitt et al 2010;Levitt et al 2011). Nevertheless, current policies do not emphasise the role of agriculture and food-based strategies for improving nutrition.…”

Section: The Afghan Contextmentioning

confidence: 99%

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Maestre¹,

Poole

2018

IDS Bulletin

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A community food system analysis as formative research for a comprehensive anemia control program in Northern Afghanistan

Abstract: Afghanistan, Women, Anemia, Iron, Food, Social network,

Cited by 5 publications

References 26 publications

Reducing Anemia Prevalence in Afghanistan: Socioeconomic Correlates and the Particular Role of Agricultural Assets

Reducing Anemia Prevalence in Afghanistan: Socioeconomic Correlates and the Particular Role of Agricultural Assets

Review of policies, data, and interventions to improve maternal nutrition in Afghanistan

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