(LB03-10-25) Effectiveness of Nutrition Interventions Through Primary Health Care in Reducing Stunting and Wasting Among Children Under 5 Years in a Fragile Setting in Afghanistan

Objectives: This study tested the effectiveness of an integrated nutrition program in reducing stunting and wasting in a low-resource and fragile setting in Afghanistan with a terrain that is comprised of mountains, harsh weather conditions, food insecurity, and limited access to health services.

Methods: The study used a quantitative cross-sectional study design. Two rounds of household surveys were done to assess reduction in stunting and wasting among children under 5, and changes in behaviours. The sample size was calculated to detect a 2% percent relative rate of reduction baseline-to-end-line change in stunting. Statistical tests such as chi-square tests for categorical variables and t-tests for continuous variables were used to analyze the pre-and post-intervention differences. The significance of differences was determined using p-values (p < 0.05) to assess statistical significance. The effect size was measured using Cohen’s h which quantifies the magnitude of change between proportions.

Results: Exclusive breastfeeding for children aged 0–5 months significantly improved, rising from 64.0% to 80.9%. Dietary diversity (MDD) for children aged 6–24 months also improved substantially. The findings demonstrate significant improvements in children's nutritional status between baseline and midline surveys, with notable reductions in malnutrition levels and moderate-to-large effect sizes. Stunting decreased from 52.3% to 37.3% (-15.0%, P = 0.001, Cohen’s h = 0.30, moderate effect size), while severe stunting fell from 26.9% to 15.5% (-11.4%, P = 0.002, Cohen’s h = 0.28, small-to-moderate effect size). Acute malnutrition (wasting) declined significantly from 11.8% to 3.1% (-8.7%, P = 0.001, Cohen’s h = 0.35, moderate effect size).

Conclusions: The study underscores the effectiveness of a primary health care and community approach in reducing stunting in children. These findings suggest that similar models can be effectively replicated in other low-resource and fragile settings.

Funding Sources: Aga Khan Foundation Geneva