Afghanistan is the only country in the South Asia region in a conflict-affected and fragile situation. Almost all the countries ranked within the highest 10% of the Global Hunger Index and with the highest stunting rates are classified as unstable or conflict affected. The prevalence of undernutrition is significantly higher among unstable and conflict-affected settings. In 2020, an estimated 149 million children worldwide under five were stunted and 45 million were wasted. Optimal infant and young child feeding (IYCF) practices including an early initiation of breastfeeding, exclusive breastfeeding for 6 months and the introduction of micronutrient-rich and age-appropriate complementary foods from 6 months are particularly important for ensuring the healthy growth and development of young children. Malnutrition is an indicator of social and political instability as it represents a multifaceted problem linked to poverty, food insecurity and poor hygiene and health. The results will be beneficial to design interventions to prevent stunting within Afghanistan and other low–middle-income countries.
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The program monitoring and evaluation component will examine the quality of implementation, acceptability of intervention, identification of potential barriers and to learn how to enhance the program’s effectiveness through ongoing operational improvements. We will aim to compare the intervention and control group between the pre- and post-intervention assessments to isolate the effect of the intervention by difference-in-differences estimates. The primary outcome will be a reduction in the prevalence of stunting among children under two years in the intervention group compared to the control group.
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After the formative research and baseline household survey, an intervention focusing on the provision of SNF, targeting pregnant and lactating women and children 6–23 months, and SBCC strategies will be implemented for at least 12 months. Repeated cross-sectional baseline and endline surveys will be conducted in both the intervention and the control districts.
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Before launching the program, formative research will be conducted on the acceptability, appropriate use and SBCC strategies needed to support the introduction of intervention package. This will be a quasi-experimental pre-post study with the control group utilizing qualitative and quantitative methods. We will aim to assess the effectiveness of specialized nutritious foods (SNF)and social and behavior change communication (SBCC) strategies during the first 1000 days of life to prevent stunting among children in two rural districts of Badakhshan, Afghanistan. Stunting predominantly occurs during the first 1000 days of life and continues to the age of five years.