The New York Times reports: [D]espite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.

Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.

Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.

One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.

Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.

Now, M.S.F. is planning to open five satellite clinics with intensive feeding programs in Lashkar Gah to take the pressure off the overcrowded hospital.

Despite the increase in the malnutrition caseload, doctors and health officials are not sure there has actually been a sharp rise in child malnutrition that can be attributed to any single factor.

“It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.

In part, expansion of the hospital’s facilities has acted as a magnet, drawing more cases, Mr. Vandormael said. Unlike at other public hospitals in Afghanistan, patients and their caregivers do not have to pay for their own medicine and food at Bost. And M.S.F. has been able to ensure that it gets regular deliveries of Unicef-provided therapeutic foods used to treat malnutrition.

“Our treatment is better, so we get more patients as they hear about it,” said Dr. Yar Mohammad Nizar Khan, head of pediatrics at Bost Hospital.

Nonetheless, the numbers are still worrisome. Dr. Mohammad Dawood, a pediatrician at Bost Hospital, said there were seven or eight deaths a month there because of acute malnutrition from June through August, and five in September. Doctors around the country have reported similar rates.

Officials at Unicef and the Afghan Ministry of Public Health have declined to characterize child malnutrition here as an emergency, however. As defined internationally, that would mean severe acute malnutrition in more than 10 percent of children younger than 5; health officials in Afghanistan estimate the rate is more like 7 percent.

“Science-wise, the increase in number of children reporting to the hospitals is not an absolute evidence the situation is getting worse,” said Moazzem Hossain, head of nutrition for Unicef here. “It’s a good sign, the program is expanding, more are being screened, more are being found and treated.”

Another problem is unreliable statistics.

In January 2012, for instance, Unicef and the Afghan government’s Central Statistics Organization released a survey of more than 13,000 households showing that some provinces had reached or exceeded emergency levels, with more than 10 percent acute severe child malnutrition.

The survey caused an uproar, but Unicef and the Health Ministry repudiated it, saying it was based on faulty research. Unicef then financed a more thorough child nutrition survey, which was completed in November, but the government has yet to release the data, said Dr. Bashir Ahmed Hamid, head of nutrition for the Health Ministry. “Unfortunately, we faced some challenges with data analysis.”

Dr. Hamid said he expected the new data to show very high levels, probably more than 50 percent, of long-term or chronic malnutrition, which shows up as stunted growth in children. While acute malnutrition can be fatal, chronic malnutrition can cause multiple health and developmental problems. [Continue reading…]