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SUBMITTED BY AGA KHAN UNIVERSITY

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and nutrients(1). It covers two broad groups of conditions undernutrition and over nutrition or obesity. Undernutrition can further be classified into stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and/or micronutrient deficiencies(2). According to the World Health Organization (WHO) around 462 million people worldwide are underweight, an estimated 159 million children under the age of 5 years are stunted and about 50 million are wasted(3). Children and women are more vulnerable to malnutrition and the consequences of it such as elevated morbidity and mortality, especially in poor and under developed countries(4). Overall, 52 % of all deaths in young children are attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea(5). Malnutrition results in lasting impacts on a child’s ability to perform well in school and fight disease, as well as lifelong effects of lower wages and lost productivity (6-11). Growth faltering often begins in utero and continues for at least the first 2 years of post‐natal life(12). Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance. Similarly very low Body Mass Index (lower than 16) is associated with poor muscle strength and work capacity(13, 14). Low BMI values in women not only increases their morbidity and mortality but is also a contributing factor to fetal growth retardation, low-birth-weight newborns and subsequently higher rates of wasting and stunting in their children(15). BMI mortality curves, especially in low-income settings, show a marked increase in mortality at low BMI levels(16). Investing in nutrition especially of children has the power to change lives and unlock huge social and economic gains, especially in countries with a high burden of stunting. Without adequate and sustained investments in good nutrition, the Sustainable Development Goals will not be realized as two of its 17 goals (2 and 3) directly pertain to nutrition, while 12 are indirectly related to it. Malnutrition is widespread in Afghanistan, Pakistan and Tajikistan our target countries for this survey and is one of the most critical endemic public health issue responsible for significant financial burden as well as increased morbidity and mortality(17). The following table shows the status of malnutrition among women and children in the sample districts of Afghanistan, Pakistan and Tajikistan.