NLiS Country Profile: Afghanistan

Nutrition Landscape Information System (NLiS)

Definition of 'benign'
However, as an ecosystem develops, extremes of complexity can become more likely due to accumulation of complicating changes in some lineages. Because seawater contains large quantities of dissolved salts, it must be desalinated for most uses, including human consumption. Therefore, zombies are inconceivable and do not show physicalism to be false. Herbaceous plants have soft, flexible aerial portions and commonly die back each year. Subsequently, the geographer Otto Schlüter , in , argued that by defining geography as a Landschaftskunde landscape science would give geography a logical subject matter shared by no other discipline. Most species produce conspicuous cones strobili on both male and female plants, and the seeds are very large. The possible technology closest to uploading would be a relatively gradual and continuous transformation of the functioning human brain into another substrate.

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Water , a substance composed of the chemical elements hydrogen and oxygen and existing in gaseous, liquid , and solid states. It is one of the most plentiful and essential of compounds.

A tasteless and odourless liquid at room temperature, it has the important ability to dissolve many other substances. Indeed, the versatility of water as a solvent is essential to living organisms. In small quantities water appears colourless, but water actually has an intrinsic blue colour caused by slight absorption of light at red wavelengths. Although the molecules of water are simple in structure H 2 O , the physical and chemical properties of the compound are extraordinarily complicated, and they are not typical of most substances found on Earth.

For example, although the sight of ice cubes floating in a glass of ice water is commonplace, such behaviour is unusual for chemical entities.

For almost every other compound, the solid state is denser than the liquid state; thus, the solid would sink to the bottom of the liquid. The fact that ice floats on water is exceedingly important in the natural world, because the ice that forms on ponds and lakes in cold areas of the world acts as an insulating barrier that protects the aquatic life below. If ice were denser than liquid water, ice forming on a pond would sink, thereby exposing more water to the cold temperature.

Thus, the pond would eventually freeze throughout, killing all the life-forms present. Water occurs as a liquid on the surface of Earth under normal conditions, which makes it invaluable for transportation, for recreation, and as a habitat for a myriad of plants and animals. The fact that water is readily changed to a vapour gas allows it to be transported through the atmosphere from the oceans to inland areas where it condenses and, as rain , nourishes plant and animal life.

The hydrologic cycle for a description of the cycle by which water is transferred over Earth. Because of its prominence, water has long played an important religious and philosophical role in human history. In the 6th century bce , Thales of Miletus , sometimes credited for initiating Greek philosophy , regarded water as the sole fundamental building block of matter:.

It is water that, in taking different forms, constitutes the earth, atmosphere, sky, mountains, gods and men, beasts and birds, grass and trees, and animals down to worms, flies and ants.

All these are different forms of water. Two hundred years later, Aristotle considered water to be one of four fundamental elements, in addition to earth, air , and fire. The belief that water was a fundamental substance persisted for more than 2, years until experiments in the second half of the 18th century showed that water is a compound made up of the elements hydrogen and oxygen. The water on the surface of Earth is found mainly in its oceans Interestingly, the purity requirements of water for industrial use often exceed those for human consumption.

For example, the water used in high-pressure boilers must be at least Because seawater contains large quantities of dissolved salts, it must be desalinated for most uses, including human consumption. This article describes the molecular structure of water as well as its physical and chemical properties. For other major treatments of water, see climate ; environmental works ; hydrosphere ; ice ; and pollution.

It includes all liquid and frozen surface water s, ground water held in soil and rock, and atmospheric water vapour. The water molecule is composed of two hydrogen atoms, each linked by a single chemical bond to an oxygen atom. Most hydrogen atoms have a nucleus consisting solely of a proton. Two isotopic forms, deuterium and tritium , in which the atomic nuclei also contain one and two neutrons, respectively, are found to a small degree in water.

Deuterium oxide D 2 O , called heavy water , is important in chemical research and is also used as a neutron moderator in some nuclear reactors. Although its formula H 2 O seems simple, water exhibits very complex chemical and physical properties. In its solid form, ice, water is less dense than when it is liquid, another unusual property.

The root of these anomalies lies in the electronic structure of the water molecule. The water molecule is not linear but bent in a special way. The two hydrogen atoms are bound to the oxygen atom at an angle of Hydrogen atoms in water molecules are attracted to regions of high electron density and can form weak linkages, called hydrogen bonds , with those regions.

This means that the hydrogen atoms in one water molecule are attracted to the nonbonding electron pairs of the oxygen atom on an adjacent water molecule. The structure of liquid water is believed to consist of aggregates of water molecules that form and re-form continually.

This short-range order, as it is called, accounts for other unusual properties of water, such as its high viscosity and surface tension. An oxygen atom has six electrons in its outer valence shell, which can hold a total of eight electrons.

When an oxygen atom forms a single chemical bond, it shares one of its own electrons with the nucleus of another atom and receives in return a share of an electron from that atom. When bonded to two hydrogen atoms, the outer electron shell of the oxygen atom is filled. The electron arrangement in the water molecule can be represented as follows.

Each pair of dots represents a pair of unshared electrons i. Urinary iodine concentrations for determining iodine status deficiency in populations. Goitre as a determinant of the prevalence and severity of iodine deficiency disorders in populations. Iodine deficiency, list of publications. Global iodine status in and trends over the past decade. In NLIS, it is used as a proxy for access to health services and maternal care. The indicator gives the percentage of live births attended by skilled health personnel in a given period.

A skilled birth attendant is an accredited health professional—such as a midwife, doctor or nurse—who has been educated and trained to proficiency in the skills needed to manage normal uncomplicated pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of women and newborns for complications. In developed countries and in many urban areas in developing countries, skilled care at delivery is usually provided in health facilities.

Births do, however, take place in various other appropriate places, from home to tertiary referral centres, depending on availability and need. WHO does not recommend a particular setting for giving birth. Home delivery may be appropriate for normal births, provided that the person attending the delivery is suitably trained and equipped and that referral to a higher level of care is an option, however this may lead to an overestimation of births attended by skilled personal as infants delivered outside of a health facility may not have their birth method recorded.

All women should have access to skilled care during pregnancy and at delivery to ensure the detection and management of complications. One woman dies needlessly of pregnancy-related causes every minute, representing more than half a million mothers lost each year, a figure that has improved little over the past few decades.

Another 8 million or more suffer life-long health consequences from the complications of pregnancy. The lack of progress in reducing maternal mortality in many countries often reflects the low value placed on the lives of women and their limited role in setting public priorities. The lives of many women in developing countries could be saved by reproductive health interventions that people in rich countries take for granted, such as the presence of skilled health personnel at delivery. Improved sanitation facilit ies and drinking-water sources.

What do these indicators tell us? These indicators are the percentage of population with access to an improved drinking-water source and improved sanitation facilities.

How are they defined? Improved drinking-water sources are defined in terms of the types of technology and levels of services that are likely to provide safe water. Improved water sources include household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collection.

Unimproved water sources are unprotected wells, unprotected springs, vendor-provided water, bottled water unless water for other uses is available from an improved source and tanker truck-provided water. Improved sanitation facilities are defined in terms of the types of technology and levels of services that are likely to be sanitary. Improved sanitation includes connection to a public sewers, connection to septic systems, pour-flush latrines, simple pit latrines and ventilated improved pit latrines.

Service or bucket latrines from which excreta are removed manually , public latrines and open latrines are not considered to be improved sanitation. Access to safe drinking-water and improved sanitation are fundamental needs and human rights vital for the dignity and health of all people. The health and economic benefits of a safe water supply to households and individuals especially children are well documented.

Both indicators are used to monitor progress towards the Millennium Development Goals. Water, Sanitation and Hygiene. World Health Statistics, Children aged 1 y ear immunized against measles. Estimates of vaccination coverage of children aged 1 year are used to monitor vaccination services, to guide disease eradication and elimination programmes and as indicators of health system performance.

Measles vaccination coverage is defined as the percentage of 1-year-olds who have received at least one dose of measles-containing vaccine in a given year.

In countries that recommend that the first dose be given to children over 12 months of age, the indicator is calculated as the proportion of children under 24 months of age receiving one dose of measles-containing vaccine.

Measles is a leading cause of vaccine-preventable childhood deaths, and unvaccinated populations are at risk for the disease. Measles is a significant infectious disease because it is so contagious that the number of people who would suffer complications after an outbreak among nonimmune people would quickly overwhelm available hospital resources. When vaccination rates fall, the number of nonimmune persons in the community rises, and the risk for an outbreak of measles consequently rises.

Millennium Development Goals indicators database. This indicator reflects the percentage of women who consumed any iron-containing supplements during the current or past pregnancy within the last 2 years.

It provides information about the quality and coverage of perinatal medical services. Daily iron and folic acid supplementation is currently recommended by WHO as part of antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency.

However, despite its proven efficacy and wide inclusion in antenatal care programmes, its use has been limited in programme settings, possibly due to a lack of compliance, concerns about the safety of the intervention among women with an adequate iron intake, and variable availability of the supplements at community level.

This indicator is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. The indicator is defined as the proportion of women who consumed any iron-containing supplements during the current or past pregnancy within the last 2 years.

Data can be reported on any iron-containing supplement including iron and folic acid tablets IFA , multiple micronutrient tablets or powders, or iron-only tablets which will vary by country policy.

Improving the intake of iron and folic acid by women of reproductive age could improve pregnancy outcomes and enhance maternal and infant health. Iron and folic acid supplementation improve iron and folate status of women before and during pregnancy, in communities where food-based strategies are not yet fully implemented or effective.

Folic acid supplementation with or without iron provided before pregnancy and during the first trimester of pregnancy is also recommended for decreasing the risk of neural tube defects.

Anaemia during pregnancy places women at risk for poor pregnancy outcomes, including maternal mortality and also increases the risks for perinatal mortality, premature birth and low birth weight. Infants born to anaemic mothers have less than one half the normal iron reserves. Morbidity from infectious diseases is increased in iron-deficient populations, because of the adverse effect of iron deficiency on the immune system. Iron deficiency is also associated with reduced work capacity and with reduced neurocognitive development.

Demographic and Health Surveys. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for Children with diarrhoea receiving oral rehydration therapy. This indicator is the prevalence of children with diarrhoea who received oral rehydration therapy.

It is the proportion of children aged 0—59 months who had diarrhoea and were treated with oral rehydration salts or an appropriate household solution. The terms used for diarrhoea should cover the expressions used for all forms of diarrhoea, including bloody stools consistent with dysentery and watery stools, and should encompasses mothers' definitions as well as local terms.

Diarrhoeal diseases remain one of the major causes of mortality among children under 5, accounting for 1.

As oral rehydration therapy is a critical component of effective management of diarrhoea, monitoring coverage with this highly cost—effective intervention indicates progress on an intermediate outcome indicator of the Global Nutrition Targets, prevalence of diarrhoea in children under 5 years of age. Children with diarrhoea receiving zinc. This indicator reflects the prevalence of children who were given zinc as part of treatment for acute diarrhoea.

Unfortunately, there are no readily available data on this indicator, which is maintained in the NLIS to encourage countries to collect and compile data on these aspects in order to assess their national capacity. Measures to prevent childhood diarrhoeal episodes include promoting zinc intake. Diarrhoeal diseases account for nearly 2 million deaths a year among children under 5, making them the second most-common cause of child death worldwide.

The greater the prevalence of zinc supplementation during diarrhoea treatment, the better the outcome of treatment for diarrhoea. WHO and the United Nations Children's Fund UNICEF recommend exclusive breastfeeding, vitamin A supplementation, improved hygiene, better access to cleaner sources of drinking-water and sanitation facilities and vaccination against rotavirus in the clinical management of acute diarrhoea and also the use of zinc, which is safe and effective.

Specifically, zinc supplements given during an episode of acute diarrhoea reduce the duration and severity of the episode, and giving zinc supplements for days lowers the incidence of diarrhoea in the following months. Currently no data are available. The impact of zinc supplementation on childhood mortality and severe morbidity.

Report of a workshop to review the results of three large studies. Geneva , World Health Organization, Children aged months receiving v itamin A supplements. These indicators are the proportion of children aged months who received one and two doses of vitamin A supplements, respectively.

The indicators are defined as the proportion of children aged months who received one or two high doses of vitamin A supplements within 1 year. Current international recommendations call for high-dose vitamin A supplementation every months for all children between the ages of 6 and 59 months living in affected areas. The recommended doses are IU for month-old children and IU for those aged months.

Programmes to control vitamin A deficiency enhance children's chances of survival, reduce the severity of childhood illnesses, ease the strain on health systems and hospitals and contribute to the well-being of children, their families and communities. The World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of efforts to improve child survival and therefore of the achievement of the fourth Millennium Development Goal, a two-thirds reduction in mortality of children under 5 by the year As there is strong evidence that supplementation with vitamin A reduces child mortality, measuring the proportion of children who have received vitamin A within the past 6 months can be used to monitor coverage with interventions for achieving the child survival-related Millennium Development Goals.

Supplementation with vitamin A is a safe, cost-effective, efficient means for eliminating its deficiency and improving child survival. Immunization, Vaccines and Biologicals. These indicators are the proportion of children aged months who received one or two doses of vitamin A supplements. The indicator reflects the proportion of babies born in facilities that have been designated as Baby-friendly.

Proportion of births in Baby-friendly facilities is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. This indicator is defined as the proportion of babies born in facilities designated as Baby-friendly in a calendar year.

To be counted as currently Baby-friendly, the facility must have been designated within the last five years or been reassessed within that timeframe. Facilities may be designed as Baby-friendly if they meet the minimum Global Criteria, which includes adherence to the Ten Steps for Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. The Ten steps include having a breastfeeding policy that is routinely communicated to staff, having staff trained on policy implementation, informing pregnant women on the benefits and management of breastfeeding, promoting early initiation of breastfeeding, among others.

The International Code of Marketing of Breast-milk Substitutes restricts the distribution of free infant formula and promotional materials from infant formula companies. The more of the Steps that the mother experiences, the better her success with breastfeeding. Improved breastfeeding practices worldwide could save the lives of over children every year. National implementation of the Baby-friendly Hospital Initiative. Implementation of the Baby-friendly Hospital Initiative.

Mothers of children months receiving counselling, support or messages on optimal breastfeeding. Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Optimal practices include early initiation of breastfeeding within 1 hour, exclusive breastfeeding for 6 months followed by appropriate complementary with continued breastfeeding for 2 years or beyond.

Even though it is a natural act, breastfeeding is also a learned behaviour. Virtually all mothers can breastfeed provided they have accurate information, and support within their families and communities and from the health care system. This indicator has been established to measure the proportion of mothers receiving breastfeeding counselling, support or messages.

The proportion of mothers of children months who have received counselling, support or messages on optimal breastfeeding at least once in the previous 12 months is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. The indicator gives the percentage of mothers of children aged months who have received counselling, support or messages on optimal breastfeeding at least once in the last year.

Counseling and informational support on optimal breastfeeding practices for mothers has been demonstrated to improve initiation and duration of breastfeeding, which in has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life.

Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits for the mother and child, such as reducing the risk of overweight and obesity in childhood and adolescence.

Breastfeeding has also been associated with higher intelligence quotient IQ in children. Salt iodization has been adopted as the main strategy for eliminating iodine-deficiency disorders as a public health problem, and the aim is to achieve universal salt iodization. While other foodstuffs can be iodized, salt has the advantage of being widely consumed and inexpensive. Salt has been iodized routinely in some industrialized countries since the s.

This indicator is a measure of whether a fortification programme is reaching the target population adequately. The indicator is a measure of the percentage of households consuming iodized salt, defined as salt containing parts per million of iodine.

Iodine deficiency is most commonly and visibly associated with thyroid problems e. Consumption of iodized salt increased in the developing world during the past decade: This means that about 84 million newborns are now being protected from learning disabilities due to iodine-deficiency disorders.

Monitoring the situation of women and children. Sustainable elimination of iodine deficiency disorders by Micronutrient deficiencies, iodine deficiency disorders. Population with less than the minimum dietary energy consumption.

This indicator is the percentage of the population whose food intake falls below the minimum level of dietary energy requirements, and who therefore are undernourished or food-deprived. The estimates of the Food and Agriculture Organization of the United Nations FAO of the prevalence of undernourishment are essentially measures of food deprivation based on calculations of three parameters for each country: The average amount of food available for human consumption is derived from national 'food balance sheets' compiled by FAO each year, which show how much of each food commodity a country produces, imports and withdraws from stocks for other, non-food purposes.

FAO then divides the energy equivalent of all the food available for human consumption by the total population, to derive average daily energy consumption.

Data from household surveys are used to derive a coefficient of variation to account for the degree of inequality in access to food. Similarly, because a large adult needs almost twice as much dietary energy as a 3-year-old child, the minimum energy requirement per person in each country is based on age, gender and body sizes in that country.

The average energy requirement is the amount of food energy needed to balance energy expenditure in order to maintain body weight, body composition and levels of necessary and desirable physical activity consistent with long-term good health. It includes the energy needed for the optimal growth and development of children, for the deposition of tissues during pregnancy and for the secretion of milk during lactation consistent with the good health of the mother and child.

The recommended level of dietary energy intake for a population group is the mean energy requirement of the healthy, well-nourished individuals who constitute that group. FAO reports the proportion of the population whose daily food intake falls below that minimum energy requirement as 'undernourished'.

Trends in undernourishment are due mainly to: The indicator is a measure of an important aspect of food insecurity in a population.

Sustainable development requires a concerted effort to reduce poverty, including solutions to hunger and malnutrition. Alleviating hunger is a prerequisite for sustainable poverty reduction, as undernourishment seriously affects labour productivity and earning capacity.

Malnutrition can be the outcome of a range of circumstances. In order for poverty reduction strategies to be effective, they must address food access, availability and safety. Rome, October The State of Food Insecurity in the World Economic growth is necessary but not sufficient to accelerate reduction of hunger and malnutrition.

FAO methodology to estimate the prevalence of undernourishment. FAO, Rome, 9 October Infant and young child feeding. The recommendations for feeding infants and young children 6—23 months include: The caring practice indicators for infant and young child feeding available on the NLIS country profiles include: Early initiation of breastfeeding.

This indicator is the percentage of infants who are put to the breast within 1 hour of birth. Breastfeeding contributes to saving children's lives, and there is evidence that delayed initiation of breastfeeding increases their risk for mortality.

Infants under 6 months who are exclusively breastfed. This indicator is the percentage of infants aged 0—5 months who are exclusively breastfed. It is the proportion of infants aged 0—5 months who are fed exclusively on breast milk and no other food or drink, including water. The infant is however, allowed to receive ORS and drops and syrups containing vitamins, minerals and medicine.

Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important implications for the health of mothers. An expert review of evidence showed that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants.

Breast milk is the natural first food for infants. It provides all the energy and nutrients that the infant needs for the first months of life.

Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses, such as diarrhoea and pneumonia, and leads to quicker recovery from illness.

Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers and saving family and national resources. It is a secure way of feeding and is safe for the environment. Infants aged 6—8 months who receive solid, semisolid or soft foods. WHO recommends starting complementary feeding at 6 months of age. It is defined as the proportion of infants aged 6—8 months who receive solid, semisolid or soft foods.

When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide.

Children aged 6—23 months who receive a minimum dietary diversity. This indicator is the percentage of children aged 6—23 months who receive a minimum dietary diversity. As per revised recommendation by TEAM in June , dietary diversity is present when the diet contained five or more of the following food groups: Children aged 6—23 months who receive a minimum acceptable diet. This indicator is the percentage of children aged 6—23 months who receive a minimum acceptable diet.

Proportion of children aged months who receive a minimum acceptable diet is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. The composite indicator of a minimum acceptable diet is calculated from: Dietary diversity is present when the diet contained four or more of the following food groups: The minimum daily meal frequency is defined as: A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6—23 months.

Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. Source of all infant and young child feeding indicators. Infant and Young Child Feeding database. Infant and young child feeding list of publications.

Global Nutrition Monitoring Framework. Children with diarrhoea receiving oral rehydration therapy and continued feeding. This indicator is the prevalence of children with diarrhoea who received oral rehydration therapy and continued feeding. It is the proportion of children aged months who had diarrhoea and were treated with oral rehydration salts or an appropriate household solution and continued feeding. As oral rehydration therapy is a critical component of effective management of diarrhoea, monitoring coverage with this highly cost-effective intervention indicates progress towards the child survival-related Millennium Development Goals.

Health expenditure includes that for the provision of health services, family planning activities, nutrition activities and emergency aid designated for health, but excludes the provision of water and sanitation.

Health financing is a critical component of health systems. National health accounts provide a large set of indicators based on information on expenditure collected within an internationally recognized framework.

National health accounts consist of a synthesis of the financing and spending flows recorded in the operation of a health system, from funding sources and agents to the distribution of funds between providers and functions of health systems and benefits geographically, demographically, socioeconomically and epidemiologically. General government expenditure on health as a percentage of total government expenditure is the proportion of total government expenditure on health. General government expenditure includes consolidated direct and indirect outlays, such as subsidies and transfers, including capital, of all levels of government social security institutions, autonomous bodies and other extrabudgetary funds.

It consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds.

GDP is the value of all final goods and services produced within a nation in a given year. Public health expenditure consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds.

Private health expenditure is the sum of outlays for health by private entities, such as commercial or mutual health insurance providers, non-profit institutions serving households, resident corporations and quasi-corporations not controlled by government involved in health services delivery or financing, and direct household out-of-pocket payments.

These indicators reflect total and public expenditure on health resources, access and services, including nutrition. Although increasing health expenditures are associated with better health outcomes, especially in low-income countries, there is no 'recommended' level of spending on health.

The larger the per capita income, the greater the expenditure on health. Some countries, however, spend appreciably more than would be expected from their income levels, and some appreciably less. When a government spends little of its GDP or attributes less of its total expenditure on health, this may indicate that health, including nutrition , are not regarded as priorities.

National health accounts - World Health Statistics, http: Human development report http: Core health indicators http: Human development report indicator glossary for indicator 3. Wealth, health and health expenditure. General government expenditure on health as a percentage of total government expenditure is defined as the level of general government expenditure on health GGHE expressed as a percentage of total government expenditure.

The indicator contributes to understanding the weight of public spending on health within the total value of public sector operations.

It includes not just the resources channelled through government budgets but also the expenditure on health by parastatals, extrabudgetary entities and notably the compulsory health insurance.

The indicator refers to resources collected and pooled by public agencies including all the revenue modalities. The indicator provides information on the level of resources channelled to health relative to a country's wealth. These indicators reflect government and total expenditure on health resources, access and services, including nutrition, in relation to government expenditure, the wealth of the country, and per capita.

When a government attributes less of its total expenditure on health, this may indicate that health, including nutrition , are not regarded as priorities. UNDAFs usually focus on three to five areas in which the country team can make the greatest difference, in addition to activities supported by other agencies in response to national demands but which fall outside the common UNDAF results matrix. For each national priority selected for United Nations country team support, the UNDAF results matrix gives the outcome s , the outcomes and outputs of other agencies working alone or together, the role of partners, resource mobilization targets for each agency outcome and coordination mechanisms and programme modalities.

The nutrition component of the UNDAF reflects the priority attributed to nutrition by the United Nations agencies in a country and is an indication of how much the United Nations system is committed to helping governments improve their food and nutrition situation. The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is being addressed in the expected outcomes and outputs in the UNDAF.

UNDAF documents follow a predefined format, with a core narrative and a results matrix. The matrix lists the high-level expected results 'the UNDAF outcomes' , the outcomes to be reached by agencies working alone or together and agency outputs.

The results matrix the UNDAF document was used to assess commitment to nutrition , because it represents a synthesis of the strategy proposed in the document and is available in the same format in most country documents. The outcomes and outputs specifically related to nutrition were identified and counted. The outputs were compared with the evidence-based interventions to reduce maternal and child under nutrition recommended in the Lancet Nutrition Series Bhutta et al.

The method and scoring are described in detail by Engesveen et al. What are the implications? A weak nutrition component in the UNDAF document does not necessarily imply that no United Nations agency in the country is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like the UNDAF, they may receive inadequate attention from development partners to ensure the necessary sustainability or scale-up to adequately address nutrition problems in the country.

The multisectoral nature of nutrition means that it must be addressed by a wide range of actors. Basing such action in frameworks for overall development contributes to ensuring the accountability of United Nations partners. Interventions for maternal and child under nutrition and survival.

The Lancet Engesveen K et al. SCN News , Nutrition component of poverty reduction strategy papers. The poverty reduction strategy approach was introduced in to empower governments to set their own priorities and to encourage donors to provide predictable, harmonized assistance aligned with country priorities. The PRSP should state the development priorities and specify the policies, programmes and resources needed to meet the goals. It is prepared by governments in a participatory process involving civil society and development partners, including the World Bank and the International Monetary Fund, and should result in a comprehensive, country-based strategy for poverty reduction.

The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is addressed in the PRSP, in terms of recognition of under nutrition as a development problem, use of information on nutrition to analyse poverty and support for appropriate nutrition policies, strategies and programmes.

The papers were systematically searched for key words to identify the parts that concerned nutrition , food security , health outcomes and interventions that would be relevant for the World Bank method. In order to classify the commitments to nutrition in the PRSPs, a scoring system was developed, which is described in more detail by Engesveen et al.

The emphasis given to nutrition in PRSPs reflects the extent to which the government considers it essential to improve nutrition for poverty reduction and national development. In other words, it can be an indication of the government's priority for improving nutrition. A strong nutrition component in a PRSP means that the government considers nutrition a priority for poverty reduction and national development.

A weak nutrition component in the document does not necessarily imply that no government department is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like PRSPs, they may not be sufficiently sustainable or be scaled-up to adequately address nutrition problems in the country. Basing such action in frameworks for overall development contributes to ensuring the accountability of relevant government departments.

Sources and further reading. Poverty reduction strategy papers. Assessing countries' commitment to accelerate nutrition action demonstrated in poverty reduction strategy paper, UNDAF and through nutrition governance.

SCN News , , Shekar M, Lee Y-K. Mainstreaming nutrition in poverty reduction strategy papers: What does it take? A review of the early experience.

Health, Nutrition and Population Discussion Paper, Landscape analysis on countries' readiness to accelerate action in nutrition , This indicator is a description of the strengths and weaknesses of various aspects of nutrition governance in countries.

The following 10 elements or characteristics are used to assess and describe the strength of nutrition governance: These elements were identified by countries as key elements for successful development and implementation of national nutrition policies and strategies during a review of the progress of countries in implementing the World Declaration and Plan of Action for Nutrition adopted by the International Conference on Nutrition, the first intergovernmental conference on nutrition Nishida et al.

The components of the composite indicator have been identified by countries as important for determining the completeness of national nutrition plans and policies Nishida, Mutru, Imperial Laue , For instance, a national nutrition plan and policy was considered to provide the political basis for initiating action.

In many countries, official government endorsement or adoption of a national nutrition plan or policy facilitated its implementation. The role of an intersectoral coordinating committee in implementing national nutrition plans and policies was also considered crucial, although the nature i. Another important element was considered to be regular surveys and other means of collecting data on nutrition.

A periodically updated national nutrition information system and routinely collected data on food and nutrition were considered important for evaluating the effectiveness of national nutrition plans and policies and identifying subsequent actions.

Strategies for effective and sustainable national nutrition plans and policies. Modern aspects of nutrition , present knowledge and future perspective. Basel , Karger Forum for Nutrition 56 , This indicates whether a government has adopted legislation to monitor and enforce the International Code of Marketing of Breast-milk Substitutes, which helps create an environment that enables mothers to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so.

This indicator is defined on the basis of whether a government has adopted legislation for effective national implementation and monitoring of the International Code of Marketing of Breast-milk Substitutes.

The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution" Article 1.

Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally. The Code was formulated in response to the realization that such marketing resulted in poor infant feeding practices, which negatively affect the growth, health and development of children and are a major cause of mortality in infants and young children.

Breastfeeding practices worldwide are not yet optimal, in both developing and developed countries, especially for exclusive breastfeeding under 6 months of age.

In addition to the risks posed by the lack of the protective qualities of breast milk, breast-milk substitutes and feeding bottles are associated with a high risk for contamination that can lead to life-threatening infections in young infants. Infant formula is not a sterile product, and it may carry germs that can cause fatal illnesses.

Artificial feeding is expensive, requires clean water, the ability of the mother or caregiver to read and comply with mixing instructions and a minimum standard of overall household hygiene.

These factors are not present in many households in the world. Frequently asked questions , These indicators provide information on national policies for legal entitlement to maternity protection, including leave from work during pregnancy and after birth, as well breastfeeding entitlements after return to work.

Since the International Labour Organization ILO was founded in , international labour standards have been established to provide maternity protection for women workers. Key elements of maternity protection include: The right to cash benefits during absence for maternity leave is intended to ensure that the woman can maintain herself and her child in proper conditions of health and with a suitable standard of living.

The source of benefits is important due to potential discrimination in the labour market if employers have to bear the full costs. The right to continue breastfeeding a child after returning to work is important since duration of leave entitlements generally is shorter than the WHO recommended duration of exclusive and continued breastfeeding.

A composite indicator on maternity protection is included as a policy environment and capacity indicator in the core set of indicators for the Global Nutrition Monitoring Framework. It currently uses the ILO classification of compliance with Convention on three key provisions leave duration, remuneration and source of cash benefits , but an alternative method taking into account higher standards as stated in Recommendation as well as breastfeeding entitlements is under development.

The ILO periodically publishes information on the above key indicators, including the assessment of compliance with Convention No. However, an alternative method is under development which may use a scale to indicate the degree of compliance is under development. This method will also take into account higher standards for leave duration and remuneration in Recommendation , as well as breastfeeding entitlements within both the Convention and Recommendation.

Pregnancy and maternity are potentially vulnerable time for working women and their families. Expectant and nursing mothers require special protection to prevent any potential adverse effects for them and their infants. They need adequate time to give birth, to recover from delivery process, and to nurse their children. At the same time, they also require income security and protection to ensure that they will not suffer from income loss or lose their job because of pregnancy or maternity leave.

Such protection not only ensures a woman's equal access and right to employment, it also ensures economic sustainability for the well-being of the family.

Returning to work after maternity leave has been identified as a significant cause for never starting breastfeeding, early cessation of breastfeeding and lack of exclusive breastfeeding. In most low- and middle-income countries, paid maternity leave is limited to formal sector employment or is not always provided in practice. The ILO estimates that more than million women lack economic security around childbirth with adverse effects on the health, nutrition and well-being of mothers and their children.

Maternity cash benefits for workers in the informal economy. Rollins et al Why invest, and what it will take to improve breastfeeding practices? Database of national labour, social security and related human rights legislation. The legislative data are collected by ILO through periodical reviews of national labour and social security legislation and secondary sources, such as the International Social Security Association and International Network on Leave Policies and Research; as well as consultations with ILO experts in regional and national ILO offices around the world.

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