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Tetanus toxoid coverage
Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus toxoid TT, typically during pregnancy. A lifetime protection is provided if a woman has received the complete recommended series of 5
immunizations. However, according to WHO, “pregnant women with an inadequate or unknown immunization history should always receive 2 doses of tetanus toxoid-containing vaccine: the first dose as early as possible during pregnancy
and the second dose at least 4 weeks later” WHO 2006.
4
Overall, 33 percent of eligible women, according to card and recall combined, received two or more doses of TT immunization status and are considered to be protected against neonatal tetanus. While there were no differences
between urban and rural residents, there was a visible gap in coverage of Kuchi women see Table 8.5. Interestingly,
there does not appear to be a clear association between the TT coverage and level of education. However, this is likely to be a result of a low number of observations in each educational category because 92 percent of women do not have
any formal education. There is also no association between the age at delivery and TT coverage.
Table 8.5 Percentage of women who received TT vaccination, by a residence, b educational attainment, c age at delivery
Selected variables TT doses received
Less than 2 2 or more
a. Residence
Urban 68
32 Rural
66 34
Kuchi 85
15
b. Educational attainment
No education 68
32 Primary school
58 42
Secondary school 67
33 college or more
68 32
c. Age at delivery
15-19 65
35 20-24
66 34
25-29 69
31 30-34
65 35
35-39 71
29 40-44
64 36
45-49 77
23
Total 67
33
8.3.3 Child feeding patterns Exclusive breastfeeding
5
Exclusive breastfeeding of young infants is one of the most powerful interventions for ensuring good nutritional status and preventing infections and deaths in children under five. Researchers have estimated that the largest proportion of under-
five mortality – 13 percent of all deaths of young children – could be prevented with universal exclusive breastfeeding practices Jones et al. 2003. Exclusive breastfeeding should be practiced with children from birth to six months of age,
when complementary foods should be introduced and breastfeeding continued for at least another year. Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the
newborn, and feeding should be initiated within the first hour after birth.
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4
Annex VI.A includes a section on problems related to reporting on TT injections.
5
Exclusive breastfeeding is defined as giving no other food or drink – not even water – except breast milk.
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Rates of exclusive breastfeeding are relatively high in Afghanistan, but vary widely depending on the way they are measured. Calculating rates based upon whether children aged 0 to 6 months are currently breastfed and have not
yet been introduced to solid foods yields a rate nationally of 78 percent, which does not vary considerably across either residence or educational status
Table 8.6. However, when calculation of the exclusive breastfeeding rate took into consideration responses to questions about actual child feeding during the first three days, in addition to current
breastfeeding status, resulting rates were considerably lower, at only 35 percent nationally. Of concern is that only 77 percent of mothers reported giving their newborn breast milk within the first three days, a crucial period for ensuring
proper nutrition, and 55 percent of mothers reported giving their newborn liquids other than breast milk, including sugar water, glucose, herb water or tea, melted butter, or powdered milk, during this period.
Table 8.6 Percentage of last born children who were reported exclusively breastfed, by supplementation of additional liquids in irst three days after birth, and by a residence, b highest educational attainment of the mother
Selected variables
With additional liquids
Without additional liquids
a. Residence
Urban 73
35 Rural
79 35
Kuchi 82
35
b. Educational attainment of mother
No education 78
35 Primary school
77 20
Secondary school 83
38 College or more
65 42
Total 78
35
Complementary feeding
Once a child reaches about six months of age, breast milk alone is no longer sufficient to supply the energy needs of a child. Family foods should be introduced in complement to breastfeeding, which should ideally continue until 18 to 24
months of age. Proper complementary feeding is of critical importance for ensuring good nutritional status and healthy development among children. Experts estimate that if universal complementary feeding were practiced, 6 percent of
child deaths under five worldwide could be prevented Jones et al. 2003.
Nationally, 41 percent of 6-9-month-old children were given complementary feeding, according to NRVA 20078, which was defined as currently being breastfed as well as receiving solid foods as of age six months. Similar to exclusive
breastfeeding patterns, there was little variation in complementary feeding patters by either location or educational status. The lower proportion of children of women with college education currently receiving complementary foods was
not statistically different from the other groups, given the small number of women in this category.
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Table 8.7 Percentage of 6-9-month-olds receiving complementary feeding, by a residence, b highest educational attainment of mother
Residence and education of mother
