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Measuring health progress in Afghanistan

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

In an Atlantic article last week, Justin Sandefur, a research fellow at the Center for Global Development, wrote about how US foreign aid for health to the government of Afghanistan is currently under threat due to scrutiny from auditors. Read Here’s the Best Thing the U.S. has Done in Afghanistan

Sandefur argues that US funds channeled to the Afghan government have played a major role in driving down child mortality in the country, and that these achievements could be jeopardized if the US cuts this funding as a result of auditors’ concerns.

How much progress has Afghanistan made in improving child health over time? According to estimates from the Global Burden of Disease Study (GBD) 2010, mortality rates in children under five in Afghanistan fell 48% between 1990 and 2010 (download the data here). Life expectancy at birth increased from 51.7 in 1990 to 57.3 in 2010 for females and 52.2 to 58.2 for males (below is the screen grab based on the data).

Chart: Healthy years lost to disability vs. life expectancy in Afghanistan, females, 1990-2010

Afghanistan Life Expectancy1

You can also view life expectancy estimates for Afghan females and males in our online tool and compare the country’s progress to that of other nations.

The screen grab  below illustrates how child mortality in Afghanistan increased around the time of the US invasion in 2001 but then declined steeply through 2010. The multicolored triangles in the graph represent different data points from surveys analyzed by GBD researchers. These data come from surveys of Afghan households that interviewed mothers about the number of children they’ve ever had and how many of them died.

Afghanistan Child Mortality1

Note: Triangles represent data points used in the GBD analysis of mortality rates in Afghanistan. These data were obtained from sources such as the Afghan Health Survey, Multiple-Indicator Cluster Surveys, and Demographic and Health surveys. Hover over the triangles in the live tool online to get complete citation information for each data source.

This graph reveals more than just trends in child mortality in Afghanistan – it tells a story about the challenges of collecting data points during a conflict. When violence prevents data collectors from traveling to the most dangerous areas of a conflict zone, the data are likely to show an overly positive picture. For example, look at the hollow red triangles along the bottom of the figure indicated by the purple arrow. They are from a recently published survey called the Afghanistan Mortality Survey 2010.  “Data in the Afghanistan Mortality Survey were collected in safer areas of Afghanistan and are not representative of the entire country,” said Dr. Haidong Wang, a co-author on the GBD study. The data collected through this survey estimated much lower child mortality levels than the studies that reflected child mortality in the country as a whole (see blue and green triangles in the graph). Because of the bias inherent in the data from the Afghanistan Mortality Survey 2010, the data points were dropped from the GBD mortality analysis.

A study on mortality in Iraq published earlier this week by researchers from the University of Washington, the Institute for Health Metrics and Evaluation, and other collaborators also cited the challenges of collecting accurate data in a setting riddled by security concerns and large numbers of people migrating out of the country.

In countries plagued by conflict, tracking health outcomes is extremely challenging. Essential tools for tracking demographic changes, such as censuses, are often impossible to conduct in these settings. In the case of Afghanistan, we’re able to more accurately track health progress thanks to the individuals who risk their lives to obtain data from the most dangerous parts of the country.


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