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BackgroundBreastfeeding is a critical health equalizer and predictor of significant maternal and infant health outcomes, profoundly influenced by the socioeconomic and cultural status of mothers. Previous research has suggested that migration negatively impacts the breastfeeding practices of immigrant mothers. Given that Iran hosts approximately 3 million Afghan refugees, this study aimed to compare the breastfeeding practices of immigrant Afghan mothers in Iran with those of Iranian mothers.MethodsThis prospective cohort study included postpartum Iranian mothers (n = 209) and Afghan immigrant mothers (n = 327) referred to Nekuei Hedayati Forqani Hospital in Qom and Imam Khomeini Hospital complex in Tehran from January 1, 2023, to May 1, 2023. Breastfeeding quality was assessed using the Bristol Breastfeeding Assessment Tool (BBAT) at baseline (after birth) and at 2-, 4-, and 6-month follow-ups. Breastfeeding continuity was qualitatively assessed based on mothers’ reports of daily frequency and duration of breastfeeding episodes over six months.ResultsThe mean BBAT score of the Iranian cohort was significantly higher than that of Afghan mothers at baseline (7.0 ± 1.5 vs. 6.7 ± 1.7; P-value = 0.032) and at the 6-month follow-up (7.7 ± 0.5 vs. 7.1 ± 1.3; P-value < 0.001), with no significant differences at 2- and 4-month follow-ups (P-values > 0.05). Additionally, the Iranian cohort demonstrated a higher frequency of daily breastfeeding episodes (P-value = 0.001) and longer mean duration per episode compared to the Afghan cohort (P-value < 0.001).ConclusionsOur findings suggested that Afghan immigrant mothers tend to have poorer breastfeeding practices than Iranian mothers, which highlights the need for Iran’s healthcare system to offer a multicultural, accessible, educational, and supportive framework to improve these outcomes. Nonetheless, our relatively small sample size, significant sociodemographic disparities between the Iranian and Afghan cohorts, and restriction to urban sampling may limit the generalizability of our results. Future research would benefit from larger, longitudinal studies with nationally representative samples that systematically examine how socioeconomic factors influence breastfeeding practices among Afghan migrant populations in Iran.Trial registrationNot applicable.

Background The health and survival of women and their new-born babies in low income countries has been a key priority in public health since the 1990s. However, basic planning data, such as numbers of pregnancies and births, remain difficult to obtain and information is also lacking on geographic access to key services, such as facilities with skilled health workers. For maternal and newborn health and survival, planning for safer births and healthier newborns could be improved by more accurate estimations of the distributions of women of childbearing age. Moreover, subnational estimates of projected future numbers of pregnancies are needed for more effective strategies on human resources and infrastructure, while there is a need to link information on pregnancies to better information on health facilities in districts and regions so that coverage of services can be assessed. Methods This paper outlines demographic mapping methods based on freely available data for the production of high resolution datasets depicting estimates of numbers of people, women of childbearing age, live births and pregnancies, and distribution of comprehensive EmONC facilities in four large high burden countries: Afghanistan, Bangladesh, Ethiopia and Tanzania. Satellite derived maps of settlements and land cover were constructed and used to redistribute areal census counts to produce detailed maps of the distributions of women of childbearing age. Household survey data, UN statistics and other sources on growth rates, age specific fertility rates, live births, stillbirths and abortions were then integrated to convert the population distribution datasets to gridded estimates of births and pregnancies. Results and conclusions These estimates, which can be produced for current, past or future years based on standard demographic projections, can provide the basis for strategic intelligence, planning services, and provide denominators for subnational indicators to track progress. The datasets produced are part of national midwifery workforce assessments conducted in collaboration with the respective Ministries of Health and the United Nations Population Fund (UNFPA) to identify disparities between population needs, health infrastructure and workforce supply. The datasets are available to the respective Ministries as part of the UNFPA programme to inform midwifery workforce planning and also publicly available through the WorldPop population mapping project.

Malnutrition contributes to direct and indirect causes of maternal mortality, which is particularly high in Afghanistan. Women's nutritional status before, during, and after pregnancy affects their own well‐being and mortality risk and their children's health outcomes. Though maternal nutrition interventions have documented positive impact on select child health outcomes, there are limited data regarding the effects of maternal nutrition interventions on maternal health outcomes globally. This scoping review maps policies, data, and interventions aiming to address poor maternal nutrition outcomes in Afghanistan. We used broad search categories and approaches including database and website searches, hand searches of reference lists from relevant articles, policy and programme document requests, and key informant interviews. Inclusion and exclusion criteria were developed by type of source document, such as studies with measures related to maternal nutrition, relevant policies and strategies, and programmatic research or evaluation by a third party with explicit interventions targeting maternal nutrition. We ed documents systematically, summarized content, and synthesized data. We included 20 policies and strategies, 29 data reports, and nine intervention evaluations. The availability of maternal nutrition intervention data and the inclusion of nutrition indicators, such as minimum dietary diversity, have increased substantially since 2013, yet few nutrition evaluations and population surveys include maternal outcomes as primary or even secondary outcomes. There is little evidence on the effectiveness of interventions that target maternal nutrition in Afghanistan. Policies and strategies more recently have shifted towards multisectoral efforts and specifically target nutrition needs of adolescent girls and women of reproductive age. This scoping review presents evidence from more than 10 years of efforts to improve the maternal nutrition status of Afghan women. We recommend a combination of investments in measuring maternal nutrition indicators and improving maternal nutrition knowledge and behaviours.

This paper examines multidimensional poverty among children in Afghanistan using the Alkire-Foster method. Several previous studies have underlined the need to separate children from their adult nexus when studying poverty and treat them according to their own specificities. From the capability approach, child poverty is understood to be the lack of freedom to do and to be what children themselves value and have reason to value. The case of Afghanistan is particularly relevant as years of conflict aggravated by several severe droughts, political insecurity, bad governance and ongoing violence have significantly increased poverty in the country. The paper discusses the relevant dimensions when analysing child poverty and uses data from a survey carried out by Handicap International which contains information on dimensions of children's wellbeing that is typically missing in standard surveys. Ten dimension are considered in this paper: health, care and love, material deprivation, food security, social inclusion, education, freedom from economic and non-economic exploitation, shelter and environment, autonomy, and mobility. Our results show that younger children, those living in rural areas, girls and disabled children are the most deprived.

South Asia has the highest rates of malnutrition and the largest number of malnourished women and children in the world. Childhood malnutrition is the main cause of child mortality—one-third of all child deaths are due to the underlying cause of malnutrition. For the children who survive, malnutrition results in lifelong problems by severely reducing a child's ability to learn and to grow to his or her full potential. Malnutrition directly leads to less productive adults and thus to weaker national economic performance. The negative impact of malnutrition on a society's productivity and a nation's long-term development is difficult to underestimate. Malnutrition is a key development priority for the World Bank's South Asia region. The Bank intends to increase its commitment to reducing malnutrition in the region. As a first step, Bank staff are preparing a series of country assessments such as Malnutrition in Afghanistan. These assessments will be useful for governments and development partners committed to scaling up effective, evidence-based interventions to reduce malnutrition in their countries. Conclusive evidence shows that a multisectoral planning approach, followed by actions in the various sectors, is the most successful method to improve a populations' nutrition. Malnutrition in Afghanistan provides the background analysis for the development of a comprehensive nutrition action plan. The timing of this report is propitious. The international communities' interest in the developmental benefits of nutrition programming is high. This analytical report is part of a broader effort by the World Bank South Asia region to increase investments in nutrition, recognizing that good nutrition is important to economic growth and development, and because investing in well-proven nutrition interventions pays high dividends in poverty reduction and national economic development.

Afghans comprise one of the largest groups of refugees in the world, with the majority living in Pakistan. The objective of this study was to identify commonly-occurring reproductive tract infections (RTIs), des-cribe knowledge of women about RTIs, and assess physical and behavioural factors contributing to the de-velopment of RTIs. Afghan women presenting at Basic Health Units in refugee camps in Haripur, Pakistan, with reproductive health-related complaints, were included in the study (n= 634). Data collection included implementation of an interviewer-administered questionnaire, along with a physical examination and laboratory tests. A descriptive analysis was conducted first. Qualitative data were coded and analyzed us-ing predetermined themes. Chi-square test was used for determining the possible relationships between a binary outcome and categorical risk factors. Over three-fourths ( 76. 7%) of those who reported to the health clinics with reproductive complaints had an RTI. Nearly half ( 49. 5%) of these women were diagnosed with some form of vaginitis, and 14. 7% were diagnosed with clinical suspicion of pelvic inflammatory disease (PID). Women with cervical prolapse (p= 0. 033) or who cleansed after intercourse (p= 0. 002) were more likely to have vaginitis. There was a significant difference (p= 0. 017) in the prevalence of suspected PID among women who used mud only ( 11. 1%), any water ( 18. 8%), and an old cloth or toilet paper ( 9. 8%) for cleansing after defaecation. Specific physical and behavioural contributors to the high prevalence of RTIs in this population were identified, and recommendations to ameliorate these factors are offered.

To examine historical estimates of infant and under-five mortality in Afghanistan, provide estimates for rural areas from current population-based data, and discuss the methodological challenges that undermine data quality and hinder retrospective estimations of mortality. Indirect methods of estimation were used to calculate infant and under-five mortality from a household survey conducted in 2006. Sex-specific differences in underreporting of births and deaths were examined and sensitivity analyses were conducted to assess the effect of underreporting on infant and under-five mortality. For 2004, rural unadjusted infant and under-five mortality rates were estimated to be 129 and 191 deaths per 1000 live births, respectively, with some evidence indicating underreporting of female deaths. If adjustment for underreporting is made (i.e. by assuming 50% of the unreported girls are dead), mortality estimates go up to 140 and 209, respectively. Commonly used estimates of infant and under-five mortality in Afghanistan are outdated; they do not reflect changes that have occurred in the past 15 years or recent intensive investments in health services development, such as the implementation of the Basic Package of Health Services. The sociocultural aspects of mortality and their effect on the reporting of births and deaths in Afghanistan need to be investigated further.

[...]although the survey has suggested much lower maternal, infant, and child mortality rates than previous estimates, given the geographically limited samples and use of verbal autopsy data, the numbers should be treated with caution. [...]anthropometric indicators such as stunting or wasting rates, which can help evaluate malnutrition—the biggest contributor to child mortality by far, are missing. According to UNICEF's Afghanistan Country programme document 2010–2013, around 1·2 million children younger than 5 years and 550 000 pregnant or lactating mothers are at high risk of severe malnutrition in Afghanistan.