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Background: Low-income families often depend on fuels such as wood, coal, and animal dung for cooking. Such solid fuels are highly polluting and are a primary source of indoor air pollutants (IAP). We examined the association between solid fuel use (SFU) and acute respiratory infection (ARI) among under-five children in Afghanistan and the extent to which this association varies by socioeconomic status (SES) and gender. Materials and Methods: This is a cross-sectional study based on de-identified data from Afghanistan’s first standard Demographic and Health Survey (DHS) conducted in 2015. The sample consists of ever-married mothers with under-five children in the household (n = 27,565). We used mixed-effect Poisson regression models with robust error variance accounting for clustering to examine the associations between SFU and ARI among under-five children after adjusting for potential confounders. We also investigated potential effect modification by SES and sex. Additional analyses were conducted using an augmented measure of the exposure to IAP accounting for both SFU and the location of cooking/kitchen (High Exposure, Moderate, and No Exposure). Results: Around 70.2% of households reported SFU, whereas the prevalence of ARI was 17.6%. The prevalence of ARI was higher in children living in households with SFU compared to children living in households with no SFU (adjusted prevalence ratio (aPR) = 1.10; 95% CI: (0.98, 1.23)). We did not observe any effect modification by SES or child sex. When using the augmented measure of exposure incorporating the kitchen’s location, children highly exposed to IAP had a higher prevalence of ARI compared to unexposed children (aPR = 1.17; 95% CI: (1.03, 1.32)). SES modified this association with the strongest associations observed among children from the middle wealth quintile. Conclusion: The findings have significant policy implications and suggest that ARI risk in children may be reduced by ensuring there are clean cookstoves as well as clean fuels and acting on the socio-environmental pathways.

BackgroundPost-traumatic growth (PTG) is a positive psychological consequence of trauma. The aims of this study were to investigate whether combat injury was associated with deployment-related PTG in a cohort of UK military personnel who were deployed to Afghanistan, and whether post-traumatic stress disorder (PTSD), depression and pain mediate this relationship.Methods521 physically injured (n = 138 amputation; n = 383 non-amputation injury) and 514 frequency-matched uninjured personnel completed questionnaires including the deployment-related Post-Traumatic Growth Inventory (DPTGI). DPTGI scores were categorised into tertiles of: no/low (score 0–20), moderate (score 21–34) or a large (35–63) degree of deployment-related PTG. Analysis was completed using generalised structural equation modelling.ResultsA large degree of PTG was reported by 28.0% (n = 140) of the uninjured group, 36.9% (n = 196) of the overall injured group, 45.4% (n = 62) of amputee and 34.1% (n = 134) of the non-amputee injured subgroups. Combat injury had a direct effect on reporting a large degree of PTG [Relative risk ratio (RRR) 1.59 (95% confidence interval (CI) 1.17–2.17)] compared to sustaining no injury. Amputation injuries also had a significant direct effect [RRR 2.18 (95% CI 1.24–3.75)], but non-amputation injuries did not [RRR 1.35 (95% CI 0.92–1.93)]. PTSD, depression and pain partially mediate this relationship, though mediation differed depending on the injury subtype. PTSD had a curvilinear relationship with PTG, whilst depression had a negative association and pain had a positive association.ConclusionsCombat injury, in particular injury resulting in traumatic amputation, is associated with reporting a large degree of PTG.

Background In the past few decades, there has been a significant increase in the number of refugees worldwide. Every individual deserves access to the fundamental right to health, and migration can have a substantial beneficial or detrimental effect on one’s health. Foreign invasions and political instability in Afghanistan affected neighboring countries with the large influx of refugees. Discrepancies in quality of life between the host and refugee populations may lead to health inequalities. Investigations in Pakistan on the quality of life of Afghan refugees were scarce despite more than four decades of refugee status. Therefore, this study was initiated to assess the sociocultural determinants influencing health-associated quality of life among Afghan refugees in Pakistan. Methods The Punjab province and Khyber Pakhtunkhwa province refugee populations were selected as the study population for cross-sectional research based on the inclusion criteria of majority refugee representation and female participation. Quantitative research methodology with pre-validated WHOQOL-BREF questionnaires was used for data collection via multi-stage probability sampling techniques. We collected data from 1,185 study participants and applied univariate and bivariate analyses. Inferential analyses included independent t-tests and ANOVA. Results The average scores for the entire sample of Afghan refugees were highest for the social domain (58.78 ± 22.74), followed by the physical domain (53.29 ± 19.46), the general health domain (50.44 ± 20.10), the environmental domain (48.43 ± 16.30), and the psychological domain (46.52 ± 14.78). Age, marital status, family setup, mother language, number of years in the host country, residence type, family monthly income, access to health care, current health status, chronic health illness, substance abuse (smoking), cultural compatibility, linguistic barriers, and social inclusion were non-significant with all the subdomains in the inferential analysis using the independent t-test and analysis of variance. Conclusion The Afghan refugees’ average scores across all health-associated quality-of-life domains were lower than Pakistan’s host population and the standard cutoff criteria (< 60 indicates poor quality of life). The development of a national policy to include refugees in health insurance programs seems essential to improve the health-associated quality of life among Afghan refugees in Pakistan.

Background Child stunting is prevalent in low and middle-income countries (LMICs), but an information gap remains regarding its current prevalence, correlates, and the impact of vaccination against this condition in Afghanistan. This study aimed to determine the prevalence and correlates of moderate and severe stunting and the potential impact of basic and full vaccination among children under five in Afghanistan. Methods This is a secondary analysis of the 2022-23 Afghanistan Multiple Indicators Cluster Survey (MICS) including 32,989 children under 5. Descriptive statistics were employed to describe the distribution of independent variables and the prevalence of stunting across them. Chi-square analysis was used to examine the association between each independent variable with stunting. Multinomial logistic regression was used to examine the risk of stunting across different independent variables. Results A total of 32,989 children under 5 years old were included in this study. Of those 44.7% were stunted with 21.74% being severely stunted. Children aged 24–35 and 36–47 months faced the highest risk as compared to those aged 1–5 months. The prevalence was lower in female children and they were less likely to experience severe stunting. Stunting was more prevalent in rural areas, with children there 1.16 to 1.23 times more likely to be affected than urban counterparts. Lower wealth correlated with higher stunting. Younger maternal age at birth (≤ 18) correlated with increased stunting risks, particularly in severe cases. Parental education was inversely related to stunting; higher education levels in parents, especially fathers, were associated with lower stunting rates. Households with more than seven children showed a 25% and 44% higher risk of moderate and severe stunting, respectively, compared to families with 1–4 children. Improved sanitation, but not drinking water sources, was linked to reduced stunting in the adjusted model. Vaccination had a protective effect; in the adjusted analysis, basic and full vaccinations significantly lowered the risk of severe stunting by 46% and 41%, respectively. Conclusion In this nationally representative study, the prevalence of stunting was substantial (44.7%) in Afghan children. Additionally, the findings emphasize the critical factors associated with child stunting and underscore the protective role of vaccination against this condition, which provides policymakers with directions for policy efforts and intervention strategies to reduce child stunting in Afghanistan.

Background Understanding the status of early childhood development (ECD) and its associated factors could serve as the basis for future policy efforts and interventions. Therefore, this study aimed to determine the status of ECD and its associated factors among children aged 36–59 months in Afghanistan. Methods We used data from the Afghanistan Multiple Indicator Cluster Survey 2022–2023 (MICS) to assess ECD status. The outcome variable was a binary measure, indicating whether a child was developmentally on track or not. To explore the associations between ECD status and various explanatory variables, we applied binary logistic regression models, presenting both univariate and multivariate analyses. Results Among the 13,866 children aged 36 to 59 months included in the analysis, 29.95% (95% CI: 29.19-30.72%) were found to be developmentally on track. The likelihood of being developmentally on track was higher in children whose mothers had secondary [adjusted odds ratio (AOR) 1.36 (95%CI 1.04–1.77)] and higher education [1.73 (1.08–2.76)], in children whose fathers had primary [1.32 (1.05–1.67)], secondary [1.40 (1.10–1.79) and higher education [1.60 (1.21–2.11)], and in children belonging to the higher household wealth status [1.46 (1.18–1.82)]. On the other hand, the likelihood of being developmentally on track was lower in children aged 48–59 months [0.35 (0.30–0.40)], in children living in rural areas [0.77 (0.62–0.96)], in children with stunting [0.77 (0.61–0.96)], and in underweight children [0.61 (0.52–0.72)]. Conclusion Our findings indicate that 29.95% of children aged 36–59 months in Afghanistan are developmentally on track. Positive associations were found between ECD and higher parental education and household wealth status. However, living in rural areas, underweight and stunted growth were negatively associated with ECD. To improve early childhood development programs in Afghanistan, targeted interventions are needed to address the factors identified in this study.

Background: Oral health is a critical aspect of overall well‐being, with significant implications for physical health and quality of life. Despite the well‐documented understanding of oral hygiene practices, there is limited research on oral health behaviors in Afghanistan, a country with unique sociocultural and economic challenges. Objectives: This study aims to assess oral hygiene practices and identify associated risk factors among individuals in Kabul, Afghanistan, to provide insights into oral health behaviors in low‐resource settings. Methods: Institutional based cross‐sectional study was conducted from March 2021 to March 2022, involving 1948 participants from dental hospitals in Kabul. Descriptive and inferential statistical analyses, including logistic regression, were employed to explore associations between variables and oral hygiene status. Results: The study revealed that 59.7% of participants had poor oral hygiene. Key predictors of good oral hygiene included higher education levels, better wealth status, and younger age. Surprisingly, higher snack consumption was associated (AOR: 1.66, CI: 1.24–2.21) with better oral hygiene, contrary to existing literature. Continuous medication use also correlated with better oral hygiene practices with an AOR of 2.14. Conclusions: The findings highlight the complex interplay of demographic, educational, and behavioral factors in determining oral hygiene practices. Targeted interventions including health information provision regarding oral health for patients specifically for poor and uneducated individuals is recommended to enhance oral health outcomes in low‐resource settings like Afghanistan.

Background Little is known whether women’s knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap. Methods Data were used from the Afghanistan Health Survey 2018. Women’s knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0–3 ANC; ≥ 4 PNC vs. 0–3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used. Results Data were used from 9,190 ever-married women, aged 13–49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women’s knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54–2.05), 2.28(1.99–2.61), and 2.78 (2.34–3.32) on knowledge of 1, 2, and 3–5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12–2.90), 2.22(1.42–3.48), and 3.33(2.00–5.54), respectively. In women with institutional deliveries, it was 1.49(1.32–1.68), 2.02(1.78–2.28), and 2.34(1.95–2.79), respectively. Other strong predictors were women’s education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor. Conclusion Our findings suggest that pregnant women’s healthcare seeking behaviour is influenced by women’s knowledge of danger signs and symptoms during pregnancy, women’s education, socioeconomic status, access to media, husband’s, in-laws’ and relatives’ decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women’s knowledge, education, and social status.

Reports about the magnitude of co-existence of under- and over-nutrition is limited in Afghanistan. This study aimed to assess the prevalence of double burden of malnutrition (DBM) at individual and household level in Afghanistan. This study was done based on the Afghanistan National Nutrition Survey 2013, which included a representative sample of 126,890 individuals (including more than 18,000 households) throughout Afghanistan. Intra-individual DBM was defined as the co-existence of \"overweight/obese\" and \"stunting or micronutrient deficiencies\" (including anemia, vitamin A deficiency, vitamin D deficiency and iodine deficiency). At the household level, DBM was considered as having at least one household member as overweight/obese and at least one another member of that household as undernourished (stunted, wasted, underweight or any micronutrient deficiency). SPSS and Stata software were used in the current analysis. Cross-tabulations was used to estimate the prevalence and its 95% confidence interval(CI). This study was ethically approved at Tehran University of Medical sciences. The overall prevalence of intra-individual DBM was 12.5% (95% CI: 12.1; 12.9). Among the whole study participants at individual level of DBM, 11.7% (11.3; 12.1) of individuals had overweight along with stunting simultaneously and 20.5% (18.8; 22.4) had overweight and micronutrient deficiencies at the same time at individual level. The household level of DBM was found among 28.6% (95% CI: 27.9; 29.4) of households; such that 27.3% (26.6; 28.1) of households had at least one member with overweight and another member with stunting or wasting or underweight. Co-existence of overweight and micronutrient deficiencies at the same household was seen in 38.3% (35.5; 41.2). This study demonstrated a high prevalence of DBM at individual and household level in Afghanistan. Therefore, developing appropriate national macro-policies and strategies and designing appropriate programs such as public awareness programs, subsidization, food assistance programs, food fortification and dietary supplementation should be implemented by the ministry of public health, inter- related organs and international health agencies to reduce the burden of this problem in this country.