Health of Afghan children jeopardized by family behaviors, not just war

Family values and ongoing conflict within the country are dramatically affecting the health of young children in Afghanistan. A study published in the open access journal BMC Public Health suggests that poor child health can be linked to a lack of maternal education and a lack of autonomy for mothers when seeking healthcare for their children. In addition, mothers who were married as children tend to have offspring with poorer health.

Child health in Afghanistan is suffering from the impact of war: shortages of water, food and shelter and the forced displacement of families from their homes are all associated with the prevalence of easily preventable illnesses and indicators of chronic poor health.

Taufiq Mashal from the Graduate School of Tokyo Medical and Dental University led a research team including colleagues from the Ministry of Public Health, Kabul, Afghanistan. Mortality rate for children under five in this country was reported to be 191/1000 live births. This is the first study to show that specific family behaviours, along with war may have a profound effect on child health in Afghanistan.

A total of 1327 households from urban and rural areas of Kabul province participated in the study. The research team recorded height, weight and other health indicators of 2474 children under the age of five.

The children's mothers were interviewed about their marriage, level of education, access to female physicians and about the level of autonomy they had when making decisions about healthcare for their children.

The study found that 32.5% and 41.5% of children suffered from acute diarrhoea and respiratory illnesses (ARI), respectively. The prevalence of emaciation and linear growth retardation was 12.4% and 39.9%, respectively. There were correlations between these health conditions and family behaviours. For instance, a mother's lack of autonomy was associated with ARI and growth retardation while a lack of maternal education and marriage during childhood were found to be associated with the incidence of diarrhoea.

"Mothers are the primary carers for small children in Afghanistan," notes Mashal. "They are critical in securing better healthcare for children and particular attention should be paid to maternal autonomy at the household level for promotion of the health status of children in Afghanistan.

"Regarding child marriages, not only the married child but also the children of child-mothers are subject to a number of disadvantages. The poor economic and educational status of these women, and their overall immaturity caused by a lack of learning opportunities may have resulted in difficulties in preventing illness in their children."

Mashal calls for a comprehensive effort centred on the enforcement of legislation to remove the barriers preventing women obtaining healthcare for their children. According to the authors, "Culturally appropriate programs that provide families and communities with education and reproductive health services can help stop child marriage". The authors continue, "Governments should play a role in this endeavour as well as strengthen efforts to meets the basic material needs of citizens."

1. Factors associated with health and nutritional status among children under five years old in Afghanistan: family behaviour related to women and past experience of war-related hardships
Taufiq Mashal, Takehito Takano, Keiko Nakamura, Masashi Kizuki, Shafiqullah Hemat, Masafumi Watanabe and Kaoruko Seino
BMC Public Health (in press)

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