Knowledge, Perceptions, and Experiences Regarding Factors Affecting Maternal Mortality and Child Nutrition in Afghanistan

Abstract

Objective: The study focused on investigating the perceptions, knowledge, and experiences regarding maternal mortality and nutritional deficiencies among the healthcare workers, medical students, and community members in Afghanistan. Method: A descriptive cross-sectional survey employing the Snowball Sampling (SBS) method was conducted. A total of 620 people representing four geographic zones of Afghanistan participated in the study, including healthcare providers (n=75), medical students (n=386), and people from the community (n=159). Data on knowledge, practices, clinical exposure, and barriers to maternal and child nutrition were collected via structured questionnaires. Results: The primary causes of maternal death were hemorrhage (72.7%) and malnutrition (41.6%). Iron deficiency was the most common nutritional issue (76.6%), and congenital anomalies like heart defects were often attributed to malnutrition. Only 13% of professionals believed nutrition protocols had been well implemented. The medical students recorded poorly in clinical readiness, whereas 76.7% of community members had no access to government nutrition programs to speak of. Regardless of the group, poverty was identified as the main barrier. Conclusion: Despite moderate awareness of maternal nutrition's importance, systemic gaps, poor infrastructure, and inconsistent program access hinder progress. Multisectoral strategies are urgently needed to address maternal mortality and child malnutrition in Afghanistan. Efforts should prioritize education, clinical training, and equitable program delivery to improve maternal and child health outcomes.

Keywords

• Child malnutrition
• birth defects
• nutritional deficiencies
• maternal health
• Afghanistan

References

1. United Nations International Children’s Emergency Fund (UNICEF). UNICEF Afghanistan annual report 2024 [Internet]. 2024 [cited 2025 May 22]. Available from: https://www.unicef.org/afghanistan/media/11336/file/UNICEF%20Afghanistan%20annual%20report%202024_low%20res.pdf
2. Qamar K, Essar MY, Siddiqui JA, Salman A, Salman Y, Head MG. Infant and child mortality in Afghanistan: A scoping review. Health Sci Rep. 2024;7:e2224.
3. Naziri M, Higgins-Steele A, Anwari Z, Yousufi K, Fossand K, Amin SS, et al. Scaling up newborn care in Afghanistan: Opportunities and challenges for the health sector. Health Policy Plan. 2018;33(2):271–82.
4. Naeem M, Ahmad B, Malik S. Burden of congenital and hereditary anomalies in the war-affected territory at Pakistan-Afghanistan border. Asian Biomed (Res Rev News). 2022;16(6):299–309.
5. Faizi A, Sohi P. The impact of prenatal care on maternal mortality among women aged 15 to 49 in Afghanistan. Int J Contemp Med Res. 2025;3(2):55.
6. World Health Organization. Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. Geneva: WHO; 2023.
7. Ozimek JA, Kilpatrick SJ. Maternal mortality in the twenty-first century. Obstet Gynecol Clin North Am. 2018;45(2):175–86.
8. Tawfiq E, Stanikzai MH, Anwary Z, Akbari K, Sayam H, Wasiq AW, Dadras O. Quality of antenatal care services in Afghanistan: Findings from the national survey 2022–2023. BMC Pregnancy Childbirth. 2025;25:71.

9. Bartlett L, Mawji S, Whitehead S, Crouse C, Dalil S, Ahmadzai M, et al. Progress and inequities in maternal mortality in Afghanistan (RAMOS-II): A retrospective observational study. Lancet Glob Health. 2017;5(5):e545–55.
10. Centers for Disease Control and Prevention. Update on overall prevalence of major birth defects—Atlanta, Georgia, 1978–2005. MMWR Morb Mortal Wkly Rep. 2008;57(1):1–5.
11. World Health Organization. Birth defects: Report by the Secretariat (A63/10). Geneva: WHO; 2010.
12. Feldkamp ML, Carey JC, Byrne JLB, Krikov S, Botto LD. Aetiology and clinical presentation of birth defects: Population-based study. BMJ. 2017;357:j2249.
13. Hashimi SM. Determinants of congenital anomalies in Afghanistan [Master’s thesis]. Amsterdam: Royal Tropical Institute (KIT) & Vrije Universiteit Amsterdam; 2017.
14. Heckathorn D. Comment: Snowball versus respondent-driven sampling. Sociol Methodol. 2011;41:355–66.
15. Cohen N, Arieli T. Field research in conflict environments: Methodological challenges and snowball sampling. J Peace Res. 2011;48:423–35.
16. Afshar A, Hakimi M, Razmju F, Yaqooby B, Yahya MA. Challenges and opportunities for women farmers in Afghanistan. Int J Life Sci Biotechnol. 2025 Apr 1;8(1):1–9.