Afghan Children Research Articles

Prevalence and risk factors of vitamin D deficiency among Afghan primary school children

Vitamin D deficiency is common in many societies and causes rickets and non-skeletal disorders in children. There are no published data on vitamin D deficiency in Afghanistan. We, therefore, investigated the prevalence and associated factors of vitamin D deficiency in Afghan school children in Kandahar City, Afghanistan. This cross-sectional analytical study was conducted from September 2022 to April 2023 in 510 primary school students aged 6–15 years from six randomly selected schools. Data were analyzed by using descriptive statistics, Chi-square test, and multivariate logistic regression. Of the 510 enrolled children, 54.3% were boys and 91.8% were poor. The mean serum 25(OH)D concentration was 9.3 ng/mL. Vitamin D deficiency (< 20 ng/mL) was detected in 436/510 (85.5%) children that was severe in 267/510 (52.4%). By logistic regression analysis, independent factors for vitamin D deficiency were: (i) older age group 11–15 vs. 6 − 10 years, adjusted odds ratio (AOR) 2.8 (95% confidence interval 1.2–6.2), (ii) poverty AOR 2.0 (1.0–4.3), (iii) not doing outdoor physical activity AOR 4.8 (2.8–8.1), and (iv) daily sunlight exposure < 60 min AOR 2.2 (1.3–3.7). Although Kandahar is very sunny throughout the year, vitamin D deficiency is highly prevalent among school boys and girls, placing them at great risk of vitamin D-deficient rickets. More work is needed to define the country-wide prevalence of vitamin D deficiency to inform robust strategies of vitamin D supplementation, the provision of vitamin D-fortified food to the school children in Kandahar City and health education programs that can be conducted with the help of international organizations.

Central Precocious Puberty in a 5-year-old Boy with Hypothalamic Hamartoma: A Case Report and Review of the Literature

Background: Central precocious puberty (CPP) occurs due to the precipitous production of gonadotropin-releasing hormone (GnRH) and premature activation of the hypothalamic-gonadal axis. It is the most typical endocrine symptom of hypothalamic hamartoma. Hypothalamic hamartomas (HH) are rare, non-cancerous malformations of the central nervous system (CNS). They can show up as CPP related to the release of luteinizing hormone in addition to developmental delay, visual impairments, hyperactivity, or gelastic seizures in young children. Case Description: In this study, we present the case of a five-year-old Afghan child who displayed quickly evolving secondary sexual traits linked to hypothalamic dysfunction. Endocrine testing supported the central underlying cause of early puberty. The early detection of a small-sized, rounded lesion at the base of the tuber-cinereum on Magnetic Resonance Imaging (MRI) led to the diagnosis of Hypothalamic hamartoma (HH). To delay puberty, the patient was treated conservatively with a long-acting gonadotropin-releasing hormone (GnRH) analogue and his response was monitored. Conclusion: This case report includes a review of the relevant literature as well as possible management strategies for a hypothalamic hamartoma.

Evaluating the Effectiveness of the Nudge Theory in Improving the Oral Self-Care of Schoolchildren with Refugee and Immigrant Backgrounds in Mashhad, Iran.

Nudge theory proposes using subtle interventions to encourage individuals to make better decisions. The aim of this study was to evaluate the effectiveness of the Nudge theory in plaque control and assess caries experience among third-grade primary schoolchildren with refugee and immigrant backgrounds in Mashhad, Iran. Moreover, Afghan and Iranian schoolchildren were compared to assess differences in oral health outcomes. A quasi-experimental field trial was conducted in three public primary schools, comprising 309 participants approximately 9 years old. Interventions were randomly assigned to three schools: School I Messages based on Social Norms (MSN), School II Messages based on Fear of Negative Outcome (MFNO), and School III control group (C). MSN and MFNO received customized motivational video clips at baseline, while C only received Oral hygiene instruction (OHI). All participants received OHI, a brush, and toothpaste. Baseline plaque index (PI) and caries experience in primary and permanent dentition (dmft/DMFT) were recorded. PI was reassessed at two weeks, two months, and six months post-intervention. All data were subjected to statistical analysis. The mean PI decreased significantly in all three groups at the two-week follow-up (p < 0.01). The PI improvements declined over a six-month follow-up period in all groups, and the mean PI difference after six months compared to the pre-intervention was significant only in MSN and MFNO (p < 0.01), while C reverted almost to the pre-study level. Schoolchildren with at least one filled tooth or Iranian nationality showed a greater PI reduction (p < 0.01, p = 0.05). The overall mean ± SD dmft and DMFT were 4.24 ± 2.11 and 1.70 ± 1.24, respectively. Among all the examined participants, 32 (10.40%) individuals were caries-free. The mean dmft was statistically significantly higher in Afghan children than in Iranians (p = 0.01). MSN was more effective on PI reduction in the short term, while MFNO was more long-lasting. Using the Nudge theory via visual aids was more effective in motivating children to perform better oral self-care than solely traditional OHI.

Prevalence of stunting and its correlates among children under 5 in Afghanistan: the potential impact of basic and full vaccination

BackgroundChild 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.MethodsThis 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.ResultsA 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.ConclusionIn 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.

Effectiveness of Intervention Package of Specialized Nutritious Foods and BBC During the First 1,000 Days of Life to Prevent Stunting Among Children in Afghanistan

Effectiveness of Intervention Package of Specialized Nutritious Foods and BBC During the First 1,000 Days of Life to Prevent Stunting Among Children in Afghanistan

From Exclusion to Empowerment: Strategies for Enhancing the Educational Opportunities of Afghan Migrant Children in Pakistan

The research examines the challenges Afghan migrant children face in Pakistan and offers empowering strategies. The study examines human rights, mobilization, and migration in the context of the current sociopolitical scenario, which has caused a large influx of Afghan refugees to Pakistan. The study examines structural issues and proposes ways to enhance educational opportunities for Afghan migrant children and addresses the educational challenges Afghan migrant children face. The findings show that comprehensive filtering improved the dataset for future research.. The research's main results improve our understanding of the issues and new strategies for enhancing educational inclusion. This comprehensive evaluation recommends strategies that enable students to combat educational inequalities. The study recommends an attitude change to help Afghan migrant children, their families, and their communities. It takes removing obstacles and encouraging inclusion to achieve this goal.

Refugee and asylum-seeker children and health problems in the city of Duzce, Türkiye.

This study examines the health problems and healthcare needs of refugee and asylum-seeker children and aims to develop strategies for improvement. Based on quantitative data from 448 refugee and asylum-seeker children and 222 non-refugee local children, this study was conducted at Düzce University, Department of Paediatrics, between 2010 and 2021. The refugee children originated from three countries: Iraq (n = 304), Syria (n = 101) and Afghanistan (n = 43). The data were analysed using the SPSS data analysis program. Ethical clearance was obtained from the Ethics Committee of Düzce Üniversity. The results suggest that refugee and asylum-seeker children have significantly higher rates of acute illness or infection, malnutrition (p < 0.001) and anaemia (p < 0.001) than local children as a result of living in overcrowded families (p = 0.017) and unhealthy conditions. Adolescent pregnancy (p = 0.049) emerges as an important social problem as a result of child marriage among refugee children, mostly in the form of consanguineous marriages (p < 0.001). The rate of having at least two adolescent pregnancies (under 18) was highest among Syrian refugee girls (p = 0.01). Although refugee and asylum-seeker children have higher rates of health insurance (between 74% and 95%), they have lower rates of insurance compared to local children. This research also compares the data from three nationalities, including Syria, Afghanistan and Iraq children; Iraqi and Afghan children under the international protection (IP) system with limited social support and rights had worse health conditions compared to other groups. Although Iraqi children had the highest rates of health insurance on admission (p < 0.001), they also had higher rates of chronic diseases (p = 0.001), infections (p = 0.004), allergic rhinitis (p = 0.001) and malnutrition (p < 0.001). The youngest age of admission (p = 0.006) and the shortest length of stay (p = 0.004) were for Afghan children who also had higher rates of upper respiratory infections (p = 0.021). This study highlights the urgent need for improved screening programmes and the importance of collaborative efforts to address the specific health needs of these populations. Addressing the health status of child refugees is a complex and multifaceted task that requires the active participation of healthcare professionals, policymakers and researchers, each of whom has a crucial role to play.

Coming of Age While Challenging Borders: Networks of Solidarity and Resistance of Swedish-Afghan Youths on the Move in Europe

This article examines the strategies of resistance enacted by an informal network of solidarity comprised of Afghan youths on the move in Europe and their Swedish allies. In 2015, thousands of Afghan children fleeing from the Taliban regime arrived in Europe as unaccompanied minors. Many have been hosted in Sweden and lived there for several years, until coming of age. Reaching 18 years prompted a series of consecutive losses, as the Swedish state limited their opportunities to remain in the country or even illegalized them. Subjected to threats of detention, deportation, and ill treatment, many Afghan youths re-escaped into other European countries, crafting networks of informal solidarity to help them resist border violence. This article is based on an ethnographic study that delves into the lived experiences of four Afghan youths who lived in Lisbon between February 2019 and February 2020, particularly focusing on the journey of Ahmed, a young man of Hazara ethnicity. The empirical data shed light on the solidarity enactments that enhanced the youths’ resistance in hostile environments, inviting reflection on the impacts of the European border regime and the importance of agency, care, and political contestation.

Primary school student’s mental wellbeing at schools considering the current situation in Afghanistan

This study investigates the mental wellbeing of children in primary school in Afghanistan during periods of political instability, specifically focusing on the Taliban's takeover of power in 2021. The study addresses the complex obstacles encountered by children, such as gender-based limitations on education, financial difficulties resulting in child labor, restrictions on personal independence, and changes in educational objectives, through the use of qualitative interviews conducted with teachers and students from different regions. The findings indicate significant impacts on the mental well-being of students, characterized by gender inequalities, financial difficulties, and limited liberties. Teachers also face obstacles such as evolving rules and financial hardships, which can impact their mental health. The evaluation also emphasizes the lack of supportive programs and healthcare services in Afghan schools. This research offers valuable perspectives on the experiences of students and instructors, which can help address the mental health crisis affecting primary school children in Afghanistan.

‘Jihad literacy’: the legacy of US-sponsored textbooks for Afghan children

ABSTRACT This paper uses critical discourse analysis and critical literacy to analyze the first in a series of literacy primers developed with US support for children in Afghanistan in the 1980s, called ‘Jihad literacy’. The text is analyzed for its ideological content as related to the themes of religion, violence, and martyrdom in the historical perspective of the Cold War and the Soviet Union’s invasion of Afghanistan. The paper demonstrates how the notion of ‘Jihad’ was subverted to promote a holy war against the Soviet invasion. The educational system supported by the US created a radical version of Islam based on violence and martyrdom, shaping the Afghan society to this day. We contend that the same or similar institutions shape current discourses as in the past and that children are the main victims of politico-economic warfare.

A qualitative study on the challenges of Afghan child labourers in Tehran.

Afghan refugees child labourers face many challenges as they are labelled as refugees. In an attempt to explore these challenges, the present study was conducted in Tehran with a qualitative approach. The present qualitative research was conducted using a conventional content analysis approach with 25 Afghan child labourers in 2022 in Tehran. Child labourers were selected through purposive and snowball sampling and interviewed in a semi-in-depth interview. The data were analysed based on Granheim and Lundman's criteria, as well as those of Guba and Lincoln, to further enrich the findings. A total of 3 categories, 13 sub-categories, and 183 initial codes were extracted from the data analysis, including: "psychological challenges" (history of harassment and abuse, negative effects, high-risk behaviours, and family detachment); "health challenges" (physical problems, inappropriate accommodation, medical/therapeutic problems, and health threats); and "social challenges" (neglected childhood, dual identity, educational limitations, inadequate social support, social isolation, and social humiliation). At the individual level, it is possible to meet the child labourers' health needs and make them aware of the hazards of working in the streets through physical examination at certain intervals and holding training workshops on harassment prevention, anger control, prevention of high-risk behaviours, prevention of infectious diseases such as hepatitis, and strengthening self-confidence to improve health. Also, the Afghan child labourers' work could be intervened at the social and familial level by providing accommodation in more suitable neighbourhoods, providing health insurance for child labourers, creating the chances of studying in schools, preventing dropouts, and strengthening social relations in order to improve children's health.

The precarious lives and survival strategies of unaccompanied Afghan youth in Türkiye

Unaccompanied children who do not or cannot access the child protection system in Türkiye often become engaged in child labor and find themselves living in precarity. This paper highlights narratives of survival within their culturally-assumed transition to manhood based on empirical research on the life experiences of 12 unaccompanied, male Afghan youth who came to Türkiye as unaccompanied children. These narratives reflect patriarchal culture, particularly the Taliban’s extreme manifestations of patriarchy, both in a context of war and violence. Unaccompanied Afghan children migrate for survival and, after dangerous journeys, live as irregular migrants. Their daily life is marked by (1) fear of police and deportation, (2) child labor, (3) long and challenging work routines, (4) lack of leisure time, schooling, adult protection or support and (5) lack of social security. As a result, they develop survival strategies to manage their precarious lives. Their narratives share commonalities focusing on the conditionalities of constructing manhood.

Congenital duodenal web causing partial obstruction with recurrent vomiting and abdominal distention in a toddler boy: a case report

BackgroundThe duodenal web is a thin, elongated, web-like structure that is one of the factors contributing to duodenal obstruction. Only 100 cases have been reported in the literature. We present a 2.5-year-old cachectic Afghan child who did not have any overt signs and symptoms of intestinal obstruction, like recurrent vomiting, abdominal distention, and weight loss. The web was discovered near the intersection of the third and fourth portions, which is an uncommon location for the duodenal web. The late presentation of congenital duodenal web with partial obstruction is rare but well-known and has been reported in this case.Case presentationA 2.5-year-old cachectic Afghan child who had recurrent vomiting and experienced abdominal distention was brought to Maiwand Teaching Hospital from the Jabelsuraj region of Parwan province. The patient was suffering from unusual signs and symptoms like recurrent vomiting, abdominal distention, weight loss, and constipation. The diagnosis of these anomalies was established by a detailed history, clinical features, and abdominal CT scan. In the computerized tomography scanning (CT-Scan) image reported, there was a web with stenosis and partial obstruction in the distal aspect of the third-to-fourth portion of the duodenum. After preoperative stabilization, the child was taken for surgery. The abdomen was opened by a right upper abdominal transverse incision. After web resection and duodenoplasty, the patient was shifted to the recovery room in satisfactory condition. The child was allowed to feed after 8 days, which he tolerated well.ConclusionCongenital duodenal web with partial obstruction is typically observed in the second and third years of life. It is suspected in patients with recurrent vomiting, abdominal distention, weight loss, and constipation. Partial obstruction may not have an overt presentation, making it a challenging diagnosis for general practitioners. Abdomen X-ray and CT scan usually confirm the diagnosis, and successful surgical intervention is recommended.

Health Profile of Afghan Pediatric Refugees Resettled to Philadelphia in 2021-2022.

To elucidate the physical and psychosocial health needs of newly arrived Afghan children, we conducted a retrospective chart review of patients 0 to 19 years re-settled to Philadelphia with ≥1 outpatient visit during August 2021 to August 2022. Findings on 121 patients include dental caries (74%), elevated lead (32%), eosinophilia (29%), malnutrition (25%), schistosomiasis (6%), strongyloidiasis (8%), latent tuberculosis (7%), and two cases of cutaneous leishmaniasis. Mental health symptoms include poor sleep in 16%, low energy in 10%, and behavioral concerns in 13%. Families with low English proficiency were more often met with delayed medical care (26.7% vs 11.5% P = .12). Parents with less than a high school education were more likely to experience delayed care (38.5% vs 9.1%; P = .001). We conclude that recently arrived Afghan children have unique physical and mental health needs that need to be addressed.

Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study.

This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan. The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis. The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers. Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.

Exploring the determinants ofsuccessful implementation ofa preventive mental health andwellness intervention forAfghan refugee families: a qualitative analysis.

Many refugee children experience trauma in early childhood. Effective, tailored interventions are needed to improve refugee children's access to preventive mental health. We interviewed refugee-serving stakeholders and parents participating in an evidence-based preventive mental health and wellness intervention adapted for Afghan refugee children and families who may have experienced trauma. Interview guide development was informed by two implementation science frameworks: the Consolidated Framework for Implementation Research and the Model for Adaptation Design and Impact. A three-person team coded transcripts via rapid qualitative analysis, and the study team reached consensus on themes. Six refugee-serving facilitators and five refugee parents discussed key determinants of successful implementation. Themes included: (i) modeling cultural humility to promote communication about emotions; (ii) needed linguistic support and referral networks to avoid miscommunications and missed communications; (iii) bridging connections between children, families and schools; (iv) different takeaways, or differing goals and expectations between facilitators and participants; and (v) timely, specific cultural considerations to overcome participation barriers. Overall, we found key determinants of successful implementation of a preventive mental health and wellness intervention for refugee children and families included adaptations to enhance cultural humility and sensitivity to cultural context while strengthening communication among facilitators, children and families.

Prevalence of Amblyopia among School age children in Eye University Hospital, Kabul – Afghanistan

Introduction: Amblyopia is the reduction of monocular and rarely binocular vision, in the best case, it is the correction of the refractive error, which is caused by the visual deprivation of the affected eye or the abnormality of the binocular interaction, which does not have any other pathology in the way of vision. Amblyopia occurs in the most fundamental period of the development of visual system. It is estimated that the age of occurrence is between 0-8 years old and its prevalence is between 0.2-6.2 % globally. Objective: Amblyopia is one of the worrying problems among children in Afghanistan, and epidemiological studies are considered necessary for its management. On this occasion, an attempt has been made to explain the prevalence of amblyopia in school age children, according to their age, gender and correspondence. Method and Data collection: This is a retrospective cross-sectional (descriptive) study and all the information of 2151 patients were obtained from the files of patients in the age group of 7-18 years' old who were visited by the eye University hospital from 21 March to 22 Sep 2022. Then those patients who have been diagnosed with amblyopia; have been studied. Results: Out of 2151 participants aged 7-18 years with various eye complaints, 152 of them (7%) have amblyopia. 7.9% (89 Participants) are boys and 6.09 % (63 Participants) are girls. Unilateral amblyopia is found in 74.34% of cases (113 Participants) and bilateral amblyopia in 25.65% of cases (39 Participants). Conclusion: 7% of school age children, average age of 13.39 years is suffering from amblyopia. Percentage of amblyopia is higher in boys than in girls and; most patients have unilateral amblyopia.

Developmental Prevention of Violence against Children in Afghanistan

خشونت علیه اطفال در جوامع مختلف دیده می¬شود؛ اما در افغانستان‌‌ به دلیل شرایط ناگوار اجتماعی، اقتصادی، سیاسی، فرهنگی و به‌خصوص ضعف فرایندهای آموزشی و تربیتی، این پدیده بیش‌تر بوده و پیامدهای ویران‌گری بر جای می¬گذارد. پرسش این است که در برابر امواج روز‌افزون خشونت علیه اطفال، چه تدبیری می¬توان اندیشید و کدام سازوکار پیش‌گیرانه را می¬توان برای کاهش خشونت علیه اطفال، اتخاذ کرد؟ پاسخ به این پرسش، مهم است؛ چه این‌که آیندۀ کشور، منوط به حمایت از اطفال آینده‌ساز است. نوشتۀ حاضر تلاش کرده با روش تحلیلی و با استفاده از داده‌های کتاب‌خانه‌یی و با روی‌کرد جرم¬شناختی، به این مهم بپردازد. یافته¬های تحقیق نشان می¬دهند که: پیش‌گیری وضعی و اجتماعی در شرایط کنونی افغانستان برای جلوگیری از خشونت علیه اطفال مناسب نیست. روش به‌تر، رفع آسیب‌پذیری اطفالِ در معرض خطر از طریق سازوکارهای آموزشی و نظارتی مندرج در پیش‌‌گیری رشدمدار می¬باشد،‌ که پیش-نهادهای مشخصی را در باب اصلاح متون آموزشی، ایجاد کانون مشاوره در مکتب، آموزش اولیا و مربیان، برگزاری برنامۀ حلقه¬های خانواده‌گی، تأسیس کلینیک حقوقی اطفال، ایجاد مرکز آمار و گزارش خشونت علیه اطفال و ... ارائه می¬کند. این موارد می-تواند راه¬های مؤثری برای تأمین مصونیت اطفال به‌حساب آیند

Prevalence of hypovitaminosis D among children and adolescents of Kabul: a descriptive cross-sectional study

BackgroundVitamin D is one of the most important fat-soluble vitamins necessary for normal growth and development of the human body. According to a study done in Kabul shows that economic, racial, and social concerns are thought to be the main impediments to receiving appropriate amounts of this vitamin through dietary sources in countries like Afghanistan. Hypovitaminosis D, on the other hand, is now recognized as a pandemic in both industrialized and developing countries.MethodsTo find out how common hypovitaminosis D is in children aged one month to eighteen years in afghan children Kabul, Afghanistan. Vitamin D deficiency and insufficiency are defined as serum levels of less than 20 ng/mL and 20 to 30 ng/mL, respectively. Children aged between 1 month to 18 years attending our hospital, AMC (Ariana Medical Complex) for health examination were checked for their 25-hydroxyvitamin D [25(OH)D]. Age, gender and address were recorded. 25(OH)D were determined using immunoassay auto analyzers. According to their serum 25(OH)D, the 25(OH)D were categorized into five categories: sufficiency: ≥ 30-100 ng/mL; insufficiency: ≥ 20-29 ng/mL; deficiency: < 20 ng/mL; severe deficiency: < 10 ng/mL; and intoxication: > 150 ng/mL. Participants who were intoxicated with vitamin D were excluded from the study.ResultsA total of 4008 children aged 1 month to 18 years participated in this cross-sectional study. Hypovitaminosis D was found to be prevalent in 62.5 percent of the population. When compared to boys, female children were 1.2 times more likely to be vitamin D deficient. When compared to children of illiterate women, the odds of hypovitaminosis D were 1.4, 1.9, and 5.8 times lower in children with mothers educated up to primary school, graduation, and post-graduate. The average vitamin D level was 23 ng/mL, with a median of 15 ng/mL and maximum and minimum values of 135 ng/mL and 3 ng/mL, respectively.In all, 2500 (62.5%) of the children had low levels of vitamin D in their serum. Only 400 (16%) of the patients were sufficient, whereas 917 (36.7%) were severely deficient, 733 (29.3%) were deficient, and 450 (18%) were insufficient. With a female to male ratio of 1.2:1, the majority of those, 1335 (53.4%), were females and 1165 (46.6%) were males. Patients were 8.14 years old on average, with a median age of 7 years. The majority of the patients, 2152 (86.1%), were urban, while 348 (13.9%) were rural.ConclusionThe prevalence of hypovitaminosis D was very high in Afghan children. Female sex, higher socio economic status, higher educational status of the mother and living at urban areas were the factors with strong positive association with hypovitaminosis D.

Education as a protective factor for mental health risks among youth living in highly dangerous regions in Afghanistan

BackgroundChildren in Afghanistan live in dangerous areas, and have been exposed to traumatic events and chaotic education. Progress has been made on access to education for girls who were the most affected by traditional attitudes against engagement in education.ObjectivesThe objectives were to evaluate the mental health of Afghan children living in regions of conflict and the association of mental health with school attendance for girls and boys.MethodThe study included 2707 school aged children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parental report Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location.ResultsA total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39.19% for emotional difficulties, 51.98% for conduct challenges, and 15.37% for hyperactivity/inattention. Peer relationship problems were high (82.86%) and 12.38% reported that these problems impacted daily life. The level of terrorist threat was associated with SDQ total difficulties (Adjusted Odds Ratio [AOR] = 4.08, P < 0.0001), with youth in regions with high levels of terrorist threat more likely to have problems than youth in regions with low or medium levels of danger, independent of region and ethnicity. School attendance was negatively associated with emotional symptoms (AOR = 0.65, P < 0.0001) and mental health difficulties with impairment (AOR = 0.67, P = 0.007), but positively associated with peer relationships difficulties (AOR = 1.96, P > 0.0001). Conduct (AOR = 1.66, P < .0001) and SDQ total difficulties (AOR = 1.22, P = 0.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health.ConclusionAttending school is essential for children’s mental health, across gender, and should be supported as a priority in Afghanistan despite the return of the Taliban.