Diabetes Prevalence and Associated Risk Factors among Adults in Rural Herat Province, Afghanistan: A Community-Based Cross-Sectional Study

Background Diabetes mellitus is a major public health concern in low- and middle-income countries, particularly in fragile health systems such as Afghanistan. Limited community-based evidence exists on the burden and correlates of diabetes among rural populations. This study aimed to estimate the prevalence of diabetes and identify its associated risk factors among adults living in rural areas of Herat province, Afghanistan, using the WHO Stepwise approach to noncommunicable disease (NCD) risk factor surveillance. Methods A community-based cross-sectional survey was conducted from January to December 2024 among adults aged ≥ 18 years residing in rural areas of Herat province. A multistage cluster sampling technique was applied following the WHO STEPS methodology. Data were collected on sociodemographic characteristics, behavioral and metabolic risk factors using standardized questionnaires, physical measurements, and fasting blood samples. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dL or self-reported use of antidiabetic medication. Both bivariate and multivariable logistic regression analyses were performed to determine factors associated with diabetes, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported. Results A total of 609 participants were included in the analysis (mean age: 40.6 ± 15.8 years; 51.9% were female). The overall prevalence of diabetes was 7.6% (95% CI, 5.6–9.9). In bivariate analyses, several factors—namely older age, central obesity, and hypertension—were significantly associated with diabetes. After adjusting for potential confounders in the multivariable logistic regression model, only hypertension remained independently associated with diabetes (AOR = 2.52; 95% CI: 1.37–4.63). Conclusions The prevalence of diabetes among adults in rural Herat province is considerable, highlighting an urgent need for community-level screening and preventive interventions targeting modifiable risk factors, particularly hypertension. Strengthening primary health care and integrating NCD surveillance in rural Afghanistan are essential to reduce the growing burden of diabetes.