National prevalence of diarrhea and associated factors among children under five in Afghanistan

Background Diarrhea is a leading cause of mortality and morbidity among children under five in Afghanistan. Assessing the prevalence and identifying its key determinants is essential for reducing the disease burden and effective public health interventions. Methods The study analyzes prevalence and determinants of diarrhea among children under five years, using secondary data from Multiple Indicator Cluster Survey (MICS) in Afghanistan 2022–2023, including 32,989 children representing all 34 provinces, including urban and rural regions. Multivariable logistic regression was performed to calculate adjusted odds ratios (AOR) for the association between covariates and the diarrhea outcome. Results Overall, 38.2% of children had diarrhea (95% CI: 37.0-39.4). After adjustment, children aged 6–11 months (AOR = 1.80, p < 0.001), 12–23 months (AOR = 1.72, p < 0.001), 24–35 months (AOR = 1.55, p < 0.001), and 36–47 months (AOR = 1.16, p < 0.001) had significantly higher odds of diarrhea compared with infants aged 0–5 months. Children of mothers aged 20–29 years (AOR = 0.78, p < 0.01) and 30–39 years (AOR = 0.77, p < 0.01) had significantly lower odds of diarrhea compared with those born to mothers aged < 20 years. Children from the richest households had significantly lower odds of diarrhea (AOR = 0.60, p < 0.01), as did those whose mothers had above-primary education (AOR = 0.80, p < 0.01). Higher odds of diarrhea observed among children living in households practicing open defecation (AOR = 1.19, p < 0.01), and in the South (AOR = 1.61, p < 0.001), and East (AOR = 1.47, p < 0.001) regions compared to Central region. Conclusion More than one in three children had diarrhea. Childhood diarrhea in Afghanistan remains driven by modifiable factors, particularly unsafe weaning-period practices, low maternal education, and poor sanitation, with children aged 6–35 months and those living in households practicing open defecation at substantially higher risk. Strengthening infant and young child feeding interventions, expanding girls’ education, maternal health literacy, accelerating sanitation and behavior change programs could substantially reduce diarrhea burden. Targeted implementation in high-risk regions, especially the South and East, is essential to address persistent geographic inequities.