Sanitation and Diarrheal Morbidity: Evidence from Afghanistan

Background: Lack of sanitation facilities and inadequate water is key to many diseases' outcomes, mainly diarrhea. These factors affect the health status of a country and result in increased mortality and morbidity pattern, particularly among the vulnerable population like children and women. Thus, the study assesses the linkages between diarrheal diseases and sanitation in Afghanistan affected since long by political instability, which has derailed the country's health system. Methods: We used the 2015 Afghanistan Demographic and Health Survey to assess the linkages between sanitation and diarrheal diseases among under-five children. Bivariate and multivariate analyses have been used to carry out the study. The logistic model was used to evaluate the risk factors that lead to diarrheal outcomes. Results: Our findings from the results showed that the prevalence of diarrhea among under-five children in Afghanistan was 29%. Pashai is the most affected, with 36% among ethnicities, whereas eastern Afghanistan is the most affected region with a prevalence of (38%). Open defecated Population (OR: 1.17, p<0.001), Tap water (OR: 1.31, p<0.001), Well water (OR: 1.24, p<0.001), and Sharing toilet (OR: 1.15, p<0.001) are significantly associated with childhood diarrhea. Conclusions: A significant impact has been found with inadequate sanitation, shared toilet facility, clean water, and other elements with childhood diarrhea in Afghanistan. The region-wise difference has also been found to be very high across the regions. Thus, it has been found that a lack of such factors has a more significant impact on children's health and needs a particular focus from a policy purpose.