Neighborhood-level contamination and risks of child morbidity and mortality in Afghanistan

Abstract The world’s poorest communities are most affected by environmental contamination, as they often lack access to essential sanitation services. Unsafe stool disposal practices by households further exacerbate contamination in shared neighborhood spaces, posing serious health risks not only to their own children but also to children living nearby. In this study, we examine the impact of neighborhood-level contamination and other environmental factors on child morbidity and mortality in Afghanistan. We estimate logistic regression models using cross-sectional data on 32,712 children under five from the latest publicly available Afghanistan Demographic and Health Survey, published in 2017. The findings show that children in neighborhoods where unsafe stool disposal is widespread face a 3.8 percentage points higher risk of diarrhea and a 1.1 percentage points higher risk of child mortality than those in neighborhoods where safe stool disposal is practiced. The use of polluting fuels for cooking increases the likelihood of cough in children by 1.5 percentage points and child mortality by 1.2 percentage points. In contrast, averting behaviors such as using non-shared toilets, improved water sources, and cooking in separate rooms or outdoor spaces significantly reduce the risks of these health outcomes. These findings highlight the need for targeted interventions to mitigate environmental health risks and safeguard child well-being in Afghanistan. Graphical Abstract