Afghan child mortality linked to uneducated mothers

HONG KONG (Reuters) - High child mortality rates in conservative Afghanistan are linked not just to war but to mothers being uneducated and having little or no say when their children need medical help, a study has found.

Child mortality rates in Afghanistan are among the highest in the world, and one out of every five Afghan children (or 191 out of every 1,000 live births) will not survive beyond age five.

The study of 2,474 children from 1,327 households in Kabul province found that diarrhoea (32.5 percent), acute respiratory infection (41 percent), emaciation (12.4 percent) and stuntedness (39.9 percent) were among the most common health problems, said the article published in the latest issue of BioMed Central Public Health.

"As in other countries, the primary caregivers of small children in Afghanistan are their mothers; however, in this country, mothers are subject to a number of restrictions in the decision-making process regarding child healthcare," said the article published by a team of Afghan and Japanese researchers.

The researchers said they interviewed mothers of the children and found the problems correlated most closely with mothers not having any autonomy (79.1 percent) and education (71.7 percent).

Up to 18.3 percent of the mothers also delivered their first child before they were 16, which meant they were married when they were still children, the researchers wrote.

A shortage of basic material needs was also observed in 59.1 percent of the households.

The researchers defined a lack of maternal autonomy to mean mothers requiring permission from the head of the household to bring a child to the doctor, or if she required another person - usually a male relative - to accompany her to a clinic with the child.

Afghanistan is deeply conservative and women's movements are still restricted in many parts of the country.

The researchers defined a lack of education as not having attended school for at least a year.

"The poor economic and educational status of these women, and their overall immaturity caused by a lack of learning opportunities may have resulted in difficulties in preventing illness in their children," they wrote.

They called for change in Afghan society. Families needed to be educated and the government must play its part, they said.

"Culturally appropriate programmes with multifaceted approaches that provide families and communities with education and reproductive health services can help stop child marriage," they wrote.

They said while an effective healthcare system was urgently required in Afghanistan, changes were also needed in the behavior of men toward women in their families and in the community.

"Current country-wide efforts to ensure that all women have access to formal education, the elimination of poverty and the improvement of sanitary conditions should be further enforced."

(Reporting by Tan Ee Lyn; Editing by Valerie Lee)