Health-related quality of life among parents of malnourished children under five in Herat, Afghanistan: A cross-sectional study

Background: Malnutrition in children under five remains a major public health problem in Afghanistan, driven by poverty, conflict, food insecurity, and limited health services. Although child outcomes are widely studied, the health-related quality of life (HRQoL) of caregivers has received less attention. This study evaluated HRQoL among parents of malnourished under-five children in Herat and identified socio-demographic factors associated with physical and mental health outcomes.
Methods: A cross-sectional study was conducted among 531 parents/caregivers attending nutrition and child health services in Herat. Eligible participants were adults (≥18 years) accompanying children diagnosed with acute malnutrition using MUAC criteria. Data were collected using a structured questionnaire and the validated Dari version of the SF-36. Domain scores were transformed to a 0–100 scale (higher scores indicate better HRQoL). Physical Component Summary (PCS) and Mental Component Summary (MCS) were examined using multiple linear regression in SPSS v27, with significance set at p<0.05.
Results: Participants were predominantly female (61.0%), illiterate (87.6%), unemployed (69.5%), and from poor households (70.1%). HRQoL was generally low across SF-36 domains. Social functioning had the highest mean score (47.81; 95% CI: 46.10–49.53), followed by bodily pain (46.16; 95% CI: 44.25–48.07) and physical functioning (41.07; 95% CI: 38.07–44.08). The lowest scores were observed for role-emotional (19.77; 95% CI: 16.38–23.17), general health (23.16; 95% CI: 22.31–24.02), and role-physical (24.86; 95% CI: 21.17–28.55). Fair economic status predicted higher PCS (β=3.99, p=0.031), rural residence predicted lower PCS (β=−4.98, p=0.006), and school/university education predicted higher MCS (β=7.10, p=0.031).
Conclusion: Parents of malnourished children in Herat experience substantial impairment in HRQoL, especially in emotional and general health domains. Integrating caregiver-focused psychosocial support, education, and socioeconomic assistance into nutrition programs may improve parental well-being and child recovery outcomes.