Early nutrition practices and access to food and nutrition services for young malnourished children attending MSF-supported facilities in Herat, Afghanistan: a mixed-methods study

Abstract

Afghanistan’s protracted humanitarian crisis has intensified food insecurity and child malnutrition. In 2022, Medecins Sans Frontieres (MSF) reported that 45% of malnourished children admitted to Khadestan hospital were under 6 months, yet evidence on feeding practices and access barriers for infants < 12 months in Herat is limited. To describe breastfeeding and complementary feeding among infants aged 0–11 months attending MSF-supported services in Herat and to examine caregivers’ needs and barriers to food and nutrition services using the demand-side domains of Levesque’s access-to-care framework. Explanatory mixed methods in two MSF-supported facilities (Herat Regional Hospital; Khadestan clinic). Phase 1 analysed routine programme data (August–September 2022), including infant feeding practices, maternal and child food insufficiency and related coping strategies, health-seeking behaviour, and barriers to accessing health and nutrition services for all infants 0–11 months admitted with acute malnutrition (including severe acute malnutrition, SAM). Phase 2 comprised 38 in-depth interviews with caregivers of malnourished and non-malnourished infants and key informants (Jan–Jun 2023). Participatory approaches included training community peer researchers, informed tool refinement, data collection, and interpretation. Phase 1- Sixty-seven% of the children accompanied by the mother to the MSF health facilities ( N = 236) were currently breastfed, but only 17.8% of the children aged 0–5 months received breast milk without other foods or liquids according to their mother. Women frequently cited perceived low milk supply and limited breastfeeding support. Among infants ≥ 6 months, the majority ate ≥ 3 times/day, but diets were mainly cereals with frequent sweets. Although 92.3% of mothers ate ≥ 3 times/day, 63.5% reported ≥ 1 day of food insufficiency in the prior week; coping strategies included portion reduction mostly and meal skipping. For child illness episodes, 75.0% sought facility care first, yet 62.3% reported access barriers (distance, transport costs, poor roads, seasonal constraints). Phase 2- Interviews identified constraints across Levesque domains: low female literacy and reliance on informal advice (perceive); restricted autonomy, gender norms, and language-related stigma (seek); long travel times and harsh climatic/road conditions (reach); poverty and costs of transport/medicines (pay); and reduced self-efficacy, suboptimal feeding, and maternal stress/mental health challenges (engage). Early infant feeding among infants accessing MSF-supported health facilities in Herat is shaped by socio-cultural, geographic, and economic barriers. According to the study participants, programmes may pair facility nutrition care with community-led education, early counselling and peer support, targeted food assistance during antenatal/postnatal contacts, affordable transport solutions, and integrated maternal mental health support to improve access and outcomes for infants aged 0–11 months.

The authors' abstract, as published at the source. Conflict and Health, 2026 · DOI ↗