Socioeconomic, parental, and nutritional factors associated with congenital heart disease in children: insights from a hospital-based case-control study in Kabul, Afghanistan

Background: Congenital heart disease (CHD) is one of the most common congenital anomalies and a leading cause of childhood morbidity and mortality worldwide. The etiology of CHD is multifactorial, involving genetic predisposition, environmental influences, maternal health, and socioeconomic determinants. Limited evidence exists from Afghanistan regarding factors contributing to CHD. This study was conducted to identify maternal, paternal, household, and lifestyle factors associated with CHD among children attending Ariana Medical Complex, Kabul.

Objective: To identify parental, maternal, socioeconomic, and lifestyle factors associated with CHD among children in Afghanistan.

Methods: A hospital-based case-control study was conducted at Ariana Medical Complex, Kabul, from February to August 2025. A total of 414 parents of children who underwent echocardiography were enrolled, comprising 203 cases (children with CHD) and 211 controls (children without CHD). Data were collected using a structured 109-item questionnaire covering sociodemographic, maternal, paternal, nutritional, and household factors. Associations between variables and CHD were analyzed using Chi-square tests, crude odds ratios (ORs), and 95% confidence intervals (CIs). A p-value <0.05 was considered statistically significant.

Results: Low parental education and family income were strongly associated with increased CHD risk. Compared with illiterate mothers, maternal school graduation (OR = 0.20, 95% CI: 0.10–0.39) and higher education (OR = 0.22, 95% CI: 0.12–0.43) were protective factors. Similar protective effects were observed for paternal education, with higher education associated with an OR of 0.17 (95% CI: 0.10–0.29). Children from families with a monthly income of>30,000 AFN had markedly lower odds of CHD (OR=0.07, 95% CI: 0.03–0.15) compared to families earning <10,000 AFN. Expanded family structure (OR=1.89, 95% CI: 1.27–2.82), maternal hypertension before conception (OR=2.94, 95% CI: 1.38–6.26), poor maternal nutrition during pregnancy (OR=3.26, 95% CI: 1.53–6.96), and underweight paternal status (OR=3.12, 95% CI: 1.80–5.43) increased CHD risk. Conversely, folic acid (OR=0.50, 95% CI: 0.31–0.82), calcium/vitamin D supplementation (OR=0.58, 95% CI: 0.38–0.89), and higher intake of vegetables (OR=0.21, 95% CI: 0.11–0.41) and fruits (OR=0.40, 95% CI: 0.21–0.75) during pregnancy were protective.

Conclusion: This study provides robust evidence that congenital heart disease in Afghan children is associated with a constellation of modifiable socioeconomic, parental health, and nutritional factors. The findings underscore the crucial importance of comprehensive preconception and prenatal care, dietary interventions, and broader socioeconomic improvements in reducing the burden of CHD.

Integrated public health strategies targeting key determinants can help reduce CHD incidence and improve child health in Afghanistan. Given its multifactorial causes, coordinated efforts across healthcare, education, nutrition, and social welfare are essential to support healthy pregnancies and child development.

Dr. Abdul Wahed Sidiqi, a Kabul University MD graduate (2001), became a key figure in Afghan cardiology. He founded Ariana Hospital in 2009, pioneering a cardiology practice and echocardiography training, significantly advancing opportunities for female doctors. After further training in the Netherlands and South Korea, he introduced BLS and ACLS training in Afghanistan. In 2018, he established the state-of-the-art Ariana Medical Complex. A Fellow of the European Society of Cardiology (2023), he has published extensively, including a notable 2025 article, "Global Rounds Afghanistan: A Critical Overview of Cardiovascular Medicine," in the Journal of Circulation. He serves on the editorial board of the Cardiology Research Journal and received the Best Oral Presentation Award from Cardio Hub 2025.