Abstract
BACKGROUND: Diabetes mellitus is a major public health concern in low- and middle-income countries, particularly in fragile health systems such as Afghanistan. Limited community-based evidence exists on the burden and correlates of diabetes among rural populations. This study aimed to estimate the prevalence of diabetes and identify its associated risk factors among adults living in rural areas of Herat province, Afghanistan, using the WHO Stepwise approach to noncommunicable disease (NCD) risk factor surveillance. METHODS: A community-based cross-sectional survey was conducted from January to December 2024 among adults aged ≥ 18 years residing in rural areas of Herat province. A multistage cluster sampling technique was applied following the WHO STEPS methodology. Data were collected on sociodemographic characteristics, behavioral and metabolic risk factors using standardized questionnaires, physical measurements, and fasting blood samples. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dL or self-reported use of antidiabetic medication. Both bivariable and multivariable logistic regression analyses were performed to determine factors associated with diabetes, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) reported. RESULTS: A total of 609 participants were included in the analysis (mean age: 40.6 ± 15.8 years; 51.9% were female). The overall prevalence of diabetes was 7.6% (95% CI, 5.6-9.9). In the multivariable analysis, age 45-54 years (AOR = 3.99; 95% CI: 1.31-12.16) and hypertension (AOR = 2.37; 95% CI: 1.29-4.36) were independently associated with diabetes. Education and central obesity were significant in bivariable analysis but lost significance after adjustment. CONCLUSIONS: The prevalence of diabetes among adults in rural Herat province is considerable, highlighting an urgent need for community-level screening and preventive interventions prioritizing older adults and individuals with hypertension. Strengthening primary health care and integrating NCD surveillance in rural Afghanistan are essential to reduce the growing burden of diabetes.