Epidemiology and Control of Foodborne Diseases in Resource-Limited Settings: Insights from Afghanistan

Food safety is a major global public health concern, with unsafe foods contaminated by biological, chemical, and physical hazards causing foodborne diseases (FBDs), resulting in a high global burden of illness and death. This narrative review provides an overview of current evidence on the epidemiology, risk factors, and control strategies of FBDs, with particular attention to challenges in resource-limited settings. These diseases are disproportionately severe in low- and middle-income countries (LMICs) due to interconnected factors such as poor sanitation, limited access to clean water, inadequate food safety practices, weak regulatory systems, and socioeconomic constraints, leading to high morbidity, mortality, economic losses, and an especially heavy burden on vulnerable populations like children under five, with countries such as Afghanistan further affected by fragile health systems and widespread informal food markets. This review synthesizes current evidence on the epidemiology, risk factors, and control strategies of FBDs, using Afghanistan as a representative case of a fragile and resource-limited setting. The findings highlight that microbial contamination, particularly from E. coli, Salmonella spp., and parasitic pathogens, is driven by unsafe water, informal food markets, and poor hygiene practices. Systemic challenges, including fragmented governance, insufficient surveillance systems, and limited infrastructure, further exacerbate the burden. Comparative analysis with other LMICs reveals common structural determinants, suggesting that the challenges observed in Afghanistan are broadly applicable across developing regions. The study emphasizes the importance of integrated approaches, including One Health frameworks, risk-based food safety systems, and targeted behavioral interventions. Strengthening surveillance, improving infrastructure, and enhancing regulatory coordination are critical to reducing the global burden of FBDs. This review provides actionable insights for policymakers, researchers, and international stakeholders aiming to improve food safety in resource-constrained settings.