In response to the high maternal mortality in Afghanistan, the government emphasised enhancing antenatal care (ANC) coverage to improve skilled birth attendance and reduce maternal mortality. This study aimed to explain how and why ANC interventions worked, for whom, and under what circumstances in Afghanistan between 2000 and 2024.

A rapid realist review was conducted to identify underlying programme theories and examine contextual factors and key mechanisms influencing ANC outcomes, with input from a panel of national experts. Data were extracted using context–mechanism–outcome (CMO) configurations to develop and refine theories for policy recommendations.

From 3502 papers, 1860 duplicates were removed, 63 were screened for full text and 25 were included in the final review. In total, 29 CMOs were inferred across nine interventions, classified at individual, interpersonal, community and institutional levels. We found that ANC interventions could work best by empowering women and healthcare workers (HCWs), involving husbands, hiring female community health workers (CHWs), ensuring regular contact with the same HCWs, endorsing health messages by the government, incentivising CHWs and designing and implementing interventions using participatory approaches. Interventions are less successful when there is a lack of community trust in service quality or HCW qualifications, low decision-making ability among women, discomfort during travel to health facilities, adherence to traditional practices and beliefs, hiring CHWs from outside the community, chronic stress and lack of support among HCWs and unrecognised incentives.

Our evidence synthesis can inform donors, policymakers and implementers on how to design more effective ANC interventions to achieve better health outcomes in Afghanistan. By emphasising intervention evaluation and ANC quality improvement, it highlights the importance of key social elements, such as cultural norms, power dynamics, relationships, beliefs and trust, which are likely to maximise impact. Community involvement is essential for designing and implementing effective and sustainable ANC interventions.

To examine the association between individual social capital and depression in older adults in Iran and to test the hypothesis that higher levels of social capital are inversely associated with depressive symptoms.

Cross-sectional study using baseline data from a longitudinal cohort.

Community-based study conducted in primary care settings across urban and rural areas of Birjand County, Eastern Iran.

A total of 1348 community-dwelling individuals aged 60 years and older were recruited through multistage stratified cluster random sampling. Participants who were bedridden or had end-stage disease (life expectancy

The primary outcome was depression status, measured using the Patient Health Questionnaire 9 items, with a score≥10 indicating depression. The main explanatory variable was social capital, assessed using a validated 69-item questionnaire capturing domains such as collective activity, social trust and network structure. Univariable and multivariable logistic regression analyses were conducted to estimate adjusted ORs and 95% CIs for associations between depression and social capital dimensions. Statistical analyses were performed using Stata V.12.0

Of the total participants, 268 (19.94%) were identified as having depressive symptoms, with a significantly higher prevalence among women (27.44%) compared with men (11.88%). Depression was more prevalent among those in the lowest wealth quintile (32.09%) and individuals with low literacy levels (28.10%). Participation in collective activities was inversely associated with depression in the second (OR=0.62, 95% CI (0.42 to 0.93)), third (OR=0.45, 95% CI (0.29 to 0.71)), fourth (OR=0.59, 95% CI (0.37 to 0.93)) and fifth (OR=0.37, 95% CI (0.22 to 0.61)) quintiles. Social trust was also associated with lower odds of depression in the third (OR=0.62, 95% CI (0.39 to 0.99)) and fourth (OR=0.64, 95% CI (0.42 to 0.97)) quintiles. Furthermore, the second (OR=0.63, 95% CI (0.40 to 0.99)) and fifth (OR=0.38, 95% CI (0.23 to 0.63)) quintiles of social network structure were inversely related to depression. These findings suggest that higher levels of social capital, particularly in terms of collective participation, trust and social networks, are associated with a reduced likelihood of depressive symptoms in older adults.

Higher levels of social capital, particularly collective engagement, interpersonal trust and diverse social networks, are associated with lower odds of depression in older adults. These findings support the need for community-based interventions to strengthen social capital as a strategy for mental health promotion among the elderly in low-income and middle-income settings.