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Akbarian Z, Ziay G, Schauwers W, Noormal B, Saeed I, Qanee AH, Shahab Z, Dennison T, Dohoo I, Jackson R. Brucellosis and Coxiella burnetii Infection in Householders and Their Animals in Secure Villages in Herat Province, Afghanistan: A Cross-Sectional Study. PLoS Negl Trop Dis 2015; 9:e0004112. [PMID: 26485520 PMCID: PMC4618140 DOI: 10.1371/journal.pntd.0004112] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background Brucellosis and coxiellosis are known to be endemic in ruminant populations throughout Afghanistan, but information about their prevalence and factors that affect prevalence in householders and livestock under diverse husbandry systems and pastoral settings is sparse. Methods/Principal Findings We conducted a cross-sectional survey to investigate the seroprevalence of brucellosis and Coxiella burnetii in humans and livestock in six secure districts in Herat from 26th December 2012–17th January 2013. A total of 204 households with livestock were surveyed in six Kuchi and five sedentary type villages. Blood samples from 1,017 humans, 1,143 sheep, 876 goats and 344 cattle were tested for brucellosis and Q fever. About one in six households (15.7%) had at least one Brucella seropositive person, about one in eight households (12.3%) had at least one Brucella seropositive animal and about one in four (24.5%) had either seropositive animals or humans. Ninety-seven percent of households had at least one C. burnetii seropositive person and 98.5% of households had one or more C. burnetii seropositive animals. Forty- seven householders had serological evidence of exposure to both C. burnetii and Brucella and eight animals were serologically positive for both diseases. Drinking unpasteurised milk (OR 1.6), treating animals for ticks (OR 1.4), milking sheep (OR 1.4), male gender (OR 1.4) and seropositivity to Brucella (OR 4.3) were identified as risk factors for seropositivity to C. burnetii in householders. Household factors associated with households having either Brucella seropositive animals or humans were Kuchi households (OR 2.5), having ≤4 rooms in the house (OR 2.9) and not owning land (OR 2.9). Conclusions The results from this study provide baseline information for the planning and monitoring of future interventions against these diseases. The implementation of this study greatly improved collaboration, coordination and capability of veterinary and public health professionals from government, NGOs and donor funded projects. Our study alerted authorities to a hitherto unrecognised high prevalence of C. burnetii infections, acted as a catalyst for the introduction of a national vaccination programme for protection of sheep and goats from brucellosis using Rev1 vaccine, demonstrated the benefits of a coordinated approach and fostered a better understanding of the nature of infection in different hosts and of the constraints for control faced by government services. A notable feature of the study was the enthusiasm and interest displayed by all of the participants throughout, from heads of government services to field personnel and villagers. Livestock owners regard zoonoses as adversities that affect their livestock and members of their households and do not partition them separately as medical or veterinary problems. Control programs need to take that perception into account and wherever possible avoid vesting ownership separately into veterinary or public health agencies.
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Affiliation(s)
- Zarif Akbarian
- Afghan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - Ghulam Ziay
- Central Veterinary Diagnostic & Research Laboratory, Kabul, Afghanistan
| | | | - Bashir Noormal
- Afghan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - Islam Saeed
- Afghan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - Abul Hussain Qanee
- General Directorate of Animal Health and Production, Ministry of Agriculture, Irrigation and Livestock, Kabul, Afghanistan
| | - Zabiullah Shahab
- Afghan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | | | - Ian Dohoo
- University of Prince Edward Island, Charlottetown, Canada
| | - Ronald Jackson
- EpiCentre, Massey University, Palmerston North, New Zealand
- * E-mail:
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Abstract
This study analyzes landmine victim data in the Kurdistan Region during the period 1960 to 2005. A regression analysis is used to identify the determinants and impact of the probability of getting killed by mines and unexploded ordnances. The rates of killed/injured victims are explained using a set of socioeconomic variables. As the data are a repeated cross-section in which the individuals are observed when they are subjected to landmine incidents, and to account for the dynamic aspect of the process and heterogeneity by location as well as to control for unobserved location and time effects, a pseudo panel data are created where districts are observed over the entire time period forming a panel data. The results show that (a) males, children, and the elderly are more susceptible to a higher level of landmine risks; (b) landmine training and awareness programs do not reduce the rate of landmine mortality; and (c) the rate of incidents are declining over time. This result can be used in the planning, monitoring, and resource allocation for mine action, as well as labor market programs and rehabilitation activities.
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Progress towards polio eradication worldwide, 2014-2015. Wkly Epidemiol Rec 2015; 90:253-9. [PMID: 26016011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pilsczek FH. RESPIRATORY INFECTIONS RESEARCH IN AFGHANISTAN: BIBLIOMETRIC ANALYSIS WITH THE DATABASE PUBMED. J Ayub Med Coll Abbottabad 2015; 27:464-466. [PMID: 26411140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Infectious diseases research in a low-income country like Afghanistan is important. METHODS In this study an internet-based database Pubmed was used for bibliometric analysis of infectious diseases research activity. Research publications entries in PubMed were analysed according to number of publications, topic, publication type, and country of investigators. RESULTS Between 2002-2011, 226 (77.7%) publications with the following research topics were identified: respiratory infections 3 (1.3%); parasites 8 (3.5%); diarrhoea 10 (4.4%); tuberculosis 10 (4.4%); human immunodeficiency virus (HIV) 11 (4.9%); multi-drug resistant bacteria (MDR) 18 (8.0%); polio 31 (13.7%); leishmania 31 (13.7%); malaria 46 (20.4%). From 2002-2011, 11 (4.9%) publications were basic science laboratory-based research studies. Between 2002-2011, 8 (3.5%) publications from Afghan institutions were identified. CONCLUSION In conclusion, the internet-based database Pubmed can be consulted to collect data for guidance of infectious diseases research activity of low-income countries. The presented data suggest that infectious diseases research in Afghanistan is limited for respiratory infections research, has few studies conducted by Afghan institutions, and limited laboratory-based research contributions.
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Aluisio AR, Maroof Z, Chandramohan D, Bruce J, Masher MI, Manaseki-Holland S, Ensink JHJ. Risk factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan: a prospective cohort study. PLoS One 2015; 10:e0116342. [PMID: 25679979 PMCID: PMC4332656 DOI: 10.1371/journal.pone.0116342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/08/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Childhood diarrheal illnesses are a major public health problem. In low-income settings data on disease burden and factors associated with diarrheal illnesses are poorly defined, precluding effective prevention programs. This study explores factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS A cohort of 1-11 month old infants was followed for 18 months from 2007-2009. Data on diarrheal episodes were gathered through active and passive surveillance. Information on child health, socioeconomics, water and sanitation, and hygiene behaviors was collected. Factors associated with recurrent diarrheal illnesses were analyzed using random effects recurrent events regression models. RESULTS 3,045 children were enrolled and 2,511 (82%) completed 18-month follow-up. There were 14,998 episodes of diarrheal disease over 4,200 child-years (3.51 episodes/child-year, 95%CI 3.40-3.62). Risk of diarrheal illness during the winter season was 63% lower than the summer season (HR = 0.37, 95%CI 0.35-0.39, P<0.001). Soap for hand washing was available in 72% of households and 11.9% had toilets with septic/canalization. Half of all mothers reported using soap for hand washing. In multivariate analysis diarrheal illness was lower among children born to mothers with post-primary education (aHR = 0.79, 95%CI 0.69-0.91, p = 0.001), from households where maternal hand washing with soap was reported (aHR = 0.83, 95%CI 0.74-0.92, p<0.001) and with improved sanitation facilities (aHR = 0.76, 95%CI 0.63-0.93, p = 0.006). Malnourished children from impoverished households had significantly increased risks for recurrent disease [(aHR = 1.15, 95%CI 1.03-1.29, p = 0.016) and (aHR = 1.20, 95%CI 1.05-1.37, p = 0.006) respectively]. CONCLUSIONS Maternal hand washing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and utilization suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population and these findings support multi-sector interventions to combat illness. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00548379 https://www.clinicaltrials.gov/ct2/show/NCT00548379.
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Affiliation(s)
- Adam R. Aluisio
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Zabihullah Maroof
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Bruce
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mohammad I. Masher
- Department of Paediatrics, Kabul Medical University, Kabul, Afghanistan Department of Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Semira Manaseki-Holland
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jeroen H. J. Ensink
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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García-Sánchez JE, García-Sánchez E, García-Merino E, Fresnadillo-Martínez MJ. [Polio, the long walk to the endgame]. Enferm Infecc Microbiol Clin 2015; 33:e69-78. [PMID: 25595690 DOI: 10.1016/j.eimc.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/17/2014] [Accepted: 10/01/2014] [Indexed: 11/18/2022]
Abstract
Although the WHO original target date for the global eradication of poliomyelitis was the year 2000 -thanks to vaccination and institutional, public and private, resources for that purpose-, in 2013 the disease remained endemic in three countries, Afghanistan, Pakistan and Nigeria, and some cases were described in five others. The circulation of wild type 1 poliovirus in Israel, Gaza and the West Bank and the cases in Syria were a wakeup call, as at that time there were polioviruses derived from the oral vaccine that are still circulating among the human population and can cause the development of the disease. Travelling "from" and "to" endemic areas are factors to consider in poliovirus exportation and in its spread when it reaches areas with poor immunogenicity. Wars, terrorism, intolerance, lack of culture and proliferation of anti-vaccine groups and the rise of the anti-vaccination movement are important factors in the maintenance and expansion of the virus and in the "non-vaccination" against it. Based on the international situation to date, the Emergency Committee of WHO met in May 2014 to address the problem. It is still necessary to enhance the knowledge of the disease and its agent. In the first case to perform a differential diagnosis of flaccid paralysis and to continue vaccination programs, and in the second case to keep studying and looking for the poliovirus in environmental samples, which is a model for the study of many other viruses.
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Affiliation(s)
- José Elías García-Sánchez
- Departamento de Medicina Preventiva, Salud Pública y Microbiología Médica, Facultad de Medicina, Universidad de Salamanca, Salamanca, España.
| | - Enrique García-Sánchez
- Departamento de Medicina Preventiva, Salud Pública y Microbiología Médica, Facultad de Medicina, Universidad de Salamanca, Salamanca, España
| | | | - María José Fresnadillo-Martínez
- Departamento de Medicina Preventiva, Salud Pública y Microbiología Médica, Facultad de Medicina, Universidad de Salamanca, Salamanca, España
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Simpson DM, Sadr-Azodi N, Mashal T, Sabawoon W, Pardis A, Quddus A, Garrigos C, Guirguis S, Zaidi SSZ, Shaukat S, Sharif S, Asghar H, Hadler SC. Polio eradication initiative in Afghanistan, 1997-2013. J Infect Dis 2014; 210 Suppl 1:S162-72. [PMID: 25316832 PMCID: PMC10544109 DOI: 10.1093/infdis/jiu022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This article reviews the epidemiology of polio, acute flaccid paralysis (AFP) surveillance, and the implementation of supplemental immunization activities (SIAs) in Afghanistan from 1997 thru 2013. METHODS Published reports and unpublished national data on polio cases, AFP surveillance, and SIAs were analyzed. Recommendations from independent advisory groups and Afghan government informed the conclusions. RESULTS From 1997 thru 2013, the annual number of confirmed polio cases fluctuated from a low of 4 in 2004 to a high of 80 in 2011. Wild poliovirus types 2 and 3 were last reported in 1997 and 2010, respectively. Circulating vaccine-derived poliovirus type 2 emerged in 2009. AFP surveillance quality in children aged <15 years improved over time, achieving rates>8 per 100,000 population. Since 2001, at least 6 SIAs have been conducted annually. CONCLUSIONS Afghanistan has made progress moving closer to eliminating polio. The program struggles to reach all children because of management and accountability problems in the field, inaccessible populations, and inadequate social mobilization. Consequently, too many children are missed during SIAs. Afghanistan adopted a national emergency action plan in 2012 to address these issues, but national elimination will require consistent and complete implementation of proven strategies.
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Affiliation(s)
- Diane M. Simpson
- Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, Georgia
| | - Nahad Sadr-Azodi
- Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, Georgia
| | - Taufiq Mashal
- Directorate of General Preventive Medicine, Afghanistan Ministry of Public Health, United Nations Children’s Fund, Kabul, Afghanistan
| | - Wrishmeen Sabawoon
- Office of the Ministry of Advising for the President on Health and Education Affairs and National Focal Point for Polio Eradication, United Nations Children’s Fund, Kabul, Afghanistan
| | - Ajmal Pardis
- Centers for Disease Control and Prevention, United Nations Children’s Fund, Kabul, Afghanistan
| | - Arshad Quddus
- Polio Eradication Unit, World Health Organization, and United Nations Children’s Fund, Kabul, Afghanistan
| | - Carmen Garrigos
- Polio Eradication Unit, United Nations Children’s Fund, Kabul, Afghanistan
| | - Sherine Guirguis
- Communications Program, United Nations Children’s Fund, New York, New York
| | | | - Shahzad Shaukat
- Pakistan Polio Regional Reference Laboratory, Islamabad, Pakistan
| | - Salmaan Sharif
- Pakistan Polio Regional Reference Laboratory, Islamabad, Pakistan
| | - Humayan Asghar
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt, and Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen C. Hadler
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Progress towards poliomyelitis eradication: Afghanistan and Pakistan, January 2013–August 2014. Wkly Epidemiol Rec 2014; 89:493-9. [PMID: 25368877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Shaukat S, Angez M, Alam MM, Sharif S, Khurshid A, Malik F, Rehman L, Zaidi SSZ. Molecular characterization and phylogenetic relationship of wild type 1 poliovirus strains circulating across Pakistan and Afghanistan bordering areas during 2010-2012. PLoS One 2014; 9:e107697. [PMID: 25229826 PMCID: PMC4168008 DOI: 10.1371/journal.pone.0107697] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Pakistan and Afghanistan share a long uncontrolled border with extensive population movement on both sides. Wild poliovirus transmission has never been interrupted in this block due to war against terrorism, poor public health infrastructure, misconceptions about polio vaccines and inadequate immunization activities. All these issues complicate the eradication operations and reinforce the complexity of wiping out poliomyelitis from this region. This study illustrates the origins and routes of cross-border wild poliovirus type 1 (WPV1) transmission during 2010-2012 between Pakistan and Afghanistan. Sequence analyses were conducted based on complete VP1 capsid protein sequences for WPV1 study strains to determine the origin of poliovirus genetic lineages and their evolutionary relationships. Phylogenetic tree was constructed from VP1 gene sequences applying Maximum Likelihood method using Kimura 2- parameter model in MEGA program v 5.0. A total of 72 (14.3%) out of 502 wild-type 1 polioviruses were found circulating in border areas of both countries during 2010-2012. Molecular phylogenetic analysis classified these strains in to two sub-genotypes with four clusters and 18 lineages. Genetic data confirmed that the most of WPV1 lineages (12; 66.6%) were transmitted from Pakistan to Afghanistan. However, the genetic diversity was significantly reduced during 2012 as most of the lineages were completely eliminated. In conclusion, Pakistan-Afghanistan block has emerged as a single poliovirus reservoir sharing the multiple poliovirus lineages due to uncontrolled movement of people across the borders between two countries. If it is neglected, it can jeopardize the extensive global efforts done so-far to eradicate the poliovirus infection. Our data will be helpful to devise the preventive strategies for effective control of wild poliovirus transmission in this region.
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Affiliation(s)
- Shahzad Shaukat
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Mehar Angez
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Adnan Khurshid
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Farzana Malik
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Lubna Rehman
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
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Otoukesh S, Mojtahedzadeh M, Cooper CJ, Tolouian R, Said S, Ortega L, Didia SC, Behazin A, Sherzai D, Blandon P. Lessons from the profile of kidney diseases among Afghan refugees. Med Sci Monit 2014; 20:1621-7. [PMID: 25208585 PMCID: PMC4168767 DOI: 10.12659/msm.890958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/25/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Due to a paucity of research on the profile of kidney diseases among refugee populations, specifically Afghan refugees in Iran, this study aimed to illustrate the pattern of kidney disease among Afghan refugees in Iran and create a database for evaluating the performance of future health services. MATERIAL AND METHODS This was a retrospective cross sectional study, in which we collected the demographics and profile of kidney diseases among Afghan refugees between 2005 and 2010 from referrals to the United Nations High Commissioner for Refugees (UNHCR) offices in Iran. RESULTS The total number of referrals in this group of diseases was 3193 out of 23 152 with 41.5% female and 58.5% male. Regarding age distribution, 10.5% were 0-14 years of age, 78% were 15-59, and 11.5% were ≥60. The most common health referral for females and males (0-14) was end-stage renal disease (ESRD), accounting for 34.6%. This was also the main reason of referrals for females and males aged 15-59, accounting for 73.5% and 66.6%, respectively, and in both sexes in the ≥60 age range it was 63.1%. CONCLUSIONS The pattern of our renal clinic referrals may gradually change to ESRD, which is associated with a huge economic burden. The need to provide health insurance to everyone or reform the health care system to provide coverage for more of the population can be justified and would improve cost effectiveness.
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Affiliation(s)
- Salman Otoukesh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Mona Mojtahedzadeh
- Department of Psychiatry, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Chad J. Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Ramin Tolouian
- Division of Nephrology and Hypertension, East Virginia Medical School, Norfolk, VA, U.S.A
| | - Sarmad Said
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Lauro Ortega
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - S. Claudia Didia
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Arash Behazin
- United Nations High Commissioner for Refugees (UNHCR), Tehran, Iran
| | - Dean Sherzai
- Department of Neurology, Loma Linda University, Loma Linda, CA, U.S.A
| | - Pedro Blandon
- Department of Nephrology, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
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Collins DP, Carreira S, Bernheisel CR. Fever, wet cough, rash-Dx? J Fam Pract 2014; 63:520-523. [PMID: 25353030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Douglas P Collins
- University of Cincinnati, Department of Family and Community Medicine; The Christ Hospital/ University of Cincinnati Family Medicine Residency Program, Ohio, USA.
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Abstract
The first release of military data on civilian casualties in Afghanistan is now publicly available.
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Ahmed T, Hossain M, Mahfuz M, Choudhury N, Hossain MM, Bhandari N, Lin MM, Joshi PC, Angdembe MR, Wickramasinghe VP, Hossain SMM, Shahjahan M, Irianto SE, Soofi S, Bhutta Z. Severe acute malnutrition in Asia. Food Nutr Bull 2014; 35:S14-26. [PMID: 25069289 DOI: 10.1177/15648265140352s103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe acute malnutrition (SAM) is a common condition that kills children and intellectually maims those who survive. Close to 20 million children under the age of 5 years suffer from SAM globally, and about 1 million of them die each year. Much of this burden takes place in Asia. Six countries in Asia together have more than 12 million children suffering from SAM: 0.6 million in Afghanistan, 0.6 million in Bangladesh, 8.0 million in India, 1.2 million in Indonesia, 1.4 million in Pakistan, and 0.6 million in Yemen. This article is based on a review of SAM burden and intervention programs in Asian countries where, despite the huge numbers of children suffering from the condition, the coverage of interventions is either absent on a national scale or poor. Countries in Asia have to recognize SAM as a major problem and mobilize internal resources for its management. Screening of children in the community for SAM and appropriate referral and back referral require good health systems. Improving grassroots services will not only contribute to improving management of SAM, it will also improve infant and young child feeding and nutrition in general. Ready-to-use therapeutic food (RUTF), the key to home management of SAM without complications, is still not endorsed by many countries because of its unavailability in the countries and its cost. It should preferably be produced locally from locally available food ingredients. Countries in Asia that do not have the capacity to produce RUTF from locally available food ingredients can benefit from other countries in the region that can produce it. Health facilities in all high-burden countries should be staffed and equipped to treat children with SAM. A continuous cascade of training of health staff on management of SAM can offset the damage that results from staff attrition or transfers. The basic nutrition interventions, which include breastfeeding, appropriate complementary feeding, micronutrient supplementation, and management of acute malnutrition, should be scaled up in Asian countries that are plagued with the burden of malnutrition.
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Global Polio Eradication Initiative: 10th meeting of the Independent Monitoring Board. Wkly Epidemiol Rec 2014; 89:361-7. [PMID: 25136721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Alegana VA, Wright JA, Nahzat SM, Butt W, Sediqi AW, Habib N, Snow RW, Atkinson PM, Noor AM. Modelling the incidence of Plasmodium vivax and Plasmodium falciparum malaria in Afghanistan 2006-2009. PLoS One 2014; 9:e102304. [PMID: 25033452 PMCID: PMC4102516 DOI: 10.1371/journal.pone.0102304] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/16/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Identifying areas that support high malaria risks and where populations lack access to health care is central to reducing the burden in Afghanistan. This study investigated the incidence of Plasmodium vivax and Plasmodium falciparum using routine data to help focus malaria interventions. METHODS To estimate incidence, the study modelled utilisation of the public health sector using fever treatment data from the 2012 national Malaria Indicator Survey. A probabilistic measure of attendance was applied to population density metrics to define the proportion of the population within catchment of a public health facility. Malaria data were used in a Bayesian spatio-temporal conditional-autoregressive model with ecological or environmental covariates, to examine the spatial and temporal variation of incidence. FINDINGS From the analysis of healthcare utilisation, over 80% of the population was within 2 hours' travel of the nearest public health facility, while 64.4% were within 30 minutes' travel. The mean incidence of P. vivax in 2009 was 5.4 (95% Crl 3.2-9.2) cases per 1000 population compared to 1.2 (95% Crl 0.4-2.9) cases per 1000 population for P. falciparum. P. vivax peaked in August while P. falciparum peaked in November. 32% of the estimated 30.5 million people lived in regions where annual incidence was at least 1 case per 1,000 population of P. vivax; 23.7% of the population lived in areas where annual P. falciparum case incidence was at least 1 per 1000. CONCLUSION This study showed how routine data can be combined with household survey data to model malaria incidence. The incidence of both P. vivax and P. falciparum in Afghanistan remain low but the co-distribution of both parasites and the lag in their peak season provides challenges to malaria control in Afghanistan. Future improved case definition to determine levels of imported risks may be useful for the elimination ambitions in Afghanistan.
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Affiliation(s)
- Victor A. Alegana
- Spatial Health Metrics Group, Department of Public Health, KEMRI-Wellcome Trust, Nairobi, Kenya
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, United Kingdom
| | - Jim A. Wright
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, United Kingdom
| | - Sami M. Nahzat
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Waqar Butt
- Malaria and Leishmaniasis, WHO Office, Kabul, Afghanistan
| | - Amad W. Sediqi
- National Malaria and Leishmaniasis Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Naeem Habib
- Malaria and Leishmaniasis, WHO Office, Kabul, Afghanistan
| | - Robert W. Snow
- Spatial Health Metrics Group, Department of Public Health, KEMRI-Wellcome Trust, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Peter M. Atkinson
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, United Kingdom
| | - Abdisalan M. Noor
- Spatial Health Metrics Group, Department of Public Health, KEMRI-Wellcome Trust, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Tariq TM. Occurrence of extended-spectrum b-lactamase producers among enterobacteriaceae in a paediatric tertiary care facility in Kabul. J Coll Physicians Surg Pak 2014; 24:530-531. [PMID: 25052982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/19/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine the occurrence of extended spectrum beta-lactamase (ESBL)-producing species of Enterobacteriaceae to control their spread, from March 2008 to June 2012. A total of 411 ESBL-producing isolates were reported belonging to the family Enterobacteriaceae. There were 235 (57.18%) hospital-acquired infections (HAIs) and 176 (42.82%) community-acquired infections (CAIs). Out of total isolates, majority were E. coli (n=165, 40.15%), followed by 38.93% Klebsiella spp. (n=161), 9.97% Enterobacter spp. (n=41) and 6.33% Serratia spp. (n=26). Amongst HAIs, most frequent i.e., 111/235 (47.23%) were Klebsiella spp, whereas, amongst CAIs, majority i.e., 96/176 (54.55%) were E. coli. The frequency of ESBL-producing isolates from different sites was blood (37.71%), urine (29.93%), respiratory tract (18.49%) and other sites including pus/pus swabs, CSF/body fluids and secretions (13.87%) respectively. Majority of blood stream infections were caused by ESBL-producing Klebsiella species which accounted for 55.48% of all cases who had septicaemia, whereas E. coli was responsible for causing majority of urinary tract infections (UTIs) and accounted for 78% of all UTIs cases. Intensive Care Unit (ICU) was the place where majority of infections (55%) were observed, followed by 29% in the Medical Unit and 16% in the Surgical Unit.
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Affiliation(s)
- Tariq Mahmud Tariq
- Department of Clinical Laboratory, French Medical Institute for Children, Kabul, Afghanistan
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168
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Seal LM. Adopting dogs from a warzone. J Am Vet Med Assoc 2014; 244:777-778. [PMID: 24783632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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169
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Shah SR. Largest reservoir of Polio virus in the world--the elusive way forward! Pathog Glob Health 2014; 108:61-2. [PMID: 24649864 DOI: 10.1179/2047772414z.000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Elyan DS, Monestersky JH, Wasfy MO, Noormal B, Oyofo BA. Capacity building of public health laboratories in Afghanistan: challenges and successes (2007-2011). East Mediterr Health J 2014; 20:112-119. [PMID: 24945560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/23/2013] [Indexed: 06/03/2023]
Abstract
The continuing state of conflict and the resulting devastation of infrastructure have made Afghanistan exceptionally vulnerable to disease epidemics. The paper reports initiatives by the United States Naval Medical Research Unit No. 3 to promote capacity building in a number of key medical laboratories and enable the Afghans to detect emerging and re-emerging diseases of public health importance. Equipment, supplies and laboratory staff training were critical for disease diagnosis and fulfillment of obligations of the International Health Regulations 2005. Accordingly, many diseases outbreaks were recently identified, including avian and pandemic influenza, febrile illness, watery diarrhoea, jaundice and leishmaniasis. Clinical samples and disease vectors were collected for analysis, and microbial isolates were obtained for further characterization. The expanded range and enhanced accuracy of laboratory procedures have facilitated selected local laboratories to monitor, detect, identify, assess, contain and respond to public health threats. Nevertheless, policies of sustainability and infectious diseases control need continuous support and emphasis.
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Affiliation(s)
- D S Elyan
- United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - J H Monestersky
- United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - M O Wasfy
- United States Naval Medical Research Unit No. 3, Cairo, Egypt
| | - B Noormal
- Afghanistan Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - B A Oyofo
- United States Naval Medical Research Unit No. 3, Cairo, Egypt
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Jamornthanyawat N, Awab GR, Tanomsing N, Pukrittayakamee S, Yamin F, Dondorp AM, Day NPJ, White NJ, Woodrow CJ, Imwong M. A population survey of the glucose-6-phosphate dehydrogenase (G6PD) 563C>T (Mediterranean) mutation in Afghanistan. PLoS One 2014; 9:e88605. [PMID: 24586352 PMCID: PMC3931629 DOI: 10.1371/journal.pone.0088605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/12/2014] [Indexed: 11/19/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common inherited enzyme defect and an important problem in areas with Plasmodium vivax infection because of the risk of haemolysis following administration of primaquine to treat the liver forms of the parasite. We undertook a genotypic survey of 713 male individuals across nine provinces of Afghanistan in which malaria is found, four in the north and five in the east. RFLP typing at nucleotide position 563 detected 40 individuals with the Mediterranean mutation 563C>T, an overall prevalence of 5.6%. This varied according to self-reported ethnicity, with prevalence in the Pashtun/Pashai group of 33/369 (8.9%) compared to 7/344 individuals in the rest of the population (2.0%; p<0.001, Chi-squared test). Multivariate analysis of ethnicity and geographical location indicated an adjusted odds ratio of 3.50 (95% CI 1.36-9.02) for the Pashtun/Pashai group, while location showed only a trend towards higher prevalence in eastern provinces (adjusted odds ratio = 1.73, 0.73-4.13). Testing of known polymorphic markers (1311C>T in exon 11, and C93T in intron XI) in a subset of 82 individuals wild-type at C563 revealed a mixture of 3 haplotypes in the background population and was consistent with data from the 1000 Genomes Project and published studies. By comparison individuals with G6PD deficiency showed a highly skewed haplotype distribution, with 95% showing the CT haplotype, a finding consistent with relatively recent appearance and positive selection of the Mediterranean variant in Afghanistan. Overall, the data confirm that the Mediterranean variant of G6PD is common in many ethnic groups in Afghanistan, indicating that screening for G6PD deficiency is required in all individuals before radical treatment of P. vivax with primaquine.
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Affiliation(s)
- Natsuda Jamornthanyawat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ghulam R. Awab
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Naowarat Tanomsing
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sasithon Pukrittayakamee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Fazel Yamin
- Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Arjen M. Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Charles J. Woodrow
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Mallika Imwong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Jebran AF, Schleicher U, Steiner R, Wentker P, Mahfuz F, Stahl HC, Amin FM, Bogdan C, Stahl KW. Rapid healing of cutaneous leishmaniasis by high-frequency electrocauterization and hydrogel wound care with or without DAC N-055: a randomized controlled phase IIa trial in Kabul. PLoS Negl Trop Dis 2014; 8:e2694. [PMID: 24551257 PMCID: PMC3923720 DOI: 10.1371/journal.pntd.0002694] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/29/2013] [Indexed: 12/30/2022] Open
Abstract
Background Anthroponotic cutaneous leishmaniasis (CL) due to Leishmania (L.) tropica infection is a chronic, frequently disfiguring skin disease with limited therapeutic options. In endemic countries healing of ulcerative lesions is often delayed by bacterial and/or fungal infections. Here, we studied a novel therapeutic concept to prevent superinfections, accelerate wound closure, and improve the cosmetic outcome of ACL. Methodology/Principal Findings From 2004 to 2008 we performed a two-armed, randomized, double-blinded, phase IIa trial in Kabul, Afghanistan, with patients suffering from L. tropica CL. The skin lesions were treated with bipolar high-frequency electrocauterization (EC) followed by daily moist-wound-treatment (MWT) with polyacrylate hydrogel with (group I) or without (group II) pharmaceutical sodium chlorite (DAC N-055). Patients below age 5, with facial lesions, pregnancy, or serious comorbidities were excluded. The primary, photodocumented outcome was the time needed for complete lesion epithelialization. Biopsies for parasitological and (immuno)histopathological analyses were taken prior to EC (1st), after wound closure (2nd) and after 6 months (3rd). The mean duration for complete wound closure was short and indifferent in group I (59 patients, 43.1 d) and II (54 patients, 42 d; p = 0.83). In patients with Leishmania-positive 2nd biopsies DAC N-055 caused a more rapid wound epithelialization (37.2 d vs. 58.3 d; p = 0.08). Superinfections occurred in both groups at the same rate (8.8%). Except for one patient, reulcerations (10.2% in group I, 18.5% in group II; p = 0.158) were confined to cases with persistent high parasite loads after healing. In vitro, DAC N-055 showed a leishmanicidal effect on pro- and amastigotes. Conclusions/Significance Compared to previous results with intralesional antimony injections, the EC plus MWT protocol led to more rapid wound closure. The tentatively lower rate of relapses and the acceleration of wound closure in a subgroup of patients with parasite persistence warrant future studies on the activity of DAC N-055. Trial Registration ClinicalTrails.gov NCT00947362 In many countries of the Middle East such as Afghanistan, cutaneous leishmaniasis is a highly prevalent, chronic and stigmatizing skin disease. Poor hygiene conditions frequently aggravate the lesions due to bacterial and fungal superinfections. Classical treatments with injections of pentavalent antimony are hampered by costs, side effects, resistance development, supply and manufactural quality problems. In the present study on Afghan patients with Leishmania tropica-induced skin lesions we evaluated the clinical effect of an initial removal of lesion tissue by electrocoagulation using a bipolar high-frequency electrosurgery instrument, followed by daily moist wound treatment with or without a preparation of pharmaceutical sodium chlorite (DAC N-055). DAC N-055 is a compound with anti-infective, immunomodulatory and tissue repair-promoting effects. Our analysis revealed that the carefully performed moist wound treatment led to a rapid healing of the wounds within an average period of 6 weeks, even in the absence of the sodium chlorite preparation. This is considerably faster than the time spans previously reported for local or systemic antimony treatment. We believe that the current standard for local care of chronic wounds should also be applied to Leishmania skin lesions. If combined with an initial single high-frequency electrocoagulation, it is a highly effective, inexpensive and well-tolerated treatment option for cutaneous leishmaniasis.
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Affiliation(s)
- Ahmad Fawad Jebran
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ulrike Schleicher
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Reto Steiner
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Pia Wentker
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Farouq Mahfuz
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Hans-Christian Stahl
- Waisenmedizin e.V. Promoting Access to Care with Essential Medicine, Non-Profit Organization, Freiburg, Germany
| | - Faquir Mohammad Amin
- Leishmania Clinic, German Medical Service (NGO), Darwaze-e-Lahory, Kabul, Afghanistan
| | - Christian Bogdan
- Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- * E-mail: (CB); (KWS)
| | - Kurt-Wilhelm Stahl
- Waisenmedizin e.V. Promoting Access to Care with Essential Medicine, Non-Profit Organization, Freiburg, Germany
- * E-mail: (CB); (KWS)
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Cross AM, Davis C, Penn-Barwell J, Taylor DM, De Mello WF, Matthews JJ. The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices. J R Nav Med Serv 2014; 100:152-156. [PMID: 25335309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. METHODS A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. RESULTS Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. CONCLUSIONS The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.
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174
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Progress towards poliomyelitis eradication: Afghanistan, January 2012–August 2013. Wkly Epidemiol Rec 2013; 88:465-71. [PMID: 24236326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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175
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Abstract
Seye Abimbola and colleagues provide a view from Nigeria, Pakistan, and Afghanistan on global efforts to eradicate polio in those countries. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Seye Abimbola
- National Primary Health Care Development Agency, Abuja, Nigeria
- * E-mail:
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177
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Singh PK, Rai RK, Alagarajan M. Addressing maternal and child health in post-conflict Afghanistan: the way forward. East Mediterr Health J 2013; 19:826-831. [PMID: 24313047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Afghanistan's maternal and child mortality rates are among the highest in the world. The country faces challenges to meet the Millennium Development Goals set for 2015 which can be attributed to multiple causes related to accessibility, affordability and availability of health-care services. This report addresses the challenges in strengthening maternal and child health care in Afghanistan, as well discussing the areas to be prioritized. In order to ensure sound maternal and child health care in Afghanistan, policy-makers must prioritize monitoring and surveillance systems, integrating maternal and child health care with rights-based family planning methods, building human resources, offering incentives (such as the provision of a conditional cash transfer to women) and promoting action-oriented, community-based interventions. On a wider scale, the focus must be to improve the health infrastructure, organizing international collaboration and expanding sources of funding.
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Affiliation(s)
- P K Singh
- International Institute for Population Sciences, Mumbai, India
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179
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Delawer FM, Isono M, Ueki H, Zhuben M, Zafari M, Seddiq MK, Habib H, Ayoubi MK. Management of paediatric tuberculosis in provincial and district hospitals in Afghanistan. East Mediterr Health J 2013; 19:698-703. [PMID: 24975354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/08/2012] [Indexed: 06/03/2023]
Abstract
Case detection, diagnosis and treatment of tuberculosis 1 B) in children are challenging issues vorldwide. This study in Afghanistan aimed to evaluate paediatric TB case management, including contact investigation, at health facilities where all diagnostic processes were available. In 7 out of 8 regions of the country 1 province was selected. Documents used for management of paediatric TB cases were reviewed in 15 distinct hospitals and 8 provincial hospitals in the selected provinces. The key issues which emerged were: a low suspect rate among total outpatients (0.4%) and a very low suspect rate among children aged < 5 years; low performance of suspect management (68.5% suspects received further examinations); low utilization of other diagnostic methods; a high early defaulter rate (14.0%); and insufficient coverage of contact management (74.0%). This survey indicated that the Afghanistan national TB programme needs to develop plans to improve the quality of diagnosis, suspect management and contact management in paediatric TB cases.
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180
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Abstract
Limited data are available on the use of internal fixation in combat zone hospitals. The authors performed a retrospective review of 713 surgical cases during 2 Operation Enduring Freedom deployments to a Level III theater hospital in 2007 and 2009 to 2010. The epidemiology and short- to intermediate-term outcomes of patients treated with internal fixation devices were studied. The authors found that, with judicious use, internal fixation under a damage control protocol in a combat theater hospital can be performed with acceptable complication rates.
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Reynolds J, Wood M, Mikhail A, Ahmad T, Karimullah K, Motahed M, Hazansai A, Baktash SH, Anwari N, Kizito J, Mayan I, Rowland M, Chandler C, Leslie T. Malaria "diagnosis" and diagnostics in Afghanistan. Qual Health Res 2013; 23:579-591. [PMID: 23275460 DOI: 10.1177/1049732312470761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In many malaria-endemic areas, including Afghanistan, overdiagnosis of malaria is common. Even when using parasite-based diagnostic tests prior to treatment, clinicians commonly prescribe antimalarial treatment following negative test results. This practice neglects alternative causes of fever, uses drugs unnecessarily, and might contribute to antimalarial drug resistance. We undertook a qualitative study among health workers using different malaria diagnostic methods in Afghanistan to explore perceptions of malaria diagnosis. Health workers valued diagnostic tests for their ability to confirm clinical suspicions of malaria via a positive result, but a negative result was commonly interpreted as an absence of diagnosis, legitimizing clinical diagnosis of malaria and prescription of antimalarial drugs. Prescribing decisions reflected uncertainty around tests and diagnosis, and were influenced by social- and health-system factors. Study findings emphasize the need for nuanced and context-specific guidance to change prescriber behavior and improve treatment of malarial and nonmalarial febrile illnesses.
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Affiliation(s)
- Joanna Reynolds
- London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK.
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Wilson KL, Schenarts PJ, Bacchetta MD, Rai PR, Nakayama DK. Pediatric trauma experience in a combat support hospital in eastern Afghanistan over 10 months, 2010 to 2011. Am Surg 2013; 79:257-260. [PMID: 23461950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We reviewed the pediatric trauma experience of one Combat Support Hospital (CSH) in Afghanistan to focus on injuries, surgery, and outcomes in a war zone. We conducted a review of all pediatric patients over 10 months in an eastern Afghanistan CSH. We studied 41 children (1 to 18 years; mean, 8.5 years; median, 9 years), 28 (68.2%) with penetrating injuries. Blasts (13 patients) and burns (nine) were the most common mechanisms. At arrival 19 (46.3%) underwent endotracheal intubation, four (9.8%) had no palpable blood pressure, 10.6 per cent (four of 38) a Glasgow coma score of 5 or less, 30.6 per cent (11 of 36) base deficits of 6 or less, and 41.7 per cent (15 of 36) hematocrit 30 or less. Red cells were given in 14 (34.1%) and plasma in 11 (26.8%). Of 32 total nonburn patients, 12 (37.5%) had multiple system injuries. Three-fourths of injuries were severe (75.8% [47 of 62] Abbreviated Injury Score 3 or greater). Thirty-two patients (78.0%) required major operations: burn and wound care, orthopedic, chest, abdominal, vascular, and neurosurgical. Second operations were performed in 16 (39.0%), most often burn and orthopedic procedures. Six died (14.6%), 13 were transferred to other hospitals (31.7%), and 20 were discharged to home (48.8%; two not noted). Broad experience in operative trauma care, pediatric resuscitation, and critical care is a priority for military surgeons.
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Affiliation(s)
- Kenneth L Wilson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
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Benson J, Phillips C, Kay M, Webber MT, Ratcliff AJ, Correa-Velez I, Lorimer MF. Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study. PLoS One 2013; 8:e57998. [PMID: 23469126 PMCID: PMC3585239 DOI: 10.1371/journal.pone.0057998] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/30/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. METHODS In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. RESULTS 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. CONCLUSION Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.
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Affiliation(s)
- Jill Benson
- Discipline of General Practice, University of Adelaide, South Australia, Australia.
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Saeed KMI, Bano R, Asghar RJ. Evaluation of the national tuberculosis surveillance system in Afghanistan. East Mediterr Health J 2013; 19:200-207. [PMID: 23516833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Afghanistan has 2 tuberculosis surveillance systems, the National Tuberculosis Control Programme (NTP) and the Health Management Information System (HMIS). An evaluation of these surveillance systems in January/ February 2010 was done to identify their strengths and weaknesses and to formulate recommendations. Attributes of the programmes were evaluated using US Centers for Disease Control and Prevention guidelines. Usefulness and flexibility of the NTP system were good; stability, representativeness and data quality were average. Simplicity, acceptability and timeliness were poor. Reporting delays regularly exceeded 3 months. Positive predictive value and sensitivity were 11% and 70% respectively. The HMIS system was simple, acceptable and stable, with timely reporting. Reporting and feedback were good, as this system has strong government support. Flexibility, data quality and representativeness were average. Positive predictive value and sensitivity were 10% and 68% respectively. No outbreaks were detected by ther system. The NTP and HMIS surveillance systems are duplicative and neither covers the private sector.
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Affiliation(s)
- K M I Saeed
- Afghanistan Notional Public Health Institute, Ministry of Public Health, Kabul, Afghanistan.
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187
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Pastuszka M, Goś R, Jurowski P, Chrzaszcz A, Smigielski J, Nowak MS. [Ocular findings in Polish Armed Forces in Iraq and Afghanistan, a review of medical examinations by The Military Medical Commission in Łodz]. Klin Oczna 2013; 115:296-299. [PMID: 24908920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine the prevalence of ocular disorders among Polish soldiers returning from Iraq and Afghanistan military campaigns. MATERIAL AND METHODS A retrospective review of medical records of the Military Medical Commission of Lodz, Poland was performed. Records of 296 randomly selected soldiers, including 98 who returned from Iraq in 2004 and in 198 who returned from Afghanistan in 2012, were assessed. All subjects underwent comprehensive ocular examinations according to the military regulations. We used statistical analysis to review the results. RESULTS The incidence of ocular disorders in Iraq and Afghanistan groups was 17.3% and 15.1%, respectively. The study revealed that the most common disorders among soldiers were refractive errors affecting 6.8% subjects, followed by defective color vision (4.7%) and solar retinopathy (3.0%). Combat injuries were diagnosed in 3 subjects, including 2 cases of corneal injury and 1 case of retinal detachment due to blast exposure. CONCLUSIONS Combat injuries occurred in 1% of soldiers returning from Iraq and Afghanistan military campaigns. There were no statistically significant differences between Iraq and Afghanistan groups in the incidence of ocular disorders. Solar retinopathy was the most common problem related to the long-term exposure to rough climate conditions in both groups. ocular findings, Iraq, Afghanistan.
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Hassan M, Khaliq MF, Noorani MM. The polio bomb: what must Pakistan do? J PAK MED ASSOC 2012; 62:1365. [PMID: 23866499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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189
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Atkinson B, Latham J, Chamberlain J, Logue C, O'Donoghue L, Osborne J, Carson G, Brooks T, Carroll M, Jacobs M, Hopkins S, Hewson R. Sequencing and phylogenetic characterisation of a fatal Crimean - Congo haemorrhagic fever case imported into the United Kingdom, October 2012. Euro Surveill 2012; 17:20327. [PMID: 23218389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A patient with fever, and haemorrhagic symptoms was admitted to a hospital in Glasgow on 2 October 2012. Since he had returned from Afghanistan, serum samples were sent for diagnosis at the Rare and Imported Pathogens Laboratory, where a real-time reverse transcriptase-PCR diagnosis of Crimean – Congo haemorrhagic fever was made within 3 hrs after receipt of the sample. Hereafter the patient was transferred to a high-security infectious diseases unit in London but died on 6 October.
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Affiliation(s)
- B Atkinson
- Microbiology Services Division, Health Protection Agency, Salisbury, United Kingdom
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Affiliation(s)
- Syed H Abidi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
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191
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Centers for Disease Control and Prevention (CDC). Progress toward poliomyelitis eradication - Afghanistan and Pakistan, January 2011-August 2012. MMWR Morb Mortal Wkly Rep 2012; 61:790-5. [PMID: 23034587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In 1988, the World Health Assembly resolved to eradicate polio, which led to the establishment of the Global Polio Eradication Initiative (GPEI). In 2012, however, the transmission of indigenous wild poliovirus (WPV) continued uninterrupted in Afghanistan, Pakistan, and Nigeria, leading the World Health Assembly to declare completion of polio eradication a programmatic emergency for global public health. This report updates previous reports and describes polio eradication activities and progress in Afghanistan and Pakistan during January 2011-August 2012, as of September 9, 2012. During 2011, 80 WPV cases were confirmed in Afghanistan, compared with 25 WPV cases in 2010; 17 WPV cases were confirmed during January-August 2012, compared with 34 WPV cases for the same period in 2011. In Pakistan, 198 WPV cases were confirmed in 2011, compared with 144 WPV cases in 2010; 30 WPV cases were confirmed during January-August 2012, compared with 88 WPV cases during the same period in 2011. During January 2011-August 2012, no WPV type 3 (WPV3) cases were confirmed in Afghanistan, and four confirmed WPV3 cases and one case with coinfection of WPV3 and WPV type 1 (WPV1) were reported in Pakistan. Violence targeting vaccinators has occurred previously in Afghanistan and recently in Pakistan. To progress further toward interruption of WPV transmission within their countries and across their shared border, the governments of Afghanistan and Pakistan might consider reviewing the implementation of their national emergency action plans and determine how to enhance the safety of vaccination teams within conflict-affected areas of both countries.
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Progress towards eradicating poliomyelitis: Afghanistan and Pakistan, January 2011–August 2012. Wkly Epidemiol Rec 2012; 87:381-8. [PMID: 23074736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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O'Reilly KM, Durry E, ul Islam O, Quddus A, Abid N, Mir TP, Tangermann RH, Aylward RB, Grassly NC. The effect of mass immunisation campaigns and new oral poliovirus vaccines on the incidence of poliomyelitis in Pakistan and Afghanistan, 2001-11: a retrospective analysis. Lancet 2012; 380:491-8. [PMID: 22766207 PMCID: PMC3418593 DOI: 10.1016/s0140-6736(12)60648-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Pakistan and Afghanistan are two of the three remaining countries yet to interrupt wild-type poliovirus transmission. The increasing incidence of poliomyelitis in these countries during 2010-11 led the Executive Board of WHO in January, 2012, to declare polio eradication a "programmatic emergency for global public health". We aimed to establish why incidence is rising in these countries despite programme innovations including the introduction of new vaccines. METHODS We did a matched case-control analysis based on a database of 46,977 children aged 0-14 years with onset of acute flaccid paralysis between Jan 1, 2001, and Dec 31, 2011. The vaccination history of children with poliomyelitis was compared with that of children with acute flaccid paralysis due to other causes to estimate the clinical effectiveness of oral poliovirus vaccines (OPVs) in Afghanistan and Pakistan by conditional logistic regression. We estimated vaccine coverage and serotype-specific vaccine-induced population immunity in children aged 0-2 years and assessed their association with the incidence of poliomyelitis over time in seven regions of Afghanistan and Pakistan. FINDINGS Between Jan 1, 2001, and Dec 31, 2011, there were 883 cases of serotype 1 poliomyelitis (710 in Pakistan and 173 in Afghanistan) and 272 cases of poliomyelitis serotype 3 (216 in Pakistan and 56 in Afghanistan). The estimated clinical effectiveness of a dose of trivalent OPV against serotype 1 poliomyelitis was 12·5% (95% CI 5·6-18·8) compared with 34·5% (16·1-48·9) for monovalent OPV (p=0·007) and 23·4% (10·4-34·6) for bivalent OPV (p=0·067). Bivalent OPV was non-inferior compared with monovalent OPV (p=0·21). Vaccination coverage decreased during 2006-11 in the Federally Administered Tribal Areas (FATA), Balochistan, and Khyber Pakhtunkhwa in Pakistan and in southern Afghanistan. Although partially mitigated by the use of more effective vaccines, these decreases in coverage resulted in lower vaccine-induced population immunity to poliovirus serotype 1 in FATA and Balochistan and associated increases in the incidence of poliomyelitis. INTERPRETATION The effectiveness of bivalent OPV is comparable with monovalent OPV and can therefore be used in eradicating serotype 1 poliomyelitis whilst minimising the risks of serotype 3 outbreaks. However, decreases in vaccination coverage in parts of Pakistan and southern Afghanistan have severely limited the effect of this vaccine. FUNDING Poliovirus Research subcommittee of WHO, Royal Society, and Medical Research Council.
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Affiliation(s)
- Kathleen M O'Reilly
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
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Leslie T, Mikhail A, Mayan I, Anwar M, Bakhtash S, Nader M, Chandler C, Whitty CJM, Rowland M. Overdiagnosis and mistreatment of malaria among febrile patients at primary healthcare level in Afghanistan: observational study. BMJ 2012; 345:e4389. [PMID: 22833603 PMCID: PMC3404186 DOI: 10.1136/bmj.e4389] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the accuracy of malaria diagnosis and treatment at primary level clinics in Afghanistan. DESIGN Prospective observational study. SETTING 22 clinics in two Afghan provinces, one in the north (adjoining Tajikistan) and one in the east (adjoining Pakistan); areas with seasonal transmission of Plasmodium vivax and Plasmodium falciparum. PARTICIPANTS 2357 patients of all ages enrolled if clinicians suspected malaria. INTERVENTIONS Established (>5 years) microscopy (12 clinics in east Afghanistan), newly established microscopy (five clinics in north Afghanistan), and no laboratory (five clinics in north Afghanistan). All clinics used the national malaria treatment guidelines. MAIN OUTCOME MEASURES Proportion of patients positive and negative for malaria who received a malaria drug; sensitivity and specificity of clinic based diagnosis; prescriber's response to the result of the clinic slide; and proportion of patients positive and negative for malaria who were prescribed antibiotics. Outcomes were measured against a double read reference blood slide. RESULTS In health centres using clinical diagnosis, although 413 of 414 patients were negative by the reference slide, 412 (99%) received a malaria drug and 47 (11%) received an antibiotic. In clinics using new microscopy, 37% (75/202) of patients who were negative by the reference slide received a malaria drug and 60% (103/202) received an antibiotic. In clinics using established microscopy, 50.8% (645/1269) of patients who were negative by the reference slide received a malaria drug and 27.0% (342/1269) received an antibiotic. Among the patients who tested positive for malaria, 94% (443/472) correctly received a malaria drug but only 1 of 6 cases of falciparum malaria was detected and appropriately treated. The specificity of established and new microscopy was 72.9% and 79.9%, respectively. In response to negative clinic slide results, malaria drugs were prescribed to 270/905 (28.8%) and 32/154 (21%) and antibiotics to 347/930 (37.3%) and 99/154 (64%) patients in established and new microscopy arms, respectively. Nurses were less likely to misprescribe than doctors. CONCLUSIONS Despite a much lower incidence of malaria in Afghanistan than in Africa, fever was substantially misdiagnosed as malaria in this south Asian setting. Inaccuracy was attributable to false positive laboratory diagnoses of malaria and the clinicians' disregard of negative slide results. Rare but potentially fatal cases of falciparum malaria were not detected, emphasising the potential role of rapid diagnostic tests. Microscopy increased the proportion of patients treated with antibiotics producing a trade-off between overtreatment with malaria drugs and probable overtreatment with antibiotics.
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Affiliation(s)
- Toby Leslie
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Centers for Disease Control and Prevention (CDC). Progress toward interruption of wild poliovirus transmission--worldwide, January 2011-March 2012. MMWR Morb Mortal Wkly Rep 2012; 61:353-7. [PMID: 22592275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In January 2012, completion of polio eradication was declared a programmatic emergency for global public health by the Executive Board of the World Health Organization (WHO). Despite major progress since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, circulation of indigenous wild poliovirus (WPV) continues in three countries (Afghanistan, Nigeria, and Pakistan). India has not reported a polio case since January 2011, and is considered polio-free since February 2012. This report highlights progress toward global polio eradication during January 2011-March 2012. The number of polio cases reported globally decreased by 52%, from 1,352 in 2010 to 650 in 2011. Those 650 cases included 341 (53%) reported from the four polio-endemic countries (Afghanistan, India, Nigeria, and Pakistan), 230 (35%) from previously polio-free countries in which WPV importations led to reestablished transmission for ≥12 months (Angola, Chad, and Democratic Republic of the Congo [DRC]), and 79 (12%) from nine countries affected by outbreaks. Compared with 2010, WPV cases increased in 2011 in Afghanistan (69%), Nigeria (66%), and Pakistan (27%), but decreased in India (98%). During January-March 2012, 59% fewer cases were reported worldwide (as of May 15) compared with the same period in 2011, and all cases in 2012 have been reported from Afghanistan, Chad, Nigeria, and Pakistan. Although progress toward polio eradication was substantial in 2011, persistent WPV circulation in 2012, particularly in Nigeria and Pakistan, poses an ongoing threat to eradication efforts, underscoring the need for emergency measures by polio-affected countries and those at risk for outbreaks after importation.
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Manaseki-Holland S, Maroof Z, Bruce J, Mughal MZ, Masher MI, Bhutta ZA, Walraven G, Chandramohan D. Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial. Lancet 2012; 379:1419-27. [PMID: 22494826 PMCID: PMC3348565 DOI: 10.1016/s0140-6736(11)61650-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vitamin D has a role in regulating immune function, and its deficiency is a suggested risk factor for childhood pneumonia. Our aim was to assess whether oral supplementation of vitamin D(3) (cholecalciferol) will reduce the incidence and severity of pneumonia in a high-risk infant population. METHODS We did a randomised placebo-controlled trial to compare oral 100,000 IU (2·5 mg) vitamin D(3) with placebo given to children aged 1-11 months in Kabul, Afghanistan. Randomisation was by use of a computer-generated list. Vitamin D or placebo was given by fieldworkers once every 3 months for 18 months. Children presenting at the study hospital with signs of pneumonia had their diagnosis confirmed radiographically. Our primary outcome was the first or only episode of radiologically confirmed pneumonia. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00548379. FINDINGS 1524 children were assigned to receive vitamin D(3) and 1522 placebo. There was no significant difference between the incidence of first or only pneumonia between the vitamin D (0·145 per child per year, 95% CI 0·129-0·164) and the placebo group (0.137, 0·121-0·155); the incidence rate ratio was 1·06 (95% CI 0·89-1·27). From 652 children during five separate periods of testing serum calcifediol, only one child in each of two testing periods had results greater than 375 nmol/L in the intervention group--a toxic level. INTERPRETATIONS Quarterly bolus doses of oral vitamin D(3) supplementation to infants are not an effective intervention to reduce the incidence of pneumonia in infants in this setting. FUNDING Wellcome Trust and British Council.
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Affiliation(s)
- Semira Manaseki-Holland
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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198
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Tan PH, Chew B, Wee WC, Tan B. A land untouched by dentistry - singapore brings dental care to afghanistan. Singapore Dent J 2012; 32:39-48. [PMID: 23739286 DOI: 10.1016/s0377-5291(12)70015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In 2007, the Singapore Armed Forces deployed a Dental Project Team (DPT) to the capital city of the Bamiyan Province in Afghanistan. The team set up the province's first modern dental facility. Besides providing primary dental care to the 60,000 population there, the Singaporeans also trained and prepared a team of Afghan dentist and dental assistants. The Afghan dental team took over the dental clinic and continued to provide care when it was time for the DPT to depart for home. Braving challenging security and austere living conditions, the DPT completed its mission successfully.
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Affiliation(s)
- Peng Hui Tan
- Roots! Advanced Endodontics, Novena Medical Center, Singapore.
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Plourde M, Coelho A, Keynan Y, Larios OE, Ndao M, Ruest A, Roy G, Rubinstein E, Ouellette M. Genetic polymorphisms and drug susceptibility in four isolates of Leishmania tropica obtained from Canadian soldiers returning from Afghanistan. PLoS Negl Trop Dis 2012; 6:e1463. [PMID: 22272366 PMCID: PMC3260320 DOI: 10.1371/journal.pntd.0001463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease characterized by the presence of one or more lesions on the skin that usually heal spontaneously after a few months. Most cases of CL worldwide occur in Southwest Asia, Africa and South America, and a number of cases have been reported among troops deployed to Afghanistan. No vaccines are available against this disease, and its treatment relies on chemotherapy. The aim of this study was to characterize parasites isolated from Canadian soldiers at the molecular level and to determine their susceptibility profile against a panel of antileishmanials to identify appropriate therapies. METHODOLOGY/PRINCIPAL FINDINGS Parasites were isolated from skin lesions and characterized as Leishmania tropica based on their pulsed field gel electrophoresis profiles and pteridine reductase 1 (PTR1) sequences. Unusually high allelic polymorphisms were observed at several genetic loci for the L. tropica isolates that were characterized. The drug susceptibility profile of intracellular amastigote parasites was determined using an established macrophage assay. All isolates were sensitive to miltefosine, amphotericin B, sodium stibogluconate (Pentostam) and paromomycin, but were not susceptible to fluconazole. Variable levels of susceptibility were observed for the antimalarial agent atovaquone/proguanil (Malarone). Three Canadian soldiers from this study were successfully treated with miltefosine. CONCLUSIONS/SIGNIFICANCE This study shows high heterogeneity between the two L. tropica allelic versions of a gene but despite this, L. tropica isolated from Afghanistan are susceptible to several of the antileishmanial drugs available.
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Affiliation(s)
- Marie Plourde
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Adriano Coelho
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Yoav Keynan
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Oscar E. Larios
- Department of Medicine and Laboratory Medicine, Divisions of Infectious Diseases and Microbiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Momar Ndao
- National Reference Center for Parasitology, McGill University, Montreal General Hospital/Research Institute, Montréal, Québec, Canada
| | | | - Gaétan Roy
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Ethan Rubinstein
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marc Ouellette
- Centre de Recherche en Infectiologie du Centre de Recherche du CHUQ and Département de Microbiologie, Immunologie et Infectiologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
- * E-mail:
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Armed Forces Health Surveillance Center (AFHSC). Update: malaria, U.S. Armed Forces, 2011. MSMR 2012; 19:2-6. [PMID: 22309389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
U.S. service members are at risk of malaria when they are assigned to endemic areas (e.g., Korea), participate in operations in endemic areas (e.g., Afghanistan, Africa) and visit malarious areas during personal travel. In 2011, 124 service members were reported with malaria. Nearly three-fourths of cases were presumably acquired in Afghanistan (n=91) and one-fifth were considered acquired in Africa (n=24). One-quarter of cases were caused by P. vivax and one-fifth by P. falciparum (including 6 Afghanistan-acquired infections); most cases were reported as "unspecified" malaria. Malaria was diagnosed/reported from 51 different medical facilities in the United States, Afghanistan, Kyrgyzstan, Iraq, Germany and Korea. Providers of care to military members should be knowledgeable regarding and vigilant for clinical presentations of malaria outside of endemic areas.
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