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Islam MT, Bruce M, Alam K. Patterns and determinants of healthcare utilization and medication use before and during the COVID-19 crisis in Afghanistan, Bangladesh, and India. BMC Health Serv Res 2024; 24:416. [PMID: 38570763 PMCID: PMC10988829 DOI: 10.1186/s12913-024-10789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/08/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND COVID-19 rapidly spread through South Asian countries and overwhelmed the health systems that were unprepared for such an outbreak. Evidence from high-income countries showed that COVID-19 impacted healthcare utilization, including medication use, but empirical evidence is lacking in South Asia. This study aimed to investigate the effect of COVID-19 on healthcare utilization and medication use in South Asia. METHOD The current study used longitudinal data from the 'Premise Health Service Disruption Survey' 2020 and 2021. The countries of interest were limited to Afghanistan, Bangladesh, and India. In these surveys, data related to healthcare utilization and medication use were collected for three-time points; 'Pre-COVID phase', 'Initial phase of COVID-19 outbreak', and 'One year of COVID-19 outbreak'. Generalized estimating equation (GEE) along with McNemar's test, Kruskal-Wallis test and χ2 test were applied in this study following the conceptualization of Andersen's healthcare utilization model. RESULT The use of healthcare and medication was unevenly impacted by the COVID-19 epidemic in Afghanistan, Bangladesh, and India. Immediately after the COVID-19 outbreak, respondents in Bangladesh reported around four times higher incomplete healthcare utilization compared to pre-COVID phase. In contrast, respondents in Afghanistan reported lower incomplete utilization of healthcare in a similar context. In the post COVID-19 outbreak, non-adherence to medication use was significantly higher in Afghanistan (OR:1.7; 95%CI:1.6,1.9) and India (OR:1.3; 95%CI:1.1,1.7) compared to pre-COVID phase. Respondents of all three countries who sought assistance to manage non-communicable diseases (NCDs) had higher odds (Afghanistan: OR:1.5; 95%CI:1.3,1.8; Bangladesh: OR: 3.7; 95%CI:1.9,7.3; India: OR: 2.3; 95% CI: 1.4,3.6) of non-adherence to medication use after the COVID-19 outbreak compared to pre-COVID phase. CONCLUSION The present study documented important evidence of the influence of COVID-19 epidemic on healthcare utilization and medication use in three countries of South Asia. Lessons learned from this study can feed into policy responses to the crisis and preparedness for future pandemics.
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Affiliation(s)
- Md Tauhidul Islam
- Murdoch Business School, Murdoch University, 6150, Perth, WA, Australia.
| | - Mieghan Bruce
- School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, 6150, Perth, WA, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, 6150, Perth, WA, Australia
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Esmat E, Haidary AM, Saadaat R, Rizvi SN, Aleena S, Haidari M, Hofiani SMS, Hussaini N, Hakimi A, Khairy A, Abdul-Ghafar J. Association of hormone receptors and human epidermal growth factor receptor-2/neu expressions with clinicopathologic factors of breast carcinoma: a cross-sectional study in a tertiary care hospital, Kabul, Afghanistan. BMC Cancer 2024; 24:388. [PMID: 38539179 PMCID: PMC10967195 DOI: 10.1186/s12885-024-12129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is one of the major causes of death worldwide. It is the most common cause of death before the age of 70 years. The incidence and mortality of BC are rapidly increasing, posing great challenges to the health system and economy of every nation. METHODOLOGY A cross-sectional analytical study was conducted at the Department of Pathology and Clinical Laboratory of the French Medical Institute for Mothers and Children (FMIC) to demonstrate the association of human epidermal growth factor receptor 2 (Her2/Neu) and estrogen receptor (ER)/ progesterone receptor (PR) with clinical as well as pathological parameters among women with BC. A consecutive nonprobability sampling method was used for this study over a span of one and a half years. RESULTS One hundred twenty participants diagnosed with breast cancer were included in the study. The mean age at diagnosis was 44.58 ± 11.16 years. Out of the total patients, 68 (56.7%) were above 40 years old, 108 (90%) were married, 94 (78.3%) were multiparous, and 88 (73.3%) had a history of breastfeeding. 33.3% of cases were within the age range of menopause (40-50 years). The positive expression rates of ER, PR, and Her2/neu were found to be 48.8%, 44.6%, and 44.6%, respectively, and Her2/neu overexpression was found to be higher among ER/PR-negative cases. CONCLUSION In our study, we demonstrated that among Afghan women, grade II invasive ductal carcinoma, not otherwise specified, was the most common type of BC and frequently affected women above the age of 40. We also revealed that the percentage of negative ER (50.4%), negative PR (54.4%), and concordant ER/PR-negative cases were high compared to other possibilities. Additionally, the study revealed that expression of Her2/neu was in contrast with the expression of ER and PR receptors. The findings of our study still support the importance of performing immunohistochemical stains for hormonal receptor classification in terms of better clinical outcomes and prognosis.
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Affiliation(s)
- Esmatullah Esmat
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Ramin Saadaat
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Syeda Naghma Rizvi
- Aga Khan University School of Nursing and Midwifery (AKU-SoNaM), Karachi, Pakistan
| | - Syeda Aleena
- Aga Khan University School of Nursing and Midwifery (AKU-SoNaM), Karachi, Pakistan
| | - Mujtaba Haidari
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Sayed Murtaza Sadat Hofiani
- Department of Academic and Research, Postgraduate Medical Education (PGME), French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Nasrin Hussaini
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Ahmadullah Hakimi
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Abdullatif Khairy
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan.
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Huda MD, Rahman M, Mostofa MG, Sarkar P, Islam MJ, Adam IF, Duc NHC, Al-Sobaihi S. Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey. Glob Heart 2024; 19:31. [PMID: 38524910 PMCID: PMC10959132 DOI: 10.5334/gh.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness. Methods This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains. Results The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores. Conclusions Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.
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Affiliation(s)
- Md. Durrul Huda
- Diabetic Hospital, Chapai Nawabganj, Bangladesh
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Mosiur Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Md. Golam Mostofa
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Prosannajid Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - Md. Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia
| | | | | | - Saber Al-Sobaihi
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe) at Osaka University, Osaka, Japan
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Anwari P, Burnett E, Chavers TP, Samsor A, Safi H, Safi N, Clark AD, Parashar UD, Tate JE. Post-marketing surveillance of intussusception after Rotarix administration in Afghanistan, 2018-2022. Vaccine 2024; 42:2059-2064. [PMID: 38413278 DOI: 10.1016/j.vaccine.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/21/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND In January 2018, Afghanistan introduced the monovalent oral rotavirus vaccine (Rotarix) nationwide, administered as a 2-dose series at six and ten weeks of age. We describe characteristics of intussusception cases and assess potential intussusception risk associated with Rotarix vaccination in Afghan infants. METHODS Multi-center prospective active hospital-based surveillance for intussusception was conducted from May 2018 to March 2022 in four sentinel sites in Afghanistan. We applied the Brighton Level 1 criteria for intussusception and verified vaccination status by reviewing vaccine cards. We used the self-controlled case series (SCCS) methodology to compare intussusception incidence in the 1 to 21 days after each dose of Rotarix vaccination against non-risk periods. RESULTS A total of 468 intussusception cases were identified in infants under 12 months, with 264 cases aged between 28 and 245 days having confirmed vaccination status contributing to the SCCS analysis. Most case-patients (98 %) required surgery for treatment, and over half (59 %) of those who underwent surgery required intestinal resection. Nineteen (7 %) case-patients died. Eighty-six percent of case-patients received the first dose of Rotarix, and 69 % received the second dose before intussusception symptom onset. There was no increased risk of intussusception in the 1-7 days (relative incidence: 0.9, 95 % CI: 0.1, 7.5), 8-21 days (1.3, 95 % CI: 0.4, 4.2), or 1-21 days (1.1, 95 % CI: 0.4, 3.4) following receipt of the first dose or in the 1-7 days (0.2, 95 % CI: 0.3, 1.8), 8-21 days (0.7, 95 % CI: 0.3, 1.5), or 1-21 days (0.6, 95 % CI: 0.3, 1.2) following the second dose. CONCLUSION Rotarix vaccination was not associated with an increased intussusception risk, supporting its continued use in Afghanistan's immunization program. However, there was a high level of death and resection due to intussusception among Afghan infants.
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Affiliation(s)
- Palwasha Anwari
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Eleanor Burnett
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
| | - Tyler P Chavers
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
| | | | | | | | - Andrew D Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Umesh D Parashar
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
| | - Jacqueline E Tate
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
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Kabir A, Kamboh AA, Abubakar M, Baloch H, Nizamani ZA. Foot-and-mouth disease virus dynamics in border areas of Pakistan with Afghanistan. Mol Biol Rep 2024; 51:370. [PMID: 38411732 DOI: 10.1007/s11033-024-09262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/26/2023] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Foot and mouth disease (FMD) is a highly contagious disease that impacts cloven-hoofed animals globally. The illegal trade of livestock between the border regions of Pakistan and Afghanistan can contribute to the spread of this disease. This study focuses on investigating the outbreaks of FMD that occurred in this area from June 2020 to May 2021. METHODS RESULTS: A total of 233 epithelial tissue samples were collected, and 77% were found positive for FMDV through an antigen-detection by ELISA and molecular conformation through RT-PCR. The study found three serotypes of FMDV dominating in the border area of Pakistan with Afghanistan: O, A, and Asia-1. The outbreak activity was peaked between August/September followed by July/October 2020. Phylogenetic analysis conducted using the VP1 region sequence showed that serotype O isolates belonged to the Middle East-South Asia (ME-SA) topotype, PanAsia-2 lineage, and ANT-10 sub-lineage, while serotype Asia-1 isolates belonged to a novel lineage BD-18.The highest prevalence of serotype O of FMDV was found in cattle and buffalo of 1-2 year age group, while the highest outbreak ratio of serotype O was recorded in goats of 0-1 year age group and sheep of > 2 year age group. The serotype O was more prevalent in male than female sheep. The type A was more prevalent in females of sheep and goats than their corresponding males. The serotype Asia-1 was more prevalent in females of cattle and sheep than their corresponding males. The outbreak epidemiology of FMD varied significantly between various regions, months of study, animal species, age groups, and gender. CONCLUSIONS The study found that FMD outbreaks in the border area of Pakistan and Afghanistan were diverse and complicated, and that different types of FMDV were circulating. The study recommended effective actions to stop FMD transmission in this area.
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Affiliation(s)
- Abdul Kabir
- Department, of Veterinary Microbiology, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, 70060, Pakistan
| | - Asghar Ali Kamboh
- Department, of Veterinary Microbiology, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, 70060, Pakistan.
| | | | - Hasina Baloch
- Department, of Veterinary Microbiology, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, 70060, Pakistan
| | - Zaheer Ahmed Nizamani
- Department of Veterinary Pathology, Faculty of Animal Husbandry and Veterinary Sciences, Sindh Agriculture University, Tandojam, 70060, Pakistan
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Wesemann U, Renner KH, Rowlands K, Köhler K, Hüttermann N, Himmerich H. Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident-a quasi-experimental cohort study. Front Public Health 2024; 12:1357836. [PMID: 38584933 PMCID: PMC10995976 DOI: 10.3389/fpubh.2024.1357836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction There is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress. Methods N = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders. Results When comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0). Discussion These results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Karl-Heinz Renner
- Faculty of Human Sciences, Institute of Psychology, Bundeswehr University Munich, Neubiberg, Germany
| | - Katie Rowlands
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Kai Köhler
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Nils Hüttermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Hubertus Himmerich
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
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Hahad O. Burden of Disease Due to Air Pollution in Afghanistan-Results from the Global Burden of Disease Study 2019. Int J Environ Res Public Health 2024; 21:197. [PMID: 38397687 PMCID: PMC10888459 DOI: 10.3390/ijerph21020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Air pollution is a significant risk factor for a range of diseases and leads to substantial disease burden and deaths worldwide. This study aimed to investigate the burden of disease in Afghanistan attributed to air pollution in 2019. METHODS Data from the Global Burden of Disease (GBD) Study 2019 were used to investigate disability-adjusted life-years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to air pollution in Afghanistan. RESULTS In 2019, air pollution in Afghanistan was associated with significant health impacts, and contributed to 37,033 deaths (14.72% of total deaths), 1,849,170 DALYs (10.80% of total DALYs), 76,858 YLDs (2.07% of total YLDs), and 1,772,311 YLLs (13.23% of total YLLs). The analysis further revealed that lower respiratory infections, neonatal disorders, ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes mellitus were the leading causes of mortality and disease burden associated with air pollution in Afghanistan from 1990 to 2019. Comparative assessments between 1990 and 2019 underscored air pollution as a consistent prominent risk factor that ranked closely with other risk factors, like malnutrition, high blood pressure, and dietary risks, in contributing to deaths, DALYs, YLDs, and YLLs. In a comparative country analysis for the year 2019, Afghanistan emerged as having a substantial burden of disease due to air pollution, closely mirroring other high-burden nations like China, India, Pakistan, and Bangladesh. DISCUSSION Air pollution is one of the major health risk factors that significantly contribute to the burden of disease in Afghanistan, which emphasizes the urgent need for targeted interventions to address this substantial public health threat.
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Affiliation(s)
- Omar Hahad
- Department of Cardiology I, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
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Lambert M, Rezaie M, Jeannin M, Sina N, Mahyar Z, Marks L. The oral health situation and treatment need of schoolchildren Afghanistan: a cross-sectional study. Eur J Paediatr Dent 2024; 25:1. [PMID: 38329026 DOI: 10.23804/ejpd.2024.1902] [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: 02/09/2024]
Abstract
AIM The present study explores the treatment need for dental caries in schoolchildren in Herat, Afghanistan. METHODS A convenience sample of 13 schools were selected for the study. All schools were located in the urban areas near Herat and were selected through allocation by the Ministry of Health, which also approved the study protocol. In the schools, classes were allocated by the principal of the school. All the children in the allocated classes were included in the survey. Data collection was performed in the school setting by trained Afghan dentist examiners. To measure caries experience, DMFT/dmft scores were used, counting the number of decayed (measured at both white spot (D≥1) and cavitation level (D≥3), according to WHO criteria), missing and filled teeth. CONCLUSION Dental caries is a considerable oral health problem in the study population. The present sample has a high proportion of untreated carious lesions and a very low level of restorative care. Moreover, significant differences were shown in relation to gender and age groups. The present survey results confirm the need for professional operative and preventive oral health care in this region.
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Affiliation(s)
- M Lambert
- ELOHA (Equal Lifelong Oral Health for All) research group, Dental Public Health, Oral Health Sciences, Ghent University, Belgium
| | - M Rezaie
- ELOHA (Equal Lifelong Oral Health for All) research group, Dental Public Health, Oral Health Sciences, Ghent University, Belgium
| | - M Jeannin
- ELOHA (Equal Lifelong Oral Health for All) research group, Dental Public Health, Oral Health Sciences, Ghent University, Belgium
| | - N Sina
- University of Herat, Faculty of Stomatology, Herat, Afghanistan
| | - Z Mahyar
- University of Herat, Faculty of Stomatology, Herat, Afghanistan
| | - L Marks
- Faculty of Medicine & Health Sciences, University of Antwerp, Belgium - Department of Cranio-Maxillofacial Surgery - Special Care in Dentistry, Antwerp University Hospital, Antwerp, Belgium
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Kovess-Masfety V, Sabawoon A, Keyes K, Karam E. Prevalence, risk factors, and comorbidities of psychotic experiences in Afghanistan: a highly stressful environment. Soc Psychiatry Psychiatr Epidemiol 2024; 59:99-109. [PMID: 37558897 DOI: 10.1007/s00127-023-02539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To estimate the prevalence and demographic, psychiatric, and trauma-focused correlates of psychotic experiences (PEs) in the Afghan general population. METHODS Data were drawn from a cross-sectional household survey implemented in eight regions of Afghanistan (N = 4445). The CIDI structured instrument was administered to adults to assess psychiatric disorders and psychotic experiences; life events and PTSD were assessed using validated instruments. Weighted multivariate models integrated socio-demographics, regions, traumas as determinants of PE. RESULTS PEs were frequently reported in the Afghan population: 27.50% of the population reported a lifetime PE. PEs were more common among specific ethnic groups, and were associated with lower income in adjusted regression models. PEs were associated with mental health problems including major depressive disorders (OR = 3.43), PTSD (OR = 5.08), generalized anxiety (OR = 4.2); lifetime suicidal attempts (OR 6.04), lifetime suicidal thoughts (OR = 3.42), addiction (OR = 2.18); and psychological distress and impairment due to mental health (OR = 2.95 and 2.46, respectively). CONCLUSION Psychotic experiences in the Afghan general population confirm general population findings in other countries, that psychotic experiences are common and associated with economic and social marginalization, and part of a continuum of mental health problems experienced in populations. Efforts to reduce and treat psychotic experiences within a broad array of psychiatric conditions are needed.
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Affiliation(s)
- V Kovess-Masfety
- LPPS, University of Paris Cité, Paris, France.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - A Sabawoon
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Governance Institute of Afghanistan (GI-A), Kabul, Afghanistan
| | - K Keyes
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - E Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center University of Balamand, Beirut, Lebanon
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Stanikzai MH, Wafa MH, Tawfiq E, Jafari M, Le CN, Wasiq AW, Rahimi BA, Baray AH, Ageru TA, Suwanbamrung C. Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan. PLoS One 2023; 18:e0295246. [PMID: 38150430 PMCID: PMC10752561 DOI: 10.1371/journal.pone.0295246] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients. OBJECTIVES This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan. METHODS A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs. RESULTS We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)]. CONCLUSION Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.
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Affiliation(s)
- Muhammad Haroon Stanikzai
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Hashim Wafa
- Faculty of Medicine, Neuropsychiatric and Behavioral science Department, Kandahar University, Kandahar, Afghanistan
| | - Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Cua Ngoc Le
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
| | - Abdul Wahed Wasiq
- Faculty of Medicine, Department of Internal Medicine, Kandahar University, Kandahar, Afghanistan
| | - Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Ahmad Haroon Baray
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Temesgen Anjulo Ageru
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
| | - Charuai Suwanbamrung
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
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11
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Salam AS, Qayumi R, Majeed Siddiqi A, Naseem M, Mansoor M, Butcher R, Bakhtiari A, Renneker K, Willis R, Jimenez C, Dejene M, Safi N, Heggen A, Solomon AW, Harding-Esch EM, Alizoi N. Prevalence of Trachoma in 72 Districts of Afghanistan in 2018-2019: Results of 35 Population-based Prevalence Surveys. Ophthalmic Epidemiol 2023; 30:608-618. [PMID: 35272540 PMCID: PMC10581673 DOI: 10.1080/09286586.2021.2015784] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 03/08/2021] [Revised: 10/16/2021] [Accepted: 12/05/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND To determine where interventions are needed to eliminate trachoma as a public health problem, prevalence data are needed. We aimed to generate baseline population-based data on trachoma prevalence in suspected-endemic areas of Afghanistan. METHODS Cross-sectional population-based prevalence surveys designed according to World Health Organization (WHO) recommendations were conducted in 35 evaluation units (EUs) covering 72 districts. In selected households, all resident individuals aged ≥1 year were examined for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT) according to the WHO simplified trachoma grading system. Water, sanitation and hygiene access was assessed in households of survey participants. RESULTS 104,104 people aged ≥1 year were examined, including 43,774 children aged 1-9 years and 46,439 people aged ≥15 years. The age-adjusted prevalence of TF in 1-9-year-olds was ≥5% in 3 EUs, with the highest EU TF prevalence being 7.8%. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in all EUs. The majority of households had access to an improved water source within 30 minutes of the house. However, only a minority of households had an improved latrine and/or a handwash station. CONCLUSIONS Trachoma is not a public health problem in the majority of EUs surveyed. However, antibiotic mass drug administration, promotion of facial cleanliness and environmental improvement (the A, F and E components of the SAFE strategy) are needed for trachoma elimination purposes in three of the EUs surveyed in Afghanistan.
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Affiliation(s)
| | | | | | | | | | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Naimullah Safi
- Afghanistan Country Office, World Health Organization, Kabul, Afghanistan
| | | | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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12
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Literacka E, Konior M, Izdebski R, Żabicka D, Herda M, Gniadkowski M, Korzeniewski K. High risk of intestinal colonization with ESBL-producing Escherichia coli among soldiers of military contingents in specific geographic regions. Eur J Clin Microbiol Infect Dis 2023; 42:1523-1530. [PMID: 37857920 PMCID: PMC10651695 DOI: 10.1007/s10096-023-04684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
One-hundred Polish soldiers of a contingent in Afghanistan in 2019 were screened for Enterobacterales resistant to newer-generation β-lactams at their departure and return. Seventeen percent were colonized in the gut at the departure, whereas 70% acquired carriage in Afghanistan. The commonest organisms were extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-Ec; 96.6%). All isolates were sequenced and were clonally diverse overall, even within the same sequence type, indicating that independent acquisitions mainly. ESBL-Ec were often multi-drug-resistant. Soldiers stationing in certain regions are at high risk of acquiring resistant bacteria that may cause endogenous infection, be transmitted to vulnerable individuals, and spread resistance genes.
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Affiliation(s)
- E Literacka
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland.
| | - M Konior
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - R Izdebski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - D Żabicka
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - M Herda
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - M Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - K Korzeniewski
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
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13
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Soderstrom MA, Blyth DM, Carson ML, Campbell WR, Yabes JM, Shaikh F, Stewart L, Tribble DR, Murray CK, Kiley JL. Seasonality of Microbiology of Combat-Related Wounds and Wound Infections in Afghanistan. Mil Med 2023; 188:304-310. [PMID: 37948254 PMCID: PMC10637295 DOI: 10.1093/milmed/usad115] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/02/2023] [Accepted: 03/28/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Battlefield-related wound infections are a significant source of morbidity among combat casualties. Seasonality of these infections was demonstrated in previous conflicts (e.g., Korea) but has not been described with trauma-related health care-associated infections from the war in Afghanistan. METHODS The study population included military personnel wounded in Afghanistan (2009-2014) medevac'd to Landstuhl Regional Medical Center and transitioned to participating military hospitals in the United States with clinical suspicion of wound infections and wound cultures collected ≤7 days post-injury. Analysis was limited to the first wound culture from individuals. Infecting isolates were collected from skin and soft-tissue infections, osteomyelitis, and burn soft-tissue infections. Data were analyzed by season (winter [ December 1-February 28/29], spring [March 1-May 31], summer [June 1-August 31], and fall [September 1-November 30]). RESULTS Among 316 patients, 297 (94.0%) sustained blast injuries with a median injury severity score and days from injury to initial culture of 33 and 3.5, respectively. Although all patients had a clinical suspicion of a wound infection, a diagnosis was confirmed in 198 (63%) patients. Gram-negative bacilli (59.5% of 316) were more commonly isolated from wound cultures in summer (68.1%) and fall (67.1%) versus winter (43.9%) and spring (45.1%; P < .001). Multidrug-resistant (MDR) Gram-negative bacilli (21.8%) were more common in summer (21.8%) and fall (30.6%) versus winter (7.3%) and spring (19.7%; P = .028). Findings were similar for infecting Gram-negative bacilli (72.7% of 198)-summer (79.5%) and fall (83.6%; P = .001)-and infecting MDR Gram-negative bacilli (27.3% of 198)-summer (25.6%) and fall (41.8%; P = .015). Infecting anaerobes were more common in winter (40%) compared to fall (11%; P = .036). Gram-positive organisms were not significantly different by season. CONCLUSION Gram-negative bacilli, including infecting MDR Gram-negative bacilli, were more commonly recovered in summer/fall months from service members injured in Afghanistan. This may have implications for empiric antibiotic coverage during these months.
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Affiliation(s)
- Matthew A Soderstrom
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX 78234, USA
| | - Dana M Blyth
- Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - M Leigh Carson
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Wesley R Campbell
- Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Joseph M Yabes
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX 78234, USA
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Clinton K Murray
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX 78234, USA
| | - John L Kiley
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX 78234, USA
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Endler M, Hassan L, Gemzell-Danielsson K, Babak S, Sohail R. "I hope to all the world they don't forget women of Afghanistan": An interrupted survey among doctors in Afghanistan. Int J Gynaecol Obstet 2023; 163:402-408. [PMID: 37458177 DOI: 10.1002/ijgo.14979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To assess current access to essential sexual and reproductive health (SRHR) services in Afghanistan and how access has changed with the transition of power. METHODS This is a cross-sectional study based on data from an anonymous survey among doctors in Afghanistan in May 2022, analyzed using descriptive statistics. The survey recorded subjective estimates of access to SRHR services, barriers to access, extent of maternal mortality or near miss due to preventable factors, and the effect of the regime change on access. RESULTS The data collection was interrupted after 60 responses. A majority of providers responded that their population went hungry often or always. According to our criteria for "access", that 75% or more of the population was estimated to have it, no respondents (0%) assessed that access existed for services for gender-based violence. The corresponding proportion responding that access existed was 3.4% for services after rape, 12.6% for legal abortion, 13.3% for antenatal care, and 20% for labor care. According to 41.7% of respondents, untreated postpartum hemorrhage accounted for a large or very large proportion of preventable maternal mortality or near miss. Almost half of respondents (47.4%) reported the same for lack of skilled providers, 66.2% reported it for the concept "too many pregnancies", and 55% reported it for malnutrition and poor health. According to 43.3% of respondents, the regime change had reduced access to labor care to a large extent, 33.9% of respondents said this in relation to access to contraceptives, and 43.1% for overall access for internally displaced persons. CONCLUSION Interim data suggest that women in some settings in Afghanistan have no access to SRHR services, that preventable factors account for a large portion of maternal deaths or near miss, and that access has deteriorated since the transition of power.
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Affiliation(s)
- Margit Endler
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Rubina Sohail
- Services Institute of Medical Sciences/Services Hospital, Lahore, Pakistan
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15
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Sediqi MS, Wali A, Ibrahimi MA. Prevalence of pediatric sepsis in hospitalized children of Maiwand Teaching Hospital, Kabul, Afghanistan. BMC Pediatr 2023; 23:510. [PMID: 37845607 PMCID: PMC10577964 DOI: 10.1186/s12887-023-04318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 09/17/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Sepsis is a clinical syndrome associated with a systemic reaction to infection that is seen as a bacteremia with systemic symptoms. Sepsis is one of the most important problems in children and is associated with many deaths, so recognizing this disease and it's causing factors and identifying the predisposing factors for it is of great importance. Globally, the prevalence and occurrences of sepsis and septic shock are increasing, while the incidence of deaths from them has decreased with the improvement of diagnostic and treatment facilities. According to a 2015 World Health Organization report, approximately 5.9 million children under 5 years old have lost their lives due to sepsis worldwide, the majority of which have occurred in developing countries. METHODS This study was conducted in the pediatric department of Maiwand Teaching Hospital (MTH) in 2020 as a descriptive cross-sectional study. All children who were admitted to the pediatric department of Maiwand Teaching Hospital during 2020 were included in the research. Among them, the prevalence of sepsis in children with respect to age and sex was studied. The study included children over the age of 28 days who were admitted to the Maiwand Teaching Hospital pediatrics department in 2020. However, in this study, patients have been categorized into five categories according to age: less than two months, two months to one year, one to three years, three to five years old, and older than five years old. RESULTS This study was conducted in the pediatric department of Maiwand Teaching Hospital in 2020 as a descriptive cross-sectional study, and it was found that the prevalence of sepsis in children who were admitted to the pediatric department at this year was 50.5%, including the highest prevalence in males (65.75%) and at the age of two months to one year (37.9%). In this study, it was found that the prevalence of sepsis was higher (88.46%) among urban children than children who were living in villages (11.53%). In this study, the mortality rate was 2.44% for patients admitted to Maiwand Teaching Hospital. CONCLUSIONS In this study, it was found that the prevalence of sepsis was 50.5% in children admitted to the pediatrics department of Maiwand Teaching Hospital, of whom 67.75% were boys, 37.94% were aged two months to three years old, and it was more prevalent (88.46%) among children living in cities. The mortality rate was 2.44%.
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Affiliation(s)
- Mohammad Sharif Sediqi
- Department of Pediatrics, Kabul University of Medical Sciences, P.O. Box 1003, Kabul, 2496300, Afghanistan.
| | - Abdulwali Wali
- Department of Pediatrics, Kabul University of Medical Sciences, P.O. Box 1003, Kabul, 2496300, Afghanistan
| | - Mohammad Akbar Ibrahimi
- Department of Pediatrics, Kabul University of Medical Sciences, P.O. Box 1003, Kabul, 2496300, Afghanistan
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Bjork A, Akbar IE, Chaudhury S, Wadood MZ, Ather F, Jorba J, Martinez M. Progress Toward Poliomyelitis Eradication - Afghanistan, January 2022-June 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1020-1026. [PMID: 37733636 PMCID: PMC10519716 DOI: 10.15585/mmwr.mm7238a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
When the Global Polio Eradication Initiative began in 1988, wild poliovirus (WPV) transmission was reported in 125 countries. Since 2017, Afghanistan and Pakistan remain the only countries with uninterrupted endemic WPV type 1 (WPV1) transmission. This report describes activities and progress toward polio eradication in Afghanistan during January 2022-June 2023. Two WPV1 cases were reported during January-December 2022 and five during January-June 2023 (as of August 26), all from three provinces in the southeast and east regions bordering Pakistan. All five 2023 patients had reportedly received ≥16 oral poliovirus vaccine doses. WPV1 was detected in sewage samples from a site in the south region in May 2023 and one in the north region in June 2023, the first detections since February 2021 and March 2020, respectively. Restrictions on house-to-house vaccination limit the effectiveness of vaccination campaigns in parts of the south and northeast regions. Because of population movement, the risk for transmission in Afghanistan and Pakistan will remain if WPV1 circulation continues in either country. Despite operational improvements in vaccination activities, interruption of WPV1 transmission in Afghanistan will require committed, uninterrupted efforts, including ongoing coordination with Pakistan on polio eradication activities, to address vaccination coverage gaps that sustain WPV1 circulation.
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17
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Mohammed RN, Khawari A, Shaguy JA, Abouzied A. A GIS-based approach to identifying communities underserved by primary health care services-An Afghanistan case study. Front Public Health 2023; 11:1209986. [PMID: 37809002 PMCID: PMC10552865 DOI: 10.3389/fpubh.2023.1209986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023] Open
Abstract
Afghanistan has been in an active state of conflict and war for twenty continuous years. Social services like health and education have been badly affected, facing issues such as service disruption, brain drain, and generalized instability. Health indices that provide proxy indicators for general population wellness, such as maternal health, child mortality, and immunization coverage, show that the health services available to the Afghan population are sub-optimal. Investment in social service and interventions has increased. The World Bank and the United Nations through its agencies (The World Health Organization (WHO) and United Nations' Children's Fund (UNICEF) are providing social support through targeted and strategic programs. However, the topographic and environmental realities of Afghanistan, with its broad mountain coverage, propensity toward natural disasters, and latent conflict, has made data and information gathering arduous. Since data is essential for measurement and management, the WHO Health Emergencies (WHE) information management unit at WHO Afghanistan has delivered an innovative form of data analysis, specialized and targeted at providing improved information on communities that are not adequately covered by health services. Deploying a geographical information system (GIS) approach, the WHE team has collated primary and secondary data from a combination of datasets to produce a far-reaching piece of analysis. The analysis of underserved communities in hard to reach, remote locations, provides a live, evidence-based information product. This provides a working tool that is essential to primary health programming and intervention in Afghanistan. The estimates show that approximately 9.5 million individuals in 22,181 villages across 34 provinces are underserved by primary health services. This paper is presented to explain the underpinning methodology.
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Affiliation(s)
| | | | | | - Alaa Abouzied
- Health Emergency, World Health Organization, Kabul, Afghanistan
- Public Health Department, Faculty of Medicine, Cairo University, Giza, Egypt
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18
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Schwartz L, Lane H, Hassanpoor Z. Overview and understanding of mental health and psychosocial support in Afghanistan. Int Health 2023; 15:601-607. [PMID: 37490026 PMCID: PMC10472885 DOI: 10.1093/inthealth/ihad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/19/2022] [Revised: 03/30/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
More than four decades of war in Afghanistan has been both a main driver for poor mental health, and a barrier to the development of crucial mental health services. A study conducted by BMC Psychiatry in 2021, across eight regions in Afghanistan, found staggering levels of depressive and anxiety disorders among the general population. Almost one-half of those interviewed (47.12%) reported having high levels of distress in the last month, and almost 40% (39.44%) reported experiencing impairment to their lives due to poor mental health. Yet, despite the common experiences of much of the population, mental health is a hugely stigmatized topic of discussion in Afghanistan, due to a myriad of cultural, religious, socioeconomic and environmental factors. And now, under the de-facto Taliban government, mental health has been deprioritized in the face of a crumbling economy and acute levels of poverty, all but forgotten. This paper sought to review the impact and change to mental health services under the de-facto government, and to provide the reader with greater awareness into the current situation in Afghanistan and equip them with insight into how to respond to the mental health needs of Afghans.
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Affiliation(s)
- Lyla Schwartz
- Peace of Mind Association, 147 Wheel Meadow Drive, Longmeadow, Boston MA, 01106, United States
| | - Hannah Lane
- Peace of Mind Association, 147 Wheel Meadow Drive, Longmeadow, Boston MA, 01106, United States
| | - Zainab Hassanpoor
- Peace of Mind Association, 147 Wheel Meadow Drive, Longmeadow, Boston MA, 01106, United States
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Gaina A, Tahoun M, Mashal O, Safi H, Alizai F, Jalil H, Abouzeid A. The largest reported outbreak of CCHF in hospital settings: lessons from Kandahar, Afghanistan. Lancet Infect Dis 2023; 23:e330-e331. [PMID: 37524104 DOI: 10.1016/s1473-3099(23)00478-4] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Alexandru Gaina
- World Health Organization Country Office Afghanistan, Kabul, Afghanistan.
| | - Mohamed Tahoun
- World Health Organization Country Office Afghanistan, Kabul, Afghanistan; High Institute of Public Health, Alexandria University, Alexandria Governorate, Egypt
| | - Omar Mashal
- World Health Organization Country Office Afghanistan, Kabul, Afghanistan
| | - Hafizullah Safi
- World Health Organization Country Office Afghanistan, Kabul, Afghanistan
| | | | | | - Alaa Abouzeid
- World Health Organization Country Office Afghanistan, Kabul, Afghanistan; Faculty of Medicine, Cairo University, Cairo, Egypt
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20
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Nasari A, Nasari AS, Marzouk S, Dee EC, Jahanbeen F. Cancer Care in Afghanistan: Perspectives on Health Services Under the Taliban Regime. JCO Glob Oncol 2023; 9:e2300358. [PMID: 37972331 PMCID: PMC10846784 DOI: 10.1200/go.23.00358] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
Abstract
Cancer landscape in Afghanistan continues to suffer under Taliban—global support is essential.
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Affiliation(s)
- Alaha Nasari
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Amina Surosh Nasari
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sammer Marzouk
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edward Christopher Dee
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Faramarz Jahanbeen
- Alaha Nasari, BA, Harvard University, Cambridge, MA; Amina Surosh Nasari, MD, CUNY School of Medicine, New York, NY; Sammer Marzouk, MA, Harvard University, Cambridge, MA; Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Faramarz Jahanbeen, MD, MBA, MPH, Harvard T.H. Chan School of Public Health, Boston, MA
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Razai MS, Berry-Hart T, Tawakoli AR, Ahmad A, Hargreaves S. Silent suffering of Afghanistan's LGBT+ community. Lancet Glob Health 2023; 11:e1331-e1332. [PMID: 37591575 DOI: 10.1016/s2214-109x(23)00316-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George's University of London, London SW17 0RE, UK.
| | | | | | - Ayesha Ahmad
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Sally Hargreaves
- Population Health Research Institute, St George's University of London, London SW17 0RE, UK; The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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22
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Rahimi BA, Rafiqi N, Tareen Z, Kakar KA, Wafa MH, Stanikzai MH, Beg MA, Dost AK, Taylor WR. Prevalence of soil-transmitted helminths and associated risk factors among primary school children in Kandahar, Afghanistan: A cross-sectional analytical study. PLoS Negl Trop Dis 2023; 17:e0011614. [PMID: 37695763 PMCID: PMC10513306 DOI: 10.1371/journal.pntd.0011614] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/21/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are global health problem, especially in low-income countries. Main objectives of this study were to estimate the prevalence and intensity of STH and its risk factors among school children in Kandahar city of Afghanistan. METHODOLOGY/PRINCIPAL FINDINGS This was a school-based cross-sectional analytical study, with data collected during eight-month-period (May-December, 2022) from 6- and 12-years old school children in Kandahar city, Afghanistan. All the stool samples were examined by saline wet mount method and Kato-Katz technique. Data were analyzed by using descriptive statistics, Chi square test, and multivariate logistic regression. A total of 1275 children from eight schools of Kandahar city were included in this study. Mean age of these children was 8.3 years with 53.3% boys. The overall prevalence of any intestinal parasitic infection was 68.4%. The overall prevalence of STH infection was 39.1%, with Ascaris lumbricoides (29.4%) as the most prevalent STH species. Mean intensity of overall STH infection was 97.8. Multivariate logistic regression revealed playing barefoot (AOR 1.6, 95% CI 1.1-2.2), not washing hands after defecating and before eating (AOR 1.3, 95% CI 1.0-1.7), having untrimmed nails (AOR 1.4, 95% CI 1.1-1.8), and belonging to poor families (AOR 1.3, 95% CI 1.0-1.7) as the risk factors associated with the predisposition of school children for getting STH in Kandahar city of Afghanistan. CONCLUSIONS/SIGNIFICANCE There is high prevalence of STH among school children of Kandahar city in Afghanistan. Most of the risk factors are related to poverty, decreased sanitation, and improper hygiene. Improvement of socioeconomic status, sanitation, and health education to promote public awareness about health and hygiene together with periodic mass deworming programs are better strategies for the control of STH infections in Afghanistan.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Department of Pediatrics, Faculty of Medicine, Malalay Institute of Higher Education, Kandahar, Afghanistan
| | - Najeebullah Rafiqi
- Department of Surgery, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Zarghoon Tareen
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Khalil Ahmad Kakar
- Department of Public Health, Faculty of Medicine, Malalay Institute of Higher Education, Kandahar, Afghanistan
| | - Mohammad Hashim Wafa
- Department of Psychiatry, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Mohammad Asim Beg
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Abdul Khaliq Dost
- Department of Surgery, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Walter R. Taylor
- Mahidol Oxford Tropical Medicine Clinical Research Unit (MORU), Mahidol University, Bangkok, Thailand
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Taylor L. "Countless lives" at risk in Afghanistan as health services collapse, warns WHO. BMJ 2023; 382:1961. [PMID: 37620016 DOI: 10.1136/bmj.p1961] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
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Razai MS, In-Practice N, Mahmood A, Alizada B, Hargreaves S. Two years on from Taliban takeover of Afghanistan, the Hazaras community is a neglected people at risk of genocide. BMJ 2023; 382:1888. [PMID: 37582579 DOI: 10.1136/bmj.p1888] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Affiliation(s)
| | - Nihr In-Practice
- Population Health Research, St George's University of London, UK
| | - Alisina Mahmood
- Institute for Advanced Studies on Asia, University of Tokyo, Japan
| | | | - Sally Hargreaves
- Population Health Research, St George's University of London, UK
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Watson C. Can the world really stop wild polio by the end of 2023? Nature 2023; 620:706-707. [PMID: 37582941 DOI: 10.1038/d41586-023-02577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
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Mohammady N, Mousavi SH, Rezaie F, Homam H. Preeclampsia and COVID-19 in Afghanistan: additional burden on Afghan pregnant women's health. Hypertens Res 2023; 46:2062-2063. [PMID: 37237105 PMCID: PMC10213577 DOI: 10.1038/s41440-023-01316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/04/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Affiliation(s)
| | - Sayed Hamid Mousavi
- Medical Research Center, Kateb University, Kabul, Afghanistan.
- Afghanistan National Charity Organization for Special Diseases (ANCOSD), Kabul, Afghanistan.
| | - Fatima Rezaie
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Huma Homam
- Medical Research Center, Kateb University, Kabul, Afghanistan
- Afghanistan National Charity Organization for Special Diseases (ANCOSD), Kabul, Afghanistan
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Le TD, Gurney JM, Singh KP, Nessen SC, Schneider ALC, Agimi Y, Bebarta VS, Herson PS, Stout KC, Cardin S, Crowder AT, Ling GSF, Stackle ME, Pusateri AE. Trends in Traumatic Brain Injury Among U.S. Service Members Deployed in Iraq and Afghanistan, 2002-2016. Am J Prev Med 2023; 65:230-238. [PMID: 36870787 DOI: 10.1016/j.amepre.2023.01.043] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major health issue for service members deployed and is more common in recent conflicts; however, a thorough understanding of risk factors and trends is not well described. This study aims to characterize the epidemiology of TBI in U.S. service members and the potential impacts of changes in policy, care, equipment, and tactics over the 15 years studied. METHODS Retrospective analysis of U.S. Department of Defense Trauma Registry data (2002-2016) was performed on service members treated for TBI at Role 3 medical treatment facilities in Iraq and Afghanistan. Risk factors and trends in TBI were examined in 2021 using Joinpoint regression and logistic regression. RESULTS Nearly one third of 29,735 injured service members (32.4%) reaching Role 3 medical treatment facilities had TBI. The majority sustained mild (75.8%), followed by moderate (11.6%) and severe (10.6%) TBI. TBI proportion was higher in males than in females (32.6% vs 25.3%; p<0.001), in Afghanistan than in Iraq (43.8% vs 25.5%; p<0.001), and in battle than in nonbattle (38.6% vs 21.9%; p<0.001). Patients with moderate or severe TBI were more likely to have polytrauma (p<0.001). TBI proportion increased over time, primarily in mild TBI (p=0.02), slightly in moderate TBI (p=0.04), and most rapidly between 2005 and 2011, with a 2.48% annual increase. CONCLUSIONS One third of injured service members at Role 3 medical treatment facilities experienced TBI. Findings suggest that additional preventive measures may decrease TBI frequency and severity. Clinical guidelines for field management of mild TBI may reduce the burden on evacuation and hospital systems. Additional capabilities may be needed for military field hospitals.
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Affiliation(s)
- Tuan D Le
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; Department of Epidemiology and Biostatistics, UT Tyler School of Medicine, The University of Texas at Tyler Health Science Center, Tyler, Texas.
| | - Jennifer M Gurney
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; Joint Trauma System, Fort Sam Houston, Texas
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, UT Tyler School of Medicine, The University of Texas at Tyler Health Science Center, Tyler, Texas
| | | | - Andrea L C Schneider
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yll Agimi
- Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, Maryland
| | - Vikhyat S Bebarta
- Department of Emergency Medicine and Center for COMBAT Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; CU Center for COMBAT Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Anesthesiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paco S Herson
- Department of Anesthesiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Katharine C Stout
- Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, Maryland
| | - Sylvain Cardin
- Naval Medical Research Unit-San Antonio TX, Fort Sam Houston, Texas
| | - Alicia T Crowder
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Geoffrey S F Ling
- Department of Neurology, School of Medicine, John Hopkins University, Baltimore, Maryland
| | - Mark E Stackle
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Anthony E Pusateri
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; Department of Neurology, School of Medicine, John Hopkins University, Baltimore, Maryland
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Neyazi N, Mosadeghrad AM, AbouZeid A. Non-communicable diseases in Afghanistan: a silent tsunami. Lancet 2023; 401:2035-2036. [PMID: 37330735 DOI: 10.1016/s0140-6736(23)01071-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Narges Neyazi
- Health System Development Department, World Health Organization, Kabul 1001, Afghanistan.
| | | | - Alaa AbouZeid
- Health Emergencies Department, World Health Organization, Kabul 1001, Afghanistan; Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
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Abstract
Pakistan and Afghanistan pose risks for international transmission of polioviruses as the last global reservoir for wild poliovirus type 1 (WPV1) and a reservoir for type 2 circulating vaccine-derived polioviruses (cVDPV2s). Widespread transmission of WPV1 and cVDPV2 in 2019-2020 and resumption of intensive supplemental immunization activities (SIAs) in 2020-2021 using oral poliovirus vaccine (OPV) led to decreased transmission of WPV1 and cVDPV2 as of the end of 2021. Using an established dynamic disease transmission model, we explore multiple bounding scenarios with varying intensities of SIAs using bivalent OPV (bOPV) and/or trivalent tOPV (tOPV) to characterize potential die out of transmission. This analysis demonstrates potential sets of actions that may lead to elimination of poliovirus transmission in Pakistan and/or Afghanistan. Some modeled scenarios suggest that Pakistan and Afghanistan could increase population immunity to levels high enough to eliminate transmission, and if maintained, achieve WPV1 and cVDPV2 elimination as early as 2022. This requires intensive and proactive OPV SIAs to prevent transmission, instead of surveillance followed by reactive outbreak response. The reduction of cases observed in 2021 may lead to a false sense of security that polio has already or soon will die out on its own, but relaxation of immunization activities runs the risk of lowering population immunity to, or below, the minimum die-out threshold such that transmission continues. Transmission modeling may play a key role in managing expectations and supporting future modeling about the confidence of no virus circulation in anticipation of global certification decisions.
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Dávila M, López P, Ramiro-Gonzalez M, Saénz de Urturi AM, Palmera RDP, Sánchez C, Wijers IGM, Moreno I, Riesco F, Oliva L, Béjar S, Vera I, González G, Carreras F, Aparicio P. Evacuation of Refugees from Afghanistan: Health Control at the Spanish Border in the Context of the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:5292. [PMID: 37047908 PMCID: PMC10094144 DOI: 10.3390/ijerph20075292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Following the announcement of the retreat of troops from Afghanistan, the Spanish Government organised the so-called "Antigone Operation" for the evacuation of Afghan collaborators. The most relevant ministries were involved in the response. The Ministry of Health, through the Foreign Health Department, performed the health control on arrival. The whole operation was conducted at an air base. It included the health control of refugees composed of temperature measurement, a basic visual control and a coronavirus disease (COVID-19) rapid antigen test for those over 12 years of age; the assessment of their basic needs (food and hygiene); identification and security procedures; and the initial administrative processing. The refugees were accommodated in a temporary facility at the base, where they waited to be transferred to their final destinations. Between 19 and 27 August 2021, 2168 refugees arrived on 17 flights; 680 of them were children under 12 years of age. One thousand four hundred and ninety-nine rapid antigen tests were performed, with one positive result. "Antigone Operation" is unprecedented in Spain and is one of the most complex operations carried out in recent years. The COVID-19 pandemic required the establishment of a health control system on arrival, performed by Foreign Health, which contributed significantly to the overall success of the operation.
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Affiliation(s)
- Miguel Dávila
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Patricia López
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Maria Ramiro-Gonzalez
- Directorate General for Public Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | | | | | - Concepción Sánchez
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Irene G. M. Wijers
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Iratxe Moreno
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Fernando Riesco
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Lourdes Oliva
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Sergio Béjar
- National Institute of Social Security (NISS), Ministry of Inclusion, Social Security and Migration, 11011 Cádiz, Spain
| | - Inmaculada Vera
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Gloria González
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Fernando Carreras
- Deputy Directorate of Foreign Health, Ministry of Health of Spain, 28014 Madrid, Spain
| | - Pilar Aparicio
- Directorate General for Public Health, Ministry of Health of Spain, 28014 Madrid, Spain
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Ryu MY, Martin MJ, Jin AH, Tabor HK, Wren SM. Characterizing Moral Injury and Distress in US Military Surgeons Deployed to Far-Forward Combat Environments in Afghanistan and Iraq. JAMA Netw Open 2023; 6:e230484. [PMID: 36821112 PMCID: PMC9951040 DOI: 10.1001/jamanetworkopen.2023.0484] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Moral injury and distress (MID), which occurs when individuals have significant dissonance with their belief system and overwhelming feelings of being powerless to do what is believed to be right, has not been explored in the unique population of military surgeons deployed far forward in active combat settings. Deployed military surgeons provide care to both injured soldiers and civilians under command-driven medical rules of engagement (MROE) in variably resourced settings. This practice setting has no civilian corollary for comparison or current specific tool for measurement. OBJECTIVE To characterize MID among military surgeons deployed during periods of high casualty volumes through a mixed-methods approach. DESIGN, SETTING, AND PARTICIPANTS This qualitative study using convergent mixed methods was performed from May 2020 to October 2020. Participants included US military surgeons who had combat deployments to a far-forward role 2 treatment facility during predefined peak casualty periods in Iraq (2003-2008) and Afghanistan (2009-2012), as identified by purposeful snowball sampling. Data analysis was performed from October 2020 to May 2021. MAIN OUTCOMES AND MEASURES Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey and individual, semistructured interviews were conducted to thematic saturation. RESULTS The total cohort included 20 surgeons (mean [SD] age, 38.1 [5.2] years); 16 (80%) were male, and 16 (80%) had 0 or 1 prior deployment. Deployment locations were Afghanistan (11 surgeons [55%]), Iraq (9 surgeons [45%]), or both locations (3 surgeons [15%]). The mean (SD) MMD-HP score for the surgeons was 104.1 (39.3). The primary thematic domains for MID were distressing outcomes (DO) and MROE. The major subdomains of DO were guilt related to witnessing horrific injuries; treating pregnant women, children, and US soldiers; and second-guessing decisions. The major subdomains for MROE were forced transfer of civilian patients, limited capabilities and resources, inexperience in specialty surgical procedures, and communication with command. Postdeployment manifestations of MID were common and affected sleep, medical practice, and interpersonal relationships. CONCLUSIONS AND RELEVANCE In this qualitative study, MID was ubiquitous in deployed military surgeons. Thematic observations about MID, specifically concerning the domains of DO and MROE, may represent targets for further study to develop an evaluation tool of MID in this population and inform possible programs for identification and mitigation of MID.
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Affiliation(s)
- Madeline Y. Ryu
- Stanford University School of Medicine, Stanford, California
| | - Matthew J. Martin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles County and USC Medical Center, Los Angeles, California
| | | | - Holly K. Tabor
- Stanford Center for Biomedical Ethics, Department of Medicine, Stanford University, Stanford, California
| | - Sherry M. Wren
- Surgical Service, Palo Alto Veterans Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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Nasiri K, Akseer N, Tasic H, Rafiqzad H, Akseer T. Disability types, determinants and healthcare utilisation amongst Afghan adults: a secondary analysis of the Model Disability Survey of Afghanistan. BMJ Open 2023; 13:e062362. [PMID: 36717138 PMCID: PMC9887472 DOI: 10.1136/bmjopen-2022-062362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The needs of people with disability in Afghanistan are not well understood. We describe the characteristics, healthcare utilisation patterns, and experience of care among Afghan adults with moderate or severe disability (MSD) by disability type. DESIGN We mapped 47 questions related to functional disability in the cross-sectional Model Disability Survey of Afghanistan (MDSA) 2019 into 7 disability domains based on the WHO Disability Assessment Schedule 2.0. We conducted multivariable hierarchical logistic regression to identify drivers of high disability burden. SETTING The MDSA primary sampling unit were villages in rural areas and neighbourhoods in urban areas, and the secondary sample units were the settlements within districts. PARTICIPANTS The MDSA collected data for 14 520 households across all 34 provinces. The adult tool of the survey was administered to a randomly selected household member aged 18 years or older. MAIN OUTCOME MEASURES The main outcome measured was moderate or severe disability (MSD), which was estimated using a Rasch composite score. RESULTS MSD prevalence was upwards of 35% in 6/7 domains. Across most disability types, being a woman, older age, residing in rural areas, being uneducated, non-Pashtun ethnicity, being unmarried, living in a household in the low-income tertiles and a non-working household had the highest levels of MSD (p<0.05). Determinants of MSD varied by domain; however, variables including better access to health facilities and better experience of care (higher satisfaction with time spent and respect during visits) were generally protective. People with MSD in the self-care and life activities domains had the highest and lowest healthcare utilisation, respectively. CONCLUSIONS Disability in Afghanistan is at public health crisis levels, with vulnerable populations being impacted most severely. To ensure progress towards Afghanistan's 2030 Sustainable Development Goals, targeted interventions for disability types based on population risk factors should be implemented.
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Affiliation(s)
- Khalidha Nasiri
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Modern Scientist Global, St. Catharines, Ontario, Canada
| | - Nadia Akseer
- Modern Scientist Global, St. Catharines, Ontario, Canada
- School of Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hana Tasic
- Modern Scientist Global, St. Catharines, Ontario, Canada
| | - Hadia Rafiqzad
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
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Ahmadi A, Rahimi A, Wardak MF, Ahmadi H, Lucero-Prisno DE. Tobacco harm reduction in Afghanistan: a recipe for improving smokers' health. Subst Abuse Treat Prev Policy 2023; 18:7. [PMID: 36683028 PMCID: PMC9867861 DOI: 10.1186/s13011-023-00517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/15/2022] [Accepted: 01/16/2023] [Indexed: 01/23/2023] Open
Abstract
Tobacco Harm Reduction (THR) offers a promising approach to addressing the significant burden of smoking in Afghanistan. Over three million Afghans smoke daily, making it a leading cause of preventable deaths in the country. While the previous Afghan government implemented various tobacco cessation policies and strategies, these measures were only partially effective in reducing the number of smokers or smoking-related deaths. In 2021, community-based initiatives in Kabul and Herat started advocating for Tobacco Harm Reduction (THR) as a novel, realistic, and practical approach proven to promote smoking abstinence and minimize tobacco harm. However, implementing THR strategies in Afghanistan faces numerous challenges, including a lack of governmental support, funding issues, unfavorable market conditions, the high cost-effectiveness of THR products, and misconceptions about these products. To effectively promote THR in Afghanistan and overcome these challenges, it will be necessary to implement THR policies that support THR products for smokers, regulate the market for these products, produce them locally with healthcare professional oversight, conduct more engaging advocacy campaigns, and secure domestic sponsors.
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Affiliation(s)
- Attaullah Ahmadi
- École des Hautes Études en Santé Publique, Paris, France
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Ali Rahimi
- Medical Faculty, Herat University, Students Street, Herat, 3001 Afghanistan
| | | | | | - Don Eliseo Lucero-Prisno
- Faculty of Management and Development Studies, University of the Philippines Open University, Los Banos, Laguna Philippines
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Affiliation(s)
- Leonard Rubenstein
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Rabia Jalazai
- Johns Hopkins Hospital Department of Internal Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Nancy Glass
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
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Mohamed A, Akbar IE, Chaudhury S, Wadood MZ, Ather F, Jorba J, Martinez M. Progress Toward Poliomyelitis Eradication - Afghanistan, January 2021-September 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1541-1546. [PMID: 36480464 PMCID: PMC9762895 DOI: 10.15585/mmwr.mm7149a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Afghanistan and Pakistan are the two remaining countries with endemic wild poliovirus type 1 (WPV1) transmission (1). During 2019-2020, these countries reported their highest numbers of WPV1 cases since 2014 and experienced outbreaks of type 2 circulating vaccine-derived poliovirus (cVDPV2) (2-4).* In Afghanistan, the number of WPV1 cases nearly doubled, from 29 in 2019 to 56 in 2020; 308 cVDPV2 cases were reported during 2020. After years of active conflict, the Afghanistan government was fully replaced by the Taliban de facto government on August 15, 2021. This report describes activities and progress toward polio eradication in Afghanistan during January 2021-September 2022 and updates previous reports (3,4). During January-December 2021, four WPV1 and 43 cVDPV2 cases were detected, representing decreases of 93% from 56 cases and 86% from 308 cases, respectively, during 2020. During January-September 2022 (reported as of October 20), two WPV1 cases and zero cVDPV2 cases were detected. Although no supplementary immunization activities (SIAs)† occurred during July-October 2021, SIAs resumed during November 2021 in all districts after the political transition, and 3.5-4.5 million previously unreachable persons have been vaccinated since. However, restrictions on how SIAs are conducted are still in place in the critical South Region provinces of Kandahar, Helmand, and Uruzgan. If efforts to vaccinate all children are enhanced and expanded, Afghanistan has an opportunity to interrupt WPV1 transmission during 2023.
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Noh JW, Lee LJ, Kim KB, Cha J, Kwon YD. Factors influencing injury or death due to traumatic events in Afghanistan's crisis-affected populations: a cross-sectional nationwide study. BMJ Open 2022; 12:e063329. [PMID: 36576193 PMCID: PMC9723898 DOI: 10.1136/bmjopen-2022-063329] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Afghanistan, with one of the world's largest refugee populations, suffers an enormous burden of injury resulting in loss of life. This study aims to identify the epidemiology of injuries or death in the crisis-affected populations across Afghanistan and to investigate factors associated with injuries or deaths due to traumatic events. DESIGN Cross-sectional study. SETTING This study analysed Whole Afghanistan Assessment 2019 data. This survey geographically covered all 34 accessible provinces in Afghanistan. PARTICIPANTS 31 343 displaced and shock-affected households in Afghanistan. PRIMARY AND SECONDARY OUTCOME MEASURES Injury or death of household members due to traumatic events. RESULTS 2561 (8.2%) reported at least one household member had been injured or deceased because of a significant conflict or natural disaster in the past year. Households experienced significant events such as active conflict or violence (prevalence ratio, PR=5.575, p<0.001), earthquake (PR=3.118, p=0.004), flood (PR=1.534, p=0.008) and avalanche or heavy snowfall (PR=3.450, p<0.001) were significantly associated with injury or death. The likelihood of injury or death was significantly higher for long-distance households than for households living within a 5 km radius of the nearest healthcare facilities (6-10 km: PR=1.402, p=0.030; >10 km: PR=1.560, p=0.020). CONCLUSION The study provides an epidemiological profile of injuries or death in crisis-affected populations across Afghanistan. Results also suggest that certain factors place the crisis-affected populations in Afghanistan at high risk for injuries or death, which can inform the development of surveillance and prevention programmes, the monitoring of patterns over time and the formulation of healthcare policies.
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Affiliation(s)
- Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Gangwon-do, Korea (the Republic of)
| | - Lena J Lee
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Kyoung-Beom Kim
- Industry-Academic Cooperation Foundation, Yonsei University, Wonju, Gangwon-do, Korea (the Republic of)
| | - Jiho Cha
- Moonsoul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Korea (the Republic of)
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul, Korea (the Republic of)
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Mendes A, Whiteman A, Nygren B, Kaplan B, Hussain I, Soofi S, Martinez M, Farag NH. Immunity to poliovirus in Afghanistan: A household sampling method for serological assessment based on geographical information systems. Geospat Health 2022; 17. [PMID: 36468597 DOI: 10.4081/gh.2022.1107] [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] [Received: 05/11/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023]
Abstract
Afghanistan continues to experience challenges affecting polio eradication. Mass polio vaccination campaigns, which aim to protect children under the age of 5, are a key eradication strategy. To date, the polio program in Afghanistan has only employed facility-based seroprevalence surveys, which can be subject to sampling bias. We describe the feasibility in implementing a cross-sectional household poliovirus seroprevalence survey based on geographical information systems (GIS) in three districts. Digital maps with randomly selected predetermined starting points were provided to teams, with a total target of 1,632 households. Teams were instructed to navigate to predetermined starting points and enrol the closest household within 60 m. To assess effectiveness of these methods, we calculated percentages for total households enrolled with valid geocoordinates collected within the designated boundary, and whether the Euclidean distance of households were within 60 m of a predetermined starting point. A normalized difference vegetation index (NDVI) image ratio was conducted to further investigate variability in team performances. The study enrolled a total of 78% of the target sample with 52% of all households within 60 m of a pre-selected point and 79% within the designated cluster boundary. Success varied considerably between the four target areas ranging from 42% enrolment of the target sample in one place to 90% enrolment of the target sample in another. Interviews with the field teams revealed that differences in security status and amount of non-residential land cover were key barriers to higher enrolment rates. Our findings indicate household poliovirus seroprevalence surveys using GIS-based sampling can be effectively implemented in polio endemic countries to capture representative samples. We also proposed ways to achieve higher success rates if these methods are to be used in the future, particularly in areas with concerns of insecurity or spatially dispersed residential units.
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Affiliation(s)
- Amalia Mendes
- Geospatial Research Analysis and Services Program, Office of Innovation and Analytics, Agency for Toxic Substance and Disease Registry, Atlanta.
| | - Ari Whiteman
- Geospatial Research Analysis and Services Program, Office of Innovation and Analytics, Agency for Toxic Substance and Disease Registry, Atlanta.
| | - Benjamin Nygren
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta.
| | - Brian Kaplan
- Geospatial Research Analysis and Services Program, Office of Innovation and Analytics, Agency for Toxic Substance and Disease Registry, Atlanta.
| | - Imtiaz Hussain
- Department of Pediatrics and Child Health, Aga Khan University, Karachi.
| | - Sajid Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi.
| | - Maureen Martinez
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta.
| | - Noha H Farag
- Polio Eradication Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta.
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Adams RS, Hoover P, Forster JE, Caban J, Brenner LA. Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications. J Head Trauma Rehabil 2022; 37:361-370. [PMID: 36075868 PMCID: PMC9643596 DOI: 10.1097/htr.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/26/2022]
Abstract
OBJECTIVE Challenges associated with case ascertainment of traumatic brain injuries (TBIs) sustained during the Afghanistan/Iraq military operations have been widespread. This study was designed to examine how the prevalence and severity of TBI among military members who served during the conflicts were impacted when a more precise classification of TBI diagnosis codes was compared with the Department of Defense Standard Surveillance Case-Definition (DoD-Case-Definition). SETTING Identification of TBI diagnoses in the Department of Defense's Military Health System from October 7, 2001, until December 31, 2019. PARTICIPANTS Military members with a TBI diagnosis on an encounter record during the study window. DESIGN Descriptive observational study to evaluate the prevalence and severity of TBI with regard to each code set (ie, the DoD-Case-Definition and the more precise set of TBI diagnosis codes). The frequencies of index TBI severity were compared over time and further evaluated against policy changes. MAIN MEASURES The more precise TBI diagnosis code set excludes the following: (1) DoD-only extender codes, which are not used in other healthcare settings; and (2) nonprecise TBI codes, which include injuries that do not necessarily meet TBI diagnostic criteria. RESULTS When comparing the 2 TBI classifications, the DoD-Case-Definition captured a higher prevalence of TBIs; 38.5% were classified by the DoD-Case-Definition only (>164 000 military members). 73% of those identified by the DoD-Case-Definition only were diagnosed with nonprecise TBI codes only, with questionable specificity as to whether a TBI occurred. CONCLUSION We encourage the field to reflect on decisions made pertaining to TBI case ascertainment during the height of the conflicts. Efforts focused on achieving consensus regarding TBI case ascertainment are recommended. Doing so will allow the field to be better prepared for future conflicts, and improve surveillance, screening, and diagnosis in noncombat settings, as well as our ability to understand the long-term effects of TBI.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | - Peter Hoover
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jeri E. Forster
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesus Caban
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Lisa A. Brenner
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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Eser S, Özgür S, Shayan NA, Abdianwall MH. Risk Factors Related to Esophageal Cancer, a Case-Control Study in Herat Province of Afghanistan. Arch Iran Med 2022; 25:682-690. [PMID: 37542400 PMCID: PMC10685874 DOI: 10.34172/aim.2022.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/27/2022] [Indexed: 08/06/2023]
Abstract
BACKGROUND The Herat province of Afghanistan is located on the Asian Esophageal Cancer Belt (AECB), a wide area in Central and Eastern Asia where very high rates of esophageal cancer (EC) have been observed. Several risk factors have been reported in the AECB Region by previous studies. Considering lack of information in Afghanistan on this issue, a study was conducted to determine the major risk factors related to EC in order to guide protective measures. METHODS A population-based case-control study was performed from July 2015 to August 2016 among 657 EC patients in the Herat Province and 180 histopathological confirmed cases and 189 controls were interviewed. A structured questionnaire was used and face-to-face interviews were conducted. RESULTS Low body mass index (BMI), low socio-economic status, family history of EC, consumption of dark tea, very hot beverage and qulurtoroosh were found to be statistically significant for EC and esophageal squamous cell carcinoma (ESCC) in univariate analyses. According to multivariate analyses, sex (OR=2.268; 95% CI=1.238-4.153), very hot beverages (OR=2.253; 95% CI=1.271- 3.996), qulurtoroosh (OR=5.679; 95% CI=1.787-18.815), dark tea (OR=2.757; 95% CI=1.531-4.967), high previous BMI (OR=0.215; 95% CI=0.117-0.431) and low socio-economic status (OR=1.783; 95% CI=1.007-3.177) were associated with ESCC. Being male was found to increase the risk of ESCC with OR=2.268 (95% CI=1.238-4.153). CONCLUSION Consuming very hot beverages dark tea and a local food, qulurtoroosh, were found as important risk factors for EC. Our findings warrant further studies and necessitate the implementation of protective measures for EC which is one of the leading cancers in the region.
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Affiliation(s)
- Sultan Eser
- Balıkesir University, Faculty of Medicine, Department of Public Health, 10145, Balıkesir, Turkey
| | - Su Özgür
- Ege University Faculty of Medicine Department of Biostatistics and Medical Informatics, 35040 Bornova, İzmir, Turkey
| | - Nasar Ahmad Shayan
- Western University, Faculty of Medicine, Department of Epidemiology and Biostatistics, London- On, Canada
| | - Mohammed Haris Abdianwall
- Nangarhar University, Faculty of Medicine, Department of Clinical Ophthalmology, Celalabad, Afghanistan
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Stanikzai MH, Hashim-Wafa M. Tuberculosis (TB) care challenges in post-conflict settings: The case of Afghanistan. Indian J Tuberc 2022; 69:383-384. [PMID: 36460366 DOI: 10.1016/j.ijtb.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/02/2021] [Accepted: 03/03/2022] [Indexed: 06/17/2023]
Abstract
Tuberculosis (TB) is a huge global health concern, especially for low and middle-income countries. In Afghanistan, TB is highly prevalent that is attributed in part to, notable poverty, resource constraints, and a mismanaged health care system that engulf the country. This article describes unique challenges for TB care in Afghanistan. It concludes this endemic problem may now multiply due to COVID-19 and political challenges and transform into a disaster that may result in higher morbidity and mortality among TB patients. We recommend addressing the need for appropriate and timely TB-care amid the post-conflict setting. Additionally, the health workforce needs to play a vital role in policy advocacy and health service delivery that promotes TB care in this post-conflict and resource-limited setting.
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Affiliation(s)
| | - Mohammad Hashim-Wafa
- Neuropsychiatric and Behavioral Science Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.
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Kovess-Masfety V, Karam E, Keyes K, Sabawoon A, Sarwari BA. Access to Care for Mental Health Problems in Afghanistan: A National Challenge. Int J Health Policy Manag 2022; 11:1442-1450. [PMID: 34124868 PMCID: PMC9808366 DOI: 10.34172/ijhpm.2021.46] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/18/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This paper describes the access to care for mental health problems in Afghanistan, according to the nature of the mental health problems and the service provider. Following the Andersen model, it evaluates the respective roles in access to care of "predisposing," "needs," "enabling" factors, and other "environmental" factors such as exposure to traumatic events and level of danger of the place of residence. METHODS Trans-sectional probability survey in general population by multistage sampling in 16 provinces, nationally representative: N=4445 (15 years or older), participation rate of 81%. Face to face interviews using standardized measures of mental health (CIDI, Composite International Diagnostic Interview). Different logistic regression models are presented. RESULTS The 12-month rate of mental health help-seeking was 6.56% with substantial regional variation (2.35% to 12.65%). Providers were mainly from the health sector; the non-health sector (religious and healers) was also prevalent. Most consultations were held in private clinics (non-governmental organisation, NGO). The severity of mental health disorders as well as the perceived impairment due to mental health were independently very important: odds ratio (OR) = 6.04 for severe disorder, OR=3.79 for perceived impairment. Living in a dangerous area decreased access to care: for high level of danger and for very high level: OR=0.22. Gender, education and ethnicity were not associated with mental health help-seeking after controlling for exposure to trauma. CONCLUSION Access to care for mental health problems depended mainly on the needs as defined as disorder severity level and impairment, and on environmental factors such as exposure to traumatic events. The system seems equitable; however, this is counterbalanced by a very challenging environment. This survey is a testimony to the hardship experienced by the Afghan population and by health professionals, and to the efforts to deliver organized mental healthcare in a challenging situation. This research may inform and support policy-makers and NGOs in other countries undergoing similar challenges.
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Affiliation(s)
- Viviane Kovess-Masfety
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Conseil Santé, Clichy, France
- Laboratoire de Psychopathologie et Processus de Santé (LPPS), Université de Paris, Boulogne-Billancourt, France
| | - Elie Karam
- Department of Psychiatry & Clinical Psychology, St. George Hospital University Medical, Beirut, Lebanon
- Faculty of Medicine, University of Balamand Medical Center, University of Balamand, Beirut, Lebanon
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Katherine Keyes
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Ajmal Sabawoon
- Governance Institute of Afghanistan (GI-A), Kabul, Afghanistan
| | - Bashir Ahmad Sarwari
- Department of Mental Health & Substance Abuse, Primary Health Care Directorate, Ministry of Public Health, Kabul, Afghanistan
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Saeedzai SA, Sahak MN, Arifi F, Abdelkreem Aly E, Gurp MV, White LJ, Chen S, Barakat A, Azim G, Rasoly B, Safi S, Flegg JA, Ahmed N, Ahadi MJ, Achakzai NM, AbouZeid A. COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study. BMJ Open 2022; 12:e060739. [PMID: 35896297 PMCID: PMC9334691 DOI: 10.1136/bmjopen-2021-060739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The primary objectives were to determine the magnitude of COVID-19 infections in the general population and age-specific cumulative incidence, as determined by seropositivity and clinical symptoms of COVID-19, and to determine the magnitude of asymptomatic or subclinical infections. DESIGN, SETTING AND PARTICIPANTS We describe a population-based, cross-sectional, age-stratified seroepidemiological study conducted throughout Afghanistan during June/July 2020. Participants were interviewed to complete a questionnaire, and rapid diagnostic tests were used to test for SARS-CoV-2 antibodies. This national study was conducted in eight regions of Afghanistan plus Kabul province, considered a separate region. The total sample size was 9514, and the number of participants required in each region was estimated proportionally to the population size of each region. For each region, 31-44 enumeration areas (EAs) were randomly selected, and a total of 360 clusters and 16 households per EA were selected using random sampling. To adjust the seroprevalence for test sensitivity and specificity, and seroreversion, Bernoulli's model methodology was used to infer the population exposure in Afghanistan. OUTCOME MEASURES The main outcome was to determine the prevalence of current or past COVID-19 infection. RESULTS The survey revealed that, to July 2020, around 10 million people in Afghanistan (31.5% of the population) had either current or previous COVID-19 infection. By age group, COVID-19 seroprevalence was reported to be 35.1% and 25.3% among participants aged ≥18 and 5-17 years, respectively. This implies that most of the population remained at risk of infection. However, a large proportion of the population had been infected in some localities, for example, Kabul province, where more than half of the population had been infected with COVID-19. CONCLUSION As most of the population remained at risk of infection at the time of the study, any lifting of public health and social measures needed to be considered gradually.
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Affiliation(s)
- Sayed Ataullah Saeedzai
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | | | - Fatima Arifi
- WHE, World Health Organization, Kabul, Afghanistan
| | - Eman Abdelkreem Aly
- Information Systems for Health Unit, WHO Eastern Mediterranean Regional Office, Cairo, Egypt
| | | | - Lisa J White
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Universiry of Oxford, Oxford, UK
| | - Siyu Chen
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Universiry of Oxford, Oxford, UK
| | - Amal Barakat
- Infectious Hazard Preparedness Unit, WHO Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Giti Azim
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Bahara Rasoly
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Soraya Safi
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Jennifer A Flegg
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Nasar Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Mohmmad Jamaluddin Ahadi
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Niaz M Achakzai
- Department of Molecular Biology, Forensic Medicine Directorate, Ministry of Public Health, Kabul, Afghanistan
- Central Public Health Laboratory (CPHL), Ministry of Public Health, Kabul, Afghanistan
| | - Alaa AbouZeid
- Department of Public Health, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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Arcos González P, Zabibdullah A, Cernuda Martínez J, Castro Delgado R. Exploring COVID-19 pandemic side effects: The case of routine immunization in Afghanistan. J Glob Health 2022; 12:03039. [PMID: 35861477 PMCID: PMC9302038 DOI: 10.7189/jogh.12.03039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ahmadi SJ, Jobson L, Earnest A, McAvoy D, Musavi Z, Samim N, Sarwary SAA. Prevalence of Poor Mental Health Among Adolescents in Kabul, Afghanistan, as of November 2021. JAMA Netw Open 2022; 5:e2218981. [PMID: 35737391 PMCID: PMC9226996 DOI: 10.1001/jamanetworkopen.2022.18981] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study assesses the mental health of adolescents in Afghanistan and evaluates their risk of having a psychiatric disorder by age and sex.
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Affiliation(s)
| | - Laura Jobson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniel McAvoy
- Centre for Humanitarian Leadership, Deakin University, Melbourne, Australia
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | - Nasratullah Samim
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
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Colombo S. Are death and suffering in Ukraine different than in Yemen, Afghanistan or Ethiopia? Double standards in humanitarian assistance. Epidemiol Prev 2022; 46:130-133. [PMID: 35775289 DOI: 10.19191/ep22.3.036] [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: 06/15/2023]
Affiliation(s)
- Sandro Colombo
- Independent consultant, former WHO Medical Officer, Las Rozas, Madrid (Spain);
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Nascimento RBH, de Matos Brasil AG, Pires JP, de Moura Gabriel IW, Bezerra BLL, Bessa MMM, Neto MLR, Lima NNR, Gurgel E Silva SQ, de Alcântara TB. Afghan children and adolescents: The burden of poor mental health in contexts of widespread poverty, social inequality and persistent violence. Child Abuse Negl 2022; 127:105574. [PMID: 35217319 DOI: 10.1016/j.chiabu.2022.105574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
In Afghanistan, the burden of poor mental health arises in contexts of widespread poverty, social inequality, and persistent violence. Generations of Afghans were born during the conflict, and some never knew peace. Children make up more than half (57%) of the population in need of emergency humanitarian assistance in Afghanistan. Recent assessments indicate that more than a third of children have been exposed to psychological distress due to the loss of family and community members and the constant risk of death and injury. Children and teens are struggling with anxieties and fears, desperately in need of mental health support. The lack of social support manifested itself in various forms of suffering in both children and adolescents. The quality of the environment where children and adolescents grow up shapes their well-being and development.
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Affiliation(s)
| | | | - Jeully Pereira Pires
- School of Medicine, Federal University of Cariri - UFCA, Barbalha, Ceará, Brazil
| | | | - Bruno Lívio Luna Bezerra
- School of Medicine, Faculty of Medicine of Juazeiro do Norte - FMJ/IDOMED, Juazeiro do Norte, Ceará, Brazil
| | - Maria Misrelma Moura Bessa
- Center for Studies and Research in Public Heath - NUEPESC - Centro Universitario Paraíso, Juazeiro do Norte, Ceará, Brazil
| | - Modesto Leite Rolim Neto
- School of Medicine, Federal University of Cariri - UFCA, Barbalha, Ceará, Brazil; School of Medicine, Faculty of Medicine of Juazeiro do Norte - FMJ/IDOMED, Juazeiro do Norte, Ceará, Brazil
| | - Nadia Nara Rolim Lima
- Graduate Program (Post-Doctoral) in Neuropsychiatry, Federal University of Pernambuco - UFPE, Pernambuco, Brazil
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Pritchard N, Worrell MC, Shahum A, Nwankwo A, Smith D, Koch JJ, Ballard T. Notes from the Field: Response to Measles Among Persons Evacuated from Afghanistan — Joint Base McGuire-Dix-Lakehurst, New Jersey, August–October 2021. MMWR Morb Mortal Wkly Rep 2022; 71:609-610. [PMID: 35482554 PMCID: PMC9098233 DOI: 10.15585/mmwr.mm7117a3] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rahimi BA, Ishaq N, Mudaser GM, Taylor WR. Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study. PLoS One 2022; 17:e0265487. [PMID: 35404980 PMCID: PMC9000062 DOI: 10.1371/journal.pone.0265487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/21/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality in children but there are no published data on the treatment outcomes of ABM in Afghanistan. METHODS We conducted a prospective observational cohort study over one year, February 2020 to January 2021 in a tertiary care hospital in Kandahar, Afghanistan. AMB was diagnosed clinically and on lumbar puncture findings. Binary logistic regression assessed factors for death. RESULTS A total of 393 ABM children of mean age 4.8 years were recruited. Most were males [231 (58.8%)], living in rural areas [267 (67.9%)] and in households of >10 inhabitants [294 (74.8%)]. Only 96 (24.4%) had received against both Haemophilus influenzae type b (Hib) or pneumococcal (PCV) vaccines. Children were treated with combination of ceftriaxone and ampicillin and 169/321 (52.6%) received dexamethasone. Of the 321 children with a known outcome, 69 (21.5%) died. Death was significantly associated with: not receiving dexamethasone [adjusted odds ratio (AOR) 4.9 (95% CI 2.6-9.5, p <0.001)], coma on admission [AOR 4.6 (I 2.3-9.5, p <0.001)], no PCV [AOR 2.8 (1.2-6.6, p = 0.019)] or Hib vaccine [AOR 2.8 (1.2-6.6, p = 0.019)], and being male [AOR 2.7 (1.4-5.5, p = 0.005). CONCLUSIONS ABM causes significant morbidity and mortality in Afghan children that may be improved by greater use of PCV and Hib vaccines. Adjunct dexamethasone should be evaluated formally in our setting.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Research Unit of Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Niamatullah Ishaq
- Department of Radiology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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50
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Affiliation(s)
- Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Rainawari, Srinagar, Jammu and Kashmir, India; Directorate of Health Services Kashmir, Jammu and Kashmir, India
| | | | | | - Zahra Legris
- Department of Psychiatry, St James's Hospital, Dublin, Ireland
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