Epidemiologic study of chronic osteomyelitis in Paktya and Kabul, Afghanistan

Background: Osteomyelitis is an infection of the bone that can occur from direct or indirect invasion by a pathogens, both of these types can potentially progress to subacute and chronic osteomyelitis that lasts longer than 4 weeks. This disease has important characteristics such as long-term clinical course, long periods of silence, the treatment of the recurrence of serious complications of the disease is difficult financially and it takes a lot of money epidemiology of chronic osteomyelitis in the Afghanistan is largely unknown. The aim of this study was epidemiologic study of chronic osteomyelitis in adult clients of Paktya city regional hospital and Wazir Akbar Khan Hospital in Kabul city of Afghanistan.Methods: This descriptive cross-sectional study was performed in patients' with chronic osteomyelitis who referred in this two hospitals in Paktya city regional hospital and the Wazir Akbar Khan hospital in Kabul During the March 2019 to March 2020, 70 patients were identified with chronic osteomyelitis. The information required for the study, such as general information, underlying diseases of the patients collected from these two medical centers. After encoding, the necessary information was entered into the computer and analyzed.Results: According to the findings of this study the prevalence of chronic bone infections in male were 64% (n=45) in female were 36% (n=25), current findings showed 44.3% of all patient involved with tibial (n=31) chronic osteomyelitis and the most common underlying disease causing chronic osteomyelitis is the direct entry of infection as a result of trauma.Conclusions: Our study showed the chronic osteomyelitis is higher in the male population than in the female population and highest incidence of chronic osteomyelitis site was tibia result of trauma because of humid climate, poor personal and hospital environmental health status and relatively poor medical facilities in Afghanistan may contribute to higher morbidity.

Knowledge and attitude towards epilepsy among students of economics in Herat, Afghanistan

Objective: We conducted a study on knowledge and attitude towards epilepsy in Afghanistan, where there is no previous report, where Islam coexist with shamanistic concepts derived from earlier beliefs and practices. Methods: A self-administered questionnaire consisting of 19 questions and 72 items, based on questions used in previous studies was distributed to students of economics at Herat University. Results: Of 515 returned questionnaires, 243 were analysed after exclusion of the insufficiently completed questionnaires. Fewer respondents in our survey than in others reported to ever heard or read of epilepsy. Spirit possession as a cause for epilepsy was held by less than 10% of our respondents. Students who marked at least one item that indicated that they viewed Islamic beliefs positively (i.e. Curse from God as a cause of epilepsy, would pray when witnessing a seizure, would recommend to see an imam to a relative with epilepsy) were reluctant to share their room with a person with epilepsy (54.3% vs. 35.4%; p < 0.001) or marry a person with epilepsy (61.2% vs. 37.0%; p < 0.001). They were more pessimistic concerning the effectiveness of treatment of epilepsy. Nevertheless they would more often recommend a relative with epilepsy to see a doctor (63.8% vs 38.6%; p < 0.001). Medical doctors, imams and traditional healers were recommended for the treatment of seizures and epilepsy by the same students, indicative of syncretic concepts and mixed attitude to epilepsy. Conclusion: This study shows that Afghan economic students have mixed modern scientific as well as shamanistic and Islamic concepts of epilepsy.

Reduciendo la Mortalidad Materna en zonas de conflicto: Experiencia quirúrgica-anestésica en el Hospital Boost, Afganistán / Reducing maternal mortality in conflict areas: Surgical-anesthetic experience in Boost Hospital - Afghanistan

Introduction: Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009. Method: Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012. Results: 5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (n = 1721) of patients were female. In the Gyneco-obstetric (G) area, the average age was 31.3 years. 848 Cesarean operations (76%) were performed and 95% of these were urgent. Of these patients (n = 598) 64% were at ASA II. Spinal anesthesia (SA) was administered in 44.4% (n = 415) of patients, followed by general anesthesia without intubation (GA-) in 39.3% (n = 367). In 16% (n = 151), general anesthesia was administered with endotracheal intubation (GA+). Transoperatory mortality was 0.8% (n=7). Conclusions: The Boost Hospital offers a surgical service of relevance in the south of Afghanistan. This hospital is supported by Doctors without Borders (MSF) and has helped to reduce the maternal mortality in that region through the provision of quality care in obstetric emergencies. By applying health standards, and medical teams and material, MSF has helped the Afghan population, particularly gestating mothers, to improve its health while achieving a transoperatory mortality in Cesareans of <1%.

Introducción: Helmand cuya capital es Lashkar-Gah es una de las provincias más volátiles entre las más afectadas por conflictos en Afganistán. Médicos sin Fronteras empezó a trabajar en el Hospital Boost en 2009. Método: Revisión retrospectiva de procedimientos quirúrgicos en Médicos sin Fronteras-Centro Operacional de Bruselas del 11 de febrero de 2010 al 30 de septiembre de 2012. Resultados: Se realizaron 5719 cirugías a 4334 pacientes, siendo de urgencia un 47% y primera intervención un 75%. 39.7% (n = 1721) de pacientes fueron de género femenino. En relación al área Gineco-obstétrica (G), la edad media fue de 31.3 años. Se realizaron 848 cesáreas (76%) de las cuales el 95% fueron urgentes. De estas pacientes (n = 598) el 64% era ASA II. En cuanto al tipo de anestesia, se administró Anestesia espinal (SA) en un 44.4% (n = 415), seguido de anestesia general sin intubación (GA-) en un 39.3% (n = 367), y en un 16% (n = 151) se administró anestesia general con intubación endotraqueal (GA+); con una mortalidad transoperatoria de 0.8% (n = 7). Conclusiones: El Hospital Boost brinda un servicio quirúrgico de relevancia en el sur de Afganistán. Dicho hospital es apoyado por Médicos sin Fronteras (MSF), lo cual ha ayudado a reducir la mortalidad materna en esa región con la provisión de asistencia de calidad en emergencias obstétricas. Con la aplicación de estándares de salud, equipo, y material médico, MSF ha logrado que la población afgana, y particularmente las gestantes, mejore su salud, logrando una mortalidad transoperatoria de intervenciones por Cesáreas de < 1%.

Assessment of Medical and Pharmacy Students’ Knowledge & Perceptions about Generic Medicines’ Prices & Quality in Kabul- Afghanistan.

Objective: This study aimed to assess medical and pharmacy students‟ knowledge and perception about generic medicines‟ prices and quality in Kabul Afghanistan. Method: Convenience sampling was perfomed. The sample size was determined using RAOSOFT calculator by using 95% confidence interval with a margin of error of 5%. Results: Among the calculated sample size of 255, in total 220 (response rate 86.27%), 95 pharmacy and 125 medical students agreed to participate in the survey. SPSS version 16 was used for data analysis. Overall, 67.84% of the respondents had knowledge about generic medicines, while 80.39% expressed their concern about the quality of generic medicines. During the analysis it was found that 98.2% respondents were strongly agreed that can control the cost of the treatment if generic medicines are used, and 65% of the interviewees suggested that highest patient prices of branded medicines has increased inclination towards the prescription of generic medicines. While in regards to the quality of generic medicines 44.8% of the respondents asserted, that safety, effectiveness and quality of generics is their major concerns. Conclusion: The current study emphasizes that awareness and knowledge about generic medicines is required. Concerns about the quality and prices of generic medicines should be addressed to ensure the access of safe and cost-effective generic medicines.

Multiple Indicator Cluster Survey 2003 in Afghanistan: Outdated Sampling Frame and the Effect of Sampling Weights on Estimates of Maternal and Child Health Coverage.

Due to an urgent need for information on the coverage of health service for women and children after the fall of Taliban regime in Afghanistan, a multiple indicator cluster survey (MICS) was conducted in 2003 using the outdated 1979 census as the sampling frame. When 2004 pre-census data became available, population- sampling weights were generated based on the survey-sampling scheme. Using these weights, the population estimates for seven maternal and child healthcare-coverage indicators were generated and compared with the unweighted MICS 2003 estimates. The use of sample weights provided unbiased estimates of population parameters. Results of the comparison of weighted and unweighted estimates showed some wide differences for individual provincial estimates and confidence intervals. However, the mean, median and absolute mean of the differences between weighted and unweighted estimates and their confidence intervals were close to zero for all indicators at the national level. Ranking of the five highest and the five lowest provinces on weighted and unweighted estimates also yielded similar results. The general consistency of results suggests that outdated sampling frames can be appropriate for use in similar situations to obtain initial estimates from household surveys to guide policy and programming directions. However, the power to detect change from these estimates is lower than originally planned, requiring a greater tolerance for error when the data are used as a baseline for evaluation. The generalizability of using outdated sampling frames in similar settings is qualified by the specific characteristics of the MICS 2003—low replacement rate of clusters and zero probability of inclusion of clusters created after the 1979 census.

Reproductive Tract Disorders among Afghan Refugee Women Attending Health Clinics in Haripur, Pakistan.

Afghans comprise one of the largest groups of refugees in the world, with the majority living in Pakistan. The objective of this study was to identify commonly-occurring reproductive tract infections (RTIs), describe knowledge of women about RTIs, and assess physical and behavioural factors contributing to the development of RTIs. Afghan women presenting at Basic Health Units in refugee camps in Haripur, Pakistan, with reproductive health-related complaints, were included in the study (n=634). Data collection included implementation of an interviewer-administered questionnaire, along with a physical examination and laboratory tests. A descriptive analysis was conducted first. Qualitative data were coded and analyzed using predetermined themes. Chi-square test was used for determining the possible relationships between a binary outcome and categorical risk factors. Over three-fourths (76.7%) of those who reported to the health clinics with reproductive complaints had an RTI. Nearly half (49.5%) of these women were diagnosed with some form of vaginitis, and 14.7% were diagnosed with clinical suspicion of pelvic inflammatory disease (PID). Women with cervical prolapse (p=0.033) or who cleansed after intercourse (p=0.002) were more likely to have vaginitis. There was a significant difference (p=0.017) in the prevalence of suspected PID among women who used mud only (11.1%), any water (18.8%), and an old cloth or toilet paper (9.8%) for cleansing after defaecation. Specific physical and behavioural contributors to the high prevalence of RTIs in this population were identified, and recommendations to ameliorate these factors are offered.

Detection of mixed Plasmodium falciparum & P. vivax infections by nested-PCR in Pakistan, Iran & Afghanistan.

Background & objectives: Species identification and information on transmission pattern of malaria parasite in any malaria endemic area is key to success for a malaria control programme. In this investigation, malaria diagnosis using molecular method was used to assess the transmission pattern of malaria parasite in three malaria endemic regions: Afghanistan, Iran and Pakistan. Methods: Blood samples were collected from the patients presenting with vivax malaria from Afghanistan (n = 108), Iran (n = 200) and Pakistan (n = 199). Malaria parasite detection was made by the gold standard (microscopy) and also nested-PCR assay, using 18S small sub-unit ribosomal RNA (ssrRNA) gene. Results: Based on microscopy method, the level of mixed infection was zero to 2.5 per cent; however, nested-PCR assay detected 6.5, 22 and 23.5 per cent mixed infections in samples collected from Afghanistan, Iran and Pakistan, respectively. The present results showed that the co-infection of P. vivax with P. falciparum was frequent in malaria endemic regions of Iran and Pakistan. Interpretation & conclusion: The present data suggest the need for improving microscopy diagnosis method and the clinician should also have careful clinical observation, along with the reports on Giemsa-stained thick blood films, particularly in summer time when P. vivax is predominant. Also sharing information on transmission pattern of mixed infection among these countries may help in designing better control strategies for malaria.

Case histories of infectious disease management in developing countries: Phnom Penh and Kabul / As doenças infecciosas nos países em desenvolvimento: Phnom Penh e Cabul

Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections).

A assistência à saúde em países em desenvolvimento é afetada pela pobreza extrema, instabilidade política e doenças que podem ter menor importância em países industrializados. O objetivo deste trabalho foi apresentar dois casos e histórias de médicos que trabalham em hospitais de países em desenvolvimento e discutir as oportunidades de investigação clínica e cooperação. São discutidos casos de pacientes em Phnom Penh, no Camboja, com histoplasmose, meningite criptocócica, sarna, lesões cerebrais e vírus da imunodeficiência humana, e de pacientes em Kabul, no Afeganistão, com cirrose hepática, síndrome nefrótica e úlcera facial. Maior apoio ao desenvolvimento por parte dos países desenvolvidos é essencial, e uma cooperação mutuamente benéfica é possível, visto que problemas clínicos similares existem em ambos os lados (p. ex. infecções cardiovasculares oportunistas). Exemplos para possível apoio à medicina hospitalar incluem intercâmbio de médicos para visitas com objetivos definidos (p. ex. controle de infecção ou treinamento em ecocardiografia) e colaboração com investigações clínicas e projetos desenvolvidos localmente (p. ex. epidemiologia de doenças cardiovasculares ou infecções hospitalares causadas por via sanguínea).

Reconstruction of Medical Education in Afghanistan / 医学教育

1) Afghanistan is one of countries facing serious health situation in the world, and Japan starts support in various area after Tokyo international conference for Afghanistan reconstruction in January, 2002.<BR>2) International Research Center for Medical Education (IRCME), the University of Tokyo, sent faculties as members of JICA expert team for Kabul in 2003 and 2004, and launched support reconstruction of medical education of Afghanistan.<BR>3) IRCME formed consortium in cooperation with Japan Society for Medical Education, International Medical Center of Japan Bureau of International Cooperation and other institutions in order to carry out Medical Education Project to support medical education development of Kabul Medical University, Afghanistan.