Status of water, sanitation, and hygiene and standard precautions in healthcare facilities and its relevance to COVID-19 in Afghanistan

BACKGROUND@#To protect the health and safety of healthcare workers (HCWs), it is essential to ensure the provision of sustainable water, sanitation, and hygiene (WASH) services and standard precautions in healthcare facilities (HCF). The objectives of this short communication were 1) to assess the availability of WASH services and standard precautions in HCFs in seven provinces in Afghanistan before the COVID-19 pandemic, and 2) to elucidate the relevance of these patterns with the number of reported HCW infections from COVID-19 in the mentioned provinces.@*METHODS@#We analyzed secondary data from the 2018-19 Afghanistan Service Provision Assessment survey, which included 142 public and private HCFs in seven major provinces in Afghanistan. Data on COVID-19 cases were obtained from the Afghanistan Ministry of Public Health Data Warehouse. Weighted prevalence of WASH services and standard precautions were calculated using frequencies and percentages. ArcGIS maps were used to visualize the distribution of COVID-19 cases, and scatter plots were created to visualize the relevance of WASH services and standard precautions to COVID-19 cases in provinces.@*RESULTS@#Of the 142 facilities surveyed, about 97% had improved water sources, and over 94% had improved toilet for clients. Overall, HCFs had limited availability of hygiene services and standard precautions, which was lower in private than public facilities. More than half of the facilities had safe final disposal and appropriate storage of sharps and medical waste. Of the seven provinces, Herat province had the highest cumulative COVID-19 case rate among HCWs per 100,000 population and reported lower availability of WASH services and standard precautions in HCFs compared to other provinces.@*CONCLUSION@#Our findings show disparities in the availability of WASH services and standard precautions in public and private facilities. Private facilities had a lower availability of hygiene services and standard precautions than public facilities. Provinces with higher availability of WASH services and standard precautions in HCFs had a lower cumulative COVID-19 case rate among HCWs per 100,000 population. Pre-pandemic preparation of adequate WASH services and standard precautions in HCFs could be potentially important in combating infectious disease emergence.

A erradicação da poliomielite em quatro tempos / La erradicación de la poliomielitis en cuatro tiempos / Poliomyelitis eradication in four stages

O objetivo deste artigo é rever o "estado da arte" dos avanços, obstáculos e estratégias para atingir a erradicação global da pólio. As ações de controle da poliomielite iniciaram na década de 1960 com o advento das duas vacinas antipoliomielíticas, a vacina oral da pólio (VOP) e a vacina inativada da pólio (VIP). No período de 1985 a 2020, são implementadas estratégias para atingir a meta de erradicação do poliovírus selvagem (WPV). Após o sucesso da interrupção da transmissão autóctone do WPV na região da Américas, foi lançada a meta da erradicação global. Descrevemos o processo de erradicação em quatro tempos: (1) O advento das vacinas VIP e VOP iniciou a era do controle da poliomielite; (2) A utilização massiva e simultânea da VOP teve impacto significativo sobre a transmissão do poliovírus selvagem no final da década de 1970 no Brasil; (3) Políticas públicas (nacionais e internacionais) decidem pela erradicação da transmissão autóctone do poliovírus selvagem nas Américas e definem as estratégias epidemiológicas para interromper a transmissão; e (4) A implantação das estratégias de erradicação interrompeu a transmissão autóctone do WPV em quase todas as regiões do mundo, exceto no Paquistão e Afeganistão, onde, em 2020, cadeias de transmissão do WPV1 desafiam as estratégias de contenção do vírus. Por outro lado, a persistência e a disseminação da circulação do poliovírus derivado da VOP, em países com baixa cobertura vacinal, somadas às dificuldades para substituir a VOP pela VIP constituem, atualmente, os obstáculos para a erradicação a curto prazo. Finalmente, discutimos as estratégias para superar os obstáculos e os desafios na era pós-erradicação.

El objetivo de este artículo es revisar el "estado de la cuestión" de los avances, obstáculos y estrategias para alcanzar la erradicación global de la polio. Las acciones de control de la poliomielitis se iniciaron en la década de 1960, con el advenimiento de las dos vacunas antipoliomielíticas, la vacuna oral de la polio (VOP) y la vacuna inactivada de la polio (VIP). En el período de 1985 a 2020, se implementan estrategias para alcanzar la meta de la erradicación del virus de la polio salvaje (WPV). Tras el éxito de la interrupción de la transmisión autóctona del WPV en la región de las Américas, se lanzó la meta de la erradicación global. Describimos el proceso de erradicación en cuatro tiempos: (1) El advenimiento de las vacunas VIP y VOP inició la era del control de la poliomielitis; (2) La utilización masiva y simultánea de la VOP tuvo un impacto significativo sobre la transmisión del virus de la polio salvaje, al final de la década de 1970, en Brasil; (3) Políticas públicas (nacionales e internacionales) deciden la erradicación de la transmisión autóctona del virus de la polio salvaje en las Américas y definen las estrategias epidemiológicas para interrumpir la transmisión; y (4) La implantación de las estrategias de erradicación interrumpió la transmisión autóctona del WPV en casi todas las regiones del mundo, excepto en Paquistán y Afganistán, donde, en 2020, cadenas de transmisión del WPV1 desafían las estrategias de contención del virus. Por otro lado, la persistencia y la diseminación de la circulación del virus de la polio, derivado de la VOP, en países con baja cobertura de vacunas, sumadas a las dificultades para substituir la VOP por la VIP constituyen, actualmente, los obstáculos para la erradicación a corto plazo. Finalmente, discutimos las estrategias para superar los obstáculos y los desafíos en la era poserradicación.

This article's objective is to review the "state of the art" in the progress, obstacles, and strategies for achieving global polio eradication. Poliomyelitis control measures began in the 1960s with the advent of two vaccines, the oral polio vaccine (OPV) and the inactivated polio vaccine (IPV). From 1985 to 2020, strategies were implemented to reach the goal of eradication of wild poliovirus (WPV). Following the success with the interruption of indigenous WPV transmission in the Americas, the goal of global eradication was launched. We describe the process of eradication in four historical stages: (1) The advent of the inactivated and oral polio vaccines launched the age of poliomyelitis control; (2) The massive and simultaneous use of OPV had a significant impact on WPV transmission in the late 1970s in Brazil; (3) Domestic and international public policies set the goal of eradication of indigenous WPV transmission in the Americas and defined the epidemiological strategies to interrupt transmission; and (4) The implementation of eradication strategies interrupted indigenous WPV transmission in nearly all regions of the world except Pakistan and Afghanistan, where in 2020 the WPV1 transmission chains have challenged the strategies for containment of the virus. Meanwhile, the persistence and dissemination of circulation of OPV-derived poliovirus in countries with low vaccination coverage, plus the difficulties in replacing OPV with IPV, are currently the obstacles to eradication in the short term. Finally, we discuss the strategies for overcoming the obstacles and challenges in the post-eradication era.

Human Skeletal Remains from Ancient Burial Sites in India: With Special Reference to Harappan Civilization / 체질인류학회지

Harappan Civilization is well known for highly sophisticated urban society, having been flourished in extensive regions of northwestern part of Pakistan and northeastern part of Afghanistan as its heyday around 4500 years ago. Most archaeologists agree on the periodization of this civilization as three different phases (Early, Mature and Late), which represent its cultural process of origin, development and decline. From the Harappan sites, one can note that there were about more than fifty burial sites discovered so far related with the civilization. In this article, we are trying to introduce the brief picture of the Harappan burials from the archaeological as well as anthropological perspectives.

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).

Gender differences in KAP related to HIV/AIDS among freshmen in Afghan universities.

This cross-sectional study aimed to describe the level of knowledge, perception/ attitude, and practices related to HIV among 1,054 freshmen students in four Afghan universities differences between genders. A probability, two stage sampling method was used. Data were collected by a self administered structured questionnaire. SPSS software was used for data analysis. Descriptive and inferential statistics were performed. Most of respondents were male (72.1%), their average age was 20.1 +/- 2 years, and most were unmarried (93.4%). The majority (90.8%) were aware of HIV but only 28.3% had a good level of knowledge. Around one-third (35.6%) had a positive level of attitude toward HIV. Approximately 30% had at least one risk practice; therefore, they were counted as high-risk behavior group members. Females were statistically more knowledgeable than males, and high-risk behaviors were significantly more prevalent among males; p = 0.01 and p = 0.001, respectively. However, general awareness, and attitude were not statistically different between genders. A considerable proportion of students (14.6%), as compared to peer-countries, were sexually active. A very high level of sharing injecting needles (4.5%) and shaving sets (20.8%) were also reported among informants.

Knowledge, attitude and practice of Afghan refugee women residing in Zahedan about family planning

Considering the high number of Afghan refugees in Zahedan and the important issue of their life style, the present study was carried out to determine knowledge, attitude and practice of Afghan Refugee women residing in Zahedan about family planning. A sample of 397 married women was interviewed at their homes. Statistical analysis was performed using Chi-square, t-student and Kruskal Wallis tests by SPSS. Our findings indicated that there existed low marriage and pregnancy age and high rate of pregnancy and illiteracy among them. Most Afghan refugee women had knowledge about oral contraceptives and the most common contraception used by them was oral and injectable contraception. Forty eight and sixth percent were using no contraception, for which, intention to have more children, being pregnant and husband's disagreement were mentioned as main reasons. Unwanted pregnancy was reported by 20.4% with improper use of contraception as its main reason. They believed that having son in the family [51.8%] and early marriage of daughters [57.8%] are necessary. There was a significant relationship between knowledge, attitude, practice with literacy, husband's literacy, ethnicity, and their religion [P < 0.001]. Iranian health system presents health services to refugee Afghan women similar to Iranian women. It is necessary to continue those services and to provide effective training based on their changing needs

La guerra de afganistan y el terrorismo / The war of Afghanistan and terrorism

Este número esta dedicado exclusivamente a medir las consecuencias en Bolivia de lo fue el 11 de septiembre y los hechos posteriores a este, en particular la guerra de Afganistan.

Supplementary feeding programs: a critical analysis

Foi feita análise crítica dos Programas de Suplementaçäo Alimentar no Brasil e em vários outros países do mundo. Embora poucos programas tenham sidos rigorosamente avaliados, observou-se que em relaçäo aos seus principais objetivos a maioria deles näo tem se mostrando satisfatória. Algumas medidas säo sugeridas para melhorá-los, dando-se ênfase especial aos programas no Brasil

Pattern of preventable diseases in Afghanistan: suggestions to reduce the morbidity and mortality at IGICH.

Over nine years period (1354-1362), 1,39,436 children were admitted in Indira Gandhi Institute of Child Health (IGICH), Kabul. Of these 51,212 (46.8%) children were hospitalised with preventable diseases. Seventy four per cent of patients were under five years of age. Among the infectious diseases, gastroenteritis accounted for nearly 70% of admissions. Tuberculosis, measles, diphtheria and typhoid fever were other common infectious diseases. Malnutrition of varying degree was the core problem among the hospitalised children and was seen in nearly two thirds of admissions. Twenty per cent of them had severe protein energy malnutrition which contributed for higher mortality. Gastroenteritis contributed for half (51.5%) of the mortality. Septicemia, tetanus neonatorum and central nervous system infections were associated with high mortality especially among the neonates. Deaths following 6-target preventable diseases accounted for nearly 1/4th of deaths (20.4-24.6%) over these years.