Hijab or Niqab Interacts with Facemasks Usage at Healthcare Settings in Kabul, Afghanistan: A Multi-Center Observational Study.

Purpose: We aimed to understand the extent of facemask usage resulting from the third wave of the COVID-19 pandemic in an Afghan context. In Afghanistan, new COVID-19 variants, low vaccination rates, political turmoil, and poverty interact not only with the third wave of the COVID-19 pandemic but also with facemask usage. Methods: We collected data (n = 1970) by visually observing the usage and type of facemasks used among visitors entering healthcare facilities in Kabul. We conducted an observational study observing the use of facemasks among 1279 men and 691 women. Results: While 71% of all participants adhered to wearing facemasks, 94% of these users wore surgical masks, and 86% wore all types of facemasks correctly. Interestingly, women adhered to wearing facemasks more than men. Specifically, of all the participants who were not wearing masks, 20% were men, and only 8% were women. Even though men were more in number in our study (64.9%), women have a higher adherence rate to wearing facemasks than men. Conclusions: We conclude that gender socialization and expectations of women to wear the niqab or hijab interact with their adherence to wearing facemasks. Additionally, since Afghanistan is one of the poorest countries in the world, which has witnessed a considerable period of political turmoil, we spotlight that our findings are rare in scholarship as they represent a distinct non-Western Islamic society with a low scale of COVID-19 vaccination. Therefore, more research is needed to assess the general population's socioeconomic and geopolitical barriers to facemask use, given that Afghanistan is an underrepresented social context. Our findings are expected to aid health policymakers in developing novel prevention strategies for the country.

High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study.

Severe Acute Respiratory Syndrome Corona Virus Type-2 (SARS-COV-2) was first detected in China and created a global pandemic rapidly. Subsequently after serious efforts different types of vaccines produced against the virus and recommended for all people including pregnant women. The aim of this study was to realize the willingness of pregnant women to accept the COVID-19 vaccine in Kabul Afghanistan. For this purpose, a cross-sectional study was conducted in gynecology wards of several hospitals in Kabul, Afghanistan from 10th of July to 20th of August 2021 through direct interview with the pregnant women who had come for prenatal care to the healthcare centers. The collected data were analyzed through Statistical Package for Social Studies (SPSS) version 25. Simple descriptive analysis computed for demographic characteristics and bi-variable (Chi-square) analysis was carried out to find out the associations of taking vaccine with demographic variables. A p-value of < 0.05 was considered significant at 95% confidence interval. A total of 491 who were completed the inclusion criteria included in the analysis. A small portion of pregnant women (8.6%) illustrated the intent to get the COVID-19 vaccine if it is recommended by the health authorities in Afghanistan. Our study found a high rate of COVID-19 vaccine refusal among pregnant women in Kabul, Afghanistan. They showed the concern on adverse effects of the vaccine as the main reason for refusal, emphasizing the need to reduce the misconception on vaccine efficacy and campaigns to enhance awareness on the vaccine safety and benefits for mothers and babies.

Knowledge, Attitude, and Practices Toward Tuberculosis Among Hospital Outpatients in Kabul, Afghanistan.

Background: Tuberculosis (TB) is a high-burden respiratory infectious disease. There was a sharp decline in the number of confirmed TB cases during the pandemic; this is likely to be influenced by the COVID-19 pandemic response, with under-reporting due to resource diversion. There are typically 13,000 tuberculosis-associated deaths in Afghanistan annually, with significant problems posed by drug-resistant TB. Method: A cross-sectional descriptive study was conducted in Afghanistan on Kabul residents who visited the adult outpatient departments of public hospitals for any health-related reason from 1st January to 20th March 2022. The study scored their knowledge, attitude, and practices (KAP) toward tuberculosis. The sample size was calculated using Epi-Info, and the minimum sample size was 385. The sampling method is chosen the non-probability convenient sampling for data gathering. Data were analyzed using SPSS version 28, and we used the Mann-Whitney test, Chi-square or fisher extract test, spearman correlations, and binary logistic regression model. Results: Of 829 participants, 450 (54.3%) were males and 379 (45.7) females. The median age was 28 years, and 63.3% were married. Most participants were unemployed (75.5%), but 54% had a monthly income >3,000 Afghanis, indicating the reliance on family. By TB knowledge score, 727 (87.7%) participants had good knowledge, and 800 (96.5%) participants had a positive attitude toward treatment and control. Only 2 participants reported poor practices regarding prevention. Regarding the binary logistic regression, young age, being a male, belonging to the "1,000-3,000" Afghani monthly income category, and having a positive attitude were significant predictors of good TB knowledge (P-value = 0.009, 0.000, 0.003, and 0.009), respectively. A positive attitude was expected to have good knowledge 6.035 times more than a negative attitude (95% CI: 1.572-23.167). Conclusion: The study findings highlighted that outpatients in Kabul had good knowledge, attitude, and practice toward TB. More studies are needed to highlight KAP in different Afghan populations, including in other parts of the country.

Facemask Usage Among Pedestrians in Most Crowded Urban Districts of Kabul, Afghanistan, During the Third COVID-19 Wave: An Observational Study.

The COVID-19 has spread to everywhere since its emergence from Wuhan. In countries with a low vaccination rate, the use of facemasks is essential to limit the risk of COVID-19 transmission. We have conducted this study in June 2021 to estimate the prevalence of facemask usage, and investigate the use of different types of facemasks and their distribution among pedestrians in the most crowded urban districts of Kabul during the third COVID-19 wave in Afghanistan. Using a multistage sampling method, a total of 5,000 pedestrians were selected from five most crowded urban districts of the city. The data was gathered by an observational method. The percentage, mean, and standard deviation were used to describe the variables. The χ2 test analysis was used to assess the relationship between two categorical variables. Of the 5,000 observations, the most common age group was 10-39 years with high participation of male (87.2%). A total of 2,013 (40.3%) people used facemasks (95% CI). Females used facemasks significantly more than males (64.6% versus 36.7%, P < 0.001). Among the pedestrians who used a facemask, most of them (88.6%) wore their facemask correctly. In conclusion the prevalence of facemask use in Kabul was fairly low especially among elderly people (≥ 60 years). Hence, the observed rates probably cannot protect the community against the COVID-19. Therefore, it is important to emphasize the public health recommendations via educational programs and national campaigns to support the strict use of facemasks in public places.