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.

Self-reported adherence to preventive practices during the third wave of COVID-19 in Afghanistan.

Objective: The study objectives were aimed to highlight the areas where public awareness is needed to enhance preventive practices among the public. Hence, to avoid the spread of virus in public settings. In addition, the study has provided compelling data and evidence on the coronavirus disease-2019 trend for health policymakers to make strategic decisions. Introduction: The coronavirus disease-2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus type-2. The disease has spread across the globe. In Afghanistan, thousands of confirmed cases with hundreds of deaths have been reported. In addition, due to insufficient healthcare workforce, insecurity, fragile healthcare infrastructure, low coronavirus disease-2019 vaccination and low testing capacity, the true nature of the pandemic is unlcear. Method: An online survey of the general population in Afghanistan was conducted from April-May 2021. Convenience sampling technique was used to recruit the respondents. Social media platforms were used (WhatsApp, Twitter and Facebook Messenger) to disseminate the electronic survey instrument. Written informed consent was taken from the participants before the filling questionnaires. Data collection was guided through a self-administered questionnaire developed by the researchers according to the World Health Organization guidelines. The sample size was calculated using EPI software. The inclusion criteria were being 18 years or older and having access to the Internet to fill out the online questionnaire. IBM SPSS Statistics version 25.0 was used for analysis. Descriptive statistics (frequencies, percentages) and bi-variable (chi-square) analyses were done. A p value of <0.05 was considered significant at a 95% confidence interval. Results: From 1094 respondents, 78% were male. The majority of respondents were aged ⩽30 years and had an undergraduate education. Nearly 1 in 3 participants were healthcare workers, and 70% lived in households with five or more family members. Overall, 70% of the respondents reported good preventive practices. The majority of the participants reported covering their mouth and nose while coughing and sneezing and cleaning their hands regularly and using alcohol. Meanwhile, 80% of the participants wore a mask when going outside. Moreover, people with post-graduate education had a higher level of preventive practices than those with an undergraduate education.The results of logistic regression revealed participants residence in Kabul, healthcare workers, family size less than 5, avoid meeting people outside, gender, and avoiding 3Cs, were the significant determinants of adhering to good preventive practices. Conclusion: Generally, the public in Afghanistan followed infection prevention rules. However, certain areas require further improvement, such as observing social distance and avoiding shaking hands when meeting others. Negligence of these prevention practices can lead to an increase in infection transmission among people. Public awareness should be continued to keep the people supportive of the government policies.

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.

Public Perception and Preparedness to Fight Against the Third Wave of COVID-19 in Kabul, Afghanistan.

The avalanche of Corona Virus 2019 (COVID-19) cases has placed an unprecedented load on Afghanistan's government and public health authorities, putting the country in jeopardy. The primary goal of this research was to shed light on the country's capital, Kabul, and to examine the existing preparedness and perceptions of its population in the midst of COVID-19's third wave, which could result in decentralization and fragmentation of the already overburdened health-care system. An online, cross-sectional survey was conducted by the lecturers of the Kabul University of Medical Sciences between April 15, 2021 and April 25, 2021, to evaluate the preparedness of the Kabul citizens amidst the third wave of COVID-19. About 1736 citizens from Kabul participated in the survey. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. All categorical variables were reported using frequencies and percentages. The findings revealed that the most common source of COVID-19-related information was social media (74.8%). In addition, 34.4% of subjects had previously been infected with COVID-19. It was reassuring to see that 78.4% of residents said they knew more about COVID-19 than they did about prior COVID-19 waves. A majority (81.5%) expressed willingness to resist the third wave, but 89.4% said that the country's government would be unable to develop an effective COVID-19 vaccine within the next 6 months. The findings of this present study indicates that citizens of Kabul are active in obtaining accurate information and disseminating it in the community. The citizens also reported sufficient COVID-19 related knowledge; however, they were more motivated to fight against the third wave of COVID-19. In regards to vaccination, they believed that the government could not vaccinate the public anytime soon. Hence, the enactment of non-pharmaceutical measures is important in the fight against the pandemic.

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.

Availability of Personal Protective Equipment Among Health-care Workers in Jordan During the COVID-19 Pandemic: A Web-Based Survey.

PROPOSE: The inception of the COVID-19 has put health-care workers (HCWs) in a precarious situation across the world. In spite of the challenges in Jordan, the high awareness and preparedness of HCWs made it feasible for the country to control the contagious virus. The study aimed to provide a useful insight into availability of PPE among HCWs in Jordan, which could help the policy/decision-makers of public health to design better programs based on the information reported. METHODS: This cross-sectional online survey was conducted during July 2020 for the evaluation of the availability of personal protective equipment (PPE) among HCWs in Jordan. RESULTS: A total of 751 HCWs responded from different parts of the country, who were actively working at different hospitals in Jordan. The majority of the participants (94%) reported having sufficient knowledge about COVID-19 and more than two-thirds of participants (68%) reported that PPE were provided by the Jordanian Ministry of Health. The majority (91%) of participants reported availability of medical face masks, while only 26% reported having facial protective shields. CONCLUSION: The study highlighted sufficient availability of PPE during the COVID-19 pandemic, which may have caused minimal infection rates among HCWs in Jordan.

The Third Wave of the COVID-19 Arrived in Afghanistan: A Severe Case with Skin Manifestation.

The COVID-19 is an ongoing global pandemic that has put the world in a devastating situation. The virus is able to attack multiple body systems and cause a variety of clinical problems ranging from asymptomatic to critical cases. Although young individuals are more likely to suffer milder forms of the disease, critical cases also might happen. Recent literature has revealed that, along with other clinical symptoms, skin manifestations have also progressively grown. In Afghanistan where COVID-19 has entered into a third wave, many people do not take the initial mild symptoms seriously to prevent further spreading in the community. We report symptoms of skin rash, fatigue, muscle pain, dry cough and fever at the onset of the disease, followed by rapid lung damage in a 23-year-old young adult, who did not have any preexisting risk factors. This case highlights the importance of urgent skin assessment of the COVID-19 patient complaining of any skin symptoms.

Food Security, Conflict, and COVID-19: Perspective from Afghanistan.

Afghanistan, a country challenged by war and conflicts, has been in a state of turmoil for several years. The prolonged suffering has brought many challenges to the country's inhabitants. Among these, food security is one important cause for concern. Food security occurs when people continuously have physical and economic access to adequate, safe, and nutritious food to meet their dietary requirements and food preferences for a functional and healthy life. Amid the pandemic, Afghanistan has witnessed a large increase in food shortages due to its dependence on neighboring countries. In light of current circumstances, food insecurity, coupled with political instability and the third wave of the COVID-19, have made it extremely hard for people to access daily provisions. Hence, people are left to navigate the COVID-19 pandemic with economic recession and poverty as the backdrop of the other health crises. To mitigate food security, international attempts are the required at this critical juncture. The aim of this article is to understand the causes leading to food insecurity and its implications in Afghanistan and to propose solutions that will improve the overall food security at the policy and implementation levels.

Prevalence of Symptoms of Anxiety Among Residents of Kabul During Pandemic of COVID-19: A Report from Capital of Afghanistan.

PURPOSE: This study was conducted to evaluate the prevalence of symptoms of anxiety among residents of Kabul during the present COVID-19 pandemic. METHODS: This descriptive cross-sectional, community based survey was conducted in Kabul, Afghanistan, during the COVID-19 pandemic. Data were collected from July 11, 2020, to July 16, 2020. A bilingual (Dari and English) questionnaire was used for data collection. The first section of the questionnaire collected sociodemographic information of the respondents and the second comprised a self-report standardized scale, i.e. Generalized Anxiety Disorder-7 (GAD-7) to assess symptoms of anxiety. The survey form was distributed through online platforms. All residents of Kabul who used social apps such as WhatsApp and Facebook were eligible to participate in the study and participation was voluntary and non-commercial. RESULTS: Altogether 1135 complete responses were received. The majority of them were males and aged 18-34 years. Almost 18% were healthcare workers. Overall, 28.2% of the respondents reported symptoms of moderate to severe anxiety, 38.8% reported symptoms of mild anxiety, and nearly one third of the respondents reported no symptoms. Female participants reported significantly higher levels of anxiety compared with males (39.7% versus 25.6%; p = 0.0001). No significant association was noted between anxiety levels and age groups, occupations, and healthcare workers versus non-healthcare workers. CONCLUSION: The findings suggest that a gender-specific psychosocial protocol needs be integrated into the public health emergency plans to fight against the current pandemic.

The Third Wave of the COVID-19 in Afghanistan: An Update on Challenges and Recommendations.

The COVID-19 has spread to almost all countries since its emergence from Wuhan, China. Afghanistan has entered the third wave of the COVID-19 pandemic in May 2021. The county is bracing the third wave at a time when challenges like continuous conflict, illiteracy, poverty, inadequate healthcare personnel and service coverage, inadequate testing capacity, shortage of laboratory kits and reagents, lower public awareness and lower public trust on the government have brought it to its knees. All stakeholders including government, healthcare workers, civil societies, the public and the international community should combine their efforts to combat such a devastating situation. Although the inception of vaccination program against COVID-19 seems relieving, but it may take several months until a significant proportion of the people get vaccinated to reach the herd immunity. Thus, non-pharmaceutical intervention should be followed strictly. Moreover, awareness campaigns should also be continued to educate people and keep them supportive of the government plans and policies. Otherwise, the current wave may cause deadly consequences in such a complex situation.

Public Willingness and Hesitancy to Take the COVID-19 Vaccine in Afghanistan.

COVID-19 has been causing a global threat to almost all countries for more than one year. Vaccination of the majority of any country's population is considered to be an effective way of controlling the spread and mortality of this infection. Therefore, it is important to assess the public's willingness to be vaccinated against COVID-19. In this study, we evaluated the public willingness and hesitancy to take the vaccine in Afghanistan, during December 2020 and January 2021. Sociodemographic data, awareness on vaccine production, vaccine availability, willingness and hesitancy to take the COVID-19 vaccine were collected. The Statistical Package for Social Studies (SPSS) version 25 was used for data analysis. A total of 806 complete responses were received. Majority of the respondents were ≤ 40 years old (89.8%) and male (72.7%). Less than two-thirds (509; 63%) of the participants reported willingness to take the vaccine when it becomes available, whereas almost one-third (297; 37%) of them were hesitant to take the COVID-19 vaccine. More female than male respondents were willing to take the vaccine (χ2 = 13.176, P value = 0.001). A significant portion of the public were not willing to take the COVID-19 vaccine. In a country like Afghanistan, which already has a low coverage of vaccination, this could pose a challenge for the vaccination program against COVID-19 to be effective. The Ministry of Public Health should work on public trust and change people's mindset about vaccine reality and efficacy to prevent the rejection of this health intervention.

A Survey on the Health and Financial Status of Private Educational Institutions in Afghanistan During COVID-19 Pandemic.

PURPOSE: The worldwide spread of the coronavirus named SARS-CoV-2 has disrupted the world economy and the economy of Afghanistan as part of it. In addition, it has affected health and education in the country. The aim of this study is to highlight the damage the pandemic has done to private educational institutes in Afghanistan, in terms of finances, health and educational aspects. This is to draw attention to the setbacks the COVID-19 pandemic has caused to post-war (ie, post 2001) Afghan private education. METHODS: A cross-sectional study was conducted with the help of Afghanistan's Educational Centers Association (AECA) members to analyze the impact of the COVID-19-related lockdown. The questionnaire for the survey was distributed through SurveyMonkey to founders of educational institutes. It included basic demographics, perception of and exposure to COVID-19 by the participants and the educational and financial state of their institutions. Data analysis was conducted using SPSS software version 25. RESULTS: Almost all participants who completed the questionnaire were male; 82% of them were under 35 years old, the others were older. Fifty-one percent obtained their COVID-19-related information through social media. Fifty-six percent confirmed that either they themselves or employees had tested positive with COVID-19. Eighty-seven percent of their educational institutes were not conducting any online classes. Only 2% received continued payment from their students. Five percent did not pay rent for their center's lease. Regarding the economic damage during the lockdown period (March to July 2020) they encountered, 47% reported a loss of 2000-5000$ with a decreasing amount of participants responding and an ascending amount of financial loss. CONCLUSION: COVID-19 pandemic caused a significant financial and educational loss to the private educational institutes in Afghanistan. The lockdown induced by it affected students' fees transactions, induction of online classes, substantial financial loss, and it elevated the health crisis according to the founders of private educational institutes' reports.

Tongue ulcer in a patient with COVID-19: a case presentation.

BACKGROUND: The emergence of COVID-19 has devastated many parts of the world. From asymptomatic to symptomatic, the virus causes a wide spectrum of presentations. COVID-19 patients may present with oral manifestations. In Afghanistan, where COVID-19 has severely strained the health care system, much of the population lacks proper oral hygiene. This makes the oral cavity a perfect site for SARS-CoV-2 to manifest clinical signs. CASE PRESENTATION: A 62-year-old male was evaluated in the Dentistry Teaching Clinic of Kabul University of Medical Sciences for a painful erosive lesion on dorsal surface of his tongue. He also complained of fever, cough, and taste alteration. He was referred to Afghan Japan Hospital for COVID-19 testing and tested positive. He was followed on for the treatment of SARS-CoV2. After 2 weeks, the patient tested negative and returned to the dentistry clinic for follow-up. Although there were no other signs of COVID-19, the painful erosive lesion on his tongue persisted. Oral evaluation were performed and the patient was advised to practice good hygiene. After 10 days, we observed an asymptomatic geographic tongue without fever and myalgias and the lesion of dorsal surface of tongue improved from severe condition to moderate. CONCLUSION: In conclusion, patients with suspected or confirmed SARS-CoV-2 should be screened for symptoms and physical findings in the oral mucosa To prevent such an outcome, awareness programs need to be implemented for the diagnosis and management of clinical symptoms among patients.

Knowledge, Attitudes, and Practices of Medical Students Regarding COVID-19 in Afghanistan: A Cross-Sectional Study.

BACKGROUND: The coronavirus pandemic has had devastating effects on many nations, including Afghanistan. Public awareness and following recommendations play an important part in managing such a large-scale crisis, which are affected largely by knowledge, attitudes, and practices (KAP). Medical students can act as reliable sources of information for the public in such a scenario. This study aimed to investigate KAP of medical students regarding COVID-19. METHODS: A cross-sectional online survey was conducted in October 2020 among medical students in Afghanistan, Kabul University of Medical Sciences. Information on sociodemographics and KAP, was collected using a web-based questionnaire. RESULTS: A total of 1,169 medical students completed the survey. More than half were female (54.6%), a majority (95%) aged ≥20 years, and more than half (56.2%) lived in the city of Kabul. Overall, students had acceptable KAP regarding COVID-19, except for a few undesirable responses with regard to the risks of close contact with COVID-19 patients, incubation periods, and groups vulnerable to COVID-19. CONCLUSION: Overall, the students had acceptable KAP regarding COVID-19, except for the few undesired aforementioned responses, which need more focus during awareness campaigns in future.

A Survey of the Healthcare Workers in Afghanistan during the COVID-19 Pandemic.

Healthcare workers (HCWs) in Afghanistan faced many challenges during the COVID-19 pandemic. A cross-sectional, online survey was conducted from July 4, 2020 to July 12, 2020 to evaluate the working conditions and health situation of HCWs in Afghanistan during the pandemic. Healthcare workers from 34 provinces, who were actively working in Afghan hospitals, were invited to participate in this study; 925 HCWs completed the survey. The results showed that 85% of the HCWs participated in the study were tested positive for COVID-19. This highlights the critical need of HCWs for personal protective equipment when caring for suspected and/or confirmed cases of the COVID-19.