Evacuation of Refugees from Afghanistan: Health Control at the Spanish Border in the Context of the COVID-19 Pandemic.

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.

Intergenerational trauma: A silent contributor to mental health deterioration in Afghanistan.

Multiple theories, including family systems, epigenetics, attachments, and many others, have proposed mechanisms for trauma transmission from generation to generation. Intergenerational trauma is today one of the most important psychosocial issues affecting Afghans' mental health and psychology, with the potential to affect subsequent generations. A variety of factors have impacted the mental health of the Afghan population over the years, including years of conflict, socioeconomic instability, natural disasters, chronic drought conditions, economic turmoil, and food insecurity, all of which have been exacerbated by recent political turbulence and the The Coronavirus pandemic COVID-19 pandemic that has further increased the susceptibility to intergenerational trauma among the Afghan population. International bodies must play a role in addressing intergenerational trauma among Afghans. Breaking the chain in future generations will be possible by resolving political issues, providing adequate health facilities, financial support, and eliminating stigmas associated with mental health issues.

Knowledge, attitudes and practices of university students toward COVID-19 in Southern region, Afghanistan: a cross-sectional study.

BACKGROUND: Successful implementation of preventive measures and level of awareness in particular among university students in Afghanistan could play a crucial role in spreading the information for better control of the ongoing pandemic. Therefore, the aim of this study was to determine the level of knowledge, attitudes and practices (KAP) regarding COVID-19 among Kandahar university students. METHODS: A cross-sectional study conducted among undergraduate students to investigate their KAP regarding COVID-19 from January to March, 2021. The data were collected using a structured questionnaire (socio-demographic characteristics, KAP questionnaire) by phone call interviews. RESULTS: From 359 participants, 88.9% were males, 81.3% were single, 65.1% lived in urban areas, and more than 64% of the students were less than 23 years old. Overall, 86.6% of the study participants had adequate level of knowledge and 87.5% had positive attitudes toward COVID-19. Almost one-third of the participants had good practices regarding COVID-19. All KAP scores were higher in male students. Significant difference of good practice (p < 0.001) was observed among students who were in high socioeconomic status (SES) group. In univariate analysis, female sex (ß: -0.75, p = 0.007) was negatively and watching television (ß: 0.44; p = 0.014) was positively associated with knowledge score. However, in multivariate linear regression analysis, the knowledge score was significantly associated with age (ß: -0.115; p = 0.004); attitude score was significantly associated with female sex (ß: -2.776; p < 0.001) and radio use (ß: -0.974; p = 0.031); and practice score was significantly associated with female sex (ß: -3.704; p = 0.002) and urban area (ß: 1.702; p = 0.016). CONCLUSIONS: The overall knowledge and attitudes regarding COVID-19 among university students were desirable. Higher university year, young age, male sex and living in urban areas were significantly associated with good KAP regarding COVID-19. Good practices towards COVID-19 should be increased through awareness programs.

Knowledge, attitudes, and practices towards seasonal influenza vaccination among pregnant women and healthcare workers: A cross-sectional survey in Afghanistan.

Background: Despite recommendation by the World Health Organization (WHO), influenza vaccination coverage among high-risk groups remains suboptimal in Afghanistan. This study aims to document the knowledge, attitudes, and practices of seasonal influenza vaccine uptake among two priority groups, pregnant women (PWs) and healthcare workers (HCWs). Methods: This cross-sectional study enrolled PWs and HCWs in Kabul, Afghanistan, from September to December 2021. Data on vaccine intention and uptake, knowledge, and attitudes towards vaccination were collected. Simple linear regression was used to predict the impact of sociodemographic characteristics on the KAP score. Results: A total of 420 PWs were enrolled in Afghanistan. The majority (89%) of these women had never heard of the influenza vaccine but 76% intended to receive the vaccine. Of the 220 HCWs enrolled, 88% were unvaccinated. Accessibility and cost were factors which encouraged vaccination among HCWs. Fear of side effects and affordability were identified as key barriers. HCWs reported high level of vaccine intention (93%). PWs aged under 18 years (ß: 6.5, P = 0.004), between 18 and 24 years (ß: 2.9, P = 0.014), currently employed (ß: 5.8, P = 0.004), and vaccinated against COVID-19 (ß: 2.8, P = 0.01) were likely to have a higher attitude score. Among HCWs, being female was a predictor for poor vaccination practice (ß: -1.33, P < 0.001) whereas being vaccinated against COVID-19 was a predictor for higher practice score (ß: 2.4, P < 0.001). Conclusion: To increase influenza vaccination coverage among priority groups, efforts should be made to address issues such as lack of knowledge, limited availability, and cost barriers.

The provision and utilization of essential health services in Afghanistan during COVID-19 pandemic.

Introduction: The COVID-19 pandemic has disrupted provision of essential health services and overwhelmed even robust health systems worldwide. The Afghanistan health system has suffered both from the pandemic, as well as from political upheaval and regime change. Methods: We evaluated essential service delivery using data collected from a cross-sectional survey of health care facilities in Afghanistan based on administration of a World Health Organization standardized assessment of frontline service readiness. A multi-stage sampling scheme was used to identify a representative sample of 92 health facilities (68 clinics and 24 hospitals) providing essential health services in five provinces. Facility managers were asked to report on changes in health service delivery in late 2021 and early 2022 (corresponding to the end of a significant national COVID-19 surge in infections) compared to the same period one year earlier. Results: Among health facilities evaluated; 29 were in urban and 63 were in rural settings. Most facilities reported an increase in the provision of outpatient care particularly in maternal and child health services as well as for tuberculosis, chronic respiratory diseases, mental health, and substance abuse; the number of in-patients also increased. In contrast, provision of services for malaria, neglected tropical diseases, and community outreach programs decreased. Nearly all facilities used strategies to maintain services, including targeting high-risk patients, promoting self-care, and redirecting patients to alternative health care sites. Nearly three fourth (70.6%) of facilities provided no training about COVID-19 to staff; only 65.2% referred COVID-19 patients to designated hospitals and 44.6% had safe transportation for these patients. Discussion: Increased demand for services during this period was likely due to a backlog in need generated during the preceding COVID-19 surge and the political changes happened a few months earlier to this survey. Facilities used various methods to maintain services, although the decrease in provision of community outreach was concerning. Facilities appeared to be able to maintain essential health services, despite an increase in demand. However, awareness and training of COVID-19 protocols and appropriate and safe referrals need to be improved. In general, these series of surveys are informative and helpful to identify any changes in provision of essential health services and can facilitate recovery of health systems during and after pandemics.

Progress Toward Poliomyelitis Eradication - Afghanistan, January 2021-September 2022.

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.

Knowledge, attitudes, practice of people toward the COVID-19 pandemics, and its impact in Afghanistan.

COVID-19 pandemic disrupted the social and economic norms. Knowledge, Attitude and Practices studies are used to address the information gap for further strategic decision making to control the pandemic. This study aimed to find the level of Knowledge, Awareness, Attitudes, and behavioral practices of the people of Afghanistan about the COVID-19 and its impact on health and socio-economic dimension of their routine lives. We used a cross-sectional method with two stage sampling design. Data analysis was performed using SPSS v.20. The survey focused on adults including men and women all over the country to represent the country, including the urban and rural areas. Most of the respondents are in the age group of 21-30 years (46.5%); 60.15% of the participants are married. Almost 75% of females and 84% of males were literate and most participants have a bachelor's degree (34%). More than 80% of participants knew they can prevent themselves from contacting COVID-19 through hand washing frequently with soap and water and wearing a mask. More than 80% of participants responded that they would go for a lab test for detection of the virus as well as COVID-19 vaccination if it is available. Almost 35% reported always wearing a mask to prevent COVID-19 transmission; more than half of participants always wash their hands, more than 60% of them do not touch their eyes, nose, and mouth frequently. Nearly 60% of participants indicated that their household had problems satisfying food needs partly during the COVID-19 pandemic. Nearly half of participants believed that the government was successful in applying lockdown measures and in awareness rising (56.8 and 69.8%). The study findings provide some useful insight about the KAP of communities in Afghanistan, which could assist policy makers in public health to design and implement interventions based on the information gaps reported.

Unraveling the Jeopardy: Child health in Afghanistan.

A humanitarian crisis started in Afghanistan after the United States and international Allies withdrew in August 2021, causing numerous challenges and have especially impacted children. Children in Afghanistan have been affected by a long history of suffering from violence, war, and poverty. The US withdraw and COVID-19 pandemic have caused an economic crisis causing high rates of child malnutrition and prevented them from receiving healthcare and education. In the long run, the impacts of the current situation will significantly affect the child growth, education, and psychological health. There is a need for international organizations to intervene now to ensure children do not further suffer and have the option for a bright future. In turn, ensuring a brighter future for Afghanistan.

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.

COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study.

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.

Statistical Analysis of the COVID-19 Mortality Rates with Probability Distributions: The Case of Pakistan and Afghanistan.

The COVID-19 pandemic has shocked nations due to its exponential death rates in various countries. According to the United Nations (UN), in Russia, there were 895, in Mexico 303, in Indonesia 77, in Ukraine 317, and in Romania 252, and in Pakistan, 54 new deaths were recorded on the 5th of October 2021 in the period of months. Hence, it is essential to study the future waves of this virus so that some preventive measures can be adopted. In statistics, under uncertainty, there is a possibility to use probability models that leads to defining future pattern of deaths caused by COVID-19. Based on probability models, many research studies have been conducted to model the future trend of a particular disease and explore the effect of possible treatments (as in the case of coronavirus, the effect of Pfizer, Sinopharm, CanSino, Sinovac, and Sputnik) towards a specific disease. In this paper, varieties of probability models have been applied to model the COVID-19 death rate more effectively than the other models. Among others, exponentiated flexible exponential Weibull (EFEW) distribution is pointed out as the best fitted model. Various statistical properties have been presented in addition to real-life applications by using the total deaths of the COVID-19 outbreak (in millions) in Pakistan and Afghanistan. It has been verified that EFEW leads to a better decision rather than other existing lifetime models, including FEW, W, EW, E, AIFW, and GAPW distributions.