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.

The family planning conundrum in Afghanistan.

INTRODUCTION: In Afghanistan, despite the high awareness levels of contraceptive methods, the contraceptive prevalence is low and short birth spacing is common. The aim of this study was to understand the perception about family planning and contraceptive utilization among reproductive-aged married women, their husbands, their mothers-in-law, religious leaders and healthcare providers. METHODS: Focus group discussions and semi-structured interviews were conducted among married women of reproductive age (n = 482), their husbands (n = 133), their mothers-in-law (n = 194), their religious leaders (n = 16), and healthcare providers (n = 36) in rural and urban areas in five provinces. RESULTS: Bigger family size was generally considered as desirable for emotional, economic and social well-being. The majority endorsed contraception. However, some religious scholars and their followers argued that contraception is a sinful act in Islam by interpreting contraception as equivalent to infanticide and suppression of the increase of the Muslim population. Healthcare providers attempted to disseminate health benefits of modern contraception on a family basis. However, fear of various side effects and doubts about their effectiveness due to irregular supply were prevalent in communities. DISCUSSION: It is important to increase awareness on the health benefits of appropriate birth spacing at community level. Public health campaigns supported by Islamic religious scholars and a system that ensures appropriate counselling and a steady supply of contraceptives are likely to increase contraceptive utilization.