Project description:BackgroundsThroughout the world, there exists a clear need for the maintenance of cancer statistics, forming an essential part of any rational programme of cancer control, health-care planning, etiological research, primary and secondary prevention, benefiting both individuals and society. The present work reports only on the prevalence of cancers in the Oncology Department of Jamhuriyat Hospital, Kabul, Afghanistan following several decades of war.Materials and methodsA quantitative retrospective cross-sectional study was conducted using the medical records of patients diagnosed and treated from October 2015 to December 2017. Data includes information on gender, age, economic status, address and types of cancer diagnosed. The data was transferred to a customized form and analysed using Microsoft Excel program to classify cancer types.ResultsThe total number of patients with completed documents were 1025. Of these, 403 (39.3%) were male and 622 (60.7%) female. Most of the patients were in the age range of 20-70 years old. The most common cancers in women were breast cancer (45.8%), followed by oesophagus (12.5%), colorectal (4.8%), Non-Hodgkin Lymphoma (4.7%), sarcoma (4.7%), ovary (3.8%), both stomach and liver (2.6%) and cervix uteri (1.9%). Contrarily to men, esophageal cancer was highest (21.8%), followed by stomach (12.2%), Non-Hodgkin Lymphoma (9.4%), sarcoma (8.9%), gastroesophageal junction (8.9%), colorectal (8.6%), Hodgkin lymphoma (4.7%), testis (4.2%), liver (3.2%), lung (2.7%) and Nonmelanoma skin squamous cell carcinoma 9 (2.2%).ConclusionResults showed that the most frequent cancers among Afghans were breast and oesophagus. The most common cancer in men was oesophagus and stomach at the age range of 50-70 years while in women, breast and oesophagus cancers were common and within the age range of 25-65 years old.
Project description:BackgroundTo determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan.MethodsAn observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH.ResultsAmong the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%).ConclusionsAccording to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.
Project description:BackgroundTuberculosis (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.MethodA 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.ResultsOf 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).ConclusionThe 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.
Project description:BackgroundKabul (Afghanistan) is a major focus of cutaneous leishmaniasis (CL) caused by Leishmania tropica. Microscopy remains the reference test for diagnosis despite its low performance. We evaluated whether Loopamp™ Leishmania Detection Kit (Loopamp) and CL Detect™ Rapid Test (CL Detect), detecting Leishmania DNA and antigen, respectively could improve CL diagnosis.MethodsA diagnostic accuracy study with prospective inclusion was conducted in a leishmaniasis reference clinic in Kabul. Slit skin samples from CL suspects were analysed by microscopy. Samples taken with a dental broach were tested with CL Detect, Loopamp, and PCR. All samples were transferred to the Academic Medical Center (AMC, the Netherlands) for PCR and Loopamp analyses. The diagnostic performance of the tests was evaluated against a reference combining microscopy and PCR.Findings274 CL suspects were included in the study. In Kabul, CL Detect had a 65·4% sensitivity [95% Confidence Interval (CI): 59.2-71.2%] and a 100% specificity [95% CI: 80.5-100%], while these were 87.6% [95%CI: 82.9-91.3%] and 70.6% [95% CI: 44.0-89.7%] for Loopamp. At AMC the Loopamp's sensitivity (92.2% [95% CI: 88.2-95.2%]) and specificity (94.1% [95% CI: 71.3-99.8%]) were higher. An algorithm where CL Detect negative suspects would be tested by Loopamp yielded a 93.4% sensitivity [95% CI: 89.6-96.1%] and a 94.1% specificity [95% CI: 71.3-99.8%] when Loopamp's performance at AMC was used.InterpretationThe high specificity of CL Detect and the performance of Loopamp allow their use in a diagnostic algorithm that would minimize the number of CL patients referred for confirmation. FUND: Federal Ministry of Education and Research, Germany.
Project description:Teenagers have a high prevalence of ascariasis in low-income countries with endemic disease, and their hygienic behaviors and access to proper sanitation may be limited in rapidly urbanizing settings. We studied university students in Kabul to estimate the proportion with ascariasis and determine the prevalence of risk factors for infection. Ascariasis was assessed through microscopy for 520 students attending Kabul Medical University. Overall, 15.8% of students were infected. Living in a hostel (21.2% versus 10.4% in houses) using well water (27.7% versus 9.7% for piped water), eating street food (29.4% versus 3.0% for those who do not), and eating unwashed vegetables (63.6% versus 8.8% for those who do not) were risk factors for infection. Recent city migrants who live in group hostels, including students, are important targets for interventions to reduce ascariasis. Such interventions could include encouraging individuals to prepare their own food and use only potable water.
Project description:A plethora of studies on the prevalence of poor mental health have been undertaken in the general population. Nevertheless, an understanding of the prevalence of poor mental health in the context of high-risk settings, such as construction, is missing. This is noteworthy as poor mental health is widespread in this context. Given that over 100 million people work in construction on a global scale, a better understanding of the burden of poor mental health in construction is needed. To this end, a review on the prevalence of key mental health-related conditions in construction was undertaken. Through this review, over 1000 papers were identified through PubMed and Google Scholar. After applying inclusion and exclusion criteria, a final set of 19 documents were included. Results showed that anxiety and depressive disorders, as well as psychological distress, have a high burden in construction. Vulnerable population subgroups (e.g., women, minority ethnic groups) were identified. Construction is a high-risk setting and despite this, the burden of poor mental health in this context is not given the importance it deserves. This review sheds light on the prevalence of key conditions, which are linked to high humanistic and economic burden. This review provides a foundation and useful starting point for further investigations, and results from this review may be used to inform future research, workplace interventions, and policy.
Project description:Tuberculosis (TB) is a major public health problem in Afghanistan, but experience in implementing effective strategies to prevent and control TB in urban areas and conflict zones is limited. This study shares programmatic experience in implementing DOTS in the large city of Kabul. We analyzed data from the 2009-2015 reports of the National TB Program (NTP) for Kabul City and calculated treatment outcomes and progress in case notification using rates, ratios, and confidence interval. Urban DOTS was implemented by the NTP in partnership with United States Agency for International Development (USAID)-funded TB projects, the World Health Organization (WHO), and the private sector. Between 2009 and 2015, the number of DOTS-providing centers in Kabul increased from 22 to 85. In total, 24,619 TB patients were enrolled in TB treatment during this period. The case notification rate for all forms of TB increased from 59 per 100,000 population to 125 per 100,000. The case notification rate per 100,000 population for sputum-smear-positive TB increased from 25 to 33. The treatment success rate for all forms of TB increased from 31% to 67% and from 47% to 77% for sputum-smear-positive TB cases. The treatment success rate for private health facilities increased from 52% in 2010 to 80% in 2015. In 2013, contact screening was introduced, and the TB yield was 723 per 100,000-more than two times higher than the estimated national prevalence of 340 per 100,000. Contact screening contributed to identifying 2,509 child contacts of people with TB, and 76% of those children received isoniazid preventive therapy. The comprehensive urban DOTS program significantly improved service accessibility, TB case finding, and treatment outcomes in Kabul. Public- and private-sector involvement also improved treatment outcomes; however, the treatment success rate remains higher in private health facilities. While the treatment success rate increased significantly, it remains lower than the national average, and more efforts are needed to improve treatment outcomes in Kabul. We recommend that the urban DOTS approach be replicated in other countries and cities in Afghanistan with settings similar to Kabul.
Project description:Overweight/obesity constitutes a major risk factor for non-communicable diseases (NCDs), whose global prevalence is growing rapidly, including in Afghanistan. However, the effects of risk factors on NCDs have rarely been studied in the educator workforce. Therefore, the objective of this study is to determine the prevalence, determinants, and association of overweight/obesity with NCD-related biomedical indicators among schoolteachers in Afghanistan. The sample comprised 600 schoolteachers aged 18 years and above. We conducted questionnaire interviews, anthropometric measurements, and blood biochemistry tests. The main explanatory variable was overweight/obesity (body mass index ≥ 25.0 kg/m2). NCD-related biomedical indicators were the outcome variables. Poisson regression models were applied to investigate the association between overweight/obesity and outcome variables. The prevalence of overweight/obesity was 58.2%, which was significantly higher in women, those aged 41-50 years, married participants, and those with 10-20 years of working experience than in their counterparts. After adjusting for sociodemographic variables and lifestyle behaviors, overweight/obesity was significantly associated with hypertension (adjusted prevalence ratio [aPR] = 1.83, 95% confidence interval [CI]: 1.33-2.51); elevated levels of glycosylated hemoglobin (HbA1c) (aPR = 1.35, 95% CI: 1.01-1.79), total cholesterol (aPR = 1.67, 95% CI:1.14-2.44), low-density lipoprotein cholesterol (LDL-C) (aPR = 1.29, 95% CI: 1.10-1.50), and triglycerides (aPR = 1.98, 95% CI: 1.57-2.50), and having three or more comorbidities (aPR = 1.90, 95% CI: 1.47-2.47). Our findings demonstrated a high prevalence of overweight/obesity among schoolteachers. In addition, we found significant associations of overweight/obesity with a higher prevalence of hypertension; elevated serum levels of HbA1c, total cholesterol, LDL-C, and triglycerides; and comorbid conditions in schoolteachers. The findings highlight the need for worksite interventions that promote weight control among schoolteachers with overweight/obesity to reduce the burden of NCDs.
Project description:Studies in Afghanistan have shown substantial mental health problems in adults. We did a survey of young people (11-16 years old) in the country to assess mental health, traumatic experiences, and social functioning.In 2006, we interviewed 1011 children, 1011 caregivers, and 358 teachers, who were randomly sampled in 25 government-operated schools within three purposively chosen areas (Kabul, Bamyan, and Mazar-e-Sharif municipalities). We assessed probable psychiatric disorder and social functioning in students with the Strength and Difficulties Questionnaire multi-informant (child, parent, teacher) ratings. We also used the Depression Self-Rating Scale and an Impact of Events Scale. We assessed caregiver mental health with both international and culturally-specific screening instruments (Self-Reported Questionnaire and Afghan Symptom Checklist). We implemented a checklist of traumatic events to examine the exposure to, and nature of, traumatic experiences. We analysed risk factors for mental health and reports of traumatic experiences.Trauma exposure and caregiver mental health were predictive across all child outcomes. Probable psychiatric ratings were associated with female gender (odds ratio [OR] 2.47, 95% CI 1.65-3.68), five or more traumatic events (2.58, 1.36-4.90), caregiver mental health (1.11, 1.08-1.14), and residence areas (0.29, 0.17-0.51 for Bamyan and 0.37, 0.23-0.57 for Mazar-e-Sharif vs Kabul). The same variables predicted symptoms of depression. Two thirds of children reported traumatic experiences. Symptoms of post-traumatic stress were associated with five or more traumatic events (3.07, 1.78-5.30), caregiver mental health (1.06, 1.02-1.09), and child age (1.19, 1.04-1.36). Children's most distressing traumatic experiences included accidents, medical treatment, domestic and community violence, and war-related events.Young Afghans experience violence that is persistent and not confined to acts of war. Our study emphasises the value of school-based initiatives to address child mental health, and the importance of understanding trauma in the context of everyday forms of suffering, violence, and adversity.Wellcome Trust.