Search

Summary Objectives To characterize hepatitis C virus (HCV) epidemiology and inform public health research, policy, and programming priorities in Afghanistan. Methods Records of HCV incidence and prevalence were reviewed systematically and synthesized following PRISMA guidelines. Meta-analyses were implemented using a DerSimonian–Laird random effects model with inverse variance weighting to estimate HCV prevalence among various at risk populations. A risk of bias assessment was incorporated. Results The search identified one HCV incidence and 76 HCV prevalence measures. HCV incidence was only assessed among people who inject drugs (PWID), and was reported at 66.7 per 100 person-years. Meta-analyses estimated HCV prevalence at 0.7% among the general population (range 0–9.1%, 95% confidence interval (CI) 0.5–0.9%), 32.6% among PWID (range 9.5–70.0%, 95% CI 24.5–41.3%), and 2.3% among populations at intermediate risk (range 0.0–8.3%, 95% CI 1.3–3.7%). No data were available for other high risk populations such as hemodialysis, thalassemia, and hemophilia patients. Conclusions HCV prevalence among the general population in Afghanistan is comparable to global levels. Data are needed for the level of infection among key clinical populations at high risk of infection. There is also an immediate need for expansion of harm reduction programs among PWID and prisoners.

OBJECTIVE: This study aimed to assess the potential impact a proposed family planning model would have on reducing maternal and infant mortality in Afghanistan. BACKGROUND: Afghanistan has a high total fertility rate high infant mortality rate and high maternal mortality rate. Afghanistan also has tremendous socio-cultural barriers to and misconceptions about family planning services. METHODS: We applied predictive statistical models to a proposed family planning model for Afghanistan to better understand the impact increased family planning can have on Afghanistans maternal mortality rate and infant mortality rate. We further developed a sensitivity analysis that illustrates the number of maternal and infant deaths that can be averted over 5 years according to different increases in contraceptive prevalence rates. RESULTS: Incrementally increasing contraceptive prevalence rates in Afghanistan from 10% to 60% over the course of 5 years could prevent 11653 maternal deaths and 317084 infant deaths a total of 328737 maternal and infant deaths averted. CONCLUSION: Achieving goals in reducing maternal and infant mortality rates in Afghanistan requires a culturally relevant approach to family planning that will be supported by the population. The family planning model for Afghanistan presents such a solution and holds the potential to prevent hundreds of thousands of deaths. Copyright (c) 2013 John Wiley & Sons Ltd.

Background Little information is available regarding blood supply safety in Afghanistan. The purpose of this study was to assess blood safety through serologic and observational measures in Afghanistan. Study Design and Methods This cross-sectional assessment included the 40 highest-volume facilities collecting and transfusing blood nationally identified in a previous survey. At each facility, study representatives completed a standardized instrument assessing staff performance of transfusion-related activities and performed rapid testing for human immunodeficiency virus, syphilis, and hepatitis B and C with rapid diagnostic tests on clinically discarded specimens. Reactive samples received confirmatory testing. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests. Results Between November 2010 and May 2011, a total of 332 blood donor collection procedures were observed. Only 52.4% of observed encounters correctly screened and deferred donors by international criteria. Public and private facilities demonstrated glove use, proper sharps disposal, and patient counseling and relayed screening test results in less than 75% of observed events, significantly less likely than military facilities (p

BACKGROUND: The purpose of this study was to assess functionality and resources of facilities providing blood collection and transfusion services in Afghanistan. STUDY DESIGN AND METHODS: This national cross-sectional assessment included facilities collecting or transfusing blood identified through official data sources and private key informants. At each facility, study representatives completed a standardized instrument assessing presence of records logbook, electricity, refrigeration, and required transfusion-transmitted infection (TTI; human immunodeficiency virus, syphilis, and hepatitis B and C) test kits. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests. RESULTS: Between August and November 2010, a total of 243 facilities were surveyed with public (52.3%, n = 127) and private (43.2%, n = 105) sector comprising the majority. Most (63%) facilities were urban, with 23.5% located in Kabul province. Of 92,682 units collected nationally in the 12 months before evaluation, 7.5% (n = 6952) had no disposition record. Many (62%, n = 151) facilities had an established recordkeeping system; the remainder provided estimates. Half of surveyed facilities had regular power supply (57.8%), refrigerators for storing blood (52.3%), or all necessary TTI test kits (62.1%). Military (83.3%) and public (74.8%) facilities were more likely to have all TTI test kits present compared to private (46.7%, p

BACKGROUND: As a result of more than 20 years of war in Afghanistan, its blood supply system has been damaged. We carried out an assessment of that blood supply system to determine the type and extent of assistance needed to increase blood availability and safety. STUDY DESIGN AND METHODS: An assessment tool was developed, daily activities in Afghanistan were observed, and key personnel were interviewed. RESULTS: Because there was no donor recruitment organization, most blood was obtained by the family replacement system. There was an inadequate supply of stored blood, which led to use of blood before screening test results for transfusion-transmitted disease were complete. Whole blood was provided but blood components were not produced. Blood was tested intermittently for human immunodeficiency virus Types 1 and 2, hepatitis B surface antigen, hepatitis C virus, and syphilis using agglutination-based screening methods. CONCLUSIONS: A dedicated staff is in place but to strengthen the blood supply system in Afghanistan, it will be important to address infrastructure and facilities, organization, standard operating methods, supplies and equipment, training, quality assurance, and transfusion medicine education.

Little information is available regarding blood supply safety in Afghanistan. The purpose of this study was to assess blood safety through serologic and observational measures in Afghanistan.This cross-sectional assessment included the 40 highest-volume facilities collecting and transfusing blood nationally identified in a previous survey. At each facility, study representatives completed a standardized instrument assessing staff performance of transfusion-related activities and performed rapid testing for human immunodeficiency virus, syphilis, and hepatitis B and C with rapid diagnostic tests on clinically discarded specimens. Reactive samples received confirmatory testing. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests.Between November 2010 and May 2011, a total of 332 blood donor collection procedures were observed. Only 52.4% of observed encounters correctly screened and deferred donors by international criteria. Public and private facilities demonstrated glove use, proper sharps disposal, and patient counseling and relayed screening test results in less than 75% of observed events, significantly less likely than military facilities (p0.01). Of 1612 specimens assessed, confirmed cases of hepatitis B (n = 6), hepatitis C (n = 1), and syphilis (n = 3) were detected among units already prescreened and accepted for transfusion.Lapses in proper donor screening contributed to the presence of confirmed-positive units available for transfusion, as detected in this study. Steps must be taken to ensure standardization of testing kits requirements, documentation, and mandatory training and continuing education for blood bank staff with regard to counseling, drawing, processing, and transfusion of blood products.

The purpose of this study was to assess functionality and resources of facilities providing blood collection and transfusion services in Afghanistan.This national cross-sectional assessment included facilities collecting or transfusing blood identified through official data sources and private key informants. At each facility, study representatives completed a standardized instrument assessing presence of records logbook, electricity, refrigeration, and required transfusion-transmitted infection (TTI; human immunodeficiency virus, syphilis, and hepatitis B and C) test kits. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests.Between August and November 2010, a total of 243 facilities were surveyed with public (52.3%, n = 127) and private (43.2%, n = 105) sector comprising the majority. Most (63%) facilities were urban, with 23.5% located in Kabul province. Of 92,682 units collected nationally in the 12 months before evaluation, 7.5% (n = 6952) had no disposition record. Many (62%, n = 151) facilities had an established recordkeeping system; the remainder provided estimates. Half of surveyed facilities had regular power supply (57.8%), refrigerators for storing blood (52.3%), or all necessary TTI test kits (62.1%). Military (83.3%) and public (74.8%) facilities were more likely to have all TTI test kits present compared to private (46.7%, p 0.01) but not nongovernmental organization (40.0%, p = 0.37) facilities.In Afghanistan, blood donation and transfusion occur with substantial differences in data recording and TTI test availability, with private facilities less likely to have these resources. Efforts are needed to improve available resources and ensure that facilities are in compliance with national standards for donor screening.

This study aimed to assess the potential impact a proposed family planning model would have on reducing maternal and infant mortality in Afghanistan.Afghanistan has a high total fertility rate, high infant mortality rate, and high maternal mortality rate. Afghanistan also has tremendous socio-cultural barriers to and misconceptions about family planning services.We applied predictive statistical models to a proposed family planning model for Afghanistan to better understand the impact increased family planning can have on Afghanistan's maternal mortality rate and infant mortality rate. We further developed a sensitivity analysis that illustrates the number of maternal and infant deaths that can be averted over 5 years according to different increases in contraceptive prevalence rates.Incrementally increasing contraceptive prevalence rates in Afghanistan from 10% to 60% over the course of 5 years could prevent 11,653 maternal deaths and 317,084 infant deaths, a total of 328,737 maternal and infant deaths averted.Achieving goals in reducing maternal and infant mortality rates in Afghanistan requires a culturally relevant approach to family planning that will be supported by the population. The family planning model for Afghanistan presents such a solution and holds the potential to prevent hundreds of thousands of deaths.

As a result of more than 20 years of war in Afghanistan, its blood supply system has been damaged. We carried out an assessment of that blood supply system to determine the type and extent of assistance needed to increase blood availability and safety.An assessment tool was developed, daily activities in Afghanistan were observed, and key personnel were interviewed.Because there was no donor recruitment organization, most blood was obtained by the family replacement system. There was an inadequate supply of stored blood, which led to use of blood before screening test results for transfusion-transmitted disease were complete. Whole blood was provided but blood components were not produced. Blood was tested intermittently for human immunodeficiency virus Types 1 and 2, hepatitis B surface antigen, hepatitis C virus, and syphilis using agglutination-based screening methods.A dedicated staff is in place but to strengthen the blood supply system in Afghanistan, it will be important to address infrastructure and facilities, organization, standard operating methods, supplies and equipment, training, quality assurance, and transfusion medicine education.