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Zoaib Habib Tharwani,1 Prince Kumar,1 Yumna Salman,1 Zarmina Islam,1 Shoaib Ahmad,2 Mohammad Yasir Essar3 1Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; 2District Head Quarters Teaching Hospital, Faisalabad, Pakistan; 3Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Mohammad Yasir Essar, Email yasir.essar@gmail.comAbstract: Typhoid, and its extra drug resistant form which is highly prevalent Pakistan, is increasing the burden on healthcare through multiple factors. These range from lack of sanitation, the collapsing economy, and poor access to clean drinking water which have made it arduous for the government and various other organizations in containing it. With the COVID-19 pandemic, treatment of typhoid became a challenge as focus was driven towards limiting the COVID-19 spread, and hence preferential use of antibiotics such as azithromycin may limit future empirical antibiotic therapy for typhoid. Socioeconomic disparities and geographical as well as demographic barriers further limit access to appropriate typhoid management. Lastly, illiteracy and self-medication with antibiotics may predispose Pakistan to another outbreak of typhoid. These concerns, although largely unaddressed effectively, need immediate action. Previously, the government and international organizations have made efforts to control the spread through the introduction of TCV as a part of EPI and awareness, additional improvements are needed. These include: improving access to telemedicine in rural areas, extensive vaccination programs, and routine awareness programs especially in schools.Keywords: typhoid, COVID-19, water sanitation, healthcare, vaccine, Pakistan

Zarmina Islam,1 Parvathy Mohanan,2 Wajeeha Bilal,1 Taleen Hashmi,1 Zainab Rahmat,1 Ikran Abdi,3 Mehr Muhammad Adeel Riaz,4 Mohammad Yasir Essar5 1Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; 2Medical University Sofia, Sofia, Bulgaria; 3Faculty of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan; 4Punjab Medical College, Faisalabad, Pakistan; 5Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Mohammad Yasir EssarKabul University of Medical Sciences, Kabul, Afghanistan, Tel +992 117118300, Email Yasir.essar@gmail.comAbstract: Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two. Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians. Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan’s government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.Keywords: dengue, COVID-19, Pakistan, healthcare infrastructure

Sadia Yaqoob,1 Amna Saleem,1 Furqan Ahmad Jarullah,1 Areeba Asif,1 Mohammad Yasir Essar,2 Shaista Emad3 1Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan; 2Department of Dentistry, Kabul University of Medical Sciences, Kabul, Afghanistan; 3Department of Biochemistry, Sohail University, Karachi, PakistanCorrespondence: Mohammad Yasir EssarDepartment of Dentistry, Kabul University of Medical Sciences, Kabul, 1001, AfghanistanEmail yasir.essar@gmail.comBackground: In the wake of coronavirus (COVID-19) global alert, people have begun to practice safety measures in order to reduce the exposure to life-threatening disease. The largest at risk population is undoubtedly the frontline healthcare workers (HCWs) who are using personal protective equipment (PPE), essentially face masks, to battle against this deadly virus. This study was conducted with the prime intention to reveal an association between face mask and acne and measure the prevalence of acne amongst HCWs amidst COVID-19 outbreak in Karachi. Furthermore, this study aimed to identify the type of mask generating acne, locate the common sites, assess the severity and establish an association of mask use with the skin type.Methods: This cross-sectional study was carried out at Medicare Cardiac and General Hospital, Jinnah Medical College Hospital, Jinnah Postgraduate Medical Centre and Jamal Noor Hospital located in Karachi, Pakistan. A total of 348 HCWs were interviewed, of which only 193 met the inclusion criteria. All information was recorded on a predesigned proforma and analyzed using SPSS 25.0.Results: Among 193 participants, acne was prevalent in 103 (53.4%) participants with maximum cases reported in female HCWs, and in doctors (p< 0.05). Out of 73 HCWs using N-95 masks, 46 (44.7%) developed acne, with a p-value of 0.036. Skin type and past history of acne also yielded statistically significant results. Among all the skin types, HCWs with oily skin (64, 62.1%) were prone to face resurgence of acne or new-onset acne. The most common sites of eruption of acne were along the cheeks (45.1%) followed by the nose (40.9%). Majority of the population suffered from mild acne. Moderate and severe acne eruption was particularly observed in those wearing N-95 and surgical masks.Conclusion: The use of face masks is associated with high rates of acne eruption. Disseminating the guidelines and indications of World Health Organization (WHO) regarding proper use of mask, encouraging awareness among HCWs and following proper doffing and donning protocol as endorsed by Centers for Disease Control and Prevention (CDC) will possibly minimize the adverse reactions.Keywords: acne, facemask, healthcare worker, COVID-19

Arash Nemat,1,2 Nahid Raufi,3 Mohammad Yasir Essar,4 Qingchun Zeng2 1Department of Microbiology, Kabul University of Medical Sciences, Kabul, Afghanistan; 2Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China; 3Department of Dermatology, Kabul University of Medical Sciences, Kabul, Afghanistan; 4Medical Research Center, Kateb University, Kabul, AfghanistanCorrespondence: Arash NematDepartment of Microbiology, Kabul University of Medical Sciences, 3rd District, Jamal Mina, Kabul, 1001, AfghanistanTel +93 706 717 987Email dr.arashnemat@yahoo.comPurpose: 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.Keywords: learning center, coronavirus, education crisis, survey, school, student

Nomophobia (no-mobile-phone phobia) is the fear and anxiety of being without a mobile phone. This study pioneers the investigation of nomophobia in Afghanistan using the Nomophobia Questionnaire (NMP-Q), addressing a crucial gap in the field. We collected statistical data from 754 undergraduate medical students, comprising men (56.50 %) and women (43.50 %), and analyzed the dimensions of nomophobia. While results revealed that all but two participants were nomophobic, they identified three significant dimensions affecting the level of nomophobia among participants: (a) gender, (b) age, and (c) marital status. The study's contributions are precious, given the peculiarity of Afghan political turmoil, security, and human rights issues, especially for women. For example, the study's data collection was abruptly halted in December 2022 due to the Taliban regime's decision to make it illegal for women to enroll in universities as students. Therefore, while examining the characteristics of nomophobia across societies is imperative, it is also vital to investigate what is true of one society, Afghanistan, at one point in time and space. The study concludes by emphasizing the need to broaden participants' scope in future studies to better understand the prevalence of nomophobia across broader societal contexts and forces., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background and Aims: Since 1990, global child and infant mortality rates have typically stabilized or decreased due to improved healthcare, vaccination rollouts, and international funding. However, Afghanistan continues to face the highest child and infant mortality rates globally, with 43 deaths per 1000 live births. This study aims to examine the factors contributing to this high mortality rate and propose interventions to address the issue., Methods: A comprehensive literature search was conducted using databases such as Google Scholar and PubMed, focusing on articles published in English within the last 10 years (2013-2023). The search terms included "Child mortality," "Infant mortality," "SIDS," "COVID-19," and "Afghanistan." Original studies, systematic reviews, case studies, and reports meeting the inclusion criteria were selected for analysis. Additional sources from organizations such as UNICEF, the World Bank Group, WHO, and EMRO were also reviewed., Results: The study findings reveal significant challenges contributing to Afghanistan's high infant and child mortality rates. These challenges include birth defects, preterm birth, malnutrition, sudden infant death syndrome (SIDS), traumatic injuries, fatal infections, infanticide, and abuse. The ongoing conflict, insecurity, and humanitarian crises further exacerbate the situation, leading to increased child casualties. Despite efforts by international agencies like UNICEF to provide vaccines and maternal education, the infant mortality rate remains high., Conclusion: In conclusion, Afghanistan's child and infant mortality rates are of significant concern, and it is imperative that action be taken to reduce the incidence of child and infant mortality rates., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Background: In the Eastern Mediterranean region, Afghanistan ranks third for the world's highest burden of malaria. The vast majority (95%) of malaria cases in Afghanistan are attributed to Plasmodium falciparum and 5% to Plasmodium vivax . Most cases occur in low-altitude regions, especially in the eastern province of Nangarhar, where agriculture and farming are predominant. To better understand the public sentiment toward malaria, this study aimed to understand the knowledge, attitude, and practice of patients toward malaria who visited public and private hospitals of Nangarhar province., Methods: A cross-sectional descriptive study was conducted on Nangarhar residents who visited the adult Outpatient departments of eight local public and private health facilities. Data collection took place from 1st August 2022 to 15th September 2022., Results: Of 700 participants, 37.9% ( n  = 265) identified as male and 62.1% ( n  = 435) identified as female. The majority of participants (84.6 %) were within the (18-40) age range, followed by 12.7% in the (41-60) age range, and 2.7% were aged 61 years or older. Moreover, 99.7% ( n  = 698) of the participants had heard of malaria. The main sources of information about malaria were family members (31.3%, n  = 219), television (32.6%, n  = 228), Internet (12.6%, n  = 88), school (11.3%, n  = 79), and health facilities (31.4%, n  = 220). Most respondents correctly identified mosquito bites as the primary mode of malaria transmission (72.6%, n  = 508). Others suggested that transmission could occur by close contact with a malaria patient (14.0%, n  = 98) and drinking contaminated water (17.3%, n  = 121). The majority of participants (70.6%) agreed that malaria is a serious and life-threatening disease. A significant number of participants (96.6%) reported owning an insecticide-treated mosquito net at home, and 87.0% reported using the net., Conclusion: Overall, participants reported good knowledge, attitude, and practice toward malaria. This may be linked to the awareness campaigns and preventive programs in Nangarhar province that have contributed to participant's willingness to prevent malaria and treat themselves if they get infected. Public health campaigns are difficult in Afghanistan with weak governance and conflict, and thus, populations may find themselves at risk if health promotion activities are stopped., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Competing Interests: The authors have declared that no competing interests exist.

Background and Aim: Afghanistan is grappling with a severe health crisis marked by a high prevalence of infectious diseases, particularly tuberculosis, malaria, HIV, and the added strain of the COVID-19 pandemic. The nation's healthcare system, already fragile, faces formidable challenges. Socioeconomic constraints, including limited resources and financial barriers, hinder healthcare accessibility, leading to delayed or inadequate care. Environmental factors, such as poor sanitation and crowded living conditions, exacerbate the transmission of diseases, especially waterborne illnesses. Governance issues, encompassing transparency, corruption, and political instability, disrupt healthcare efficiency and resource allocation. Addressing these multifaceted issues is vital to enhance Afghanistan's healthcare system and overall well-being. The withdrawal of international support has exacerbated these challenges. The primary research goal is to deeply understand Afghanistan's health system, focusing on the major disease burdens: Tuberculosis, Malaria, AIDS, COVID-19, Measles, Hepatitis, and Cholera. The study aims to assess the feasibility and effectiveness of current approaches, presenting a comprehensive view of challenges and opportunities within the Afghan healthcare system. The research concludes by highlighting policy implications, practical implementation, and offering recommendations for future endeavors., Methodology: This paper provides a thorough analysis of the literature concerning infectious diseases in Afghanistan and the enhancement of the healthcare system in the nation. A systematic exploration of the literature was conducted through PubMed and Google Scholar databases. The search terms used encompassed "Tuberculosis" OR "TB," "Malaria," "acquired immunodeficiency syndrome" OR "AIDS," "Human immunodeficiency virus" OR "HIV," "COVID-19," "Measles," "Hepatitis virus," "Cholera," "Health system improvement," and "Afghanistan." Additionally, external sources like UNICEF, CDC, and WHO were referenced., Results: In conclusion, while improving access to vital medicines and vaccines is crucial for enhancing health outcomes in Afghanistan, significant challenges must be addressed to ensure the effectiveness and sustainability of such strategies. The Afghan health system's fragile governance, corruption, logistical complexities, and failure to address broader social and economic factors pose significant risks and obstacles to the implementation of proposed health strategies. Therefore, the strategies discussed in this analysis align with key Sustainable Development Goals, particularly SDG 3, and their successful implementation will have implications not only for the health and well-being of Afghanistan but also for global health., Conclusion: Hence, by adopting a comprehensive approach with complementary interventions as discussed, we can address issues in the Afghan health system and reduce transmissible diseases' burden, thereby building a better world for all., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background and Objectives : Bartter syndrome (BS) is a rare group of autosomal-recessive disorders that usually presents with hypokalemic metabolic alkalosis, occasionally with hyponatremia and hypochloremia. The clinical presentation of BS is heterogeneous, with a wide variety of genetic variants. The aim of this systematic review was to examine the available literature and provide an overview of the case reports and case series on BS. Materials and Methods : Case reports/series published from April 2012 to April 2022 were searched through Pubmed, JSTOR, Cochrane, ScienceDirect, and DOAJ. Subsequently, the information was extracted in order to characterize the clinical presentation, laboratory results, treatment options, and follow-up of the patients with BS. Results : Overall, 118 patients, 48 case reports, and 9 case series ( n = 70) were identified. Out of these, the majority of patients were male ( n = 68). A total of 21 patients were born from consanguineous marriages. Most cases were reported from Asia (73.72%) and Europe (15.25%). In total, 100 BS patients displayed the genetic variants, with most of these being reported as Type III ( n = 59), followed by Type II ( n = 19), Type I ( n = 14), Type IV ( n = 7), and only 1 as Type V. The most common symptoms included polyuria, polydipsia, vomiting, and dehydration. Some of the commonly used treatments were indomethacin, potassium chloride supplements, and spironolactone. The length of the follow-up time varied from 1 month to 14 years. Conclusions : Our systematic review was able to summarize the clinical characteristics, presentation, and treatment plans of BS patients. The findings from this review can be effectively applied in the diagnosis and patient management of individuals with BS, rendering it a valuable resource for nephrologists in their routine clinical practice.

Objective: To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education., Methods: The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ 2 test was performed to determine the association between gender and different violence forms., Results: A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance., Conclusion: This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: The authors have declared that no competing interests exist.

Decades of political turmoil and stifling war, among other issues, has turned Afghanistan into the world's largest humanitarian crisis. Just 4 months after the Taliban seized control, the majority of the Afghan population face starvation, with >3.3 million children unable to afford basic food resources, leading to dozens of deaths every week. Restrictions on humanitarian assistance, withholding of vital food supplies and inadequate medical care play a major role in exacerbating the rates of malnutrition in the vulnerable paediatric population. Global interference is warranted to avoid unfathomable consequences in mitigating this public health catastrophe., (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background and Aims: South Asian countries, including Pakistan, Afghanistan, India, and Bangladesh, have a high prevalence of pulmonary and extra-pulmonary tuberculosis (EPTB). This prevalence is influenced by various risk factors such as ethnicity, nutrition, socioeconomic disparities, high out-of-pocket healthcare expenses, and specific Mycobacterium Tuberculosis (TB) lineages. The COVID-19 pandemic has likely hindered access to healthcare and led to under-reporting of EPTB cases nationally and internationally. This rapid review aimed to summarize the literature on the prevalence and disease outcomes of EPTB in the mentioned countries, compare the situations across countries, and provide recommendations for future action., Methods: The review utilized PubMed and Google Scholar databases to search for literature on EPTB in South Asian countries. The search string included keywords related to different forms of EPTB and the countries of interest while excluding pulmonary tuberculosis., Results: The results showed that both TB, including drug-resistant TB, and EPTB are prevalent and burdensome in South Asia. In Pakistan, pleural TB was the most commonly reported form of EPTB, followed by lymph node TB, abdominal TB, osteoarticular TB, Central Nervous System TB, and miliary TB. In India, lymph node TB(LNTB) was more common among EPTB cases. Bangladesh reported a high prevalence of EPTB involving lymph node, pleura, and abdomen, while Afghanistan had a higher prevalence of forms such as LNTB and tuberculous meningitis., Conclusion: In conclusion, the prevalence of EPTB in Pakistan, Afghanistan, India, and Bangladesh is alarmingly high and negatively impacts population health. Effective measures are needed for treatment and management of this condition, along with addressing current and future challenges. Strengthening the evidence base through surveillance and research is crucial to understand the patterns and significant factors related to EPTB, requiring investment in these areas., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Self-medication (SM) with over-the-counter (OTC) medications is a prevalent issue in Afghanistan, largely due to poverty, illiteracy, and limited access to healthcare facilities. To better understand the problem, a cross-sectional online survey was conducted using a convenience sampling method based on the availability and accessibility of participants from various parts of the city. Descriptive analysis was used to determine frequency and percentage, and the chi-square test was used to identify any associations. The study found that of the 391 respondents, 75.2% were male, and 69.6% worked in non-health fields. Participants cited cost, convenience, and perceived effectiveness as the main reasons for choosing OTC medications. The study also found that 65.2% of participants had good knowledge of OTC medications, with 96.2% correctly recognizing that OTC medications require a prescription, and 93.6% understanding that long-term use of OTC drugs can have side effects. Educational level and occupation were significantly associated with good knowledge, while only educational level was associated with a good attitude towards OTC medications (p < 0.001). Despite having good knowledge of OTC drugs, participants reported a poor attitude towards their use. Overall, the study highlights the need for greater education and awareness about the appropriate use of OTC medications in Kabul, Afghanistan., (© 2023. The Author(s).)

Tuberculosis (TB), at present, is the leading infectious etiology of death globally. In Pakistan, there are approximately 510,000 new cases annually, with more than 15,000 of them developing into drug-resistant TB, making the nation the fifth-leading country in TB prevalence in the world. Due to the ongoing COVID-19 pandemic, the focus has drifted away from TB screening, diagnostic and health awareness campaigns, and therapeutic measures endangering knowledge, attitude, and practices (KAP) towards TB in our population. We conducted a cross-sectional descriptive study in Pakistan to assess the KAP of Pakistani residents attending the adult outpatient departments of public hospitals for any health-related concerns. Our sample size was 856 participants, with a median age of 22 years. Occupation-wise, those who were employed had better knowledge of TB than those who were unemployed [odds ratio (OR): 1.011; 95% confidence interval (CI): 1.005-1.8005]. No differences were observed in TB knowledge between those adherents to common preventive practices versus those not adherent (OR: 0.875; 95% CI: 0.757-1.403). More than 90% of participants agreed that TB is dangerous for the community, and the majority opted against stigmatizing TB patients (79.1%). People who could read and write were 3.5 times more likely to have a good attitude towards TB compared to those who could not (OR: 3.596; 95% CI: 1.821-70.230; p=0.037). Similarly, employed subjects had better attitudes compared to unemployed ones (OR: 1.125; 95% CI: 0.498-1.852; p=0.024) and those with better knowledge of TB had a better attitude grade (OR: 1.749; 95% CI: 0.832-12.350; p=0.020). Age, occupation, and educational status were statistically significant among the two groups (p=0.038, p=0.023, p=0.000). Literate subjects had three times better practice towards TB than illiterate subjects (OR: 3.081; 95% CI: 1.869-4.164; p=0.000). Future education and awareness programs should target specific groups, such as the unemployed and illiterate, with practice-focused approaches. Our study outcomes can enable the concerned officials and authorities to take appropriate evidence-based steps to direct the efforts efficiently to curtail the burden of TB in Pakistan and to limit its progression, which could potentially lead our nation to become a multi drug-resistant TB endemic territory.

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., (© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Competing Interests: We declare no competing interests.

Competing Interests: None declared.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Basic life support (BLS) is a type of emergency care provided by healthcare workers and public safety professionals to individuals experiencing cardiac arrest, respiratory distress, or other cardiopulmonary emergencies. Despite having a high burden of cardiovascular disease and trauma from conflict in Afghanistan, little is known about the level of BLS knowledge Afghani healthcare workers have. A cross-sectional study was conducted in Kabul, Afghanistan, to assess healthcare workers' training and knowledge of BLS. The study, which took place from March to June 2022 across multiple public and private hospitals, was approved by the institutional ethics committee of Ariana Medical Complex. The sample size was calculated using a nonprobability convenience sampling method, and the study population consisted of healthcare workers actively working in a health center who were willing to complete a questionnaire. The results of the study showed that most participants (71.3%) were in the 21-30-year-old age range, and a third (32.3%) were doctors. 95.3% of participants had poor knowledge of BLS, with a mean score of 4.47±1.58 out of 13. Additionally, it was evident from questionnaire responses that providers are not adequately performing BLS. These findings suggest that further work, including regular BLS courses, is necessary to improve the knowledge and practice of BLS by healthcare workers in Afghanistan., Competing Interests: None.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Competing Interests: The authors declare to have no conflicts of interest and no financial interests related to the material of this manuscript.

Background: In Pakistan, 74 children out of 1000 lose their lives annually due to diarrheal illness. This commentary addresses the contributing factors aggravating this growing dilemma and the effect of a simultaneous rise in COVID-19 cases in a healthcare system ready to collapse, along with providing recommendations to alleviate the problems causing this spike in diarrheal cases., Methods: This narrative review has emphasized the causes of the spike in pediatric diarrheal illnesses in Pakistan as well as recommendations offered to lessen the burden by incorporating recent literature ( n  = 68). Tactics to tackle COVID-19 alongside diarrheal illnesses were also included. Pakistan was chosen to be assessed due to its high burden of child and infant mortality due to preventable causes., Results: The provision of safe drinking water, the proper use of Integrated Management of Newborn and Childhood Illnesses (IMNCI), adequate awareness of the benefits of breastfeeding, the use of correct rehydration techniques such as Oral Rehydration Therapy, and the crucial implementation of the EPI vaccination schedule can curb this increase in diarrheal cases., Conclusion: The increased prevalence of diarrheal diseases amongst the pediatric population of Pakistan can be attributed largely due to unsanitary drinking water. Emphasis must be put in the provision of safe drinking water. During the first years of life, children can be kept safe from deadly pathogens just by adequate breastfeeding. IMNCI and EPI must also be properly implemented., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

While the Coronavirus pandemic continues to spread havoc across the world, countries like Pakistan are faced with another challenge: the steady rise of vector borne diseases alongside a spike in COVID-19 cases. Moreover, signs and clinical manifestations of multiple arbovirus infections mimic those experienced in COVID-19, causing further complications in management and diagnosis. Without urgent adequate management and testing equipment, the recent surge of COVID-19 along with the steady rise in Vector Borne Diseases (VBDs) could collapse the exhausted Pakistani healthcare system. This article explores the impact of COVID-19 on the management, diagnosis, and treatment of the common arbovirus infections of Pakistan, including dengue (DENV), malaria, chikungunya (CHIKV), and other foreign infections that are on a hazardous rise., Competing Interests: None., (© 2022 The Authors.)

Monkeypox (MPX) is a zoonotic disease caused by the MPX virus from the poxviridae family of orthopoxviruses. Typically, endemic in central and west Africa, it has now become a matter of concern since cases have been reported in non-endemic countries around mid-June 2022, especially in the European region, with the transmission not related to travel. The diagnosis is made by PCR testing of the skin lesions. Even though treatment is symptomatic, antiretrovirals, such as tecovirimat, are used in severe cases. Vaccination with second and third generation vaccines is approved for prophylaxis in high risk individuals. Unfortunately, these options of treatment and prevention are only available in high income countries at the moment. This review, through a thorough literature search of articles from 2017 onward, focuses on epidemiology, clinical manifestations, challenges, treatment, prevention and control of MPX virus and how they can be corelated with other viral outbreaks including COVID-19, Acute Hepatitis of unknown origin, Measles and Dengue, to better predict and therefore prevent its transmission. The previous COVID-19 pandemic increased the disease burden on healthcare infrastructure of low-middle income countries, therefore, this recent MPX outbreak calls for a joint effort from healthcare authorities, political figures, and NGOs to combat the disease and prevent its further spread not only in high income but also in middle- and low-income countries.

Over the years, several developing countries have been suffering from high infant and child mortality rates, however, according to the recent statistics, Pakistan falls high on the list. Our narrative review of copious research on this topic highlights that several factors, such as complications associated with premature births, high prevalence of birth defects, lack of vaccination, unsafe deliveries, poor breastfeeding practices, complications during delivery, sudden infant death syndrome (SIDS), poor socioeconomic conditions, and a struggling healthcare system, have influenced these rates. Bearing in mind the urgency of addressing the increased infant and child mortality rate in Pakistan, multiple steps must be taken in order to prevent unnecessary deaths. An effective initiative could be spreading awareness and education among women, as a lack of education among women has been indirectly linked to increased child mortality in Pakistan across many researches conducted on the issue. Furthermore, the government should invest in healthcare by hiring more physicians and providing better supplies and improving infrastructure, especially in underdeveloped areas, to decrease child mortality due to lack of clean water and poor hygiene. Lastly, telemedicine should be made common in order to provide easy access to women who cannot visit the hospital.

Background: Awareness of rights is a precondition to establishing rule of law in society. Sexual and Reproductive Health and Rights (SRHR) are closely knitted in the human rights framework as they overlap with other human rights such as the right to health and life. However, awareness about these rights remains a challenge. Considering the importance of these rights this study has measured the awareness of adolescents about SRHR in Bahawalpur (Division) of Pakistan., Methodology: We conducted a cross-sectional study in the Divison of Bahawalpur, Pakistan from October 2019 to December 2019. The study included a sample size of 500 respondents which included 250 young females of age 15-19 and 250 their parents (mother). The reasoning behind including only females in this study was the increased vulnerability and greater impact of SRHR in their life compared to males. The age range 15-19 was primarily selected as females this age will better understand and respond to the questionnaire compared to females in their early adolescent years. The quantitative research was conducted using two-stage cluster sampling. Detailed structured questionnaires were distributed among the respondents to obtain their points of view on the awareness of SRHR. The population was divided into multi-clusters with 25 households comprising 250 households for the division of Bahawalpur. The information was also gathered from the doctors and the teachers through interviews. The data were analyzed using SPSS version 21., Results: The study explored the knowledge and understanding of adolescent SRHR thereby highlighting the key restrictions in Bahawalpur, Pakistan, which prohibit adolescents from gaining access to SRHR and exercising it. There is a significant portion of adolescents who strongly agreed with the importance and awareness level and think they should be more aware of information regarding SRHR. However, they are of the view that they are less independent in practicing them., Conclusion: The study found a low level of awareness about SRHR among young female and their parents in Bahawalpur, Pakistan. It is a need of time and responsibility of the local government of the Bahawalpur region to devise clear and proper policies which give access to these rights. This can be done by including the information on these rights in the course curriculum and teachers keeping in view the cultural and regional restrictions that guide the young female about SRHR., Competing Interests: The authors declare no conflict of interest, (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

The widespread prevalence of fungal infections in the second wave of COVID-19 pandemic could be owed to ubiquitous and injudicious use of steroids and immunosuppressive nature of the virus. However, these fungal infections also meant increased use of antifungal drugs, hence endangering their supply. Amphotericin B is the first line drug for mucormycosis which was declared as an epidemic in India during the second wave. With the increasing demand of the drug, came challenges to manufacture and supply large quantities of the drug and exploitation by creating a black market and spread of false information and imprudent usage. It is of utmost importance to be prepared with adequate supply all over the nation and implementing safety regulations in manufacturing and supply of large quantities of drugs during the demanding times and make them accessible at a reasonable rate., (© Individual authors.)

Background: Vaccine hesitancy (VH) is prevalent in conflict zones due to a lack of essential resources and knowledge, thereby escalating the coronavirus disease of 2019 (COVID-19) cases in these territories. This has resulted in a higher incidence of cases from exposure to a single COVID-19 positive case and further burdens the health care system of conflict zones which are already on the brink of collapsing., Aim: This narrative review aims to determine VH to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in five conflict zones that include Somalia, Yemen, Palestine, Syria, and Afghanistan., Methodology: A Boolean search was carried out in MEDLINE-PubMed from inception till 6 June 2022. The search was performed by using the following keywords: "(SARS-CoV-2 OR covid OR covid 19) AND (vaccine hesitancy OR covid vaccine acceptance OR intention to vaccinate) AND (Syria OR Yemen OR Palestine OR Afghanistan OR Somalia"). The full text of all relevant articles in English along with their supplementary material was extracted., Results: All the included studies reported at least 30% or more increase in vaccine hesitancy among conflict settings. VH was mostly due to a lack of available resources, lack of appropriate knowledge, and believing misleading rumors about the vaccine., Discussion: Considering the massive amount of reluctance among people residing in conflict zones, the need to take effective measures against VH is undoubtedly apparent. This can be accomplished by carrying out mass vaccinations by the governments and proper health education through raising the public awareness regarding vaccines, thereby eliminating rumors that exacerbate the fear of adverse effects., Conclusion: The approach described in this article to combat VH can be implemented to increase vaccination rates and significantly alleviate R 0 across the globe., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Siddiqui, Priya, Adnan, Abbas, Qamar, Islam, Rahmat, Essar and Farahat.)

Background: Vaccine hesitancy is not a new phenomenon to Pakistan. This is evidenced through the slow progress of previous vaccination campaigns and programs against MMR, BCG, and especially polio. This issue continues to persist and is therefore becoming the cause of low COVID-19 vaccination rates in Pakistan., Aim: To provide insights about COVID-19 vaccine hesitancy among Pakistanis, and its potential harm on public health. Moreover, we aim provide recommendations to counter the factors limiting the COVID-19 vaccination in Pakistan., Methodology: A Boolean search was conducted to find the literature in MEDLINE-PubMed, Google Scholar, and Clinicaltrials.gov databases up till March 16, 2022. Specific keywords were used which comprised of "SARS-CoV-2," "COVID-19," "vaccine hesitancy," "vaccine acceptance," "intention to vaccinate," and "Pakistan," with use of "OR" and "AND." Only free full-text original studies in English language were used to compare and contrast., Results: As proven by various studies, COVID-19 vaccination rates are influenced by multiple factors, including inaccurate beliefs about COVID-19, hesitancy amongst healthcare workers, uncertainty regarding vaccine's efficacy and fear of side effects. Various conspiracy theories and lower testing rates among others also add up to impose a negative impact on the vaccination rates and public health of Pakistan. This may lead to newer strains of potentially harmful COVID-19, mental health deterioration, and prolonged lockdowns., Conclusion: Vaccine hesitancy is a global public health threat, and its impacts are pronounced in Pakistan. This is reflected in the COVID-19 pandemic; low vaccination rates in Pakistan may lead to future outbreaks of new, potentially harmful, strains of COVID-19 which can prolong lockdowns in the country and affect mental health of the population. To improve the current situations, it is imperative for the government, educational institutes, and healthcare systems to develop trust and continually use dialogue, communication, and education to address misconceptions to improve COVID-19 vaccination in Pakistan., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID-19 pandemic. However, those in conflict-based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict-based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Competing Interests: None.

Africa experienced the third wave of the coronavirus disease in 2019, which caused an 18% rise in cases in most parts of the continent. As of January 2022, the region had an estimated 10.4 million cumulative cases and more than 233,000 deaths, which add up to the burden on the fragile healthcare system, which continues to face a shortage of staff and resources. In addition, the progression of the pandemic further threatens the supply of healthcare workers in Africa due to the increased risk of infection and death, where more than 10,000 healthcare workers in 40 countries have been infected with the virus. This is amid low vaccination coverage, with only 27% of healthcare workers in Africa being fully vaccinated against the disease. Despite the delayed start and slow progression of the pandemic in Africa, there are increasing concerns over the challenges on the African healthcare workers such as economic insecurity and stressful working conditions, which are associated with limited access to personal protective equipment and other vital resources such as ventilators. In addition, the pandemic further predisposes African healthcare workers to social stigma, burnout, insomnia, depression, and fear of safety in their families. The aim of this study is to highlight the challenges faced by African healthcare workers, provide recommendations for change, and emphasize the need to prioritize their physical and mental well-being., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)