Health related indicators NRVA 2011-2012 (mid-term results, preliminary figures)

No	Indicators		Remarks
1	Total settled population	25,490,000 (male 13177000,  female 12313000)
2	Population under 15	46.2%
3	Sex ratio	107%
4	Dependency ratio	102%	May be one of the highest in the world
5	Average household size	7.5 persons
6	Access to safe drinking water	48%
7	Access to improve sanitation	9%
8	Births attended by skilled health personnel	40%
9	Security assessment
	Very secure	44%
	Moderately secure	34%
	Not secure, not insecure	9%
	Moderately insecure	6%
	Very insecure	7%

Environmental Health

The country’s health care delivery system has been steadily progressing over the last ten years, with an increasing coverage of primary health care services throughout the country. The country has managed to develop its vision, roadmap and policy frameworks that guided its health development drive to extend adequate coverage of basic health service to the majority of the country’s population. Major priorities in the health sector are improve the nutritional status, strengthen human resource management and development, increase equitable access to quality health services, strengthen the stewardship role of MoPH and governance in the health sector, improve health financing, enhance evidence-based decision making, support regulation and standardization of the private sector to provide quality health services, support health promotion and community empowerment, advocate for and promote healthy environments, create an enabling environment for the production and availability of quality pharmaceuticals.

In spite of too many challenges the Ministry of Public Health in the light of the MoPH five years strategic plan 2011-2015, succeeded to develop the National Environmental Health Strategy for 2012- 2015. The strategy focuses on management and leadership, WASH, food safety, radiation safety/protection, environmental hygiene/sanitation, occupational health and house and urban hygiene. The strategy will guide the MoPH and its partners in their work over the next five years.

Access to safe drinking water, improved sanitation and air quality

Afghanistan faces a number of basic environmental health (EH) issues, such as unsafe drinking water; inadequate sanitation facilities, drainage and water supply; improper solid and hazardous waste management; chemical contamination; poor air quality and unhygienic food handling at all stages of supply, storage and transport.

Access to safe drinking water has increased over the last few years. 57% of households obtain drinking water from an improved source (urban 82% vs. rural 51%). However, the country has a long way to go in improving sanitation. Only 31% of households have an improved toilet facility, while another 20% do not have toilet facility at all. Less than half (43%) of households in Afghanistan have regular electricity supply.

Various studies have highlighted the gaps between knowledge and practice, in particular where people have acknowledged the need but could not follow recommended hygiene practices due to lack of water or other facilities.

Drinking water treatments rely only on disinfection by chlorination or some basic filters in certain places of the country. The quality of underground water, which has already been reported with contamination of ammonia and nitrate, is also threatened by construction of septic wells, particularly in urban areas.

To date, limited data has been compiled on air pollutant emissions. Preliminary data indicates high amounts of dust and polyaromatic hydrocarbons in the air, which is most likely originated from vehicle exhaust emissions. MoPH estimated that more than 3,000 people may die only in Kabul because of air pollution every year.

Total population (CSO 2012)	27,000,000
Access to improved source of drinking water*    %      Urban  % Rural    %	57 82 51
Appropriate treatment of drinking water** %	20
Population live in households using improved sanitation facilities*  % Urban  % Rural    %	31 60  25
Households use a specific place for hand washing*  % Urban  % Rural    %	60 83 55
Household with regular electricity supply**  %	43

                   

     *MICS 2010     **AMS 2010

Non-communicable Diseases in Afghanistan at a glance

Non-communicable Diseases in Afghanistan 

Of the 57 million global deaths in 2008, 63% were due to NCDs. As the impact of NCDs increases, and as the population age, annual NCDs deaths are projected to continue to rise worldwide, and the greatest increase is expected to occur in low and middle income countries. It is assumed that NCDs affect mostly high income population, while the evidence tells a very different story. Nearly 80% of NCDs deaths occur in low and middle income countries. The demographic and epidemiological transitions in South Asia are resulting in an increasing share of the diseases burden related to NCDs. Over half of the disease burden in South Asia is attributed to NCDs. This proportion is expected to rise significantly.

The current data shows that the burden of NCDs is escalating in Afghanistan. They are the cause of more than 35% mortality, as indicated in Afghanistan Mortality Survey (AMS) 2010. The major contributor includes Cardiovascular Diseases (Female 17.9% Male 14%), Cancer (Female 8.3% Male 7.3%), Diabetes Mellitus (Female 2.7% Male 3.7), and Respiratory Disease (female 2.3% Male 1.9%).  Among female, the leading causes of death are infectious/parasitic and Cardiovascular disease (18% each) followed by respiratory infections (15%). NCDs share common preventable and modifiable risk factors like tobacco use, unhealthy diets, physical inactivity, and harmful use of Alcohol.

Risk Factors for NCDs

Tobacco use is a major risk factor for NCDs. It is the only product in the world that kills half of its users. Almost 6 million people die from direct and passive smoking each year. By 2020, this number will increase to 7.5 million, accounting for 10% of all deaths. If current trends continue, tobacco will kill nearly 8 million people every year throughout the period leading to 2030. Smoking is estimated to cause 71% of lung cancer, 42% of chronic respiratory disease and nearly 10% of cardiovascular diseases. The highest incidence of smoking among men is in low-middle income countries.

In Afghanistan data on smoking and its effects on health is limited. However, the Global Youth Tobacco Survey of 2010 indicates that more than 16% of youths have ever tried or experimented smoking, 90 % of them tried a cigarette in the age of 13 years, 17% of children have been affected by passive smoking, 21 % of students said that most of their closest friends smoke cigarettes, 18 % of students think that passive smoking is not harmful. In addition, a recent study conducted in Kabul indicates that the prevalence of cigarette smoking among men aged 15 years and older is estimated to be 35.2%. Study findings show that 46% of respondents were smoking in some point in their life. Totally 85.4% (35.2% currently smokers and 50.2% passive smokers) of respondents were somehow exposed to cigarettes smoke. Study findings indicates that those who grew up in a family where family members were smoking, are more likely to smoke compared to those respondents whose family members were not smoking.

Globally, approximately 3.2 million people die each year due to physical inactivity. People who are insufficiently physically active have a 20-30% increased risk of all cause mortality. Moreover, nearly 2.3 million die from the harmful use of Alcohol. Unfortunately almost no data is available on these risk factors in Afghanistan.

Total population	29,117,000
Smoking  prevalence in Age 15 years and above  %	35
Passive smoking prevalence  %	50
Causes of Deaths (AMS 2010)
Communicable, maternal, perinatal and nutritional condition (2010) %	Female 52.8  --  Male 42.6
Non-communicable Disease  (2010) %	Female 37.5  -- Male 33.3
Cancer (2010) %	Female 8.4 --  Male 7.3
Cardiovascular Diseases (2010) %	Female 17.5 -- Male 14
Injuries (2010) %	Female 6.7 -- Male 20.8

http://www.voanews.com/dari/news/Pakistan-Afghanistan-Polio-162760716.html

خطر مصاب شدن 350 هزار طفل به مرض فلج

یک داکتر پاکستانی که در فعالیتهای واکسیناسیون پولیو نقش داشت، به روز دوشنبه در شهر کراچی به ضرب گلوله مهاجمین ناشناس کشته شد.

این تازه ترین ضربه بر فعالیتهای ضد پولیو در پاکستان بود.

درعین حال طالبان پاکستان بطور احتجاج بر حمله طیارات بی پیلوت برنامه واکسیناسیون دو روزه را که در پاکستان جریان دارد، درمناطق تحت فرمان شان منع قرارداده اند.آنها ادعا می کنند که به بهانه واکسین معلومات درمورد طالبان جمع آوری می شود.

بنا برهمین موانع مقامات در پاکستان دربخشهای از مناطق قبایلی واکسیناسیون پولیو را به تعویق انداخته اند. مقامات حکومت مرکزی ازحکومت های محلی خواسته اند تا شورشیان را متقاعد بسازند تا این کمپاین را درمناطق قبایلی نیز اجازه بدهند.

بدنبال پخش این خبر که شکلیل افریدی، یک داکتر پاکستانی برای یافتن بن لادن، رهبر اسبق شبکه القاعده، در پاکستان به سی آی ای، سازمان استخبارات امریکا، از طریق راه اندازی کمپاین واکسیناسیون همکاری نمود، برنامه واکسیناسیون در مناطق سرحدی پاکستان به افغانستان به مشکلاتی مواجه شده است.

داکتررفیق مسئول پولیوازصندوق اطفال ملل متحد در مناطق قبایل پاکستان به صدای امریکا گفت که حکومت پاکستان از توقف برنامه واکسیناسیون نگرانی دارد و می گوید که درتمام مناطق قبایلی یک تعداد زیاد اطفال در معرض خطر قراردارد.

رفیق گفت که معلوماتی را که حکومت به دسترس ما قرارداده، تعداد مجموعی این اطفال به ٣٥٠ هزار میرسد و درین تعداد مناطقی هم شامل است که دسترسی به ان مشکل است.

داکتر رفیق می گوید که واضح است درجاهایی که مهاجرین افغان موجود اند و واکسیوناسیون با مشکلات مواجه میباشد، آنها نیز متضرمی شوند.

داکتر نجیب الله صافی، از انجمن صحت عامه افغانستان، میگوید مهاجرین افغان چون به تمام مناطق افغانستان رفت امد دارند ازین سبب تصمیم به تعویق انداختن واکسیناسیون پولیودر هردو کشورتاثیر ناگوار دارد.

داکتر نجیب الله صافی می افزاید نباید صحت در مجموع و خاصتا برنامه واکسیناسیون به طور خاص شکار رقابتهای سیاسی گردد. هرگاه چنین کاری صورت گیرد ازیک طرف اطفال از صحت محروم می شوند و از جانب دیگر حیات کارمندان صحی خاصتا واکسیناتورها با خطر مواجه می باشد.

مقامات پاکستانی میگویند که در سرحدات با افغانستان در ٢٢ نقطه مراکز واکسیناسیون وجود دارد، اما بازهم تعداد زیاد اطفال درمنطقه از واکسیون بی بهره خواهند شد.

پولیو هنوز هم درافغانستان، پاکستان و نایجریا به مشاهده رسیده است و یک تعداد اطفال را فلج ساخته است. گفته می شود این مرض اطفال زیر سن پنج سال را می تواند حتی در ظرف چند ساعت فلج سازد و حتی در برخی موارد می تواند به مرگ اطفال بینجامد.

“Neither peace, development nor human rights can flourish in an atmosphere of corruption.”

12. National Malaria Indicators Survey, 2008

Dr. Randa Youssef, Dr. Najibullah Safi, Dr. Hamida Hemeed, Dr. Walid Sediqi, Dr. Jamal Abdul Naser, Dr. Waqar Butt

Conclusion and Recommendation:

The survey was accomplished successfully in 10 provinces with different levels of malaria endemicity during the peak transmission season of P. falciparum. The sample selected provided a representation of all population 47 subgroups that adequately mirrored the population of the 10 provinces.

Bed net coverage is low (26.7%) with a much lower coverage with ITNs (10.7%) and LLINs (9.9%). Coverage with bed nets is low in rural areas (23.2%) and high risk provinces including Hirat (6.2%) and Faryab (7.1%) and Nimroz (0.0%) where population are at a much higher risk of malaria.

The least wealthy has lower access to bed net. Majority of bed net (89.0%) available at community level were purchased and the cost of bed net was the barrier that prevented 74.5% of the head of households to acquire it. Less than a quarter (22.1%) of the surveyed population reported the habit of sleeping under bed nets. This proportion is especially low in rural areas (17.5%) than urban ones (31.3%). The night of the survey less than 5% of the surveyed population in urban (4.7%) and rural areas (4.0%) slept under bed net. Only 16.6% of the bed nets available to the population were used the night of the survey.

The prevalence of self reported fever the day of the survey was very low in both rural areas (8.0%; 95%CI= 7.35, 8.59) and urban areas urban areas (3.8%; 95%CI= 3.18, 4.42). Also the point prevalence of fever at the time of the survey was low (2.8%; 95%CI= 2.57, 3.27) among rural (3.8%) and urban (2.0%) population. Two week period prevalence of fever was low in urban (2.5%) and rural (3.9%) areas. These fevers were mostly due to respiratory and gastrointestinal infections as reflected by the described associated symptoms and the fact that most of them received antipyretics (56.8%) and/or antibiotics (34.1%) that resulted in a cure or improvement of the condition in 86.4% of the instances. Only 40 out of the 169 who visited a health care facility for the treatment of fever reported in the two weeks prior to the survey had their blood tested for malaria and 22 out of them reported a positive test. Only 18 patients reported receiving antimalarial drugs in Badagshan (n=11), Nangarhar (n=5), Bamyan (n=1) and Kunar (n=1); 16 of them were rural dwellers and 15 reported receiving chloroquine. Just more than half of those who reported fever in the two weeks prior to the survey (59.8%) took action to treat the fever and nearly half of them (53.3%) visited a health care facility. Governmental health facility was visited by nearly half (51.5%) of those who sought a health care facility for the treatment of fever. Patients had to travel for an average duration of 41.07 minutes and to wait for an average duration of 41.64 minutes to be seen. Only 33.7% incurred the cost of consultation which was on average 69.21 AFG. For those who did not take any action to treat the fever as well as those who did not visit a health care facility, the most frequently stated barriers were the unavailability of facility in the area of residence (24.5%), the long travel distance to 48 the facility (22.7%) as well as the unaffordable cost of consultation (46.0%).

General public should be encourage to use the available health care facilities in the event if sickness. All stated barriers for visiting health care facility should be considered by the MoPH in the respective provinces to ensure appropriate diagnosis and adequate treatment including the long travel and waiting time at the facility as well as the cost of consultation.

At the time of the survey, only 45 subjects were positive for the parasite yielding a point prevalence of 0.4%. In view of the low point prevalence and the predominance of P. vivax, information that will soon be available from analysis of the blood drops collected on filter paper will provide a better insight into situation of malaria in the surveyed provinces by describing historical infection among the population. Research is needed into disease vector to identify potential risks of transmission.

Less than half (43.1%) of the surveyed population reported receiving health education messages addressing areas related to malaria transmission and disease prevention. Intensification of information, education and communication efforts is highly recommended to improve people knowledge and enable then to adopt a behavior that obviate risks of malaria infection. Very low proportions of the population living in high risk provinces were aware of the actual risks of malaria transmission and infection. This lack of essential knowledge has an adverse effect on people behavior regarding taking appropriate protective measures and seeking medical care once malaria is suspected. Health education messages should emphasize on risk of malaria in different geographical localities. Messages should address clearly how the disease is acquired and what are its manifestations to enable people to protect themselves and seek medical care once symptoms are suspected.

Nearly a quarter (23.8%) of the surveyed population did not know the best preventive measure for malaria and less than half (46.0%) perceived bed net as the best measure to prevent malaria. Health education messages should address measures of prevention against malaria with special emphasis on effectiveness of insecticide treated bed nets. Health education messages should as well take into consideration the misconception of the population related to the health hazards of using insecticide impregnated. Health care facilities should consider health education activities of relevance to malaria as part of the routine services provided to the population. Health education messages using mass media will ensure the wide spread of accurate and up to date information. Radio and television are the most suitable mass media in view of the high rates of illiteracy among the population.

The information, reports and lessons learned from this survey should be made available to all partners. A national seminar including all partners and the health staff involved in the survey will create a sense of ownership and facilitate usage of information and implementation of the survey recommendations. The data base of the survey should be linked to the available geographical information systems for further spatial analysis of the information. Using the experiences and lessons learned from this survey, a population based survey should be planned for other malarious areas which were not part of the survey at this stage. Survey results and experiences should be shared with the international community. MoPH of Afghanistan is encouraged to prepare a scientific paper for publication in international journals.

Afghanistan Annual Malaria Journal (2009) P 37-49

Full Report Available at: 

http://moph.gov.af/Content/Media/Documents/Afghanistan-Malaria-Indicator-Survey2812201014573359.pdf

11. Progress and Challenges to Malaria Control in Afghanistan

Najibullah Safi, Toby Leslie, Mark Rowland

Abstract:

Malaria in Afghanistan, as in most of South Asia, is the product of two coexistent species, Plasmodium falciparum and P. vivax. Transmission of disease is relatively low, and the predominant species is P. vivax, causing 80‐90% of cases. In the most endemic areas, incidence is estimated at 10‐100 per 1000 person years for vivax malaria and 1‐10 per 1000 person years for falciparum malaria.

Treatment for the two species differs because vivax remains susceptible to chloroquine, while falciparum malaria has developed unsupportable levels of resistance. Falciparum malaria, if confirmed is treated with the more expensive sulfadoxine‐pyrimethamine with artesunate (SP/AS). Malaria incidence is sufficiently low that the majority of cases suspected to have malaria by clinical evaluation are negative on blood examination (slide positivity rate is 15‐30% in most areas). In the absence of diagnosis, the present policy is to treat all suspected cases with SP and chloroquine. In many areas, diagnosis is unavailable or unreliable and therefore many patients are inappropriately treated. Delivery of diagnostics is therefore crucial. Delivery of personal protection is by insecticide treated nets, and there has been a rapid rise in coverage. Perhaps the biggest barrier to effective malaria treatment in this region, where vivax malaria predominates, is the absence of effective anti‐relapse therapy that can provide radical cure. Primaquine use is unavailable because of the presence of G6PD deficiency in the population.

There are numerous challenges to providing sufficient pressure on malaria to maintain control in South Asia, amongst the most important of which is the continued socio‐political instability in the region. If the goal of eradication or elimination of malaria is to be achieved, this prerequisite is required.

Afghanistan Annual Malaria Journal (2009) P 15-29