Concurrent Brucellosis and Q Fever Infection: a Case Control Study in Bamyan Province, Afghanistan

Background: More than 500,000 people are affected by brucellosis each year while the incidence of Q fever is poorly recorded. Consistent outbreaks of brucellosis have been reported in Afghanistan, affecting social and economic life. This study aimed to determine the means of propagation of brucellosis and Q-fever and establish appropriate control measures for both.Methods and Materials: An outbreak of 1,317 cases of brucellosis and Q fever was investigated from May 2011 to the end of 2012 in Bamyan province of Afghanistan.A total of 100 cases were selected by random sampling with equal number of neighbor controls. Data were collected through structured questionnaire.Results: The average age was 30 years ±14 years. Of those sampled, 62% were female, 38% were male, and resided in three districts: Punjab, Yakawlang and Waras. Using multivariate analysis, being a housewife (OR=7.36), being within proximity of kitchens to barns (OR= 2.98), drinking un-boiled milk (OR= 5.26), butchering (OR= 3.53) and purchasing new animals in the last six months (OR= 3.53) were significantly associated with contraction of brucellosis and Q fever.Conclusion: Health educators should focus on families dealing with animals, especially on females. Pasturing, healthy milking, dunging, and slaughtering practices, along with use of safe dairy products should be the focus of preventive measures

Concurrent Brucellosis and Q Fever Infection: a Case Control Study in Bamyan Province, Afghanistan

Background: More than 500,000 people are affected by brucellosis each year while the incidence of Q fever is poorly recorded. Consistent outbreaks of brucellosis have been reported in Afghanistan, affecting social and economic life. This study aimed to determine the means of propagation of brucellosis and Q-fever and establish appropriate control measures for both. Methods and Materials: An outbreak of 1,317 cases of brucellosis and Q fever was investigated from May 2011 to the end of 2012 in Bamyan province of Afghanistan.A total of 100 cases were selected by random sampling with equal number of neighbor controls. Data were collected through structured questionnaire. Results: The average age was 30 years ±14 years. Of those sampled, 62% were female, 38% were male, and resided in three districts: Punjab, Yakawlang and Waras. Using multivariate analysis, being a housewife (OR=7.36), being within proximity of kitchens to barns (OR= 2.98), drinking un-boiled milk (OR= 5.26), butchering (OR= 3.53) and purchasing new animals in the last six months (OR= 3.53) were significantly associated with contraction of brucellosis and Q fever. Conclusion: Health educators should focus on families dealing with animals, especially on females. Pasturing, healthy milking, dunging, and slaughtering practices, along with use of safe dairy products should be the focus of preventive measures

The prevalence of Anemia and Malaria, and their association, among pregnant women attending antenatal clinics in Laghman Province, Afghanistan : a cross-sectional study

Introduction: Anemia in pregnancy is one of the commonest problems affecting pregnant women in developing countries and puts the mother and fetus at risk for death. In developing countries, anemia prevalence in pregnant women is reported to be between 40-60 %. Afghanistan Multiple Indicator Cluster Survey, 2000 shows that anemia (Hb\u3c11g/d1) is widespread in all Afghanistan. Several factors contribute to anemia during pregnancy and due to complex etiology of pregnancy anemia the relative role of risk factors is difficult to estimate. In addition to nutritional deficiencies malaria, which is prevalent in Afghanistan, regarded as a major risk factor for anemia during pregnancy. The objective of the study was to estimate the prevalence of anemia and malaria in pregnant women, and to examine any relationship between anemia and malaria during pregnancy. Methodology: Survey of attending pregnant women to all (n=5) Comprehensive Health Centers was conducted during August-October, 2007 in Laghman province. A sample of 830 pregnant women attending the CHCs between the ages 15 to 49 years was interviewed and tested for malaria and anemia. Clients attending for their first antenatal visits were included in the study regardless of the trimester of the pregnancy. Anemia, our dependent variable, was defined as per WHO criteria (hemoglobin level below 11g/d1 in the first and third trimesters and below 10.5g/dl in the second trimester) and a mother was labeled with malaria parasitemia (the main exposure variable) if Plasmodium parasites seen by the direct microscopic visualization on the thick and thin blood smear slides. Thick smears were used to identify the parasites and thin smears for identifying the specific species. Mothers were considered as workers if working for last one year or more. Data were analyzed using SAS for windows version 9.1. Proportions of the anemia, malaria and other nominal variables were calculated. Binomial Logistic Regression and Linear Regression statistical methods were used in the univariate and multivariable levels to assess the relationship between the dependent and independent variables. Results: The overall prevalence of anemia in this population was 52.9 %, 95% CI = [49.5%-56.3%]. All anemic participants were moderately anemic and there were no severe anemic case. The prevalence of malaria parasitemia in the sample was 7.3%, 95% CI= [5.6%-9.l%]. All the malaria cases in this sample were Plasmodium vivax. In multivariable analysis, we found that pregnancy trimester, living in a particular type of district, and working to earn money were significantly associated with anemia. Conclusion: We estimated high prevalence of anemia (52.9%) and malaria (7.6%) among pregnant women. Third trimester, living in the rural areas, and working to earn money for last one year or more are important risk factors for anemia in pregnant women. Thus, control and prevention measures against anemia should be directed to all pregnant women, especially targeting working, rural population and women in their third trimester of pregnancy. Rural areas must given more attention, because most of the women working to earn money are from rural areas. Since malaria and anemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of interventions for the prevention and control of malaria infection and anemia in pregnant women

Concurrent Brucellosis and Q Fever Infection: a Case Control Study in Bamyan Province, Afghanistan

Background: More than 500,000 people are affected by brucellosis each year while the incidence of Q fever is poorly recorded. Consistent outbreaks of brucellosis have been reported in Afghanistan, affecting social and economic life. This study aimed to determine the means of propagation of brucellosis and Q-fever and establish appropriate control measures for both. Methods and Materials: An outbreak of 1,317 cases of brucellosis and Q fever was investigated from May 2011 to the end of 2012 in Bamyan province of Afghanistan.A total of 100 cases were selected by random sampling with equal number of neighbor controls. Data were collected through structured questionnaire. Results: The average age was 30 years ±14 years. Of those sampled, 62% were female, 38% were male, and resided in three districts: Punjab, Yakawlang and Waras. Using multivariate analysis, being a housewife (OR=7.36), being within proximity of kitchens to barns (OR= 2.98), drinking un-boiled milk (OR= 5.26), butchering (OR= 3.53) and purchasing new animals in the last six months (OR= 3.53) were significantly associated with contraction of brucellosis and Q fever. Conclusion: Health educators should focus on families dealing with animals, especially on females. Pasturing, healthy milking, dunging, and slaughtering practices, along with use of safe dairy products should be the focus of preventive measures

Modelling the COVID-19 pandemic in context: an international participatory approach.

The SARS-CoV-2 pandemic has had an unprecedented impact on multiple levels of society. Not only has the pandemic completely overwhelmed some health systems but it has also changed how scientific evidence is shared and increased the pace at which such evidence is published and consumed, by scientists, policymakers and the wider public. More significantly, the pandemic has created tremendous challenges for decision-makers, who have had to implement highly disruptive containment measures with very little empirical scientific evidence to support their decision-making process. Given this lack of data, predictive mathematical models have played an increasingly prominent role. In high-income countries, there is a long-standing history of established research groups advising policymakers, whereas a general lack of translational capacity has meant that mathematical models frequently remain inaccessible to policymakers in low-income and middle-income countries. Here, we describe a participatory approach to modelling that aims to circumvent this gap. Our approach involved the creation of an international group of infectious disease modellers and other public health experts, which culminated in the establishment of the COVID-19 Modelling (CoMo) Consortium. Here, we describe how the consortium was formed, the way it functions, the mathematical model used and, crucially, the high degree of engagement fostered between CoMo Consortium members and their respective local policymakers and ministries of health

Additional file 1 of Strengthening event-based surveillance (EBS): a case study from Afghanistan

Supplementary Material 1

COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study

Objective The primary objectives were to determine the magnitude of COVID-19 infections in the general population and age-specific cumulative incidence, as determined by seropositivity and clinical symptoms of COVID-19, and to determine the magnitude of asymptomatic or subclinical infections.Design, setting and participants We describe a population-based, cross-sectional, age-stratified seroepidemiological study conducted throughout Afghanistan during June/July 2020. Participants were interviewed to complete a questionnaire, and rapid diagnostic tests were used to test for SARS-CoV-2 antibodies. This national study was conducted in eight regions of Afghanistan plus Kabul province, considered a separate region. The total sample size was 9514, and the number of participants required in each region was estimated proportionally to the population size of each region. For each region, 31–44 enumeration areas (EAs) were randomly selected, and a total of 360 clusters and 16 households per EA were selected using random sampling. To adjust the seroprevalence for test sensitivity and specificity, and seroreversion, Bernoulli’s model methodology was used to infer the population exposure in Afghanistan.Outcome measures The main outcome was to determine the prevalence of current or past COVID-19 infection.Results The survey revealed that, to July 2020, around 10 million people in Afghanistan (31.5% of the population) had either current or previous COVID-19 infection. By age group, COVID-19 seroprevalence was reported to be 35.1% and 25.3% among participants aged ≥18 and 5–17 years, respectively. This implies that most of the population remained at risk of infection. However, a large proportion of the population had been infected in some localities, for example, Kabul province, where more than half of the population had been infected with COVID-19.Conclusion As most of the population remained at risk of infection at the time of the study, any lifting of public health and social measures needed to be considered gradually