Strategies to tackle non-communicable diseases in Afghanistan: A scoping review

Validation of a Slovenian version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) for use with patients in family medicine

BACKGROUND

Chronic non-communicable diseases are the world's leading cause of death and disability. The emerging field of lifestyle medicine requires equipping healthcare professionals with instruments, knowledge, skills and competencies. Measuring an individual's lifestyle with a valid and reliable instrument is the first step in promoting it. The aim of the study was to validate the Slovenian adaptation of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ).

METHODS

A cross-sectional study was conducted among 666 questionnaire participants, and they were adult participants (aged 18 and above) from family medicine practices with cardiovascular diseases (CVDs) risk factors (e.g., hypertension, high cholesterol) but without a diagnosis of acute CVDs. The questionnaire included demographic data and anthropological measures and a translated English HLPCQ questionnaire. The instrument was translated using the forward-backwards translation method. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki. In addition to assessing the construct validity of the questionnaire, exploratory and confirmatory factor analyses were used to determine content and face validity, and internal consistency reliability.

RESULTS

The mean age of male participants was 41.34 (± 13.220) years, the mean age of female participants was 40.31 (± 11.905) years. The Cronbach's alpha was 0.852, and all questionnaire subscales had positive correlations. Sampling adequacy was confirmed by the Kaiser-Meyer-Olkin (KMO) index (0.851), and Bartlett's test of sphericity was significant (χ² = 4647.694, p < 0.001), indicating suitability for Principal Component Analysis (PCA). PCA revealed a five-factor solution, accounting for 50.67% of the total variance.

CONCLUSIONS

The most influential factors for a healthy lifestyle were daily routine, healthy dietary choices, avoidance of harmful dietary habits, organized physical activity, and social and mental balance. The Slovenian version had high factor validity and reliability. It can be used in Slovenian Community Health Centre to assess an individual's control over various lifestyle dimensions. The instrument also holds potential for use in public health initiatives, supporting early identification of lifestyle-related risk factors and promoting preventive care strategies in the primary care setting.

Implications of the dissemination of healthy lifestyle advice for Afghan adults without histories of hypertension diagnosis or treatment

Objectives

This study explored the relationship between receiving healthy lifestyle advice from healthcare providers and hypertension among undiagnosed individuals in Afghanistan, defined as adults with no previous hypertension diagnosis or treatment history.

Materials and Methods

Data were extracted from the 2018-19 Afghanistan National Non-Communicable Diseases Risk Factors Survey, comprising 2,838 participants. Outcomes included hypertension (systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg) and elevated blood pressure (systolic blood pressure 120-129 mmHg and diastolic blood pressure <80 mmHg). Bivariate and multivariable multinomial logistic regression analyses were conducted to assess associated factors.

Results

Among the 2,838 participants, 1,344 (47.4%) had hypertension and 344 (12.1%) had elevated blood pressure. Most participants were aged <40 years (63.8%), male (55.8%), and ever-married (80.2%). Multivariable analysis revealed that not receiving healthy lifestyle advice was significantly associated with hypertension (adjusted relative risk ratio [aRRR]=1.24; 95% confidence interval [CI]: 1.04-1.47) and elevated blood pressure (aRRR=1.40; 95% CI: 1.08-1.81). Sociodemographic and behavioral factors such as age, sex, marital status, education, occupation, fruit consumption, physical activity, and excess weight were significantly associated with hypertension, whereas only sex and excess weight were significantly associated with elevated blood pressure.

Conclusion

Our findings underscore the association between receiving healthy lifestyle advice from healthcare providers and a lower prevalence of hypertension among undiagnosed Afghan adults. Accordingly, healthcare providers should recommend lifestyle changes to help manage hypertension among adults.

The availability and distribution of health services and resources across different regions in Afghanistan

Background

Ensuring equitable access to healthcare services is fundamental to a robust healthcare system, especially during humanitarian crises. This study analyzes the availability and distribution of health resources across Afghanistan, aiming to provide a data-driven understanding of healthcare resource access and identify potential disparities, a critical aspect of effective humanitarian response planning.

Methods

Principal investigators collated related data and literature from databases and data warehouses in a systematic approach using search strings and collection tools to query databases and available data warehouses to assess the availability and distribution of health services and resources across different regions in Afghanistan, with the principal database queried being the Afghanistan Health Resources Availability database (HeRAMS), an electronic and web-based system conceived by the World Health Organization. An Excel version was sourced.

Results

The sub-health center represents 31.1% of the health facilities, followed by the basic health center (22.5%) and the mobile health team (17.1%). More than 85% of these facilities are fully operational, with the highest percentage observed in the Southern and Northeastern regions at 96.8%, followed closely by the central highland and Southeastern regions. Outpatient services for primary care are notably prevalent in the Northeastern, Southeastern, Southern, Eastern, and Northern region, conversely, the Capital and Central Highland regions demonstrate the lowest provision of primary care services. Antenatal care services are accessible at a level exceeding 70% in nearly all regions, with the highest accessibility in the Northeastern region at 91.3%, the prevalence of non-communicable illness clinics was observed to be below 50%, with the highest availability in the Southern region at 49.4%, followed by the Southeastern region. In terms of sanitation facilities, availability surpasses 70% across Afghanistan, with the highest observed in the Northeastern region at 89.2%.

Conclusion

The study highlights significant disparities in healthcare access across various regions, with notable challenges in the availability of critical services. Furthermore, the study underscores the significant impact of financial constraints and equipment shortages on the functionality of healthcare facilities, particularly in the Northeastern and Western regions. This analysis emphasises the need for targeted resource allocation and infrastructure improvements to address inequities in access to essential healthcare services, particularly for underserved populations, thereby facilitating the achievement of equitable health outcomes in Afghanistan.

Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study

Background

Although depression is a frequently occurring mental disorder in patients with hypertension, little is known about the symptoms of depression among Afghan hypertensive patients.

Objective

This study aimed to analyze the prevalence and predictors of depression symptoms among Afghan hypertensive patients.

Methods

This was a secondary analysis of a multi-center cross-sectional study conducted between August and December 2022 across three major provinces in Afghanistan. Socio-demographic and clinical characteristics of the eligible participants were used in the analysis. A score of ≥ 5 on the PHQ-9 (Patient Health Questionnaire) was considered the cut-off point for labeling hypertensive patients as screening positive for depressive symptoms. We performed binary logistic regression to determine the predictors of depression symptoms among hypertensive patients.

Results

Out of 853 hypertensive patients, 51.8% (95% CI: 48.4-55.2%) had depressive symptoms. Binary logistic regression revealed that low monthly household income [AOR=1.42, 95% CI (1.01-1.97), low education level [2.41 (1.57-3.71)], physical inactivity [1.81 (1.22-2.71)], poor blood pressure control [2.41 (1.57-3.71)], and the presence of medical comorbidity [1.59 (1.15-2.19)] were the predictors of depression symptoms.

Conclusion

This study showed a high prevalence of depressive symptoms among Afghan hypertensive patients. Moreover, we found that low monthly household income, physical inactivity, low education level, poor blood pressure control, and the presence of medical comorbidity were the predictors of depression symptoms. Our findings suggest that hypertensive patients should be screened for mental health symptoms, and those most at risk for depression should seek supportive counseling.

A comparative systematic review of risk factors, prevalence, and challenges contributing to non-communicable diseases in South Asia, Africa, and Caribbeans

BACKGROUND

Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies.

AIM

To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic.

METHOD

A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria.

RESULTS

Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa.

CONCLUSION

Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions.

Risk factors for non-communicable diseases in Afghanistan: insights of the nationwide population-based survey in 2018

BACKGROUND

Noncommunicable diseases (NCDs) account for a substantial number of deaths in Afghanistan. Understanding the prevalence and correlates of major NCD risk factors could provide a benchmark for future public health policies and programs to prevent and control NCDs. Therefore, this study aimed to examine the prevalence and correlates of NCD risk factors among adults aged 18-69 years in Afghanistan.

METHODS

We used data from the Afghanistan STEPS Survey 2018. The study population were 3650 (1896 males and 1754 females) adults aged 18-69 years sampled from all 34 provinces through a multistage cluster sampling process. Information on behavioural and biological risk factors was collected. We used STATA (version 18.0) for data analysis.

RESULTS

Of the total participants, 42.8% were overweight or obese, 8.6% were current smokers, 26.9% had insufficient physical activities, 82.6% had low consumption of fruits and vegetables, and only 0.5% had ever consumed alcohol. Approximately 15% of participants had a high salt intake, while 25% and 8% had elevated blood pressure and blood glucose levels, respectively. Similarly, around 18% had elevated total cholesterol. The study revealed a lower prevalence of current smoking among females [AOR = 0.17, 95%CI (0.09-0.30)] compared with males, but a higher prevalence in those who had higher education levels [1.95 (1.13-3.36)] compared with those with no formal education. Insufficient physical activity was higher in participants aged 45-69 years [1.96 (1.39-2.76)], females [4.21 (1.98-8.84)], and urban residents [2.38 (1.46-3.88)] but lower in those with higher education levels [0.60 (0.37-0.95)]. Participants in the 25th to 75th wealth percentiles had higher odds of low fruit and vegetable consumption [2.11 (1.39-3.21)], while those in the > 75th wealth percentile had lower odds of high salt intake [0.63 (0.41-0.98)]. Being overweight/obese was more prevalent in participants aged 45-69 years [1.47 (1.03-2.11)], females [1.42 (0.99-2.01)], currently married [3.56 (2.42-5.21)] or ever married [5.28 (2.76-10.11)], and urban residents [1.39 (1.04-1.86)]. Similarly, high waist circumference was more prevalent in participants aged 45-69 years [1.86 (1.21-2.86)], females [5.91 (4.36-8.00)], those being currently married [4.82 (3.12-7.46)], and those being in 25th to 75th wealth percentile [1.76 (1.27-2.43)]. A high prevalence of elevated blood pressure was observed in participants aged 45-69 years [3.60 (2.44-5.31)] and currently married [2.31 (1.24-4.31)] or ever married [6.13 (2.71-13.8)] participants. Elevated blood glucose was more prevalent in older adults ([1.92 (1.09-3.39)] for 45-69 and [3.45 (2.44-5.31)] for 30-44 years), urban residents [2.01 (1.33-3.03)], and ever-married participants [4.89 (1.48-16.2)]. A higher prevalence of elevated cholesterol was observed in females [2.68 (1.49-4.82)] and those currently married [2.57 (1.17-5.63)] or ever married [4.24 (1.31-13.73)].

CONCLUSION

This study used up-to-date available data from a nationally representative sample and identified the prevalence of NCDs and associated risk factors in Afghanistan. Our findings have the potential to inform and influence health policies by identifying people at high risk of developing NCDs and can assist policymakers, health managers, and clinicians to design and implement targeted health interventions.

Exploring barriers to access to care following the 2021 socio-political changes in Afghanistan: a qualitative study

BACKGROUND

Following the change of government in August 2021, the social and economic landscape of Afghanistan deteriorated into an economic and humanitarian crisis. Afghans continue to struggle to access basic healthcare services, making Universal Health Coverage (UHC) in the country a major challenge. The aim of this study was to perform a qualitative investigation into the main access to care challenges in Afghanistan and whether these challenges have been influenced by the recent socio-political developments, by examining the perspectives of health professionals and hospital directors working in the country.

METHODS

Health professionals working in facilities run by an international non-government organisation, which has maintained continuous operations since 1999 and has become a key health reference point for the population, alongside the public health system, and hospital directors working in government hospitals were recruited to participate in an in-depth qualitative study using semi-structured interviews.

RESULTS

A total of 43 participants from ten provinces were interviewed in this study. Four issues were identified as critical barriers to achieving UHC in Afghanistan: (1) the lack of quality human resources; (2) the suboptimal management of chronic diseases and trauma; (3) the inaccessibility of necessary health services due to financial hardship; (4) the unequal accessibility of care for different demographic groups.

CONCLUSIONS

Health professionals and hospital directors shed light on weaknesses in the Afghan health system highlighting chronic issues and issues that have deteriorated as a result of the 2021 socio-political changes. In order to improve access to care, future healthcare system reforms should consider the perspectives of Afghan professionals working in the country, who are in close contact with Afghan patients and communities.

Prevalence and correlates of diabetes and impaired fasting glucose among adults in Afghanistan: Insights from a national survey

Objectives

Afghanistan is experiencing an escalating burden of noncommunicable diseases, with diabetes and impaired fasting glucose being of particular concern. To explore the prevalence of diabetes and impaired fasting glucose and associated factors among adult Afghans.

Methods

This cross-sectional study used secondary data from a nationally representative survey, conducted in 2018 in Afghanistan. A blood sample was collected from the fingertip and tested through a strip to measure blood glucose. The complex sampling design and sampling weights were accounted for in all analyses to produce representative estimates of the target population in Afghanistan.

Results

Of 3890 Afghan adults aged 18-69 years who participated in this survey, 11.07% and 10.32% had diabetes and impaired fasting glucose, respectively. For overweight individuals with abdominal obesity, the risk for diabetes became significantly elevated, with an adjusted relative risk ratio of 2.12 (95% CI: 1.10-4.09). However, the most pronounced effect was observed among individuals classified as having obesity with abdominal obesity with an adjusted relative risk ratio of 2.54 (95% CI: 1.37-4.70). Moreover, high cholesterol level was significantly associated with both impaired fasting glucose (ARRR: 2.52, 95% CI: 1.55-4.12) and diabetes (ARRR: 4.12, 95% CI: 2.59-6.56), whereas high blood pressure was significantly associated with only diabetes (ARRR: 1.82, 95% CI: 1.16-2.86).

Conclusions

This investigation provides critical insight into the prevalence of diabetes and IFG among Afghan adults aged 18-69 years. Relative to the global average, the higher prevalence observed calls for specifically designed interventions targeting individuals with cardiometabolic risk factors, such as elevated body mass index, abdominal obesity, hypertension, and hypercholesterolemia.

Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey

Background

In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness.

Methods

This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains.

Results

The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores.

Conclusions

Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.

High sedentary behavior and low physical activity among adults in Afghanistan: results from a national cross-sectional survey

Objective

The study aimed to evaluate the prevalence and correlates of sedentary behavior and combination of sedentary behavior and low physical activity among adults in Afghanistan in 2018.

Methods

This was a national representative cross-sectional study. The study utilized the data from Afghanistan STEPS survey 2018, where 3,956 adults (ages between 18 and 69 years) were interviewed at community-dwelling level. Using the Global Physical Activity Questionnaire, we have calculated the sedentary behavior and physical inactivity. Logistic regression was applied to investigate factors associated high sedentary behavior and low physical activity.

Results

Approximately half of the participants (49.8%) exhibited high levels of sedentary behavior, 40.3% low physical activity and 23.5% had both high sedentary behavior and low physical activity. Adjusted logistic regression analysis revealed that individuals who were employed (AOR: 0.34, 95% CI: 0.13-0.88) or self-employed (AOR: 0.60, 95% CI: 0.38-0.94) had significantly lower odds of both high SB and low physical activity than those whose work status was unpaid. Furthermore, older age (AOR: 1.75, 95% CI: 1.35-2.28), urban residence (AOR: 3.17, 95% CI: 1.72-6.05), having 4 or 5 adult household members (AOR: 1.77, 95% CI: 1.21-2.58) and being underweight (AOR: 1.78, 95% CI: 1.02-3.12) were found to be associated with high sedentary behavior. Moreover, factors such as female sex, having 4 or 5 or 6 or more adult household members, urban residence, overweight, and diabetes were positively associated, and male sex (AOR: 0.24, 95% CI: 0.12-0.51), being employed (AOR: 0.34, 95% CI: 0.13-0.88) or self-employed (AOR: 0.60, 95% CI: 0.38-0.94) were negatively associated with the occurrence of combination of high sedentary behavior and low physical activity.

Conclusion

Half of the participants had high sedentary behavior, and one in four had both high sedentary behavior and low physical activity together. These findings emphasize the importance of targeted interventions aimed at reducing sedentary behavior and promoting physical activity, particularly among vulnerable populations such as females, individuals from lower socioeconomic background, urban residents, and those with chronic conditions. Addressing these factors can contribute to improving public health outcomes and reducing negative health impacts of sedentary behavior in Afghanistan.

Cancer prevalence, incidence, and mortality rates in Afghanistan in 2020: A review study

BACKGROUND

Afghanistan is in an epidemiological transition, as cancer is the second leading cause of mortality due to non-communicable diseases. This study is the first to provide a comprehensive perspective on the overall cancer situation in Afghanistan by discussing the top five most common cancers, their incidence variations, risk factors, and preventive measures. The limited number of cancer studies conducted in Afghanistan highlights the importance of the present review.

RECENT FINDINGS

This article provides an overview of cancer burden in Afghanistan in 2020. It utilizes IARC-generated GLOBOCAN 2020 data for one, three, and five-year prevalence rates, the estimated number of new cancer cases, and mortality rates by age group in Afghanistan. According to GLOBOCAN, the top five common cancers in both sexes in Afghanistan were breast (n = 3173, 14.3%), stomach (n = 2913, 7.8%), lung (n = 1470, 6.6%), cervix uteri (n = 1200, 5.4%), and colorectum (n = 1084, 4.9%).

CONCLUSION

This study provides a brief overview of the general cancer situation in Afghanistan, and a more in-depth analysis of the five common cancers identified. Effective therapies, awareness, and prevention initiatives targeting lifestyle, immunization, early diagnosis, and environmental risk factors are essential for addressing the impact of population growth and aging on cancer incidence in Afghanistan. Further research and extensive studies are needed to better understand cancer burden in the country.

Strategies to strengthen a climate-resilient health system: a scoping review

BACKGROUND

Climate change is a major global threat to human health and puts tremendous pressure on health systems. Therefore, a resilient health system is crucial to enhance, maintain, and restore the population's health. This study aimed to identify interventions and actions to strengthen a climate-resilient health system to deal with the adverse health effects of climate change.

METHOD

This study was a scoping review. Five databases and Google Scholar search engine were searched using relevant keywords. Initially, 4945 documents were identified, and 105 were included in the review. Content thematic analysis method was applied using MAXQDA 10 software.

RESULTS

Overall, 87 actions were identified for building a climate-resilient health system and were classified into six themes (i.e., governance and leadership; financing; health workforce; essential medical products and technologies; health information systems; and service delivery). The most commonly reported actions were formulating a national health and climate change adaptation plan, developing plans for essential services (electricity, heating, cooling, ventilation, and water supply), assessing the vulnerabilities and capacities of the health system, and enhancing surveillance systems targeting climate-sensitive diseases and their risk sources.

CONCLUSIONS

A holistic and systemic approach is needed to build a climate-resilient health system owing to its complex adaptive nature. Strong governance and leadership, raising public awareness, strategic resource allocation, climate change mitigation, emergency preparedness, robust health services delivery, and supporting research, are essential to building a climate-resilient health system.