RESUMEN
BACKGROUND: The Taliban takeover in August 2021 ended a decades-long conflict in Afghanistan. Yet, along with improved security, there have been collateral changes, such as the exacerbation of the economic crisis and brain drain. Although these changes have altered the lives of Afghans in many ways, it is unclear whether they have affected access to care. This study aimed to analyse Afghans' access to care and how this access has changed after August 2021. METHODS: The study relied on the collaboration with the non-governmental organisation EMERGENCY, running a network of three hospitals and 41 First Aid Posts in 10 Afghan provinces. A 67-item questionnaire about access to care changes after August 2021 was developed and disseminated at EMERGENCY facilities. Ordinal logistic regression was used to evaluate whether access to care changes were associated with participants' characteristics. RESULTS: In total, 1807 valid responses were returned. Most respondents (54.34%) reported improved security when visiting healthcare facilities, while the ability to reach facilities has remained stable for the majority of them (50.28%). Care is less affordable for the majority of respondents (45.82%). Female respondents, those who are unmarried and not engaged, and patients in the Panjshir province were less likely to perceive improvements in access to care. CONCLUSIONS: Findings outline which dimensions of access to care need resource allocation. The inability to pay for care is the most relevant barrier to access care after August 2021 and must therefore be prioritised. Women and people from the Panjshir province may require ad hoc interventions to improve their access to care.
RESUMEN
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.
RESUMEN
An online survey was conducted to determine associations between equine transport management and transport-related injuries and problem behaviors in Italy. The survey was composed of four sections: respondents' demographic information and background, transport management practices, journey details and vehicle design, and transport injuries experienced by the horse in the previous two-year period. Univariable and multivariable logistic regression with a binary outcome variable was performed to explore associations between variables (respondents' and journeys' details and transport practices) and equine transport-related problem behaviors (TRPBs) and injuries. TRPBs were also considered an explanatory variable for injuries. The survey generated 201 responses; only 148 were complete and analyzed. TRPBs were reported by 14.45% of the respondents and the odds of TRPBs was linked to the respondent gender (p = 0.034), the use of tranquilizers prior to transport (p = 0.002), the use of a whip for loading (p = 0.049), the lack of protection equipment (p = 0.050), and shavings (p = 0.025) on the vehicle floor. Horse injuries (11.49%) were reported by more respondents who did not check the brakes of their transport vehicle before traveling (p = 0.043), had vehicles with padding on the chest bar (p = 0.038), and for horses reported to display TRPBs (p = 0.001). Finally, 10 respondents reported they were injured during horse transport (10/140; 7.14%), 50% simultaneously with their horses. The study findings should be interpreted with caution due to small sample size bias and participants' recall bias. Nevertheless, the results are in concordance with the literature, confirming that horse transport is a risk for the horse's and handler's health and well-being. Further studies are needed to identify best management practices to educate equine industry members on how to minimize transport-related problems.