Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study.

INTRODUCTION: This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan. METHODS: The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis. RESULTS: The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers. CONCLUSIONS: Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.

State of neonatal health care in eight countries of the SAARC region, South Asia: how can we make a difference?

The South Asian Association for Regional Cooperation (SAARC) is an organization of eight countries--Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, Sri Lanka and Afghanistan. The major objectives of this review are to examine trends and progress in newborn and neonatal health care in the region. A landscape analysis of the current state of neonatal mortality, stillbirths and trends over the years for each country and the effective interventions to reduce neonatal mortality and stillbirths was undertaken. A modelling exercise using the Lives Saved Tool (LiST) was also undertaken to determine the impact of scaling up a set of essential interventions on neonatal mortality and stillbirths. The findings demonstrate that there is an unacceptably high and uneven burden of neonatal mortality and stillbirths in the region which together account for 39% of global neonatal deaths and 41% of global stillbirths. Progress is uneven across countries in the region, with five of the eight SAARC countries having reduced their neonatal mortality rate by more than 50% since 1990, while India (43%), Afghanistan (29%) and Pakistan (25%) have made slower progress and will not reach their MDG4 targets. The major causes of neonatal mortality are intrapartum-related deaths, preterm birth complications and sepsis which account for nearly 80% of all deaths. The LiST analysis shows that a gradual increase in coverage of proven available interventions until 2020 followed by a uniform scale-up to 90% of all interventions until 2030 could avert 52% of neonatal deaths (0.71 million), 29% of stillbirths (0.31 million) and achieve a 31% reduction in maternal deaths (0.25 million). The analysis demonstrates that the Maldives and Sri Lanka have done remarkably well while other countries need greater attention and specific focus on strategies to improve neonatal health.

Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance.

BACKGROUND: In 2003 the Afghan Ministry of Public Health (MoPH) adopted the Integrated Management of Childhood Illness (IMCI) for delivering child health services in primary care facilities. Key problems were subsequently identified: high cost of training, frequent health worker turnover and poor quality of IMCI implementation by those trained - specifically in the use of job aids and protocols for assessment, classification, treatment and counselling. The high financial, human resources and opportunity costs of implementing IMCI spurred the MoPH to prioritize developing a shortened IMCI course of comparable quality to the 11-Day training. METHODS: This cross-sectional evaluation compared knowledge before and after training, and health worker performance in assessment, classification and treatment of sick children in two similar cohorts, eight months post-training. RESULTS: The mean increase in knowledge scores of the thirty 7-Day course trainees was 29 [95% Confidence Interval (CI): 24, 34] compared to 23 (95% CI: 18, 28) in the 31 trained in the 11-Day course. During assessment visits, mean scores in the 7-Day course trainees and the 11-Day course trainees were 93% (95% CI: 91, 95) versus 94% (95% CI: 91, 96) in assessment; 95% (95% CI: 89, 100) versus 96% (95% CI: 91, 100) in classification; 95% (95% CI: 92, 100) versus 97% (95% CI: 95, 100) in treatment; and 81% (95% CI: 76, 86) versus 80% (95% CI: 75, 85) in counselling. The 7-Day course was 36% less expensive than the 11-Day course. For each course opportunity costs, measured as numbers of children who potentially received poorer care than usual during trainee absence, were 3,160 for the 11-Day course and 2,016 for the 7-Day course. This measure was chosen because trainee absence commonly resulted in higher patient volumes per remaining provider or complete closure of a health facility with one single health worker. CONCLUSION: Given similar performance and knowledge of health workers trained in both courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a shorter course, it seems prudent to standardize the 7-Day course in Afghanistan where child mortality rates remain unacceptably high.

Improving nutrition in Afghanistan through a community-based growth monitoring and promotion programme: a pre-post evaluation in five districts.

In Afghanistan, malnutrition in children less than 60 months of age remains high despite nutritional services being offered in health facilities since 2003. Afghanistan's Ministry of Public Health solicited extensive community consultation to develop pictorial community-based growth monitoring and promotion (cGMP) tools to help illiterate community health workers (CHWs) provide nutritional assessment and counselling. The planned evaluation in the five districts where cGMP was implemented demonstrated that a mean weight-for-age (WFA) Z-score of 414 participant children was 0.3 Z-scores higher than that of matched non-participants who lived outside of cGMP programme catchment areas. The mean change in WFA Z-scores at evaluation was 0.3 (95% CI 0.3, 0.4) Z-scores higher than at entry into the programme. The most influential factor on WFA Z-score changes in participants was initial WFA Z-score. Those with an initial WFA Z-score of less than -2 experienced a mean increase of 0.33 (95% CI 0.29, 0.38) WFA Z-scores per session attended, while those with a baseline WFA Z-score of greater than zero showed a decrease of 0.19 (95% CI 0.22, 0.15) WFA Z-scores per session attended. These results are encouraging since they demonstrate that the cGMP programme in Afghanistan for illiterate women has some potential to contribute to improving nutrition, specifically in underweight children of either sex who enter the programme at less than nine months of age and attend 50% or more sessions.

Afghanistan's basic package of health services: its development and effects on rebuilding the health system.

In 2001, Afghanistan's Ministry of Public Health inherited a devastated health system and some of the worst health statistics in the world. The health system was rebuilt based on the Basic Package of Health Services (BPHS). This paper examines why the BPHS was needed, how it was developed, its content and the changes resulting from the rebuilding. The methods used for assessing change were to review health outcome and health system indicator changes from 2004 to 2011 structured along World Health Organisation's six building blocks of health system strengthening. BPHS implementation contributed to success in improving health status by translating policy and strategy into practical interventions, focusing health services on priority health problems, clearly defining the services to be delivered at different service levels and helped the Ministry to exert its stewardship role. BPHS was expanded nationwide by contracting out its provision of services to non-governmental organisations. As a result, access to and utilisation of primary health care services in rural areas increased dramatically because the number of BPHS facilities more than doubled; access for women to basic health care improved; more deliveries were attended by skilled personnel; supply of essential medicines increased; and the health information system became more functional.