Hospital In Kabul Research Articles

The prevalence of episiotomy and associated factors at Shahrara Teaching Hospital in Kabul, Afghanistan

BackgroundEpisiotomy is done to expand the birth canal but can cause serious complications. It is still commonly performed in many parts of the world representing a quality-of-care and quality-of-life challenge. There is currently no data regarding the prevalence of episiotomy in Afghanistan. The aim of this study was to determine the prevalence of episiotomy and associated factors in women who delivered at a teaching hospital in Kabul, Afghanistan.MethodsA retrospective, cross-sectional study was conducted at Shahrara Teaching Hospital. The study sample included all women at Shahrara Teaching Hospital with vaginal delivery during the first six months of 2023. Demographic and clinical information was gathered from medical records. Descriptive statistics were calculated. Logistic regression was performed to assess the independent predictors of episiotomy.ResultsA total of 1,288 women had vaginal delivery during the study period and 306 (23.76%) delivered using episiotomy. Higher parity was associated with lower odds of episiotomy (OR: 0.01 95% CI 0.007–0.022; p < 0.0001) and a longer duration of labor during stage 2 was associated with higher odds of episiotomy (OR: 1.04 95% CI 1.01–1.07; p = 0.02). An association between Apgar score at the first minute of birth was also associated with higher odds of episiotomy (OR: 1.72 95% CI 0.98–3.03; p = 0.06) although this did not reach statistical significance at a value of p < 0.05. Also of note, the majority of patients received oxytocin (72.2%) and only 1 vacuum delivery was performed representing two additional quality-of-care issues.ConclusionsThis study is the first to estimate the prevalence of episiotomy in Afghanistan. The rate of episiotomy found in this study was higher than WHO recommendations but lower compared to studies from other low-income or middle-income countries in Asia and Africa. Additional efforts, including national guidelines or policies and workforce training, are needed to further reduce the rate.

Comprehensive Evaluation of Nurses' Competencies and Performance in Hospital Infection Control Practices: A Case Study of Ali Abad Teaching Hospital, Afghanistan

Hospital-acquired infections (HAIs) remain a significant public health concern, posing challenges to healthcare systems worldwide. Nurses, as frontline healthcare workers, play a critical role in preventing and controlling these infections. However, their knowledge and practices regarding infection prevention and control are often inconsistent, which can lead to varying levels of infection prevention. The primary aim of this study was to assess the awareness, attitudes, and practices of nurses at Aliabad Teaching Hospital in Kabul, Afghanistan, concerning hospital-acquired infections. A descriptive cross-sectional study was conducted over a three-month period, involving 150 nurses working in different departments of the hospital. Data was collected through a structured questionnaire that assessed demographic information, awareness, attitudes, and practices related to infection prevention. The study found that a significant majority of nurses (81.36%) were aware of HAIs, but only 42.5% reported possessing the necessary skills to manage these infections effectively. Nurses who received regular training and used personal protective equipment (PPE) exhibited higher levels of competency in infection control practices. However, there were areas where improvement was needed, particularly in hand hygiene practices and consistent use of PPE. The study concluded that while there is a general awareness of HAIs among nurses, there is a need for continuous training and strengthening infection control measures to enhance patient safety and improve healthcare outcomes.

A Retrospective Study on Correlation of Facial Fractures and Type of Trauma in Patients Admitted in Department of Maxillofacial Surgery of Stomatology National and Specialized Hospital, Kabul, Afghanistan.

Facial bone fractures represent a significant clinical challenge due to their prevalence and the complexity of treatment required. Understanding the demographic patterns, causes, and treatment outcomes of these injuries is crucial for improving patient care and developing targeted prevention strategies. This study aims to analyze the demographic characteristics, etiological factors, anatomical distribution, and treatment modalities of patients presenting with facial bone fractures at Stomatology National and Specialized Hospital in Kabul, Afghanistan, during 2022. A retrospective analysis was conducted on 463 patients with facial bone fractures treated at the hospital. Data collected included patient demographics, causes of trauma, fracture location, and treatment methods. Statistical analysis was performed to identify patterns and correlations. The study included 463 patients (378 males and 85 females), aged between 3 and 88 years, with a mean age of 26.34 years. The primary causes of trauma were road traffic accidents (RTAs) (29.6%), interpersonal violence (26.1%), and falls (23.3%). The mandible was the most commonly fractured bone (74.1%), with the parasymphysis being the predominant site of injury. Treatment predominantly involved closed reduction (54.9%), with a significant portion of patients undergoing open reduction and internal fixation (ORIF) (45.1%). The findings highlight RTAs, interpersonal violence, and falls as the leading causes of facial bone fractures. The mandible is the most frequently affected bone. Closed reduction remains the most common treatment modality. These insights underline the need for enhanced preventive measures, including stricter enforcement of traffic regulations and targeted interventions to address interpersonal violence and fall prevention.

Demography of Haemorrhoids in Jamhuriat Hospital, Kabul.

Hemorrhoids, common benign anorectal conditions, are associated with various factors, such as low fiber intake, constipation, and pregnancy. Treatment typically involves procedures such as banding and surgery. This retrospective investigation aimed to assess the frequency and demography of hemorrhoids in Kabul, Afghanistan. This study was conducted at Jamhuriat Hospital in Kabul, Afghanistan. Two hundred and fifty-two patients who were diagnosed with hemorrhoids were included. All pertinent demographic data were collected from the medical records and analyzed using IBM SPSS Statistics 25. Males composed 83.7% of the patients, and 32.9% were aged 30-40 years. A lower socioeconomic status was common (61.1%). Bleeding, prolapse, and pain were frequent symptoms. Surgical management was common for third- and fourth-degree hemorrhoids (51.6%). This study found a high prevalence of hemorrhoids among males (83.7%) and low-income individuals (61.1%), highlighting the need for further research into risk factors for delayed presentation.

Using Mobile Health (mHealth) Applications to Improve Access to Healthcare in Afghanistan

This study investigates the utilization of mobile health (mHealth) applications to improve healthcare access in Afghanistan. The research employs a mixed-methods approach, combining qualitative interviews and quantitative surveys with healthcare providers, patients, technology experts, and health administrators at Sehat Hospital in Kabul. Through thematic analysis of interview data and descriptive and inferential analysis of survey responses, the study explores the current landscape of mHealth applications, including their availability, features, usage patterns, and perceived impact on healthcare delivery and patient outcomes. The findings reveal diverse perceptions among participants regarding the accessibility, relevance, and effectiveness of mHealth interventions in Afghanistan. Challenges related to security, cultural adaptation, and user awareness are identified, alongside opportunities for enhancing the design and implementation of mHealth solutions. The study contributes valuable insights into the potential of mHealth applications to address healthcare disparities and improve patient outcomes in resource-constrained settings like Afghanistan. Recommendations for policymakers, healthcare providers, and technology developers are provided to optimize the use of mHealth technologies and maximize their impact on healthcare delivery. Overall, this research underscores the importance of contextually relevant and user-centered approaches in leveraging technology to advance healthcare access and quality in Afghanistan.

The Role of Pharmacists in Providing Pharmaceutical Services in Selected Government Hospitals in Kabul

Objective: This study aims to investigate the role of pharmacists in delivering pharmaceutical services within selected government hospitals in Kabul, utilizing the SERVQUAL model. Methods: A quantitative research design was employed, utilizing a sample population of 338 patients who were hospitalized in the selected hospitals. A structured questionnaire was used to collect data on socio-demographic characteristics and perceptions of pharmaceutical services. The data were analyzed using the linear regression test to examine the relationships between the role of pharmacists and the combined indices. Results: he results indicated a significant positive relationship between the role of pharmacists and the combined indices of tangible factors, reliability and credibility, responsiveness, reassurance, and empathy (R = 0.642, R-squared = 0.412, Adjusted R-squared = 0.403, p &lt; 0.001). Tangible factors, reliability and credibility, and empathy demonstrated the most substantial influence on the pharmacists' role. Conclusion: The results demonstrate that patients in selected hospitals within Kabul are content with the quality of services provided. Based on the SERVQUAL model, patient satisfaction with service quality is achieved across five dimensions: tangible factors, reliability, responsiveness, assurance, and empathy. Notably, the reliability variable garners the highest satisfaction level, while the empathy variable receives the lowest. These findings emphasize the need for targeted efforts to enhance empathy, communication, and the overall quality of pharmaceutical services delivered by pharmacists in selected hospitals within Kabul.

Case Series Study on Recovery of Left Ventricle Systolic Function After Percutaneous Coronary Intervention In ST-Segment Elevation Myocardial Infarction Patients at FMIC Hospital in Kabul, Afghanistan.

Background Left ventricle dysfunction is the most recurrent consequence of ST-elevated myocardial infarction, and still, it is a powerful predictor of mortality. The percutaneous coronary intervention of the culprit artery disease in acute coronary syndrome is related to a significant improvement of left ventricle segmental function. It is a retrospective case series study on a patient population with the diagnosis of ST-elevated myocardial infarction patients who presented to the hospital within 12 hours and underwent percutaneous coronary intervention at the French Medical Institute of Mother and Children Hospital. Data was collected retrospectively from the patient's medical record files and analyzed. We took the patients with Left ventricle dysfunction on echocardiography on the first presentation before percutaneous coronary intervention and saw the left ventricle function after three months of follow-up. We reviewed the charts of 102 patients (78.4% male and 21.6% female) with a diagnosis of St-elevated myocardial infarction who presented within 12 hours of chest pain. Of 102 patients, 55.9% had hypertension, 21.6% diabetes, 22.5% dyslipidemia, and 19.6% history of smoking, and their mean age was 58.11 ± 11.993 years. We noticed that percutaneous coronary intervention led to significant left ventricle dysfunction improvement in the patient population with ST-elevated myocardial infarction who presented within 12 hours of chest pain.

Postpartum depression among primigravida mothers in Kabul, Afghanistan

Introduction: Postpartum depression (PPD) is a prevalent mental health issue affecting women post-childbirth, particularly primigravida mothers. This study aims to explore the prevalence and risk factors of PPD among primigravida mothers in Kabul, Afghanistan, a low- and middle-income country with limited research on PPD among primigravida mothers. Materials and Methods: A descriptive cross-sectional study design was employed, and data were collected from 200 primigravida mothers who gave birth in Rabia Balkhi and Malalai Hospitals in Kabul. A structured questionnaire was utilized to gather data on socio-demographic characteristics, PPD symptoms, and risk factors, which were analyzed using descriptive statistics and SPSS. Results: The study findings revealed that 42.5% of the primigravida mothers in Kabul experienced symptoms of PPD according to EPDS scores. This prevalence rate was higher than global estimates and previous studies in high-income countries. Risk factors associated with PPD among primigravida mothers in Kabul included a history of depression or mental health problems (55.5%), job loss or financial difficulties (74.5%), trauma related to natural disasters or war (63%), experiences of physical or verbal abuse (34.5%), lack of social support or feelings of isolation (23%), and difficulties adjusting to motherhood (48.5%). Conclusion: The study highlights the prevalence and risk factors of Postpartum Depression among primigravida mothers in Kabul, Afghanistan, emphasizing the need for interventions to support new mothers' mental health, including prioritizing screening, providing targeted support, and addressing socioeconomic and environmental challenges, through investment in mental health services and public health campaigns.

Treatment outcomes for maculopathy secondary to retinal vein occlusion in Afghanistan.

The objective of this study was to investigate the efficacy of intravitreal antivascular endothelial growth factor (VEGF) therapy in the treatment of macular edema secondary to retinal vein occlusion (RVO) in Afghanistan. A retrospective analysis was conducted of all RVO cases that underwent intravitreal ant-VEGF injection at the two leading hospitals in Kabul. The main outcome measures were visual acuity and central retinal thickness as determined by optical coherence tomography. Information was also collected on the distance traveled by each patient and the frequency of injections. One hundred and twenty-five eyes of 121 patients (86 males) with RVO were identified as having undergone treatment, with a mean age of 53.1 years (range 20-80). The only agent used was bevacizumab. The mean central retinal thickness reduced from 624.2 ± 24.9 μm at the baseline to 257.8 ± 5.7 μm following treatment (P < 0.001). There was a small increase in visual acuity from 1.33 LogMAR at the baseline to 1.13 LogMAR following the most recent injection (P = 0.03, paired t-test). The mean distance traveled by patients was 173.9 km (range 2-447 km). Despite the challenges of health-care provision in Afghanistan, this review shows that the use of intravitreal bevacizumab has provided an effective treatment for macular edema after RVO.

Analysis of Primary Tooth Extractions and Associated Factors in 3 to 5-Year-Old Children in Kabul, Afghanistan: A Retrospective Study.

Understanding the patterns and reasons behind the extraction of children's primary teeth is crucial for improving oral health outcomes. This retrospective investigation aimed to discern the patterns and factors contributing to primary tooth extraction among pediatric patients aged 3 to 5 years treated at the Pediatric Surgery Department of the National Curative and Specialized Stomatology Hospital in Kabul, Afghanistan. Between January and May 2023, we conducted an extensive review of dental records, focusing on patients aged 3 to 5 years who had undergone primary tooth extraction. Data were collected on patients' age, gender, specif tooth extracted, and reasons for tooth extraction. Statistical analysis was performed using SPSS Statistics version 25. Among 150 subjects reviewed, 53.3% were male. Primary first molars were the most commonly extracted teeth (29.3%). Dental caries was the leading cause of extraction (50%), followed by periodontitis (31.3%) and root resorption (18.7%). Mandibular extractions (58.6%) were more frequent than maxillary extractions (41.4%). No significant differences were found based on age or tooth type. Weak correlations were observed between specific tooth extractions, age, and etiology. This study reveals a higher frequency of extractions in older children, primarily due to dental caries, periodontitis, and root resorption, with a slight male predominance. While no significant differences were noted in extraction patterns based on age or tooth type, understanding these trends is essential for improving pediatric dental care.

Excessive Dilution of Oral Antibiotic Suspensions and Oversized Bottles: An Exploratory Survey Based on Pediatrician’s Experiences in Kabul

Medication errors in the reconstitution of oral suspensions, which include excessive dilution, may affect the treatment outcome despite the correct diagnosis and selection of appropriate treatment. Objective: To document the practice of parents/caregivers adding more than double the recommended volume of water to oversized bottles of oral Azithromycin or Cefixime suspensions. Method: An exploratory survey was conducted using self-administered anonymous questionnaires. It involved the participation of 32 pediatricians from different pediatrics departments at Maiwand Teaching Hospital, an inner-city hospital in Kabul. The survey aimed to gather pediatricians' experiences with parents/caregivers adding excessive water to Azithromycin or Cefixime oral suspensions to approximately twice the recommended concentration Results: Twenty-five participating pediatricians (78.1%) reported encountering at least one instance where more than double the recommended amount of water was added to Azithromycin or Cefixime suspensions. The majority of these cases (84%) were observed in the outpatient department. Eighteen participants (72%) thought the issue was rare or infrequent, while seven (28%) thought it was frequent. Conclusion: Bottles of oversized oral antibiotic suspensions had been filled up with water to nearly their full volumes, which reduced the concentration of active substances to half or less, and may threaten the treatment outcome. This problem is not confined to any particular country but can arise in any situation where non-healthcare professionals reconstitute pediatric oral suspensions using oversized bottles. Improved reconstitution education, separate diluent bottles for oral suspension, and the establishment of standards and ceilings relative to total dose volume for oral suspension bottles are recommended.

Spinal tuberculosis in Afghanistan: A 2019‐2020 study of patients in Kabul hospitals

AbstractBackgroundTuberculosis (TB) is endemic in many low‐income countries, which can affect the spine in 1%–5% of those with an active infection. This study reports the clinical characteristics of patients admitted for spinal TB in Kabul, Afghanistan, a country with very limited resources.MethodsThis was a descriptive study among 26 patients treated for spinal TB in three major referral hospitals in Kabul, Afghanistan, between March 2019 and April 2020. The sociodemographic and clinical details, gender, age, site of infection, presenting complaints, signs, and symptoms of the patients were retrieved from their medical records. Summary statistics were analyzed using SPSS version 20. Ethics approval was obtained from the ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran.ResultsData were available for 26 patients with spinal TB admitted consecutively. The mean age of the sample was 38.2 years (SD 17.5), and there were 16 males and 10 females. Median time from symptom onset to hospital admission was 60 days. The most common diagnostic imaging technique used was magnetic resonance imaging (92.3%), followed by computed tomography (7.7%). The majority of the lesions involved the lumbar spine (61.4%), followed by the thoracolumbar spine (30.8%). Back pain was the most common manifestation in 21 patients (80.8%), and varying degrees of neurological impairment were found in 16 (61.5%) patients. There were no deaths among the patients up to the discharge date.ConclusionsThis study describes the clinical characteristics of spinal TB among patients in Kabul, Afghanistan. It is essential to strengthen preventive strategies and to improve health awareness about clinical features of spinal TB in patients with chronic back pain even in the absence of signs of TB.

The Relationship Between Empowerment and Social Support Among Pregnant Afghan Women: A Crosssectional Study in Kabul City, Afghanistan

Background and Purpose: Afghanistan experiences a significant maternal mortality rate, which could be mitigated through the empowerment of women and increased social support. This study aimed to explore the relationship between empowerment and social support among pregnant women seeking care at governmental hospitals in Kabul City, Afghanistan. Materials and Methods: A cross-sectional study was conducted in 4 governmental hospitals in Kabul, Afghanistan, in 2020. Through a convenient sampling, 428 pregnant women were recruited. The Kameda empowerment (Cronbach α=0.89) was used to measure woman empowerment. Sarason social support questionnaires with two subscales, including social support number (Cronbach α=0.95) and social support satisfaction (Cronbach α=0.96), were used to collect the study data. Then, the obtained data were analyzed using SPSS software, version 16, and the Pearson correlation test determined the association between variables at the significance level of P&lt;0.05. Results: The study participants’ Mean±SD age was 26.55±5 years. Many were illiterate (28.3%), and more than half (79.7%) were homemakers. Almost two-thirds had no sources of income (71.3%). The Mean±SD gestational age was 32.16±5.04 weeks, and 77.6% of participants wanted their pregnancy. The Mean±SD score for empowerment from 428 research samples was 85.48±9.02, for social support number was 5.49±0.65 (which indicates the low number of people who support women), and for social support satisfaction was 1.5±0.43 (which indicates a low level of social support satisfaction). Empowerment had a positive significant relationship with social support satisfaction (r=0.157, P=0.01) and social support number (r=0.129, P=0.007). Conclusion: Given the significant positive relationship between empowerment and social support in pregnant Afghan women, the low scores of social support call for more attention to the special needs of Afghan women to enhance the social safety net and improve social support, particularly among pregnant women, and eventually enhance the empowerment and reduce the maternal mortality rate among them.

Misuse of Respiratory Inhalers Among Hospitalized Patients in a Tertiary Health Care Hospital in Kabul.

Evaluation of the techniques of respiratory inhaler use among stable inpatients with COPD in Ali Abad Teaching Hospital. This cross-sectional study was conducted between April 2020 and October 2022 at the cardiopulmonary department of Ali-Abad Teaching Hospital. Participants were requested to demonstrate how to use their prescribed inhalation devices. The inhaler's accuracy was evaluated using checklists that had been previously established and included key procedures. We studied 318 patients performing a total of 398 inhalation maneuvers with five different IDs. Across all studied inhalation maneuvers, the maximum number of misuses was observed in those using the Respimat (97.7%), and the minimum number of misuses was observed in those using the Accuhaler (58.8%). For the pMDI, the steps "take a deep breath after activating the inhaler" and "hold the breath a few seconds" were most frequently inaccurately performed. Regarding the pMDI with spacer, the steps "exhale fully" were most commonly carried out in mistake. For the Respimat, the steps "hold the breath a few seconds after inhalation activation" and "exhale fully" were most frequently inaccurately performed. According to gender, the misuse was less in females for all studied inhalers (p<0.05). Higher proportion of literate participant correctly used all types of inhalers as compared to the illiterate patients (p<0.05). According to the findings of this study, the majority of patients (77.6%) lacked knowledge of proper inhaler technique. The misuse rates were high for all studied inhalers; however, among studied inhalers, the Accuhaler had the greatest proportion of correct inhalation techniques. In order to ensure proper inhaler technique, patients should be educated before receiving inhaler medicines. Therefore, it is crucial for doctors, nurses, and other healthcare professionals to comprehend the problems with the performance and proper usage of these inhaler devices.

Association between household air pollution and pneumonia among children under five years old admitted at the Indira Gandhi children’s hospital in Kabul, Afghanistan

Introduction: Pneumonia is the single largest cause of death of children under the age of five (U5) globally, and nearly half of these (0.6 million/ year) occur because of Household Air Pollution (HAP). Combustion of wood and fossil fuels, inefficient stoves, and poor ventilation exacerbate HAP. Almost one in five deaths among U5 children in Afghanistan is due to pneumonia. The current case-control study is to find the association between pneumonia admissions of U5 children at the Children’s Hospital and HAP in Afghanistan.&#x0D; Materials and methods: A hospital-based case-control study was done with caregivers of 70 confirmed pneumonia cases and 127 patients of control group from other departments in the hospital who were interviewed through a structured questionnaire.&#x0D; Results: Cases and controls were found to be same on all demographic characteristics except number of children under 1 year of age. Chi-square analysis showed that those without ventilation systems in the house to remove smoke (p=0.036) and those using traditional stoves (p=0.002) were more likely to be higher among patients with pneumonia than control group. There was also a close association between U5 pneumonia and the use of room fresheners at home (p=0.027) and smoke from room heaters (0.002). Household air pollution showed a significant association with pneumonia (p=0.000).&#x0D; Conclusion: The incidence of respiratory diseases is higher among children and women in the family who are more likely to be exposed to HAP. Household air pollution is related to pneumonia in U5 children in Afghanistan. Creating awareness among the caregivers about the factors contributing to pneumonia and providing alternatives can help reduce the mortality of children.

Civilian war victims in Afghanistan: five-year report from the Kabul EMERGENCY NGO hospital.

Afghanistan has been plagued by war for more than 30years, but little is known about the civilian cost of such a long-lasting conflict. In particular, the incidence of war injuries among civilians has largely been under-reported. EMERGENCY NGO's Surgical Centre for War Victims has been operating in Kabul since 2001, providing care free of charge to anyone injured in war. The primary aim of our study is to describe the population of patients admitted to our hospital in Kabul. This is a 5-year retrospective analysis of all recorded hospital admissions at EMERGENCY NGO's hospital in Kabul, Afghanistan, from 1 January 2017 to 31 December 2021. During the study period, 16,053 patients were admitted. Of these, 85.7% were male and 17.5% were under 14years old. The proportion of male patients increased progressively with the age ranges (from 63.4 to 89.0%). Bullet wounds were the most frequent kind of injury (55.6%), followed by shell, stab and mine wounds (32.2%, 8.3% and 3.9% respectively). Only 5.8% of patients arrived at our hospital within the "golden hour" following injury. No significant reduction in the hospitalization trend was observed over the study period. The overall in-hospital mortality rate was 4.41%, which bore no correlation to the number of admissions. This study provides for the first time epidemiology of war-related injuries in a hospital located in a place of long-standing conflict.

Professor Georgy Savvovich Chepcheruk (on the 80&lt;sup&gt;th&lt;/sup&gt; anniversary of his birthday)

Georgy Savvovich Chepcheruk was born on September 8, 1942 in the village of Gremyache, Rivne region of the Ukrainian SSR. After graduating from elementary school in 1955, he studied at the Dubna Medical School in the Rivne region until 1958. Then, for two years, he worked as the head of the feldsher-midwife station. In 1960, he was drafted into the ranks of the Soviet army. He began his service as a paramedic of an artillery regiment, from where, in 1962, he entered the Military Medical Academy named after S. M. Kirov. He graduated from the Academy in 1968 with a GOLD MEDAL. After graduating from the Academy, he served for 4 years as the head of the medical service of a submarine in the Red Banner Black Sea Fleet. In 1972, having successfully passed the entrance exams, he entered the postgraduate course at the Department of Hospital Surgery of the Military Medical Academy named after S. M. Kirov. In 1976, he defended his PhD dissertation on the subject: «Clotted hemothorax and early fibrinothorax after pneumonectomy». He held positions from teacher to deputy head of the department. From 1984 to 1987, he served in the Democratic Republic of Afghanistan as an adviser to the chief surgeon of the Central Military Hospital in Kabul. In 1988, he defended his doctoral dissertation on the subject: «Pathogenetic bases for the prevention and treatment of pleural empyema». From 1989 to 1994 – Deputy Head of the Department of Hospital Surgery. From this position in 1994, he retired from the ranks of the Armed Forces continuing to work in civil healthcare on the basis of the hospital of the Ministry of Internal Affairs of St. Petersburg until 2018. Georgy Savvovich devoted all his main activities in medicine to thoracic surgery. The results of his practical and scientific activity of many years were published in more than 170 scientific papers, 7 monographs and guidelines for physicians. Georgy Savvovich was a «pioneer» in the use of direct-acting fibrinolytic therapy in thoracic surgery as an alternative to surgical treatment in such pathological conditions as fibrinothorax, pleural empyema, clotted hemothorax.

Estimating the Cancer Treatment Cost for 5 Common Types of Cancer with Separating Out-of-Pocket and Governmental Costs in Afghanistan, 2020.

The objective this study was to estimate the cost of cancer treatment services for 5 common types of cancer (Breast, Esophageal, Colorectal, Stomach and lung) by the public sector and patients. This study was a cross-sectional study that conducted using the medical records of patients who were registered in the Jamhuriyat Hospital from 1, 2020 to 12, 2020. The prevalence-based approach was used to estimate the costs of five major cancer types. The data of 769 patients were eligible to include for the analysis. The considered cost of services was obtained from the average cost in 3 private hospitals in Kabul. Also all costs converted in to US dollar using the exchange rate of each USD equaling to AFN 77 in 2020. The data was analyzed using Ms. Excel Program. The total number of patients with 5 types of cancer were 769. Of these, female, in the age group of 40-60 years and were illiterate. The most common cancers based on the cancer treatment services' costs of health services was breast cancer, followed by esophagus, colorectal, stomach and lung. Moreover, the most common cancers based on the cancer treatment services' costs of health services which cancer patients needed was breast cancer, followed by esophagus, colorectal, stomach and lung. Moreover, total cost of cancer treatment is US$590,662.98, in which Patients paid USD 82,537 of it out-of-pocket. The costs of cancer treatment services for 5 common types of cancer are high which a considerable portion are paid by patients. There is a need for the government to pay more attention to the provision of these services and to increase the centers providing these services and the existing facilities. Also, support of the international community in this process can enable more people to access these services and reduce the economic burden on patients.

High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study

Severe Acute Respiratory Syndrome Corona Virus Type-2 (SARS-COV-2) was first detected in China and created a global pandemic rapidly. Subsequently after serious efforts different types of vaccines produced against the virus and recommended for all people including pregnant women. The aim of this study was to realize the willingness of pregnant women to accept the COVID-19 vaccine in Kabul Afghanistan. For this purpose, a cross-sectional study was conducted in gynecology wards of several hospitals in Kabul, Afghanistan from 10th of July to 20th of August 2021 through direct interview with the pregnant women who had come for prenatal care to the healthcare centers. The collected data were analyzed through Statistical Package for Social Studies (SPSS) version 25. Simple descriptive analysis computed for demographic characteristics and bi-variable (Chi-square) analysis was carried out to find out the associations of taking vaccine with demographic variables. A p-value of < 0.05 was considered significant at 95% confidence interval. A total of 491 who were completed the inclusion criteria included in the analysis. A small portion of pregnant women (8.6%) illustrated the intent to get the COVID-19 vaccine if it is recommended by the health authorities in Afghanistan. Our study found a high rate of COVID-19 vaccine refusal among pregnant women in Kabul, Afghanistan. They showed the concern on adverse effects of the vaccine as the main reason for refusal, emphasizing the need to reduce the misconception on vaccine efficacy and campaigns to enhance awareness on the vaccine safety and benefits for mothers and babies.

EMERGENCY REPEAT CESAREAN SECTION IN WOMEN IN MALALAI AND SHARARA HOSPITALS

Repeat cesarean deliveries are associated with complications of cesarean section (CS) and predisposition to morbidity resulting from placenta previa, morbidly adherent placenta, complicated surgeries, uterine rupture and bladder injury. Successful trial of labor and vaginal birth after cesarean section (VBAC) results in decrease in maternal morbidity. An unsuccessful trial of labor after Cesarean (TOLAC) is defined as failure to achieve a vaginal birth after cesarean section in women undergoing a TOLAC and the delivery ending with emergency cesarean section. In this study we aim to determine the frequency of inter delivery interval and emergency cesarean section attempt at vaginal delivery among women with one previous CS. The descriptive cross-sectional study was conducted at Malalai and Sharara maternity hospitals in Kabul, for three consecutive months. The collected data were presented as mean, standard deviation (±SD),frequency and percentage.A total of 204 women with one previous CS out of 180 were eligible for TOLAC according to the hospital protocol and 35 women (19.4%) of the studied women had emergency cesarean, 34.47% women with their inter delivery interval were between 16-19 months most cases of unsuccessful TOLAC 43% were seen among women between 25 to 29 y old with mean age of 26.43 ± 5.6. In our study frequency of repeat emergency cesarean in women with prior CS was found as 19.4%, most cases have been seen in women with short inter delivery interval, most cesarean performed between 37-39 week of gestational age, fetal distress was the most indication of repeat emergency cesareans. &nbsp;