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Poor utilization of maternal healthcare services remains a public health concern in most low and middle-income countries (LMICs), including Afghanistan. Late, inadequate, or no utilization of antenatal care (ANC) services pose a great concern. This study assessed the predictors of ANC service utilization among Afghan pregnant women, using secondary data from the Afghanistan Health Survey 2018 (AHS2018). In this study, we used data from 10,855 ever-married women, aged 13-49 years, who gave birth in the two years prior to the survey or those women who were currently pregnant. The outcome variable was defined as a binary variable on ANC utilization (≥1 ANC visit equals 1, and zero otherwise). We fitted a binary logistic regression model and examined the associations between ANC utilization and explanatory variables, providing findings based on univariate and multivariate analysis. STATA version 17 was employed for the data analysis. Overall, 63.2%, 22.0%, and 3.1% of women had at least one ANC visit, ≥4 ANC visits, and ≥8 ANC visits during their last pregnancy, respectively. Higher odds of ANC utilization were observed in women who could read and write (AOR = 1.55, 95%CI: 1.36-1.77), whose husbands could read and write (AOR = 1.42, 95%CI: 1.29-1.56), who knew 1 sign (AOR = 1.93, 95%CI: 1.74-2.14), 2 signs (AOR = 2.43, 95%CI: 2.17-2.71) and ≥ 3 signs (AOR = 1.55, 95%CI: 1.36-1.77) of complicated pregnancy, and those with almost daily access to radio (AOR = 1.19, 95%CI: 1.08-1.327) and TV (AOR = 1.92, 95%CI: 1.73-2.13). We also found that women with one (AOR = 0.64, 95%CI: 0.49-0.84) and more than one (AOR = 0.60, 95%CI: 0.47-0.76) parity status, those for whom in-laws and others decided for their birthplace [(AOR = 0.85, 95%CI: 0.74-0.97) and (AOR = 0.63, 95%CI: 0.55-0.72), respectively], and those that resided in rural areas (AOR = 0.89, 95%CI: 0.79-1.00) had reduced odds of ANC utilization. ANC service utilization is unacceptably low by pregnant women in Afghanistan. The predictors of ANC utilization identified by the study should be considered in the design of future interventions to enhance antenatal care utilization in Afghanistan.

Using postnatal care (PNC) within the first week following childbirth is crucial, as both the mother and her baby are particularly vulnerable to infections and mortality during this period. In this study, we examined the factors associated with early postnatal care (EPNC) use in Afghanistan. We used data from the multiple indicator cluster survey (MICS) 2022–2023. The study population was ever-married women who delivered a live child during their recent pregnancy within the 2 years preceding MICS 2022–23. The outcome was EPNC and defined as the first check of the mother within the first week of delivery. A binary logistic regression was used, and odds ratio (OR) and 95% CI were obtained. Out of 12,578 women, 16.0% received EPNC. EPNC was lower in women who delivered at home [AOR 0.35 (95% CI 0.28–0.44)] compared with women who delivered at public clinics. EPNC was higher in women with ≥ 4 antenatal care (ANC) visits [1.29 (1.02–162)], in women in the highest quintile of wealth status [1.70 (1.25–2.32)], and in women with access to radio [1.76 (1.45–2.15)]. EPNC use among Afghan women remains low (16.0%). Key factors associated with ENPC utilization include place of delivery, ANC utilization, wealth status, and radio access.

AbstractThe covid-19 pandemic saw frequent changes and conflicts in mask policies and politicization of masks. On reviewing the evidence, including studies published after the pandemic, the data suggest respirators are more effective than masks in healthcare, but must be continuously worn to be protective. Healthcare and aged care settings amplify outbreaks, so protection of patients and staff is paramount. Most guidelines assume risk is only present during close contact or aerosol generating procedures, but studies show intermittent use of respirators is not protective. New research in aerosol science confirms the risk of infection is widespread in health facilities. In community settings, any mask use is protective during epidemics, especially if used early, when combined with hand hygiene, and if wearers are compliant. Community use of N95 respirators is more protective than surgical masks, which are more protective than cloth masks, but even cloth masks provide some protection. Mask guidelines should be adaptable to the specific context and should account for rising epidemic activity, and whether a pathogen has asymptomatic transmission. The main rationale for universal masking during pandemics is asymptomatic transmission, which means risk of transmission cannot be self-identified. The precautionary principle should be applied during serious emerging infections or pandemics when transmission mode is not fully understood, or vaccines and drugs are not available. If respirators are not available, medical or cloth masks could be used as a last resort. Data exist to support extended use and reuse of masks and respirators during short supply. In summary, extensive evidence generated during the covid-19 pandemic confirms the superiority of respirators and supports the use of masks and respirators in the community during periods of high epidemic activity. Some gaps in research remain, including economic analyses, research in special population groups for whom masking is challenging, and research on countering disinformation.

Background Understanding the status of early childhood development (ECD) and its associated factors could serve as the basis for future policy efforts and interventions. Therefore, this study aimed to determine the status of ECD and its associated factors among children aged 36–59 months in Afghanistan. Methods We used data from the Afghanistan Multiple Indicator Cluster Survey 2022–2023 (MICS) to assess ECD status. The outcome variable was a binary measure, indicating whether a child was developmentally on track or not. To explore the associations between ECD status and various explanatory variables, we applied binary logistic regression models, presenting both univariate and multivariate analyses. Results Among the 13,866 children aged 36 to 59 months included in the analysis, 29.95% (95% CI: 29.19-30.72%) were found to be developmentally on track. The likelihood of being developmentally on track was higher in children whose mothers had secondary [adjusted odds ratio (AOR) 1.36 (95%CI 1.04–1.77)] and higher education [1.73 (1.08–2.76)], in children whose fathers had primary [1.32 (1.05–1.67)], secondary [1.40 (1.10–1.79) and higher education [1.60 (1.21–2.11)], and in children belonging to the higher household wealth status [1.46 (1.18–1.82)]. On the other hand, the likelihood of being developmentally on track was lower in children aged 48–59 months [0.35 (0.30–0.40)], in children living in rural areas [0.77 (0.62–0.96)], in children with stunting [0.77 (0.61–0.96)], and in underweight children [0.61 (0.52–0.72)]. Conclusion Our findings indicate that 29.95% of children aged 36–59 months in Afghanistan are developmentally on track. Positive associations were found between ECD and higher parental education and household wealth status. However, living in rural areas, underweight and stunted growth were negatively associated with ECD. To improve early childhood development programs in Afghanistan, targeted interventions are needed to address the factors identified in this study.

People with cancer have an increased risk of cardiovascular disease. Risk prediction equations developed in New Zealand accurately predict 5-year cardiovascular disease risk in a general primary care population in the country. We assessed the performance of these equations for survivors of cancer in New Zealand. For this validation study, patients aged 30–74 years from the PREDICT open cohort study, which was used to develop the New Zealand cardiovascular disease risk prediction equations, were included in the analysis if they had a primary diagnosis of invasive cancer at least 2 years before the date of the first cardiovascular disease risk assessment. The risk prediction equations are sex-specific and include the following predictors: age, ethnicity, socioeconomic deprivation index, family history of cardiovascular disease, smoking status, history of atrial fibrillation and diabetes, systolic blood pressure, total cholesterol to HDL cholesterol ratio, and preventive pharmacotherapy (blood-pressure-lowering, lipid-lowering, and antithrombotic drugs). Calibration was assessed by comparing the mean predicted 5-year cardiovascular disease risk, estimated using the risk prediction equations, with the observed risk across deciles of risk, for men and women, and according to the three clinical 5-year cardiovascular disease risk groups in New Zealand guidelines (<5%, 5% to <15%, and ≥15%). Discrimination was assessed by Harrell's C statistic. 14 263 patients were included in the study. The mean age was 61 years (SD 9) for men and 60 years (SD 8) for women, with a median follow-up of 5·8 years for men and 5·7 years for women. The observed cardiovascular disease risk was underpredicted by a maximum of 2·5% in male and 3·2% in female decile groups. When patients were grouped according to clinical risk groups, observed cardiovascular disease risk was underpredicted by less than 2% in the lower risk groups and overpredicted by 2·2% for men and 3·3% for women in the highest risk group. Harrell's C statistics were 0·67 (SE 0·01) for men and 0·73 (0·01) for women. The New Zealand cardiovascular disease risk prediction equations reasonably predicted the observed 5-year cardiovascular disease risk in survivors of cancer in the country, in whom risk prediction was considered clinically appropriate. Prediction could be improved by adding cancer-specific variables and considering competing risks. Our findings suggest that the equations are reasonable clinical tools for use in survivors of cancer in New Zealand. Auckland Medical Research Foundation, Health Research Council of New Zealand.

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.

To assess the prevalence of promotions on foods and non-alcoholic drinks purchased by New Zealand households and to determine if they vary according to healthiness of products. We undertook a cross-sectional analysis of Nielsen New Zealand Homescan® 2018/19 panel data. We conducted multivariate analyses to examine the variability in quantities of healthy v. unhealthy food and beverage products purchased on promotion. Promotion was self-reported by the panellist. Healthiness of products was measured by the Health Star Rating (HSR) system. We also carried out a subgroup analysis for beverages according to the threshold of < 5 g v. ≥ 5 g sugar per 100 ml content of products. The Nielsen New Zealand Homescan® data were linked with two New Zealand Food Composition Databases (Nutritrack and the FOODfiles). Food and beverage purchases data by 1800 panel households were used. Overall, 46 % (1 803 601/3 940 458) of all purchases made were on promotion. Compared with purchases of food and beverage products with HSR < 3·5 (unhealthy), food and beverage products with HSR ≥ 3·5 (healthy) were significantly less likely to be on promotion (OR = 0·78, 95 % CI 0·77, 0·79). The subgroup analysis for beverages shows that products with < 5 g sugar per 100 ml were significantly less likely to be on promotion than those with ≥ 5 g sugar per 100 ml (OR = 0·77, 95 % CI 0·75, 0·79). Policies to improve healthy food retailing should focus on increasing the promotion of healthier food and drink options in stores and supermarkets.

Mother-newborn skin-to-skin contact (SSC) involves placing the naked infant on the mother's bare chest within the first hour of birth and is crucial for thermoregulation, bonding, breastfeeding initiation, and promoting neonatal health. This study examined the prevalence, and factors associated with SSC in Afghanistan. Data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022-23 were used and analysed from ever-married women, aged 15-49 years, who delivered a live infant in the past 2 years. The outcome was SSC, placing the naked infant on the mother's bare chest and initiating breastfeeding within the first hour of birth. Adjusted odds ratios [AOR: (95%CI)] of factors associated with SSC were obtained by a logistic regression model. Of 11,992 women, 32.9% practiced SSC. The likelihood of SSC was greater in women with primary [1.38 (1.14-1.68)] and secondary or higher [1.29 (1.06-1.57)] education, in women who had access to media [1.36 (1.11-1.65)], and those who owned mobile phones [1.27 (1.11-1.45)]. The likelihood of SSC was lower in women who delivered at home [0.26 (0.21-0.33)], those who delivered at private clinics or hospitals [0.50 (0.41-0.61)], and those with cesarean section [0.12 (0.08-0.17)]. Women living in rural areas, and women with deliveries conducted by traditional birth attendants/community healthcare workers and by relatives/others had lower odds of SSC [0.76 (0.63-0.92), 0.37 (0.27-0.53), 0.45 (0.33-0.59), respectively]. The low prevalence of SSC in Afghanistan highlights the need for targeted health interventions. Efforts should focus on improving access to public clinics and hospitals, enhancing education, training of healthcare providers, and leveraging media and mobile phone access to promote SSC. Interventions should prioritize rural women and women who have undergone cesarean sections to increase SSC rates and improve neonatal health outcomes.

Background Maternal and newborn mortality is a public health concern in low- and middle-income countries (LMICs), including Afghanistan, where the evolving socio-political circumstances have added new complexities to healthcare service delivery. Birth outcomes for both pregnant women and their newborns are improved if women receive benefits of quality antenatal care (ANC). Objectives This study aimed to assess the contents of ANC services and identify predictors of utilization of services by pregnant women during ANC visits to health facilities in Afghanistan. Methods In this cross-sectional study, we used data from the Afghanistan Health Survey 2018 (AHS2018). We included a total of 6,627 ever-married women, aged 14–49 years, who had given birth in the past 2 years or were pregnant at the time of survey and had consulted a health worker for ANC services in a health facility. The outcome was defined as 1–4 services and 5–8 services that a pregnant woman received during an ANC visit. The services were (i) taking a pregnant woman’s blood pressure, (ii) weighing her, (iii) testing her blood, (iv) testing her urine, (v) providing advice on nutrition, (vi) advising about complicated pregnancy, (vii) advising about the availability of health services, and (viii) giving her at least one dose of Tetanus Toxoid (TT) vaccine. The binary outcome (1–4 services versus 5–8 services) was used in a multivariable logistic regression model. Results Of all 6,627 women, 31.4% (2,083) received 5–8 services during ANC visits. Only 1.3% (86) received all 8 services, with 98.7% (6,541) receiving between 1 and 7 services, and 71.6% (4,745) women had their blood pressure measured during ANC visits. The likelihood (adOR = Adjusted Odds Ratio) of receiving 5–8 services was higher in women who could read and write (adOR = 1.33: 1.15–1.54), in women whose husbands could read and write (adOR = 1.14: 1.00-1.28), in primipara women (adOR = 1.42: 1.02–1.98), in women who knew one danger sign (adOR = 5.38: 4.50–6.45), those who knew 2 danger signs (adOR = 8.51: 7.12–10.19) and those who knew ≥ 3 danger signs (adOR = 13.19: 10.67–16.29) of complicated pregnancy, and in women who had almost daily access to TV (adOR = 1.16: 1.01–1.33). However, the likelihood of receiving 5–8 services was lower in women who used private clinics (adOR = 0.64: 0.55–0.74) and who received services from nurses (adOR = 0.27 (0.08–0.88). Conclusion Our findings have the potential to influence the design and implementation of ANC services of health interventions to improve the delivery of services to pregnant women during ANC visits.

Objectives Delayed neonatal bathing, defined as postponing the first bath until at least 24 h after birth, is a key component of essential newborn care that helps maintain thermal stability and reduces the risk of hypothermia and infection. This study estimates the national prevalence of delayed neonatal bathing and identifies its determinants in Afghanistan. This study analyzed data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022–2023. We fitted multivariable binary logistic regression models to determine factors associated with delayed neonatal bathing. Results Out of 7,702 women, 68.6% reported delayed neonatal bathing. After adjustment, the odds of delayed bathing were higher among women whose household head completed primary education (AOR 1.38; 95% CI: 1.10–1.73), those delivering in health facilities (AOR 1.57; 95% CI: 1.29–1.91), and women attending 1–3 antenatal care (ANC) visits (AOR 1.29; 95% CI: 1.08–1.53) or 4–7 ANC visits (AOR 1.40; 95%CI: 1.14–1.72) or ≥ 8 ANC visits (AOR 2.05; 95% CI: 1.46–2.87). Conversely, women in the richest wealth quintile were less likely to delay bathing (AOR 0.69; 95% CI: 0.51–0.94). Tailored interventions that leverage antenatal contacts and facility-based care may further improve the adoption of optimal newborn bathing practices in Afghanistan.