The recent political crisis in Afghanistan will result in the influx of refugees to the United States and other locations who may need medical attention immediately or in the coming months. As such, familiarity of the diagnostic team, including pathologists and laboratory professionals, with the epidemiology of disease in Afghanistan and surrounding region can improve differential diagnoses, ensure the completeness of diagnostic workups, and assist with seeking expert advice for difficult or rarely encountered cases.
Diseases
Cancer: Breast, Stomach, Lip/Oral (and other smoking/tobacco-related), and Esophagus are most common. Underdiagnosed.
COVID-19: Testing has been very limited, with little confidence in official statistics. Public mitigation efforts limited due to conflict. Vaccine uptake low (<3% of population). Delta surge currently
Crimea-Congo Hemorrhagic Fever: Increasing since 2016, 483 cases in 2018, incubation = 2 weeks
Diarrhea: ~30% incidence (E. coli, Campylobacter, Shigella, Salmonella); Rotavirus vaccination rates <60%; incubation period is typically less than 5 days (2 days on average)
Fasciola (liver fluke): Increasing in region, sheep or goat exposure most common
Giardia: Up to 11% of children
Hepatitis A: Commonly Underdiagnosed
Hepatitis B: Vaccination rates less than 65%
Hepatitis C: Commonly Underdiagnosed
HIV: Less than 0.1% (Total estimated = 12,000)
Leishmaniasis: Highly endemic (cutaneous
Leprosy: Endemic (80% multi-bacillary); central highland provinces
Malaria (P. falciparum, P. vivax): 80-95% P. falciparum, ~100,000 cases per year total. Approximately 8/1000 Afghans infected; slide positivity rate >17%.
Measles: Vaccination rate <60%
Pneumonia/Respiratory Infections: Pneumococcus (vaccine preventable) most common in children (60% vaccination rate); Haemophilus vaccination rate <60%; Diphtheria/Pertussis vaccination rate between 60 - 80%
Poliomyelitis: 1 case in 2021 of wild type, 43 cases of vaccine-derived. Last reservoir of polio in central Asia. Eradication campaigns have been majorly disrupted due to conflict
Rabies: Rabid dogs are common, incubation up to 1 year
Taenia saginata (beef tapeworm): Common
Thalassemia: 3.5% prevalence with severe, transfusion-dependent forms encountered
Tuberculosis: Common, MDR-TB = 1% of confirmed cases, ~80% vaccinated with BCG
Typhoid Fever: ~100,000 cases per year, incubation up to 30 days
Languages and Religion: Afghan Persian or Dari (official) (Dari functions as the lingua franca), Pashto (official), Uzbek, English, Turkmen, Urdu, Pashayi, Nuristani, Arabic, Balochi, other. Literacy (over age 15) is 55.5% for males and 29.8% for females. More than 99% of all Afghani are Muslim.
Health System Status: The World Health Organization, UNICEF, and USAID have attempted various programs to improve health with limited success due to challenges of poverty and civil conflict. As such, diseases of any type may be encountered at advanced stages and without prior treatment.
References and Resources
1. Afghanistan Health (Wikipedia): https://en.wikipedia.org/wiki/Health_in_Afghanistan
2. CDC Travel Advice for Afghanistan: https://wwwnc.cdc.gov/travel/destinations/traveler/none/afghanistan
3. CIA Factbook Entry (Afghanistan): https://www.cia.gov/the-world-factbook/countries/afghanistan/
4. WHO Afghanistan Health System: http://www.emro.who.int/afg/programmes/health-system-strengthening.html
5. USAID: https://www.usaid.gov/afghanistan/health
6. UNICEF: https://www.unicef.org/afghanistan/health
7. Sanitation and Diarrheal Morbidity: Evidence from Afghanistan. Manzoor Ahmad Malik, Saddaf Naaz Akhtar medRxiv 2020.10.20.20216333; doi: https://doi.org/10.1101/2020.10.20.20216333
8. Afghanistan Country Cancer Profile 2020. https://www.iccp-portal.org/system/files/plans/AFG_2020.pdf
9. Caravedo MA, Cabada MM. Human Fascioliasis: Current Epidemiological Status and Strategies for Diagnosis, Treatment, and Control. Res Rep Trop Med. 2020;11:149-158. Published 2020 Nov 26. doi:10.2147/RRTM.S237461. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705270/
10. Hepatitis is a silent killer: only 1 in 20 Afghans with viral hepatitis know they have the disease: http://www.emro.who.int/afg/afghanistan-news/hepatitis-day-2016.html#:~:text=Only%201%20in%2020%20people,likely%20to%20be%20significantly%20higher.
11. https://borgenproject.org/common-diseases-in-afghanistan-war/
12. Crimean-Congo Hemorrhagic Fever: https://www.cdc.gov/vhf/crimean-congo/pdf/factsheet.pdf
13. Malaria and Leishmaniasis in Afghanistan: http://www.emro.who.int/afg/programmes/malaria-leishmaniasis.html
14. Polio in Afghanistan: https://polioeradication.org/where-we-work/afghanistan/
15. COVID-19 in Afghanistan: https://www.worldometers.info/coronavirus/country/afghanistan/ ; https://covid19.who.int/region/emro/country/af
16. https://www.worldometers.info/coronavirus/country/afghanistan/ ; https://covid19.who.int/region/emro/country/af
