Population: 28 million Total TB cases notified (2009): 26358 Treatment Success Rate for new smear-positive TB cases (2008): 88%
Country Director: Mohammad Khakerah Rashidi London School of Hygiene & Tropical Medicine Profile of Dr Rashidi E-mail: mrashidi @ msh.org Telephone: +93 (0) 799 344 106 Lead Partner: MSH
Afghanistan is a country situated in South Asia; shares border in the north with central Asian republics of Tajikistan, Uzbekistan and Turkmenistan, in the east with China, in the west with Iran and South and South East with Pakistan. Total country population is 24.4 million plus 2 million additional refugees live in Iran and Pakistan. It consisted of 34 provinces and 398 districts. There are 2100 heath facilities of different types and NTP Afghanistan extended the coverage to 1061 heath facilities. The health system is contracted out with non-governmental organizations i.e. they provide all services defined in the basic package of health services including tuberculosis. The TB services are integrated at service delivery point. Afghanistan continues to emerge from almost three decades of civil strife and national warfare which left the country with some of the worst health indicators in the world. The country suffers greatly from very high levels of neonatal mortality rate of 60/1000 live bird, infant mortality rate (IMR) at 111/1000 live births, Under 5 Mortality Rate (U5MR) at 161/1000 live births and the maternal mortality ratio (MMR) is estimated at 1600 for 100,000 live births, the highest in the world. The malnutrition rate for children under five is more than 2% and chronic malnutrition rate is 54%. There has been significant progress in health, education, water and sanitation over the last years.
Afghanistan is one of the 22 high burden countries in the world. The prevalence of TB cases is extremely high (337 per 100,000 population), incidence for new sputum smear positive is 79, and for all new cases occurring in the country is 189 in 100,000 population and people in the most productive age groups of the society (15-44 years) are mostly affected with TB. More importantly, TB affects more female than male in Afghanistan: more than 64% of all cases occur among female. The DOTS population coverage is 97%, however the health facility coverage reaches to 51%. In 2010, the treatment success rate was 88%, sputum conversion rate was 89%. The mortality rate is 38 in 100000 populations in a year. The proportion of new TB cases with MDR-TB is 5.6%. The HIV/AIDS prevalence seems lower in Afghanistan; the incidence is 2% and there are fewer co-infections i.e. only seven co-infected cases diagnosed in the country. The case notification in Afghanistan is a core indicator to monitor the trend. Since 2008 there was a declining trend for this indicator and TB CAP’s intervention resulted in diverting this. For example, 88% of additional cases notified in 2010 are attributed to TB CAP intervention.
Quarterly Review Meeting - Afghanistan
The TB CARE I Plans for the Coming Year
TB CARE I covers 13 USAID-supported provinces and for some activities it will extend its assistance to six quick impact provinces and to all 34 provinces country wide. TB CARE I will assist the NTP in the following technical areas: • Universal and early access: Urban DOTS and community-based DOTS • TB infection control: Expand TBIC coverage to additional health facilities, monitor implementation, develop new SOPs and train staff on new tools • M&E and research: Introduce first ever TBIS database and electronic reporting; increase research capacity; and promote evidence-based decision-making • Health systems strengthening: Increase NTP’s leadership skills; develop new policies TB CARE I will assist NTP to expand DOTS to urban setting such as Kabul city and to rural areas of the country through CB-DOTS in 13 USAID supported provinces. Moreover, the TB infection control measures will be scaled up to additional health facilities in 19 provinces. The TB information system strengthening will be expanded to all 34 provinces and sufficient number of staff from NTP, BPHS implementers and MOPH will be trained on TBIS utilization, supervision and monitoring. The engagement of female health workers in DOTS implementation will be further expanded to additional six provinces; totally 100 female health workers will be trained on DOTS. In addition, on the job training will be conducted for 372 health facility staff to expose them to DOTS model centers and copy the procedure at their health facilities in their return. The leadership and management skills of NTP at various levels will be strengthening using MOST for TB tool.