Burden of tuberculosis in Afghanistan: update on a war-stricken country.
OBJECTIVE
To review Afghans Tuberculosis (TB) Control Program and assesses the impact of disruption induced by the war in Afghanistan.


METHODS
National TB control program of Afghanistan was reviewed in terms of its milestones, achievement parameters, and potential barriers. Information and data were collected by review visits to the Ministry of Health and health facility survey of non-governmental organizations working for TB control in Afghanistan. Local and international literature was consulted.


RESULTS
Mortality and morbidity figures due to tuberculosis remained alarmingly high in the last two decades, especially among women. Current estimates show that the incidence of active TB cases is 278 per 100,000 and mortality mounts to 15,000 cases per year. The epidemiological profile reflecting the situation of Afghans inside and outside the country is extremely deplorable. The situation has worsened due to the cessation of TB control activities during the war. Compliance of patients and access to the treatment has become very difficult in an emergency situation. Similarly, an increasing number of TB cases among Afghans refugees in Pakistan have also been observed. Overcrowded refugee camps and lack of treatment facilities increases manyfold the risk of further transmission.


CONCLUSIONS
TB is a major public health threat inside and outside war-stricken Afghanistan. TB control activities need prompt attention of health authorities in reestablishing TB control network. World Health Organization's guidelines and nationwide Directly Observed Treatment Short Course strategy should be adopted and sufficient resources allocated. It is vital to build a peaceful environment with a viable and durable alliance of local and international donors in the fight against TB.
Khan
Ibrahim M
IM
Section of International Public Health, School of Public Health, University of Bielefeld, Pf 100131, D-33501 Bielefeld, Germany. ibrahim.khan@uni-bielefeld.de
Laaser
Ulrich
U
D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011634:Public Health / Q000592:standards / Q000639:trends; D012307:Risk Factors; D017678:Sex Distribution; D014376:Tuberculosis / Q000453:epidemiology*; D014857:Warfare