The health condition of spinal cord injuries in two Afghan towns

Study design: Cross-sectional. Objectives: To describe the population with spinal cord injury (SCI) in two major towns of Afghanistan. Setting: Kabul and Herat, Afghanistan, March-July 2001. Methods: The residents of Kabul and Herat (N = 311) with traumatic SCI were retrieved and investigated. They underwent standardised interviews and clinical examinations assessing socio-demographic characteristics and information on health condition, injury, quality of life and rehabilitation outcome. Results: The study population could be considered as the survivors in the harsh living conditions in Afghanistan of a supposedly much larger group, counting proportionately fewer females and fewer cervical lesions than expected. Acute care was practically nonexistent. Prevalences of urinary tract infections and pressure sores were high as no good management was available. Basic rehabilitation helped persons with SCI to attain a fairly good level of independence (total functional independence measure score mean = 95, SD = 19). Their quality of life was significantly lower than their neighbours of same age and sex (P < 0.0001). Along with the economic security and good access to the home, the use of the orthopaedic Centre of the International Committee of the Red Cross (ICRC) contributed to a better quality of life. Conclusion: Thanks to the rehabilitation programme of the ICRC providing a basic but comprehensive rehabilitation, persons with SCI in Afghanistan are coping rather well. This result is remarkable considering the difficult economic and sanitary circumstances in the poorest country in the world.