A multicenter hospital-based analysis of cystic Echinococcosis in Afghanistan: Filling a National data gap

BACKGROUND: Cystic Echinococcosis (CE), a neglected zoonotic disease caused by Echinococcus granulosus, is highly endemic in Afghanistan due to livestock-dependent livelihoods, poor sanitation, limited healthcare access, and unregulated animal practices. Despite its substantial morbidity and economic burden, national surveillance and clinical data remain scarce. OBJECTIVE: This study aims to describe the clinical and demographic characteristics of surgically treated CE patients at five referral hospitals in Kabul, Afghanistan. The objective is to fill the gap of limited national-level data on CE, provide evidence for targeted clinical management, resource allocation, and inform the development of effective public health interventions to address this neglected disease. METHODOLOGY: This retrospective hospital based surgical case series analyzed 330 surgically treated CE patients admitted to five hospitals in Kabul (2021-2025). Data on demographics, geographic origin, affected organs, and clinical records were extracted from archived medical documents. Descriptive analysis prioritized epidemiological and clinical characterization. RESULTS: Patients (6-78 years) originated from 31 provinces, with Kabul (107 cases), Faryab (35), and Balkh (24) as top sources. No significant gender predominance was observed (52.12% male, 47.87% female). Lungs were the most affected organ (86.66%), followed by the liver (11.51%); 81.31% of patients <20 years had pulmonary CE. Most cases (45.45%) were recorded in 2025, reflecting improved record retrieval. DISCUSSION & CONCLUSION: CE persists as a major public health challenge in Afghanistan, driven by fragmented surveillance, inadequate prevention, and unequal treatment access. The high proportion of pulmonary CE and young patients highlights unique local epidemiological patterns. Addressing CE requires a multisectoral "One Health" approach integrating surveillance, community education, veterinary interventions, and expanded diagnostic/treatment capacity to break the poverty-disease cycle.