Hijab or Niqab Interacts with Facemasks Usage at Healthcare Settings in Kabul, Afghanistan: A Multi-Center Observational Study

Purpose: We aimed to understand the extent of facemask usage resulting from the third wave of the COVID-19 pandemic in an Afghan context. In Afghanistan, new COVID-19 variants, low vaccination rates, political turmoil, and poverty interact not only with the third wave of the COVID-19 pandemic but also with facemask usage. Methods: We collected data (n = 1970) by visually observing the usage and type of facemasks used among visitors entering healthcare facilities in Kabul. We conducted an observational study observing the use of facemasks among 1279 men and 691 women. Results: While 71% of all participants adhered to wearing facemasks, 94% of these users wore surgical masks, and 86% wore all types of facemasks correctly. Interestingly, women adhered to wearing facemasks more than men. Specifically, of all the participants who were not wearing masks, 20% were men, and only 8% were women. Even though men were more in number in our study (64.9%), women have a higher adherence rate to wearing facemasks than men. Conclusions: We conclude that gender socialization and expectations of women to wear the niqab or hijab interact with their adherence to wearing facemasks. Additionally, since Afghanistan is one of the poorest countries in the world, which has witnessed a considerable period of political turmoil, we spotlight that our findings are rare in scholarship as they represent a distinct non-Western Islamic society with a low scale of COVID-19 vaccination. Therefore, more research is needed to assess the general population’s socioeconomic and geopolitical barriers to facemask use, given that Afghanistan is an underrepresented social context. Our findings are expected to aid health policymakers in developing novel prevention strategies for the country