TY - JOUR
T1 - Where giving birth is a forecast of death
T2 - Maternal mortality in four districts of Afghanistan, 1999-2002
AU - Bartlett, Linda A.
AU - Mawji, Shairose
AU - Whitehead, Sara
AU - Crouse, Chadd
AU - Dalil, Suraya
AU - Ionete, Denisa
AU - Salama, Peter
N1 - Funding Information:
The study was funded by UNICEF, the US Centers for Disease Control and Prevention, and the US Agency for International Development. Investigators from the Centers for Disease Control and Prevention directed the project, assisted by UNICEF and Afghanistan Ministry of Health staff. All the authors had full access to all the data for the study and made the final decision to submit for publication.
PY - 2005/3/5
Y1 - 2005/3/5
N2 - Background: Maternal mortality in Afghanistan is uniformly identified as an issue of primary public-health importance. To guide the implementation of reproductive-health services, we examined the numbers, causes, and preventable factors for maternal deaths among women in four districts. Methods: We did a retrospective cohort study of women of reproductive age (15-49 years) who died between March 21, 1999, and March 21, 2002, in four selected districts in four provinces: Kabul city, Kabul province (urban); Alisheng district, Laghman province (semirural); Maywand, Kandahar province (rural); and Ragh, Badakshan province (rural, most remote). Deaths among women of reproductive age were identified through a survey of all households in randomly selected villages and investigated through verbal-autopsy interviews of family members. Findings: In a population of 90 816, 357 women of reproductive age died; 154 deaths were related to complications during pregnancy, childbirth, or the puerperal period. Most maternal deaths were caused by ante-partum haemorrhage, except in Ragh, where a greater proportion of women died of obstructed labour. All measures of maternal risk were high, especially in the more remote areas; the maternal mortality ratio (per 100 000 livebirths) was 418 (235-602) in Kabul, 774 (433-1115) in Alisheng, 2182 (1451-2913) in Maywand, and 6507 (5026-7988) in Ragh. In the two rural sites, no woman who died was assisted by a skilled birth attendant. Interpretation: Maternal mortality in Afghanistan is high and becomes significantly greater with increasing remoteness. Deaths could be averted if complications were prevented through optimisation of general health status and if complications that occurred were treated to reduce their severity - efforts that require a multisectoral approach to increase availability and accessibility of health care.
AB - Background: Maternal mortality in Afghanistan is uniformly identified as an issue of primary public-health importance. To guide the implementation of reproductive-health services, we examined the numbers, causes, and preventable factors for maternal deaths among women in four districts. Methods: We did a retrospective cohort study of women of reproductive age (15-49 years) who died between March 21, 1999, and March 21, 2002, in four selected districts in four provinces: Kabul city, Kabul province (urban); Alisheng district, Laghman province (semirural); Maywand, Kandahar province (rural); and Ragh, Badakshan province (rural, most remote). Deaths among women of reproductive age were identified through a survey of all households in randomly selected villages and investigated through verbal-autopsy interviews of family members. Findings: In a population of 90 816, 357 women of reproductive age died; 154 deaths were related to complications during pregnancy, childbirth, or the puerperal period. Most maternal deaths were caused by ante-partum haemorrhage, except in Ragh, where a greater proportion of women died of obstructed labour. All measures of maternal risk were high, especially in the more remote areas; the maternal mortality ratio (per 100 000 livebirths) was 418 (235-602) in Kabul, 774 (433-1115) in Alisheng, 2182 (1451-2913) in Maywand, and 6507 (5026-7988) in Ragh. In the two rural sites, no woman who died was assisted by a skilled birth attendant. Interpretation: Maternal mortality in Afghanistan is high and becomes significantly greater with increasing remoteness. Deaths could be averted if complications were prevented through optimisation of general health status and if complications that occurred were treated to reduce their severity - efforts that require a multisectoral approach to increase availability and accessibility of health care.
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U2 - 10.1016/S0140-6736(05)71044-8
DO - 10.1016/S0140-6736(05)71044-8
M3 - Article
C2 - 15752530
AN - SCOPUS:14744287073
SN - 0140-6736
VL - 365
SP - 864
EP - 870
JO - Lancet
JF - Lancet
IS - 9462
ER -