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Availability and quality of emergency obstetric and neonatal care services in Afghanistan.

International Journal of Gynaecology and Obstetrics

Quality Indicators, Health Care, Afghanistan, Pregnancy, utilization, statistics & numerical data, standards, Perinatal Care, Outcome and Process Assessment (Health Care), mortality, Obstetric Labor Complications, Maternal Mortality, Infant, Newborn, Humans, Health Services Accessibility, Health Care Surveys, Female, Emergency Medical Services, Delivery, Obstetric, Cross-Sectional Studies

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      To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) facilities in Afghanistan, as defined by UN indicators. In a cross-sectional study of 78 first-line referral facilities located in secure areas of Afghanistan, EmONC service delivery was evaluated by using Averting Maternal Deaths and Disabilities (AMDD) Program assessment tools. Forty-two percent of peripheral facilities did not perform all 9 signal functions required of comprehensive EmONC facilities. The study facilities delivered 17% of all neonates expected in their target populations and treated 20% of women expected to experience direct complications. The population-based rate of cesarean delivery was 1%. Most maternal deaths (96%) were due to direct causes. The direct and indirect obstetric case fatality rates were 0.8% and 0.2%, respectively. Notable progress has been made in Afghanistan over the past 8 years in improving the quality, coverage, and utilization of EmONC services, but gaps remain. Re-examination of the criteria for selecting and positioning EmONC facilities is recommended, as is the provision of high-quality, essential maternal and neonatal health services at all levels of the healthcare system, linked by appropriate communication and functional referral systems. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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