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OBJECTIVE:To identify correlates of severe acute maternal morbidity (SAMM) in Kabul, Afghanistan. METHODS:The present case-control study enrolled postpartum couples at four public maternity hospitals between September 2007 and December 2009. Eligibility was determined by: spousal consent; SAMM criteria from chart review for cases; and matching by age, parity, and time since previous delivery for controls (uncomplicated deliveries). Staff administered questionnaires to women and their husbands separately. SAMM correlates were analyzed with conditional logistic regression in models including (proximate) and excluding (distal) care factors. RESULTS:Among 285 case and 285 control couples, the most frequent SAMM diagnoses were obstructed labor (104 [36.5%]) and hemorrhage requiring transfusion (102 [35.8%]). In both models, SAMM was associated with the husband having more than one wife (distal: adjusted odds ratio [aOR] 48.6, 95% CI 5.4-436.5; proximate: 141.8, 3.5-5819.0), prior stillbirth(s) (distal: 16.2, 6.1-42.9; proximate: 8.0, 2.9-22.4), and complications in a prior pregnancy (distal: 5.4, 95% CI 2.5-12.1; proximate: 7.1, 2.5-20.4). In the proximate model, SAMM was associated with visiting another facility before hospitalization (aOR 7.5, 95% CI 3.1-17.9), male-reported planned home delivery (5.5, 1.5-20.0), and provider-determined care-seeking (4.8, 1.6-14.9). CONCLUSION:Planned home delivery and referral to multiple facilities or by providers are factors associated with SAMM that are potentially amenable to intervention in Afghanistan.

Introduction Over the last two years, the Global Polio Eradication Initiative (GPEI), a private-public partnership that has reduced polio worldwide by 99% since its launch in 1988, has greatly expanded [...]

Five years before the 2015 deadline for achieving the United Nations' Millennium Development Goals (MDGs), the picture on progress is mixed. Persisting challenges include dysfunctional health systems, gaps in reliable [...]

Objective: To measure prevalence of prior/current Plasmodium vivax and Plasmodium falciparum (PV and PF), Brucella spp. (BR), dengue virus (DENV), Leishmania donovani (visceral leishmaniasis; VL), and Crimean-Congo hemorrhagic fever (CCHF) virus exposure among Afghan National Army (ANA) recruits., Methods: Randomly chosen, nationally representative serum samples from consenting men aged 18-40 years and who were screened between February 2010 and January 2011 were tested, with ∼25 samples/province. Samples were screened for PV and PF antigens and VL antibody with rapid diagnostic tests. Reactive malaria screening results were confirmed with polymerase chain reaction assay. Enzyme-linked immunosorbent assays were used to screen for CCHF and DENV antibodies; reactive DENV samples were confirmed with the plaque-reduction neutralization test. BR screening and confirmatory testing was performed with slide and tube agglutination, respectively. Correlates of BR titres >1:80 were analyzed using logistic regression., Results: Of 809 participants contributing specimens, 62% had previously lived outside Afghanistan, predominantly in Pakistan and Iran. CCHF (4.1%, n = 33), DENV (2.1%, n = 17), and VL (1.0%, n = 8) antibody prevalence was low. For PV and PF, only 7 out of 56 reactive samples had detectable nucleic acid. For BR, 8.0% (n = 65) of samples had screening titers >1:40, of which 83.1% had confirmatory titers >1:80. Participants from Kabul and surrounding provinces had lower odds (OR = 0.19, 95% CI: 0.04-1.00) of BR antibody compared with other regions., Conclusions: BR exposure was relatively common with a nearly national distribution, whereas geographic distribution for other pathogens aligned roughly with the expected vector distribution. Public health protection measures should include vector control, food safety, and enhanced diagnostics for acute febrile illness.