title: Monitoring perinatal outcomes in hospitals in Kabul, Afghanistan: The first step of a quality assurance process.
abstract: OBJECTIVE
  Afghanistan is one of the countries with highest maternal and perinatal mortality in the world. Lack of reliable data, however, makes it difficult to select and prioritise the interventions that would be most cost effective. To gain some evidence, we review and analyse perinatal outcomes in facilities in Kabul and examine the role of patient risk and clinical practice factors.
  
  
  METHODS
  We used data for 2006 from a facility-based maternal and newborn surveillance system based on labour and delivery logbooks in the four government hospitals with maternity services in Kabul to analyse perinatal mortality and understanding potentially modifiable factors.
  
  
  RESULTS
  Data was collected for 53,524 births during 2006. Perinatal mortality was 43.5 per 1000 total births and the stillbirth rate was 38. For babies with a birthweight of > or =2500 g, the risk of perinatal death if delivered by cesarean section was 3.57 (CI = 3.08-4.13) times the risk of those delivered vaginally. Babies born of mothers with risk factors were 6.49 (CI = 5.64-7.48) times more likely to die. The perinatal mortality rate in babies of women with risk factors undergoing cesarean section was 220.5 per 1000 total births.
  
  
  CONCLUSIONS
  Facility-based monitoring of perinatal health is possible in resource-limited settings. The situation in hospitals in Kabul is precarious with high levels of perinatal mortality. Improved intrapartum care, especially for women with risk factors, is needed to positively impact perinatal health.
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva 27, Switzerland.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Guidotti
authors.forename: Tharani
authors.initials: T
authors.lastname: Kandasamy
authors.forename: Ana Pilar
authors.initials: AP
authors.lastname: Betrán
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.forename: Farima
authors.initials: F
authors.lastname: Hakimi
authors.forename: Paul
authors.initials: P
authors.lastname: Van Look
authors.forename: Faizullah
authors.initials: F
authors.lastname: Kakar
mesh_terms: D000346:Afghanistan; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D012307:Risk Factors