title: Availability and quality of emergency obstetric and neonatal care services in Afghanistan.
abstract: OBJECTIVE
  To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) facilities in Afghanistan, as defined by UN indicators.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Jhpiego, Baltimore, MD 21231, USA. ymkim@jhpiego.net
authors.forename: Young-Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Partamin
authors.initials: P
authors.lastname: Zainullah
authors.forename: Jaime
authors.initials: J
authors.lastname: Mungia
authors.forename: Hannah
authors.initials: H
authors.lastname: Tappis
authors.forename: Linda
authors.initials: L
authors.lastname: Bartlett
authors.forename: Nabila
authors.initials: N
authors.lastname: Zaka
mesh_terms: D000346:Afghanistan; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D018743:Perinatal Care / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D019984:Quality Indicators, Health Care