title: The contribution of unimproved water and toilet facilities to pregnancy-related mortality in Afghanistan: analysis of the Afghan Mortality Survey.
abstract: OBJECTIVE
  To estimate the effect of unimproved household water and toilet facilities on pregnancy-related mortality in Afghanistan.
  
  
  METHODS
  The data source was a population-based cross-sectional study, the Afghan Mortality Survey 2010. Descriptive, univariate and multivariate logistic regression analyses were carried out, comparing 69 pregnancy-related deaths (cases) and 15386 surviving women (non-cases) who had a live birth or stillbirth between 2007 and 2010.
  
  
  RESULTS
  After adjusting for confounders, households with unimproved water access had 1.91 the odds of pregnancy-related mortality [95% confidence interval (CI) 1.11-3.30] compared to households with improved water access. We also found an association between unimproved toilet facilities and pregnancy-related mortality (OR = 2.25; 95% CI 0.71-7.19; P-value = 0.169), but it was not statistically significant.
  
  
  CONCLUSIONS
  Unimproved household water access was an important risk factor for pregnancy-related mortality in Afghanistan. However, we were unable to discern whether unimproved water source is a marker of unhygienic environments or socio-economic position. There was weak evidence for the association between unimproved toilet facilities and pregnancy-related mortality; this association requires confirmation from larger studies.
authors.affiliation: Department of Epidemiology and Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Gon
authors.forename: Laura
authors.initials: L
authors.lastname: Monzon-Llamas
authors.forename: Lenka
authors.initials: L
authors.lastname: Benova
authors.forename: Barbara
authors.initials: B
authors.lastname: Willey
authors.forename: Oona M R
authors.initials: OM
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003625:Data Collection; D004777:Environment; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D012499:Sanitation / Q000592:standards*; D012959:Socioeconomic Factors; D014038:Toilet Facilities / Q000592:standards*; D014867:Water; D014881:Water Supply / Q000592:standards*; D055815:Young Adult
chemical_list: D014867:Water
keywords: Afganistán; Afghanistan; assainissement; cross-sectional study; estudio croseccional; fuentes de agua; instalaciones sanitarias mortalidad materna; installations de toilette; maternal mortality; mortalité maternelle; ressources d'eau; sanitation; toilet facilities; water resources; étude transversale