title: Assessing post-abortion care in health facilities in Afghanistan: a cross-sectional study.
abstract: BACKGROUND
  Complications of abortion are one of the leading causes of maternal mortality worldwide, along with hemorrhage, sepsis, and hypertensive diseases of pregnancy. In Afghanistan little data exist on the capacity of the health system to provide post-abortion care (PAC). This paper presents findings from a national emergency obstetric and neonatal care needs assessment related to PAC, with the aim of providing insight into the current situation and recommendations for improvement of PAC services.
  
  
  METHODS
  A national Emergency Obstetric and Neonatal Care Needs Assessment was conducted from December 2009 through February 2010 at 78 of the 127 facilities designated to provide emergency obstetric and neonatal care services in Afghanistan. Research tools were adapted from the Averting Maternal Death and Disability Program Needs Assessment Toolkit and national midwifery education assessment tools. Descriptive statistics were used to summarize facility characteristics, and linear regression models were used to assess the factors associated with providers' PAC knowledge and skills.
  
  
  RESULTS
  The average number of women receiving PAC in the past year in each facility was 244, with no significant difference across facility types. All facilities had at least one staff member who provided PAC services. Overall, 70% of providers reported having been trained in PAC and 68% felt confident in their ability to perform these services. On average, providers were able to identify 66% of the most common complications of unsafe or incomplete abortion and 57% of the steps to take in examining and managing women with these complications. Providers correctly demonstrated an average of 31% of the tasks required for PAC during a simulated procedure. Training was significantly associated with PAC knowledge and skills in multivariate regression models, but other provider and facility characteristics were not.
  
  
  CONCLUSIONS
  While designated emergency obstetric facilities in Afghanistan generally have most supplies and equipment for PAC, the capacity of healthcare providers to deliver PAC is limited. Therefore, we strongly recommend training all skilled birth attendants in PAC services. In addition, a PAC training package should be integrated into pre-service medical education.
authors: Jhpiego/Afghanistan, Johns Hopkins University/Afghanistan, House 289, Street 3, Ansari Wat, Shar-e Naw, Kabul, Afghanistan. Nasrat.Ansari@jhpiego.org.
authors: Nasratullah
authors: N
authors: Ansari
authors: Jhpiego/Afghanistan, Johns Hopkins University/Afghanistan, House 289, Street 3, Ansari Wat, Shar-e Naw, Kabul, Afghanistan. Partamin@jhpiego.org.
authors: Partamin
authors: P
authors: Zainullah
authors: Jhpiego/USA, Johns Hopkins University, Baltimore, USA. Young-Mi.Kim@jhpiego.org.
authors: Young Mi
authors: YM
authors: Kim
authors: Jhpiego/USA, Johns Hopkins University, Baltimore, USA. Hannah.Tappis@jhpiego.org.
authors: Hannah
authors: H
authors: Tappis
authors: Jhpiego/USA, Johns Hopkins University, Baltimore, USA. Adrienne.Kols@jhpiego.org.
authors: Adrienne
authors: A
authors: Kols
authors: Jhpiego/USA, Johns Hopkins University, Baltimore, USA. Sheena.Currie@jhpiego.org.
authors: Sheena
authors: S
authors: Currie
authors: Jhpiego/USA, Johns Hopkins University, Baltimore, USA. Jaime.Mungia@jhpiego.org.
authors: Jaime
authors: J
authors: Haver
authors: VU University Amsterdam, Amsterdam, Netherlands. J.J.M.van_Roosmalen@lumc.nl.
authors: Jos
authors: J
authors: van Roosmalen
authors: VU University Amsterdam, Amsterdam, Netherlands. j.e.w.broerse@vu.nl.
authors: Jacqueline E W
authors: JE
authors: Broerse
authors: Leeuwarden Medical Center, Department of Obstetrics & Gynecology, Leeuwarden, Netherlands. jelle.stekelenburg@online.nl.
authors: Jelle
authors: J
authors: Stekelenburg
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D000346:Afghanistan; D000359:Aftercare / Q000592:standards*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004864:Equipment and Supplies; D005260:Female; D006301:Health Services Needs and Demand; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016014:Linear Models; D008427:Maternal Health Services / Q000592:standards*; D008880:Midwifery / Q000592:standards*; D009774:Obstetrics / Q000592:standards*; D010561:Personnel Staffing and Scheduling; D011247:Pregnancy; D016526:Workload
references: Int J Gynaecol Obstet. 2014 Sep;126(3):223-6
references: 24893962
references: Int J Gynaecol Obstet. 2014 Jul;126 Suppl 1:S20-3
references: 24743025
references: Midwifery. 2014 Oct;30(10):1056-62
references: 24290947
references: Contraception. 2014 Dec;90(6 Suppl):S39-48
references: 24825123
references: Int Fam Plan Perspect. 2003 Sep;29(3):106-11
references: 14519586
references: Stud Fam Plann. 2007 Mar;38(1):11-22
references: 17385379
references: BJOG. 2007 Nov;114(11):1337-9
references: 17949375
references: BJOG. 2007 Nov;114(11):1368-75
references: 17803715
references: Stud Fam Plann. 2009 Jun;40(2):123-32
references: 19662804
references: Best Pract Res Clin Obstet Gynaecol. 2010 Aug;24(4):467-77
references: 20227350
references: Int J Gynaecol Obstet. 2012 Mar;116(3):192-6
references: 22196990
references: Lancet. 2012 Feb 18;379(9816):625-32
references: 22264435
references: J Nepal Health Res Counc. 2012 Jan;10(1):5-9
references: 22929628
references: Int J Gynaecol Obstet. 2012 Nov;119(2):125-9
references: 22858205
references: Glob Public Health. 2013;8(4):417-34
references: 23590804
references: Lancet. 2013 May 18;381(9879):1747-55
references: 23683641
references: Midwifery. 2013 Oct;29(10):1166-72
references: 23916402
references: Hum Resour Health. 2013;11:51
references: 24083659
references: Bull World Health Organ. 2014 Mar 1;92(3):155
references: 24700971
references: Lancet. 2014 Sep 13;384(9947):980-1004
references: 24797575