Get access

Implementing a Facility-Based Maternal and Perinatal Health Care Surveillance System in Afghanistan

Authors

  • Mary M. Dott MD,

    Search for more papers by this author
    • Mary Dott, MD, is a pediatrician working with the WHO Collaborating Center in Reproductive Health (WHO/CC), which is located in the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC).

  • Nasreen Orakail MD,

    Search for more papers by this author
    • Nasreen Orakail, MD, is an obstetrician/gynecologist and the director of the Afghan Ministry of Health's Rabia Balkhi Hospital in Kabul.

  • Hameeda Ebadi MD,

    Search for more papers by this author
    • Hameeda Ebadi, MD, is the local project director for the WHO/CC's activities in Afghanistan.

  • Filiberto Hernandez MPA, MD,

    Search for more papers by this author
    • Filiberto Hernandez, MD, MPA, is the project director leading health activities in Afghanistan for CDC's WHO/CC.

  • Kitty MacFarlane CNM, MPH,

    Search for more papers by this author
    • Kitty MacFarlane, CNM, MPH, is a nurse-midwife leading the midwifery training components in Afghanistan for CDC's WHO/CC.

  • Patricia L. Riley CNM, MPH,

    Corresponding authorSearch for more papers by this author
    • Patricia L. Riley, CNM, MPH, is a nurse-midwife and senior policy advisor within CDC's Office of Global Health, who collaborated on this project.

  • Roberta Prepas CNM, MN,

    Search for more papers by this author
    • Roberta Prepas, CNM, MN, JD, is a nurse-midwife consultant who helped to implement perinatal surveillance in Afghanistan.

  • Brian J. McCarthy MSc, MD

    Search for more papers by this author
    • Brian J. McCarthy, MSc, MD, is the principal investigator of CDC's WHO/CC.


Patricia L. Riley, CNM, MPH, Office of Global Health, Centers for Disease Control and Prevention, Mail Stop D-69, Atlanta, GA 30333. E-mail: pyr0@cdc.gov

Abstract

Afghanistan has one of the highest maternal and perinatal mortality rates in the world. Lack of a health information system presented obstacles to efforts to improve the quality of care and reduce mortality. To rapidly overcome this deficit in a large women's hospital, staff implemented a facility-based maternal and perinatal surveillance system known as “BABIES,” which is specially designed for intervention and evaluation in low-resource settings. During a 12-month period, 15,509 deliveries resulted in 28 maternal deaths and a perinatal mortality rate of 56 per 1000 births. When stratified by birth weight and perinatal period of death, fetuses weighing at least 2500 g who died during the antepartum period contributed the most cases of perinatal death. This finding suggests that the greatest reduction in perinatal mortality would be realized by increasing access to high-quality antepartum care. Among fetuses weighing at least 2500 g, 93 deaths occurred during the intrapartum period. These deaths will continue to be monitored to ensure that the chosen interventions are improving intrapartum care for mothers and newborns. Because of its simplicity, flexibility, and ability to identify interventions, BABIES is a valuable tool that enables clinicians and program managers to prioritize resources.

Ancillary