BackgroundLittle current information is available for prevalence of vertically-transmitted infections among the Afghan population. The purpose of this study is to determine prevalence and correlates of human immunodeficiency virus (HIV), syphilis, and hepatitis B and C infection among obstetric patients and model hepatitis B vaccination approaches in Kabul, Afghanistan.MethodsThis cross-sectional study was conducted at three government maternity hospitals in Kabul, Afghanistan from June through September, 2006. Consecutively-enrolled participants completed an interviewer-administered survey and whole blood rapid testing with serum confirmation for antibodies to HIV, T. pallidum, and HCV, and HBsAg. Descriptive data and prevalence of infection were calculated, with logistic regression used to identify correlates of HBV infection. Modeling was performed to determine impact of current and birth dose vaccination strategies on HBV morbidity and mortality.ResultsAmong 4452 women, prevalence of HBsAg was 1.53% (95% CI: 1.18 – 1.94) and anti-HCV was 0.31% (95% CI: 0.17 – 0.53). No cases of HIV or syphilis were detected. In univariate analysis, HBsAg was associated with husband's level of education (OR = 1.13, 95% CI: 1.01 – 1.26). Modeling indicated that introduction of birth dose vaccination would not significantly reduce hepatitis-related morbidity or mortality for the measured HBsAg prevalence.ConclusionIntrapartum whole blood rapid testing for HIV, syphilis, HBV, and HCV was acceptable to patients in Afghanistan. Though HBsAg prevalence is relatively low, periodic assessments should be performed to determine birth dose vaccination recommendations for this setting.

ObjectiveTo assess readiness and quality of essential newborn care and neonatal resuscitation practices in public health facilities in Afghanistan.DesignCross-sectional assessment.Setting226 public health facilities in Afghanistan, including 77 public health facilities with at least five births per day (high-volume facilities) and 149 of 1736 public health facilities with fewer than five births per day (low-volume facilities).ParticipantsManagers of 226 public health facilities, 734 skilled birth attendants (SBAs) working at these facilities, and 643 women and their newborns observed during childbirth at 77 high-volume health facilities.Outcome measuresAvailability of knowledgeable SBAs, availability of supplies and compliance with global guidelines for essential newborn care and neonatal resuscitation practices.ResultsAt high-volume facilities, 569/636 (87.9%) of babies were dried immediately after birth, 313/636 (49.2%) were placed in skin-to-skin contact with their mother and 581/636 (89.7%) had their umbilical cord cut with a sterile blade or scissors. A total of 87 newborn resuscitation attempts were observed. Twenty-four of the 87 (27.5%) began to breath or cry after simply clearing the airway or on stimulation. In the remaining 63 (72.5%) cases, a healthcare worker began resuscitation with a bag and mask; however, only 54 (62%) used a correct size of mask and three babies died as their resuscitation with bag and mask was unsuccessful.ConclusionsThe study indicates room for improvement of the quality of neonatal resuscitation practices at public health facilities in Afghanistan, requiring only strengthening of the current best practices in newborn care. Certain basic and effective aspects of essential newborn care that can be improved on with little additional resources were also missing, such as skin-to-skin contact of the babies with their mother. Improvement of compliance with the standard newborn care practices must be ensured to reduce preventable newborn mortality and morbidity in Afghanistan.

Background Midwives are the key skilled birth attendants in Afghanistan. Rapid assessment of public and private midwifery education schools was conducted in 2017 to examine compliance with national educational standards. The aim was to assess midwifery education to inform Afghanistan Nurses and Midwives Council and other stakeholders on priorities for improving quality of midwifery education. Methods A cross-sectional assessment of midwifery schools was conducted from September 12–December 17, 2017. The Midwifery Education Rapid Assessment Tool was used to assess 29 midwifery programs related to infrastructure, management, teachers, preceptors, clinical practice sites, curriculum and students. A purposive sample of six Institute of Health Sciences schools, seven Community Midwifery Education schools and 16 private midwifery schools was used. Participants were midwifery school staff, students and clinical preceptors. Results Libraries were available in 28/29 (97%) schools, active skills labs in 20/29 (69%), childbirth simulators in 17/29 (59%) and newborn resuscitation models in 28/29 (97%). School managers were midwives in 21/29 (72%) schools. Median numbers of students per teacher and students per preceptor were 8 (range 2–50) and 6 (range 2–20). There were insufficient numbers of teachers practicing midwifery (132/163; 81%), trained in teaching skills (113/163; 69%) and trained in emergency obstetric and newborn care (88/163; 54%). There was an average of 13 students at clinical sites in each shift. Students managed an average of 15 births independently during their training, while 40 births are required. Twenty-four percent (7/29) of schools used the national 2015 curriculum alone or combined with an older one. Ninety-one percent (633/697) of students reported access to clinical sites and skills labs. Students mentioned, however, insufficient clinical practice due to low case-loads in clinical sites, lack of education materials, transport facilities and disrespect from school teachers, preceptors and clinical site providers as challenges. Conclusions Positive findings included availability of required infrastructure, amenities, approved curricula in 7 of the 29 midwifery schools, appropriate clinical sites and students’ commitment to work as midwives upon graduation. Gaps identified were use of different often outdated curricula, inadequate clinical practice, underqualified teachers and preceptors and failure to graduate all students with sufficient skills such as independently having supported 40 births.

Little is known about blood-borne infection awareness and knowledge among obstetric populations and health care providers in Afghanistan. HIV and hepatitis B awareness and knowledge are described among 4452 intrapartum patients completing an interviewer-administered questionnaire and whole-blood rapid testing and 123 obstetric care providers completing a questionnaire between June 2006 and September 2006. Participants were enrolled from three Kabul public maternity hospitals. Most participants were aware of HIV (50.8% of patients and 95.9% of providers) and hepatitis (72.1% of patients and 91.1% of providers). Correct transmission knowledge (defined as naming three correct routes and no incorrect routes) was lower for both groups (HIV: 19.4% for patients and 59.7% for providers; hepatitis B: 1.90% for patients and 33.9% for providers). Correct HIV transmission knowledge among providers was independently associated with level of education (AOR=1.75, 95% CI: 1.20-2.55). While HIV and hepatitis B awareness is common, correct and comprehensive knowledge is not. Continuing education for providers and health communications strategies should address identified knowledge gaps.

Objective-This study was conducted to assess prevalence and correlates of prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan.Study design-Medically-eligible (e.g., conditions not requiring urgent medical attention, such as eclampsia, or not imminently delivering (dilation ≥8 cm)) obstetric patients admitted to three Kabul public hospitals were consecutively enrolled in this cross-sectional study. An intervieweradministered questionnaire assessed demographic information, health utilization history, including prior contraceptive use, and intent to use contraception. Correlates of prior contraceptive use were determined with logistic regression.Results-Of 4452 participants, the mean age was 25.7 years (SD±5.7 years), 66.4% repoited pregnancy prior to the presenting gestation, 88.4% had ≥1 prenatal care visit, and 82.4% reported the current pregnancy was desired. Most (67.4%) had no formal education. One-fifth (22.8%) reported using contraception prior to this pregnancy. Among women with any pregnancy prior to the current gestation (98.6% of prior users), prior contraceptive use was independently associated with having lived outside Afghanistan in the last five years (AOR=1.35, 95% CI: 1.12 -1.63), having a skilled attendant at the last birth (AOR=1.35, 95% CI: 1.07 -1.71), having a greater number of living children (AOR=1.30, 95% CI: 1.20 -1.41), longer mean birth interval (years) (AOR=1.21, 95% CI: 1.11 -1.38), and higher educational level (AOR=1.16, 95% CI: 1.09 -1.22). Immediate desire for Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access