Purpose Initiating antenatal care (ANC) visits by pregnant women during first trimester, known as timely initiation of ANC visits, is crucial for wellbeing of mothers and their unborn babies. We examined whether sociodemographic characteristics of pregnant women predict timely initiation of ANC visits. Patients and Methods Data collected for the Afghanistan Health Survey 2018 (AHS 2018) were analyzed. A binary outcome variable was created as women with ANC visits in 0–3 months (first trimester) vs women with ANC visits in ≥4 months of pregnancy. A multivariable generalized linear model was employed. Results A total of 6862 ever-married women, aged 14–49 years, with a history of pregnancy, including current pregnancy, were included. The prevalence of timely initiation of ANC visits was 55.8%. The likelihood (OR = odds ratio) of timely initiation of ANC visits was higher in women aged 30–39 years [OR 1.12 (95% CI: 1.00–1.25)], in women who could read and write [OR 1.12 (95% CI: 0.99–1.21)], in women who used public primary care facilities [OR 1.14 (95% CI: 1.01–1.28)], in women who received consultation on ANC from a doctor or midwife [OR 1.22 (95% CI: 0.72–2.08), OR 1.13 (95% CI: 0.67–1.92)] respectively, in women at fourth and highest quintiles of wealth status [OR 1.24 (95% CI: 1.04–1.48), OR 1.14 (95% CI: 0.92–1.40)] respectively, in women who intended to become pregnant [OR 1.56 (95% CI: 1.35–1.81)], in women who used the internet [OR 1.53 (95% CI: 1.13–2.06)], and in women who listened to radio [OR 1.16 (95% CI: 1.03–1.30)]. However, the likelihood was lower in women who had given birth at least twice [OR 0.67 (95% CI: 0.50–0.89)], and in women who lived in rural areas [OR 0.87 (95% CI: 0.75–1.00)]. Conclusion To promote timely initiation of ANC visits, healthcare interventions to increase availability of midwives and doctors, and improve accessibility to primary care clinics, especially in rural areas, need to be implemented.

Background: In the past few decades, the rate of cesarean section (CS) has increased worldwide which is common in high income countries. Although cesarean section has lots of socioeconomic impacts in the career of mothers and babies especially in LMICs like Afghanistan, it is also increasing in such countries. In compare to vaginal delivery the cesarean section has higher risks for maternal health. The most important aim of this study is to search the commonest indications of cesarean section at the only teaching hospital in west region of Afghanistan, Ghalib Teaching Hospital in 2017.Material and Method: This was a cross-sectional study. Among 456 pregnant women who came to Ghalib Teaching Hospital, 287(63%) had vaginal delivery and 169 (37%) had cesarean section delivery in 2017. Data was collected reviewing medical records; patients discharge certificate and a questionnaire which consisted of the data like; history of previous cesarean sections, age, and so on. Data was analyzed by epi info 7.Results: the prevalence of cesarean section in Ghalib Teaching Hospital was 37%, the median age was 28 years old, the mean age was 23.83 and the most ages were between 21-25 (42.5%). The commonest indications were severe oligohydramnios (29.5%) followed by previous cesarean section (12.4%) and elective cesarean section 10.9% (on maternal request). The least indication was cephalopelvic disproportion (3.09%). In our research we had more than one indication about 10.3%.Conclusion: according to the research the commonest indication of cesarean section was severe oligohydromnios which shows emergency indication among pregnant women. As the women in Afghanistan want many children so they usually do not consider having cesarean section deliveries. Cesarean section on maternal request also has high rate which needs appropriate guidelines and also policies to decrease this high rate of selective cesarean section. In our research 52.1% of indications of CS was fetal factors. This shows in LMICs many fathers have valued to the health of babies instead of mothers. It is highly needed to inform fathers to know about health of both babies and mothers.

Background: acute secondary peritonitis is an inflammation of the peritoneum. Surgeons in this field face this deadly pathology, and in Afghanistan, where health services have not yet been systematically standardized, the establishment of this pathology is more likely to be challenging. The aim of this study was to address the most causal factors as well as causes of delayed referral of acute secondary peritonitis at the only tertiary referral hospital in west region of Afghanistan, Herat Regional Hospital. Results: 496 patients were operated with diagnosis of acute secondary peritonitis. 58% of patients were male and the highest age group were being from 10-19 years old (32.25%). 75.21% of these patients had a delay of more than 24 hours from the onset of the first complaint to laparotomy with the highest number (23.18%) delays for 3 days, even 2 patients had symptoms for 31 to 60 days (0.40%). The most common symptoms were abdominal pain with 97%, followed by nausea and vomiting 81% and anorexia 74%. Among all pathologies, acute appendicitis was the most common cause of peritonitis (64.5%) followed by small bowel perforation (9.7%) and peptic ulcer perforation (8.5%). According to late referral 79% started medical treatment after consulting a general doctor, 15% didn’t come to health facilities due to long distances and 6% started home treatment due to wrong believes. Conclusion: According to our research, there is still some acute abdomen patients who come late to health facilities and this is because of the limited resources, cultural issues and lack of the knowledge of the general doctors. In order to decrease the number of these patients we need to expand knowledge of both patients and health staffs, in another word consulting abdominal pain patients should be obligatory by surgeons.