To determine the risk factors associated with toxic-shock syndrome (TSS) in menstruating women, we conducted a retrospective telephone study of 52 cases and 52 age-matched and sex-matched controls. Fifty-two cases and 44 controls used tampons (P < 0.02). Moreover, in case-control pairs in which both women used tampons, cases were more likely than controls to use tampons throughout menstruation (42 of 44 vs. 34 of 44, respectively; P < 0.05). There were no significant differences in brand of tampon used, degree of absorbency specified on label, frequency of tampon change, type of contraceptive used, frequency of sexual intercourse, or sexual intercourse during menstruation. Fourteen of 44 cases had one or more definite or probable recurrences during a subsequent menstrual period. In a separate study, Staphylococcus aureus was isolated from 62 of 64 women with TSS and from seven of 71 vaginal cultures obtained from healthy controls (P < 0.001).

Anaemia in pregnancy continues to be a major public health problem in the world. Despite decades of proposed solutions, women in developing countries are still suffering the effects of having to go through a pregnancy in an anaemic state. Based on 1988 data, the World Health Organisation estimated that up to 56% of all women living in developing countries are anaemic ([Hb] < 11 g/dL), compared with 18% in industrialised countries'. The greatest burden of anaemia is borne by Asia and Africa where it is estimated that 60% and 52% of women, respectively, are anaemic, and between 1% and 5% are severely anaemic ([Hb] < 7 g/dL). In this

Facility-based monitoring of perinatal health is possible in resource-limited settings. The situation in hospitals in Kabul is precarious with high levels of perinatal mortality. Improved intrapartum care, especially for women with risk factors, is needed to positively impact perinatal health.

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The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.