Elsewhere: Lancet assessment of mixed outcomes in Afghan health

The Lancet reports the release of the first national comprehensive mortality survey of Afghanistan as providing cause for both hope and concern.

To improve rebuilding efforts as well as gauging development initiatives and years of multisectoral investment by the international community, the Afghan Public Health Institute of the Ministry of Public Health and the Central Statistics Organisation undertook the Afghanistan Mortality Survey (AMS) 2010. AMS 2010 is the first national comprehensive mortality survey of 222,351 households, 47 848 women aged 12—49 years, and verbal autopsies of 3157 deaths in the 3 years preceding the survey, and covers 87% of the population in 34 provinces in the country. ...

The most encouraging progress is in maternal health, with an overall increase in coverage of antenatal care, skilled birth attendance, and births in health facilities to 63%, 34%, and 32%, respectively. Despite these achievements, fewer than 16% of women reported having at least four antenatal visits (the minimum necessary to provide adequate screening for pregnancy complications), while 71.5% women had not received postnatal check-ups for their last birth, which is vital for monitoring delivery complications.

This is in a context where...

According to a UNICEF fact sheet released last month, Afghanistan is one of the most dangerous places for a pregnant woman or a child to be born. Afghanistan has the highest rate of maternal mortality in the world, with 1400 women out of every 100 000 livebirths dying of a complication related to pregnancy or childbirth, while its mortality rate for children younger than 5 years is ranked second in the world, with 199 deaths per 1000 livebirths. Even if a child is lucky enough to survive birth, he or she could only expect to live 44 years, while the life expectancy at birth of the world overall is 67.2 years for 2005—10.

However,

this report is not without limitations. First, 9% of the total populations in Afghanistan, who live in the rural areas of Helmand, Kandahar, and Zabul provinces in the south zone, are not represented in the survey owing to security reasons, which seriously limits the report’s usefulness for planning. Second, although the survey has suggested much lower maternal, infant, and child mortality rates than previous estimates, given the geographically limited samples and use of verbal autopsy data, the numbers should be treated with caution. ... Finally, anthropometric indicators such as stunting or wasting rates, which can help evaluate malnutrition—the biggest contributor to child mortality by far, are missing. According to UNICEF’s Afghanistan Country programme document 2010—2013, around 1.2 million children younger than 5 years and 550,000 pregnant or lactating mothers are at high risk of severe malnutrition in Afghanistan.

The Lancet concludes, ominously:

To safeguard what has been gained with so much difficulty, sufficient and consistent assistance must be ensured from the international community.

Hear hear! And let’s be reminded again of Tony Blair’s 2001 pledge that we will not abandon Afghanistan.