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Trop Med Int Health. 2014 Dec;19(12):1488-99. doi: 10.1111/tmi.12394. Epub 2014 Oct 20.

The contribution of unimproved water and toilet facilities to pregnancy-related mortality in Afghanistan: analysis of the Afghan Mortality Survey.

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Department of Epidemiology and Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.



To estimate the effect of unimproved household water and toilet facilities on pregnancy-related mortality in Afghanistan.


The data source was a population-based cross-sectional study, the Afghan Mortality Survey 2010. Descriptive, univariate and multivariate logistic regression analyses were carried out, comparing 69 pregnancy-related deaths (cases) and 15386 surviving women (non-cases) who had a live birth or stillbirth between 2007 and 2010.


After adjusting for confounders, households with unimproved water access had 1.91 the odds of pregnancy-related mortality [95% confidence interval (CI) 1.11-3.30] compared to households with improved water access. We also found an association between unimproved toilet facilities and pregnancy-related mortality (OR = 2.25; 95% CI 0.71-7.19; P-value = 0.169), but it was not statistically significant.


Unimproved household water access was an important risk factor for pregnancy-related mortality in Afghanistan. However, we were unable to discern whether unimproved water source is a marker of unhygienic environments or socio-economic position. There was weak evidence for the association between unimproved toilet facilities and pregnancy-related mortality; this association requires confirmation from larger studies.


Afganistán; Afghanistan; assainissement; cross-sectional study; estudio croseccional; fuentes de agua; instalaciones sanitarias mortalidad materna; installations de toilette; maternal mortality; mortalité maternelle; ressources d'eau; sanitation; toilet facilities; water resources; étude transversale

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