U.S. Health Officials Optimistic About Reducing Mortality Rate At Women's Hospital In Kabul

Main Category: Pregnancy / Obstetrics
Also Included In: Pediatrics / Children's Health;  Primary Care / General Practice
Article Date: 04 Jan 2008 - 7:00 PDT

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HHS and CDC officials on Wednesday said they are encouraged that the mortality rate of women and infants at the HHS-funded Rabia Balkhi Women's Hospital in Kabul, Afghanistan, can be reduced, the Atlanta Journal-Constitution reports. A team of experts -- led by Mary Lou Valdez, deputy director of HHS' Office of Global Health Affairs -- evaluated the Balkhi Hospital from Nov. 29 to Dec. 13, 2007, and the agency plans to send pediatric and obstetric experts to the hospital to work with Afghan physicians this month or next month (Young, Atlanta Journal-Constitution, 1/3).

CDC and Afghan health ministry officials became concerned that the HHS training program in Kabul encouraged physicians to perform caesarean sections before physicians were adequately trained after a 67% increase in infant mortality at the hospital occurred in 2006. Infants delivered by c-section at the hospital are nearly four times more likely to die than those delivered vaginally. Of the 18 maternal deaths at the hospital in 2006, two-thirds involved c-sections infants. The c-section rate and postoperative infection rate at the hospital increased by 45% and 66%, respectively, in 2006, according to CDC data.

A contractor's assessment of the hospital found that Afghan physicians at the hospital often did not have basic knowledge of anatomy and physiology and lacked skills needed to resuscitate women and infants. In addition, the hospital routinely lacked basic supplies, including surgical gloves and antibiotics.

HHS in November 2002 had started a maternal and child health campaign in Afghanistan after a UNICEF-CDC survey revealed that the country had a maternal mortality rate of approximately 1,600 deaths for every 100,000 live births, one of the highest rates in the world. Former HHS Secretary Tommy Thompson and officials from the U.S. Department of Defense and Afghanistan's Ministry of Public Health in April 2003 opened the renovated Balkhi Hospital. About $23 million has been spent on the project.

Rep. Henry Waxman (D-Calif.), chair of the House Committee on Oversight and Government Reform, last month opened an investigation into possible mismanagement of the hospital and requested documents from HHS Secretary Mike Leavitt about Balkhi's training program (Daily Women's Health Policy Report, 12/7/07). According to the Journal-Constitution, HHS currently is developing a joint quality assurance program at Balkhi and three other Kabul maternity hospitals.

Brian McCarthy, a maternal health expert and head of CDC's mission at Balkhi, said that he is hopeful that the new training and quality assurance programs will reduce c-section-related deaths among infants with normal weights, adding that he feels "much better" about where the project is headed (Atlanta Journal-Constitution, 1/3).

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