Najafizada Said Ahmad Maisam, Bourgeault Ivy Lynn, Labonté Ronald
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, Canada.
Telfer School of Management, University of Ottawa, Canada.
Cent Asian J Glob Health. 2017 Mar 20;6(1):240. doi: 10.5195/cajgh.2017.240. eCollection 2017.
Afghanistan has a high maternal mortality rate of 400 per 100,000 live births. Although direct causes of maternal morbidity and mortality in Afghanistan include hemorrhage, obstructed labor, infection, high blood pressure, and unsafe abortion, the high burden of diseases responsible for maternal mortality arises in large part due to social determinants of health. The focus of this literature review is to examine the impact of various social determinants of health on maternal health in Afghanistan, filling an important gap in the existing literature.
This narrative review was conducted using Arksey and O'Malley's framework of (1) defining the question, (2) searching the literature, (3) assessing the studies, (4) synthesizing selected evidence in context, and (5) summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications.
A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality.
Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care) is the long-term solution to the maternal health problems in Afghanistan. National and international organizations' long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally.
阿富汗的孕产妇死亡率很高，每10万例活产中有400例死亡。虽然阿富汗孕产妇发病和死亡的直接原因包括出血、难产、感染、高血压和不安全堕胎，但造成孕产妇死亡的疾病负担很大程度上是由健康的社会决定因素导致的。本综述的重点是研究各种健康社会决定因素对阿富汗孕产妇健康的影响，填补现有文献中的一个重要空白。
本叙述性综述采用了阿克西和奥马利的框架，即(1)界定问题，(2)检索文献，(3)评估研究，(4)结合背景综合选定的证据，以及(5)总结背景的潜在方案影响。我们在Medline、CABI全球健康数据库和谷歌学术上搜索了相关出版物。
本综述共纳入38篇文章/报告。我们发现，孕产妇教育、社会文化习俗和社会基础设施等社会决定因素对孕产妇健康有重大影响。医疗保健可能是直接决定因素，但它受到其他决定因素的影响，为了减轻医疗保健负担以及实现孕产妇死亡率的长期降低，必须解决这些决定因素。
由于社会因素对孕产妇健康结果的重要性，多个政府部门（即教育、劳动和社会事务、信息和文化、交通和农村发展等，以及医疗保健部门）的坚定参与是解决阿富汗孕产妇健康问题的长期办法。建议阿富汗和全球的国家和国际组织对教育、地方经济、文化变革和社会基础设施等社会投资做出长期承诺。
