• Giorgia Gon, Laura Monzon-Llamas, Lenka Benova, Barbara Willey, and Oona M R Campbell.
• Department of Epidemiology and Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
• Trop. Med. Int. Health. 2014 Dec 1; 19 (12): 1488-99.

ObjectiveTo estimate the effect of unimproved household water and toilet facilities on pregnancy-related mortality in Afghanistan.MethodsThe 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.ResultsAfter 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.ConclusionsUnimproved 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.© 2014 John Wiley & Sons Ltd.

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