Morbidity and mortality in childhood in Afghanistan: a study of 40 492, consecutive admissions to the Institute of Child Health, Kabul.

During a three-year period, 336029 children were accorded ambulatory care and 40 492 children were admitted to the Institute of Child Health, Kabul, for in-patient treatment. Sixty-three per cent were boys. Three-quarters (75.3%) were under five years of age and provided 81.7% of the overall mortality. Children with acute gastroenteritis and respiratory infections together accounted for 49.9% of all admissions and 34.5% of all deaths. Malnutrition of varying degrees was a core problem and was seen in 67% of hospitalized children. The infectious diseases as a single group accounted for 70.7% of the morbidity and 71.9% of the mortality. Septicaemia and infections of the central nervous system were associated with the highest case fatality rates, especially among newborn babies. Six-target diseases and accidents accounted respectively for 10.4 and 9.7% of all deaths. Sixty-three per cent of children died within 24 hours of admission and the majority of deaths occurred after regular hospital working hours. In order to safeguard the well being of children in Afghanistan, and to reduce their morbidity and mortality, it will be mandatory to ensure effective delivery of primary health care, improve nutritional standards, provide safe drinking water, immunize the vulnerable population, make free elementary education universal and improve the lot of women and future mothers.