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Mobile outreach health services for mothers and children in conflict-affected and remote areas: a population-based study from Afghanistan
  1. Karen Edmond1,
  2. Khaksar Yousufi2,
  3. Malalai Naziri2,
  4. Ariel Higgins-Steele2,
  5. Abdul Qadir Qadir3,
  6. Sayed Masoud Sadat3,
  7. Alexandra L Bellows4,
  8. Emily Smith4
  1. 1 United Nations Childrens Fund, Kabul, Afghanistan
  2. 2 UNICEF, Kabul, Afghanistan
  3. 3 Ministry of Public Health, Kabul, Afghanistan
  4. 4 Harvard T.H. Chan School of Public Health, Boston, USA
  1. Correspondence to Dr Karen Edmond, United Nations Childrens Fund, Kabul, Afghanistan; karen.edmond{at}


Objective To assess whether sustained, scheduled mobile health team (MHT) services increase antenatal care (ANC), postnatal care (PNC) and childhood immunisation in conflict-affected and remote regions of Afghanistan.

Design Cross-sectional, population-based study from 2013 to 2017. Proportions were compared using multivariable linear regression adjusted for clustering and socio-demographic variables.

Setting 54 intervention and 56 control districts in eight Afghanistan provinces.

Participants 338 796 pregnant women and 1 693 872 children aged under 5 years.

Interventions ‘Intervention districts’ that received MHT services for 3 years compared with ‘control districts’ in the same province without any MHT services over the same period.

Main outcome measures District-level and clinic-level ANC, PNC, childhood immunisation (pentavalent 3, measles 1), integrated management of childhood immunisation services.

Results Proportion of pregnant women receiving at least one ANC visit was higher in intervention districts (83.6%, 161 750/193 482) than control districts (61.3%, 89 077/145 314) (adjusted mean difference (AMD) 14.8%;95% CI: 1.6% to 28.0%). Proportion of children under 1 year receiving their first dose of measles vaccine was higher in intervention (73.8%, 142 738/193 412) than control districts (57.3%, 83 253/145 293) (AMD 12.8;95% CI: 2.1% to 23.5%). There was no association with PNC (AMD 2.8%;95% CI: −5.1% to 10.7%). MHTs did not increase clinic-level service provision for ANC (AMD 41.32;95% CI: -52.46 to 135.11) or any other outcomes.

Conclusions Sustained, scheduled MHT services to conflict-affected and remote regions were associated with improved coverage of important maternal and child health interventions. Outreach is an essential service and not just an ‘optional extra’ for the most deprived mothers and children.

  • health services research
  • maternal and child health
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  • Contributors KME conceptualised and wrote the first draft of the paper. The other authors all made substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data; and revised the work critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement There are no available unpublished data from the study.

  • Patient consent for publication Not required.

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