Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries
Introduction Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.Methods...
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2021-01-01
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| author | Özge Tunçalp Cassimo Bique Ahmet Metin Gülmezoglu Veronique Filippi Richard Adanu Bela Ganatra Bukola Fawole Philip Govule Zahida Qureshi Luis Gadama Seni Kouanda Caron Rahn Kim Sally Griffin Hedieh Mehrtash Soe Soe Thwin Folasade Adenike Bello Ausbert Thoko Msusa Nafiou Idi Sourou Goufodji Jean-Jose Wolomby-Molondo Kidza Yvonne Mugerwa Thierry Madjadoum |
| author_facet | Özge Tunçalp Cassimo Bique Ahmet Metin Gülmezoglu Veronique Filippi Richard Adanu Bela Ganatra Bukola Fawole Philip Govule Zahida Qureshi Luis Gadama Seni Kouanda Caron Rahn Kim Sally Griffin Hedieh Mehrtash Soe Soe Thwin Folasade Adenike Bello Ausbert Thoko Msusa Nafiou Idi Sourou Goufodji Jean-Jose Wolomby-Molondo Kidza Yvonne Mugerwa Thierry Madjadoum |
| author_sort | Özge Tunçalp |
| collection | DOAJ |
| description | Introduction Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.Methods A cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.Results There were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).Conclusion There is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care. |
| format | Article |
| id | doaj-art-2dca2d73ff6c495eb61209a660276f45 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-01-01 |
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| spelling | doaj-art-2dca2d73ff6c495eb61209a660276f452025-08-20T02:09:45ZengBMJ Publishing GroupBMJ Global Health2059-79082021-01-016110.1136/bmjgh-2020-003702Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countriesÖzge Tunçalp0Cassimo Bique1Ahmet Metin Gülmezoglu2Veronique Filippi3Richard Adanu4Bela Ganatra5Bukola Fawole6Philip Govule7Zahida Qureshi8Luis Gadama9Seni Kouanda10Caron Rahn Kim11Sally Griffin12Hedieh Mehrtash13Soe Soe Thwin14Folasade Adenike Bello15Ausbert Thoko Msusa16Nafiou Idi17Sourou Goufodji18Jean-Jose Wolomby-Molondo19Kidza Yvonne Mugerwa20Thierry Madjadoum21Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, SwitzerlandMozambican Society of Obstetrician and Gynaecologists (AMOG), Maputo, MozambiqueUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandLondon School of Hygiene & Tropical Medicine, London, UKSchool of Public Health, University of Ghana, Legon, GhanaUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandDepartment of Obstetrics and Gynaecology, University of Ibadan, Ibadan, NigeriaEpidemiology and Disease Control, University of Ghana College of Health Sciences, Accra, Greater Accra, GhanaDepartment of Obstetrics and Gynaecology, University of Nairobi, Nairobi, KenyaMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, MalawiInstitut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina FasoDepartment of Reproductive Health and Research, World Health Organization, Geneve, SwitzerlandInternational Centre for Reproductive Health-Mozambique (ICRHM), Maputo, MozambiqueUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland20 Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandDepartment of Obstetrics and Gynaecology, University of Ibadan, Ibadan, NigeriaCentre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, MalawiUniversité Abdou Moumouni de Niamey, Niamey, NigerCentre de Recherche en Reproduction Humaine et en Démographie, Cotonou, BeninCliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of CongoDepartment of Obstetrics and Gynaecology, Makerere University, Kampala, UgandaHopital Regional de Koumra, N’Djamena, ChadIntroduction Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.Methods A cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.Results There were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).Conclusion There is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.https://gh.bmj.com/content/6/1/e003702.full |
| spellingShingle | Özge Tunçalp Cassimo Bique Ahmet Metin Gülmezoglu Veronique Filippi Richard Adanu Bela Ganatra Bukola Fawole Philip Govule Zahida Qureshi Luis Gadama Seni Kouanda Caron Rahn Kim Sally Griffin Hedieh Mehrtash Soe Soe Thwin Folasade Adenike Bello Ausbert Thoko Msusa Nafiou Idi Sourou Goufodji Jean-Jose Wolomby-Molondo Kidza Yvonne Mugerwa Thierry Madjadoum Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries BMJ Global Health |
| title | Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries |
| title_full | Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries |
| title_fullStr | Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries |
| title_full_unstemmed | Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries |
| title_short | Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries |
| title_sort | understanding abortion related complications in health facilities results from who multicountry survey on abortion mcs a across 11 sub saharan african countries |
| url | https://gh.bmj.com/content/6/1/e003702.full |
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