Decrease in Use of Manual Vacuum Aspiration in Postabortion Care in Malawi: A Cross-Sectional Study from Three Public Hospitals, 2008–2012

Abstract

ObjectivesTo investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008–2012.MethodsA retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed.ResultsAltogether, 5121 women were included. One third (34.2%) of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7%) to 2009 (31.0%), with a rapid decline after 2010 (28.5%) ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012.ConclusionUse of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines.

‘It’s a very complicated issue here’: understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study

“…Furthermore, QECH is the largest referral hospital in Malawi and sees the majority of women with abortion complications. Odland et al (2014) found Chiradzulu had the lowest use of MVA (7.4%) compared with two other Malawian hospitals. Interviews were supplemented by unstructured observations of care practices (but no direct interactions with patients) made during the 4-week study period, to provide contextual insights concerning organizational set up, resources and staff dynamics.…”

“…and they were check listing, so people were doing it. (P.1, nurse, QECH) Participants also felt that monitoring MVA rates is beneficial and suggested that MVA usage increased in Chiradzulu following the dissemination of results demonstrating it had the lowest usage between 2008 and 2012 (Odland et al 2014). They attributed this to appointing a PAC coordinator who organizes a MVA staff rota and monitors supplies.…”

“…Reasons suggested for this included: a lack of MVA equipment, equipment being locked up to prevent its use in inducing abortions and a lack of trained staff. Moreover, a recent study found declining MVA use in three Malawian hospitals during 2009-12 from 31.0 to 4.9%, with a corresponding increase in D&C (Odland et al 2014). Studies have shown MVA to be more cost-effective than D&C in Malawi (Benson et al 2015) and other low-and middle-income countries (LMIC) (Johnston et al 2007;Maonei et al 2014).…”

Incidence of induced abortion in Malawi, 2015

“…Although use of manual vacuum aspiration (MVA) for treatment of incomplete abortion is recommended by WHO and favorable to use of dilation and curettage (D&C) [34], recent studies have documented declining MVA use in PAC in selected hospitals in Malawi [35]. In our study, when asked how treatment for abortion complications could be improved, 74% of HFS respondents said “have more commodities available” while 64% said “have more trained people available” (data not shown), which supports findings from a qualitative study of PAC providers to understand declines in use of MVA in recent years [36].…”

Effects of refresher training on the use of manual vacuum aspiration in the treatment of incomplete abortions: a quasi-experimental study in Malawi

“…In Malawi, medical treatment is used infrequently and most incomplete abortions are treated surgically. 14 A fear of misuse of misoprostol to induce abortions could be one of the reasons most incomplete abortions in Malawi are treated surgically. Another concern is that patients can be lost to follow-up and subsequently need attention because of serious septic abortions.…”