Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

Owolabi, Onikepe; Cresswell, Jenny A.; Vwalika, Bellington; Osrin, David; Filippi, Véronique

doi:10.1016/j.contraception.2016.08.014

Cited by 31 publications

(37 citation statements)

References 33 publications

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“…The abortion‐related near‐miss ratio in our study was much lower than reported in Zambia, likely accounted for by differences in near‐miss definition criteria. In the Zambian estimate, clinical and management‐based criteria were re‐defined and diagnostic thresholds for near‐miss were lowered compared with our study. The prevalence of maternal near miss associated with ectopic pregnancy was comparable with observations from Iran .…”

Section: Discussioncontrasting

confidence: 84%

Maternal near‐miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

Adanikin

Umeora

Nzeribe

et al. 2019

BJOG

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Objective To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals.Design Secondary analysis of a nationwide cross-sectional study.Setting Forty-two tertiary hospitals.Population Women admitted for pregnancy-related complications.Methods All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria.Main outcome measures Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance. ResultsOf 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortionrelated infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival.Conclusions Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival.

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Section: Discussioncontrasting

confidence: 84%

Maternal near‐miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

Adanikin

Umeora

Nzeribe

et al. 2019

BJOG

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“…There were 0.9 and 2.1 severe abortion complications per 100 deliveries in Tanzania and Uganda, respectively. These values are similar to that of 1.5 per 100 live births reported in a study from Zambia . Studies that did not specifically include abortion as a screening event have reported lower rates; for example, another study in Uganda reported 39 abortion‐related near‐misses per 25 840 live births (0.16 per 100 deliveries) .…”

Section: Discussionsupporting

confidence: 81%

“…Studies that did not specifically include abortion as a screening event have reported lower rates; for example, another study in Uganda reported 39 abortion‐related near‐misses per 25 840 live births (0.16 per 100 deliveries) . Lowering the threshold of blood transfusion also increased the identification of abortion‐related near‐miss cases, an observation made by a previous study in Zambia …”

Section: Discussionmentioning

confidence: 94%

“…This improved the comparability of the results. The study also used a prospective design with continuous data collection—a design that has been proposed to lead to better identification of cases …”

Section: Discussionmentioning

confidence: 99%

“…The study also used a prospective design with continuous data collection-a design that has been proposed to lead to better identification of cases. 24 The study indicates, however, that the incidence of near-miss and the mortality index depend on the type of obstetric complication. Data collection was done by staff employed in the maternity wards, whereas other studies have used research nurses for data collection.…”

Section: Proportion Of Complications Per Reported Deliveries (%)mentioning

confidence: 97%

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Rethinking the definition of maternal near‐miss in low‐income countries using data from 104 health facilities in Tanzania and Uganda

Pembe

Hirose

Al‐beity

et al. 2019

Intl J Gynecology & Obste

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Objective To assess the consistency of maternal near‐miss incidence and mortality index between two definitions across 104 facilities in Tanzania and Uganda. Methods Based on WHO guidance, cross‐sectional near‐miss data were collected in Tanzania (July 2015 to October 2016) and Uganda (June 2016 to September 2017). Prepartum hemorrhage and abortion were included as additional screening events and the number of blood units transfused was recorded. Near‐miss incidence and mortality index were determined by using two near‐miss definitions: the WHO standard definition, and a modified definition including women receiving at least 1 unit of blood. A sensitivity analysis excluded the additional screening events. Results Near‐miss incidence differed between Tanzania and Uganda (1.79 and 4.00, respectively, per 100 deliveries) when estimated by the standard definition, but was similar (5.24 and 4.94, respectively) by the modified definition. The mortality index was higher in Tanzania than in Uganda when estimated by the standard definition (8.56% vs 3.54%), but was similar by the modified definition (3.10% vs 2.89%). Conclusion The modified definition provided a more consistent estimate of near‐miss incidence and mortality index. Lowering the threshold for units of blood transfusion might improve comparability between settings, but more research is needed.

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Setting the research agenda for induced abortion in Africa and Asia

Scott

Filippi

Moore

et al. 2018

Intl J Gynecology & Obste

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Provision of safe abortion is widely recognized as vital to addressing the health and wellbeing of populations. Research on abortion is essential to meet the UN Sustainable Development Goals. Researchers in population health from university, policy, and practitioner contexts working on two multidisciplinary projects on family planning and safe abortion in Africa and Asia were brought together for a workshop to discuss the future research agenda on induced abortion. Research on care-seeking behavior, supply of abortion care services, and the global and national policy context will help improve access to and experiences of safe abortion services. A number of areas have potential in designing intervention strategies, including clinical innovations, quality improvement mechanisms, community involvement, and task sharing. Research on specific groups, including adolescents and young people, men, populations affected by conflict, marginalized groups, and providers could increase understanding of provision, access to and experiences of induced abortion. Methodological and conceptual advances, for example in the measurement of induced abortion incidence, complications, and client satisfaction, conceptualizations of induced abortion access and care, and methods for follow-up of patients who have induced abortions, will improve the accuracy of measurements of induced abortion, and add to understanding of women's experiences of induced abortions and abortion care.

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Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

Cited by 31 publications

References 33 publications

Maternal near‐miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

Maternal near‐miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

Rethinking the definition of maternal near‐miss in low‐income countries using data from 104 health facilities in Tanzania and Uganda

Setting the research agenda for induced abortion in Africa and Asia

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