Severity and management of postabortion complications among women in Zimbabwe, 2016: a cross-sectional study

Abstract

ObjectivesAbortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe.DesignProspective, facility-based 28 day survey among women seeking PAC and their providers.Setting127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities.Participants1002 women presenting with abortion complications during the study period.Main outcome measuresSeverity of abortion complications and associated factors, delays in care seeking, and clinical management of complications.ResultsOverall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception.ConclusionZimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.

Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities

“…This EmOC benchmark recommendation has been used to assess population coverage of abortion services [12,13,16]. When analyzing data from women's health records in the PMS dataset, we applied facilitylevel weights accounting for the complex sample design, including adjusting for stratification by province and facility level, clustering of women at the facility level, and facility non-response, as well as applying a finite population correction [3]. The statistical analysis was conducted in Stata version 15.0 [17].…”

“…Overall, 127 facilities participated out of the 133 facilities we selected, resulting in a facility-level response rate of 95%. More detail on the PMS sample and study design can be found in Madziyire et al [3].…”

“…There were 1 There were 263 women missing on variable for PAC procedure and an additional 8 missing on the trimester variable; 249 women were missing on PAC provider variable; 72 women were missing on the contraceptive counseling variable 2 The WHO recommends misoprostol, manual vacuum aspiration (MVA), or electric vacuum aspiration (EVA) for first trimester procedures and dilatation and evacuation (D&E) and misoprostol for second trimester procedures. The denominator for this calculation is all PAC procedures performed as reported in the PMS 3 Of PAC patients who received the recommended first trimester procedure, 51% received MVA, 5% received EVA and 44% received misoprostol (at the national level) 4 Of PAC patients who received the recommended second trimester procedure, 39% received misoprostol, 14% received digital evacuation, and 47% received forceps evacuation (at the national level) 5 Out of all PAC patients who had been discharged at time of interview (25 PAC patients had not yet been discharged at time of interview) 6 Short acting reversible contraceptive methods include male condom, female condom, pills and injectables 7 Long acting reversible methods include IUD and implant. Permanent methods include female sterilization (no PAC patients' partners received male sterilization at discharge).…”

“…In Eastern Africa, where Zimbabwe is located, an estimated 76% of abortions are considered unsafe [2]. In Zimbabwe, four in ten women who have an abortion experience complications that require treatment [1], and of the women who do seek treatment for abortion complications, around 40% experienced moderate to severe complications, and 3% were classified as a maternal near-miss [3]. Despite a critical need for post-abortion care (PAC) services to treat abortion complications, there are some indications that the Zimbabwean health system is struggling to provide quality PAC services: over half of facilities that provide PAC in Zimbabwe reported stock-outs of essential PAC medicines and supplies, such as misoprostol and manual vacuum aspiration (MVA) kits [1].…”

Estimating Abortion Incidence: Assessment of a Widely Used Indirect Method

“…The results show that the HFS past month estimate is substantially higher than the PMS estimate in Ethiopia (a difference of 24%) and much closer (and in the opposite direction) in the two other countries (− 6% Table 6 Comparison of annual number of PAC Cases estimated by HFS and PMS surveys for four surveys in three countries with available data. Sources Gebrehiwot et al (2016), Moore et al (2016), Mohamed et al (2015), Ziraba et al (2015), Madziyire et al (2018) (Table 6). Overall, it is likely to be more difficult to ensure complete coverage of all patients, especially in larger facilities, because greater caseloads combined with multiple points of admission and treatment may make it difficult to achieve 100% coverage of incoming patients.…”