The Imperative to Expand Provision, Access and Use of Misoprostol for Post-Abortion Care in sub-Saharan Africa

Kulczycki, Andrzej

doi:10.29063/ajrh2016/v20i3.3

Cited by 18 publications

(18 citation statements)

References 8 publications

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“…However, case reports, case series, commentaries, and editorials will be excluded from the review. All studies with primary objective to determine the prevalence of unsafe abortion and/or its associated factors among reproductive aged women in Sub-Saharan Africa will be considered [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

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Unsafe abortion and associated factors among reproductive aged women in Sub-Saharan Africa: a protocol for a systematic review and meta-analysis

Gebremedhin

Semahegn

Usmael³

et al. 2018

Syst Rev

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BackgroundUnsafe abortion is a neglected public health problem contributing for 13% of maternal death worldwide. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. The prevalence of unsafe abortion is associated with restricted abortion law, poor quality of health service, and low community awareness. Hence, the aim of this systematic review and meta-analysis is to identify and summarize the available evidence to generate an abridged evidence on the prevalence of unsafe abortion and its associated factors in Sub-Saharan Africa.MethodsThe development of the systematic review methodology has followed the procedural guideline depicted in the preferred reporting items for systematic review and meta-analysis protocol statement. Observational studies that have been conducted from January 1, 1994, up to December 31, 2017, in Sub-Saharan African countries will be included in the systematic review and meta-analysis. MEDLINE (via PubMed), EMBASE, CINAHL, and PopLine will be searched to retrieve available studies. Relevant studies will be retrieved using the search strings applied to different sources. The Joanna Briggs Institute quality assessment tool will be used to critically appraise the methodological robustness and validity of the finding to avoid erroneous data due to confounded or biased statistics. Data extraction template will be prepared to record abstracted information from selected studies. The selection of relevant studies, data extraction, and quality assessment of studies will be carried out by two authors. Meta-analysis using Mantel–Haenszel random effects model will be carried out. The presence of heterogeneity between studies will be checked using the I2 value.DiscussionUnsafe abortion is not yet reduced significantly in Sub-Saharan Africa, and maternal death rate due to unsafe abortion remains high. Currently, there is a gap in availability of abridged evidence on unsafe abortion and this negatively influenced the current service delivery. This finding will help stakeholders to design appropriate strategy. The finding of this systematic review and meta-analysis will be helpful to inform policy-makers, programmers, planners, clinician’s decision making, researchers, and women clients at large.Systematic review registrationPROSPERO 2017: CRD42017081437.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0775-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

“…Unsafe abortion is identified as one of the major cause of maternal morbidity and mortality [ 7 ]. In Sub-Saharan Africa (SSA), abortion is more common and it tends to be clandestine and unsafe that has a substantially contribution to maternal mortality [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Unsafe abortion and associated factors among reproductive aged women in Sub-Saharan Africa: a protocol for a systematic review and meta-analysis

Gebremedhin

Semahegn

Usmael³

et al. 2018

Syst Rev

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“…26 Studies show substantial promise to extend the option for treating incomplete abortion and miscarriage with misoprostol at the district and lower levels in remote, rural, and impoverished areas, where access to PAC and surgery is mostly restricted. 11,13 Misoprostol is heat stable, relatively inexpensive, and easy to administer, and has yet to be demonstrated and effectively operationalized at mid-and lower-level facilities. 27 Furthermore, there are many gaps in the literature on service delivery aspects of misoprostol, particularly for PAC, hindering efforts to institutionalize its more widespread safe, acceptable, and effective use, which needs rigorous advocacy and support at various levels.…”

Section: Discussionmentioning

confidence: 99%

“…27 Furthermore, there are many gaps in the literature on service delivery aspects of misoprostol, particularly for PAC, hindering efforts to institutionalize its more widespread safe, acceptable, and effective use, which needs rigorous advocacy and support at various levels. 11 Programs should ensure that both MVA and misoprostol are available at HFs, and women should be informed of appropriate treatment options, staff should be trained, and communities should be informed. 19 EmONC guidelines were available at fewer than half of public and private HFs.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Providing high-quality PAC in all facilities is ethical and considered a humanitarian imperative. 11 When high-quality PAC is available, morbidity and mortality associated with unsafe or incomplete abortion can be greatly reduced. 10 The World Health Organization (WHO) recommends use of manual vacuum aspiration (MVA) or medical treatment of abortions utilizing misoprostol-based regimens.…”

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confidence: 99%

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Health Facility Capacity to Provide Postabortion Care in Afghanistan: A Cross-Sectional Study

Maruf

Tappis²,

Lu³

et al. 2019

Preprint

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Background: Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births, Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes. Contraceptive prevalence rate has fluctuated between 10–20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated health facilities’ capacity to provide postabortion care, and skilled birth attendants’ knowledge and perceptions. Methods: Accessible public health facilities with at least five births per day on average (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Data collection methods for provision included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions.Results: Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Seventy percent of public facilities expected to provide basic emergency obstetric and newborn care had functional manual vacuum aspiration supplies in the delivery room. More than 80% of public health facilities had male condoms, oral contraceptive pills, intrauterine devices, and injectables. Conclusions: This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, and availability of supplies.

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Preventing death following unsafe abortion: a case series from urban Uganda

Namagembe

Nakimuli

Byamugisha

et al. 2022

AJOG Global Reports

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The Imperative to Expand Provision, Access and Use of Misoprostol for Post-Abortion Care in sub-Saharan Africa

Cited by 18 publications

References 8 publications

Unsafe abortion and associated factors among reproductive aged women in Sub-Saharan Africa: a protocol for a systematic review and meta-analysis

Unsafe abortion and associated factors among reproductive aged women in Sub-Saharan Africa: a protocol for a systematic review and meta-analysis

Health Facility Capacity to Provide Postabortion Care in Afghanistan: A Cross-Sectional Study

Preventing death following unsafe abortion: a case series from urban Uganda

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