Unsafe Abortion in Sierra Leone: An Examination of Costs and Burden of Treatment on Healthcare Resources

Paul, Mary; Gebreselassie, Hailemichael; Samai, Mohamed; Benson, Janie; Sas, Kargbo

doi:10.4172/2167-0420.1000228

Cited by 5 publications

(12 citation statements)

References 17 publications

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“…Twelve studies were located in Eastern Africa (Ethiopia [10]; Malawi [11]; Rwanda [18]; Uganda [21]; Tanzania [20]), Western Africa (Burkina Faso [22]; Nigeria [23]; Senegal [17]; Sierra Leone [7]), Southern Asia (Bangladesh [24]), South America (Colombia [25]), and Central America (El Salvador [9]). All of these countries are in a group of Low-Middle Income Countries (LMICs) based on World Bank classi cation, with seven of them are low-income countries.…”

Section: Field and Study Settingmentioning

confidence: 99%

“…The PACCM is a bottom-up 'ingredients' approach that relies on expert opinion for estimating the health-system-cost component [21]. Study in Sierra Leone used the modi ed Delphi approach to solicit information [7]. Two studies in Nigeria and Malawi used savings, an excel-based tool to estimate per-case PAC costs [11,23].…”

Section: Costing Toolsmentioning

confidence: 99%

“…Unsafe abortion has detrimental consequences and generates preventable costs at multiple levels. On the societal level, many studies have con rmed that unsafe abortion leads to a high burden of morbidity and mortality [7]. Based on a public-health systems perspective, the treatment of complications due to spontaneous and induced abortion consume a disproportionate and signi cant amount of the maternal and gynecological hospital resources worldwide [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…On the societal level, many studies have con rmed that unsafe abortion leads to a high burden of morbidity and mortality [7]. Based on a public-health systems perspective, the treatment of complications due to spontaneous and induced abortion consume a disproportionate and signi cant amount of the maternal and gynecological hospital resources worldwide [7][8][9][10]. At the individual level, unsafe abortion can be harmful for women as it can result in severe complications and can require treatment through prolonged hospital stays [10].…”

Section: Introductionmentioning

confidence: 99%

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Health System Cost of Post-Abortion Care (PAC): A Systematic Review

Sihaloho¹,

Habibie²,

Kamilah³

et al. 2021

Preprint

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Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

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Section: Field and Study Settingmentioning

confidence: 99%

Section: Costing Toolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Health System Cost of Post-Abortion Care (PAC): A Systematic Review

Sihaloho¹,

Habibie²,

Kamilah³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…This cost could be reduced by 53% with a shift to safe abortion services. 10 In recent times, abortion has received considerable attention, and its legality and availability have often generated controversy. Gruber et al (1999) show that the child who would have been born had abortion remained outlawed was 60% more likely to live in a single parent household.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive abortion care in the Tain District of Ghana: an analysis of DHIMS2 data for 2010-2016

Adjei¹,

Asante²,

Baafi³

et al. 2018

Ghana Medical Journal

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Background: Access to safe abortion services reduces incidence of unsafe abortion. However, other studies have documented negative impacts such as rise in sexually transmitted infections in jurisdictions with liberal abortion laws. Objective: We assessed the impact of Comprehensive Abortion Care (CAC) services on selected reproductive health indicators in the Tain district. Method: Aggregated service data on abortion, contraception (family planning), and delivery antenatal Human Immuno-deficiency Virus (HIV) infection status of women age 10-49 years were extracted from the District Health Information Management System version 2 (DHIMS-2) database for the period 2010 to 2016. Data were converted to rates using projected population figures from the Ghana Statistical Service and presented as tables and graph for trend analysis. Results: The proportion of unsafe abortion increased from 2010 to 2012 and declined from 2013 onwards with increasing proportions of women opting for safe induced abortions; while spontaneous abortions followed an incremental trend from 2010 to 2013; leveling out from 2014. The family planning acceptor rates stayed above 38% over the period. The total fertility rate (women age 10-14 inclusive) increased sequentially from 4.6/1000 women in 2010 to 89.4/1000 in 2016. The HIV infection prevalence were 2.2%, 3.7%, 3.4%, 3.8%, 2.5%, 2.3% and 2.7% for 2010 to 2016 respectively. Conclusion: Access to Comprehensive Abortion Care (CAC) services reduces the incidence of unsafe abortions. Improved access to contraception may not necessarily lead to a decline in abortion or fertility rates. Liberalizing abortion does lead to a rise in the prevalence of sexually transmitted infections (HIV).

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The cost of post-abortion care (PAC): a systematic review

Sihaloho

Habibie

Kamilah

et al. 2022

BMC Health Serv Res

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Background Despite the increasing trend of Postabortion Care (PAC) needs and provision, the evidence related to its cost is lacking. This study aims to review the costs of Postabortion Care (PAC) per patient at a national level. Methods A systematic review of literature related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidates Health Economic Evaluation (CHEERS) checklist. PAC costs were extrapolated into US dollars ($US) and international dollars ($I), both in 2019. Results Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, the highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58–212.47, while the lowest is in Malawi ($US15.2–139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services is in El Salvador ($US65.22–240.75), while the lowest is in Bangladesh ($US15.71–103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 has the highest average indirect medical cost, while Rwanda with $US51.44 has the lowest. Conclusions Our review shows variability in the cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC services, although it is still seemingly underestimated. When a study compared the use of UE (Uterine Evacuation) method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspectives, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

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Unsafe Abortion in Sierra Leone: An Examination of Costs and Burden of Treatment on Healthcare Resources

Cited by 5 publications

References 17 publications

Health System Cost of Post-Abortion Care (PAC): A Systematic Review

Health System Cost of Post-Abortion Care (PAC): A Systematic Review

Comprehensive abortion care in the Tain District of Ghana: an analysis of DHIMS2 data for 2010-2016

The cost of post-abortion care (PAC): a systematic review

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