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Ouattara M, Sié A, Seynou M, Kagoné M, Bountogo M, Kouanda I, Ouédraogo R, Bangha M, Juma K, Athero S. Profil des utilisatrices et facteurs associés à la satisfaction des clientes de la qualité des soins après avortement au Burkina Faso: étude transversale menée dans six régions. Sex Reprod Health Matters 2024; 31:2272483. [PMID: 38189431 PMCID: PMC10810668 DOI: 10.1080/26410397.2023.2272483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
RésuméMalgré la dépénalisation de l'avortement et la gratuité des soins après avortement (SAA), les femmes Burkinabè vivent des relations difficiles avec les soignants. Cette étude vise à déterminer le profil des femmes recevant des SAA, leur perception de la qualité des SAA et ses déterminants dans des structures sanitaires publiques et confessionnelles du pays. Une enquête quantitative a été menée auprès de 2174 femmes vues pour des SAA et recrutées de façon exhaustive de 2018 à 2020. Un questionnaire structuré a été administré à la sortie des soins. Une analyse uni-, bi- et multivariée a été faite. La majorité des clientes de SAA vivait en milieu rural (55%), avait 25 ans et plus (60%), vivait en couple (87%) et était sans-emploi (59%). La grossesse était non désirée chez 17% des femmes et 4% d'entre elles souhaitaient avorter. La satisfaction globale de la qualité des SAA était de 84%. Dans l'analyse multivariée, ses déterminants étaient la résidence en milieu rural (OR = 1.80 [1.38; 2.34]), un niveau scolaire primaire (OR = 1.48 [1.06; 2.07]) ou secondaire (OR = 1.95 [1.38; 2.74]), et avoir eu au moins un enfant (OR = 1.43 [1.02; 2.00]). Les facteurs associés à une faible satisfaction des SAA étaient une grossesse non désirée (OR = 0.64 [0.46; 0.89]) ou avoir souhaité avorter (OR = 0.09 [0.05; 0.16]). Le niveau de satisfaction globale est acceptable mais faible chez les clientes ayant souhaité avorter. Il est fondamental d'organiser un programme de formation des professionnels des SAA sur la communication, la relation interpersonnelle et l'empathie pendant les soins de santé.
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Affiliation(s)
- Mamadou Ouattara
- Chercheur, MD, épidémiologiste et Biostatisticien, Centre de recherche en santé de Nouna, Nouna, Burkina Faso. Correspondence:
- Chercheur, Directeur, MD, épidémiologiste, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Ali Sié
- Scientifique d'appui (Guest Scientist), Institut de santé mondiale de Heidelberg, Heidelberg, Allemagne
- Chercheur associé, Université de Californie à San Francisco, San Francisco, États-Unis
- Chercheure, épidémiologiste, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Mariam Seynou
- Enseignant chercheur, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Moubassira Kagoné
- Chercheur, socio-anthropologue, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Mamadou Bountogo
- Chercheure, épidémiologiste, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Idrissa Kouanda
- Gestionnaire des bases de données, Centre de recherche en santé de Nouna, Nouna, Burkina Faso
| | - Ramatou Ouédraogo
- Chercheure, socio-anthropologue, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
| | - Martin Bangha
- Chercheur, démographe, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
| | - Kenneth Juma
- Statisticien, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
| | - Sherine Athero
- Gestionnaire des bases de données, Centre africain de recherche sur la population et la santé, Nairobi, Kenya
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Mwadhi MK, Bangha M, Wanjiru S, Mbuthia M, Kimemia G, Juma K, Shirima J, Unda S, Achieng A, Both J, Ouedraogo R. Why do most young women not take up contraceptives after post-abortion care? An ethnographic study on the effectiveness and quality of contraceptive counselling after PAC in Kilifi County, Kenya. Sex Reprod Health Matters 2023; 31:2264688. [PMID: 37937821 PMCID: PMC10653685 DOI: 10.1080/26410397.2023.2264688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Post-abortion care (PAC) counselling and the provision of contraceptive methods are core components of PAC services. Nevertheless, this service is not uniformly provided to PAC patients. This paper explores the factors contributing to young women leaving health facilities without counselling and contraceptive methods. The paper draws from an ethnographic study conducted in Kilifi County, Kenya, in 2021. We conducted participant observation in health facilities and neighbouring communities, and held in-depth interviews with 21 young women aged 15-24 who received PAC. In addition, we interviewed 11 healthcare providers recruited from the public and private health facilities observed. Findings revealed that post-abortion contraceptive counselling and methods were not always offered to patients as part of PAC as prescribed in the PAC guidelines. When PAC contraceptive counselling was offered, certain barriers affected uptake of the methods, including inadequate information, coercion by providers and partners, and fears of side effects. Together, these factors contributed to repeat unintended pregnancies and repeat abortions. The absence of quality contraceptive counselling therefore infringes on the right to health of girls and young women. Findings underscore the need to strengthen the capacities of health providers on PAC contraceptive counselling and address their attitudes towards young female PAC patients.
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Affiliation(s)
- Mercy Kadzo Mwadhi
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Martin Bangha
- Associate Research Scientist, African Population and Health Research Center, Nairobi, Kenya
| | - Shelmith Wanjiru
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Michelle Mbuthia
- Communications Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kimemia
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Juma
- Research Officer, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Shirima
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Shilla Unda
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Anne Achieng
- Research Assistant, African Population and Health Research Center, Nairobi, Kenya
| | - Jonna Both
- Senior Researcher, Rutgers, Utrecht, Netherlands
| | - Ramatou Ouedraogo
- Research Scientist, African Population and Health Research Center, Nairobi, Kenya
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Chakhame BM, Darj E, Mwapasa M, Kafulafula UK, Maluwa A, Odland JØ, Odland ML. Women's perceptions of and experiences with the use of misoprostol for treatment of incomplete abortion in central Malawi: a mixed methods study. Reprod Health 2023; 20:26. [PMID: 36732793 PMCID: PMC9893686 DOI: 10.1186/s12978-022-01549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Abortion-related complications are among the common causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first-trimester incomplete abortions but is seldom used for post-abortion care in Malawi. METHODS A descriptive cross-sectional study that used mixed methods was conducted in three hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for quantitative part and thematic analysis for qualitative part. RESULTS From the qualitative data, three themes emerged around the following areas: experienced effects, support offered, and women's perceptions. Most women liked misoprostol and reported that the treatment was helpful and effective in expelling retained products of conception. Quantitative data revealed that the majority of participants, 376 (94%) were satisfied with the support received, and 361 (90.3%) believed that misoprostol was better than surgical treatment. The majority of the women 364 (91%) reported they would recommend misoprostol to friends. CONCLUSIONS The use of misoprostol for incomplete abortion in Malawi is acceptable and regarded as helpful and satisfactory among women.
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Affiliation(s)
- Bertha Magreta Chakhame
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elisabeth Darj
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway
| | - Mphatso Mwapasa
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Alfred Maluwa
- grid.493103.c0000 0004 4901 9642Malawi University of Science and Technology, Thyolo, Malawi
| | - Jon Øyvind Odland
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,grid.49697.350000 0001 2107 2298School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002 South Africa ,grid.465487.cFaculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Maria Lisa Odland
- grid.5947.f0000 0001 1516 2393Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Obstetrics and Gynecology, St. Olav’s University Hospital, Trondheim, Norway ,Malawi-Liverpool-Welcome Trust Research Institute, Blantyre, 312225 Malawi ,grid.10025.360000 0004 1936 8470Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3BX UK
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Owolabi O, Riley T, Otupiri E, Polis CB, Larsen-Reindorf R. The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study. BMC Health Serv Res 2021; 21:1104. [PMID: 34654428 PMCID: PMC8520210 DOI: 10.1186/s12913-021-07141-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/29/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. METHODS We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. RESULTS Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. DISCUSSION Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. CONCLUSIONS SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.
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Affiliation(s)
- Onikepe Owolabi
- Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY 10038 USA
- Vital Strategies, 100 Broadway, 4th Floor, New York, 10005 USA
| | - Taylor Riley
- Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY 10038 USA
| | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Chelsea B. Polis
- Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY 10038 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Roderick Larsen-Reindorf
- Department of Obstetrics & Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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