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Pasquier E, Owolabi OO, Powell B, Fetters T, Ngbale RN, Lagrou D, Fotheringham C, Schulte-Hillen C, Chen H, Williams T, Moore AM, Adame Gbanzi MC, Debeaudrap P, Filippi V, Benova L, Degomme O. Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings. Reprod Health 2024; 21:114. [PMID: 39103920 DOI: 10.1186/s12978-024-01835-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR). METHODS We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively. RESULTS Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time. CONCLUSION Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.
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Affiliation(s)
- Estelle Pasquier
- Epicentre - Médecins Sans Frontières, Paris, France.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | - Richard Norbert Ngbale
- Ministère de la Santé et de la Population de la République Centrafricaine, Bangui, Central African Republic
| | | | | | | | - Huiwu Chen
- Epicentre - Médecins Sans Frontières, Paris, France
| | - Timothy Williams
- Epicentre - Médecins Sans Frontières, Abuja, Jigawa State, Nigeria
| | | | | | - Pierre Debeaudrap
- CEPED, Institut de Recherche pour le Développement, Université Paris Descartes, INSERM 1244, Paris, France
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health - London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium
| | - Olivier Degomme
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Haile TG, Abraha TH, Gebremeskel GG, Zereabruk K, Welu TH, Grum T, Asres N. Induced abortion in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0302824. [PMID: 38713662 PMCID: PMC11075855 DOI: 10.1371/journal.pone.0302824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/10/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND One of the main factors contributing to maternal morbidity and mortality is induced abortion. The WHO estimates that over 44 million induced abortions take place annually around the world. The majority of these abortions-about 50%-are unsafe, significantly increasing maternal morbidity and contributing to 13% of maternal deaths. Thus, this review aimed to estimate the pooled prevalence of induced abortion and its associated factors in Africa. METHODS To find literature on the prevalence of induced abortion and its associated factors, a thorough search of the internet databases such as PubMed/MEDLINE, African Journals Online, and Google Scholar was conducted. The data were extracted using a structured method of data collection. Software called STATA 14 was used to do the analysis. funnel plot and Egger regression test were used to evaluate potential publication bias. I2 statistics and Cochrane's Q were used to measure the heterogeneity at a p-value < 0.05. RESULTS 976 studies were found through a thorough search of electronic databases. Finally, 46 full-text abstract papers were included in this study. The estimated pooled prevalence of induced abortion was 16% (95% CI: 13%-19%). According to the sub-group analysis, most studies were conducted in Ethiopia, and the pooled prevalence was 19% (95% CI: 10%-30%). Similarly, the subgroup analysis by year of study showed that the prevalence of induced abortion was 39% (95% CI: 17%-64%) among studies conducted in 2019. CONCLUSION The results of this study thus imply that the pooled prevalence of induced abortion is higher than that of earlier studies that were published in some nations. the data from this study are needed to support reproductive and adolescent health programmers and policymakers and to formulate recommendations for future clinical practice and guidelines.
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Affiliation(s)
- Teklehaimanot Gereziher Haile
- Department of Maternity and Neonatal Nursing, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Teklehaymanot Huluf Abraha
- Department of Reproductive and Family Health, School of Public Health, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Gebreamlak Gebremedhn Gebremeskel
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Kidane Zereabruk
- Department of Adult Health Nursing, School of Nursing, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Tesfay Hailu Welu
- Department of Midwifery, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Teklit Grum
- Department of Reproductive and Family Health, School of Public Health, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
| | - Negasi Asres
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Comprehensive Specialized Hospital, Aksum University, Aksum, Tigray, Ethiopia
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Lewandowska M, Scott R, Meiksin R, Reiter J, Salaria N, Lohr PA, Cameron S, Palmer M, French RS, Wellings K. How can patient experience of abortion care be improved? Evidence from the SACHA study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241242675. [PMID: 38794997 PMCID: PMC11128172 DOI: 10.1177/17455057241242675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. OBJECTIVE Our study aimed to examine women's satisfaction with abortion care and their suggestions for improvements. DESIGN Qualitative, in-depth, semi-structured interviews. METHODS A purposive sample of 48 women with recent experience of abortion was recruited between July 2021 and August 2022 from independent sector and National Health Service abortion services in Scotland, Wales and England. Interviews were conducted by phone or via video call. Women were asked about their abortion experience and for suggestions for any improvements that could be made along their patient journey - from help-seeking, the initial consultation, referral, treatment, to aftercare. Data were analyzed using the Framework Method. RESULTS Participants were aged 16-43 years; 39 had had a medical abortion, 8 a surgical abortion, and 1 both. The majority were satisfied with their clinical care. The supportive, kind and non-judgmental attitudes of abortion providers were highly valued, as was the convenience afforded by remotely supported home management of medical abortion. Suggestions for improvement across the patient journey centred around the need for timely care; greater correspondence between expectations and reality; the importance of choice; and the need for greater personal and emotional support. CONCLUSION Recent changes in models of care present both opportunities and challenges for quality of care. The perspectives of patients highlight further opportunities for improving care and support. The principles of timely care, choice, management of expectations, and emotional support should inform further service configuration.
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Affiliation(s)
- Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Scott
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Natasha Salaria
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Patricia A Lohr
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
| | - Sharon Cameron
- NHS Lothian, Chalmers Centre, Edinburgh, UK
- Queen’s Medical Research Institute, The University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
| | - Melissa Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca S French
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Baum SE, Jacobson L, Ramirez AM, Katz A, Grosso B, Bercu C, Pearson E, Gebrehanna E, Chakraborty NM, Dirisu O, Chowdhury R, Zurbriggen R, Filippa S, Tabassum T, Gerdts C. Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries. BMJ Open 2023; 13:e067513. [PMID: 37730400 PMCID: PMC10510917 DOI: 10.1136/bmjopen-2022-067513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion. METHODS We conducted interviews with people seeking abortion aged 15-41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants. RESULTS We identified six themes that contributed to high-quality abortion care from the clients' perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain. CONCLUSIONS People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.
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Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, Oakland, California, USA
| | - Laura Jacobson
- Ibis Reproductive Health, Oakland, California, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | | | - Anna Katz
- Ibis Reproductive Health, Oakland, California, USA
- University of California Berkeley School of Law, Berkeley, California, USA
| | - Belen Grosso
- Colectiva Feminista La Revuelta, Neuquen, Argentina
| | - Chiara Bercu
- Ibis Reproductive Health, Oakland, California, USA
| | | | - Ewenat Gebrehanna
- School of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Akinyemi A, Owolabi OO, Erinfolami T, Stillman M, Bankole A. Quality of information offered to women by drug sellers providing medical abortion in Nigeria: Evidence from providers and their clients. Front Glob Womens Health 2022; 3:899662. [PMID: 36060610 PMCID: PMC9428275 DOI: 10.3389/fgwh.2022.899662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence confirmed that the demand for medical abortion (MA) increased significantly during the COVID-19 outbreak in many developing countries including Nigeria. In an abortion-restrictive setting like Nigeria, local pharmacies, and proprietary patent medicine vendors (PPMVs) continue to play a major role in the provision of MA including misoprostol. There is the need to understand these providers' knowledge about the use of misoprostol for abortion and the quality of information they provide to their clients. This analysis is focused on assessing the quality of care provided by both drug seller types, from drug sellers' and women's perspectives. Methodology This study utilized primary data collected from drug sellers (pharmacists and PPMVs) and women across 6 Local Government Areas in Lagos State, Nigeria. The core sample included 126 drug sellers who had sold abortion-inducing drugs and 386 women who procured abortion-inducing drugs from the drug sellers during the time of the study. We calculate quality-of-care indices for the care women received from drug sellers, drawing on WHO guidelines for medication abortion provision. The index based on information from the sellers had two domains—technical competency and information provided to clients, while the index from the women's perspectives includes an additional domain, client experience. Results Results show that the majority of drug sellers in the sample, 56% (n = 70), were pharmacists. However, far more than half of women 60% (n = 233) had visited PPMVs. Overall, the total quality score amongst all drug sellers (mean 0.48, SD0.15) was higher than the total score calculated based on women's responses (mean 0.39, SD 0.21). Using our quality-of-care index, pharmacies and PPMVs seem to have similar technical competency (mean score of 0.23, SD 0.13 in both groups (range 0–1), whilst PPMV's performed better on the information provided to client domain (mean score of 0.79, SD 0.17 compared with pharmacies 0.69, SD 0.25). Based on women's reports, PPMVs scored better on both quality of care domains (technical competency and information provided to clients) compared with pharmacies. Program/Policy Implication In resource-constrained settings such as Nigeria, particularly in the context of health emergencies like COVID-19, there is the need to continue to strengthen and engage PPMVs' capacity and skills in dispensing and administration of MA drugs as a harm reduction strategy. Also, there is the need to target frontline providers in pharmacies for training and skill upscale in MA provision.
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Affiliation(s)
- Akanni Akinyemi
- Center for Research, Evaluation Resources, and Development, Abuja, Nigeria
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ife, Nigeria
- *Correspondence: Akanni Akinyemi
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Chakraborty NM, Pearson E, Gerdts C, Baum SE, Powell B, Montagu D. Toward a Standard Measure of Abortion Service Quality-A Stakeholder First Approach. Front Glob Womens Health 2022; 3:903914. [PMID: 35859730 PMCID: PMC9289106 DOI: 10.3389/fgwh.2022.903914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Measurement of the quality of abortion services is essential to service improvement. Currently, its measurement is not standardized, and some of the tools which exist are very long, and may deter use. To address this issue, this study describes a process used to create a new, more concise measure of abortion care quality, which was done with the end users in mind. Using a collaborative approach and engaging numerous stakeholders, we developed an approach to defining and selecting a set of indicators, to be tested against abortion outcomes of interest. Indicators were solicited from 12 abortion service provision entities, cataloged, and grouped within a theoretical framework. A resource group of over 40 participants was engaged through surveys, webinars, and one in-person meeting to provide input in prioritizing the indicators. We began with a list of over 1,000 measures, and engaged stakeholders to reduce the list to 72 indicators for testing. These indicators were supplemented with an additional 39 indicators drawn from qualitative research with clients, in order to ensure the client perspective is well represented. The selected indicators can be applied in pharmacies, facilities, or with hotlines, and for clients of surgical or medical abortion services in all countries. To ensure that the final suggested measures are most impactful for service providers, indicators will be tested against outcomes from 2,000 abortion clients in three countries. Those indicators which are well correlated with outcomes will be prioritized.
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Affiliation(s)
- Nirali M. Chakraborty
- Metrics for Management, Baltimore, MD, United States
- *Correspondence: Nirali M. Chakraborty
| | | | | | - Sarah E. Baum
- Ibis Reproductive Health, Oakland, CA, United States
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Baguiya A, Mehrtash H, Bonet M, Adu‐Bonsaffoh K, Compaoré R, Bello FA, Govule P, Msusa AT, Kim CR, Kouanda S. Abortion‐related infections across 11 countries in Sub‐Saharan Africa: Prevalence, severity, and management. Int J Gynaecol Obstet 2022; 156 Suppl 1:36-43. [DOI: 10.1002/ijgo.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya‐HDSS) Research Institute of Health Sciences Ouagadougou Burkina Faso
- Doctoral School Saint Thomas d'Aquin University Ouagadougou Burkina Faso
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) World Health Organization Geneva Switzerland
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) World Health Organization Geneva Switzerland
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
| | - Kwame Adu‐Bonsaffoh
- Biomedical and Public Health Department Research Institute of Health Sciences Ouagadougou Burkina Faso
| | - Rachidatou Compaoré
- Biomedical and Public Health Department Research Institute of Health Sciences Ouagadougou Burkina Faso
| | | | - Philip Govule
- Department of Epidemiology and Disease Control School of Public Health University of Ghana Accra Ghana
| | - Ausbert Thoko Msusa
- Department of Obstetrics and Gynecology College of Medicine University of Malawi Blantyre Malawi
| | - Caron R. Kim
- Department of Sexual and Reproductive Health and Research UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) World Health Organization Geneva Switzerland
| | - Séni Kouanda
- Biomedical and Public Health Department Research Institute of Health Sciences Ouagadougou Burkina Faso
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