Clients' perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal

Maternal satisfaction with the quality of post-abortion care in Ethiopia at teaching hospitals of Amhara regional state by 2023

BACKGROUND

Every year, complications from abortion cause millions of women's serious injuries and over 47,000 deaths globally. While many regions of Sub-Saharan Africa restrict access to safe abortion procedures, Ethiopia's government is attempting to address maternal morbidity and mortality associated with abortion by offering post-abortion care services to all women. The primary determinant of the quality of health treatment is thought to be client satisfaction. Services for post-abortion are still lacking and disregarded in Ethiopia's contemporary healthcare system. Thus, this study's main goal was to investigate the state of post-abortion care services, with a particular emphasis on client satisfaction, the suitability of legal requirements for safe abortion services, service provider competency, and the establishment of animosity.

METHODS

A facility-based cross sectional study was conducted from March 01/2023 to July 30/2023. The study was conducted at eight selected maternity teaching hospitals located in the Amhara regional state. Eight BSc midwives who had received three days of training collected the data via a structured questionnaire. A quota sampling technique was carried out for all post-abortion patients who were consecutively served at facilities. The chi-square test and multivariable logistic regression methods were employed using SPSS 23. The strength of associations and significance level were examined using P values of less than 0.05 and odds ratios at 95% confidence intervals respectively. Multicollinearity and model fitness were also checked.

RESULTS

A total sample size of 384 were employed with a response rate of 100%.The overall magnitude of women's satisfaction in this study was (34.11% (27.45%_39.05%)). Educational status, living solely, having an unplanned pregnancy and having a hostile infrastructure are the determining factors for women's satisfaction with the quality of Post-abortion care.

CONCLUSION AND RECOMMENDATION

The overall magnitude of women's satisfaction (34.11% (27.45%_39.05%)) is extremely low in this study. Therefore, health care providers and policy makers in the health sector had to struggle with the quality of PAC for improved client satisfaction.

Quality of post-abortion care services in the greater Accra region: connecting the perspectives of service providers and experiences of clients

BACKGROUND

Access to quality abortion services will not only help to reach SDG Target 3.1 and Goal 3 of Agenda 2063 but will also enhance maternal health in sub-Saharan Africa. Post-abortion care was thus introduced as a key component in managing complications from abortion. However, not much is known about the quality of post-abortion care services and practices. The main objective of this study was to examine the connecting experiences of clients and service providers perspectives on the quality of post-abortion care services.

METHODS

An in-depth interview technique was used to collect data from 18 purposively selected post-abortion care clients and 13 post-abortion care service providers from selected health facilities in urban Accra. Data were analysed using NVivo 12 software using a quantitative thematic analysis technique.

RESULTS

We noted that the providers' perspectives and clients' experiences or narratives about PAC quality converged around interpersonal and technical quality. Apart from the consensus on what quality meant and what clients received, there were subtle divergences or variations in quality perspectives. Specifically, while the clients considered quality communication to be concerned with behaviour and mannerisms, service providers perceived it as patient-centred. Also, while clients considered quality treatment to be the immediate outcome of treatment, service providers perceived it as one with no adverse event. We also found that the quality of PAC services at health facilities could be improved by making consumables readily available and the provision of separate treatment rooms.

CONCLUSION

Although PAC services are generally considered high quality in the Greater Accra region, there is still room for improvement. The private health facility owners, the Ministry of Health and the Ghana Health Services could take pragmatic steps to enhance synchronisation of notions of quality PAC services through sensitisation and education based on existing PAC protocol requirements.

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

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.

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

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.

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

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.

Women's perceptions of and experiences with the use of misoprostol for treatment of incomplete abortion in central Malawi: a mixed methods study

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.

The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study

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.