Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

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• 作者：Onikepe O. Owolabi^a ; ^{Onikepe.owolabi@lshtm.ac.uk} ; Jenny A. Cresswell^a ; ^{Jenny.cresswell@lshtm.ac.uk} ; Bellington Vwalika^b ; ^{vwalikab@gmail.com} ; David Osrin^c ; ^{d.osrin@ucl.ac.uk} ; Veronique Filippi^a ; ^{Veronique.filippi@lshtm.ac.uk}
• 关键词：Abortion-related near-miss ; Abortion-related mortality ; WHO near-miss criteria ; Prospective morbidity methodology ; Termination of pregnancy ; Induced abortion
• 刊名：Contraception
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：95
• 期：2
• 页码：167-174
• 全文大小：232 K
• 卷排序：95

文摘

To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized.Study designWe conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index.ResultsParticipating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births.ConclusionsAbortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception.ImplicationsThe abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology.