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High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

BACKGROUND: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospit...

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Autores principales: Pasquier, Estelle, Owolabi, Onikepe O., Fetters, Tamara, Ngbale, Richard Norbert, Adame Gbanzi, Mariette Claudia, Williams, Timothy, Chen, Huiwu, Fotheringham, Claire, Lagrou, Daphne, Schulte-Hillen, Catrin, Powell, Bill, Baudin, Elisabeth, Filippi, Veronique, Benova, Lenka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985077/
https://www.ncbi.nlm.nih.gov/pubmed/36871004
http://dx.doi.org/10.1186/s12884-023-05427-6
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author Pasquier, Estelle
Owolabi, Onikepe O.
Fetters, Tamara
Ngbale, Richard Norbert
Adame Gbanzi, Mariette Claudia
Williams, Timothy
Chen, Huiwu
Fotheringham, Claire
Lagrou, Daphne
Schulte-Hillen, Catrin
Powell, Bill
Baudin, Elisabeth
Filippi, Veronique
Benova, Lenka
author_facet Pasquier, Estelle
Owolabi, Onikepe O.
Fetters, Tamara
Ngbale, Richard Norbert
Adame Gbanzi, Mariette Claudia
Williams, Timothy
Chen, Huiwu
Fotheringham, Claire
Lagrou, Daphne
Schulte-Hillen, Catrin
Powell, Bill
Baudin, Elisabeth
Filippi, Veronique
Benova, Lenka
author_sort Pasquier, Estelle
collection PubMed
description BACKGROUND: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). METHODS: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. RESULTS: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). CONCLUSION: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-023-05427-6.
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spelling pubmed-99850772023-03-05 High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study) Pasquier, Estelle Owolabi, Onikepe O. Fetters, Tamara Ngbale, Richard Norbert Adame Gbanzi, Mariette Claudia Williams, Timothy Chen, Huiwu Fotheringham, Claire Lagrou, Daphne Schulte-Hillen, Catrin Powell, Bill Baudin, Elisabeth Filippi, Veronique Benova, Lenka BMC Pregnancy Childbirth Research BACKGROUND: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). METHODS: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. RESULTS: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). CONCLUSION: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-023-05427-6. BioMed Central 2023-03-04 /pmc/articles/PMC9985077/ /pubmed/36871004 http://dx.doi.org/10.1186/s12884-023-05427-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Pasquier, Estelle
Owolabi, Onikepe O.
Fetters, Tamara
Ngbale, Richard Norbert
Adame Gbanzi, Mariette Claudia
Williams, Timothy
Chen, Huiwu
Fotheringham, Claire
Lagrou, Daphne
Schulte-Hillen, Catrin
Powell, Bill
Baudin, Elisabeth
Filippi, Veronique
Benova, Lenka
High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)
title High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)
title_full High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)
title_fullStr High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)
title_full_unstemmed High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)
title_short High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)
title_sort high severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-saharan africa (amoco study)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985077/
https://www.ncbi.nlm.nih.gov/pubmed/36871004
http://dx.doi.org/10.1186/s12884-023-05427-6
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