Post-abortal care among patients admitted at Moi teaching and referral hospital, Eldoret, Kenya

Abstract

Background: The magnitude of abortion in Kenya is high, with an estimated 464,690 abortions and 7,900 abortion-related deaths occurring annually. Most of these morbidities and mortalities are preventable through access to quality post-abortal care (PAC) which involves: proper treatment of complications of abortion, post-abortal counseling and provision of contraception. Despite the high proportion of abortion in Kenya, there is very little literature on the services that post-abortal patients receive in health facilities. Objective: To assess whether post-abortal patients in Moi Teaching and Referral Hospital (MTRH) are receiving PAC in line with IPAS‟ elements. Methodology: A facility-based, cross-sectional study was undertaken at the MTRH gynecological ward from January-May 2014, among patients admitted with a diagnosis of abortion and their health care providers. Patients were sampled consecutively while providers were purposively selected. A total of 316 patients and 20 providers were interviewed. Data was obtained from MTRH records to independently calculate the abortion ratio. PAC services were assessed using International Projects Assistance Services‟ (IPAS‟) four essential elements: emergency treatment, counseling, contraceptive service and linkage to other reproductive health services. Data was analyzed using STATA version 12. A descriptive analysis of both patients and providers was performed and frequency distributions obtained. Bivariate and multivariate associations between patients‟ socio-demographic and reproductive characteristics were assessed using the chi-squared test and logistic regression respectively. P-values were reported at 95% significance level. Results: The hospital based abortion ratio for MTRH during the study period was 9.5 abortions per 100 live births. Most (82%) patients were between 20 and 35 years old and were admitted with complaints of first trimester per vaginal bleeding (76%). Thirty eight percent of post-abortal patients had unintended pregnancies, and 25% had prior abortions. Using IPAS‟ four essential elements for assessment, we obtained the following results. Uterine evacuation was done mostly (89%) by manual vacuum aspiration (MVA) whereas medical evacuation was not performed. Ceftriaxone and metronidazole (94%) were the most common prophylactic antibiotics administered, while diclofenac (69%) was the most common procedural analgesic given. The majority (74%) of patients reported the MVA procedure as being very painful. The desired duration before the next pregnancy was two to five years, whereas the most common contraceptive methods offered were pills (56%) and barrier methods (50%). Advice on resumption of fertility was offered to only 35% of cases. Logistic regression showed a significant association between “having an unintended pregnancy” and “having a previous abortion” (OR=0.4, p= 0.07) and “adoption of a contraceptive method” and “religion” (OR 6.2, p=0.013). Only 60% of providers were trained on PAC. Conclusion: The hospital-based abortion ratio of MTRH was low compared to other regions. Most patients didn‟t receive comprehensive IPAS-recommended PAC. There was appropriate use of MVA for uterine evacuation however; prophylactic antibiotics given to post-abortal patients were inappropriate and procedural analgesia inadequate. Advice on resumption of fertility was rarely given and most of the contraceptives offered were the least effective methods, for the desired inter-pregnancy interval. A limitation to this study was information and recall bias. Recommendations: Health care providers involved in PAC should ensure the use of appropriate prophylactic antibiotics and adequate procedural analgesia. Post-abortal fertility and contraceptive counseling should emphasize the most effective methods to achieve the desired inter-pregnancy interval. Quality checks should be carried out to ensure adherence to IPAS recommendations for PAC.