ASSESSMENT OF POST-ABORTION CARE SERVICES IN PUBLIC HEALTH FACILITIES IN BAUCHI STATE


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TABLE OF CONTENTS

Title Page
Summary
Table of Contents
List of Acronyms

Chapter One – Introduction
1.1       Problem statement
1.2       Justification
1.3       Aims and objectives of study

Chapter Two – Literature review
2.1       Definition of unsafe abortion
2.2       Scope of the problem
2.3       Health consequences
2.4       Relationship between unsafe abortion and abortion law
2.5       Lack of contraception access and use
2.6       Origins of post-abortion care
2.7       Essential elements of PAC Model
2.8       Availability of post-abortion care in hospitals
2.9       Equipment and supplies needed

Chapter Three – Methodology
3.1       Background of study
3.2       Study design
3.3       Study population
3.4       Sample size
3.5       Sampling technique
3.6       Methods of data collection
3.7       Quality assurance of data
3.8       Method of data analysis
3.9       Limitations of study
3.9.1    Ethical considerations
3.9.2    Duration of study

Chapter Four – Results

Chapter Five – Discussion
5.1       Availability of Post-Abortion Care in Hospitals
5.2       Availability of basic equipment for PAC in Hospital
5.3       Equipment and Supplies Needed

Chapter six – Conclusion and Recommendations
6.1       Conclusion
6.2       Recommendations
References
Appendices



SUMMARY


Worldwide, an estimated five million women are hospitalized each year for treatment of abortion-related complications, such as hemorrhage and sepsis. Almost all abortion-related deaths occur in developing countries.2These deaths are highest in Africa, where there were an estimated 650 deaths per 100,000 unsafe abortions in 2003, compared with

10 per 100,000 in developed regions. African women suffer the world‘s highest abortion related deaths estimated at 680 deaths per 100,000 abortions, compared to 330 deaths per 100,000 abortions in the rest of the developing world. Complications of abortion are one of the major causes of maternal mortality in Nigeria, causing the death of women in thousands annually.

Comprehensive Post-abortion care (PAC) services are obtainable only at tertiary health care centers and to some extent, at secondary care level in most States in Northern Nigeria. However, recently several Non-governmental organizations (NGOs), both local and international are involved in the provision of PAC services in rural and urban communities more especially in health facilities in such areas. The availability, accessibility and affordability of such services in such facilities especially in the rural areas is unclear to many concerned individuals and groups some of whom are calling for the expansion of PAC services especially in the primary and secondary levels of care.

For about a decade now the Bauchi state government, several NGOs both international and local are involved in provision of post-abortion care services in Bauchi state but the maternal mortality (presently at 1549 deaths/100,000 livebirths5 ) and morbidity in the state remain high. It is a well-known fact the post-abortion complications are one of the major causes of maternal death especially in the rural areas, therefore its availability, accessibility and affordability in all health facilities in Bauchi state cannot be overemphasized.

The study is a facility based descriptive cross sectional survey designed to assess the availability of post abortion care services at both public secondary and primary health facilities in rural and urban areas of Bauchi state using quantitative methods; interviewer-administered questionnaire (for providers and managers) and a facility checklist.

In addition, the study also determined the knowledge of providers and managers regarding post abortion care.

A total of eighteen (18) public health facilities located within Bauchi state were surveyed using multistage sampling method. Nine (9) facilities were secondary while the remaining nine (9) were primary health facilities. Only primary health centers and maternities that offered ANC, Delivery, post-natal and FP services were included in the survey. Health posts, dispensaries and Health clinics were excluded. The study populations were, Facility health care providers, Managers of Health facilities, Public primary and secondary health-care facilities in Bauchi State.

Quantitative data was collected in this study using three (3) structured questionnaires. Quantitative Data collected were analyzed with the aid of computer Microsoft Excel version 2007.
All the Secondary Health Care (SHC) facilities surveyed provided PAC services 24hours a day, only four (4) that was 44% of the Primary Health Care (PHC) facilities provided the service 24hrs a day. PAC services were free in 89% of the SHC facilities as against 33% in the PHC facilities. Paucity of staff to provide PAC services was a challenge in all the facilities. Intra-facility contraceptive referral arrangement was poor (11%) in PHC facilities. Sexually Transmitted Infections (STI) risk analysis was virtually lacking (72%) in all facilities.

PAC services were provided by only CHEWs in 33% of the PHC facilities surveyed, while in 67% of such facilities midwives, Nurses and CHEWs provided same service to clients.

Majority (56%) of PHC facilities had challenges with logistic system for ordering and storage of drugs and were also lacking in locked storage area (56%) for medical supplies. Only 39% of the facilities surveyed had adequate records for abortion cases and the PHC facilities were more affected with only 22% of such facilities with such records. Service delivery protocols and guidelines for PAC were absent (0%) in PHC facilities and only available in 22% of the SHC facilities surveyed, the same applied to availability for MVA log book.

Cost of managing first trimester incomplete abortion was free in 45% of the facilities surveyed. The cost was as low as three hundred naira (N300) in 6% of the facilities. Regarding awareness and Knowledge of PAC among Healthcare Providers in the surveyed facilities, one hundred and eight (108) healthcare providers were approached in the survey and out of that number, One hundred and five (105) respondents were interviewed, three (3) declined, which gave a response rate of ninety-seven percent (97%). The ages of the respondents ranged from 18 years to 52 years with an average of 31years. Almost all the respondents (85%) were female with only a few (15%) males. About halve (47%) of the respondents were Nurse/Midwives followed by Community Health Extension Workers (CHEWs) that made up 41% while 12% were medical doctors.


Of the total of forty-nine (49) midwives /Nurses working in the maternity, family planning and labour wards interviewed almost all (98%) were aware of PAC but only 51% of the CHEWs were aware. Of all the Nurse/Midwives, only 30% knew that all modern contraceptive methods can be used (assuming there are no contra-indications) for post-abortion FP, while only 16% of the CHEWs had that knowledge.

Knowledge of the number of elements of PAC was below average in all the three cadres of healthcare providers, Doctors (39%) and Nurse/Midwives (27%) and CHEWs (7%).

In view of the above findings it is highly recommended that the Bauchi state MOH, PHCDA and Developmental partners should provide the entire comprehensive PAC package, including family planning counseling and method provision and choice at both PHC and SHC facilities to reduce maternal morbidity and mortality in the State and country as a whole.

CHAPTER ONE

INTRODUCTION

The term "abortion" refers to the termination of pregnancy from whatever cause before the fetus is capable of extra-uterine life. "Spontaneous abortion" refers to those terminated pregnancies that occur without deliberate measures, whereas "induced abortion" refers to termination of pregnancy through a deliberate intervention intended to end the pregnancy.1 Estimates are that at least 15% of all pregnancies end in spontaneous abortion1and, according to World Health Organization estimates, up to 15% of pregnancy-related mortality worldwide is due to abortion.

A woman‘s fertility can return quickly following an abortion from as early as two weeks.

This may leave a lot of women with unmet need for family planning and the risk of another unintended pregnancy and in some cases subsequent repeated abortion.2

Moreover, in many settings, women who have an abortion rarely leave the health facility "armed with the knowledge and the means to avoid repeating the process of unprotected intercourse and unwanted pregnancy". Most post-abortion cases admitted to public sector hospitals receive only the emergency care component of the case management, and are usually discharged from hospitals without adequate family planning counseling.

Women who have had an abortion and who risk future unwanted pregnancies represent an important group whose family planning needs remain unmet in many developing countries. To reduce this risk, it is vital to provide a comprehensive package of post-abortion care (PAC) services that includes both medical and preventive healthcare. The key elements of post-abortion care are: emergency treatment of incomplete abortion and potentially life-threatening complications, post-abortion family planning counseling and services, links between post-abortion emergency services and other priority reproductive healthcare services and community support and mobilization......


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