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
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5 août 2024
- ISIDORE Id: 10670/1.c3507d...
- hal: hal-04691596
- doi: 10.1186/s12978-024-01835-9
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info:eu-repo/semantics/altIdentifier/doi/10.1186/s12978-024-01835-9
info:eu-repo/semantics/OpenAccess
Mots-clés
Maternal health Quality of care Abortion Postabortion care Hospital Humanitarian Nigeria Central African Republic -bio]Sujets proches
Care and treatment Infirmaries Benevolent institutions Medical and sanitary affairs Hospitals, charities, etc Hospitals and sanitoriumsCiter ce document
Estelle Pasquier et al., « 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 », HAL SHS (Sciences de l’Homme et de la Société), ID : 10.1186/s12978-024-01835-9
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BackgroundAbortion-related complications remain a major 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).MethodsWe 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. These indicators were measured in four components of a cross-sectional multi-method study:- An assessment of the hospitals’ PAC signal functions,- A survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC,- A prospective review of the medical records of 520 and 548 women presenting for abortion complications, and- A survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.ResultsAmong 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% of cases were treated with dilatation and sharp curettage. Over 80% of women received blood transfusions or curative antibiotics when indicated. However, antibiotics were administered to about 30% of patients without documented indication.Among discharged women in CAR, 99% received contraceptive counseling, while only 39% did so in Nigeria. Over 80% of women in Nigeria reported positive experiences regarding 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 times before seeing a healthcare provider. In terms of communication, only 15% of patients in both hospitals felt able to ask questions during treatment.The risk of abortion-near-miss occurring ≥ 24 hours 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 the best care all the time.ConclusionOur comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen a patient-centered approach, engaging patients in their own care and ensuring privacy, short waiting times, and quality provider-patient communication. Health professionals would also benefit from instituting antibiotic stewardship programs to prevent antibiotic resistance.
