| dc.description.abstract | Background: Treatment for complications after unsafe abortions has a huge impact on the already over-stretched health system in Malawi, a country where termination of pregnancy is only legal to save a woman’s life. Given the many benefits of misoprostol for treatment of incomplete abortion, its use is preferred in high-income countries and increasing in the developing world. In Malawi incomplete abortions are mainly treated surgically using either manual vacuum aspiration (MVA) or surgical curettage. Increasing the use of MVA instead of curettage has been challenging, due to reasons such as broken equipment and lack of training. Misoprostol is the recommended treatment of incomplete abortions in the first trimester, and is the cheapest treatment method and easy to administer. For misoprostol to be implemented as a standard treatment for incomplete abortion, a deeper understanding of the health professionals’ perceptions, experiences, motivations and obstacles is needed. This might uncover issues that can be overcome to improve PAC in Malawi.
Methods: This qualitative study is conducted in correlation to the PhD ‘The Use of Misoprostol in the Management of Incomplete Abortion in Selected Health Facilities in Malawi’. Using semi-structured in-depth interviews, 10 health care workers of different cadres at Bwaila hospital, a public district hospital, were interviewed 1 year following a training intervention on the use of misoprostol. Interviews were recorded, transcribed verbatim and analysed using ‘Systematic Text Condensation’. The aim was to explore the health care workers perceptions on the use of the misoprostol.
Results: The health care workers expressed satisfaction with the increased use of misoprostol. They mentioned reduced workload, less hospitalization, task-shifting and good availability of the drug. Benefits for the mothers were also highlighted. Challenges mentioned was finding out who was eligible for the drug and drug failure. They experienced the mothers were not aware of or unsure about their last menstrual period. Most participants agreed that misoprostol was efficient, however they also expressed concerns regarding ‘treatment failure’, and this made some of them choose MVA over misoprostol.
Conclusion: This study provides insight into challenges and benefits that health care workers experience from increased use of misoprostol. Health professionals’ at Bwaila hospital are mostly experiencing benefits from the increased use of misoprostol and are positive to the implementation of the drug. This thesis supports more use of misoprostol in the treatment of incomplete abortions in Malawi. | |