| dc.description.abstract | Malawi is a landlocked, low-income country in sub-Saharan Africa with a population of about 17.6 million. The country has one of the highest maternal mortality rates in the world and up to a quarter of these deaths are due to complications of abortions. Malawi has a restrictive abortion law, and abortion is only legal to save a pregnant woman´s life. Still, there are thousands of induced abortions in the country every year, making unsafe abortions common. This puts more women at risk of complications such as incomplete abortion that can lead to haemorrhage, sepsis, and potentially death if left untreated. Incomplete abortion is when some products of conception remain in the uterus after a premature loss of pregnancy. Surgical treatment with vacuum aspiration or medical treatment with misoprostol are the recommended treatments for incomplete abortion by the World Health Organization (WHO). Even though many low- and middle-income countries (LMICs), such as Malawi, have a high rate of abortion complications, they have not fully embraced the use of medical management in the treatment of incomplete abortions. To make post-abortion care (PAC) more accessible, cheaper and safer there is a need to increase the use of misoprostol.
A quasi-experimental study with a training intervention aiming at increasing the use of misoprostol in the management of incomplete abortions was performed. The intervention was evaluated using both quantitative and qualitative methods. The study was implemented to provide research-based evidence that could improve PAC services in Malawi. The study was designed to educate healthcare workers on the use of misoprostol; evaluate the effectiveness of a training intervention and explore women‘s and healthcare workers’ perceptions of and experiences with using misoprostol in the management of first-trimester incomplete abortions. The study was conducted in the central region of Malawi, with three district hospitals as intervention sites and two as control sites. Data were extracted from records of women treated for incomplete abortions before and after one year of the intervention. Women receiving misoprostol at the study sites were followed up and filled in a pretested questionnaire on their experience with the treatment. Additionally, in-depth interviews (IDIs) were conducted with a sub-sample of the women. Lastly, focus group discussions (FDGs) and IDIs were conducted with the healthcare workers involved in the treatment.
The findings revealed that the training was effective in increasing the usage of misoprostol in PAC. In the intervention sites, the use of misoprostol increased from 22.8% to 35.9%. It was further revealed that women and health care workers accepted the use of misoprostol as treatment of first trimester incomplete abortions and were satisfied with its use. Many women indicated that they would recommend the drug to their friends. Preference was given to misoprostol as compared to surgical management by healthcare workers. Based on the findings, it is our recommendation to the Malawi Ministry of Health to scale up the use of the drug by training more healthcare workers in its use, to ensure availability of the drug and to make sure that supportive supervision is always provided to staff. | en_US |
