Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo

Reproductive Health

Antoinette Tshefu¹  Daniel Katuashi Ishoso¹  Thérèse Delvaux²  Michèle Dramaix³  Yves Coppieters⁴  Guy Mukumpuri⁵ 

[1] Community Health Department, Kinshasa School of Public Health, University of Kinshasa, PO Box11850, Kinshasa1, Democratic Republic of Congo;Public Health Department, Institute of Tropical Medicine, ITM, Antwerp, Belgium;Research Centre of Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium;Research Centre “Policies and Health Systems-International Health”, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium;Safe Motherhood Division, National Reproductive Health Program, Ministry of Public Health, Kinshasa, Democratic Republic of Congo;

关键词: Democratic Republic of the Congo;    Post abortion care;    Intervention;    Medical practices;   

DOI  :  10.1186/s12978-021-01130-x

来源: Springer

【 摘 要 】

ObjectivesTo evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization.MethodologyWe estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis.ResultsThe implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a non-significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception.ConclusionDespite significant improvement in the management of PAC, the uptake in WHO approved technology—namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.

【 授权许可】

CC BY