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Background. Although the vast majority of abortions are performed in the first trimester, still 10-15% of terminations of pregnancies have taken place in the second trimester period globally. As compared to first trimester, second trimester abortions are disproportionately contribute for maternal morbidity and mortality especially in low-resource countries where access to safe second trimester abortion is limited. The main aim of this study was to assess the prevalence and associated factors of induced second trimester abortion in Amhara region referral hospitals, northwest Ethiopia. Methods. Institution based cross-sectional study was conducted in Amhara region referral hospitals among 416 women who sought abortion services. Participants were selected using systematic sampling technique. Data were collected using pretested structured questionnaire through interviewing. After the data were entered and analyzed; variables which have P value < 0.2 in bivariate analysis, not colinear, were entered into multiple logistic regressions to see the net effect with 95% CI and P value < 0.05. Results. The prevalence of induced second trimester abortion was 19.2%. Being rural (AOR = 1.86 [95% CI = 1.11-3.14]), having irregular menstrual cycle (AOR = 1.76 [95% CI = 1.03-2.98]), not recognizing their pregnancy at early time (AOR = 2.05 [95% CI = 1.21-3.48]), and having logistics related problems (AOR = 2.37 [95% CI = 1.02-5.53]) were found to have statistically significant association with induced second trimester abortion. Conclusion. Induced second trimester abortion is high despite the availability of first trimester abortion services. Therefore, increase accessibility and availability of safe second trimester abortion services below referral level, counseling and logistical support are helpful to minimize late abortions.
Institution based cross-sectional study was conducted in Amhara region referral hospitals. Based on the 2007 Census, the Amhara region has a total population of 17,221,976 of whom 8,580,396 were women. The region has 5 referral hospitals, 19 general/district hospitals, 220 health centers, and 2,941 health posts. The study was conducted from July 5, 2013, to January 5, 2014 (for 6 months). All women who came for abortion service during the study period in Amhara region referral hospitals were the source population for study. Women excluded from study were those having gestational trophoblastic disease (partial mole) and those who cannot hear or are seriously ill with coma during data collection period. The sample size was calculated using single population proportion formula with 50% prevalence of second trimester abortion due to no previous study. Assuming a marginal error of 5% and 10% nonrespondent rate, the estimated sample size was 422. The sample for each referral hospital was arranged based on their patient flow by reviewing the 6-month report of the previous year. After proportional allocation of the samples for each referral hospital, systematic sampling technique was used to select the study subjects and participants were interviewed based on their exit after they received all the necessary abortion care. Structured questionnaire which was developed by reviewing different literatures was used for the study. The questionnaire was prepared in English, translated to Amharic, and then translated back to English to check for consistency. Data was collected via exit interview. The data was collected by five BSc degree holder midwives, one in each referral hospital. Two supervisors who have BSc degree in midwifery were assigned for supervisory activities along with the principal investigator. Training was given to the data collectors and supervisors on the objective, relevance of the study, confidentiality of information, respondent's right, informed consent, and techniques of interview. Before the actual data collection, pretest was conducted in Finote Selam Zonal Hospital for one month with 21 clients in May 2013 to ensure the validity of the survey tool and to standardize the questionnaire. The supervisor and the principal investigator made frequent checks on the data collection process to ensure the completeness and consistency of the gathered information and errors found during the process were also corrected. Induced second trimester abortion was the dependent variable for study and the independent variables were sociodemographic factors (age, marital status, educational status, residence, monthly income, religion, ethnicity, husband's occupation, and educational status), reproductive characteristics (nature of menses, gravidity, parity, number of live births, current conditions of pregnancy, contraceptive history, and abortion history), logistical factors (taking time while finding money, transportation problem, referral problem, and not having information about where the service is given, distant from the institute), and medical factors (fetal deformity, maternal illness). After data were collected, each questionnaire was given code and checked visually for completeness. The data were entered into Epi-info version 3.5.1 and transported to SPSS version 20 software packages for analysis. Data cleaning was performed using frequencies, sorting, listing to see missed values, and outliers and then correction was made by reviewing the original paper. Bivariate analysis was carried out first to observe the crude association between independent and outcome variables. The variables which have P value < 0.2 in bivariate analysis, not colinear, were entered into multiple logistic regressions to assess the net effect by controlling confounders. Finally, statistically significant variables which fit final regression model were identified using odds ratio with 95% confidence interval and P value < 0.05.
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