Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

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Study Justification:
– The study aimed to investigate the magnitude and severity of abortion-related complications in health facilities in Zambia, where abortion is legal but stigmatized.
– By understanding the incidence of abortion-related near-miss complications, policymakers can better address the challenges faced by the Zambian health system and work towards reducing maternal mortality and morbidity due to unsafe abortion.
– The study also aimed to demonstrate the usefulness of the World Health Organization (WHO) near-miss criteria in obtaining data in low-income settings.
Highlights:
– The study was conducted in 35 district, provincial, and tertiary hospitals over 5 months.
– Out of the admissions for post-abortion care, 16% were identified as near-miss complications.
– There were 14 abortion-related maternal deaths recorded during the study.
– The abortion-related near-miss rate for the three provinces in Zambia was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births.
– The hospital mortality index was 3%.
Recommendations:
– Efforts should be made to de-stigmatize access to abortion provision in Zambia.
– Expanded access to modern contraception should be prioritized to reduce the incidence of unsafe abortions.
– Routine hospital records should incorporate the WHO near-miss criteria to obtain useful data on abortion-related complications in low-income settings.
Key Role Players:
– Ministry of Health: Responsible for implementing policies and programs related to reproductive health and safe abortion.
– Health facility administrators: Ensure the availability of necessary resources and training for healthcare providers.
– Healthcare providers: Responsible for providing safe and accessible abortion services and post-abortion care.
– Community leaders and organizations: Play a role in reducing stigma and promoting awareness about safe abortion and contraception.
Cost Items for Planning Recommendations:
– Training programs for healthcare providers on safe abortion procedures and post-abortion care.
– Availability of necessary medical equipment and supplies for safe abortion services.
– Awareness campaigns to reduce stigma and promote access to safe abortion and contraception.
– Implementation of programs to expand access to modern contraception methods.
– Monitoring and evaluation systems to track the progress of reducing abortion-related complications.

Objectives To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized. Study design We conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index. Results Participating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births. Conclusions Abortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception. Implications The abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology.

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The study titled “Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces” provides valuable insights into the challenges faced by the Zambian health system regarding abortion-related complications. The study highlights the need for interventions to improve access to maternal health and reduce the incidence of abortion-related complications.

Based on the study’s findings, the following recommendations can be made:

1. Destigmatize access to abortion provision: Efforts should be made to reduce the social stigma surrounding abortion in Zambia. This can be achieved through public awareness campaigns, education programs, and community engagement initiatives. By destigmatizing abortion, women will feel more comfortable seeking safe and legal abortion services, reducing the likelihood of complications.

2. Expand access to modern contraception: Increasing access to modern contraception methods is crucial in preventing unintended pregnancies and reducing the need for unsafe abortions. This can be achieved by improving the availability and affordability of contraceptives, providing comprehensive sexual and reproductive health education, and ensuring that healthcare facilities offer a wide range of contraceptive options.

3. Strengthen healthcare systems: The study highlights the importance of utilizing routine hospital records to obtain useful data on abortion-related complications. It is essential to strengthen healthcare systems in Zambia to ensure accurate and comprehensive data collection, analysis, and reporting. This will enable policymakers and healthcare providers to identify trends, monitor progress, and implement evidence-based interventions to improve maternal health outcomes.

4. Enhance training and capacity-building: Healthcare providers should receive comprehensive training on safe abortion procedures, post-abortion care, and the management of abortion-related complications. This will ensure that women receive appropriate and timely care, reducing the risk of severe complications and maternal mortality.

5. Collaborate with international organizations and partners: Collaboration with international organizations and partners can provide technical expertise, financial support, and resources to implement innovative solutions for improving access to maternal health in Zambia. This can include sharing best practices, supporting research initiatives, and advocating for policy changes that prioritize women’s reproductive rights and healthcare.

By implementing these recommendations, Zambia can work towards reducing the incidence of abortion-related complications, improving access to safe abortion services, and ultimately enhancing maternal health outcomes.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health and reduce the incidence of abortion-related complications in Zambia is as follows:

1. Destigmatize access to abortion provision: Efforts should be made to reduce the social stigma surrounding abortion in Zambia. This can be achieved through public awareness campaigns, education programs, and community engagement initiatives. By destigmatizing abortion, women will feel more comfortable seeking safe and legal abortion services, reducing the likelihood of complications.

2. Expand access to modern contraception: Increasing access to modern contraception methods is crucial in preventing unintended pregnancies and reducing the need for unsafe abortions. This can be achieved by improving the availability and affordability of contraceptives, providing comprehensive sexual and reproductive health education, and ensuring that healthcare facilities offer a wide range of contraceptive options.

3. Strengthen healthcare systems: The study highlights the importance of utilizing routine hospital records to obtain useful data on abortion-related complications. It is essential to strengthen healthcare systems in Zambia to ensure accurate and comprehensive data collection, analysis, and reporting. This will enable policymakers and healthcare providers to identify trends, monitor progress, and implement evidence-based interventions to improve maternal health outcomes.

4. Enhance training and capacity-building: Healthcare providers should receive comprehensive training on safe abortion procedures, post-abortion care, and the management of abortion-related complications. This will ensure that women receive appropriate and timely care, reducing the risk of severe complications and maternal mortality.

5. Collaborate with international organizations and partners: Collaboration with international organizations and partners can provide technical expertise, financial support, and resources to implement innovative solutions for improving access to maternal health in Zambia. This can include sharing best practices, supporting research initiatives, and advocating for policy changes that prioritize women’s reproductive rights and healthcare.

By implementing these recommendations, Zambia can work towards reducing the incidence of abortion-related complications, improving access to safe abortion services, and ultimately enhancing maternal health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health in Zambia, the following methodology can be used:

1. Baseline data collection: Gather data on the current incidence of abortion-related complications, maternal mortality, and access to maternal health services in Zambia. This can be done through surveys, interviews, and analysis of existing health records.

2. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the incidence of abortion-related near-miss complications, maternal mortality rate, contraceptive prevalence rate, and stigma levels surrounding abortion.

3. Intervention implementation: Implement the recommendations outlined in the abstract, including destigmatizing access to abortion provision, expanding access to modern contraception, strengthening healthcare systems, enhancing training and capacity-building for healthcare providers, and collaborating with international organizations and partners.

4. Data collection post-intervention: Collect data on the indicators identified in step 2 after the implementation of the recommendations. This can be done through surveys, interviews, and analysis of health records.

5. Data analysis: Analyze the data collected in steps 1 and 4 to compare the baseline and post-intervention indicators. Calculate the changes in the incidence of abortion-related near-miss complications, maternal mortality rate, contraceptive prevalence rate, and stigma levels surrounding abortion.

6. Evaluation: Assess the impact of the recommendations by comparing the changes in the indicators. Determine if there has been a reduction in the incidence of abortion-related complications, improvement in access to maternal health services, and reduction in stigma surrounding abortion.

7. Recommendations and policy implications: Based on the evaluation results, provide recommendations for further interventions and policy changes to sustain and enhance the improvements in access to maternal health in Zambia.

By following this methodology, researchers and policymakers can assess the effectiveness of the recommendations outlined in the abstract and make informed decisions on how to further improve access to maternal health in Zambia.

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