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Background Post abortion complications are the third leading cause of maternal death after hemorrhage and hypertension in Botswana where abortion is not legalized. This study aimed at assessing the management of post abortion complications in Botswana. Methods A retrospective study was conducted at four hospitals in Botswana in 2014. Socio-demo-graphic, patient management and outcomes data were extracted from patients’ medical records. Descriptive statistics and chi-square test were used to analyze and present the data. Result A total of 619 patients’ medical records were reviewed. The duration of hospital stay prior to uterine evacuation ranged from less than an hour to 480 hours. All the patients received either prophylactic or therapeutic antibiotics. Use of parenteral antibiotics was significantly associated with severity of abortion, second trimester abortion, use of blood products and the interval between management’s decision and uterine evacuation. Uterine evacuation for retained products of conception was achieved by metallic curettage among 516 (83.4%) patients and by vacuum aspiration in 18 (2.9%). At all the study sites, Misoprostol or Oxytocin were used concurrently with surgical evacuation of the uterus. None use of analgesics or anesthetics in the four hospitals ranged between 12.4% to 28.8%. Conclusion There is evidence of delayed patient care and prolonged hospital stay. Metallic curette was the primary method used for uterine evacuation across all the facilities. Pain management and antibiotics use was not standardized. A protocol has to be developed with the aim of standardizing post abortion care.
Botswana, a middle income country in Southern Africa, has a total population of 2.02 million inhabitants with a female to male ratio of 1.05. Half of this female population is in the reproductive age of 15–49 years with a total fertility rate of 2.9 Children per woman [14, 15]. There are 28 public hospitals: 3 referral, 10 district and 15 primary hospitals in the country. A 2012 report of referral Hospitals in Botswana revealed that abortion complications accounted for more than 60–65% of admissions to Gynecology wards (Unpublished report). A retrospective, institution based, cross sectional study was conducted at four selected hospitals in Botswana. Data was collected from patients`records admitted for the management of post-abortion complications between January and August 2014. The term post-abortion complication was used in our study for all patients admitted with pregnancy loss before 24 weeks regardless of the cause. Data was collected from four hospitals, selected using convenience sampling in the different districts. These included two referral: Princes Marina Hospital (PMH) and Nyangabgwe Referral Hospital (NRH); and two district hospitals: Mahalapye and Maun hospitals located in the southern, central and northern parts of the country. All patients’ records were reviewed for individual and clinical information, including their management outcome for post-abortion complications. Data was collected by trained clinicians and midwives who were members of investigating team. The data collected included patient socio-demographic variables, abortion complications, patient management and treatment outcome. Information on patient management and outcomes such as: diagnosis, intervention interval and standard of care, use of blood products, operative interventions, means of uterine evacuation, administration of antibiotics, counseling, post abortion family planning and any abortion related maternal death were collected. Completeness and accuracy of the data were checked. Data was collected at the respective hospitals using a structured data extraction sheet. All records of threatened abortion, ectopic pregnancy, molar pregnancy and other abnormal non pregnancy related uterine bleeding were excluded from the study. The patients were grouped into different levels of severity as follows: SPSS 22 software was used for data entry, cleaning and analysis. Frequencies, percentage, and chi-square test were utilized in the presentation of the findings. A p-value of less than 0.05 was considered statistically significant. Ethical clearance was obtained from the institutional review boards of the University of Botswana, Ministry of Health and ethical committees of the four study hospitals. As the study was retrospective, patients had already been managed as per the hospital management protocol and hence the data extraction did not have any effect on the patient care. Since all the patients were not in the hospital at the time of data collection, informed consent was waived by the institutional review boards to access patient`s records.
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