“Confidence comes with frequent practice”: health professionals’ perceptions of using manual vacuum aspiration after a training program

Odland, Maria Lisa; Membe‐Gadama, Gladys; Kafulafula, Ursula; Odland, Jon Øyvind; Darj, Elisabeth

doi:10.1186/s12978-019-0683-z

Cited by 9 publications

(10 citation statements)

References 27 publications

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“…The importance of training and supervision should, however, not be forgotten [ 13 , 27 , 31 , 34 , 39 , 40 ]. Most of the nurse/midwife technicians in this study would prefer more proper training, which has also previously been found in Malawi [ 21 ]. Training can be done frequently at little cost.…”

Section: Discussionsupporting

confidence: 71%

“…Considering the challenges with MVA, increased use of misoprostol in post-abortion care (PAC) may be the way forward in Malawi and other low-income countries with restrictive abortion laws. A study in Malawi found that health personnel were aware of misoprostol as an option in treating incomplete abortions but were not using the method because they were unfamiliar with it [ 21 ]. Other reasons for the low use of misoprostol were fear of misuse or loss to follow-up [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…A study in Malawi found that health personnel were aware of misoprostol as an option in treating incomplete abortions but were not using the method because they were unfamiliar with it [ 21 ]. Other reasons for the low use of misoprostol were fear of misuse or loss to follow-up [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Health care providers’ perceptions of using misoprostol in the treatment of incomplete abortion in Malawi

Wagenheim

Savosnick

Chakhame

et al. 2022

BMC Health Serv Res

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Background In Malawi, abortion is only legal to save a pregnant woman’s life. Treatment for complications after unsafe abortions has a massive impact on the already impoverished health care system. Even though manual vacuum aspiration (MVA) and misoprostol are the recommended treatment options for incomplete abortion in the first trimester, surgical management using sharp curettage is still one of the primary treatment methods in Malawi. Misoprostol and MVA are safer and cheaper, whilst sharp curettage has more risk of complications such as perforation and bleeding and requires general anesthesia and a clinician. Currently, efforts are being made to increase the use of misoprostol in the treatment of incomplete abortions in Malawi. To achieve successful implementation of misoprostol, health care providers’ perceptions on this matter are crucial. Methods A qualitative approach was used to explore health care providers’ perceptions of misoprostol for the treatment of incomplete abortion using semi-structured in-depth interviews. Ten health care providers were interviewed at one urban public hospital. Each interview lasted 45 min on average. Health care providers of different cadres were interviewed in March and April 2021, nine months after taking part in a training intervention on the use of misoprostol. Interviews were recorded, transcribed verbatim and analyzed using ‘Systematic Text Condensation’. Results The health care providers reported many advantages with the increased use of misoprostol, such as reduced workload, less hospitalization, fewer infections, and task-shifting. Availability of the drug and benefits for the patients were also highlighted as important. However, some challenges were revealed, such as deciding who was eligible for the drug and treatment failure. For these reasons, some health care providers still choose surgical treatment as their primary method. Conclusion Findings in this study support the recommendation of increased use of misoprostol as a treatment for incomplete abortion in Malawi, as the health care providers interviewed see many advantages with the drug. To scale up its use, proper training and supervision are essential. A sustainable and predictable supply is needed to change clinical practice. Plain English Summary Unsafe abortion is a major contributor to maternal mortality worldwide. Unsafe abortion is the termination of an unintended pregnancy by a person without the required skills or equipment, which might lead to serious complications. In Malawi, post-abortion complications are common, and the maternal mortality ratio is among the highest in the world. Retained products of conception, referred to as an incomplete abortion, are common after spontaneous miscarriages and unsafe induced abortions. There are several ways to treat incomplete abortion, and the drug misoprostol has been successful in the treatment of incomplete abortion in other low-income countries. This study explored perceptions among health care providers using misoprostol to treat incomplete abortions and whether the drug can be fully embraced by Malawian health care professionals. Health personnel at a Malawian hospital were interviewed individually regarding the use of the drug for treating incomplete abortions. This study revealed that health care providers interviewed are satisfied with the increased use of misoprostol. They highlighted several benefits, such as reduced workload and that it enabled task-shifting so that various hospital cadres could now treat patients with incomplete abortions. The health care workers also observed benefits for women treated with the drug compared to other treatments. The challenges mentioned were finding out who was eligible for the drug and drug failure. This study supports scaling up the use of misoprostol in the treatment of incomplete abortions in Malawi; the Ministry of Health and policymakers should support future interventions to increase its use.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Health care providers’ perceptions of using misoprostol in the treatment of incomplete abortion in Malawi

Wagenheim

Savosnick

Chakhame

et al. 2022

BMC Health Serv Res

Self Cite

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“…However, the change that we observed was greater than that observed in other African countries such as Malawi for example where the percentage of MVA rise from 6.9% in 2013 to 17.4% in 2015 with following implementation of a PAC strategy and a corresponding change in dilation-curettage use from 91 to 78.9% during the same period [ 32 ]. Modest changes were attributed to defective equipment and a lack of financial support [ 33 ]. Similar studies in Zimbabwe and Uganda reported rates of MVA of 12% and 14% and rates of dilatation-curettage of 75% and 69%, respectively [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Objectives To 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. Methodology We 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. Results The 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 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. Conclusion Despite 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.

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“…9,25,26 On an individual level, respondents also identified the lack of skills or confidence in MVA and MA as a key factor affecting their use, a finding that has also been recorded in previous literature. 27 Respondents cited a general disinterest among some in being trained on a new method, especially older doctors, as driving the lack of interest and skill. Training and sensitization played a key role in the respondent's own stories of transition from D&C to recommended methods, and was similarly identified by nearly all respondents as being necessary to encourage MVA and MA use.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico

Küng¹,

Ochoa²,

Avendano³

et al. 2021

Womens Health (Lond Engl)

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Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.

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“Confidence comes with frequent practice”: health professionals’ perceptions of using manual vacuum aspiration after a training program

Cited by 9 publications

References 27 publications

Health care providers’ perceptions of using misoprostol in the treatment of incomplete abortion in Malawi

Health care providers’ perceptions of using misoprostol in the treatment of incomplete abortion in Malawi

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

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico

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