Abortion-related near-miss morbidity and mortality in 43 health facilities with differences in readiness to provide abortion care in Uganda. Issue 2 (5th February 2021)

• Record Type: Journal Article
• Authors: Atuhairwe, Susan; Gemzell-Danielsson, Kristina; Byamugisha, Josaphat; Kaharuza, Frank; Tumwesigye, Nazarius Mbona; Hanson, Claudia
• Is Part Of: BMJ global health. Volume 6:Issue 2(2021)
• Publication Date: 2021-02-05
• Subjects: abortion -- near-miss -- maternal morbidity -- maternal mortality -- trimester -- Uganda; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2020-003274
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Introduction: With a view to inform policy for improved postabortion care, we describe abortion-related near-miss and mortality by sociodemographic risk factors and management options by pregnancy trimester in Uganda. Methods: This secondary data analysis used an adapted WHO near-miss methodology to collect cross-sectional maternal near-miss and abortion complications data at 43 health facilities in Central and Eastern Uganda in 2016–2017. We computed abortion severe morbidity, near-miss and mortality ratios per 100 000 live births, and described the proportion of cases that worsened to an abortion near-miss or death, stratified by geographical region and trimester. We tested for association between independent variables and abortion near-miss, and obtained prevalence ratios for association between second trimester near-miss and independent demographic and management indicators. We assessed health facility readiness for postabortion care provision in Central and Eastern regions. Results: Of 3315 recorded severe abortion morbidity cases, 1507 were near-misses. Severe abortion morbidity, near-miss and mortality ratios were 2063, 938 and 23 per 100 000 live births, respectively. Abortion-related mortality ratios were 11 and 57 per 100 000 in Central and Eastern regions, respectively. Abortion near-miss cases were significantly associated with referral (p<0.001). Second trimester had greater abortion mortality than first trimester. Eastern region had greater abortion-related morbidity and mortality than Central region with facilities in the former characterised by inferior readiness to provide postabortion care. Conclusions: Uganda has a major abortion near-miss morbidity and mortality; with mortality higher in the second trimester. Life-saving commodities are lacking especially in Eastern region compromising facility readiness for postabortion care provision.