abortion-related morbidity and mortality in conflict-affected and fragile settings study

Conditions: Abortion Complication

Summary: to describe and estimate the burden of abortion-related complications, particularly near-miss complications and deaths, and their associated factors among women presenting for abortion-related complications in health facilities supported by médecins sans frontières (msf) in african fragile and/or conflict-affected settings.

multi-sites mixed-methods study with 4 components: 1. a quantitative observational descriptive study among women presenting for abortion-related complications to determine the frequency and severity of abortion-related complications including near-miss cases and death. data will be collected through a medical records review and a quantitative survey among women presenting for abortion-related complications to determine the sociodemographic and clinical characteristics of the women with abortion-related complications, the type of abortion, the type and severity of complications and the clinical management received. it will also give insight into the characteristics of near-miss events following unsafe abortion. 2. a qualitative study about women's experiences associated with a near-miss event (and potentially life threatening): their pathway of access to care including their decision-making process, their own perceptions and opinions and other factors or conditions that might contribute to the near-miss event (in-depth face to face interviews). 3. a rapid health facility assessment with the health professional in charge of post-abortion care will complement the assessment of the quality of management of complications 4. a knowledge attitudes, practice and behavior quantitative survey among health care providers involved in the management of abortion-related complications will identify provider-associated factors that may contribute to near-miss events.

Eligibility criteria:
medical record review: inclusion criteria: women * with any signs or symptoms of abortion-related complications, i.e. any signs or symptoms of complications of spontaneous or induced abortion, whatever the abortion stage: inevitable, missed, incomplete, complete abortion . * or with a presentation primary diagnosis of ectopic pregnancy or molar pregnancy exclusion criteria: * threatened abortion (defined as vaginal bleeding with a closed cervix after having excluded the diagnosis of ectopic pregnancy or molar pregnancy) * history of abortion-related complications and presenting for an unrelated issue * refusal to participate quantitative interview: inclusion criteria: all women included in the medical record review subcomponent and hospitalized (who stayed overnight or more) exclusion criteria: participation to the interview as potentially harmwful to the woman according to her health care provider, refusal to participate. qualitative interview: inclusion criteria: women eligible for the quantitative interview and who experienced at least 1 criterion of near-miss event or potentially life-threatening conditions exclusion criteria: participation to the interview as potentially harmwful to the woman according to her health care provider, refusal to participate. rapid facility assessment: key-informant: the provider in charge of the service providing post-abortion care kapb survey: inclusion criteria: health professionals (i.e. doctors, midwives, clinical officers, medical officers, nurses, aidmidwives, aid-nurses) involved in pac and sac services in the study site health facility literate exclusion criteria: refusal to participate.

Keywords: near-miss risks factors maternal health abortion maternal mortality