Epidemiology of Unsafe Abortion Related Maternal Health Complications and Disabilities in Western Uganda

ABSTRACT Unsafe abortion is a public health, sexual and reproductive health problem affecting so many women globally yet it is neglected. It has led to the death of many women, leaving others with both long term and short te1m complications and disabilities. The aim of the study was to determine the epidemiology and cost of management of unsafe abmtion related maternal health complications and disabilities western Uganda. The study was longitudinal and employed quantitative methods. Four hundred and four patients with abo1tion complications aged 15-49 years attending gynecology clinics and wards in the selected refenal hospitals were enrolled. Purposive sampling was used to select the hospitals. Data was collected using case record forms. Analysis of data was done using epidata 3.0 data base and SPSS version 16.0. Out of the 404 patients, 20.3% (1 in 5 cases that repmted in the hospitals) had induced abortion related complications resulting from induced (intended) unsafe abortion. Young (15-24 years) women had a higher tendency of inducing abortion (65.9%). Age, marital status, socio-economic status and level of education were identified as associated factors for induced unsafe abortion. The fatality rate from induced abortion was 1 death in 82 cases and 3 women out of 82 who induce abortion survived death but with permanent disability of hysterectomy. The mean cost (sundries and drugs) for managing a patient with induced abortion related complications was 1.6 times higher than that for spontaneous abortion. 82.9% of the patients who had induced abortions were not using family planning when they got pregnant and 17.1% had family planning failure. From The findings, it is strongly recommend that Public health practitioners and policy makers need to take on the role of legal or political advocates to establish policy for safe induced abmtion.

TABLE OF CONTENTS 

DECLARATION ...................................................................................................................................... ii 

CERTIFICATION .................................................................................................................................... iii 

DEDICATION ......................................................................................................................................... iv 

ACKNOWLEDGEMENTS ...................................................................................................................... v 

LIST OF TABLES ................................................................................................................................... ix 

LIST OF FIGURES .................................................................................................................................... X 

ABBREVIATIONS .................................................................................................................................. xi 

DEFINITION OF TERMS ...................................................................................................................... xii 

ABSTRACT ........................................................................................................................................... xiii 

CHAPTER ONE ....................................................................................................................................... 1 

INTRODUCTION ..................................................................................................................................... 1 

1.0 Introduction ................................................................................................................................... 1 

1.1 Background ......................................................................................................................................... 1 

1.1.1. Historical Background ..................................................................................................................... 1 

1.1.2 Theoretical Background ................................................................................................................... 3 

1 .1.3 Conceptual Background .................................................................................................................. .4 

1.1.4 Contextual Background .................................................................................................................... 5 

1.2 Statement of the problem .................................................................................................................... 7 

1.3.0 Objectives ......................................................................................................... : ............................... 8 

1.3.1 Main objective .................................................................................................................................. 8 

1.3.2 Specific objectives ............................................................................................................................ 8 

1.4 Research questions .............................................................................................................................. 8 

1.5 Scope of the study ................................................................................................ ,. .............................. 9 

1.6 Significance of the study ................................................................................................................... 10 

1.7 Conceptual model .............................................................................................................................. 11 

CHAPTER TW0 ..................................................................................................................................... 13 

vi 

LITERATURE REVIEW ........................................................................................................................ 13 

2.0 Introduction ....................................................................................................................................... 13 

2.1 Background ....................................................................................................................................... 13 

2.2 Prevalence and distribution of maternal health complications related to unsafe abortions ............... 13 

2.3 Outcomes from unsafe abortion ........................................................................................................ 14 

2.4 Associated factors for unsafe abortion related maternal health complications and methods used .... 14 

2.5 Cost of management of the complications ........................................................................................ 15 

CHAPTER THREE ................................................................................................... : ............................. 17 

RESEARCH METHODOLOGY ............................................................................................................ 17 

3.0 Introduction ....................................................................................................................................... 17 

3.1 Study area .......................................................................................................................................... 17 

3.2 Study design ........................................................................................................ , ............................. 17 

3.3 Study population ............................................................................................................................... 17 

3.4 Inclusion criteria ............................................................................................................................... 18 

3.5 Exclusion criteria ............................................................................................................................... 18 

3.6 Sample size ........................................................................................................... ,. ............................ 18 

3. 7 Sampling technique ........................................................................................................................... 19 

3.8 Data collection ................................................................................................................................... 19 

3.8.1 Data collection procedure ............................................................................................................... 20 

3.9 Data quality control ........................................................................................................................... 20 

3.10 Data analysis ................................................................................................................................... 20 

3.11 Ethical considerations ...................................................................................................................... 21 

3.12 Limitations of the study ................................................................................................................... 21 

CHAPTER FOUR ................................................................................................................................... 22 

RESULTS PRESENTATION, ANALYSIS AND INTERPRETATION ................. : ............................. 22 

4.0 Introduction ....................................................................................................................................... 22 

4.1 Demographic Enrollment Parameters ................................................................................................ 23 

vii 

4.1 Proportion oflnduced Unsafe Abortion Maternal Health Related Complications ............................ 24 

4.2 Associated factors for unsafe induced abortion related maternal health complications .................... 28 

4.3 Outcome of management of the cases ............................................................................................... 32 

CHAPTER FIVE ..................................................................................................................................... 35 

DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS ........................................................ 35 

5.0 Introduction ....................................................................................................................................... 35 

5.1 Discussion ........................................................................................................... ." ............................. 35 

5.1.1 Proportion and distribution of unsafe abortion cases and their complications ............................... 35 

5.1.2. Presenting demographic parameters in the patients enrolled and associated factors for unsafe 

induced abortion ...................................................................................................................................... 36 

5 .1.3 Outcome of management.. ............................................................................. ····:··· ........................ .40 

5.1.4. Cost of sundries and drugs used in the management of the patients ............................................ .41 

5.2 Conclusions ...................................................................................................................................... .43 

5.3 Recommendations ............................................................................................................................ .44 

REFERENCES ....................................................................................................................................... .45 

Appendix I: Consent form ...................................................................................................................... 50 

Appendix 2: Case Record Form .............................................................................................................. 51 

Appendix 3: Approvalletter .................................................................................................................... 58 

Appendix 4: Introductory letter ............................................................................................................... 59 

Appendix 5: Permission letter from KIU-TH ............................................................ .-............................. 60 

Appendix 6: Permission letter from KRRH ............................................................................................ 61 

Appendix 7: Permission letter from FRRH ............................................................................................. 62 

Appendix 8: Permission letter from HRRH ............................................................................................ 63