Other > Journal Blog
Lancet Global Health. 2017 November 10
Fotheringham C
Lancet Global Health. 2017 November 10
Technical Report > Evidence Brief
Pasquier E, Owolabi OO, Fetters T, Chen H, Williams TN, et al.
2022 August 30
English
Français
Abortion complications remain a major cause of maternal mortality worldwide and abortion-related mortality has decreased very little over the last decade, unlike maternal mortality linked to other main causes such as haemorrhage, infection or obstructed labour. Global estimates suggest that most abortion-related deaths are the result of unsafe induced abortions, 97% of which occur in low- and middle-income countries which can be largely prevented by providing comprehensive abortion care, including post- abortion care, contraceptive services, and safe abortion care.
At 829 deaths for every 100,000 live births, the Central African Republic (CAR) has one of the world’s highest maternal mortality ratios. Abortion-related complications are a major contributor to maternal mortality, estimated at almost one in four (24%) of the maternal deaths in one study led by the Central African Ministry of Health and UNFPA. Further, CAR is one of the most fragile countries in the world, rating 174th out of the 178 countries in the Fund for Peace Fragility Index with different parts of the country regularly affected by decades-long armed conflict.
A lack of evidence on abortion complications in fragile settings limits the understanding of women’s needs in access to comprehensive abortion care in this context. This study describes the burden of abortion-related complications and their contributing factors in the maternity of Castors in Bangui, CAR. This evidence brief presents selected results of two components of the AMoCo Study (Abortion-related Morbidity and Mortality in Conflict-affected and Fragile Settings): 1) A quantitative observational study of clinical characteristics of women presenting with any type of abortion complications, and 2) A quantitative survey with a sub-group of these women who were hospitalized.
At 829 deaths for every 100,000 live births, the Central African Republic (CAR) has one of the world’s highest maternal mortality ratios. Abortion-related complications are a major contributor to maternal mortality, estimated at almost one in four (24%) of the maternal deaths in one study led by the Central African Ministry of Health and UNFPA. Further, CAR is one of the most fragile countries in the world, rating 174th out of the 178 countries in the Fund for Peace Fragility Index with different parts of the country regularly affected by decades-long armed conflict.
A lack of evidence on abortion complications in fragile settings limits the understanding of women’s needs in access to comprehensive abortion care in this context. This study describes the burden of abortion-related complications and their contributing factors in the maternity of Castors in Bangui, CAR. This evidence brief presents selected results of two components of the AMoCo Study (Abortion-related Morbidity and Mortality in Conflict-affected and Fragile Settings): 1) A quantitative observational study of clinical characteristics of women presenting with any type of abortion complications, and 2) A quantitative survey with a sub-group of these women who were hospitalized.
Protocol > Research Study
Pasquier E, Fetters T, Owolabi OO, Ngbale RN, Moore AM, et al.
2020 December 15
OVERALL AIM
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.
OBJECTIVES
Primary objective:
- To describe the frequency of near-miss events and deaths among women presenting for
abortion-related complications.
Secondary objective:
- To describe the frequency of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To describe the severity of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To identify risk factors quantitatively associated with abortion-related near-miss events;
- To describe the quality of the clinical management of abortion-related complications
(including near-miss cases) and the heath facilities capacity to manage these complications
- To describe the experiences of women who present as near-miss cases, including their
decision-making processes, access, pathways to care as well as conditions and factors that
could contribute to the life-threatening conditions and near-miss event.
- To describe the knowledge, attitudes, practices, and behaviors of health care workers in
relation to abortion;
- To describe the characteristics, management, outcomes of ectopic and molar pregnancies
ClinicalTrials.gov: NCT04331847
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.
OBJECTIVES
Primary objective:
- To describe the frequency of near-miss events and deaths among women presenting for
abortion-related complications.
Secondary objective:
- To describe the frequency of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To describe the severity of abortion-related complications overall and by types (hemorrhage, infection, perforation, etc.)
- To identify risk factors quantitatively associated with abortion-related near-miss events;
- To describe the quality of the clinical management of abortion-related complications
(including near-miss cases) and the heath facilities capacity to manage these complications
- To describe the experiences of women who present as near-miss cases, including their
decision-making processes, access, pathways to care as well as conditions and factors that
could contribute to the life-threatening conditions and near-miss event.
- To describe the knowledge, attitudes, practices, and behaviors of health care workers in
relation to abortion;
- To describe the characteristics, management, outcomes of ectopic and molar pregnancies
ClinicalTrials.gov: NCT04331847
Other > Journal Blog
PLoS Blogs. 2019 March 4
Fotheringham C, Kumar M, Schulte-Hillen C
PLoS Blogs. 2019 March 4
Other > Pre-Print
Res Sq. 2023 March 20; DOI:10.21203/rs.3.rs-2671712/v1
Moore AM, Pasquier E, Williams TN, Fetters T, Powell B, et al.
Res Sq. 2023 March 20; DOI:10.21203/rs.3.rs-2671712/v1
BACKGROUND
Conducting abortion research in fragile settings presents challenges, many of which are present in other low-resourced settings to various degrees but when appearing all together, collectively served to create a set of barriers to collecting data that required creative adaptations to address and even then, we could not overcome all of them.
RESULTS
Challenges that we experienced in the course of this mixed methods research project included limited access to the study sites by research team members, research being delayed to prioritize life-saving priorities which must take precedence when resource constraints mean that both cannot be carried out, a population skeptical of participating in research due to having negative experiences with the state/other actors as well as due to being research-naïve, geographic and language constraints impacting participant recruitment because of the fact that people are coming from various displaced locations to a particular health facility, a low literacy population meant that they could not read the consent form and due to the stigmatized subject matter we did not want a family member consenting them, and respondents’ challenges participating around the time of discharge because respondents needed to travel home with family members.
CONCLUSIONS
These strategies are relevant not only to abortion research but also other research in resource-constrained/fragile and conflict-affected contexts. Improving the health of the most vulnerable can only be done through understanding barriers to care in insecure and challenging environments. Recommendations include to plan for offsite and long-distance training, supervision, and quality assurance; attempt to negotiate flexible timelines with donors; hire field staff whose only responsibility is data collection; where possible, find a way to include the most vulnerable members of the study population; adapt informed consent processes for low literacy populations; and consider including travel support for respondents. Iterating improvements in data collection innovations in these contexts will advance the field by spurring more research upon which to base policy and practices.
Conducting abortion research in fragile settings presents challenges, many of which are present in other low-resourced settings to various degrees but when appearing all together, collectively served to create a set of barriers to collecting data that required creative adaptations to address and even then, we could not overcome all of them.
RESULTS
Challenges that we experienced in the course of this mixed methods research project included limited access to the study sites by research team members, research being delayed to prioritize life-saving priorities which must take precedence when resource constraints mean that both cannot be carried out, a population skeptical of participating in research due to having negative experiences with the state/other actors as well as due to being research-naïve, geographic and language constraints impacting participant recruitment because of the fact that people are coming from various displaced locations to a particular health facility, a low literacy population meant that they could not read the consent form and due to the stigmatized subject matter we did not want a family member consenting them, and respondents’ challenges participating around the time of discharge because respondents needed to travel home with family members.
CONCLUSIONS
These strategies are relevant not only to abortion research but also other research in resource-constrained/fragile and conflict-affected contexts. Improving the health of the most vulnerable can only be done through understanding barriers to care in insecure and challenging environments. Recommendations include to plan for offsite and long-distance training, supervision, and quality assurance; attempt to negotiate flexible timelines with donors; hire field staff whose only responsibility is data collection; where possible, find a way to include the most vulnerable members of the study population; adapt informed consent processes for low literacy populations; and consider including travel support for respondents. Iterating improvements in data collection innovations in these contexts will advance the field by spurring more research upon which to base policy and practices.
Journal Article > ResearchFull Text
BMC Pregnancy Childbirth. 2023 March 4; Volume 23 (Issue 1); 143.; DOI:10.1186/s12884-023-05427-6
Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame Gbanzi MC, et al.
BMC Pregnancy Childbirth. 2023 March 4; Volume 23 (Issue 1); 143.; DOI:10.1186/s12884-023-05427-6
BACKGROUND
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).
METHODS
We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
RESULTS
We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
CONCLUSION
Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).
METHODS
We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.
RESULTS
We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).
CONCLUSION
Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
Technical Report > Evidence Brief
Powell B, Chen H, Pasquier E, Owolabi OO, Fetters T, et al.
2023 July 1
English
Français
Technical Report > Evidence Brief
Fetters T, Lissouba P, Moore AM, Lagrou D, Pasquier E, et al.
2022 December 1
Conference Material > Slide Presentation
Pasquier E, Lissouba P, Chen H, Williams TN, Baudin E, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/bxth-m543
Technical Report > Evidence Brief
Powell B, Chen H, Pasquier E, Fetters T, Owolabi OO, et al.
2023 July 1
English
Français