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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Pregnancy and Childbirth 1/2015

Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors

Zeitschrift:
BMC Pregnancy and Childbirth > Ausgabe 1/2015
Autoren:
Abdhalah Kasiira Ziraba, Chimaraoke Izugbara, Brooke A Levandowski, Hailemichael Gebreselassie, Michael Mutua, Shukri F Mohamed, Caroline Egesa, Elizabeth W Kimani-Murage
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Author’s contributions

AKZ, BAL, HG, CI, CE, SM and EWK-M participated in the design and implementation of the study and jointly conceptualized the idea of writing this paper. AKZ, BAL, and HG carried out the analysis and drafted the first draft of the manuscript. MM participated in data and manuscript preparation while CI, CE, SM and EWK-M participated in the interpretation, writing of results and overall manuscript preparation. All authors read and approved the final manuscript.

Abstract

Background

Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya.

Methods

A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women’s socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses.

Results

Over three quarters of abortions clients presented with moderate or severe complications. About 65 % of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7–48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3–7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79).

Conclusions

Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.
Literatur
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