背景:阿富汗是世界上孕产妇死亡率最高的国家之一,2017年估计每10万名活产中有638人死亡。感染,产科出血,不安全堕胎是孕产妇死亡的三大主要原因。自2006年以来,避孕普及率在10%至20%之间波动。2016年阿富汗全国孕产妇和新生儿健康护理质量评估评估了提供优质常规和急诊产科和新生儿护理的设施准备情况,包括堕胎后护理服务。
方法:每天至少生育5人的无障碍公共卫生设施(n=77),全国代表性的公共卫生设施样本,每天出生少于5个(n=149),并评估了20个有目的地选择的私人医疗机构。检查堕胎后护理的评估部分包括设施清单和用于验证药物的记录审查工具,供应,设备,和设施记录的可用性,和一个采访工具,以收集有关熟练接生员的知识和看法的信息。
结果:大多数设施都有用品,设备,和管理堕胎后护理的药物,包括计划生育咨询和服务提供。在公共设施,36%的熟练接生员要求说出解决人工流产并发症的基本措施,提到了手动真空抽吸(在私人设施中为23%);提到咨询的不到四分之一。当被问及应该向堕胎后的客户提供什么信息时,73%的人表示需要计划生育咨询(70%在私人设施)。几乎所有每天平均分娩5个或更多的高容量公共卫生设施以及每天平均分娩0-4次的低容量公共卫生设施的不到5%报告在过去3个月中删除了保留的受孕产品。在评估的77个高容量设施中,58(75%)报告使用米索前列醇去除残留的受孕产物,59(77%)报告使用手动真空抽吸,和67(87%)报告使用扩张和刮宫。
结论:本研究提供的证据表明,在包括堕胎后计划生育在内的阿富汗卫生机构中,堕胎后护理服务的提供仍有改进的空间。获得高质量的堕胎后护理需要额外的投资,以提高提供者的知识和实践,供应和设备的可用性。
阿富汗是世界上孕产妇死亡率最高的国家之一。感染,分娩时出血,和不安全堕胎是该国死亡的三个主要原因。避孕药的摄入量很低,只有五分之一的已婚妇女使用避孕药具。2016年,在选定数量的公共和私人医疗机构(n=226;n=20)进行了全国孕产妇和新生儿健康护理质量评估,以评估医疗机构提供堕胎后护理的能力。以及熟练的助产士对这种护理的知识和看法。堕胎后护理是一项必不可少的服务,通过提供堕胎后计划生育咨询和服务,使妇女在流产和堕胎并发症中幸存下来,并减少意外怀孕,社区赋权,和动员。这项研究的结果表明,大多数设施都有用品,设备,以及给予堕胎后护理的药物,包括计划生育服务。然而,助产士的知识及其在公共和私人设施提供高质量堕胎后护理服务的能力存在差距。这项研究提供的证据表明,阿富汗医疗机构的堕胎后护理服务仍有改善的空间。获得高质量的堕胎后护理需要额外的投资,以提高提供者的知识和实践,和供应的可用性。
BACKGROUND: Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services.
METHODS: Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants\' knowledge and perceptions.
RESULTS: Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0-4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage.
CONCLUSIONS: This
study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers\' knowledge and practice, availability of supplies and equipment.
Afghanistan has one of the highest burdens of maternal mortality in the world. Infections, bleeding around childbirth, and unsafe abortion are the three leading causes of mortality in the country. The uptake of contraceptives is low, and only one-fifth of married women use contraceptives. A National Maternal and Newborn Health Quality of Care Assessment was conducted in 2016 at a selected number of public and private health facilities (n = 226; n = 20) to evaluate health facilities’ capacity to provide postabortion care, and skilled birth attendants’ knowledge and perceptions with regard to such care. Postabortion care is an essential package of services to make women survive complications of miscarriage and abortion and reduce unplanned pregnancies by providing postabortion family planning counseling and services, community empowerment, and mobilization. The result of this
study showed that most facilities had supplies, equipment, and drugs to give postabortion care, including family planning services provision. However, there are gaps in birth attendants’ knowledge and their capacity to deliver high-quality postabortion care services at public and private facilities. This
study provides evidence that there is room for improvement in postabortion care services provision at health facilities in Afghanistan. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, and availability of supplies.