背景:在马拉维,堕胎是合法的,只有挽救孕妇的生命。不安全堕胎后并发症的治疗对已经贫困的医疗保健系统产生了巨大影响。即使手动真空抽吸(MVA)和米索前列醇是妊娠早期不完全流产的推荐治疗选择,在马拉维,采用锐利刮治的手术治疗仍是主要的治疗方法之一.米索前列醇和MVA更安全,更便宜,而锋利的刮宫术有更多并发症的风险,如穿孔和出血,需要全身麻醉和临床医生。目前,马拉维正在努力增加米索前列醇在治疗不完全流产中的应用。为了成功实施米索前列醇,医疗保健提供者对这件事的看法至关重要。
方法:采用一种定性的方法,通过半结构化的深度访谈,探讨卫生保健提供者对米索前列醇治疗不完全流产的看法。在一家城市公立医院采访了10名医疗保健提供者。每次面试平均持续45分钟。在参加米索前列醇使用培训干预9个月后,于2021年3月和4月对不同干部的医疗保健提供者进行了采访。采访被记录下来,逐字转录并使用“系统文本浓缩”进行分析。
结果:医疗保健提供者报告了增加米索前列醇使用的许多优点,例如减少工作量,少住院,更少的感染,和任务转移。药物的可用性和对患者的益处也被强调为重要。然而,暴露了一些挑战,例如决定谁有资格获得药物和治疗失败。由于这些原因,一些医疗保健提供者仍然选择手术治疗作为他们的主要方法。
结论:本研究的结果支持在马拉维增加使用米索前列醇治疗不完全流产的建议,正如接受采访的医疗保健提供者看到该药物的许多优点。为了扩大其使用范围,适当的培训和监督至关重要。需要可持续和可预测的供应来改变临床实践。不安全堕胎是全球孕产妇死亡的主要原因。不安全堕胎是指没有所需技能或设备的人终止意外怀孕,这可能会导致严重的并发症。在马拉维,流产后并发症很常见,孕产妇死亡率是世界上最高的。受孕的保留产品,被称为不完全流产,在自然流产和不安全的人工流产后很常见。有几种方法可以治疗不完全流产,在其他低收入国家,米索前列醇已成功用于治疗不完全流产。这项研究探讨了使用米索前列醇治疗不完全流产的医疗保健提供者的看法,以及马拉维医疗保健专业人员是否可以完全接受该药物。马拉维一家医院的卫生人员就使用该药物治疗不完全流产进行了单独采访。这项研究表明,接受采访的医疗保健提供者对增加米索前列醇的使用感到满意。他们强调了几个好处,例如减少工作量,并使任务转移,以便各种医院干部现在可以治疗不完全流产的患者。与其他治疗方法相比,医护人员还观察到接受该药物治疗的妇女的益处。提到的挑战是找出谁有资格获得药物和药物失败。这项研究支持在马拉维扩大使用米索前列醇治疗不完全流产;卫生部和政策制定者应支持未来的干预措施,以增加其使用。
BACKGROUND: In Malawi, abortion is only legal to save a pregnant woman\'s life. Treatment for complications after unsafe abortions has a massive impact on the already impoverished health care system. Even though manual vacuum aspiration (MVA) and misoprostol are the recommended treatment options for incomplete abortion in the first trimester, surgical management using sharp curettage is still one of the primary treatment methods in Malawi. Misoprostol and MVA are safer and cheaper, whilst sharp curettage has more risk of complications such as perforation and bleeding and requires general anesthesia and a clinician. Currently, efforts are being made to increase the use of misoprostol in the treatment of incomplete abortions in Malawi. To achieve successful implementation of misoprostol, health care providers\' perceptions on this matter are crucial.
METHODS: A qualitative approach was used to explore health care providers\' perceptions of misoprostol for the treatment of incomplete abortion using semi-structured in-depth interviews. Ten health care providers were interviewed at one urban public hospital. Each interview lasted 45 min on average. Health care providers of different cadres were interviewed in March and April 2021, nine months after taking part in a training intervention on the use of misoprostol. Interviews were recorded, transcribed verbatim and analyzed using \'Systematic Text Condensation\'.
RESULTS: The health care providers reported many advantages with the increased use of misoprostol, such as reduced workload, less hospitalization, fewer infections, and task-shifting. Availability of the drug and benefits for the patients were also highlighted as important. However, some challenges were revealed, such as deciding who was eligible for the drug and treatment failure. For these reasons, some health care providers still choose surgical treatment as their primary method.
CONCLUSIONS: Findings in this study support the recommendation of increased use of misoprostol as a treatment for incomplete abortion in Malawi, as the health care providers interviewed see many advantages with the drug. To scale up its use, proper training and supervision are essential. A sustainable and predictable supply is needed to change clinical practice. Unsafe abortion is a major contributor to maternal mortality worldwide. Unsafe abortion is the termination of an unintended pregnancy by a person without the required skills or equipment, which might lead to serious complications. In Malawi, post-abortion complications are common, and the maternal mortality ratio is among the highest in the world. Retained products of conception, referred to as an incomplete abortion, are common after spontaneous miscarriages and unsafe induced abortions. There are several ways to treat incomplete abortion, and the drug misoprostol has been successful in the treatment of incomplete abortion in other low-income countries. This study explored perceptions among health care providers using misoprostol to treat incomplete abortions and whether the drug can be fully embraced by Malawian health care professionals. Health personnel at a Malawian hospital were interviewed individually regarding the use of the drug for treating incomplete abortions. This study revealed that health care providers interviewed are satisfied with the increased use of misoprostol. They highlighted several benefits, such as reduced workload and that it enabled task-shifting so that various hospital cadres could now treat patients with incomplete abortions. The health care workers also observed benefits for women treated with the drug compared to other treatments. The challenges mentioned were finding out who was eligible for the drug and drug failure. This study supports scaling up the use of misoprostol in the treatment of incomplete abortions in Malawi; the Ministry of Health and policymakers should support future interventions to increase its use.