Decrease in use of manual vacuum aspiration in postabortion care in Malawi : a cross-sectional study from three public hospitals, 2008-2012

OBJECTIVES: To investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008–2012. METHODS: A retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed. RESULTS: Altogether, 5121 women were included. One third (34.2%) of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7%) to 2009 (31.0%), with a rapid decline after 2010 (28.5%) ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012. CONCLUSION: Use of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines.The study was partly funded by the Norwegian Agency for Development Cooperation (Norad) and the Kamuzu College of Nursing.http://www.plosone.orgam201

Demographic characteristics of women who received treatment for retained products of conception after incomplete abortion in three hospitals in Malawi, 2008–2012^a.

<p>(n = 5121)</p>a<p>Numbers are given as n (%) unless otherwise indicated</p>b<p>Unmarried: Single, separated, divorced, widowed.</p>c<p>Rural: Chiradzulu and Mangochi Hospital. Urban: QECH</p>d<p>Gainful employment; Cleaner, Farmer, Businesswoman, Policewoman and other.</p

Use of manual vacuum aspiration for removal of retained products of conception after incomplete abortions in three hospitals^a in Malawi between 2008–2012.

<p>First trimester^b. ^a Queen Elisabeth Central Hospital (QECH), Mangochi District Hospital, Chiradzulu District Hospital. ^b Up to 12 weeks of gestation.</p

Surgical methods used for removal of retained products of conception after incomplete abortion by year and hospital in three hospitals in Malawi, 2008–2012^a.

<p>All trimesters^b.</p>a<p>Numbers are given as n (%) unless otherwise indicated.</p>b<p>Gestational age up to 28 weeks.</p>c<p>Queen Elisabeth Central Hospital (QECH).</p>d<p>Manual Vacuum Aspiration (MVA).</p>e<p>Dilatation and sharp Curettage (D&C).</p

Surgical methods used for removal of retained products of conception after incomplete abortion by year and hospital in three hospitals in Malawi, 2008–2012^a.

<p>Abortions in 1^st trimester^b.</p>a<p>Numbers are given as n (%) unless otherwise indicated.</p>b<p>Gestational age up to 12 weeks.</p>c<p>Queen Elisabeth Central Hospital (QECH).</p>d<p>Manual Vacuum Aspiration (MVA).</p>e<p>Dilatation and sharp Curettage (D&C).</p