Abstract
ObjectivesTo investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008–2012.MethodsA 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.ResultsAltogether, 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.ConclusionUse 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.
Highlights
Malawi is a small landlocked country in South-Eastern Africa, and is one of the poorest countries in the world [1]
Malawi has among other serious issues one of the highest maternal mortality rates (MMR) in the world [2]
Studies indicate that 24–30% of all maternal mortality in Malawi is caused by unsafe abortions [6,7]
Summary
Malawi is a small landlocked country in South-Eastern Africa, and is one of the poorest countries in the world [1]. The MMR has decreased over the past years, but the numbers are still high, and every year 3,000 women die from pregnancy-related causes [2]. Studies indicate that 24–30% of all maternal mortality in Malawi is caused by unsafe abortions [6,7]. This is because induced abortion is highly restricted and is only legal in order to save a pregnant womans life [7,8]. It is inaccessible for the majority of women [7,9]
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