Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review

Julius Sama Dohbit,Rakya Inna,Humphry Tatah Neng,Alphonse Nyong Ngalame,Robert Tchounzou,Benova Lenka,Darolles Wekam Mwadjie,Therese Delvaux,Emile Telesphore Mboudou,Fulbert George Nkwele Mangala,Claude Ndoua Noa,Eugene Justine Kongnyuy,Diane Modjo Kamdem,Gregory Ekane Halle,Bilkissou Moustapha

doi:10.4236/ojog.2020.1090119

Abstract

Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.

Highlights

Abortion is the termination of pregnancy before the age of viability of the fetus
Services offered in Sub-Saharan Africa (SSA) in the following databases; Cochrane (CENTRAL), POPLINE, African Index Medicus (AIM), GOOGLE SCHOLAR and MEDLINE using diverse and relevant Medical sub headings (MeSH) and search terms concerning our topic of interest, such as; “Post abortion care” AND “Sub Saharan Africa”, “Abortion care” AND “Africa”
Selection criteria All articles which met with the following criteria: 1) Published in English language only, 2) Published between the years 2000 and 2018, 3) Both experimental and non-experimental studies, 4) All articles addressing at least a component of post abortion care either in a specific country, or in a sub-region or in the entire SSA region; were included in the study

Summary

Introduction

Abortion is the termination of pregnancy before the age of viability of the fetus. Abortion can be classified as either spontaneous or induced, early or late and safe or unsafe [1] [2]. World Health Organization (WHO) defines unsafe abortion as a procedure for termination of a pregnancy done either by an individual lacking the necessary training or in an environment not conforming to minimal medical standards or both [3]. Abortion is a major public health problem especially in developing countries, resulting in severe complications including maternal death [3]. Over 13% of maternal deaths in the world are attributed to unsafe abortions and its complications such as bleeding, pelvic infection or abscess, genital trauma, secondary infertility and death [7] [8]. An estimated 7 million complications result from unsafe abortions [5]. This alarming figure is maintained by the very high proportion of unintended pregnancies in these developing countries

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