\u201cConfidence comes with frequent practice\u201d: health professionals\u2019 perceptions of using manual vacuum aspiration after a training program

Maria Lisa Odland,Elisabeth Darj,Jon Øyvind Odland,Ursula Kafulafula,Gladys Membe-Gadama

doi:10.1186/s12978-019-0683-z

Abstract

BackgroundMalawi has one of the highest maternal mortality rates in the world, with unsafe abortion as a major contributor. Curettage is most frequently used as the surgical method for treating incomplete abortions, even though it is costly for an impoverished health system and the less expensive and safe manual vacuum aspiration (MVA) method is recommended.MethodsThe aim of this 2016–17 study is to explore health worker’s perception of doing MVA 1 year after an educational intervention. Focus group discussions were recorded, transcribed verbatim, and analyzed using content analysis for interpreting the findings. A knowledge, attitude and practice survey was administered to health professionals to obtain background information before the MVA training program was introduced.ResultsPrior to the training sessions, the participants demonstrated knowledge on abortion practices and had positive attitudes about participating in the service, but preferred curettage over MVA. The training was well received, and participants felt more confident in doing MVA after the intervention. However, focus group discussions revealed obstacles to perform MVA such as broken equipment and lack of support. Additionally, the training could have been more comprehensive. Still, the participants appreciated task-sharing and team work.ConclusionTraining sessions are considered useful in increasing the use of MVA. This study provides important insight on how to proceed in improving post-abortion care in a country where complications of unsafe abortion are common and the health system is low on resources.

Highlights

Malawi has one of the highest maternal mortality rates in the world, with unsafe abortion as a major contributor
Unsafe abortion is defined by the World Health Organization (WHO) as “a procedure for termination of a pregnancy done by an individual who does not have the necessary training or in an environment not conforming to minimal medical standards”, and worldwide around 25 million unsafe abortions are performed every year [10]
A positive attitude regarding treatment of incomplete abortions as an important part of the job was stated by 96.2% of the participants, while 56.6% of the participants preferred manual vacuum aspiration (MVA) to dilatation and curettage (D&C) and regarded it as easier to use and safer (Table 2)

Summary

Introduction

Malawi has one of the highest maternal mortality rates in the world, with unsafe abortion as a major contributor. Unsafe abortion is defined by the World Health Organization (WHO) as “a procedure for termination of a pregnancy done by an individual who does not have the necessary training or in an environment not conforming to minimal medical standards”, and worldwide around 25 million unsafe abortions are performed every year [10] It occurs most commonly in countries where there is a restrictive abortion law, like Malawi. A recent systematic review revealed several barriers to using misoprostol such as fear and apprehensions at policy, provider and community level, shortage of staffing and stock depletion [18] These are factors that could contribute to most incomplete abortions in Malawi being treated surgically. Stock depletion of medicines is a common problem in Malawi [19], and it makes sense to treat patients surgically

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