Prevalence and Characteristics of Maternal Near-miss and Management Outcomes Among Women Who Sought Post Abortion Care at the Princess Christian Maternity Hospital, Freetown Sierra Leone 2018-2019

Abstract

Background: The World Health Organization (2011) affirmed that most of the unsafe abortions accounting for 22 million cases and subsequent 47,000 deaths occur in developing countries. Most of these countries have laws in place outlawing abortion making it difficult to have the process done openly. Most of these patients include adolescents. The Sierra Leone Demographic and Health Survey report in 2013 revealed that adolescents contribute to around 25 percent of total maternal deaths which makes this population vulnerable. Women seeking care for post abortion complications have been increasing in the country with a significant number of patients presenting with maternal near miss events. Globally, there are more than 46 million cases of induced abortion which occur annually with more than 20 million being unsafe abortions (1). Thus, it is essential to investigate complications arising from unsafe abortion and management outcomes to understand the existing burden. Objective: To compare the prevalence and characteristics of maternal near-miss and management outcomes between adolescents (10-19 years) and other women of reproductive age (20-49 years) who sought post abortion care at PCMH between 1st January 2018 - 31st December 2019. Methodology: This is a facility-based retrospective comparative cross-sectional study. It was conducted at the Princess Christian Maternity Hospital (PCMH) in Freetown Sierra Leone. A total of 459 patients were recruited into the study which included 153 adolescents (10- 19 years) and 306 other women of reproductive age (20–49 years). Patient records were reviewed using a structured questionnaire and the modified WHO maternal near-miss tool. Data analysis was done using SPSS software. The prevalence of maternal near miss was calculated based on a specified formula including women who sought post abortion care between 2018 - 2019. A Pearson chi-square test or Fischer’s exact test was used to compare categorical variables and outcome variables. Independent samples t-test was used to compare continuous variables and the study outcome variables. All comparisons were performed at 0.05 significance level. Results: The findings from the study revealed that, 88.9% of adolescents were dependent compared to 23.5% among other WRA. The probability of adolescents seeking treatment elsewhere before presenting to hospital was 52% lower compared to other WRA (41.2% vs 72.9%). The total prevalence of maternal near miss was 24.4%. The prevalence of maternal near miss however, was slightly higher in other WRA 25.2% compared to 22.9% among adolescents. The probability of adolescent women receiving blood transfusion was 77% lower compared to other WRA, (OR =0.23, 95%CI:0.18 – 0.94, p =0.049). The common characteristics of MNM included Transfusion (69.6%), Sepsis (19.6%) and Laparotomy (8.1%). Other observed characteristics were hysterectomy, shock and severe malaria. There was no association between the exposed and non-exposed groups based on MNM characteristics. Many of the patients in the adolescent group did not have any evidence of complications, 60.8% compared to 55.6% (170) in other WRA. Maternal near miss was slightly higher among other WRA 25.2% (77) compared to 22.9% (35) in adolescents. Conclusion and Recommendations: The findings have shown that there are no major significant differences between adolescents and other women of reproductive age. However, the risk of adverse complications was highly prevalent across the groups. Thus, it is essential to review the current laws to allow for safer abortion