Department of Obstetrics and Gynaecology, Makerere University CHS, Kampala, Uganda
Reproductive Endocrinology and Infertility, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda.
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-003274.
With a view to inform policy for improved postabortion care, we describe abortion-related near-miss and mortality by sociodemographic risk factors and management options by pregnancy trimester in Uganda.
This secondary data analysis used an adapted WHO near-miss methodology to collect cross-sectional maternal near-miss and abortion complications data at 43 health facilities in Central and Eastern Uganda in 2016-2017. We computed abortion severe morbidity, near-miss and mortality ratios per 100 000 live births, and described the proportion of cases that worsened to an abortion near-miss or death, stratified by geographical region and trimester. We tested for association between independent variables and abortion near-miss, and obtained prevalence ratios for association between second trimester near-miss and independent demographic and management indicators. We assessed health facility readiness for postabortion care provision in Central and Eastern regions.
Of 3315 recorded severe abortion morbidity cases, 1507 were near-misses. Severe abortion morbidity, near-miss and mortality ratios were 2063, 938 and 23 per 100 000 live births, respectively. Abortion-related mortality ratios were 11 and 57 per 100 000 in Central and Eastern regions, respectively. Abortion near-miss cases were significantly associated with referral (p<0.001). Second trimester had greater abortion mortality than first trimester. Eastern region had greater abortion-related morbidity and mortality than Central region with facilities in the former characterised by inferior readiness to provide postabortion care.
Uganda has a major abortion near-miss morbidity and mortality; with mortality higher in the second trimester. Life-saving commodities are lacking especially in Eastern region compromising facility readiness for postabortion care provision.
为了为改善流产后护理提供政策信息，我们描述了乌干达按社会人口风险因素和妊娠阶段划分的与流产相关的接近死亡病例和死亡病例，并描述了 43 个卫生机构在 2016-2017 年期间发生的流产并发症数据。我们计算了每 10 万活产的流产严重发病率、接近死亡病例和死亡率，并按地理位置和妊娠阶段描述了病情恶化至流产接近死亡病例或死亡的病例比例。我们测试了独立变量与流产接近死亡病例之间的关系，并获得了第二孕期接近死亡病例与独立人口统计学和管理指标之间的关联的患病率比。我们评估了乌干达中部和东部地区提供流产后护理的卫生机构的准备情况。
在记录的 3315 例严重流产发病率病例中，有 1507 例为接近死亡病例。严重流产发病率、接近死亡病例和死亡率分别为 2063、938 和 23 例/10 万活产。中部和东部地区的流产相关死亡率分别为 11 和 57 例/10 万。与转诊相关的流产接近死亡病例显著相关（p<0.001）。第二孕期的流产死亡率高于第一孕期。与中部地区相比，东部地区的流产发病率和死亡率更高，前者的设施在提供流产后护理方面准备不足。
乌干达的流产接近死亡病例发病率和死亡率较高；其中第二孕期的死亡率更高。救命的商品尤其在东部地区缺乏，使提供流产后护理的设施准备不足。
