Task-shifting treatment of incomplete abortion with misoprostol to lower-level providers in Mozambique
ESC Congress Library. Bique C. 05/28/14; 50458; A-041
Dr. Cassimo Bique
Dr. Cassimo Bique
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Abstract
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Objectives: In Mozambique, abortion-related complications are a major cause of maternal mortality. Issues of supply and human resources limit the reach of manual vacuum aspiration (MVA) to treat incomplete abortion in Mozambique. Misoprostol is an effective, non-surgical alternative to MVA and has the potential to ensure PAC services are widely available.


Methods: An operations research project was conducted in two districts of Mozambique introduced misoprostol as a first line treatment of incomplete abortion for cases with a uterine size equivalent to gestational age up to 12 weeks without signs of complications in all health facilities within the health system (Centro de Saude or CS 2/3, CS 1, and hospital).  All providers, including lower-level providers not previously trained in MVA, were trained to use misoprostol.  MVA was reserved for more complicated cases, larger uterine size, and as a backup method if misoprostol was unsuccessful. A referral system and contraceptive services were fully integrated to ensure comprehensive services. Data for analysis comes from client records, client exit interviews, and provider interviews.


Results: From July 2010-January 2011, 300 women were treated with misoprostol.  188 women participated in the exit interview. Maternal and child health (MCH) nurses provided 86% of PAC services across all facility levels. At the lowest level facilities (CS 2/3), parteira elementar (low-level nurses not trained in MVA) treated 30% of women receiving misoprostol.  Client records showed providers gave the correct dose and route of misoprostol in all cases. All providers participating in the provider interview (n=28) agreed or strongly agreed that it was easy to learn how to use misoprostol to treat incomplete abortion, that they felt comfortable using misoprostol to treat incomplete abortion, and that they would recommend the use of misoprostol to other qualified health care providers.


Conclusions: This operations research demonstrated that quality PAC services can be provided at all levels of the Mozambican health care system. The introduction of misoprostol expanded access to PAC by building the capacity of providers not previously trained in MVA to treat incomplete abortion. We recommend that policymakers consider integrating the use of misoprostol for treatment of incomplete abortion and miscarriage as part of PAC at all levels of the health system.

Objectives: In Mozambique, abortion-related complications are a major cause of maternal mortality. Issues of supply and human resources limit the reach of manual vacuum aspiration (MVA) to treat incomplete abortion in Mozambique. Misoprostol is an effective, non-surgical alternative to MVA and has the potential to ensure PAC services are widely available.


Methods: An operations research project was conducted in two districts of Mozambique introduced misoprostol as a first line treatment of incomplete abortion for cases with a uterine size equivalent to gestational age up to 12 weeks without signs of complications in all health facilities within the health system (Centro de Saude or CS 2/3, CS 1, and hospital).  All providers, including lower-level providers not previously trained in MVA, were trained to use misoprostol.  MVA was reserved for more complicated cases, larger uterine size, and as a backup method if misoprostol was unsuccessful. A referral system and contraceptive services were fully integrated to ensure comprehensive services. Data for analysis comes from client records, client exit interviews, and provider interviews.


Results: From July 2010-January 2011, 300 women were treated with misoprostol.  188 women participated in the exit interview. Maternal and child health (MCH) nurses provided 86% of PAC services across all facility levels. At the lowest level facilities (CS 2/3), parteira elementar (low-level nurses not trained in MVA) treated 30% of women receiving misoprostol.  Client records showed providers gave the correct dose and route of misoprostol in all cases. All providers participating in the provider interview (n=28) agreed or strongly agreed that it was easy to learn how to use misoprostol to treat incomplete abortion, that they felt comfortable using misoprostol to treat incomplete abortion, and that they would recommend the use of misoprostol to other qualified health care providers.


Conclusions: This operations research demonstrated that quality PAC services can be provided at all levels of the Mozambican health care system. The introduction of misoprostol expanded access to PAC by building the capacity of providers not previously trained in MVA to treat incomplete abortion. We recommend that policymakers consider integrating the use of misoprostol for treatment of incomplete abortion and miscarriage as part of PAC at all levels of the health system.

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