Assessment of Quality of Safe Abortion Care in Private for Non-Profit Institutions, Addis Ababa, Ethiopia

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Addis Ababa University


Background: Nearly 52 million abortions are carried out worldwide, of these 20 million are unsafe and 68,000 die each year. Of all unsafe abortions practiced, 97% is problems of developing countries. In Ethiopia, unsafe abortion is the most common cause of maternal mortality, accounting for up to 32% of maternal deaths in the country. Objective: To assess quality of safe abortion services in private for non-profit institutions in Addis Ababa. Methods: A facility based cross-sectional study was conducted among safe abortion users from August, 2009 to June, 2010. The study used multiple research approach of quality of abortion care: A structured interviewer administered questionnaire, observation, provider interview and supplies and equipment assessment were employed. The institutions which were included in the study sample were selected using the rule of thumb and a total of seven institutions incorporated in the sample. A total of four hundred twenty two clients for exit interview, forty-two observations, and forty-three health service providers interview were done. Data entry, cleaning, and analysis was done using Epi-info version 3.5.1 and SPSS version 11. Result: From total of 422 safe abortion clients interviewed 192 (45.5%) were never married, the mean age of respondents were 23.5 + SD 3.9 and 60 (14.2%) of the respondents have had history of previous abortion. The average clients waiting time was 3.2hours. Ninety-two percent of clients claimed that they were treated with politeness & respect. Forty-five percent of clients given information about danger sign that need re-visiting the health institutions & information regarding other reproductive issues like tetanus immunization, Rh counseling, and VCT were very low. Two hundred ninety five (88.9%) of post abortion clients were left with family planning methods. Those women who said the counseling time adequate four times more likely to be satisfied with the overall service [Adjusted OR=3.6, (95% CI (1.6, 8.2)]. ix Women who received anti-pain treatment on the average three times more likely satisfied with the service [Adjusted OR=2.6, 95% CI (1.1, 6.2)]. The likelihood of satisfaction in those clients who were given appointment for follow-up was six times [Adjusted OR=5.9, 95% CI (2.2, 15.9)]. Majority of health service providers had got refresher training. Conclusion: Ninety-three percent of the clients were expressed their overall satisfaction with the service they received. The majority of post-abortion clients were left with contraceptive, but linkage to other reproductive health like Rh screening, VCT and TT immunization were not adequately adept across all the institutions. Follow-up appointment, anti-pain, and adequate counseling statistically significant with the overall satisfaction of clients. Majority of health service providers had got refresher training & positive attitude towards safe abortion clients, Infection prevention uniformly practiced. Recommendations: Offering Anti-pain management, appropriate counseling & follow up appointment provide for all clients’ to deliver quality service by reducing the waiting time as much as possible, reducing miss opportunity on family planning counseling & linkage to other reproductive health, capacity building for care service providers & supportive supervision are crucial to improve the quality of safe abortion service.