THE QUALITY OF POST ABORTION CAREPACKAGE OFFERED TO WOMEN PRESENTING TO TWO REFERRAL HOSPITALS IN BOMET COUNTY

Abstract

In 2011, WHO reported 56 million abortions worldwide. The majority of these occurred in the developing world. Maternal mortality in Kenya isstill high at 488/100,000 live births, with abortion related deaths contributing to the top five causes of maternal mortality. The Comprehensive post abortion care package (CPAC), which offers holistic care, has been shown to decrease the rate of maternal mortality and morbidity. This study aimedto determine if all the elements of CPAC were offered to women presenting to hospitals in Bomet County and thesewomen’s level of satisfaction with care. A Cross-sectional study was undertaken at two referral hospitals in Bomet County, Tenwek Mission hospital and Longisa County referral hospital.Analysis of the responses involved categorical independent and dependent variables and Likert scales.100 respondents were surveyed with a mean age of 26.6 years, range (16-42yrs). Generally, access to care was poor with 70% accessing care after 24 hours despite life threatening complications. This led to high cost of care where a majority 62% needing blood and 89% requiring evacuation of retained products of conception. Gaps were noted in uptake of family planning services where only 46% were offered a contraceptive method with an uptake of 36% and of these, the options chosen were mainly short-term methods. Those who were more than 25 years were more likely to be offered a family planning option (56%) compared to those less than 24 years (22%) in thefaith-based facility with OR of 0.22(0.06,0.83) P value <0.02. On spiritual care and emotional counseling, 100% of respondents reported having been emotionally affected by the abortion but only 66% reported care in that area. Only 46% of the patients were tested and counselled for HIV and STIs. Linkage to care was also generally poorly represented with patients reporting late access to care, improper referral system and inadequacies in follow-up after discharge. Results generally indicate that there are still gaps in how frequently each of the elements of CPAC with only 30% of the respondents receiving the whole CPAC package as per the guidelines. Nevertheless, most patients reported satisfaction with the services they received with a p value of < 0.05. Efforts need to be put in place to advocate for adherence to CPAC as stipulated in the guidelines with the aim of reducing the vicious cycle of repeat abortions and maternal morbidity and mortality.