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ORIGINAL ARTICLE
Open Access

The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment

Erick Yegon, Japheth Ominde, Colin Baynes, Esther Ngadaya, Rehema Kahando, Justin Kahwa and Grace Lusiola
Global Health: Science and Practice August 2019, 7(Supplement 2):S315-S326; https://doi.org/10.9745/GHSP-D-19-00050
Erick Yegon
aEngenderHealth, Nairobi, Kenya.
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  • For correspondence: eyegon@engenderhealth.org
Japheth Ominde
aEngenderHealth, Nairobi, Kenya.
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Colin Baynes
bEngenderHealth, Washington, DC, USA.
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Esther Ngadaya
cThe National Institutes of Medical Research, Dar es Salaam, Tanzania.
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Rehema Kahando
dEngenderHealth, Dar es Salaam, Tanzania.
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Justin Kahwa
dEngenderHealth, Dar es Salaam, Tanzania.
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Grace Lusiola
dEngenderHealth, Dar es Salaam, Tanzania.
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Figures & Tables

Figures

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  • FIGURE 1
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    FIGURE 1

    Critical Steps Component and Overall Score of PAC MVA Cases Directly Observed

    Abbreviation: MVA, manual vacuum aspiration.

    Note: The categories of PAC critical steps were drawn from separate sources, hindering direct comparisons of provider performance between MVA and misoprostol treatment approaches in Figure 1 and 2.

  • FIGURE 2
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    FIGURE 2

    Critical Steps Component and Overall Score of PAC Misoprostol Cases Directly Observed

    Note: The categories of PAC critical steps were drawn from separate sources, hindering direct comparisons of provider performance between MVA and misoprostol treatment approaches in Figure 1 and 2.

Tables

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    TABLE 1.

    Domains of Structural Quality Assessed to Determine the Readiness to Provide PAC

    Domains of Structural QualityMeasures Assessed
    Service availabilityReported service availability of uterine evacuation and contraceptive methods; times of service availability; availability of contraceptives to PAC clients by treatment method and contraceptive method type
    Human resource capacityNumber of staff by training status in all PAC treatment methods, LARCs; reported proportion of time trained staff are available at facility to perform PAC
    Service delivery environmentObserved privacy and cleanliness of PAC provision environment, availability of running water, electricity, toilet, and information, education, and communication materials on PAC; presence of sink, operating furniture, and essential linens
    Supplies and contraceptivesAvailability of essential supplies, medications, and contraceptives in PAC provision setting (i.e., those required to implement the signal functions)
    Infection prevention and waste managementSystem in place for solid infectious waste disposal, liquid infectious waste disposal, availability of protocols for collection and processing of waste, facility staff trained in waste management, and availability of infection prevention materials and supplies
    Health information systemAvailability and completeness of PAC register, documentation of gestational age, and treatment detail of clients in obstetrical register and maternal death register
    • Abbreviations: LARCs, long-acting reversible contraceptives; PAC, postabortion care.

    • View popup
    TABLE 2.

    Critical Components of PAC Service Delivery Assessed in Direct Observations of Client-Provider Interaction

    Treatment MethodCritical Components
    MVAInitial counseling and assessment; triage; initial history; family planning history; family planning counseling; medical evaluation; discussion of treatment options; initial infection prevention; MVA preparations; MVA procedure; post-MVA infection prevention; post-procedure care/other; and predischarge care (13 components)
    MisoprostolInitial counseling and assessment; initial and reproductive health history (including family planning); medical evaluation; establishes diagnosis/confirms eligibility for misoprostol; informs of treatment options; provides correct information on misoprostol; ensures client understands expected effects and side effects; ensures client understands signs of complications; counsels women on return to fertility and family planning; and follow-up (10 components)
    • Abbreviations: MVA, manual vacuum aspiration; PAC, postabortion care.

    • View popup
    TABLE 3.

    Utilization of PAC and Uptake of Contraception by Level of Care, September 2015 to March 2016

    Health Center (n=13)Hospital (n=9)Regional Referral Hospital (n=3)Total (N=25)
    PAC volume, total number (min, max per facility)520 (13, 70)827 (61, 183)828 (114, 503)2,175
    Family planning uptake, mean % (min, max)62 (51, 92)66 (99, 0)39 (8, 81)54
    LARCs uptake, mean % (min, max)4 (0, 30)5 (0, 26)2 (0.6, 7)4
    • Abbreviations: LARCs, long-acting reversible contraceptives; PAC, postabortion care.

    • View popup
    TABLE 4.

    Median Percentage of Structural Quality and Readiness Criteria Fulfilled by Key Subjects for Health Centers, Hospitals, and District Hospitals

    Key Subject/VariableHealth Center (n=13)Hospital (n=9)Regional Referral Hospital (n=3)
    Triage and service availability424462
    Human resource capacity585873
    Service delivery environment606073
    Supplies and contraceptives414353
    Infection prevention and waste management556766
    Health information system384672
    Overall454961
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Global Health: Science and Practice: 7 (Supplement 2)
Global Health: Science and Practice
Vol. 7, No. Supplement 2
August 22, 2019
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The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment
Erick Yegon, Japheth Ominde, Colin Baynes, Esther Ngadaya, Rehema Kahando, Justin Kahwa, Grace Lusiola
Global Health: Science and Practice Aug 2019, 7 (Supplement 2) S315-S326; DOI: 10.9745/GHSP-D-19-00050

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The Quality of Postabortion Care in Tanzania: Service Provider Perspectives and Results From a Service Readiness Assessment
Erick Yegon, Japheth Ominde, Colin Baynes, Esther Ngadaya, Rehema Kahando, Justin Kahwa, Grace Lusiola
Global Health: Science and Practice Aug 2019, 7 (Supplement 2) S315-S326; DOI: 10.9745/GHSP-D-19-00050
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