TITLE:
Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review
AUTHORS:
Alphonse Nyong Ngalame, Robert Tchounzou, Humphry Tatah Neng, Fulbert George Nkwele Mangala, Rakya Inna, Diane Modjo Kamdem, Bilkissou Moustapha, Julius Sama Dohbit, Eugene Justine Kongnyuy, Claude Ndoua Noa, Benova Lenka, Gregory Ekane Halle, Darolles Wekam Mwadjie, Therese Delvaux, Emile Telesphore Mboudou
KEYWORDS:
Post Abortion Care (PAC), Misoprostol, Contraception, Midlevel Cadres, Sub-Saharan Africa
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.9,
September
23,
2020
ABSTRACT: Saharan Africa (SSA)
contributes 29% of the global unsafe abortions with 62% of abortion-related
deaths. This is due to restrictive abortion laws, low quality post abortion
care (PAC) and inadequate access to effective modern contraception. The overall
objective was to review current literature on PAC in SSA and make
recommendations for improvement especially in Cameroon. A literature review was
conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index
Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries
ranging from observational studies to systematic reviews with meta-analysis.
Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally
safe and effective. 2) There is comparable effectiveness between physicians and trained
mid-level cadres in PAC management. 3) PAC contraception uptake was increased
when offered immediately before patient leaves the facility. 4) Gaps to PAC
service use include inadequate access, low quality care and less
adolescent-friendly environment. Task shifting of PAC to trained mid-level
staff, decentralization of medical PAC using misoprostol, offering post
abortion counselling and contraception to clients before leaving the health
facility, encouraging linkage and provider-community partnership in PAC and
reinforcement of advocacy for less restrictive abortion laws in Cameroon are
recommended.