[Improving the quality of care after spontaneous abortions in rural Senegal].
OBJECTIVE
To evaluate the feasibility and impact on quality of decentralising care for spontaneous abortion (post-abortion care, PAC) in rural areas of Senegal.


METHODS
This prospective study concerns all patients who had PAC services at 6 medical centres in the districts of Kaolack and Fatick. A preintervention baseline study was performed to evaluate the number of cases treated in these centres. We then introduced a new treatment protocol for PAC, which included manual vacuum aspiration (MVA) and quarterly visits for supervision in each centre from 1 August 2001 through 30 September 2002. An evaluation was performed at the end of the program and 6 months after that. Results were compared with the baseline data for the 14 months before the intervention period. We used the chi(2) test to compare proportions and set the threshold of significance at 5%.


RESULTS
The new model for PAC made it possible to increase the number of patients treated for incomplete abortion by 22%. Their average age was 25 years, and 71% had first-trimester pregnancy losses. MVA was performed for 56%. Hospitalisation lasted a mean of 4 hours compared with the 48 hours at baseline, and the proportion of patients referred to the regional hospital for complications fell from 35% to 7%. The mean direct average cost fell by 3,500 F CFA. The number of patients with contraception in place before discharge rose from 0 to 20%, and 94% of the patients questioned were satisfied with the quality of the services they received. Six month after the program ended, the level of utilisation of PAC services continued to increase (by 11%) and the proportion leaving with contraception reached 33%.


CONCLUSIONS
Decentralisation of PAC treatment in rural areas is possible without major expense, and it improves care for women with incomplete abortions.
Cissé
Cheikh Tidiane
CT
Clinique gynécologique et obstétricale, CHU de Dakar, BP 15 745, CP 12 522 Dakar-Fann Sénégal. ctcisse@yahoo.fr
Diagne
Abdoulaye
A
Faye
El Hadj Ousseynou
el HO
D000022:Abortion, Spontaneous / Q000191:economics / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003267:Contraception; D003376:Counseling; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D011787:Quality of Health Care; D012424:Rural Population; D012675:Senegal; D011795:Surveys and Questionnaires