title: Health-related quality of life and social support among women treated for abortion complications in western Uganda.
abstract: BACKGROUND
  While the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda.
  
  
  METHODS
  We interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support.
  
  
  RESULTS
  Our study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported "some or severe" problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p<0.001; and anxiety/depression: 60% v 22%, p<0.001). After adjusting for age, social support, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p < 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average number of people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was associated with smaller mean differences in EQ-5D utility score.
  
  
  CONCLUSIONS
  Our study suggests that abortion complications are associated with diminished HRQoL and the magnitude of the association depends on social support. However, the mediating role of social support in a setting of social and legal proscriptions to induced abortion is complex.
authors.affiliation: Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA. slubinga@uw.edu
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Lubinga
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Levine
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Jenny
authors.forename: Joseph
authors.initials: J
authors.lastname: Ngonzi
authors.forename: Peter
authors.initials: P
authors.lastname: Mukasa-Kivunike
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects* / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D003268:Contraception Behavior / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D011247:Pregnancy; D011788:Quality of Life; D057566:Self Report; D012923:Social Class; D012944:Social Support; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult