title: Decrease in use of manual vacuum aspiration in postabortion care in Malawi: a cross-sectional study from three public hospitals, 2008-2012.
abstract: OBJECTIVE
  To investigate the use of manual vacuum aspiration in postabortion care in Malawi between 2008-2012.
  
  
  METHODS
  A retrospective cross-sectional study was done at the referral hospital Queen Elisabeth Central Hospital, and the two district hospitals of Chiradzulu and Mangochi. The data were collected simultaneously at the three sites from Feb-March 2013. All records available for women admitted to the gynaecological ward from 2008-2012 were reviewed. Women who had undergone surgical uterine evacuation after incomplete abortion were included and the use of manual vacuum aspiration versus sharp curettage was analysed.
  
  
  RESULTS
  Altogether, 5121 women were included. One third (34.2%) of first trimester abortions were treated with manual vacuum aspiration, while all others were treated with sharp curettage. There were significant differences between the hospitals and between years. Overall there was an increase in the use of manual vacuum aspiration from 2008 (19.7%) to 2009 (31.0%), with a rapid decline after 2010 (28.5%) ending at only 4.9% in 2012. Conversely there was an increase in use of sharp curettage in all hospitals from 2010 to 2012.
  
  
  CONCLUSIONS
  Use of manual vacuum aspiration as part of the postabortion care in Malawi is rather low, and decreased from 2010 to 2012, while the use of sharp curettage became more frequent. This is in contrast with current international guidelines.
authors: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Maria L
authors: ML
authors: Odland
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Hanne
authors: H
authors: Rasmussen
authors: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Geir W
authors: GW
authors: Jacobsen
authors: Kamuzu College of Nursing, Blantyre, Malawi.
authors: Ursula K
authors: UK
authors: Kafulafula
authors: Kamuzu College of Nursing, Blantyre, Malawi.
authors: Piaroza
authors: P
authors: Chamanga
authors: Kamuzu College of Nursing, Blantyre, Malawi; Department of Community Medicine, University of Tromsø, Tromsø, Norway; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
authors: Jon Ø
authors: JØ
authors: Odland
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008295:Malawi; D005791:Patient Care / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D014619:Vacuum Curettage / Q000706:statistics & numerical data*