title: Severe morbidities associated with induced abortions among misoprostol users and non-users in a tertiary public hospital in Ghana.
abstract: BACKGROUND
  Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana.
  
  
  METHODS
  This was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher's exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.
  
  
  RESULTS
  Overall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks' gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06).
  
  
  CONCLUSIONS
  Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.
authors: Komfo Anokye Teaching Hospital, Kumasi, Ghana. damdel2000@yahoo.com.
authors: Francis J M K
authors: FJ
authors: Damalie
authors: Edward T
authors: ET
authors: Dassah
authors: Emmanuel S K
authors: ES
authors: Morhe
authors: Emmanuel K
authors: EK
authors: Nakua
authors: Harry K
authors: HK
authors: Tagbor
authors: Henry S
authors: HS
authors: Opare-Addo
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D005869:Ghana; D006779:Hospitals, Public; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D007902:Length of Stay; D008107:Liver Diseases / Q000453:epidemiology; D016595:Misoprostol / Q000627:therapeutic use*; D015999:Multivariate Analysis; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012648:Self Care / Q000706:statistics & numerical data*; D018805:Sepsis / Q000453:epidemiology*; D062606:Tertiary Care Centers; D014592:Uterine Hemorrhage / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol