title: Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors.
abstract: BACKGROUND
  Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya.
  
  
  METHODS
  A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women's socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses.
  
  
  RESULTS
  Over three quarters of abortions clients presented with moderate or severe complications. About 65% of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7-48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3-7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79).
  
  
  CONCLUSIONS
  Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.
authors.affiliation: African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya. akziraba@yahoo.com.
authors.forename: Abdhalah Kasiira
authors.initials: AK
authors.lastname: Ziraba
authors.affiliation: African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya. cizugbara@aphrc.org.
authors.forename: Chimaraoke
authors.initials: C
authors.lastname: Izugbara
authors.affiliation: Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA. levandowskib@ipas.org.
authors.forename: Brooke A
authors.initials: BA
authors.lastname: Levandowski
authors.affiliation: Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, USA. gebreselassieh@ipas.org.
authors.forename: Hailemichael
authors.initials: H
authors.lastname: Gebreselassie
authors.affiliation: African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya. mmutua@aphrc.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Mutua
authors.affiliation: African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya. smohamed@aphrc.org.
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Mohamed
authors.affiliation: African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya. carlyn.egesa@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Egesa
authors.affiliation: African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, off Kirawa road, Kitisuru, P.O. Box 10787-00100, Nairobi, Kenya. ekimani@aphrc.org.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Kimani-Murage
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D012720:Severity of Illness Index; D012959:Socioeconomic Factors