Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces.
OBJECTIVE
To describe the magnitude and severity of abortion-related complications in health facilities and calculate the incidence of abortion-related near-miss complications at the population level in three provinces in Zambia, a country where abortion is legal but stigmatized.


METHODS
We conducted a cross-sectional study in 35 district, provincial and tertiary hospitals over 5 months. All women hospitalized for abortion-related complications were eligible for inclusion. Cases of abortion-related near-miss, moderate and low morbidity were identified using adapted World Health Organization (WHO) near-miss and the prospective morbidity methodology criteria. Incidence was calculated by annualizing the number of near-misses and dividing by the population of women of reproductive age. We calculated the abortion-related near-miss rate, abortion-related near-miss ratio and the hospital mortality index.


RESULTS
Participating hospitals recorded 26,723 births during the study. Of admissions for post-abortion care, 2406 (42%) were eligible for inclusion. Near-misses constituted 16% of admitted complications and there were 14 abortion-related maternal deaths. The hospital mortality index was 3%; the abortion-related near-miss rate for the three provinces was 72 per 100,000 women, and the near-miss ratio was 450 per 100,000 live births.


CONCLUSIONS
Abortion-related near-miss and mortality are challenges for the Zambian health system. Adapted to reflect health systems capabilities, the WHO near-miss criteria can be applied to routine hospital records to obtain useful data in low-income settings. Reducing avoidable maternal mortality and morbidity due to abortion requires efforts to de-stigmatize access to abortion provision, and expanded access to modern contraception.


CONCLUSIONS
The abortion-related near-miss rate is high in Zambia compared with other restrictive contexts. Our results suggest that near-miss is a promising indicator of unsafe abortion; can be measured using routine hospital data, conveniently defined using the WHO criteria; and can be incorporated into the frequently utilized prospective morbidity methodology.
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom. Electronic address: Onikepe.owolabi@lshtm.ac.uk.
Onikepe O
OO
Owolabi
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom. Electronic address: Jenny.cresswell@lshtm.ac.uk.
Jenny A
JA
Cresswell
Department of Obstetrics and Gynecology, School of Medicine, University Teaching Hospital, PO Box 50110, Lusaka, Zambia. Electronic address: vwalikab@gmail.com.
Bellington
B
Vwalika
UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom. Electronic address: d.osrin@ucl.ac.uk.
David
D
Osrin
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom. Electronic address: Veronique.filippi@lshtm.ac.uk.
Veronique
V
Filippi
D000028:Abortion, Induced / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D002648:Child; D003267:Contraception; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D063130:Maternal Death; D008428:Maternal Mortality; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D011247:Pregnancy; D011446:Prospective Studies; D014944:World Health Organization; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
Abortion-related mortality; Abortion-related near-miss; Induced abortion; Prospective morbidity methodology; Termination of pregnancy; WHO near-miss criteria