title: High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized.
abstract: Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications.
  
  
  
  A retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients' records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed.
  
  
  
  A total of 619 patients' records were reviewed with a mean (SD) age of 27.12 (5.97) years. The majority of abortions (95.5%) were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%). Offensive vaginal discharge (17.9%), tender uterus (11.3%), septic shock (3.9%) and pelvic peritonitis (2.4%) were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2%) of the cases followed by hypovolemic and septic shock 65 (10.5%). There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively).
  
  
  
  Abortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care to insure implementation of standard protocol and reduce complications.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
authors.forename: Tadele
authors.initials: T
authors.lastname: Melese
authors.affiliation: Consultant Public Health Specialist, Addis Ababa, Ethiopia.
authors.forename: Dereje
authors.initials: D
authors.lastname: Habte
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
authors.forename: Billy M
authors.initials: BM
authors.lastname: Tsima
authors.affiliation: School of Nursing, University of Botswana, Gaborone, Botswana.
authors.forename: Keitshokile Dintle
authors.initials: KD
authors.lastname: Mogobe
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
authors.forename: Kesegofetse
authors.initials: K
authors.lastname: Chabaesele
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
authors.forename: Goabaone
authors.initials: G
authors.lastname: Rankgoane
authors.affiliation: Botswana Ministry of Health, Gaborone, Botswana.
authors.forename: Tshiamo R
authors.initials: TR
authors.lastname: Keakabetse
authors.affiliation: Botswana Ministry of Health, Gaborone, Botswana.
authors.forename: Mabole
authors.initials: M
authors.lastname: Masweu
authors.affiliation: School of Nursing, University of Botswana, Gaborone, Botswana.
authors.forename: Mosidi
authors.initials: M
authors.lastname: Mokotedi
authors.affiliation: School of Nursing, University of Botswana, Gaborone, Botswana.
authors.forename: Mpho
authors.initials: M
authors.lastname: Motana
authors.affiliation: Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
authors.forename: Badani
authors.initials: B
authors.lastname: Moreri-Ntshabele
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects* / Q000331:legislation & jurisprudence*; D000293:Adolescent; D000328:Adult; D001902:Botswana / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014932:Women's Health Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D055815:Young Adult