Medicine

Permanent URI for this collection

http://41.63.25.24:4000/handle/123456789/83

Browse

Browsing Medicine by Subject "Abortion--Zambia"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Determinants of coping startegies utilised by women who may have experienced an abortion
    (The University of Zambia, 2013-06-06) Chambatu, Alice
    Mental health problems and ineffective coping in women who have experienced an abortion are common and require specialist care with increased health resource utilization. However, there seems to be paucity of information in Zambia on how women cope psychologically after an abortion. Therefore the study explored determinants for coping strategies utilised by women who had experienced an abortion in Zambia.Methods.Determinants of coping strategies utilised by women who have experienced an abortion were explored. The study was conducted in Chinsali, Ikelenge, Lusaka and Siavonga Districts with a sample of 200 respondents. Interviews were conducted using semi-structured interview schedules. Two hundred participants were selected using simple random probability sampling methods. Data was entered and analysed using SPSS version 20. Several determinants for coping with an abortion were identified such as education level, staff attitude, stigma, stress and recurrent abortions. The study was guided by the Transactional Model of Stress and Coping based on the work of Lazarous and Folkman. Results. Out of the above mentioned determinants, only stress was found to have a significant association with coping with the experience of an abortion. Stress was measured by the extent to which the experience of an abortion disturbed normal daily activities.The results indicated that there was a relationship between stress and coping as confirmed by the p-value 0.00 and chi square 18.86. Respondents whose daily activities were grossly affected due to stress did not cope well.ConclusionIt was concluded that there was a relationship between stress and coping. However, the other independent variables did not show any relationship with coping.It was therefore recommended that mental health services be incorporated in reproductive health services at various levels of health care in order to manage stress among women who experienced an abortion to enhance coping well.
  • Thumbnail Image
    Item
    Potential of ketofol to provide adequate sedation and analgesia in women undergoing manual vacuum aspiration in emergency department at the University Teaching Hospitals, Lusaka, Zambia
    (The University of Zambia, 2019) Nsofwa, Nsunge
    Diagnosis of abortion in Zambia relies on clinical findings coupled with ultrasound examination. The treatment of choice in the first trimester is manual vacuum aspiration (MVA). Reducing the physical pain and anxiety during MVA is the ultimate goal of management for which, several drugs have been used solely or in combination to try to alleviate the pain associated with the procedure with variable results. However, the aspect of anxiety, which is a crucial aspect of care, is not adequately taken care of and perhaps raises ethical issues around performing MVA under local anaesthesia in emotionally vulnerable miscarrying women. A previous study done at University Teaching Hospital (UTH), Lusaka, Zambia showed that more than 90% of women undergoing MVA experience severe pain, despite receiving preoperative analgesics such as Paracetamol, Ibuprofen and Morphine. Ketofol sedation has not been tried in MVA in our setting in spite of successfully producing adequate sedation action for many short painful procedures. A pre-post interventional study with historical controls was conducted as a quality improvement study at UTH in the Department of Gynaecology to explore the potential of Ketofol sedation to provide adequate sedation and analgesia in women undergoing MVA. Pain scores were recorded using a Faces Pain Scale during the procedure (reported immediately after the procedure), at 10 minutes and at 60 minutes. During the procedure, sedation scores were determined using Ramsay Sedation Scale as well measuring heart rates and oxygen saturation. Time to discharge was also measured. A total of 94 women were studied; 54 patients who received UTH standard care in the previous study (oral Paracetamol 1g, Ibuprofen 400mg and Morphine 30mg) and 40 patients who received Ketofol sedation in addition to the UTH standard care which the patients in the historical group also received. Data from 2015 included 54 (57.4%) women who received UTH standard care (oral Paracetamol, Ibuprofen and Morphine). In the current study Ketofol sedation was administered in addition to standard care to 40 women during MVA. There was no statistical difference in all baseline characteristics of participants in both groups; p value >0.05. Pain scores were measured during the procedure (reported immediately afterwards), at 10 minutes and 60 minutes after the procedure. Women in the standard care group reported significantly higher pain scores, median 10 (IQR,8-10) compared to women in the Ketofol group median 2 (IQR 0–2); p<0.001 during the procedure, and also reported more pain at 10 minutes after the procedure however, there was no statistically significant difference in pain recorded at 60 minutes after the procedure. It was further noted that patients in the Ketofol group had significantly lower heart rates during the procedure. addition to this, it was noted, contrary to expectations, that the time to discharge was reduced in the Ketofol group compared to the standard care group, potentially due to reduced pain experienced. In conclusion, the results suggest that addition of Ketofol sedation to the current UTH standard of care reduced procedural pain experienced during MVA compared to standard care alone as well as producing effective sedation and rapid recovery. Keywords: Miscarriage, Manual Vacuum Aspiration, Sedation, Ketofol
  • Thumbnail Image
    Item
    Pre-Conception Contraceptive Use in Women Presenting With Abortion at University Teaching Hospital,Lusaka,Zambia
    (The University of Zambia, 2015) Mwila, Richard
    Background: Abortion is the loss of the pregnancy before the age of viability. It can be spontaneous or induced. It is the leading cases of admission to gynaecology emergency ward at UTH 30%-50%. The contraceptive knowledge is 97% but lack of uptake may contribute to the high prevalence of abortion cases at UTH. This study aimed to explore the contraceptive usage pre-conception in women presenting with abortion at UTH and its relationship to abortion. Methodology: This was a cross section study done at UTH gynaecology emergency ward. Every fourth woman presenting with abortion, undergoing uterine evacuation and meeting the eligibility criteria was selected to meet the sample size of 417. Structured questionnaire were administered by the trained nurses after obtaining informed concert. Data was entered in SPSS version 20 spread sheet. Descriptive analysis was done. Percentages and the mean were calculated. A logistic regression model was developed to test for independent factors, including current use of contraception, associated with type of abortion and adjusted for with other independent variables. The study had ethical approval from the University of Zambia Biomedical Research Ethics Committee. Results: The total number of respondents was 417. Age distribution was: 18-20 years 86 (20.6%), 20 to 25 years 136 (32.6%) and above 25 years 195 (46.8%) who were the majority. The education level had 18 (4.3%) with no education, 117 (28.1%) with primary education, 243 (58.3%) with secondary education and 39 (9.4%) had tertiary education. In the index pregnancy 92.6% had spontaneous abortion and 7.4% had induced abortion. On contraceptive knowledge 94% had knowledge of modern contraception and 6% had never heard of any form of modern contraception. 280 (67%) of the women said they had used one form of contraceptive and prior use of contraception was significantly associated with the type of abortion p- value 0.01. In the index pregnancy 13.7% of the women said they were on some form of contraceptive. The contraception on current pregnancy was not significantly associated with type of abortion at 5% significance level p- value 1.17. Bivariate relationship between abortion type and the study variables; marital status, education level and history of contraception use were significantly associated with abortion type p- value = <0.01, <0.01, <0.01 respectively. Using regression analysis to control for potential cofounders, unmarried women had 3.6 times increased risk of induced abortion compared to unmarried women (OR=3.61< CI 1.5-8.68, p- value= 0.004). Those who had ever used the contraceptive before had 70% reduced odds for induced abortion compared to the ones who had never used (OR=0.30, CI 0.12-0.177, p- value 0.013). Women who were using contraceptive in index pregnancy had 3.4 times increased odds of induced abortion compared to women who had not used (OR=3.43, CI 1.09-10.73, p- value 0.035). Conclusion: The study showed that women who present with abortion have high knowledge of contraceptives but were not using any form of modern contraceptive. Single women were more likely to have an induced abortion. A sizeable minority fell pregnant while on contraceptives.