Morbi-Mortality Linked to Unsafe Abortions—Difficulties in Accessing Safe Abortions in Cameroon: Meta-Analysis and Systematic Review  

作　　者：Florent Ymele Fouelifack Mosman Anyimbi Ofeh Jenny Ornella Manewoun Nsen Abeng Christophe Saha Lontsi Mvong Vendeline Amaelle Goretti Guy Sadeu Wafeu Robinson Enow Mbu Florent Ymele Fouelifack;Mosman Anyimbi Ofeh;Jenny Ornella Manewoun;Nsen Abeng;Christophe Saha Lontsi;Mvong Vendeline Amaelle Goretti;Guy Sadeu Wafeu;Robinson Enow Mbu(Department of Surgery and Specialties at the Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon;Gynecology and Obstetrics Unit of the Yaoundé Central Hospital, Yaoundé, Cameroon;Maga District Hospital, Maga, Cameroon;Public Health of Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon;CIVITAS Cameroon, Human Rights and Humanitarian Action, Yaoundé, Cameroon;Public Health Option Epidemiology, Yaoundé, Cameroon;Information Communication and Technology, American University, Yaoundé, Cameroon;Centre for the Development of Best Practices in Health (CDBPSH), National Coordinator of Building Medical Research in Africa (BMR Africa), Yaoundé, Cameroon;Family Health, Ministry of Public Health, Yaoundé, Cameroon)

机构地区：[1]Department of Surgery and Specialties at the Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon [2]Gynecology and Obstetrics Unit of the Yaoundé Central Hospital, Yaoundé, Cameroon [3]Maga District Hospital, Maga, Cameroon [4]Public Health of Higher Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon [5]CIVITAS Cameroon, Human Rights and Humanitarian Action, Yaoundé, Cameroon [6]Public Health Option Epidemiology, Yaoundé, Cameroon [7]Information Communication and Technology, American University, Yaoundé, Cameroon [8]Centre for the Development of Best Practices in Health (CDBPSH), National Coordinator of Building Medical Research in Africa (BMR Africa), Yaoundé, Cameroon [9]Family Health, Ministry of Public Health, Yaoundé, Cameroon

出　　处：《Open Journal of Obstetrics and Gynecology》2023年第2期342-359,共18页妇产科期刊（英文）

摘　　要：Background: Unsafe abortions are one of the leading causes of maternal mortality, especially in developing countries. In Cameroon, the maternal mortality rate remains high, and the scarcity of data on abortions leads to a lack of solid evidence to advocate on the extent of the abortions related complications. Our objective was to evaluate the unsafe abortions related complications, and to assess the difficulties of accessing safe abortions in our setting. Methods: We carried out a meta-analytic and systematic review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon. The keywords used for the search are seen in table I. Selection of studies was simultaneously done by two authors. Data were extracted through a form designed on Google Form. We used a random-effect model for proportion estimation, and The I² and Q statistics to assess the extent of heterogeneity. Results: A total of 430 studies were identified, from which 28 were included and analysed. About 5% (95% CI: 3 - 7) of unsafe abortions leads to death. The contribution of unsafe abortions in maternal deaths was 23% (95% CI: 20 - 27). The rate of severe bleeding and/or anemia were 40% (95% CI: 18 - 63) and the rate of infection was 17% (95% CI: 7 - 28), dominated by pelvic infections, pelviperitonitis, severe sepsis, and septic shock. Case reports described uterine perforations, uterine rupture during the following pregnancy. Abortion was performed in the practitioner’s or patient’s home in 41.4% of cases, in a health center in 35.1% of cases, in a private clinic in 21.2% of cases, drugs selling places and in traditional healer clinics. The restriction of abortion laws, the stigma surrounding abortion and its consequences at any level of the society, lead to the underreporting of unsafe abortions and a deep reluctance to advocate for safe abortion services. Conclusion: The strengthening of awareness campaigns for providBackground: Unsafe abortions are one of the leading causes of maternal mortality, especially in developing countries. In Cameroon, the maternal mortality rate remains high, and the scarcity of data on abortions leads to a lack of solid evidence to advocate on the extent of the abortions related complications. Our objective was to evaluate the unsafe abortions related complications, and to assess the difficulties of accessing safe abortions in our setting. Methods: We carried out a meta-analytic and systematic review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon. The keywords used for the search are seen in table I. Selection of studies was simultaneously done by two authors. Data were extracted through a form designed on Google Form. We used a random-effect model for proportion estimation, and The I² and Q statistics to assess the extent of heterogeneity. Results: A total of 430 studies were identified, from which 28 were included and analysed. About 5% (95% CI: 3 - 7) of unsafe abortions leads to death. The contribution of unsafe abortions in maternal deaths was 23% (95% CI: 20 - 27). The rate of severe bleeding and/or anemia were 40% (95% CI: 18 - 63) and the rate of infection was 17% (95% CI: 7 - 28), dominated by pelvic infections, pelviperitonitis, severe sepsis, and septic shock. Case reports described uterine perforations, uterine rupture during the following pregnancy. Abortion was performed in the practitioner’s or patient’s home in 41.4% of cases, in a health center in 35.1% of cases, in a private clinic in 21.2% of cases, drugs selling places and in traditional healer clinics. The restriction of abortion laws, the stigma surrounding abortion and its consequences at any level of the society, lead to the underreporting of unsafe abortions and a deep reluctance to advocate for safe abortion services. Conclusion: The strengthening of awareness campaigns for provid

关 键 词：Morbi-Mortality Unsafe DIFFICULTIES Access SAFE ABORTION Cameroon 

分 类 号：R57[医药卫生—消化系统]