Abstract
Objective:
Insecurity disrupts health systems, quality of care and increases delays in obtaining services. This paper examines the relationship between insecurity and the quality of care provided for abortion complications in high-volume hospitals in the Democratic Republic of Congo (DRC).
Methods:
Using the WHO Multi-Country Survey on Abortion complications, we analysed data for 1007 women who received care in 24 facilities in DRC. For inputs of care, we calculated the percentage of facilities in secure and insecure areas meeting 12 readiness criteria for infrastructure and capability. For process and outcomes of care, we estimated the association between security and 8 indicators using generalised estimating equation models.
Findings:
Facilities in secure areas were more likely to report functioning electricity (93.3% versus 66.7%), availability of obstetrician 24/7 (42.9% versus 28.6%) and the ability to offer several short acting contraceptives (83.3% versus 57.1%). However, a higher percentage of facilities in insecure areas reported the availability of a telephone or radio (100% versus 80.0%).
Women in insecure areas appeared more likely to experience poor quality clinical care overall than women in secure areas [adjusted odds ratio (aOR)=2.56, 95% confidence interval (CI)=1.13-5.82), p-value=0.03]. However, there was no association between security and incomplete medical records (p=0.20), use of dilatation and curettage (D&C) (p=0.84), women reporting poor experience of care (p=0.22), satisfaction with care (p=0.25) and severe maternal outcomes (p=0.56). There was weak evidence of an association between security and non-receipt of contraceptives (p=0.07), with women in insecure areas 70% less likely to report no contraception (aOR=0.31, 95% CI=0.09-1.09). Use of D&C was high in secure (41%) and insecure areas (60%).
Conclusion:
In this study, quality of care does not seem to be very different in secure and insecure areas in DRC, except for some key infrastructure, supply, and human resources elements. The frequent use of D&C for uterine evacuation, the lack of good record keeping and the lack of contraceptive should be urgently addressed.
Insecurity disrupts health systems, quality of care and increases delays in obtaining services. This paper examines the relationship between insecurity and the quality of care provided for abortion complications in high-volume hospitals in the Democratic Republic of Congo (DRC).
Methods:
Using the WHO Multi-Country Survey on Abortion complications, we analysed data for 1007 women who received care in 24 facilities in DRC. For inputs of care, we calculated the percentage of facilities in secure and insecure areas meeting 12 readiness criteria for infrastructure and capability. For process and outcomes of care, we estimated the association between security and 8 indicators using generalised estimating equation models.
Findings:
Facilities in secure areas were more likely to report functioning electricity (93.3% versus 66.7%), availability of obstetrician 24/7 (42.9% versus 28.6%) and the ability to offer several short acting contraceptives (83.3% versus 57.1%). However, a higher percentage of facilities in insecure areas reported the availability of a telephone or radio (100% versus 80.0%).
Women in insecure areas appeared more likely to experience poor quality clinical care overall than women in secure areas [adjusted odds ratio (aOR)=2.56, 95% confidence interval (CI)=1.13-5.82), p-value=0.03]. However, there was no association between security and incomplete medical records (p=0.20), use of dilatation and curettage (D&C) (p=0.84), women reporting poor experience of care (p=0.22), satisfaction with care (p=0.25) and severe maternal outcomes (p=0.56). There was weak evidence of an association between security and non-receipt of contraceptives (p=0.07), with women in insecure areas 70% less likely to report no contraception (aOR=0.31, 95% CI=0.09-1.09). Use of D&C was high in secure (41%) and insecure areas (60%).
Conclusion:
In this study, quality of care does not seem to be very different in secure and insecure areas in DRC, except for some key infrastructure, supply, and human resources elements. The frequent use of D&C for uterine evacuation, the lack of good record keeping and the lack of contraceptive should be urgently addressed.
| Original language | English |
|---|---|
| Journal | International Journal of Gynecology & Obstetrics |
| DOIs | |
| Publication status | Published - 10 Dec 2021 |