INCOMPLETE ABORTION AT THE TEACHING HOSPITAL, BLANTYRE, MALAWI

A total of 444 women treated for incomplete abortion using the manual vacuum aspiration technique, at the Queen Elizabeth Central Teaching H ospital, Blantyre, between 10th January and 9th April, 1994, were inte rviewed by means of partially structured questionnaire, to determine a mong other things, their socio- demographic profiles, contraceptive be haviour, as well as associated complications, These formed 56.0% of al l abortion cases seen in the department during the study period. All a bortion formed 68.0% of all the gynaecological admissions, and an abor tion delivery ratio of 1:4. The ages of the patients ranged from 15 to 44 years with a mean of 24.4 years. Adolescents formed 21.2% of the t otal, while those aged 35 years and above formed 8.4%. Only 15.8% of t he total were single. Their parities ranged from 0 to 12 with a mean o f 2, while number of living children ranged from 0 to 9 with a mean of 1.7. 16.9% of them had had previous abortions, with the highest numbe r of abortion being 6 and a mean of 1.6. 79.9% of the total group were housewives, and 10.6% students. Of their male partners (i.e. people r esponsible for the index pregnancy), only 4.2% were students and 25.0% of the school girls were involved with fellow school boys. Majority o f the rest (56.3%) were involved with more mature self-sustaining male s. The gestational ages ranged from 6 weeks to 20 weeks with a mean of 15 weeks. 40.2% had gestational ages of 9 to 12 weeks. However, the u terine size as determined by the examining doctor ranged from 6 to 14 weeks gestation, and 54.4% of them had uterine sizes corresponding to 9 to 12 weeks gestation and only 0.9% were bigger than 12 weeks testat ion. Only 9.0% had ever used contraceptives before. During the course of interview, 21.7% expressed a desire to use contraception after trea tment, There was strong correlation between previous use of contracept ives and future intentions. There were no serious complications noted amongst them. However, there were a good proportion of patients who we nt home with what would be labelled as anaemia clinically (Hb < 10.0 g m/dl), but because we do not do haemoglobin estimation routinely follo wing abortion, it is difficult to say what proportion did. We do not k now how many of these abortions were induced, hut our observation is t hat there were quite a few. We removed foreign bodies (sticks, reed st ems, etc.), from the genitalia of several of them, and many admitted o n direct questioning that the pregnancy was unwanted, and had gone som ewhere for help. The policy, programme, and service delivery implicati ons of these findings are discussed and some strategies for redressing the situation suggested.