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Morbidity and Mortality Linked to Unsafe Abortions in Cameroon—Difficulties in Accessing Safe Abortions: Systematic Review and Meta-Analysis. A Study Proposal

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Open Journal of Obstetrics and Gynecology 2022年第10期12卷 1102-1112页

作者： Florent Ymele Fouelifack Ako William Takang Mosman Anyimbi Ofeh Jenny Ornella Manewoun Nsen Abeng Guy Sadeu Wafeu Christophe Lontsi Saha Department of Surgery and Specialties Higher Institute of Medical Technology of Nkolondom-Yaoundé Yaoundé Cameroon Gynecology and Obstetrics Unit Yaoundé Central Hospital Yaoundé Cameroon Faculty of Health Sciences University of Bamenda Bamenda Cameroon Monatélé District Hospital Monatélé Cameroon Higher Institute of Medical Technology of Nkolondom Yaoundé Cameroon Human Rights and Humanitarian Action National Coordinator of CIVITAS Cameroon Yaoundé Cameroon Systematic Reviews and Meta-Analysis Coordinator of Cochrane Cameroon Yaoundé Cameroon Public Health Option Epidemiology Faculty of Health Sciences Catholic University of Central Africa Yaoundé Cameroon

Unsafe abortions constitute a public health problem. It is one of the causes of maternal mortality in the world and particularly in developing countries. Despite the progress made, maternal mortality remains high in Cameroon. The scarcity and disparity of data on abortions lead to a lack of strong evidence to advocate to decision-makers on the extent of the problems associated with abortions in Cameroon. Our objective is to estimate the rates of mortalities and complications related to unsafe abortions, as well as the difficulties of accessing safe abortions in Cameroon. We will carry out a systematic and meta-analytical review in the biomedical databases MEDLINE (Pubmed), Google Scholar and African Journal Online (AJOL) concerning unsafe abortions and/or difficulties in accessing safe abortions in Cameroon, without date or language restriction. Gray literature will be also consulted. Two authors will simultaneously select the studies and data extraction will be done using a Google Form. Proportions will be estimated on a random-effect model. The I2 and Q statistics will be used to assess the extent of heterogeneity across the studies. The outcome of both the quantitative and qualitative parts of the study will be commented. Death and morbidity due to abortions can be prevented. A concerted multidisciplinary and multicentric action would be essential.

关键词： Mortality Morbidity Difficulties Access Unsafe Abortion Cameroon

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

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Open Journal of Obstetrics and Gynecology 2023年第2期13卷 342-359页

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 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

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 provider b

关键词： Morbi-Mortality Unsafe Difficulties Access Safe Abortion Cameroon

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