[Improving the quality of care after spontaneous abortions in rural Senegal]. / Amélioration de la qualité des soins après avortement (SAA) en zone rurale au Sénégal.

OBJECTIVES: To evaluate the feasibility and impact on quality of decentralising care for spontaneous abortion (post-abortion care, PAC) in rural areas of Senegal. PATIENTS AND METHOD: This prospective study concerns all patients who had PAC services at 6 medical centres in the districts of Kaolack and Fatick. A preintervention baseline study was performed to evaluate the number of cases treated in these centres. We then introduced a new treatment protocol for PAC, which included manual vacuum aspiration (MVA) and quarterly visits for supervision in each centre from 1 August 2001 through 30 September 2002. An evaluation was performed at the end of the program and 6 months after that. Results were compared with the baseline data for the 14 months before the intervention period. We used the chi(2) test to compare proportions and set the threshold of significance at 5%. RESULTS: The new model for PAC made it possible to increase the number of patients treated for incomplete abortion by 22%. Their average age was 25 years, and 71% had first-trimester pregnancy losses. MVA was performed for 56%. Hospitalisation lasted a mean of 4 hours compared with the 48 hours at baseline, and the proportion of patients referred to the regional hospital for complications fell from 35% to 7%. The mean direct average cost fell by 3,500 F CFA. The number of patients with contraception in place before discharge rose from 0 to 20%, and 94% of the patients questioned were satisfied with the quality of the services they received. Six month after the program ended, the level of utilisation of PAC services continued to increase (by 11%) and the proportion leaving with contraception reached 33%. CONCLUSION: Decentralisation of PAC treatment in rural areas is possible without major expense, and it improves care for women with incomplete abortions.

[Ectopic pregnancy in Senegal]. / Grossesse extra-utérine au Sénégal.

The objective of this prospective study was to analyse the epidemiology and prognosis of ectopic pregnancy in Senegal. From January 1 to December 31, 1996, 255 ectopic pregnancies were registered. The national rate of ectopic pregnancy was 0.6%. of expected pregnancies. However, rates differed greatly between areas in Senegal, with extremes ranging from 0.85%. in Dakar to 0.32%. in Thiès. The epidemiological profile was that of a young woman-mean age: 23 years old, mean parity=3, admitted with broken ectopic pregnancy (95%). A salpingectomy was performed in all cases. The maternal mortality rate was 1.20%, while morbidity, mainly due to post-operative infection, was found in 2.7% of the cases.