Clandestine Abortions and Its Complications at the University Hospital Center of the Sino-Central African Friendship ()
1. Introduction
Clandestine abortions remain a real problem in the Central African Republic because of the multiple complications presented by this practice [1] - [5] . The most serious outcome may be maternal death [6] . We propose to study the methods of carrying out this act, the profile of the service providers and the complications that result from it.
2. Patients and Methods
This was a descriptive cross-sectional study of patients hospitalized at the University Hospital Center of the Sino-Central African Friendship over a period of 5 years from January 1st, 2015 to December 31st, 2019. In total, we studied 254 cases. Were included all patients presenting with suggestive symptoms of an avoidable induced abortion, complete and incomplete abortions, or complications arising from induced abortion or clinically proven abortion. Spontaneous and therapeutic abortions were excluded. Data were collected using pre-established survey sheets and analyzed using Epi-Info 6 software and SPSS French version.
3. Results
3.1. Frequency
We identified a total of 254 patients for 8039 live births in the same period, a frequency of 3.16%.
3.2. Age Group
The age of the patients was between 15 years old and 48 years old with an average of 25 years old (Table 1).
The 20 - 29 age group was more affected.
3.3. Parity
The pauciparous were more represented (54.3%) (Table 2).
3.4. Marital Status
Singles accounted for 42.5% (Table 3).
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Table 1. Distribution of patients according to age group.
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Table 2. Distribution of patients according to parity.
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Table 3. Distribution of patients according to their marital statut.
3.5. Socio-Professional Status
The unemployed accounted for a significant proportion of 53.6% (Table 4).
3.6. Providers Profile
The practice of induced abortions was performed by unqualified staff (first aider, matron, hygienist) in 49.7% of cases followed by medical students in 37.3% (Table 5).
3.7. Methods Used
The methods used were numerous: misoprostol (32%), the traditional method (18%), the mechanical method (50%). In this method, we note the dilation of the cervix by the cassava stem; Hegar’s candles; the probes, which are infusion tubes
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Table 4. Distribution of patients according to socio-professional status.
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Table 5. Distribution of patients according to the identity of the abortionist.
cut and introduced into the cervix, of which 2 cases had escaped at the level of the uterine muscles and emerged under the skin at the level of the pubis two years later (Table 6).
3.8. Complications
Hemorrhagic complications were numerous (60.7%) (Table 7).
4. Discussion
1) Frequency
We obtained 254 cases over a period of 5 years, a frequency of 3.16%. This result is lower than that one of Iloki who obtained 4.8% in Brazzaville, Congo [7] .
2) Age
The average age during our study was 25 years old with extremes ranging from 15 - 44 years old. This rate is similar to that one of Diabaté [8] in Mali with 23 years old and Iloki in Brazzaville with 22.6 years [7] .
3) Socio-professional status
Induced abortions were more performed among students (32.6%) and the unemployed (53.6%). This is explained first of all by the entry into the sexual life of these young girls at school who do not control their sexuality, who are afraid of their parents and a lack of knowledge of contraceptive methods. For the unemployed, their limited level of education does not orient them on contraceptive methods because they still in their lack of information, the pills have side effects that cannot be corrected or that lead to cancer. Contraception was used. We
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Table 6. Distribution of patients according to the methods used.
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Table 7. Distribution of patients according to complications.
found 11.5%, this rate is close to that one of Lawson who had 15.65% [9] .
4) Methods used
The methods used were numerous: the medical method (32%), the traditional method (18%), the mechanical method (53%). In the latter, we cite the dilation of the cervix by the cassava stem, the Hegar candles, the probes which are infusion tubing cut and introduced into the cervix, 2 cases had fled at the level of the uterine muscles and emerged on the skin at the pubis part two years later. The mechanical method in our series was lower than that one found in Bangui in 1995 by Mobima [10] with 41.33%.
5) Providers profile
The practice of induced abortions in our series was done by medical students in 37.3%, unqualified staff in 49.8% and takes place either at home or in centers run by non-governmental organization in these places, the conditions of asepsis Are not at the points, which means that complications always arise in the aftermath of the acts performed. Abortions at home, we obtained 69% which is similar to that one of Diabetes in Mali 72% [8] and Adjahoto had 73% [11] .
5. Complications
Some of our patients 43.2% were aware of the complications caused by induced abortions, they are required to do in relation to their social condition. This rate is lower than that one of Adjahoto [12] 81.3%. All complications were obtained: bleeding (60.7%), anemia (4.3%), perforation (6.6%), pelviperitonitis (23.6%), peritonitis (2.8%) and death (2%) related to sepsis. This death rate is low to that one of Diabate in Mali (10%) [8] , Tsibangu in the Democratic Republic of Congo (9.16%) [12] but close to that one of Mobima in 1995 in Bangui 3.7% [10] .
6. Conclusion
Clandestine abortion remains a real health problem for young Central African women. Adherence to contraception and awareness of unqualified staff will prevent disasters.