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Table 2 Inputs indicators—extended comprehensive post-abortion care signal functions in the Nigeria and CAR hospitals

From: Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings

 

Nigeria hospital

CAR hospital

Comprehensive PAC Signal functions

Indicator present d

Indicator present d

Drugs, supplies, and services available for Post-Abortion Care

 Parenteral Uterotonics (at least 2 uterotonics with at least 1 parenteral available for PAC)

YES (1)

YES (1)

 Removal of retention products (manual or electric vacuum aspiration for PAC)

YES (1)

YES (1)

 Parenteral antibiotics

YES (1)

YES (1)

 Intravenous fluids

YES (1)

YES (1)

 Blood transfusion (with routine screening of donor blood for HIV, Hepatitis B, C and Syphilis)

YES (1)

YES (1)

 Surgical laparotomy capability (including hysterectomy)

YES (1)

YES (1)

Drugs, supplies, and services available for Post-abortion Contraception

 3 + Modern short acting contraceptives (at least 3 methods)

YES (1)

YES (1)

 1 + Modern long-acting reversible contraceptives (at least 1 method)

YES (1)

YES (1)

 Contraception available 7/7

NO (0)

YES (1)

Infrastructure and Human Resources

 Facility open 24/7

YES (1)

YES (1)

 1 + medical doctor on duty 24/7

YES (1)

YES (1)

 3 + medical doctor registered and effectively working

YES (1)

YES (1)

TOTAL n/N, (%)

11/12(92%)

12/12(100%)

Additional signal functions to fulfill the extended capability to provide comprehensive PAC

Indicator present

Indicator present

Infrastructure

 Electricity available and functioning

YES (1)

YES (1)

 Generator available and functioning

YES (1)

YES (1)

 Refrigerator available and functioning

YES (1)

YES (1)

 Email/internet available and functioning

NO (0)

YES (1)

 Incinerator available and functioning

YES (1)

YES (1)

 Water supply available and functioning

YES (1)

YES (1)

 Sewerage system available and functioning

YES (1)

YES (1)

Referral capacity to refer patients if needed e:

 Telephone/radio call available and functioning

YES (1)

YES (1)

 Ambulance available and functioning

YES (1)

YES (1)

Guidelines, Equipment, and Human Resources

 Evidence based PAC guidelines available and accessible for clinicians b

YES (1)

YES (1)

 Clinical audits currently in use (regular mortality, morbidity and/or near-miss review)

YES (1)

YES (1)

 Critical care unit available and functioning (ICU) c

YES (1)—ICU

NO (0)—HDU

 Ultrasound available and functioning

YES (1)

YES (1)

 Biochemical/clinical laboratory available and functioning

YES (1)

YES (1)

 Anesthetist capacity on duty 24/7

YES (1)

YES (1)

TOTAL n/N, (%)

14/15(93%)

14/15(97%)

TOTAL EXTENDED CAPABILITY TO PROVIDE COMPREHENSIVE PAC a

25/27 (92.6%)

26/27 (96.3%)

  1. aSum of Comprehensive PAC signal functions + Additional signal functions
  2. bPost Abortion Guidance/Clinical Handbook (MSF or WHO guidelines or evidence-based, locally adapted guidelines)
  3. cAs per the WHO near-miss approach definition [38], an intensive care unit (ICU) is a unit that provides 24-h medical supervision (including continuous vital signs monitoring), mechanical ventilation (including oxygen) and continuous vaso-active drugs. The High Dependency Unit (HDU) is a unit with all those characteristics except the mechanical ventilation
  4. dPresence of a given indicator for a facility adds a score of one to the total category score for that facility
  5. eFacility has the communication means (phone and radio) and the referral means (ambulance) to refer the patient in case of specific severe complications that are outside the management capacity of the facility