Study title

This thesis describes a material of data on the use of Manual Vacuum Aspiration (MVA) in treating incomplete abortions in the southern part of Malawi. As it turned out, the use was still low, apart from at one hospital, which at the same time had a reduction in maternal mortality. The other hospitals had a varied and still low use of MVA in the treatment of incomplete abortion and the use of curettage was high. This is in contrast to the guidelines developed by the World Health Organization and the health authorities in Malawi, which recommends treatments with vacuum suction or medical treatment before curettage. These findings made it clear that an intervention was necessary. Queen Elizabeth Central Hospital (QECH) and Chiradzulu district hospital were chosen as intervention hospitals together with Chikwawa district hospital. Two control hospitals were also included in order to exclude that an eventual increase in the use of MVA was the result of other ongoing national campaigns or interventions. The intervention study with training health personnel in MVA was successful with a 21,3 % increase in the use of MVA after one year. Focus group discussions with the health personnel were conducted one year after the training in order to study their perceptions of doing MVA and what obstacles they possibly were faced with carrying out the procedure. It turned out that they appreciated the training and that they liked performing MVA, but that they lacked functional equipment and support from the management of the hospitals. The health authorities needs to address this if they wish to make the treatment of incomplete abortion cheaper, safer and better for the patients. This study can contribute with knowledge and improving routines so that the clinical practice is following both national and international guidelines ensuring the best practice for the patients of Malawi.