Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

The Impact of the NIHERST/NGC National Science Centre, Trinidad and Tobago on Visiting Student Groups

The aim of this study was to asses the impact of a visit to the NIHERST/NGC National Science Centre in Trinidad on four different school-age visitor groups. The research was conducted through the administering of a post-visit questionnaire immediately upon completion of each visit by each group, and via visitor feedback obtained in post-visit or pre-visit activities conducted within two weeks of the visit for three groups. Teachers/instructors who accompanied the groups on their visit also completed post-visit questionnaires and provided additional information on follow-up activities via an interview. The results of this investigation suggest that the visit to this science centre provided entertainment/enjoyment value and potential educational value to most individuals. The nature of this enjoyment was noted for various age groups and genders in this study. Quantification of the educational impact was not possible within the constraints of this study, which was unable to capture long-term effects of the supply of ‘new knowledge’ to visitors which the visit to the science centre had provided.