The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change
The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change
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DOI：
10.1111/j.1471-0528.2004.00422.x
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发表时间：
2005-03-01
影响因子：
5.8
通讯作者：
Levin, J
中科院分区：
文献类型：
--
作者：
Jewkes, R;Rees, H;Levin, J
1996年，终止妊娠在南非合法化。本文探讨了立法修改后年龄对不完全流产流行病学的影响。本研究采用多中心、前瞻性、描述性研究方法，在全国9个省的47家公立医院中，随机抽取所有妇科急诊医院的样本，并与1994年的一项类似研究结果进行比较。所有22周以下的妊娠妇女，在2000年的三周数据收集期间出现不完全流产，均纳入本研究。方法由临床医生从病例笔记中填写数据采集表。主要结果测量按年龄划分的妇女入院时的人口统计学特征和临床结果。结果总体而言，入院时无感染迹象的病例比例显著增加，（从79.5%到90.1%），而在1994年和2000年之间，疏散受到干扰的证据显著减少（4.5%到0.6%）。年龄差异很大。30岁以上的女性比21 - 30岁或21岁以下的女性严重程度低（65.5% vs 75.2% vs 76.4%，P = 0.0087），更有可能有攻击性产品（16.3%比6.0%比6.4%，P = 0.01）比年轻women.Conclusions堕胎合法化的发病率，特别是在年轻女性有直接的积极影响。这是一个重要的变化，因为1994年青少年的发病率最高。这一趋势得到了1999 - 2001年产妇死亡秘密调查的证据的支持，该调查进一步表明，自1994年以来，堕胎死亡率下降了90%以上。
Objective In 1996 termination of pregnancy was legalised in South Africa. This article examines the impact of age on the epidemiology of incomplete abortion after legislative change. It draws comparison with the findings of a similar study undertaken in 1994.Design Multicentre, prospective, descriptive study.Setting Forty-seven public hospitals in all nine provinces.Sample A stratified random sample of all hospitals treating gynaecological emergencies was drawn. All women of gestation under 22 weeks who presented with incomplete abortion during three weeks of data collection in 2000 were included.Methods A data capture sheet completed by a clinician from the case notes.Main outcome measures Demographic characteristics and clinical findings on admission by age of women.Results Overall, there was a significant increase in the proportion of cases with no signs of infection on admission (from 79.5% to 90.1%) and a significant decrease in evidence of interference on evacuation (4.5% to 0.6%) between 1994 and 2000. Substantial age differentials were seen. Women over 30 were significantly less likely than those 21 - 30 years or under 21 to be low severity (65.5% vs 75.2% vs 76.4%, P = 0.0087) and more likely to have offensive products (16.3% vs 6.0% vs 6.4%, P = 0.01) than the younger women.Conclusions Legalisation of abortion had an immediate positive impact on morbidity, especially in younger women. This is an important change as teenagers had the highest morbidity in 1994. The trend is supported by evidence from the 1999 - 2001 Confidential Enquiry into Maternal Deaths, which further suggested that abortion mortality dropped by more than 90% since 1994.