Knowledge, attitude, and practice of manual vacuum aspiration in managing incomplete abortion at lower-level health facilities of Northern Uganda

Abstract

BACKGROUND: Incomplete abortion is a significant cause of maternal morbidity and mortality, especially in low-resource settings. Manual Vacuum Aspiration (MVA) is a WHO-recommended method for managing incomplete abortion and can be safely performed by nurses and midwives. This study assessed the knowledge, attitudes, and practices (KAP) of healthcare workers in Northern Uganda's lower-level health facilities towards use of MVA for management of incomplete abortion. METHODS: This was a cross-sectional study conducted in 31 government health centers (Levels II and III) across 15 districts in Northern Uganda, involving 414 nurses and midwives selected via multi-stage random sampling. Data were collected using structured questionnaires and analyzed with Stata version 18. Descriptive statistics was used. RESULTS: There were 414 respondents, all were healthcare workers for the government of Uganda, with the mean age of 33.1 ± 7.3 years. Overall, 88.6% had adequate knowledge. Attitudes were overwhelmingly positive, with 95.2% demonstrating a positive attitude (mean composite score 77.4% ± 12.1%). However, only 189 participants (45.7%) had ever performed MVA. A lack of proper experience was the most cited barrier (72.4%). In the multivariable Poisson regression analysis, increasing age (adjusted Prevalence Ratio [aPR] = 0.96, 95% CI: 0.94-0.98, p < 0.001), shorter duration of service (aPR = 1.78 for ≥ 5 years, 95% CI: 1.35-2.35, p < 0.001), and certificate-level education (aPR = 1.61, 95% CI: 1.32-1.97, p < 0.001) were significantly associated with the practice of MVA. CONCLUSION: Although knowledge and attitudes toward MVA were high among lower cadre health workers in Northern Uganda, actual practice remained low. Increasing age, male sex, shorter duration of service, and certificate-level education were key factors associated with limited MVA practice. Targeted hands-on training programs, particularly for certificate holders and early-career health workers, along with improved availability of MVA equipment, are urgently needed to enhance practice and reduce abortion-related morbidity and mortality in the region.