{"doc_desc":{"title":"ETHIOPIA_BAOBAB (1)","idno":"DDI-ETH-APHRC-BAOBAB-2023-v1.0","producers":[{"name":"African Population and Health Research Center","abbreviation":"APHRC","affiliation":"","role":"Documentation of the DDI"}],"prod_date":"2025-08-04","version_statement":{"version":"Version 1.0(AUGUST 2025)"}},"study_desc":{"title_statement":{"idno":"DDI-ETH-APHRC-BAOBAB-2023-v1.0","title":"Measuring Abortion Incidence, Severity of  Complications, and Health Facilities\u2019 Capacity to Provide Abortion Care in Refugee Settings in Ethiopia","sub_title":"Baobab Study","alt_title":"Baobab"},"authoring_entity":[{"name":"Yohannes Wado","affiliation":"APHRC"}],"oth_id":[{"name":"Bonface Ingumba","affiliation":"African Population and Health Research Center","email":"","role":"Data Governance Officer"},{"name":"RRS and regional Health Bureaus Ethiopia","affiliation":"","email":"","role":""}],"production_statement":{"producers":[{"name":"Caroline Kabiru","affiliation":"African Population and Health Research Center","role":"Co-investigator"},{"name":"Margaret Giorgio","affiliation":"Guttmacher Institute  ","role":"Co-investigator"},{"name":"George Odwe","affiliation":"Population Council Kenya","role":"Research Associate "},{"name":"Stephanie Kung","affiliation":"Guttmacher Institute  ","role":"Research Associate "},{"name":"Peter Kisaakyee","affiliation":"Population Council Kenya","role":"Research Fellow"},{"name":"Hellen Akinyi","affiliation":"African Population and Health Research Center","role":"Data documentarist"},{"name":"Yadeta Dessie Bacha","affiliation":"African Population and Health Research Center","role":"Co-investigator"},{"name":"Bonnie Wandera","affiliation":"African Population and Health Research Center","role":"Co-investigator"},{"name":"Francis Obare","affiliation":"Population Council, Kenya","role":"Co-investigator"},{"name":"Stephen Kizito","affiliation":"Population Council, Kenya","role":"Co-investigator"},{"name":"Dagim Habteyesus","affiliation":"Population Council, Inc.","role":"Research Fellow"},{"name":"Stella Muthuri","affiliation":"Population Council, Inc.","role":"Co-investigator"},{"name":"Chi-Chi Undie","affiliation":"Population Council, Inc.","role":"Co-investigator"},{"name":"Gloria Seruwagi","affiliation":"Population Council, Inc.","role":"Co-investigator"},{"name":"Caitlin Rich","affiliation":"Guttmacher Institute  ","role":"Co-investigator"}],"copyright":"Copyright \u00a9 APHRC, 2025","funding_agencies":[{"name":"Foreign, Commonwealth & Development Office","abbreviation":"FCDO","role":"Funder"},{"name":"Norwegian Agency for Development Cooperation","abbreviation":"NORAD","role":"Funder"}],"grant_no":"QZA-21\/0135"},"series_statement":{"series_name":"Demographic and Health Survey, Round 1 [hh\/dhs-1]","series_info":"N\/A"},"version_statement":{"version_date":"2025-08-04","version_notes":"N\/A"},"study_info":{"abstract":"Abstract\nBackground\nSparse evidence is available to support improved programming and reporting on SRHR in refugee settings in the East and Horn of Africa, where unsafe abortion is one of the major causes of maternal mortality and morbidity. It is important to design studies that explicitly investigate the sexual and reproductive health needs and outcomes of refugee populations, as it is likely that these factors differ among refugee populations as compared to the general population. Understanding the state of abortion in a given context, including abortion incidence, safety, and outcomes, is challenging due to the limitations of currently available methodologies.\nObjectives: To determine the incidence of induced abortions and the severity of abortion-related complications in refugee settings in Ethiopia.\nMethods: The study employed a quantitative cross-sectional design. The study components included three separate surveys. Although the study was not nationally representative,  efforts were made to ensure representativeness at the refugee settlement\/camp level : i) representative Health Facility Survey (HFS) to estimate the number of women who receive post-abortion care (PAC) following abortion complications, ii) a Knowledgeable Informants Survey (KIS) to capture information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, and iv) a Prospective Morbidity Survey (PMS) to capture information necessary to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS also included clinical data abstraction from the medical records.\nPotential Impact: This will help host governments, humanitarian partners, and donors to seek long-term, innovative, cost-effective SRHR development solutions to bring about change in the health and lives of refugee women and girls.","coll_dates":[{"start":"2024-02-01","end":"2024-05-30","cycle":""}],"nation":[{"name":"Ethiopia","abbreviation":"ETH"},{"name":"","abbreviation":""}],"geog_coverage":"Refugee settings in Ethiopia","analysis_unit":"Abortion Incidence, Severity of Complications, and Health Facilities' Capacity to offer Post Abortion Care for people living in refugee settings in Ethiopia.\n\nIndividual - PAC patients, Knowledgeable Informants\nInstitutional (Health Facility) - PAC is providers","universe":"The study targeted women aged 15-49, living in refugee settings in Ethiopia with the following tools: a  Health Facility Survey (HFS) targeting health facilities in the refugee setting concerned and the surrounding, a Knowledgeable Informants Survey (KIS) collected information on the proportion of all women having abortions who receive facility-based treatment for abortion-related complications, and a  Prospective Morbidity Survey (PMS) captured information to describe characteristics of women receiving treatment for abortion complications, the severity of complications, the type of treatment received, and the delays in access to PAC. The PMS also included clinical data abstraction from the medical records.","notes":"Health Facility Survey (HFS) : Patient's Medical Assessment, Laboratory Findings, Assessment of Complication Severity, Management and Outcomes of abortion complications\nKnowledgeable Informants Survey (KIS)  : Background of the respondent, general question, induced abortion, answer certainity, miscarriage treatment and  stigma questions related to abortion complications\n\nProspective Morbidity Survey (PMS) : \na)PMS_Patient-provider survey:\n  basic information, Reproductive health history, Symptoms and care-seeking decisions, Quality of abortion and family planning services, Abortion knowledge and attitudes, security, conflict and violence, Pms provider section, general information on patient intake, Initial examination and observations, complication questions, procedures and medications, likely abortion questions and final outcome of the treatment \n\nb) PMS_PMS_MRR:\n Patient's Medical Assessment, Laboratory Findings, Assessment of Complication Severity, Management and Outcomes of abortion complication","study_scope":"Health Facility Survey (HFS) : Patient's Medical Assessment, Laboratory Findings, Assessment of Complication Severity, Management and Outcomes of abortion complications\nKnowledgeable Informants Survey (KIS)  : Background of the respondent, general question, induced abortion, answer certainity, miscarriage treatment and  stigma questions related to abortion complications\n\nProspective Morbidity Survey (PMS) : \na)PMS_Patient-provider survey:\n  basic information, Reproductive health history, Symptoms and care-seeking decisions, Quality of abortion and family planning services, Abortion knowledge and attitudes, security, conflict and violence, Pms provider section, general information on patient intake, Initial examination and observations, complication questions, procedures and medications, likely abortion questions and final outcome of the treatment \n\nb) PMS_PMS_MRR:\n Patient's Medical Assessment, Laboratory Findings, Assessment of Complication Severity, Management and Outcomes of abortion complication"},"method":{"data_collection":{"sampling_procedure":"Sampling took place at different levels of the study since it had different components:\nHealth Facility Survey\n\nOur sampling universe for the HFS included all facilities that theoretically offer post-abortion care (PAC) services to refugee women. In Ethiopia, the facility levels  are hospitals (public and private), health centers,  and higher level\/NGO private clinics. Our sampling universe included all facilities located within the geographical boundaries of each camp. However, in some instances women chose to seek care outside of the camp boundaries, either because those facilities are more geographically convenient to access or because women wanted greater privacy when seeking postabortion care. As such, we worked with key informants to identify additional facilities outside of the camp boundaries that served refugee women.\n\nWithin selected facilities, respondents are the most qualified to answer questions about PAC caseloads and the types of cases seen at the facility. Depending on the facility they were senior administrators, heads of the OBGYN ward, or heads of private clinics, including medical doctors, nurses and midwives.\n Knowledgeable Informant Survey\n\nThe study population of the KIS was professionals who were knowledgeable about the conditions of abortion and the provision of post-abortion care among refugee women in Ethiopia. These included medical doctors, registered nurses and midwives in public and private practice, policymakers, advocates, researchers, NGO staff, community health workers, and community leaders. Interviews were carried out at the respondents' place of work or setting of the respondents' choice. \n\nA purposive list of potential respondents working in refugee settings in Ethiopia  was drawn up by the research team, and the final selection was reviewed and approved by the study team. Respondents who were invited to participate but said they were not familiar enough with this subject to inform the study, or refused to grant an interview, were excluded.\n\nProspective Morbidity Survey\n\nWe selected a subset of health facilities that were sampled for the HFS to be included in PMS. Once our sample of PMS facilities was selected, we  attempted to survey all women who received PAC at that facility over a 28-day period. In addition, the data collectors accessed the medical charts of the PAC patients to extract data related to reported diagnosis, laboratory measurements and management procedures undertaken. \n\nWhile this study is focused on refugee women, we did not restrict participation to only refugee women seeking care. Instead, we assessed whether a patient was a member of the host community or a refugee. This allowed our study to compare severity outcomes based on refugee status. In addition, this provided additional information on the distribution of patients served within our sample of health facilities. \n\nIn accordance with previous AICM studies, we also identified one staff member at each sampled health facility to keep a real-time tally of the number of women who sought PAC over the 28-day period. This allowed the study team to adjust for non-response to the PMS survey, and this data also provided an important validation of the PAC caseload estimates that we generated from the HFS.","sampling_deviation":"HFS: Facilities in two of the 24 refugee camps in Ethiopia were excluded from the survey: one camp in Amhara region due to security challenges, and one camp in Afar region which had closed.\n\nPMS: The PMS sampling frame was drawn from the HFS sample and was informed by PAC provision, caseloads, and the proportion of refugees served. From the HFS facilities, the PMS sampling plan was to\ninclude:\n- All hospitals and MCH clinics;\n- All facilities that participated in the HFS and served at least 10 PAC patients per month; and All facilities located within refugee camps that provided PAC.\n- Facilities located outside of refugee camps that provided PAC were included at the discretion of study partners in Ethiopia.\nThis was to exclude Facilities that had low caseload of PAC patients ,which were located outside of refugee camps and served less than 6% of refugees were excluded. We deviated from this original plan mainly on the point of excluding facilities with a low caseload of PAC patients that were outside of the camp, as some of these facilities were included. These decisions were made at the discretion of study partners in Ethiopia.","coll_mode":"Other [oth]","research_instrument":"The study used four questionnaires during data collection at different data points with different target population. The questionnaires were in English. The HFS questionnaire captured information to estimate the number of women receiving treatment in facilities for complications from unsafe abortions, the KIS questionnaire was used to collect information on the proportion of all refugee women having abortions who received facility-based treatment for abortion-related complications and the PMS captured information to describe characteristics of women living in refugee settings and receiving treatment for abortion complications, the type of treatment received for complications, uptake of post-abortion family planning, and the delays in access to post-abortion care. The PMS also included charts review to abstract data on laboratory measurements, procedures and management of complications for PAC patients.","act_min":"The Baobab team and the Guttmacher team coordinated and supervised the KIS\/HFS and PMS. One co-principal investigator and a co-investigator, based in Ethiopia, closely monitored the daily data collection activities. Meanwhile, the central team provided overall leadership and coordination. A total of 11 data collectors and one coordinator participated in KIS\/HFS data collection across five regions: Gambella, Asosa, Semara, Jigjiga, and Melakdida. For the PMS, 49 data collectors and six coordinators were involved. These interviewers worked closely with their supervisors, the study coordinators, Baobab RPC and Population Council Inc. technical staff, and other project partners.","weight":"PMS : The variable named, wgt_pmsind, was used as the weighting coefficient. This weight was a product of two calculations:\n- stage 1 was the total number of PAC patients presenting at sampled facilities during PMS fielding divided by the number of patients that participated in the PMS. This was meant to account for individual-level response rates.\n-  stage2 was another division meant to account for the total universe of PAC cases (including PAC cases served at facilities not sampled in the PMS). The numerator was the total number of PAC patients estimated to be treated by facility level, which was calculated using questions from the HFS on PAC patients seen during the past month and an average month at each facility. The denominator was the total number of PAC patients presenting at sample facilities during PMS fielding by facility level.","cleaning_operations":"Interviews for all surveys was conducted face-to-face, using Open Data Kit (ODK) software on Android smartphones.  Completed ODK forms were submitted to a secure cloud server using Wi-Fi or mobile data networks accessible only to the study team. The data was later uploaded to Stata to be cleaned and analyzed.","method_notes":"N\/A"},"analysis_info":{"response_rate":"PMS: Of the 66 facilities sampled for participation in the PMS, a total of 47 participated (response rate: 71.2%). Regarding the individual-level response rate, all patients treated at the sampled facilities during\nthe study period were eligible to participate in the study. The participation rate of patients was 84.2% overall, 76.8% at health centers, 100% at private clinics, and 84.4% at hospitals.","sampling_error_estimates":"Analyses were performed in Stata 19. The dataset was weighted using the following command: svyset [pweight=wgt_pmsind]."}},"data_access":{"dataset_use":{"contact":[{"name":"African Population and Heath Research Center","affiliation":"APHRC","email":"datarequest@aphrc.org","uri":""}],"cit_req":"Use of the dataset must be acknowledged using a citation which would include:\n- the Identification of the Primary Investigator\n- the title of the survey (including country, acronym and year of implementation)\n- the survey reference number\n- the source and date of download","conditions":"All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research. This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners\/collaborators\/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:\n\n1. Data Ownership: The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.\n\n2. Purpose: The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.\n\n3. Respondent Identifiers: The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST be anonymized by removing the respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he\/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.\n\n4. Confidentiality pledge: The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.\n\n5. Reporting of errors or inconsistencies: The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.\n\n6. Publications resulting from APHRC data: The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.\n\n7. Security: The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people do not have access to the data.\n\n8. Loss of privilege to use data: In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him\/her. APHRC retains the right to revoke this agreement or inform publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.\n\n9. Acknowledgement: Any work\/reports from this data must acknowledge APHRC as the source of these data. For example, the  acknowledgement for our  data is:\n\n\"This research utilizes data collected through the \"Filling Gaps in Evidence to Enhance Sexual and Reproductive Health and Rights Among Vulnerable Populations in the East and Horn of Africa (Baobab)\" program. The Baobab Research Program Consortium was funded by the Foreign, Commonwealth & Development Office (FCDO) and implemented by the Population Council Inc., Population Council Kenya, and the African Population and Health Research Center.\nWe gratefully acknowledge all study participants, health workers, health facility leadership, refugee settlement commandants, and field research assistants for their dedication in supporting and facilitating the data collection process. We also extend our gratitude to the UNHCR Regional Bureau for the East, Horn of Africa, and Great Lakes Region, UNHCR Uganda and its implementing partners, and the Government of Uganda through the Department of Refugees in the Office of the Prime Minister, as well as the Reproductive and Infant Health Department, Ministry of Health, for their invaluable technical support.\"\n\n10. Deposit of Reports\/Papers: The user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.\n\n11. Change of contact details: The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.","disclaimer":"The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses."}}}}