A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
Identifieur interne : 001899 ( Main/Exploration ); précédent : 001898; suivant : 001900A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
Auteurs : John Kinuthia [Kenya] ; Pamela Kohler [États-Unis] ; John Okanda [Kenya] ; George Otieno [Kenya] ; Frank Odhiambo [Kenya] ; Grace John-Stewart [États-Unis]Source :
- BMC Pregnancy and Childbirth [ 1471-2393 ] ; 2015.
Abstract
Childbirth at health facilities is an important strategy to reduce maternal morbidity and mortality, improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine whether these correlates were unique when compared to HIV-uninfected women from the same region.
Women residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV status, were performed to assess correlates of facility delivery.
Overall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs. 5.4 months, p = 0.016), were more likely to know partner’s HIV status (p = 0.016), report satisfaction with delivery care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery. Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted among uninfected women.
Utilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase use of maternity services and could be enhanced by couples counseling.
Url:
DOI: 10.1186/s12884-015-0467-6
PubMed: 25885458
PubMed Central: 4344995
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya</title><author><name sortKey="Kinuthia, John" sort="Kinuthia, John" uniqKey="Kinuthia J" first="John" last="Kinuthia">John Kinuthia</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Research and Programs/Department of Reproductive Health Kenyatta National Hospital, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Research and Programs/Department of Reproductive Health Kenyatta National Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Kohler, Pamela" sort="Kohler, Pamela" uniqKey="Kohler P" first="Pamela" last="Kohler">Pamela Kohler</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Global Health and Psychosocial and Community Health, University of Washington, Seattle, WA 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Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25885458</idno><idno type="pmc">4344995</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344995</idno><idno type="RBID">PMC:4344995</idno><idno type="doi">10.1186/s12884-015-0467-6</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000676</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000676</idno><idno type="wicri:Area/Pmc/Curation">000675</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000675</idno><idno type="wicri:Area/Pmc/Checkpoint">000F38</idno><idno type="wicri:explorRef" wicri:stream="Pmc" 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Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Kohler, Pamela" sort="Kohler, Pamela" uniqKey="Kohler P" first="Pamela" last="Kohler">Pamela Kohler</name><affiliation wicri:level="2"><nlm:aff id="Aff2">Global Health and Psychosocial and Community Health, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Global Health and Psychosocial and Community Health, University of Washington, Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Okanda, John" sort="Okanda, John" uniqKey="Okanda J" first="John" last="Okanda">John Okanda</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Center for Global Health Research, Kenya Medical Research Institute, Kisumu</wicri:regionArea><wicri:noRegion>Kisumu</wicri:noRegion></affiliation></author><author><name sortKey="Otieno, George" sort="Otieno, George" uniqKey="Otieno G" first="George" last="Otieno">George Otieno</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Center for Global Health Research, Kenya Medical Research Institute, Kisumu</wicri:regionArea><wicri:noRegion>Kisumu</wicri:noRegion></affiliation></author><author><name sortKey="Odhiambo, Frank" sort="Odhiambo, Frank" uniqKey="Odhiambo F" first="Frank" last="Odhiambo">Frank Odhiambo</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>Center for Global Health Research, Kenya Medical Research Institute, Kisumu</wicri:regionArea><wicri:noRegion>Kisumu</wicri:noRegion></affiliation></author><author><name sortKey="John Stewart, Grace" sort="John Stewart, Grace" uniqKey="John Stewart G" first="Grace" last="John-Stewart">Grace John-Stewart</name><affiliation wicri:level="2"><nlm:aff id="Aff4">Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, WA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle</wicri:cityArea></affiliation></author></analytic><series><title level="j">BMC Pregnancy and Childbirth</title><idno type="eISSN">1471-2393</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Childbirth at health facilities is an important strategy to reduce maternal morbidity and mortality, improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine whether these correlates were unique when compared to HIV-uninfected women from the same region.</p></sec><sec><title>Methods</title><p>Women residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV status, were performed to assess correlates of facility delivery.</p></sec><sec><title>Results</title><p>Overall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs. 5.4 months, p = 0.016), were more likely to know partner’s HIV status (p = 0.016), report satisfaction with delivery care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery. Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted among uninfected women.</p></sec><sec><title>Conclusions</title><p>Utilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase use of maternity services and could be enhanced by couples counseling.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="De Cock, Km" uniqKey="De Cock K">KM De Cock</name></author><author><name sortKey="Fowler, Mg" uniqKey="Fowler M">MG Fowler</name></author><author><name sortKey="Mercier, E" uniqKey="Mercier E">E Mercier</name></author><author><name sortKey="De Vincenzi, I" uniqKey="De Vincenzi I">I de Vincenzi</name></author><author><name sortKey="Saba, J" uniqKey="Saba J">J Saba</name></author><author><name sortKey="Hoff, E" uniqKey="Hoff E">E Hoff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cooper, Er" uniqKey="Cooper E">ER Cooper</name></author><author><name sortKey="Charurat, M" uniqKey="Charurat M">M Charurat</name></author><author><name sortKey="Mofenson, L" uniqKey="Mofenson L">L Mofenson</name></author><author><name 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Nielsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yanagisawa, S" uniqKey="Yanagisawa S">S Yanagisawa</name></author><author><name sortKey="Oum, S" uniqKey="Oum S">S Oum</name></author><author><name sortKey="Wakai, S" uniqKey="Wakai S">S Wakai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lund, S" uniqKey="Lund S">S Lund</name></author><author><name sortKey="Hemed, M" uniqKey="Hemed M">M Hemed</name></author><author><name sortKey="Nielsen, Bb" uniqKey="Nielsen B">BB Nielsen</name></author><author><name sortKey="Said, A" uniqKey="Said A">A Said</name></author><author><name sortKey="Said, K" uniqKey="Said K">K Said</name></author><author><name sortKey="Makungu, Mh" uniqKey="Makungu M">MH Makungu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Turan, Jm" uniqKey="Turan J">JM Turan</name></author><author><name sortKey="Miller, S" uniqKey="Miller S">S Miller</name></author><author><name sortKey="Bukusi, Ea" uniqKey="Bukusi E">EA Bukusi</name></author><author><name sortKey="Sande, J" uniqKey="Sande J">J Sande</name></author><author><name sortKey="Cohen, Cr" uniqKey="Cohen C">CR Cohen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Kenya</li><li>États-Unis</li></country><region><li>Washington (État)</li></region></list><tree><country name="Kenya"><noRegion><name sortKey="Kinuthia, John" sort="Kinuthia, John" uniqKey="Kinuthia J" first="John" last="Kinuthia">John Kinuthia</name></noRegion><name sortKey="Odhiambo, Frank" sort="Odhiambo, Frank" uniqKey="Odhiambo F" first="Frank" last="Odhiambo">Frank Odhiambo</name><name sortKey="Okanda, John" sort="Okanda, John" uniqKey="Okanda J" first="John" last="Okanda">John Okanda</name><name sortKey="Otieno, George" sort="Otieno, George" uniqKey="Otieno G" first="George" last="Otieno">George Otieno</name></country><country name="États-Unis"><region name="Washington (État)"><name sortKey="Kohler, Pamela" sort="Kohler, Pamela" uniqKey="Kohler P" first="Pamela" last="Kohler">Pamela Kohler</name></region><name sortKey="John Stewart, Grace" sort="John Stewart, Grace" uniqKey="John Stewart G" first="Grace" last="John-Stewart">Grace John-Stewart</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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