A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya

BACKGROUND: 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....

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Autores principales: Kinuthia, John, Kohler, Pamela, Okanda, John, Otieno, George, Odhiambo, Frank, John-Stewart, Grace
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344995/
https://www.ncbi.nlm.nih.gov/pubmed/25885458
http://dx.doi.org/10.1186/s12884-015-0467-6
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author Kinuthia, John
Kohler, Pamela
Okanda, John
Otieno, George
Odhiambo, Frank
John-Stewart, Grace
author_facet Kinuthia, John
Kohler, Pamela
Okanda, John
Otieno, George
Odhiambo, Frank
John-Stewart, Grace
author_sort Kinuthia, John
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-43449952015-03-02 A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya Kinuthia, John Kohler, Pamela Okanda, John Otieno, George Odhiambo, Frank John-Stewart, Grace BMC Pregnancy Childbirth Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. BioMed Central 2015-02-25 /pmc/articles/PMC4344995/ /pubmed/25885458 http://dx.doi.org/10.1186/s12884-015-0467-6 Text en © Kinuthia et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kinuthia, John
Kohler, Pamela
Okanda, John
Otieno, George
Odhiambo, Frank
John-Stewart, Grace
A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
title A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
title_full A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
title_fullStr A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
title_full_unstemmed A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
title_short A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
title_sort community-based assessment of correlates of facility delivery among hiv-infected women in western kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344995/
https://www.ncbi.nlm.nih.gov/pubmed/25885458
http://dx.doi.org/10.1186/s12884-015-0467-6
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