Buzdugan Raluca, McCoy Sandra I, Webb Karen, Mushavi Angela, Mahomva Agnes, Padian Nancy S, Cowan Frances M
University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA.
University College London, London, United Kingdom.
BMC Pregnancy Childbirth. 2015 Dec 17;15:338. doi: 10.1186/s12884-015-0782-y.
In developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe.
We analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing.
Overall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100%). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95% confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95% CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69%). Overall, however 77% of home deliveries occurred among women who had accessed antenatal care and were HIV-tested.
Uptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe.
在发展中国家，建议在医疗机构分娩以保障孕产妇和新生儿健康，并预防母婴传播艾滋病毒（PMTCT）。然而，对于了解自身艾滋病毒感染状况是否会影响在医疗机构分娩的决定，我们知之甚少。我们在津巴布韦对此关联进行了研究。
我们分析了2012年开展的一项基于社区的横断面血清学调查数据，以评估津巴布韦加速实施的国家PMTCT项目。符合条件的女性（年龄≥16岁且为在调查前9至18个月出生婴儿的母亲）从十个省份中五个省份的157家医疗机构的服务区域随机抽取。参与者接受了关于分娩地点的访谈，并提供血样进行艾滋病毒检测。
总体而言，8796名（77%）母亲报告在医疗机构分娩；不同社区的接受率有所不同（30% - 100%）。在医疗机构分娩的可能性与孕产妇的艾滋病毒感染状况无关。分娩前自我报告为艾滋病毒阳性的女性与艾滋病毒阴性女性在医疗机构分娩的可能性相同，无论她们是在分娩前（调整后的患病率比（PRa）= 1.04，95%置信区间（CI）= 1.00 - 1.09）还是在孕期得知自身状况（PRa = 1.05，95% CI = 1.01 - 1.09）。未接受产前护理或未进行艾滋病毒检测的母亲最有可能在医疗机构外分娩（69%）。然而，总体而言，77%的在家分娩发生在接受过产前护理并进行过艾滋病毒检测的女性中。
艾滋病毒感染母亲和未感染母亲在医疗机构分娩的接受率相似，鉴于津巴布韦为使艾滋病毒阳性女性持续接受护理投入了大量技术和资金，这一结果有些出人意料。
