Sam-Agudu Nadia A, Isah Christopher, Fan-Osuala Chinenye, Erekaha Salome, Ramadhani Habib O, Anaba Udochisom, Adeyemi Olusegun A, Manji-Obadiah Grace, Lee Daniel, Cornelius Llewellyn J, Charurat Manhattan
International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria.
Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
BMC Pregnancy Childbirth. 2017 Jul 14;17(1):227. doi: 10.1186/s12884-017-1417-2.
Low rates of maternal healthcare service utilization, including facility delivery, may impede progress in the prevention of mother-to-child transmission of HIV (PMTCT) and in reducing maternal and infant mortality. The MoMent (Mother Mentor) study investigated the impact of structured peer support on early infant diagnosis presentation and postpartum maternal retention in PMTCT care in rural Nigeria. This paper describes baseline characteristics and correlates of facility delivery among MoMent study participants.
HIV-positive pregnant women were recruited at 20 rural Primary Healthcare Centers matched by antenatal care clinic volume, client HIV prevalence, and PMTCT service staffing. Baseline and delivery data were collected by participant interviews and medical record abstraction. Multivariate logistic regression with generalized estimating equation analysis was used to evaluate for correlates of facility delivery including exposure to structured (closely supervised Mentor Mother, intervention) vs unstructured (routine, control) peer support.
Of 497 women enrolled, 352 (71%) were between 21 and 30 years old, 319 (64%) were Christian, 245 (49%) had received secondary or higher education, 402 (81%) were multigravidae and 299 (60%) newly HIV-diagnosed. Delivery data was available for 445 (90%) participants, and 276 (62%) of these women delivered at a health facility. Facility delivery did not differ by type of peer support; however, it was positively associated with secondary or greater education (aOR 1.9, CI 1.1-3.2) and Christian affiliation (OR 1.4, CI 1.0-2.0) and negatively associated with primigravidity (OR 0.5; 0.3-0.9) and new HIV diagnosis (OR 0.6, CI 0.4-0.9).
Primary-level or lesser-educated HIV-infected pregnant women and those newly-diagnosed and primigravid should be prioritized for interventions to improve facility delivery rates and ultimately, healthy outcomes. Incremental gains in facility delivery from structured peer support appear limited, however the impact of duration of pre-delivery support needs further investigation. Religious influences on facility delivery and on general maternal healthcare service utilization need to be further explored.
ClinicalTrials.gov number NCT01936753 , registered September 2013.
包括在医疗机构分娩在内的孕产妇医疗服务利用率较低，可能会阻碍预防母婴传播艾滋病毒（PMTCT）以及降低孕产妇和婴儿死亡率方面的进展。MoMent（母亲指导）研究调查了结构化同伴支持对尼日利亚农村地区PMTCT护理中早期婴儿诊断呈现和产后孕产妇留存率的影响。本文描述了MoMent研究参与者中在医疗机构分娩的基线特征及其相关因素。
在20个农村初级卫生保健中心招募了艾滋病毒呈阳性的孕妇，这些中心根据产前保健诊所就诊量、客户艾滋病毒流行率和PMTCT服务人员配备进行匹配。通过参与者访谈和病历摘要收集基线和分娩数据。使用广义估计方程分析的多变量逻辑回归来评估在医疗机构分娩的相关因素，包括接触结构化（密切监督的指导母亲，干预组）与非结构化（常规，对照组）同伴支持的情况。
在登记的497名妇女中，352名（71%）年龄在21至30岁之间，319名（64%）是基督教徒，245名（49%）接受过中等或高等教育，402名（81%）是经产妇，299名（60%）是新诊断出感染艾滋病毒的。445名（90%）参与者有分娩数据，其中276名（62%）妇女在医疗机构分娩。在医疗机构分娩的情况在同伴支持类型上没有差异；然而，它与中等或更高教育程度（调整后比值比1.9，置信区间1.1 - 3.2）和基督教信仰（比值比1.4，置信区间1.0 - 2.0）呈正相关，与初孕（比值比0.5；0.3 - 0.9）和新诊断出感染艾滋病毒（比值比0.6，置信区间0.4 - 0.9）呈负相关。
应优先对初级水平或受教育程度较低的感染艾滋病毒的孕妇以及新诊断出感染艾滋病毒的初孕妇进行干预，以提高在医疗机构分娩的比例，并最终改善健康结局。结构化同伴支持在提高医疗机构分娩率方面的额外收益似乎有限，然而分娩前支持持续时间的影响需要进一步研究。宗教对在医疗机构分娩以及对一般孕产妇医疗服务利用的影响需要进一步探索。
ClinicalTrials.gov编号NCT01936753，于2013年9月注册。
