Department of Nursing Sciences, School of Health and Human Sciences, Pwani University, Kilifi, Kenya.
Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya.
PLoS One. 2018 Mar 20;13(3):e0194028. doi: 10.1371/journal.pone.0194028. eCollection 2018.
Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya.
A cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively.
Overall, 108 (25.4%, [95% CI: 21.3-29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4-46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2-6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2-0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers.
A quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting.
在家分娩是指在没有熟练助产士的情况下分娩，这是导致产妇死亡的一个重要因素，在资源有限的环境中，一般人群中在家分娩的比例呈下降趋势，这令人鼓舞。然而，在撒哈拉以南非洲（sSA）的艾滋病毒感染者中，在家分娩的情况知之甚少。我们描述了在肯尼亚沿海基利菲的一家农村公立卫生机构接受护理的艾滋病毒感染者中在家分娩的流行率和相关因素。
采用混合方法的横断面设计。使用访谈者管理的问卷从最近怀孕（5 年内，n=425）的艾滋病毒感染者中收集定量数据，同时使用焦点小组讨论（FGD，n=5）收集定性数据。分别使用逻辑回归和主题框架方法进行数据分析。
总体而言，108 名（25.4%，[95%CI：21.3-29.8]）参与者在家中分娩。在家分娩的相关因素包括缺乏正规教育（比值比 12.4[95%CI：3.4-46.0]，p<0.001）、有既往在家分娩史（2.7[95%CI：1.2-6.0]，p=0.019）和接受高效抗逆转录病毒治疗（HAART，0.4[95%CI：0.2-0.8]，p=0.006）。尽管强烈反对在家分娩，但主要的主题挑战包括消费者相关障碍、医疗保健提供者相关障碍和结构性障碍。
四分之一的艾滋病毒感染者在家分娩，这与该农村地区一般人群的估计相似，远低于其他 sSA 地区的估计。针对没有正规教育和有既往在家分娩史的妇女，制定一整套护理方案，同时加大 HAART 的推广力度，改善艾滋病毒感染者的母婴保健质量，可能有助于减少这一地区的在家分娩率和随后的产妇死亡率。
