Busitema University Faculty of Health Sciences, Department of Public Health, P.O. Box 236, Tororo, Uganda.
College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda.
BMC Pregnancy Childbirth. 2021 Nov 10;21(1):763. doi: 10.1186/s12884-021-04222-5.
Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda.
This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker).
The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9-9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66-11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18-0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13-0.86) were less likely to deliver at home.
Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART.
在家分娩与 HIV 母婴传播有关，在感染 HIV 的妇女中仍然很高。在乌干达北部，尚未充分研究和了解 HIV 背景下的家庭分娩预测因素。因此，我们旨在确定乌干达北部利拉地区 HIV 感染妇女在家分娩的发生率和危险因素。
这项前瞻性队列研究于 2018 年 8 月至 2020 年 1 月在乌干达北部的利拉区进行。共有 505 名在利拉地区转诊医院接受产前护理的 HIV 感染妇女连续登记并在分娩时进行随访。我们使用结构化问卷获取与暴露相关的数据，包括：社会人口统计学、生殖相关和 HIV 相关特征。使用 Stata 版本 14.0（StataCorp，德克萨斯州科林斯顿，美国）进行数据分析。我们使用泊松回归模型估计调整后的风险比，以确定与感兴趣结局（即在家中分娩，即在非卫生工作者监督下在卫生设施外分娩婴儿）相关的危险因素。
HIV 感染妇女在家分娩的发生率为 6.9%（95%CI：4.9-9.5%）。单身女性更有可能在家分娩（调整后的风险比=4.27，95%CI：1.66-11）。夜间开始分娩的妇女（夜间分娩的 ARR=0.39，95%CI：0.18-0.86）和坚持接受 ART 治疗的妇女（ARR=0.33，95%CI：0.13-0.86）不太可能在家分娩。
在家分娩在 HIV 感染妇女中仍然很高，尤其是那些没有伴侣的妇女。我们建议在 HIV 和 PMTCT 背景下加强关于生育计划和准备的咨询，特别是针对：分居、离婚、丧偶或未婚的妇女，以及不坚持接受 ART 治疗的妇女。
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