肯尼亚蒙巴萨女性性工作者人工流产终身流行率和发生率评估及其相关因素：二次队列分析。
Assessment of the lifetime prevalence and incidence of induced abortion and correlates among female sex workers in Mombasa, Kenya: a secondary cohort analysis.
机构信息
Department of Population Health, The Aga Khan University, Nairobi, Nairobi, Kenya.
International Centre for Reproductive Health Kenya, Mombasa, Kenya.
出版信息
BMJ Open. 2022 Oct 7;12(10):e053218. doi: 10.1136/bmjopen-2021-053218.
INTRODUCTION
Prevalence of lifetime-induced abortion in female sex workers (FSWs) in Kenya was previously estimated between 43% and 86%. Our analysis aimed at assessing lifetime prevalence and correlates, and incidence and predictors of induced abortions among FSWs in Kenya.
METHODS
This is a secondary prospective cohort analysis using data collected as part of the WHISPER or SHOUT cluster-randomised trial in Mombasa, assessing effectiveness of an SMS-intervention to reduce incidence of unintended pregnancy. Eligible participants were current FSWs, 16-34 years and not pregnant or planning pregnancy. Baseline data on self-reported lifetime abortion, correlates and predictors were collected between September 2016 and May 2017. Abortion incidence was measured at 6-month and 12-month follow-up. A multivariable logistic regression model was used to assess correlates of lifetime abortion and discrete-time survival analysis was used to assess predictors of abortions during follow-up.
RESULTS
Among 866 eligible participants, lifetime abortion prevalence was 11.9%, while lifetime unintended pregnancy prevalence was 51.2%. Correlates of lifetime abortions were currently not using a highly effective contraceptive (adjusted OR (AOR)=1.76 (95% CI=1.11 to 2.79), p=0.017) and having ever-experienced intimate partner violence (IPV) (AOR=2.61 (95% CI=1.35 to 5.06), p=0.005). Incidence of unintended pregnancy and induced abortion were 15.5 and 3.9 per 100 women-years, respectively. No statistically significant associations were found between hazard of abortion and age, sex work duration, partner status, contraceptive use and IPV experience.
CONCLUSION
Although experience of unintended pregnancy remains high, lifetime prevalence of abortion may have decreased among FSW in Kenya. Addressing IPV could further decrease induced abortions in this population.
TRIAL REGISTRATION NUMBER
ACTRN12616000852459.
引言
肯尼亚性工作者（FSWs）一生中人工流产的发生率此前估计在 43%至 86%之间。我们的分析旨在评估肯尼亚 FSW 一生中人工流产的发生率和相关因素，以及人工流产的发生率和预测因素。
方法
这是一项使用 WHISPER 或 SHOUT 集群随机试验中收集的数据进行的二次前瞻性队列分析，评估了短信干预减少意外怀孕发生率的效果。合格的参与者是当前的 FSW，年龄在 16-34 岁之间，不怀孕或不计划怀孕。2016 年 9 月至 2017 年 5 月期间收集了自我报告的一生中人工流产、相关因素和预测因素的基线数据。在 6 个月和 12 个月的随访中测量了人工流产的发生率。使用多变量逻辑回归模型评估一生中人工流产的相关因素，使用离散时间生存分析评估随访期间人工流产的预测因素。
结果
在 866 名合格的参与者中，一生中人工流产的发生率为 11.9%，而一生中意外怀孕的发生率为 51.2%。一生中人工流产的相关因素是目前未使用高效避孕措施（调整后的比值比（AOR）=1.76（95%CI=1.11 至 2.79），p=0.017）和曾经历过亲密伴侣暴力（IPV）（AOR=2.61（95%CI=1.35 至 5.06），p=0.005）。未计划怀孕和人工流产的发生率分别为每 100 名妇女 15.5 和 3.9 例。未发现年龄、性工作时间、伴侣状况、避孕措施使用和 IPV 经历与流产风险之间存在统计学显著关联。
结论
尽管意外怀孕的发生率仍然很高，但肯尼亚 FSW 一生中人工流产的发生率可能已经下降。解决 IPV 问题可能会进一步减少该人群中的人工流产。
试验注册号
ACTRN12616000852459。
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