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津巴布韦哈拉雷市孕妇中HIV-1和HIV-2流行趋势及风险因素

Trends in HIV-1 and HIV-2 prevalence and risk factors in pregnant women in Harare, Zimbabwe.

作者信息

Mbizvo M T, Mashu A, Chipato T, Makura E, Bopoto R, Fottrell P F

机构信息

Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Harare.

出版信息

Cent Afr J Med. 1996 Jan;42(1):14-21.

PMID:8868380
Abstract

The spread of the human immunodeficiency virus (HIV) and the resulting morbidity and mortality are major public health challenges with adverse social and economic implications. The pregnant population serves as an important marker of the extent of the problem in the sexually active low risk categorized population. Furthermore, a high HIV prevalence among women of childbearing age contributes to neonatal and infant mortality through perinatal transmission and also a large number of uninfected children become orphans. The objective of the present study was to determine the HIV prevalence rate and the risk factors in pregnant women attending antenatal care clinics in the Greater Harare area of Zimbabwe. Women presenting for antenatal care in four maternity clinics between May 1994 and June 1995 were tested for HIV-1 and HIV-2 antibodies following informed consent, counselling and completion of a questionnaire. Of the 1.168 women, 30.4 pc tested HIV-1 positive, with prevalence rates ranging from 23.6 pc at a lower density clinic, 28.6 pc in a medium density clinic, 30.7 pc in a higher density clinic and 33.2 pc at the referral maternity hospital. HIV-2 was present in 7.6 pc of the women. The 20 to 29 years age group had the highest HIV prevalence of 35 pc, (Odds Ratio (OR) = 2.4; 95 pc CI-1.33 to 4.32). Single pregnant women were more likely to test positive, (OR = 2.1; 95 pc CI = 1.2 to 3.7). Thirty five pc of the women reported previous use of condoms and in those where condom use was reported in casual relationships, there was a higher risk of HIV (OR 6.1; 95 pc CI = 2.1 to 17.3). Reported use of intravaginal herbs was associated with HIV risk (OR 1.4; 95 pc CI = 1.1 to 1.8; p < 0.03). History of genital ulcer (OR = 2.3), discharge (OR = 2.4), rash (OR = 2.7), genital ulcer with PID (OR = 5.8) was significantly associated with HIV infection. Present findings indicate a 30.4 pc HIV prevalence rate for a sample of 1,168 pregnant women in Harare. This rate is much higher than the 18 pc HIV prevalence rate reported for 1,008 pregnant women in the same Greater Harare area in 1990. We conclude that there is need for further innovative and aggressive community based as well as institutional interventions aimed at reducing HIV risk. Prevention strategies should include a wide range of socially contextualized initiatives.

摘要

人类免疫缺陷病毒(HIV)的传播及其引发的发病率和死亡率是重大的公共卫生挑战,具有不利的社会和经济影响。孕妇群体是性活跃低风险分类人群中该问题严重程度的重要标志。此外,育龄妇女中高HIV感染率通过围产期传播导致新生儿和婴儿死亡,并且大量未感染儿童成为孤儿。本研究的目的是确定津巴布韦大哈拉雷地区产前保健诊所孕妇中的HIV感染率及危险因素。1994年5月至1995年6月期间在四家产科诊所接受产前保健的妇女,在获得知情同意、接受咨询并完成问卷后,接受了HIV-1和HIV-2抗体检测。在1168名妇女中,30.4%检测出HIV-1呈阳性,感染率在低密度诊所为23.6%,中密度诊所为28.6%,高密度诊所为30.7%,转诊产科医院为33.2%。7.6%的妇女感染了HIV-2。20至29岁年龄组的HIV感染率最高,为35%(优势比(OR)=2.4;95%置信区间为1.33至4.32)。单身孕妇更易检测呈阳性(OR=2.1;95%置信区间=1.2至3.7)。35%的妇女报告曾使用过避孕套,在那些报告在偶然性关系中使用避孕套的妇女中,HIV感染风险更高(OR=6.1;95%置信区间=2.1至17.3)。报告使用阴道内草药与HIV风险相关(OR=1.4;95%置信区间=1.1至1.8;p<0.03)。有生殖器溃疡病史(OR=2.3)、分泌物(OR=2.4)、皮疹(OR=2.7)、伴有盆腔炎的生殖器溃疡(OR=5.8)与HIV感染显著相关。目前的研究结果表明,哈拉雷1168名孕妇样本的HIV感染率为30.4%。这一比率远高于1990年在同一大哈拉雷地区1008名孕妇中报告的18%的HIV感染率。我们得出结论,需要进一步采取创新和积极的基于社区及机构的干预措施以降低HIV风险。预防策略应包括广泛的针对社会背景的举措。

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