Abstract
BackgroundHome 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.MethodsThis 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).ResultsThe 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.ConclusionHome 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.
Highlights
Home delivery has been associated with mother-to-child transmission of Human Immunodeficiency Virus (HIV) and remains high among HIV-infected women
Risk factors for home delivery Single women were more likely to deliver at home (Adjusted Risk Ratio (ARR) = 4.27, 95%confidence interval (CI): 1.66–11) when compared with their married counterparts
HIV infected pregnant women whose labour started in the night time were less likely to deliver at home when compared to those whose labour started in the day time
Summary
Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Facility delivery is recommended in the context of HIV to reduce on the risk of mother to child transmission of HIV (MTCT) [1, 2]. HIV infected women who deliver outside a hospital setting are likely to suffer complications resulting into vertical HIV transmission, maternal and (or) infant death [4]. Attendance in a hospital during the antenatal period and child birth are key in facilitating appropriate referral in case of obstetric complications that can potentially lead to maternal or neonatal mortality. The neonatal mortality rate in Uganda is high at 19 deaths per 1000 live births [7, 8]
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