The prevalence and predictors of health unit delivery among HIV positive pregnant women who attend ANC at Mulago Hospital

Abstract

About 700,000 children in 2005 were infected with HIV worldwide virtually all of them through mother to child transmission (MTCT). About 90% of them occurred in sub-Saharan Africa due to a continuation of the high prevalence of HIV among women of child bearing age. (UNSAID 2007). Without specific interventions, the rate of MTCT is approximately 15-35%, with prolonged breastfeeding doubling the rate to 40%. Mother to child HIV transmission may occur at three periods; In utero (15-25%), Intrapartum delivery time (50-60%) and Postpartum breast feeding (15-20%). (International Perinatal HIV 1999). ARVs are offered during pregnancy period for PMTCT, modification of Obstetrical care and support on infant feeding are part of the service to prevent MTCT of HIV infections. Delivery under skilled birth attendance ensures that the mother benefits from modified obstetric care and thereby reduction of MTCT of HIV since the highest MCTCT occurs during labour. More than 90% of pregnant women attend ANC atleast once but few deliver from health unit. UDSHS 2006. Objective To determine the prevalence and predictors of health unit delivery among HIV positive women attending ANC in Mulago hospital Method A time motion study was used to identify independent predictor of health unit delivery among HIV positive pregnant women attending ANC clinic at Mulago hospital, 414 pregnant women from clinic were interviewed and followed until delivery, from 3rd May to 29th October 2010. Pregnant women answered questions regarding socioeconomic, local, reproductive and self-efficacy variables and whether they delivered at health unit or not. Results Seventy six (76.04%) of HIV positive pregnant women in the study delivered at health unit. After putting significant factors on bivariative analysis in logistic regression, the factors that predict health unit delivery were: older age spouse, spouse attaining tertiary level of education, disclosure of serostatus to male partner, being aware of spouse serostatus, having a planned pregnancy, having sufficient money to pay for health unit and staying within 5km from health unit. The highest predictors health unit delivery among HIV positive pregnant women attending ANC at Mulago hospital were being married to spouse who have at least attained tertiary education and disclosure of serostatus to a partner with odds ratios of 3.378 and 2.624 respectively. There is need to involve men more in ANC, encourage HIV testing and disclosure of their results.