A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya

Abstract

BackgroundChildbirth at health facilities is an important strategy to reduce maternal morbidity and mortality, improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine whether these correlates were unique when compared to HIV-uninfected women from the same region.MethodsWomen residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV status, were performed to assess correlates of facility delivery.ResultsOverall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs. 5.4 months, p = 0.016), were more likely to know partner’s HIV status (p = 0.016), report satisfaction with delivery care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery. Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted among uninfected women.ConclusionsUtilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase use of maternity services and could be enhanced by couples counseling.

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

“…Home delivery in this setting was lower compared to Western Kenya and Nairobi/Nyanza regions, which reported estimates of 53% and 31% respectively in the HIV infected populations between 2008 and 2011[25,26]. Our estimate was also lower compared to what has been previously reported in other sSA settings[21,23].…”

“…Risk factors contributing to home deliveries among HIV infected women are comparable to those in women in general population and included low socioeconomic status, long distance to nearest health facility, HIV related stigma, security concerns when a woman goes into labor at night, low education level, fear of harsh treatment at the health facility, not attending antenatal clinic(ANC), not using antiretroviral drugs(ARVs), not knowing partner’s HIV status, unsatisfactory delivery care at the health facility and high parity[4,5,22,25,26,31]. Cultural factors identified include lack of commitment from husband, a feeling that facility delivery is not necessary if previous births were free of problems, previous successful home birth, encouragement by grandmothers to have a home birth, rapid progression of labor and preference to be assisted by a TBA[4,5,26,31].…”

Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

“…Jacobs et al [11] explain that services such as counselling and provision of consumer information on health services could help address barriers related to availability. Availability barriers were expressed in various forms, such as perceiving health facility-based care which was not different from other options/alternatives [78]; being unaware of care, type and nature of services [22, 28, 47, 78–83] and having limited media exposure [22, 79, 84]. …”

“…Studies which identified demand-side affordability as a barrier reported primarily on household resources and willingness to pay rather than cash flow within society [22, 23, 25, 26, 31, 32, 34, 36–38, 40, 41, 46–48, 50, 52, 61, 66–71, 73–75, 78, 79, 83, 85–112]. Some studies cited reports by pregnant women of being too busy or having no time as reasons for non-use of maternity care services [22, 26, 63, 86, 100, 113, 114], which represent opportunity costs.…”

Factors Associated with PMTCT Cascade Completion in Four African Countries

“…Programs offering couples voluntary counseling and testing in the antenatal clinic setting have shown mixed efficacy, with improved infant nevirapine use in Kenya but not in Rwanda or Zambia [16, 33, 34]. Awareness of partner HIV status has also been associated with other beneficial outcomes among women with HIV, such as higher facility delivery rates [35]. In Kenya, HIV-infected pregnant women who reported that their partner had been tested for HIV had lower rates of vertical transmission and infant mortality, but awareness of partner HIV status was not captured [36].…”