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

Abstract

BackgroundHome delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya.MethodsA cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively.ResultsOverall, 108 (25.4%, [95% CI: 21.3–29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4–46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2–6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2–0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers.ConclusionA quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting.

Correlates of facility-based delivery among women of reproductive age from the Digo community residing in Kwale, Kenya

“…Further, our findings show that the proportion of facility-based deliveries has increased over time, which is consistent with several other studies in this setting [ 20 , 21 ]. This is likely related to the government of Kenya’s policy on free maternity services that was rolled out in June 2013.…”

Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live?

“…The study also reflected the importance of education in maternal health service use. The less educated a woman becomes, the higher her chances of having non-facility delivery [28][29][30][31][32]. Well educated women are more often than not exposed to vital information about health care utilization, including facility delivery.…”

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“…Sub-Saharan Africa and South Asia together contribute over 85% of maternal deaths, and of which only half of deliveries are institutional [ 6 ]. Previous studies across the sub-Saharan Africa report a significant proportion of mothers still deliver at home [ 8 – 10 ]. Furthermore, a cross-sectional study conducted in Abobo District showed that significant number of women (91.5%) had given birth at home [ 11 ].…”