Menu
Menu
Menu
Menu
Background: The burden of HIV is disproportionately higher among women of reproductive age contributing more than half of the global share. The situation in Ethiopia is not exceptional. The present study was done to determine the proportion of HIV among pregnant women in Amhara Regional State, Ethiopia. Method: Institutions-based cross-sectional study was conducted from October 2020 to December 2020. Systematic random sampling technique was used to select 538 study participants from pregnant women who had ANC follow-up in Referral Hospitals of the Amhara Regional State. Data on socio-demographic, clinical, obstetric, behavioral as well as psychosocial characteristics were gathered using an interviewer administered structured and standardized instruments. The data was entered into Epi-Data Manager V4.6.0.0 and exported to STATA version 14 for data analyses. Descriptive statics were computed to summarize the participant’s characteristics. Bi-variable and multivariable logistic regression analyses were conducted to identify the association between dependent and independent variables. Independent variables with a p-value of less than 0.05 were considered to be statistically significant at 95% confidence level (CI). Results: The proportion of HIV infection among pregnant women was 8.68% (95% CI: 6.5, 11.4). Completing secondary school education (Adjusted Odds Ratio (AOR = 0.15; 95% CI: 0.04—0.53), graduated from college (AOR = 0.03; 95% CI: 0.01—0.22), and family monthly income greater than 8001 ETB (1 USD = 56 ETB) (AOR = 0.19; 95% CI: 0.04—0.87) were protective factors associated with maternal HIV. On the other hand, history of previous abortion (AOR = 7.73; 95% CI: 3.33—17.95) and positive syphilis status (AOR = 10.28; 95% CI: 2.80—37.62) were risk factors associated with maternal HIV status. Conclusion: The proportion of HIV infection among pregnant women was found to be high. Advanced level of education, relatively higher monthly income, history of abortion and previous syphilis status were associated factors with HIV status. Strengthening women’s formal education; empowering women in all spheres of life (especially improving their economic standing that prevents women from engaging in risky sexual practices); educating women about HIV transmission methods and HIV prevention and control strategies using behavior change intervention strategy prepared for women to reduce their vulnerability; advocating for the use of family planning to reduce unsafe abortions and syphilis; as well as regular screening and testing for syphilis are recommended.
An institution-based cross-sectional study was conducted from October 2020 to December 2020 to determine the proportion of HIV and its associated factors among pregnant women attending ANC at referral hospitals of the Amhara Regional State, Ethiopia. There were six referral hospitals in the region serving 3.5 to 5 million people [25]. In this study, three hospitals (University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Debre Tabor Referral Hospital) were selected as the study sites out of the six referral hospitals. University of Gondar Comprehensive Specialized Hospital is located in Gondar town, Central Gondar Zone, North West Ethiopia, 727 km away from Addis Ababa [26]. Felege Hiwot Comprehensive Specialized Hospital is located in Bahir Dar; the capital city of the Amhara Regional State. And Debre Tabor Referral Hospital is found in Debre Tabor town, 665 km away from Addis Ababa. All Referral Hospitals of the Amhara Regional State offer focused ANC services, and have a separate ART as well as PMTCT clinic. The Ethiopian government began implementing Option B + (initiation of antiretroviral medication for all expectant mothers) in 2013. Since then, the service has been made available in all health facilities at no cost. Pregnant women attending ANC services in the referral hospitals of the Amhara Regional State were the source population. The study population was pregnant women attending ANC services during the study period in the selected referral hospitals of the region. Sample size was determined using single population proportion formula [n = (Za/2)2 p (1 − p)/d2], considering, 6.1% of HIV prevalence among pregnant women in the Amhara Regional State from the 2014 antenatal sentinel surveillance report of Ethiopia [11], 95% level of confidence, 3% margin of error, design effect of 2, and 10% non-response rate. The final sample size was 538. The study participants were drawn from the three selected referral hospitals of the Amhara Regional State after proportional allocation was done. We assigned the sample size for each of the hospitals based on the number of pregnant women attending ANC in those referral hospitals. The study participants were chosen based on daily flow records of pregnant women seeking ANC at these hospitals. The average daily attendance at the ANC clinics were 30, 20 and 15 in University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Debre Tabor Referral Hospital, respectively. During the study period, about 1600, 1200 and 900 pregnant women attended ANC at University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Debre Tabor Referral Hospital, respectively. Consequently, we included 233 from University of Gondar Comprehensive Specialized Hospital, 174 from Felege Hiwot Comprehensive Specialized Hospital, and 131 from Debre Tabor Referral Hospital from a total of 3,700 participants. Systematic random sampling technique was employed to select the individual study participant. Sampling interval (k) was calculated as k = 3700/538 = 7. Based on this sampling interval, study participants were selected at seven intervals until the required sample was attained. The data was collected using interviewer-administered, structured as well as standardized questionnaires. The tool consists of items on socio-demographic, obstetric, medical, and behavioral conditions of the study participants. Besides, some clinical data were collected from the charts of the participants. The tool was first developed in English and then translated to the local language, Amharic, which is the participants’ mother tongue, to avoid difficulty in communication and finally translated back to English to verify consistency. In addition, face and content validity were checked and found valid. Specifically, food insecurity was measured using the three-item household hunger score with 3-point Likert scale with Cronbach’s Alpha of 0.74 in the present study. Social support was measured using the Maternity Social Support Scale (MSSS) developed by Webster et al. 2000, with Cronbach’s Alpha of 0.55 in the current study. The data were collected by three BSc nurses working in the three referral hospitals and supervised by three MSc Nurses. To maintain the quality of the data different measures were taken. Firstly, face and content validity of the tool were performed. A range of experts such as gynaecologist, midwives, reproductive health professionals and infectious disease experts participated in the face and content validation process. Accordingly, adjustments were made based on their expertise. Secondly, a pre-test was conducted in Gondar Poly Health Centre among 50 (10%) pregnant women to check clarity and reliability of the tool. Overall, the tool was found to be valid and reliable. Thirdly, training was given to the data collectors and the supervisors on the objective and content of the questionnaire, on how to approach a patient and conduct interviews, as well as on ethical aspects of the study such as how to maintain confidentiality of the information obtained from the research, and how to respect autonomy of the participants. Finally, daily supervision was done throughout the data collection time to maintain the quality of the data. The dependent variable was HIV sero-status of pregnant women. The independent variables include socio-demographic factors (i.e. age of the mother, marital status, maternal educational status, paternal educational status, residency, maternal occupational status, paternal occupational status, family monthly income) obstetric and related factors (i.e. plan of pregnancy, parity, gravidity, gestational age, abortion history, syphilis status), behavioral factors (i.e. alcohol consumption, cigarette smoking) and other factors including level of social support and house hold food security status. HIV positive sero- status: positive HIV antibody test result which is confirmed by a second HIV antibody test, and/or positive virological test [27]. Social support: is a perception of communication of love, caring, trust, or concern of family and friends for an individual. It was measured using the Maternity Social Support Scale (MSSS). The scale contains 6-items with 5-point Likert scale. The total possible score for the scale is 30, and the cut-off points for the scale were set at 0 – 18 (low support), 19 – 24 (medium support), and > 24 (adequate support) [28]. Food security: is defined as a state in which all people at all times have both physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life [29]. In the current study, food insecurity was measured using the three items scale known as Household Hunger Score with 3-point Likert scale. The total possible score for the scale is 6 with cutoff points ranging from 0 – 1 (little to no hunger), 2 – 3 (moderate hunger), and 4 – 6 (severe hunger) [30]. Alcohol use: It was assessed with the question “Have you been drinking alcohol during your current pregnancy?” If the answer was “yes” and took any unit of alcohol during the current pregnancy, then the mother was considered to have alcohol exposure while pregnant. Cigarette smoking: It was assessed with the question “Have you been smoking since your pregnancy?” If the answer for this question was a “yes” even for once the mother was considered to have a tobacco exposure during pregnancy. The data was cleaned, coded and entered in to EpiData Manager V4.6.0.0 and exported to STATA version 14 for recoding and analysis. Descriptive and summary statistics were computed to summarize the characteristics of the participants. The association between HIV sero-status and selected independent variables such as socio-demographic, obstetric, medical and behavioral variables were tested using a binary logistic regression model. Independent variables with p-value ≤ 0.2 in the bi-variable analysis were potential candidates for the multivariable logistic regression analysis to control confounders. Variables with p-value less than 0.05 in the multivariable binary logistic regression model were considered to be statistically significant at 95% CI. Hosmer and Lemeshow’s goodness of fit test was used to check the model fitness (Prob value = 0.3202).
N/A
