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Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study.
BMC Pregnancy Childbirth. 2017 Jul 14; 17(1):227.BP

Abstract

BACKGROUND

Low rates of maternal healthcare service utilization, including facility delivery, may impede progress in the prevention of mother-to-child transmission of HIV (PMTCT) and in reducing maternal and infant mortality. The MoMent (Mother Mentor) study investigated the impact of structured peer support on early infant diagnosis presentation and postpartum maternal retention in PMTCT care in rural Nigeria. This paper describes baseline characteristics and correlates of facility delivery among MoMent study participants.

METHODS

HIV-positive pregnant women were recruited at 20 rural Primary Healthcare Centers matched by antenatal care clinic volume, client HIV prevalence, and PMTCT service staffing. Baseline and delivery data were collected by participant interviews and medical record abstraction. Multivariate logistic regression with generalized estimating equation analysis was used to evaluate for correlates of facility delivery including exposure to structured (closely supervised Mentor Mother, intervention) vs unstructured (routine, control) peer support.

RESULTS

Of 497 women enrolled, 352 (71%) were between 21 and 30 years old, 319 (64%) were Christian, 245 (49%) had received secondary or higher education, 402 (81%) were multigravidae and 299 (60%) newly HIV-diagnosed. Delivery data was available for 445 (90%) participants, and 276 (62%) of these women delivered at a health facility. Facility delivery did not differ by type of peer support; however, it was positively associated with secondary or greater education (aOR 1.9, CI 1.1-3.2) and Christian affiliation (OR 1.4, CI 1.0-2.0) and negatively associated with primigravidity (OR 0.5; 0.3-0.9) and new HIV diagnosis (OR 0.6, CI 0.4-0.9).

CONCLUSIONS

Primary-level or lesser-educated HIV-infected pregnant women and those newly-diagnosed and primigravid should be prioritized for interventions to improve facility delivery rates and ultimately, healthy outcomes. Incremental gains in facility delivery from structured peer support appear limited, however the impact of duration of pre-delivery support needs further investigation. Religious influences on facility delivery and on general maternal healthcare service utilization need to be further explored.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT01936753 , registered September 2013.

Authors+Show Affiliations

International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria. nsamagudu@ihvnigeria.org. Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA. nsamagudu@ihvnigeria.org. Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria. nsamagudu@ihvnigeria.org.International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria.International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria.International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria.Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria.Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria.International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria.University of Maryland School of Medicine, Baltimore, USA.School of Social Work and College of Public Health, University of Georgia Athens, Athens, USA.Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28705148

Citation

Sam-Agudu, Nadia A., et al. "Correlates of Facility Delivery for Rural HIV-positive Pregnant Women Enrolled in the MoMent Nigeria Prospective Cohort Study." BMC Pregnancy and Childbirth, vol. 17, no. 1, 2017, p. 227.
Sam-Agudu NA, Isah C, Fan-Osuala C, et al. Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study. BMC Pregnancy Childbirth. 2017;17(1):227.
Sam-Agudu, N. A., Isah, C., Fan-Osuala, C., Erekaha, S., Ramadhani, H. O., Anaba, U., Adeyemi, O. A., Manji-Obadiah, G., Lee, D., Cornelius, L. J., & Charurat, M. (2017). Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study. BMC Pregnancy and Childbirth, 17(1), 227. https://doi.org/10.1186/s12884-017-1417-2
Sam-Agudu NA, et al. Correlates of Facility Delivery for Rural HIV-positive Pregnant Women Enrolled in the MoMent Nigeria Prospective Cohort Study. BMC Pregnancy Childbirth. 2017 Jul 14;17(1):227. PubMed PMID: 28705148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study. AU - Sam-Agudu,Nadia A, AU - Isah,Christopher, AU - Fan-Osuala,Chinenye, AU - Erekaha,Salome, AU - Ramadhani,Habib O, AU - Anaba,Udochisom, AU - Adeyemi,Olusegun A, AU - Manji-Obadiah,Grace, AU - Lee,Daniel, AU - Cornelius,Llewellyn J, AU - Charurat,Manhattan, Y1 - 2017/07/14/ PY - 2017/01/15/received PY - 2017/07/05/accepted PY - 2017/7/15/entrez PY - 2017/7/15/pubmed PY - 2018/4/20/medline KW - HIV KW - Mentor mothers KW - Nigeria KW - Pregnancy KW - Rural populations KW - Vertical transmission SP - 227 EP - 227 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 17 IS - 1 N2 - BACKGROUND: Low rates of maternal healthcare service utilization, including facility delivery, may impede progress in the prevention of mother-to-child transmission of HIV (PMTCT) and in reducing maternal and infant mortality. The MoMent (Mother Mentor) study investigated the impact of structured peer support on early infant diagnosis presentation and postpartum maternal retention in PMTCT care in rural Nigeria. This paper describes baseline characteristics and correlates of facility delivery among MoMent study participants. METHODS: HIV-positive pregnant women were recruited at 20 rural Primary Healthcare Centers matched by antenatal care clinic volume, client HIV prevalence, and PMTCT service staffing. Baseline and delivery data were collected by participant interviews and medical record abstraction. Multivariate logistic regression with generalized estimating equation analysis was used to evaluate for correlates of facility delivery including exposure to structured (closely supervised Mentor Mother, intervention) vs unstructured (routine, control) peer support. RESULTS: Of 497 women enrolled, 352 (71%) were between 21 and 30 years old, 319 (64%) were Christian, 245 (49%) had received secondary or higher education, 402 (81%) were multigravidae and 299 (60%) newly HIV-diagnosed. Delivery data was available for 445 (90%) participants, and 276 (62%) of these women delivered at a health facility. Facility delivery did not differ by type of peer support; however, it was positively associated with secondary or greater education (aOR 1.9, CI 1.1-3.2) and Christian affiliation (OR 1.4, CI 1.0-2.0) and negatively associated with primigravidity (OR 0.5; 0.3-0.9) and new HIV diagnosis (OR 0.6, CI 0.4-0.9). CONCLUSIONS: Primary-level or lesser-educated HIV-infected pregnant women and those newly-diagnosed and primigravid should be prioritized for interventions to improve facility delivery rates and ultimately, healthy outcomes. Incremental gains in facility delivery from structured peer support appear limited, however the impact of duration of pre-delivery support needs further investigation. Religious influences on facility delivery and on general maternal healthcare service utilization need to be further explored. TRIAL REGISTRATION: ClinicalTrials.gov number NCT01936753 , registered September 2013. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/28705148/Correlates_of_facility_delivery_for_rural_HIV_positive_pregnant_women_enrolled_in_the_MoMent_Nigeria_prospective_cohort_study_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1417-2 DB - PRIME DP - Unbound Medicine ER -