PREVALENCE AND CORRELATES FOR HOME DELIVERY AMONG HIV INFECTED WOMEN IN KILIFI COUNTY

Abstract

While progress has been made towards scaling up facility deliveries, many women in sub-Saharan Africa (sSA) continue to deliver at home. Home deliveries substantially contribute to maternal morbidity and mortality. To better address the challenge of home deliveries and mother to child transmission (MTCT) of HIV infection, it is important to understand the burden and correlates of home deliveries among HIV infected women and to explore the challenges resulting to home deliveries in this population. The objective of this study was to describe the burden and correlates for home delivery among HIV infected women in Kilifi County. The study adopted a cross sectional design using a mixed methods approach. Women aged 18-49 years attending HIV care at the Comprehensive Care and Research Clinic (CCRC), located at Kilifi County Hospital (KCH) were recruited. Recruitment was done between March and June 2015. HIV infected women who had delivered within five years prior to the survey were included. Quantitative data were collected using an interviewer administered questionnaire. Two focus group discussions (FGDs) were used to collect qualitative data on women‟s experiences about home delivery. Quantitative data was subjected to univariable then multivariable logistic regression analysis using R statistical package. Qualitative data was transcribed then codes generated in QSR NVivo 11 based on a thematic framework approach. Overall, 427 participants met the eligibility criteria. Of these, 108(25.3% [95% CI, 21.2 – 29.7]) delivered at home. In univariable analysis, education level, gestation at first antenatal care (ANC), previous home delivery, receiving prevention of mother to child transmission (PMTCT) and being on antiretroviral therapy (ART) at the time of delivery v were found to be associated with place of delivery. Education level - No schooling vs. secondary/college/ higher (aOR: 13.2 [95% CI: 4.0 - 60.5], p <0.001) and previous home delivery - previous home delivery vs. never been pregnant before (aOR: 4.4[95% CI: 1.9 -11.0], p=0.001) were independent predictors of place of delivery in the multivariable analysis. In the qualitative results three major issues were addressed a) participants perceptions on hospital delivery services, b) facilitators to hospital delivery and c) barriers to hospital delivery. This study sheds more light on the burden and correlates of home delivery among HIV infected women in rural Coastal Kenya. A package of care targeting non schooled women may help scale up facility delivery.