The incidence of facility based deliveries and their predictors among HIV positive and HIV negative pregnant women in Mara region, Tanzania.

Abstract

Introduction and Background: If an HIV positive mother delivers in a health facility, interventions can be effected to ensure the safety of both mother and her newborn baby including reducing the risk of transmission of HIV to the baby. In Tanzania, only about half (51 percent) of births are assisted by health professionals. Barriers to the use of skilled delivery attendants in developing countries include cost, long distances to health facilities, fears and experiences of HIV-related stigma and discrimination. Studies done to determine the incidence of facility based deliveries and their predictors among HIV positive and HIV negative pregnant women are few and in Tanzania little information is available. Study objective: This study aimed at determining the incidence of facility based deliveries and their predictors among HIV positive and HIV negative pregnant women from April to May, 2012. Materials and Methods: A retrospective cohort study was conducted in Mara region.A structured questionnaire was used for data collection by an interviewer. Data for sero-status of sampled participants was obtained from ANC registers after which study participants were traced from the community using contact addresses left at the facility and postnatal clinics where they bring their infants for immunization and asked to self report place of their last child birth and associated predictors. Then data was entered into SPSS where incidence of institutional delivery for both groups, relative risk, p-values, confidence intervals, chi-square, logistic regression and associated predictors were calculated and analysed. Results: A total of 326 postnatal women, 50% (n= 163) from Butiama and 50%(n= 163) from Bunda districts,were involved in the study. Of these 49.3%(n=162) were HIV positive while 50.3%(n= 164) were HIV negative. The two groups were sociodemographically similar except for age and marital status. Only 44.4%(n= 72) of the HIV positive women and 45.7%(n=75) of the HIV negative women had their last childbirth in a health facility respectively. There was no significant difference in the incidence of facility based delivery between HIV positive women and HIV negative women in Mara region (p= 0.847, X2 = 0.332) even after adjusting for confounders. After adjusting for confounders, low maternal age, positive experience of facility based delivery, good knowledge of facility based delivery advantages and onset of labour during day time were significantly associated with facility based deliveries among HIV positive women (p= 0.016, 0.002, 0.042 and <0.001 respectively) while fewer numbers of living children and short distance from nearby health facility were significantly associated with facility based deliveries among HIV negative women (p= 0.012 and 0.023 respectively). Conclusion and Recommendations: This study showed that 44.4% of the HIV positive women and 45.7% of the HIV negative women in Mara region give their childbirth in health facilities respectively. There was no significant difference in the incidence of facility based deliveries between HIV positive and HIV negative women in the region. However, maternal age, experience of facility based delivery, knowledge of facility based delivery advantages and timing of onset of labour were predictors of facility based deliveries among HIV positive women while number of living children and distance from nearby health facility were predictors of facility based deliveries among HIV negative women.This study recommends increased community awareness creation activities on utilization of RCH services and revival of community health workers cadre.