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. 2017 Jul 14;17(1):227.
doi: 10.1186/s12884-017-1417-2.

Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Nadia A Sam-Agudu  1   2   3 , Christopher Isah  4 , Chinenye Fan-Osuala  4 , Salome Erekaha  4 , Habib O Ramadhani  5 , Udochisom Anaba  4 , Olusegun A Adeyemi  6 , Grace Manji-Obadiah  4 , Daniel Lee  7 , Llewellyn J Cornelius  8 , Manhattan Charurat  5
Affiliations

Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study

Nadia A Sam-Agudu et al. BMC Pregnancy Childbirth. .

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.

Keywords: HIV; Mentor mothers; Nigeria; Pregnancy; Rural populations; Vertical transmission.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Nigerian National Health Research Ethics Committee, the Ethics Review Committee of the World Health Organization, and the Institutional Review Board of the University of Maryland Baltimore and the University of Georgia Athens. Written informed consent was obtained from all study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Map of Study States and Study Sites in North-Central Nigeria. Copyright 2017 by nigeriazipcodes.com (https://nigeriazipcodes.com/). Adapted with permission
Fig. 2
Fig. 2
Site Selection and Participant Recruitment
See this image and copyright information in PMC

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