Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya
Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya
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DOI：
10.1186/1472-6874-12-34
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发表时间：
2012-10-06
影响因子：
2.5
通讯作者：
Birungi, Harriet
中科院分区：
文献类型：
--
作者：
Obare, Francis;van der Kwaak, Anke;Birungi, Harriet
背景：尽管在一般人群中15-19岁的青少年中意外怀孕和不良生育结局的经历被很好地记录下来，但对艾滋病毒携带者中的这种情况的了解有限。本文调查了肯尼亚HIV阳性少女意外怀孕、不良生育结局和产后避孕措施使用的相关因素。方法：数据来自一项横断面研究，该研究收集了肯尼亚沿海、内罗毕、尼安萨和裂谷四个省HIV阳性少女的孕产史信息。研究参与者是通过四个地区的艾滋病毒和艾滋病项目确定的。在总共797名女性参与者中，394人曾怀孕，其中24%经历过多次怀孕。结果：高阶妊娠与低阶妊娠意外怀孕的可能性是一样的(优势比[OR]：1.2；95%可信区间[CI]：0.8-2.0)，而发生在婚姻关系内的意外怀孕与发生在婚姻关系之外的意外怀孕的可能性显著降低(OR：0.1；95%CI：0.1-0.2)。与低阶妊娠相比，高阶妊娠更容易导致不良结局(OR：2.5；95%CI：1.6-4.0)。此外，发生在婚姻关系内的怀孕与发生在婚姻关系之外的妊娠相比，导致不良结局的可能性显著降低(OR：0.3；95%CI：0.1-0.9)。然而，意外怀孕与不良出生结局没有显著关联(OR：1.3；95%CI：0.5-3.3)。是否意外怀孕在产后使用避孕措施的可能性也没有显著差异(OR：0.9；95%CI：0.5~1.5)。结论：样本中HIV阳性少女再次意外怀孕的部分原因是不一致地使用避孕措施以防止复发，而高位妊娠的不良生育结局部分是由于流产。这突出表明，艾滋病毒和艾滋病方案需要向艾滋病毒阳性的青少年客户提供适当的性健康和生殖健康信息和服务，以减少出现不良生殖健康结果的风险。
Background: Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15-19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya.Methods: Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models.Results: Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8-2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1-0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6-4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1-0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5-3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5-1.5).Conclusions: The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent recurrence while poor birth outcomes among higher order pregnancies are partly due to abortion. This underscores the need for HIV and AIDS programs to provide appropriate sexual and reproductive health information and services to HIV-positive adolescent clients in order to reduce the risk of undesired reproductive health outcomes.