Date of Award

7-23-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Stephen Thung

Abstract

Purpose: The objectives of this study are to describe mode of delivery decision making among HIV positive women, understand patient knowledge and attitudes regarding elective cesarean section (ECS) for prevention of mother-to-child transmission of HIV (PMTCT), and in turn quantify the use of ECS for PMTCT at an urban Kenyan maternity hospital. Methods: This is a descriptive cross-sectional study involving the survey of postpartum HIV-infected women delivering at Pumwani Maternity Hospital (PMH) in Nairobi, Kenya. Each participant was interviewed using a standardized questionnaire. Results: 250 women participated in this study over the course of three months. The rate of delivery by ECS for PMTCT was 4.0% (10/250), though 13.6% (34/250) planned this mode of delivery. Planning ECS was positively correlated with higher education levels (OR: 1.46; 95% CI: 1.09-1.94, p=0.028) and markers of higher socio-economic status including having a private toilet (OR: 2.89; 95% CI: 1.43-3.84, p=0.002) and living in a home with greater than one room (OR: 2.89; 95% CI: 1.07-7.80, p=0.033). The strongest correlates of ECS planning included having a surgical history (OR=5.86, 95% CI: 2.92-11.77, p<0.001), attending clinic at PMH (OR=7.85, 95% CI: 4.63-13.30, p<0.001), and knowledge of ECS (OR=24.50, 95% CI: 8.10-93.35, p<0.001). Patient education regarding ECS for PMTCT was limited, and 64% (160/250) of participants had never heard of this PMTCT intervention. Most often cited concerns regarding cesarean section included increased recovery time (66.3%), minor complications (55.4%), and risk of death (48.7%). Post-counseling, 48.0% (120/250) of participants would choose elective cesarean section if offered, while 67.6% (169/250) would opt for this mode of delivery if the cost of ECS was the same as vaginal delivery. Correlates of ECS acceptability included high socioeconomic status (e.g. secondary education OR=1.64, 95% CI: 1.25-2.15, p<0.001; ability to pay for delivery OR=1.40, 95% CI: 1.12-1.76, p=0.003), surgical history (OR=2.79, 95% CI: 1.21-6.43, p=0.011), and attendance at PMH antenatal clinic (OR=3.03, 95% CI: 1.54-5.98 p=0.001). Conclusions: Patient knowledge and uptake of ECS for PMTCT is limited at PMH. Although women are aware of the dangers of ECS, post-counseling acceptability of ECS, especially if the burden of cost is removed, is high.

Comments

This is an Open Access Thesis.

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